Societal spirits in the silver streak: Unraveling complexity in drinking habits of the mature adult population

BACKGROUND

The complex interactions between an individual's drinking behavior and their social environment is crucial but understudied, particularly in mature adult populations. Our aim is to unravel these complexities by investigating how personal drinking patterns are related to those of one's social environment over time, and what the interplay is with personal factors such as occupational prestige and smoking behavior.

METHOD

The present study adopts an innovative graphical autoregressive (GVAR) panel network modeling approach to investigate the dynamics between personal drinking habits and social environmental factors, utilizing a comprehensive longitudinal dataset from the Framingham Heart Study with a large sample of predominantly mature adults (N = 1719-5718) connected within a social network. We explored both temporal and contemporaneous associations between individuals' drinking habits (self-reported), smoking behavior (self-reported), perceived job prestige (Treiman prestige score), and the drinking behaviors of their social environment. The latter consists of the proportion of abstaining, moderate drinking, and heavy drinking social connections of each subject.

RESULTS

Our findings reveal significant associations between participants' behavior and that of their peers, with reciprocal interactions, substantiating the importance of the influence of one's social network for mature individuals. We found dynamic, reciprocal associations between an individual's drinking behavior and that of their peers, with periods of increased or decreased drinking correlating with increased connections to heavy drinkers or abstainers, respectively. In addition, when individuals drink more than usual, they also tend to consume more cigarettes, and vice versa.

CONCLUSIONS

The reciprocal feedback loops identified between an individual's drinking behavior and their social environment highlight the crucial role of social influences in shaping drinking behavior, including among older people. This emphasizes the need to consider social elements in the development of future theories, models, and interventions aimed at addressing problematic alcohol consumption in this vulnerable population.

Unveiling the psychological mechanisms of mutual help groups for addiction recovery: The role of social identity factors

The effectiveness of mutual help groups (MHGs) in promoting addiction recovery has been widely acknowledged. However, the psychological mechanisms underlying the impact of MHGs remain somewhat uncertain. Drawing on a social identity perspective, this study investigated a sequential mediation model in which social support is posited as a driving factor that enhances abstinence maintenance through group identification, recovery identity, and self-efficacy. A sample of 820 smokers, participating in a 6-month collective smoking cessation programme which included access to an online help group, completed measures of social support, group identification, smoker/ex-smoker identity, and self-efficacy at the programme's outset. Smoking abstinence was assessed 6 and 9 months later. The findings supported the proposed model, indicating that social support was positively associated with MHG identification, which, in turn, was related to a stronger recovery identity. Subsequently, recovery identity was associated with increased self-efficacy, and indirectly, with smoking abstinence at both measurement times. Additional analyses testing alternative mediation models further supported the validity of the proposed model. These findings suggest that social identity factors play significant roles in accounting for the effectiveness of MHGs for addiction recovery.

Measuring recovery capital for people recovering from alcohol and drug addiction: A systematic review

Background

Recovery capital theory provides a biopsychosocial framework for identifying and measuring strengths and barriers that can be targeted to support recovery from alcohol and drug addiction. This systematic review analyzed and synthesized all quantitative approaches that have measured recovery capital since 2016.

Method

Three databases were searched to identify studies published from 2016 to 2023. Eligible studies explicitly stated they measured recovery capital in participants recovering from alcohol and/or drug addiction. Studies focusing on other forms of addiction were excluded.

Results

Sixty-nine studies met the inclusion criteria. Forty-six studies used one of the ten identified recovery capital questionnaires, and twenty-five studies used a measurement approach other than one of the ten recovery capital questionnaires. The ten recovery capital questionnaires are primarily developed for adult populations across clinical and community recovery settings, and between them measure 41 separate recovery capital constructs. They are generally considered valid and reliable measures of recovery capital. Nevertheless, a strong evidence base on the psychometric properties across diverse populations and settings still needs to be established for these questionnaires.

Conclusion

The development of recovery capital questionnaires has been a significant advance in the field of addiction recovery, in alignment with the emerging recovery-oriented approach to addiction recovery care. Additionally, the non-recovery capital questionnaire-based approaches to recovery capital measurement have an important place in the field. They could be used alongside recovery capital questionnaires to test theory, and in contexts where the application of the questionnaires is not feasible, such as analyses of data from online recovery forums.

Challenges and Prescriptions for Homeless Drug Users’ Social Reintegration; An Experience of Partnerships Between Iran and Europe NGOs

The research addressed challenges and prescriptions for reintegration of homeless people who use drugs. Data were collected through conducting semi-structured interviews. Twenty-nine participants were recruited. The primary codes were extracted and divided into two main categories of challenges and prescriptions; the former included becoming homeless after a long term recovery, workplace stigma, service users’ different cultural backgrounds, dismissing the 12-Step Program, message fatigue, negative effect of relapse on groups and cyberspace overuse; and the latter included connection by hook or by crook, abstinence-harm reduction orientation, organizational service collection, pushing boundaries of interventions, and expanding services umbrella.

Case Study Demonstration of the Potential Acceptability and Effectiveness of a Novel Telehealth Treatment for People Experiencing Gambling Harm

The evidence base for internet therapies is building but little is known yet about the acceptability and effectiveness of providing telehealth online in a group format for the treatment of gambling disorders. Therefore, this uncontrolled, real-world study aimed to evaluate the feasibility and effectiveness of providing evidence-based treatment in a group format using an online platform. This innovative approach to treatment of people experiencing gambling harm was developed during the COVID pandemic so that gamblers could access evidence-based treatment from their homes. A closed group treatment program was developed using telehealth, enabling gamblers to come together weekly to engage in a treatment program based on behavioral therapy using cue exposure. Four online gamblers who met the criteria for Gambling Disorder were recruited from a gambling help service. A case report evaluation methodology was used to gain an in-depth understanding of the effectiveness of this approach to treatment. Treatment was conducted weekly over 12 months. All participants engaged with the program and after completing treatment participants no longer met the criteria for a Gambling Disorder, were abstinent for 12 months post treatment and achieved improved life functioning. This program provides preliminary evidence that providing treatment online in a group setting can be an acceptable and effective model in the delivery of treatment for clients unable to attend face-to-face clinics or preferring telemedicine as an option for treatment delivery. These findings warrant further exploration through a larger randomized controlled study.

Advancing the science of evaluating Collegiate Recovery Program processes and outcomes: A recovery capital perspective

Collegiate recovery programs (CRPs) offer resources and programming for postsecondary students in addiction recovery to ensure they can initiate or maintain their recovery and complete college. To achieve these goals, CRPs offer a variety of activities that research and theory suggests should produce positive outcomes among their students; yet the lack of systematic evaluation research in this area means it is unknown which programming components may drive outcomes. Recovery capital theory posits a variety of factors at multiple ecological levels that might influence students' recovery experience and their engagement and success in community programs like CRPs. To address this complexity in research and evaluation work on CRPs, we provide a recovery capital-oriented theory of change and logic model for CRP evaluations, and demonstrate how this model could be used with an exemplar case. This is followed by a recovery capital-oriented data collection toolkit for future research and evaluation. These efforts should help to inform program planners and evaluators interested in understanding the influence of the ecosystem of recovery-oriented systems of care in CRPs for emerging adults.

Getting "clean" from nonsuicidal self-injury: Experiences of addiction on the subreddit r/selfharm

BACKGROUND & AIMS

Previous studies have shown that nonsuicidal self-injury (NSSI) has addictive features, and an addiction model of NSSI has been considered. Addictive features have been associated with severity of NSSI and adverse psychological experiences. Yet, there is debate over the extent to which NSSI and substance use disorders (SUDs) are similar experientially.

METHODS

To evaluate the extent that people who self-injure experience NSSI like an addiction, we coded the posts of users of the subreddit r/selfharm (n = 500) for each of 11 DSM-5 SUD criteria adapted to NSSI.

RESULTS

A majority (76.8%) of users endorsed at least two adapted SUD criteria in their posts, indicative of mild, moderate, or severe addiction. The most frequently endorsed criteria were urges or cravings (67.6%), escalating severity or tolerance (46.7%), and NSSI that is particularly hazardous. User-level addictive features positively predicted number of methods used for NSSI, number of psychiatric disorders, and particularly hazardous NSSI, but not suicidality. We also observed frequent use of language and concepts common in SUD recovery circles like Alcoholics Anonymous.

DISCUSSION & CONCLUSION

Our findings support previous work describing the addiction potential of NSSI and associating addictive features with clinical severity. These results suggest that NSSI and SUD may share experiential similarities, which has implications for the treatment of NSSI. We also contribute to a growing body of work that uses social media as a window into the subjective experiences of stigmatized populations.

SMART Recovery International and COVID-19: Expanding the reach of mutual support through online groups

Background

Mutual support groups play an extremely important role in providing opportunities for people to engage in alcohol and other drug (AOD) treatment and support. SMART Recovery groups employ cognitive, behavioural and motivational principles and strategies to offer support for a range of addictive behaviours. COVID-19 fundamentally changed the way that these groups could be delivered.

Methods

A series of online meetings were conducted by the lead author (PK) and the SMART Recovery International Executive Officer (KM), with representatives from the SMART Recovery National Offices in the Ireland (DO), United States (MR), Australia (RM), and Denmark (BSH, DA), and the United Kingdom (AK). The meetings focused on discussing the impacts of COVID-19 on SMART Recovery in each of the regions.

Results

As a result of restrictions to prevent the transmission of COVID-19, the vast majority of SMART Recovery face-to-face meetings were required to cease globally. To ensure people still had access to AOD mutual support, SMART Recovery rapidly scaled up the provision of online groups. This upscaling has increased the number of groups in countries that had previously provided a limited number of online meetings (i.e., United States, England, Australia), and has meant that online groups are available for the first time in Denmark, Ireland, Hong Kong, Spain, Malaysia and Brazil.

Discussion

Whilst the urgent and rapid expansion of online groups was required to support people during the pandemic, it has also created an opportunity for the ongoing availability of online mutual support post-pandemic. The challenge for the research community is to critically evaluate the online delivery of mutual support groups, to better understand the mechanisms through which they may work, and to help understand the experience of people accessing the groups.

Examining the Relationship Between the Use of a Mobile Peer-Support App and Self-Injury Outcomes: Longitudinal Mixed Methods Study

BACKGROUND

Many individuals who self-injure seek support and information through online communities and mobile peer-support apps. Although researchers have identified risks and benefits of participation, empirical work linking participation in these web-based spaces to self-injury behaviors and thoughts is limited.

OBJECTIVE

This study aims to investigate the relationship between behavioral and linguistic traces on a mobile peer support app and self-injury outcomes.

METHODS

Natural use data and web-based surveys (N=697) assessing self-injury outcomes were collected from 268 users (aged 13-38 years; median 19; 149/268, 55.6% female) of a mobile peer-support app for 4 months. Participants were identified as having posted self-injury content using an internal classifier. Natural log data was used to predict self-injury outcomes in a series of multilevel logistic and linear regressions.

RESULTS

Greater engagement on a mobile peer-support app was associated with a decreased likelihood of self-injury thoughts (odds ratio [OR] 0.25, 95% CI 0.09-0.73) and fewer intentions to self-injure (b=-0.37, SE 0.09), whereas posting triggering content was associated with an increased likelihood of engaging in behaviors (OR 5.37, 95% CI 1.25-23.05) and having self-injury thoughts (OR 17.87, 95% CI 1.64-194.15). Moreover, viewing triggering content was related to both a greater ability to resist (b=1.39, SE 0.66) and a greater intention to self-injure (b=1.50, SE 0.06).

CONCLUSIONS

To our knowledge, this is the first study to connect naturally occurring log data to survey data assessing self-injury outcomes over time. This work provides empirical support for the relationship between participation in online forums and self-injury outcomes, and it articulates mechanisms contributing to this relationship.

Analysis of the Emails From the Dutch Web-Based Intervention "Alcohol de Baas": Assessment of Early Indications of Drop-Out in an Online Alcohol Abuse Intervention

Nowadays, traditional forms of psychotherapy are increasingly complemented by online interactions between client and counselor. In (some) web-based psychotherapeutic interventions, meetings are exclusively online through asynchronous messages. As the active ingredients of therapy are included in the exchange of several emails, this verbal exchange contains a wealth of information about the psychotherapeutic change process. Unfortunately, drop-out-related issues are exacerbated online. We employed several machine learning models to find (early) signs of drop-out in the email data from the "Alcohol de Baas" intervention by Tactus. Our analyses indicate that the email texts contain information about drop-out, but as drop-out is a multidimensional construct, it remains a complex task to accurately predict who will drop out. Nevertheless, by taking this approach, we present insight into the possibilities of working with email data and present some preliminary findings (which stress the importance of a good working alliance between client and counselor, distinguish between formal and informal language, and highlight the importance of Tactus' internet forum).

COVID-19 Social Distancing and Online Mutual Help Engagement for Alcohol Use Recovery

Introduction:

COVID-19 and associated social distancing has presented challenges for individuals engaging in face-to-face mutual help groups (MHGs) such as Alcoholics Anonymous for alcohol use recovery. Online MHGs may be particularly appealing to individuals with limited access or inclination to attend in-person MHGs. We examined engagement within the popular “StopDrinking” online MHG, hypothesizing that engagement would increase due to demand for virtual peer support as COVID-19 social distancing progressed.

Methods:

We collected publicly available engagement data for StopDrinking from February 19, 2018 through April 30, 2020 while considering March and April of 2020 as months initially impacted by voluntary or mandated COVID-19 social distancing. Using seasonal autoregressive integrated moving average models, we predicted daily engagement for this social distancing time period based on all available engagement data collected before April 2020. Kalman filtering with 95% prediction limits was employed to define significant thresholds for observed data to reside within.

Results:

All days of observed engagement in March and April 2020 were lower than corresponding predicted values. Observed engagement fell below the lower 95% prediction limit for 36% of days, with 15 days in March and 7 days in April having significantly lower than predicted engagement.

Conclusions:

Relatively low activity on StopDrinking may signal broader population trends of problematic alcohol use and recovery disengagement during the initial COVID-19 social distancing timeframe. Continued investigation of online MHGs is needed to understand their potential for monitoring population health trends and to understand how such groups might support alcohol use recovery in contexts of crisis and isolation.

Understanding the Extent of Adolescents' Willingness to Engage With Food and Beverage Companies' Instagram Accounts: Experimental Survey Study

Background

Social media platforms have created a new advertising frontier, yet little is known about the extent to which this interactive form of advertising shapes adolescents’ online relationships with unhealthy food brands.

Objective

We aimed to understand the extent to which adolescents’ preferences for Instagram food ads are shaped by the presence of comments and varying numbers of “likes.” We hypothesized that adolescents would show the highest preferences for ads with more “likes” and comments. We predicted that these differences would be greater among adolescents who were “heavy social media users” (ie, >3 hours daily) vs “light social media users” (ie, <3 hours daily).

Methods

We recruited Black and non-Latinx White adolescents (aged 13-17 years; N=832) from Dynata, a firm that maintains online participant panels. Participants completed an online survey in which they were randomized to view and rate Instagram food ads that either did or did not show comments. Within each condition, adolescents were randomized to view 4 images that had high (>10,000), medium (1000-10,000), or low (<100) numbers of “likes.” Adolescents reported ad preferences and willingness to engage with the brand.

Results

Adolescents rated ads with medium or high numbers of “likes” higher than ads with few “likes” (P=.001 and P=.002, respectively). Heavy social media users (>3 hours/day) were 6.366 times more willing to comment on ads compared to light users (P<.001).

Conclusions

Adolescents interact with brands in ways that mimic interactions with friends on social media, which is concerning when brands promote unhealthy products. Adolescents also preferred ads with many “likes,” demonstrating the power of social norms in shaping behavior. As proposed in 2019, the Children’s Online Privacy and Protection Act should expand online advertising restrictions to include adolescents aged 12 to 16 years.

Online digital recovery support services: An overview of the science and their potential to help individuals with substance use disorder during COVID-19 and beyond

Background

The COVID-19 pandemic and related social distancing public health recommendations will have indirect consequences for individuals with current and remitted substance use disorder (SUD). Not only will stressors increase risk for symptom exacerbation and/or relapse, but individuals will also have limited service access during this critical time. Individuals with SUD are using free, online digital recovery support services (D-RSS) that leverage peer-to-peer connection (i.e., social-online D-RSS) which simultaneously help these individuals to access support and adhere to public health guidelines. Barriers to SUD treatment and recovery support service access, however, are not unique to the COVID-19 epoch. The pandemic creates an opportunity to highlight problems that will persist beyond its immediate effects, and to offer potential solutions that might help address these long-standing, systemic issues. To help providers and other key stakeholders effectively support those interested in, or who might benefit from, participation in free, social-online D-RSS, this review outlines the following: 1) theories of expected therapeutic benefits from, and potential drawbacks of social-online D-RSS participation; 2) a typology that can be used to describe and classify D-RSS; 3) a D-RSS “case study” to illustrate how to apply the theory and typology; 4) what is known empirically about social-online D-RSS; and 5) whether and how to engage individuals with these online resources.

Method

Narrative review combining research and theory on both in-person recovery supports and social-online D-RSS.

Results

Studies examining in-person recovery support services, such as AA and other mutual-help organizations, combined with theory about how social-online D-RSS might confer benefit, suggest these digital supports may engage individuals with SUD and mobilize salutary change in similar ways. While people may use in-person and digital supports simultaneously, when comparing the two modalities, communication science and telemedicine group therapy data suggest that D-RSS may not provide the same magnitude of benefit as in-person services. D-RSS can be classified based on the a) type of service, b) type of platform, c) points of access, and d) organizations responsible for their delivery. Research has not yet rigorously tested the effectiveness of social-online D-RSS specifically, though existing data suggest that those who use these services generally find their participation to be helpful. Content analyses suggest that these services are likely to facilitate social support and unlikely to expose individuals to harmful situations.

Conclusions

When in-person treatment and recovery support services are limited, as is the case during the COVID-19 pandemic, expected therapeutic benefits and emerging data, taken together, suggest providers, mentors, and other community leaders may wish to refer individuals with current and remitted SUD to free, social-online D-RSS. Given the array of available services in the absence of best practice guidelines, we recommend that when making D-RSS referrals, stakeholders familiarize themselves with theorized benefits and drawbacks of participation, use a typology to describe and classify services, and integrate current empirical knowledge, while relying on trusted federal, academic, and national practice organization resource lists.

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Social-online, digital recovery support services (D-RSS) may address systemic service access barriers highlighted by COVID-19

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To aid provider and other stakeholder practices, we review relevant D-RSS theory and research

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Theory suggests D-RSS may mobilize salutary mechanisms of behavior change, though data also point to potential challenges

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Emerging D-RSS research is promising, though rigorous studies of their effectiveness have not yet been conducted

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The typology and resource lists from organizations provided here may be used for those who wish to make D-RSS referrals

Characterizing Participation and Perceived Engagement Benefits in an Integrated Digital Behavioral Health Recovery Community for Women: A Cross-Sectional Survey

BACKGROUND

Research suggests that digital recovery support services (D-RSSs) may help support individual recovery and augment the availability of in-person supports. Previous studies highlight the use of D-RSSs in supporting individuals in recovery from substance use but have yet to examine the use of D-RSSs in supporting a combination of behavioral health disorders, including substance use, mental health, and trauma. Similarly, few studies on D-RSSs have evaluated gender-specific supports or integrated communities, which may be helpful to women and individuals recovering from behavioral health disorders.

OBJECTIVE

The goal of this study was to evaluate the SHE RECOVERS (SR) recovery community, with the following 3 aims: (1) to characterize the women who engage in SR (including demographics and recovery-related characteristics), (2) describe the ways and frequency in which participants engage with SR, and (3) examine the perception of benefit derived from engagement with SR.

METHODS

This study used a cross-sectional survey to examine the characteristics of SR participants. Analysis of variance and chi-square tests, as well as univariate logistic regressions, were used to explore each aim.

RESULTS

Participants (N=729, mean age 46.83 years; 685/729, 94% Caucasian) reported being in recovery from a variety of conditions, although the most frequent nonexclusive disorder was substance use (86.40%, n=630). Participants had an average length in recovery (LIR) of 6.14 years (SD 7.87), with most having between 1 and 5 years (n=300). The most frequently reported recovery pathway was abstinence-based 12-step mutual aid (38.40%). Participants reported positive perceptions of benefit from SR participation, which did not vary by LIR or recovery pathway. Participants also had high rates of agreement, with SR having a positive impact on their lives, although this too did vary by recovery length and recovery pathway. Participants with 1 to 5 years of recovery used SR to connect with other women in recovery at higher rates, whereas those with less than 1 year used SR to ask for resources at higher rates, and those with 5 or more years used SR to provide support at higher rates. Lifetime engagement with specific supports of SR was also associated with LIR and recovery pathway.

CONCLUSIONS

Gender-specific and integrated D-RSSs are feasible and beneficial from the perspective of participants. D-RSSs also appear to provide support to a range of recovery typologies and pathways in an effective manner and may be a vital tool for expanding recovery supports for those lacking in access and availability because of geography, social determinants, or other barriers.