"Knowing or not knowing": Living as harm reductionists in Twelve Step recovery

A review of the complex intersection between religion, spirituality, and harm reduction

BACKGROUND AND OBJECTIVES

Within substance use research, religion and spirituality (r/s) have been understudied in relation to harm reduction approaches. We perform a literature review to characterize various intersections between r/s and harm reduction.

METHODS

We searched major databases, Google Scholar, and other sources for academic articles and gray literature on the intersection between r/s and harm reduction. We describe areas of overlap and tension as well as analyze the results using three tiers of proximity to lived/living experience.

RESULTS

Of the 457 papers identified, 169 met final inclusion. Of these, 100 papers contained discussion of alignment between religious or spiritual values and harm reduction values, 39 discussed strategic uses of religious or spiritual resources, 22 discussed harm reduction practices in relation to substances with religious/spiritual relevance, such as psychedelics, and 8 discussed religious/spiritual support for harm reduction workers. Eighteen noted that content was coproduced with persons with lived/living experience, 75 of them noted content was informed by relationship with persons with lived/living experience, and in 76 no such engagement was mentioned.

DISCUSSION AND CONCLUSIONS

The relevance of r/s is not limited to abstinence-based models and has significance in the harm reduction literature.

SCIENTIFIC SIGNIFICANCE

This is the first systematic study of the complex intersection between r/s and harm reduction. The results point to opportunities to further understand r/s as both barrier to and resource for harm reduction efforts, as well as how proximity to those with lived/living experience may influence alignment with harm reduction values.

"Un attracteur de soins": Bringing People Into Care. Interdisciplinary Health Care Professionals' Attitudes Toward Opioid Agonist Therapy in France: a Qualitative Study with Implications for the United States

BACKGROUND

Opioid agonist therapies (OAT), including methadone and buprenorphine, are first-line care in national and international guidelines, yet many countries, including the United States, frequently fail to effectively engage and retain people in OAT. How OAT is delivered-including the goals and culture of care-matters to patient engagement, treatment retention, and health outcomes. France has among the highest OAT receipt and lowest opioid-related morbidity and mortality worldwide. This study explored French interprofessional health care clinicians' approach to OAT, drawing lessons to improve OAT implementation in the United States and elsewhere.

METHODS

We recruited interprofessional participants (eg, physicians, pharmacists, nurses, administrators) from diverse health care settings (eg, specialty addiction care, hospitals, public health) and regions and conducted in-depth semi-structured qualitative interviews. We conducted a reflexive thematic analysis using an inductive approach at a semantic level, identifying themes that held meaning to study participants and had implications for the United States and other contexts.

RESULTS

Twenty-one people participated. Participants described patient engagement as the primary goal of OAT, which has potential to draw people to care. They felt imposing or expecting abstinence was harmful and might obligate patients to lie or "lead a double life," resulting in mistrust, missed care opportunities, and "losing patients" who disengaged from care. Participants described balancing flexibility and structure. They felt that flexibility promotes OAT access and engagement and that clinicians should contextualize decisions within patients' risk environments, including those of an illicit drug supply and the black market. Participants described that structure should be offered as support, not punishment or control. Finally, they described that practices prioritizing engagement are sustained by policies and professional norms.

CONCLUSIONS

Our findings challenge OAT practices and policies centered on abstinence and control. They suggest that approaches that prioritize patient engagement and balance flexibility and structure may be central to achieving high rates of OAT across a population.

Attitudes toward medications for opioid use disorder among peer recovery specialists

Background: Peer recovery specialists (PRSs) are substance use service providers with lived experience in recovery. Although a large body of research demonstrates the efficacy of medications for opioid use disorder (MOUD), emerging research suggests PRSs' attitudes toward MOUD are ambivalent or mixed. Few studies have quantitatively assessed factors influencing PRSs' attitudes.Objectives: This study identifies personal and professional characteristics associated with attitudes toward MOUD among PRSs.Methods: PRSs working at publicly funded agencies in Michigan completed a self-administered web-based survey (N = 266, 60.5% women). Surveys assessed socio-demographics, treatment and recovery history, attitudes toward clients, and attitudes toward MOUD. Multiple linear regression was used to identify factors associated with attitudes toward MOUD.Results: A minority of PRSs (21.4%) reported a history of treatment with MOUD, while nearly two-thirds reported current 12-step involvement (62.5%). Compared to PRSs without a history of MOUD treatment, PRSs who had positive (b = 4.71, p < .001) and mixed (b = 3.36, p = .010) experiences with MOUD had more positive attitudes; PRSs with negative experiences with MOUD had less positive attitudes (b = -3.16, p = .003). Current 12-step involvement (b = -1.63, p = .007) and more stigmatizing attitudes toward clients (b = -.294, p < .001) were associated with less positive attitudes toward MOUD. Black PRSs had less positive attitudes than White PRSs (b = -2.50, p = .001), and women had more positive attitudes than men (b = 1.19, p = .038).Conclusion: PRSs' attitudes toward MOUD varied based on the nature of their lived experience. Findings highlight considerations for training and supervising PRSs who serve individuals with opioid use disorder.

Internet-based, continuously available Narcotics Anonymous meetings: a new resource for access to Twelve Step support for abstinence

Background: A Zoom-based website was developed in 2020 that offers continuous access to online Narcotics Anonymous (NA) meetings for the first time. This website provides immediate access for persons with substance use disorder to support abstinence from substance-related addictive disorders.Objectives: This study is designed to characterize attendees employing this online format; to evaluate their experiences for gaining support to maintain abstinence; and to compare the 24/7 experience to face-to-face (FF) meetings they attend.Methods: An anonymous 33-item survey was made available on the 24/7 NA website that links to the 24/7 meetings. Persons accessing the site could choose to fill out the survey.Results: 530 respondents completed the survey (64.9% female/35.1% male). Most had stable prior involvement in NA. They had attended more 24/7 meetings (14.9, SD 19.7) than FF meetings (4.6, SD 7.8) in the previous month. 86% had previously attended FF meetings, 48% had served as sponsors, and 92% reported that the 24/7 meetings were more comfortable for them than the FF meetings (p < .001, Cohen's d = 0.65) and more supportive of abstinence (p < .001, Cohen's d = 0.91). Of the respondents, 8% were still using drugs, of whom 52% had previously completed some of the Twelve Steps.Conclusions: The 24/7 format provides a new and easily accessible way for NA members to gain support for abstinence and is positively rated by attendees seeking support for recovery from substance use disorders. It may serve as a valuable adjunct to the traditional FF format.