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Sinclair DL, Chantry M, De Ruysscher C, Magerman J, Nicaise P, Vanderplasschen W. Recovery-supportive interventions for people with substance use disorders: a scoping review. Front Psychiatry 2024; 15:1352818. [PMID: 38577404 PMCID: PMC10991812 DOI: 10.3389/fpsyt.2024.1352818] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/08/2023] [Accepted: 03/05/2024] [Indexed: 04/06/2024] Open
Abstract
Background Recovery-supportive interventions and strategies for people with substance use disorders are a cornerstone of the emergent recovery paradigm. As compared to other services, such approaches have been shown to be holistically focused and improve outcomes (e.g. substance use, supportive relationships, social functioning, and well-being). Even so, a comprehensive overview of the nature, extent, and range of research on the topic is lacking. Methods A scoping review of the literature was conducted to characterize the main topics on recovery-supportive interventions. A systematic search was conducted in three databases: Scopus, Web of Science, and PubMed from January 2000 to July 2023 using the PRISMA-ScR. Twenty-five studies published between 2005-2022 met the inclusion criteria. Results Most studies emanated from the United States, and we found a peak in publication frequency between 2018-2022 (n = 13) relative to other years. The most prominent lines of inquiry appear to concern recovery-oriented policies; principles of recovery-oriented services (challenges encountered when implementing recovery-oriented practices, relationships with service providers characterized by trust, and service user-service provider collaboration), and recovery capital (particularly recovery-supportive networks, employment, and housing). Seventeen studies addressed co-occurring disorders, and eight addressed substance use recovery. Conclusion To advance the field, more context-specific studies are required on supporting peer professionals, (including enabling cooperation with service users, and hiring experts by experience as staff), and training of professionals (e.g., nurses, psychologists, social workers, physicians) in the principles of recovery.
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Affiliation(s)
| | - Mégane Chantry
- Institute of Health and Society (IRSS), UCLouvain, Brussels, Belgium
| | | | - Jürgen Magerman
- EQUALITY//ResearchCollective, HOGENT University of Applied Sciences and Arts, Ghent, Belgium
| | - Pablo Nicaise
- Institute of Health and Society (IRSS), UCLouvain, Brussels, Belgium
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Brousseau NM, Karpyn A, Laurenceau JP, Farmer HR, Kelly JF, Hill EC, Earnshaw VA. The Impacts of Social Support and Relationship Characteristics on Commitment to Sobriety Among People in Opioid Use Disorder Recovery. J Stud Alcohol Drugs 2022; 83:646-652. [PMID: 36136434 PMCID: PMC9523758 DOI: 10.15288/jsad.21-00225] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2021] [Accepted: 12/23/2021] [Indexed: 01/19/2023] Open
Abstract
OBJECTIVE Despite evidence that social support is beneficial for people living with opioid use disorders (OUDs), research has yet to investigate whether social support within certain relationships is more or less effective. The current study examined whether social support, relationship closeness with a disclosure partner, and/or the history of joint substance use between participants and disclosure partners affect commitment to sobriety among people receiving medications for OUD. METHOD Over a period of 3 months (two time points), participants taking OUD medications took part in a mixed-methods egocentric social network study exploring their relationships with disclosure partners before and following OUD disclosure (i.e., first telling a disclosure partner about one's OUD history or treatment). Data included 131 disclosure events/relationships clustered within 106 participants. RESULTS Greater relationship closeness was associated with increased commitment to sobriety over time. Further, significant interactions were found between social support and disclosure partner closeness, partner closeness and history of joint substance use, and social support and history of joint substance use. Higher social support was associated with greater commitment to sobriety among those disclosing to close partners. In contrast, receiving social support or disclosing to a close partner with whom there was a history of joint substance use was associated with decreased commitment to sobriety. CONCLUSIONS Findings highlight the complexities of social support among people in treatment for OUD and demonstrate that relationship closeness and a history of joint substance use with a disclosure partner may be important factors to consider before disclosure.
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Affiliation(s)
- Natalie M. Brousseau
- Institute for Collaboration on Health, Intervention, and Policy (InCHIP), University of Connecticut, Storrs, Connecticut
| | - Allison Karpyn
- Center for Research in Education and Social Policy (CRESP), University of Delaware, Newark, Delaware
- Department of Human Development and Family Sciences, University of Delaware, Newark, Delaware
| | | | - Heather R. Farmer
- Department of Human Development and Family Sciences, University of Delaware, Newark, Delaware
| | - John F. Kelly
- Department of Psychiatry, Harvard Medical School, Boston, Massachusetts
- Recovery Research Institute, Massachusetts General Hospital, Boston, Massachusetts
| | - Elizabeth C. Hill
- Center for Research in Education and Social Policy (CRESP), University of Delaware, Newark, Delaware
- Department of Human Development and Family Sciences, University of Delaware, Newark, Delaware
| | - Valerie A. Earnshaw
- Department of Human Development and Family Sciences, University of Delaware, Newark, Delaware
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Høyland SA, Schuchert A, Mamen A. A holistic perspective on continuing care for substance use and dependence: Results and implications from an in-depth study of a Norwegian continuing care establishment. NORDIC STUDIES ON ALCOHOL AND DRUGS 2022; 39:503-520. [PMID: 36284745 PMCID: PMC9549220 DOI: 10.1177/14550725221099702] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2021] [Accepted: 04/25/2022] [Indexed: 11/23/2022] Open
Abstract
This article explores, systematically and in depth, users’ perceptions of participating
in a Norwegian non-profit establishment that provides a continuing care programme for
substance use and dependence. Identified results are linked to a holistic system
perspective, where human, technology, and organisation (HTO), as well as external
environment, are viewed as intertwined. At the establishment level, i.e., where the
continuing care programme is delivered, we find that a clear holistic and user-oriented
profile – comprising combined interventions including physical and social activities – can
create a safe and stable environment that exerts a positive mental and physical influence
on the user and thereby promotes abstinence from substances. However, our results suggest
that the internal environment needs to connect more strongly with the external
environment, such as a substance-free network, close family, and working life. At the
establishment level, we conclude that there is a need to develop an explicit strategy and
practice for collaborating with the external environment, built on systemisation and
application of individual users’ insights into the design of the current interventions.
Further research should explore the presence and absence of interplays between elements of
human, technology, and organisation and the external environment, and the associated
consequences for intervention processes and users’ health outcomes. Our holistic system
model, empirically informed by data from a Norwegian context, can represent a starting
point for such endeavours. The holistic system model also constitutes an original and
novel contribution to research on continuing care interventions.
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Sang J, Patton RA, Park I. Comparing Perceptions of Addiction Treatment between Professionals and Individuals in Recovery. Subst Use Misuse 2022; 57:983-994. [PMID: 35373710 DOI: 10.1080/10826084.2022.2058706] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
Background: The purpose of this qualitative study was to compare and contrast the differing perspectives of service users and professionals regarding the current substance use disorders (SUD) services provided in Summit County, Ohio. Seven focus groups were conducted with 44 participants (52.3% male, mean age 46 years), including 15 individuals in recovery, 16 direct service providers, and 13 executive directors. The participants were asked about three areas: (1) effective treatment for SUD, (2) challenges for persons with SUD, and (3) suggestions for improving SUD treatment outcomes. The data were analyzed and coded according to major themes. Results: While there were numerous emergent themes that were concordant between service use and professionals, several differing themes between the groups were also identified. First, participants disagreed on the effectiveness of medication-assisted treatment/Medications for Opioid Use Disorder. Second, professionals identified trauma, stigma, "one-size-fits-all" approach to treatment, and limitations set by managed care act as barriers to treatment, whereas individuals in recovery reported difficulty dealing with feelings, feeling of being rushed into recovery, and the lack of long-term recovery plans as the most significant barriers. Lastly, in order to improve treatment outcomes, professionals emphasized the importance of education unlike individuals in recovery who identified sober supports as the most important factor. Conclusion: This study identified challenges in SUD recovery and highlights essential areas for consideration when developing and implementing SUD treatment. The findings can be used as guidelines to provide better services to individuals with SUDs.Supplemental data for this article is available online at https://doi.org/10.1080/10826084.2022.2058706 .
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Affiliation(s)
- Jina Sang
- School of Social Work and Family Sciences, The University of Akron, Akron, OH, USA
| | - Rikki A Patton
- School of Social Work and Family Sciences, The University of Akron, Akron, OH, USA
| | - Insun Park
- Department of Criminal Justice, The University of Akron, Akron, OH, USA
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Flora K. Understanding the therapeutic factors of the main psychological treatment stage in a residential treatment setting: a qualitative approach. JOURNAL OF SUBSTANCE USE 2021. [DOI: 10.1080/14659891.2021.2018731] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Affiliation(s)
- Katerina Flora
- Department of Psychology, University of Western Macedonia, Kozani, Greece
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Costello MJ, Li Y, Zhu Y, Walji A, Sousa S, Remers S, Chorny Y, Rush B, MacKillop J. Using conventional and machine learning propensity score methods to examine the effectiveness of 12-step group involvement following inpatient addiction treatment. Drug Alcohol Depend 2021; 227:108943. [PMID: 34390964 DOI: 10.1016/j.drugalcdep.2021.108943] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/23/2020] [Revised: 06/29/2021] [Accepted: 06/30/2021] [Indexed: 12/25/2022]
Abstract
BACKGROUND Continuing care following inpatient addiction treatment is an important component in the continuum of clinical services. Mutual help, including 12-step groups like Alcoholics Anonymous, is often recommended as a form of continuing care. However, the effectiveness of 12-step groups is difficult to establish using observational studies due to the risks of selection bias (or confounding). OBJECTIVE To address this limitation, we used both conventional and machine learning-based propensity score (PS) methods to examine the effectiveness of 12-step group involvement following inpatient treatment on substance use over a 12-month period. METHODS Using data from the Recovery Journey Project - a longitudinal, observational study - we followed an inpatient sample over 12-months post-treatment to assess the effect of 12-step involvement on substance use at 12-months (n = 254). Specifically, PS models were constructed based on 34 unbalanced confounders and four PS-based methods were applied: matching, inverse probability weighting (IPW), doubly robust (DR) with matching, and DR with IPW. RESULTS Each PS-based method minimized the potential of confounding from unbalanced variables and demonstrated a significant effect (p < 0.001) between high 12-step involvement (i.e., defined as having a home group; having a sponsor; attending at least one meeting per week; and, being involved in service work) and a reduced likelihood of using substances over the 12-month period (odds ratios 0.11 to 0.32). CONCLUSIONS PS-based methods effectively reduced potential confounding influences and provided robust evidence of a significant effect. Nonetheless, results should be considered in light of the relatively high attrition rate, potentially limiting their generalizability.
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Affiliation(s)
| | - Yao Li
- Homewood Research Institute, Guelph, ON, Canada
| | - Yeying Zhu
- Statistics and Actuarial Science, University of Waterloo, Waterloo, ON, Canada
| | - Alyna Walji
- Homewood Research Institute, Guelph, ON, Canada; Peter Boris Centre for Addiction Research, McMaster University & St. Joseph's Health Care, Hamilton, ON, Canada
| | - Sarah Sousa
- Homewood Research Institute, Guelph, ON, Canada
| | | | | | - Brian Rush
- Homewood Research Institute, Guelph, ON, Canada; Centre for Addiction and Mental Health, Toronto, ON, Canada
| | - James MacKillop
- Homewood Research Institute, Guelph, ON, Canada; Peter Boris Centre for Addiction Research, McMaster University & St. Joseph's Health Care, Hamilton, ON, Canada
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Mahoney E, Witbrodt J, Mericle AA, Polcin DL. Resident and house manager perceptions of social environments in sober living houses: Associations with length of stay. JOURNAL OF COMMUNITY PSYCHOLOGY 2021; 49:2959-2971. [PMID: 34076263 PMCID: PMC8380640 DOI: 10.1002/jcop.22620] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/26/2021] [Revised: 05/10/2021] [Accepted: 05/11/2021] [Indexed: 06/12/2023]
Abstract
AIMS Studies have shown persons living in recovery homes for drug and alcohol problems make significant, sustained improvements. However, there is limited information about factors associated with outcomes. This study examined how perceptions of social environment of one type of recovery home, sober living houses (SLHs), were associated with length of stay (LOS). METHODS SLH residents and their house managers (N = 416) completed the recovery home environment scale (RHES) that assessed social model recovery characteristics and the community-oriented program evaluation scale (CPES) that evaluated perceptions of the program environment. RESULTS Scales completed by residents predicted LOS, but those completed by house managers did not. Larger discrepancies between the two groups were associated with shorter LOS. The RHES was shown to be a stronger predictor of LOS than the CPES. CONCLUSION Results highlight the importance of the social environment in SLHs, particularly those most closely aligned with social model recovery principles.
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Affiliation(s)
- Elizabeth Mahoney
- Behavioral Health and Recovery Studies, Public Health Institute, Oakland, California
| | - Jane Witbrodt
- Alcohol Research Group, Public Health Institute, Emeryville, California
| | - Amy A. Mericle
- Alcohol Research Group, Public Health Institute, Emeryville, California
| | - Douglas L. Polcin
- Behavioral Health and Recovery Studies, Public Health Institute, Oakland, California
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Beaulieu M, Tremblay J, Baudry C, Pearson J, Bertrand K. A systematic review and meta-analysis of the efficacy of the long-term treatment and support of substance use disorders. Soc Sci Med 2021; 285:114289. [PMID: 34365074 DOI: 10.1016/j.socscimed.2021.114289] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2020] [Revised: 07/20/2021] [Accepted: 07/30/2021] [Indexed: 02/06/2023]
Abstract
RATIONALE The reconceptualization of substance use disorders (SUD) as a chronic phenomenon calls for a paradigm shift in service provision, particularly by way of long-term treatment and support. Studies that have evaluated the efficacy of long-term treatment models seem to indicate that they are an improvement on more standard short-term treatments, even though these studies do not take the durations into consideration. OBJECTIVE Measure the efficacy of SUD treatments and support lasting 18 months or more regarding their ability to decrease substance use as compared to shorter treatments. METHODS A meta-analysis based on a systematic literature review was conducted. Eight databases were consulted for peer-reviewed studies. Certain variables were coded as moderators: intervention length, participant characteristics, and treatment characteristics. RESULTS The main results suggest that the people who received a planned long-term treatment or support had a 23.9 % greater chance of abstaining or consuming moderately than did people who received a shorter standard treatment (OR = 1.347 [CI 95 % = 1.087-1.668], p < .006, adjusted OR = 1.460 [CI 95 % = 1.145-1.861]). None of the moderation analyses revealed any variation in the efficacy of the long-term treatments and support. CONCLUSIONS The reconceptualization of the SUD as a chronic disorder among people with this problem leads us to reconsider both the length of the services provided and the paradigms underlying their organization.
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Affiliation(s)
- Myriam Beaulieu
- Université Du Québec à Trois-Rivières, Centre Universitaire de Québec, 850 Av. de Vimy Entrée #8, CP. 32, Québec, QC, G1S 0B7, Canada.
| | - Joël Tremblay
- Université Du Québec à Trois-Rivières, Centre Universitaire de Québec, 850 Av. de Vimy Entrée #8, CP. 32, Québec, QC, G1S 0B7, Canada.
| | - Claire Baudry
- Université Du Québec à Trois-Rivières, Centre Universitaire de Québec, 850 Av. de Vimy Entrée #8, CP. 32, Québec, QC, G1S 0B7, Canada.
| | - Jessica Pearson
- Université Du Québec à Trois-Rivières, Centre Universitaire de Québec, 850 Av. de Vimy Entrée #8, CP. 32, Québec, QC, G1S 0B7, Canada.
| | - Karine Bertrand
- Université de Sherbrooke, Campus de Longueuil, 150, Place Charles-Le Moyne, C. P. 200, Longueuil, Québec, J4K 0A8, Canada.
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MacLean SJ, Caluzzi G, Ferry M, Bruun A, Skattebol J, Neale J, Bryant J. Why we stopped using the term 'aftercare'. Drug Alcohol Rev 2021; 41:3-6. [PMID: 34046957 DOI: 10.1111/dar.13332] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2020] [Revised: 05/04/2021] [Accepted: 05/08/2021] [Indexed: 11/29/2022]
Abstract
The words we choose to describe alcohol and other drug (AOD) treatments and interventions reveal assumptions about how we understand AOD use. Moreover, they have important implications for how the treatment is imagined, implemented and funded. Service provision which follows engagement in an intensive (usually residential) program is often called 'aftercare' in the international AOD field. In this commentary, we argue that the term 'aftercare' fails to articulate the nature of ongoing care required by people who are managing AOD use. We maintain that 'aftercare' positions post-residential care as being less important than other treatment modalities, rather than as integral to a continuum of care. It is a term that implies that care should be acute, like much treatment delivered through a medical model, and assumes that people follow linear pathways in managing their AOD use. Assumptions embedded in the term 'aftercare' such as these may disincline governments from funding ongoing services for people exiting intensive programs. Alternative terms including 'continuing coordinated care' more aptly signal the integrated and ongoing service provision that should be available to support people in sustaining changes initiated through other AOD interventions.
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Affiliation(s)
- Sarah J MacLean
- Social Work and Social Policy and Centre for Alcohol Policy Research, La Trobe University, Melbourne, Australia
| | - Gabriel Caluzzi
- Centre for Alcohol Policy Research, La Trobe University, Melbourne, Australia
| | | | - Andrew Bruun
- Youth Support and Advocacy Service, Melbourne, Australia
| | | | - Joanne Neale
- Addictions Department, King's College London, London, UK
| | - Joanne Bryant
- Centre for Social Research in Health, UNSW Sydney, Sydney, Australia
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Shaffer PM, Rodriguez CP, Gaba A, Byrne T, Casey SC, Harter J, Smelson D. Engaging vulnerable populations in drug treatment court: Six month outcomes from a co-occurring disorder wraparound intervention. INTERNATIONAL JOURNAL OF LAW AND PSYCHIATRY 2021; 76:101700. [PMID: 33864989 DOI: 10.1016/j.ijlp.2021.101700] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/30/2020] [Revised: 03/23/2021] [Accepted: 04/09/2021] [Indexed: 06/12/2023]
Abstract
OBJECTIVE Although drug treatment courts (DTCs) have demonstrated positive outcomes, participants with co-occurring mental health and substance use disorders (CODs) are a high-risk group that often struggle with treatment engagement not previously examined. This pilot study fills this gap by looking at six-month behavioral health and criminal justice outcomes among a hard to engage DTC COD participant sample in two Massachusetts DTCs receiving a wraparound-treatment (Maintaining Independence and Sobriety through Systems Integration, Outreach, and Networking-Criminal Justice - MISSION-CJ). METHODS Participants were evaluated at baseline and at six-month follow-up. Bivariate analyses examined baseline differences between clients with higher versus low engagement were examined. A mixed analysis of variance (ANOVA) for repeated measures with time as the within subject factor, and level of engagement as the between subject factor was performed for criminal justice (CJ) and behavioral health outcomes. RESULTS Participants were primarily male (86.6%), White (90.6%), living in unstable housing (86.2%), had an average of 18.94 years of criminal justice involvement, had an average of 15.49 years of regular illicit substance use, and mild mental health symptoms as measured by the BASIS-32 average total score (0.51), with no statistically significant differences at baseline from bivariate analyses. Mixed ANOVA results demonstrated significant effect time of time in MISSION-CJ on reducing nights in jail (p = 0.0266), opioid use (p = 0.0013), and mental health symptom (p = 0.0349). Additional improvements in nights in jail p = 0.0139), illicit substance use (p = 0.0358), and opioid use (p = 0.0013), were observed for clients that had high engagement in MISSION-CJ. CONCLUSIONS Wraparound services, such as MISSION-CJ, alongside DTC programming for a chronic relapsing DTC population can improve engagement in treatment and CJ and behavioral health outcomes. Future research is needed with MISSION-CJ that includes a randomized trial and a larger sample.
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Affiliation(s)
- Paige M Shaffer
- Department of Psychiatry, University of Massachusetts Medical School, Worcester, MA, USA.
| | | | - Ayorkor Gaba
- Department of Psychiatry, University of Massachusetts Medical School, Worcester, MA, USA
| | - Thomas Byrne
- School of Social Work, Boston University, Boston, MA, USA
| | | | - Jennifer Harter
- Department of Psychiatry, University of Massachusetts Medical School, Worcester, MA, USA
| | - David Smelson
- Department of Psychiatry, University of Massachusetts Medical School, Worcester, MA, USA
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Johannessen DA, Geirdal AØ, Nordfjærn T. Investigating the factor structure of a translated recovery-orientation instrument in inpatient treatment for substance use disorder. Subst Abuse Treat Prev Policy 2021; 16:24. [PMID: 33741021 PMCID: PMC7980679 DOI: 10.1186/s13011-021-00363-0] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/09/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Recovery has been outlined as a process of change through which involvement and empowerment enables individuals to reach their goals and aspirations. Recovery self-assessment (RSA) is an instrument that has been acknowledged as an applicable measure of recovery-orientation in services for people with mental health problems or substance use disorder (SUD). This study aimed to translate RSA from US English to Norwegian and to investigate the factor structure of the translated version (RSA-N). METHODS A translate/back-translate procedure was used. Confirmatory factor analysis (CFA) was applied to investigate the factor structure of RSA-N in a sample of clinicians (n = 407) working in inpatient SUD treatment facilities. RESULTS The results suggested that the hypothesised five-factor structure originally obtained by the developers showed an inadequate fit with the current data sample. RSA-N was modified and restructured by removing twelve misfitting items and combining factors with high covariance using data from one subsample. The alternative three-factor structure yielded an acceptable fit for the data from a second subsample. Acceptable alpha coefficients, suggesting good internal consistency, supported the adequacy of the three-factor structure. CONCLUSIONS Results from the present study are in line with previous findings, which have failed to replicate the hypothesised five-factor structure without modifications. Knowledge about the degree to which SUD services are recovery-oriented may contribute to SUD services' pursuit of establishing an inpatient treatment environment that fosters change and development of inpatients. The present study's findings imply RSA-N's potential as an instrument to assess recovery-orientation in inpatient SUD treatment.
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Affiliation(s)
- Dagny Adriaenssen Johannessen
- Blue Cross East, Oslo, Norway.
- Department of Social Work, Child Welfare and Social Policy, OsloMet - Oslo Metropolitan University, Oslo, Norway.
| | - Amy Østertun Geirdal
- Department of Social Work, Child Welfare and Social Policy, OsloMet - Oslo Metropolitan University, Oslo, Norway
| | - Trond Nordfjærn
- Department of Psychology, Norwegian University of Science and Technology (NTNU), Trondheim, Norway
- St. Olavs Hospital, Clinic of Substance Use and Addiction Medicine, Trondheim, Norway
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Peer Recovery Provides Sustainable Avenues for Addiction Treatment, but Is Not a One-Size-Fits-All Proposition. ADDICTIVE DISORDERS & THEIR TREATMENT 2020. [DOI: 10.1097/adt.0000000000000179] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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13
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Costello MJ, Li Y, Remers S, MacKillop J, Sousa S, Ropp C, Roth D, Weiss M, Rush B. Effects of 12-step mutual support and professional outpatient services on short-term substance use outcomes among adults who received inpatient treatment. Addict Behav 2019; 98:106055. [PMID: 31357071 DOI: 10.1016/j.addbeh.2019.106055] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2019] [Revised: 06/22/2019] [Accepted: 07/14/2019] [Indexed: 11/26/2022]
Abstract
BACKGROUND Continuing care is increasingly prioritized in the treatment of substance use disorders (SUDs). Ongoing engagement in continuing care, including mutual support (e.g., 12-step groups) and/or professional outpatient services, may enhance treatment outcomes and facilitate recovery. OBJECTIVE This study investigates how engagement in 12-step mutual support and professional outpatient services is associated with short-term substance use outcomes in a sample of patients who completed inpatient SUDs treatment. METHODS As part of the Recovery Journey Project - a longitudinal cohort study - participants completed questionnaires upon admission to an inpatient SUDs treatment program, and at 1- and/or 3-months post-discharge (n = 379). Baseline data were collected by self-administered, electronic questionnaires. Follow up data were collected by phone or email. Analyses involved multivariate Generalized Estimating Equations separately modelling self-reported abstinence and percent days abstinent (PDA) over the three time periods. RESULTS Overall, rates of self-reported abstinence and PDA increased significantly from baseline to 1- and 3-months follow up. Engagement in 12-step activities (i.e., attended 30 meetings in 30 days, had a home group, had a sponsor, did service work) and professional outpatient substance use support were each significantly associated with abstinence and PDA. Participants who reported a higher degree of 12-step involvement (defined as engagement in more 12-step activities) were also more likely to report being abstinence and greater PDA. CONCLUSIONS Engagement in continuing care, including 12-step activities and professional outpatient substance use support, was highly associated with substance use. Clinical teams should encourage participation in such activities to optimize treatment outcomes.
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Change in psychosocial factors connected to coping after inpatient treatment for substance use disorder: a systematic review. SUBSTANCE ABUSE TREATMENT PREVENTION AND POLICY 2019; 14:16. [PMID: 31053153 PMCID: PMC6499970 DOI: 10.1186/s13011-019-0210-9] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/13/2018] [Accepted: 04/22/2019] [Indexed: 11/10/2022]
Abstract
BACKGROUND Among the adult population worldwide, about 0.5% has illicit drug use disorder (DUD) and about 5% has alcohol use disorder (AUD). Dependency on alcohol, medication or illicit drugs are recognised as risk factors for disabling disease and early death. Treatment for substance use disorders (SUD) is important in promoting persistent abstinence and may be perceived as a valuable public health measure. The current systematic review aims at exploring how psychosocial factors connected to recovery capital and coping behaviour, change after inpatient SUD treatment. METHODS A systematic search was conducted in Campbell Collaboration Library, Cochrane Library, EMBASE, Epistemonikos, Medline, PsychINFO, Social Sciences Citation Index and SocINDEX. Cohort studies on psychosocial outcomes for adults who had attended to inpatient SUD treatment that exceeds 3 months, were included. The outcome of interest was change in psychosocial factors. The search results were identified as include, exclude or unclear by one author and then screened by the second author with a specific focus on studies recognised as unclear. Diverging evaluations of eligibility among the unclear studies were resolved by discussion. In case of disagreement, the third author decided the eligibility of the studies in question. RESULTS Findings imply an overall progress in mental health, and a potential improvement in employment status and perceived social support after inpatient SUD treatment. Additionally, findings indicate a decrease in substance use from admission to follow-up after discharge from inpatient SUD treatment. These findings are consistent with earlier research on important factors in recovering from SUD. Findings on change in self-efficacy, housing, education and Quality of Life (QoL) however, were scantly researched and were expected to be more prominent outcomes of interest among the included studies. CONCLUSION Due to the substantial resources used to provide SUD treatment, knowledge about recovery capital, like psychosocial factors that facilitate coping behaviour and reintegration to society, should be standardised and used by SUD treatment providers. TRIAL REGISTRATION PROSPERO registration ID: CRD42018087408.
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Johannessen DA, Nordfjærn T, Geirdal AØ. Psychosocial factors associated with coping behaviour after inpatient treatment for substance use disorder: a systematic review study protocol. BMJ Open 2019; 9:e022673. [PMID: 30670505 PMCID: PMC6347889 DOI: 10.1136/bmjopen-2018-022673] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/27/2022] Open
Abstract
INTRODUCTION Much is known about factors associated with coping with abstinence from substance use. The planned systematic review aims to summarise available studies exploring the change in psychosocial factors associated with coping after long-term (≥3 months) inpatient treatment for substance use disorder (SUD). Examples of psychosocial factors of interest are social support, housing, activity (eg, employment and education) mental health and quality of life. Coping behaviour can be understood as responses or actions taken in a stressful situation, particularly how psychosocial factors affect a person's coping behaviour with abstinence from substances in everyday life (characterised as a stressful situation). METHODS AND ANALYSIS A set of text words were developed based on the population (people with SUD), exposure (long-term inpatient SUD treatment), outcome (psychosocial factors) and study design (prospective cohort studies) of interest. A systematic search will be conducted in eight electronic databases: Campbell Collaboration Library, Cochrane Library, EMBASE, Epistemonikos, Medline, PsychINFO, Social Sciences Citation Index and SocINDEX. The titles and abstracts will be screened for relevance before a pre-piloted data collection form will be used to evaluate eligibility and extract data from the search results. The planned review will include peer-reviewed study reports published in English or Scandinavian language. ETHICS AND DISSEMINATION The target group, people with SUD, might be considered as vulnerable. Based on this, the population will be the group of interest in the planned systematic review of studies that have already been conducted. Patients and the general public will not be involved in the development of this systematic review. The results will be summarised in a study report and submitted to a peer-reviewed international journal. Additionally, results will be disseminated in the mass media and at international research conferences. PROSPERO REGISTRATION NUMBER CRD42018087408.
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Affiliation(s)
- Dagny Adriaenssen Johannessen
- Blue Cross East, Oslo, Norway
- Department of Social Work, Child Welfare and Social Policy, OsloMet - Oslo Metropolitan University, Oslo, Norway
| | - Trond Nordfjærn
- Department of Psychology, Norwegian University of Science and Technology (NTNU), Trondheim, Norway
| | - Amy Østertun Geirdal
- Department of Social Work, Child Welfare and Social Policy, OsloMet - Oslo Metropolitan University, Oslo, Norway
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Kelly JF, Bergman BG, Fallah-Sohy N. MECHANISMS OF BEHAVIOR CHANGE IN 12-STEP APPROACHES TO RECOVERY IN YOUNG ADULTS. CURRENT ADDICTION REPORTS 2018; 5:134-145. [PMID: 30416931 PMCID: PMC6224158 DOI: 10.1007/s40429-018-0203-1] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
PURPOSE OF REVIEW Empirical evidence indicates that, in general, treatments which systematically engage adults with freely available twelve-step mutual-help organizations (TSMHOs), such as Alcoholics Anonymous (AA) and Narcotics Anonymous (NA) often enhance treatment outcomes while reducing health care costs. Also evident is that TSMHOs facilitate recovery through mechanisms similar to those mobilized by professional interventions, such as increased abstinence self-efficacy and motivation, as well changing social networks. Much less is known, however, regarding the utility of these resources specifically for young adults and whether the TSMHO mechanisms are similar or different for young adults. This article provides a narrative review of the clinical and public health utility of TSMHOs for young adults, and summarizes theory and empirical research regarding how young adults benefit from TSMHOs. RECENT FINDINGS Results indicate that, compared to older adults, young adults are less likely to attend TSMHOs and attend less frequently, but derive similar benefit. The mechanisms, however, by which TSMHOs help, differ in nature and magnitude. Also, young adults appear to derive greater benefit initially from meetings attended by similar aged peers, but this benefit diminishes over time. SUMMARY Findings offer developmentally specific insights into TSMHO dynamics for young adults and inform knowledge of broader recovery needs and challenges.
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Affiliation(s)
- John F Kelly
- Recovery Research Institute, Massachusetts General Hospital & Harvard Medical School, 151 Merrimac Street, 6 Floor, Boston, MA 02114
| | - Brandon G Bergman
- Recovery Research Institute, Massachusetts General Hospital & Harvard Medical School, 151 Merrimac Street, 6 Floor, Boston, MA 02114
| | - Nilofar Fallah-Sohy
- Recovery Research Institute, Massachusetts General Hospital & Harvard Medical School, 151 Merrimac Street, 6 Floor, Boston, MA 02114
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Garrett SB, Doyle SR, Peavy KM, Wells EA, Owens MD, Shores-Wilson K, DiCenzo J, Donovan DM. Age differences in outcomes among patients in the "Stimulant Abuser Groups to Engage in 12-Step" (STAGE-12) intervention. J Subst Abuse Treat 2017; 84:21-29. [PMID: 29195590 DOI: 10.1016/j.jsat.2017.10.012] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2017] [Revised: 10/21/2017] [Accepted: 10/27/2017] [Indexed: 10/18/2022]
Abstract
Emerging adults (roughly 18-29years) with substance use disorders can benefit from participation in twelve-step mutual-help organizations (TSMHO), however their attendance and participation in such groups is relatively low. Twelve-step facilitation therapies, such as the Stimulant Abuser Groups to Engage in 12-Step (STAGE-12), may increase attendance and involvement, and lead to decreased substance use. AIMS Analyses examined whether age moderated the STAGE-12 effects on substance use and TSMHO meeting attendance and participation. DESIGN We utilized data from a multisite randomized controlled trial, with assessments at baseline, mid-treatment (week 4), end-of-treatment (week 8), and 3- and 6- months post-randomization. PARTICIPANTS Participants were adults with DSM-IV diagnosed stimulant abuse or dependence (N=450) enrolling in 10 intensive outpatient substance use treatment programs across the U.S. ANALYSIS A zero-inflated negative binomial random-effects regression model was utilized to examine age-by-treatment interactions on substance use and meeting attendance and involvement. FINDINGS Younger age was associated with larger treatment effects for stimulant use. Specifically, younger age was associated with greater odds of remaining abstinent from stimulants in STAGE-12 versus Treatment-as-Usual; however, among those who were not abstinent during treatment, younger age was related to greater rates of stimulant use at follow-up for those in STAGE-12 compared to TAU. There was no main effect of age on stimulant use. Younger age was also related to somewhat greater active involvement in different types of TSMHO activities among those in STAGE-12 versus TAU. There were no age-by-treatment interactions for other types of substance use or for treatment attendance, however, in contrast to stimulant use; younger age was associated with lower odds of abstinence from non-stimulant drugs at follow-up, regardless of treatment condition. These results suggest that STAGE-12 can be beneficial for some emerging adults with stimulant use disorder, and ongoing assessment of continued use is of particular importance.
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Affiliation(s)
- Sharon B Garrett
- University of Washington Alcohol & Drug Abuse Institute, 1107 NE 45th Street, Suite 120, Seattle, WA 98105, United States.
| | - Suzanne R Doyle
- University of Washington Alcohol & Drug Abuse Institute, 1107 NE 45th Street, Suite 120, Seattle, WA 98105, United States
| | - K Michelle Peavy
- University of Washington Alcohol & Drug Abuse Institute, 1107 NE 45th Street, Suite 120, Seattle, WA 98105, United States; Evergreen Treatment Services, 1700 Airport Way South, Seattle, WA 98134, United States
| | - Elizabeth A Wells
- University of Washington Alcohol & Drug Abuse Institute, 1107 NE 45th Street, Suite 120, Seattle, WA 98105, United States
| | - Mandy D Owens
- Health Services Research & Development, VA Puget Sound Health Care System, 1660 S. Columbian Way, Seattle, WA 98118, United States
| | - Kathy Shores-Wilson
- University of Texas Southwestern Medical Center, 5323 Harry Hines Blvd., Dallas, TX 5390-9119, United States
| | - Jessica DiCenzo
- Zuckerberg San Francisco General Hospital, 1001 Potrero Ave Rm 1C12, San Francisco, CA 94110, United States
| | - Dennis M Donovan
- University of Washington Alcohol & Drug Abuse Institute, 1107 NE 45th Street, Suite 120, Seattle, WA 98105, United States
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Davis JP, Bergman BG, Smith DC, Kelly JF. Testing a Matching Hypothesis for Emerging Adults in Project MATCH: During-Treatment and One-Year Outcomes. J Stud Alcohol Drugs 2017; 78:140-145. [PMID: 27936374 DOI: 10.15288/jsad.2017.78.140] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
OBJECTIVE Compared with older adults, emerging adults (18-29 years old) entering treatment typically have less severe alcohol use consequences. Also, their unique clinical presentations (e.g., modest initial abstinence motivation) and developmental contexts (e.g., drinking-rich social networks) may make a straightforward implementation of treatments developed for adults less effective. Yet, this has seldom been examined empirically. This study was a secondary analysis of Project MATCH (Matching Alcoholism Treatments to Client Heterogeneity) data examining (a) overall differences between emerging adults and older adults (≥30 years old) on outcomes during treatment and at 1-year follow-up, and (b) whether emerging adults had poorer outcomes on any of the three Project MATCH treatments in particular. METHOD Participants were 267 emerging adults and 1,459 older adults randomly assigned to individually delivered cognitive-behavioral therapy (CBT), motivational enhancement therapy (MET), or 12-step facilitation (TSF). Multilevel growth curve models tested differences on percentage of days abstinent (PDA) and drinks per drinking day (DDD) by age group and treatment assignment. RESULTS During treatment, compared with older adults, emerging adults reported more DDD but similar PDA. Further, emerging adults assigned to TSF had less PDA and more DDD than emerging adults and older adults assigned to CBT or MET during treatment (i.e., emerging adults in TSF has poorer outcomes initially), but this matching effect was not evident at 1-year follow-up. CONCLUSIONS This study is among the first to test age group differences across three psychosocial interventions shown to be efficacious treatments for alcohol use disorder. Although emerging adults generally did as well as their older counterparts, they may require a more developmentally sensitive approach to bolster TSF effects during treatment.
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Affiliation(s)
- Jordan P Davis
- University of Illinois at Urbana-Champaign, Urbana, Illinois
| | - Brandon G Bergman
- Center for Addiction Medicine, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts
| | - Douglas C Smith
- University of Illinois at Urbana-Champaign, Urbana, Illinois
| | - John F Kelly
- Center for Addiction Medicine, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts
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Galanter M. Combining medically assisted treatment and Twelve-Step programming: a perspective and review. THE AMERICAN JOURNAL OF DRUG AND ALCOHOL ABUSE 2017; 44:151-159. [PMID: 28387530 DOI: 10.1080/00952990.2017.1306747] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
BACKGROUND People with severe substance use disorders require long-term rehabilitative care after the initial treatment. There is, however, a deficit in the availability of such care. This may be due both to inadequate medical coverage and insufficient use of community-based Twelve-Step programs in many treatment facilities. In order to address this deficit, rehabilitative care for severe substance use disorders could be promoted through collaboration between practitioners of medically assisted treatment, employing medications, and Twelve-Step-oriented practitioners. OBJECTIVE To describe the limitations and benefits in applying biomedical approaches and Twelve-Step resources in the rehabilitation of persons with severe substance use disorders; and to assess how the two approaches can be employed together to improve clinical outcome. METHOD Empirical literature focusing on clinical and manpower issues is reviewed with regard (a) to limitations in available treatment options in ambulatory and residential addiction treatment facilities for persons with severe substance use disorders, (b) problems of long-term rehabilitation particular to opioid-dependent persons, associated with the limitations of pharmacologic approaches, (c) the relative effectiveness of biomedical and Twelve-Step approaches in the clinical context, and (d) the potential for enhanced use of these approaches, singly and in combination, to address perceived deficits. RESULTS The biomedical and Twelve-Step-oriented approaches are based on differing theoretical and empirically grounded models. Research-based opportunities are reviewed for improving addiction rehabilitation resources with enhanced collaboration between practitioners of these two potentially complementary practice models. This can involve medications for both acute and chronic treatment for substances for which such medications are available, and Twelve-Step-based support for abstinence and long-term rehabilitation. Clinical and Scientific Significance: Criteria for developing evidence-based approaches for combined treatment should be developed, and research for evidence-based treatment on this basis can be undertaken in order to develop improved clinical outcome.
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Affiliation(s)
- Marc Galanter
- a Department of Psychiatry , NYU School of Medicine , New York , NY , USA
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Pedersen ER, Neighbors C, Atkins DC, Lee CM, Larimer ME. Brief online interventions targeting risk and protective factors for increased and problematic alcohol use among American college students studying abroad. PSYCHOLOGY OF ADDICTIVE BEHAVIORS 2017; 31:220-230. [PMID: 28080092 DOI: 10.1037/adb0000242] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Research documents increased and problematic alcohol use during study abroad experiences for college students yet no research documents effective preventive programs with these students. The present randomized controlled trial was designed to prevent increased and problematic alcohol use abroad by correcting misperceptions of peer drinking norms abroad and by promoting positive and healthy adjustment into the host culture (i.e., sojourner adjustment) through brief online personalized feedback interventions. A sample of 343 study abroad college students was randomly assigned to 1 of 4 conditions including a personalized normative feedback intervention (PNF), a sojourner adjustment feedback intervention (SAF), a combined PNF + SAF intervention, and an assessment-only control condition. Generalized estimated equation analyses accounting for baseline drinking and consequences revealed an intervention effect for PNF that was mitigated by baseline drinking level, such that PNF was best for those with lighter baseline drinking, but heavier baseline drinkers receiving PNF alone or PNF + SAF drank comparatively similar or more heavily abroad to those in the control condition. However, PNF + SAF condition participants with greater baseline levels of consequences reported comparatively less consequences abroad than their control participants. Thus, PNF alone may be helpful for lighter drinkers at predeparture and the addition of SAF to PNF may help prevent consequences abroad for those reporting more consequences prior to departure abroad. This research represents an important first step in designing and implementing efficacious interventions with at-risk study abroad college students, for which no current empirically based programs exist. (PsycINFO Database Record
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Affiliation(s)
| | | | - David C Atkins
- Department of Psychiatry and Behavioral Sciences, University of Washington
| | - Christine M Lee
- Department of Psychiatry and Behavioral Sciences, University of Washington
| | - Mary E Larimer
- Department of Psychiatry and Behavioral Sciences, University of Washington
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Bergman BG, Kelly JF, Nargiso JE, McKowen JW. "The Age of Feeling in-Between": Addressing Challenges in the Treatment of Emerging Adults With Substance Use Disorders. COGNITIVE AND BEHAVIORAL PRACTICE 2016. [DOI: 10.1016/j.cbpra.2015.09.008] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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