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Knapp KS, Kulak JA, Homish DL, Granfield R, Homish GG, Kahn LS. Longitudinal trajectories in recovery capital and associations with substance use among adult drug treatment court clients. Drug Alcohol Depend 2024; 260:111343. [PMID: 38815293 DOI: 10.1016/j.drugalcdep.2024.111343] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/08/2023] [Revised: 05/16/2024] [Accepted: 05/18/2024] [Indexed: 06/01/2024]
Abstract
BACKGROUND Recovery capital (RC) refers to the resources individuals use to support substance use disorder (SUD) recovery. Individuals with SUD who are involved with the criminal justice system often have limited RC. Drug treatment courts (DTCs), including traditional drug treatment courts (tDTCs) and opioid intervention courts (OICs), can link clients to important sources of RC in the short-term, but few studies have assessed RC longitudinally. METHODS The current study analyzed five waves of data from a one-year longitudinal study on substance use and RC collected from clients of tDTCs and OICs (n=165, 52% male, 75% non-Hispanic White, Age=21-67 years). Mixed-effects models examined (1) within-person trends over time in RC, (2) individual characteristics associated with differences and changes in RC, and (3) patterns of relationships between RC and substance use over time. We also tested differences by court type. RESULTS First, OIC participants had lower RC at baseline relative to tDTC participants, and there was considerable within-person variability in RC over time. Second, the effect of a high school diploma/GED at baseline on RC change over time was greater for OIC relative to tDTC participants. Third, there was a negative concurrent within-person association between drug use and RC that became stronger over time for OIC relative to tDTC participants. CONCLUSIONS This study is among the first to examine longitudinal, within-person trajectories in RC. Results revealed important within-person variability over time in RC that was linked to education and drug use, particularly among OIC clients. Findings could help inform DTC treatment approaches.
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Affiliation(s)
- Kyler S Knapp
- School of Social Work, University at Buffalo, Buffalo, NY 14214, United States.
| | - Jessica A Kulak
- Department of Community Health & Health Behavior, School of Public Health & Health Professions, University at Buffalo, Buffalo, NY 14214, United States
| | - D Lynn Homish
- Department of Community Health & Health Behavior, School of Public Health & Health Professions, University at Buffalo, Buffalo, NY 14214, United States
| | - Robert Granfield
- Department of Sociology, College of Arts and Sciences, University at Buffalo, Buffalo, NY 14260, United States
| | - Gregory G Homish
- Department of Community Health & Health Behavior, School of Public Health & Health Professions, University at Buffalo, Buffalo, NY 14214, United States
| | - Linda S Kahn
- Primary Care Research Institute, Department of Family Medicine, University at Buffalo, Buffalo, NY 14203, United States
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Timko C, Mericle A, Vest N, Delk J, Zemore SE. Mode of mutual-help group attendance: Predictors and outcomes in a US national longitudinal survey of adults with lifetime alcohol use disorder. JOURNAL OF SUBSTANCE USE AND ADDICTION TREATMENT 2024; 164:209395. [PMID: 38740188 DOI: 10.1016/j.josat.2024.209395] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/18/2023] [Revised: 03/23/2024] [Accepted: 05/06/2024] [Indexed: 05/16/2024]
Abstract
INTRODUCTION Although attending substance use-focused mutual-help meetings online may reduce attendance barriers, associations of attendance mode with group participation and outcomes are unknown. Using longitudinal data from mutual-help group attendees, this study, after identifying differences in baseline characteristics by attendance mode, examined associations of attendance mode with mutual-help participation (number of meetings attended, involvement) and outcomes (alcohol abstinence, heavy drinking, alcohol problems). METHODS The Peer Alternatives for Addiction Study 2021 Cohort sampled attendees of 12-step groups (e.g., Alcoholics Anonymous), Women for Sobriety, LifeRing Secular Recovery, and/or SMART Recovery in-person and/or online within 30 days before baseline. The baseline sample, recruited in fall 2021, was 531 adults with lifetime alcohol use disorder, followed at 6 (88 %) and 12 months (85 %). Differences in baseline characteristics by attendance mode were tested using Chi-squares and ANOVAs. GEE models examined associations of attendance mode, time, and their interactions with mutual-help group participation and alcohol outcomes. The in-person only mode was compared to the online-only, and to the in-person plus online, modes. RESULTS At baseline, 53.7 % of participants had attended only online meetings in the past 30 days, 33.7 % had attended both in-person and online meetings, and 12.6 % had attended only in-person meetings. Online meeting attendees were less likely to endorse lifetime abstinence as an alcohol recovery goal than in-person-only meeting attendees. In adjusted models (including for recovery goal), those attending online meetings only, or both online and in-person meetings, attended a greater number of meetings compared to those attending only in-person meetings. However, online-only attendance was associated with less involvement than in-person-only attendance. In adjusted models, compared to baseline, involvement increased and outcomes improved at follow-ups. Adjusted models examining alcohol outcomes found that no attendance at mutual-help groups at follow-ups was associated with more heavy drinking compared to in-person-only attendance. CONCLUSIONS Findings inform efforts to ascertain benefits of mutual-help group participation by suggesting that online attendance is associated with attending more meetings, less involvement, and lower endorsement of abstinence as a recovery goal, and is comparable to in-person attendance on alcohol outcomes. In-person attendance may be more beneficial for less heavy drinking than terminating attendance.
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Affiliation(s)
- Christine Timko
- Center for Innovation to Implementation, VA Health Care System, Palo Alto, CA 94304, USA; Department of Psychiatry and Behavioral Sciences, Stanford University School of Medicine, Stanford, CA 94304, USA.
| | - Amy Mericle
- Alcohol Research Group, Emeryville, CA 94608, USA
| | - Noel Vest
- Department of Health Law, Policy and Management, Boston University School of Public Health, Boston, MA 02118, USA
| | - Joanne Delk
- Alcohol Research Group, Emeryville, CA 94608, USA
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Andreu M, Balcells-Olivero M, Alcaraz N, Marco O, Bueno L, Gual A, Barrio P. Destination Matters More: Relapse following Hospital-Based Treatment of Substance Use Disorders With and Without Co-Occurring Disorders. J Dual Diagn 2024; 20:111-121. [PMID: 38367999 DOI: 10.1080/15504263.2024.2311634] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/19/2024]
Abstract
OBJECTIVES Addressing substance use in psychiatric care encounters significant barriers, but the emergence of specialized services offers an opportunity to advance and scale up the integration of addiction services within psychiatric settings. However, research gaps still exist in this field, particularly in understanding the substance relapse rates of people with co-occurring disorders after a psychiatric hospitalization. This study aimed to investigate and compare the relapse rates of patients under inpatient care with exclusively addiction-related issues and those with co-occurring disorders after a hospitalization in a psychiatric ward and gain insights into differences in outcomes for these two patient groups. METHODS This retrospective analysis examined electronic medical records of patients admitted to the Acute Psychiatry Ward of the Hospital Clinic of Barcelona with a substance use disorder diagnosis between January 2019 and February 2021. Cox regression was used to identify variables independently associated with the first relapse episode. RESULTS From a total of 318 admissions (79.2% with psychiatric comorbidity), 76.1% relapsed during the study follow-up, with a median survival time of 54 days. Younger age, female gender, voluntary admission, and outpatient follow-up were independently associated with relapse. The presence of a co-occurring disorder was not associated with relapse. CONCLUSION This study highlights the need for interventions aimed at improving post-discharge abstinence rates for addiction-related hospitalizations. It also challenges the notion that co-occurring disorders automatically imply a worsened prognosis and emphasizes the importance of addressing addiction and psychiatric comorbidity in a comprehensive, integrated, and specialized manner.
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Affiliation(s)
- Magalí Andreu
- Research Group of Clinical Addictions (GRAC-GRE), Department of Psychiatry, Clinical Institute of Neuroscience, Psychiatry and Psychology Service, Hospital Clínic i Universitari de Barcelona, Barcelona, Spain
- Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain
- Doctoral Program of Medicine and Translational Research, University of Barcelona, Barcelona, Spain
| | - Mercè Balcells-Olivero
- Research Group of Clinical Addictions (GRAC-GRE), Department of Psychiatry, Clinical Institute of Neuroscience, Psychiatry and Psychology Service, Hospital Clínic i Universitari de Barcelona, Barcelona, Spain
- Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain
| | - Noelia Alcaraz
- Research Group of Clinical Addictions (GRAC-GRE), Department of Psychiatry, Clinical Institute of Neuroscience, Psychiatry and Psychology Service, Hospital Clínic i Universitari de Barcelona, Barcelona, Spain
- Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain
| | - Oriol Marco
- Research Group of Clinical Addictions (GRAC-GRE), Department of Psychiatry, Clinical Institute of Neuroscience, Psychiatry and Psychology Service, Hospital Clínic i Universitari de Barcelona, Barcelona, Spain
- Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain
| | - Laura Bueno
- Research Group of Clinical Addictions (GRAC-GRE), Department of Psychiatry, Clinical Institute of Neuroscience, Psychiatry and Psychology Service, Hospital Clínic i Universitari de Barcelona, Barcelona, Spain
- Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain
| | - Antoni Gual
- Research Group of Clinical Addictions (GRAC-GRE), Department of Psychiatry, Clinical Institute of Neuroscience, Psychiatry and Psychology Service, Hospital Clínic i Universitari de Barcelona, Barcelona, Spain
- Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain
| | - Pablo Barrio
- Research Group of Clinical Addictions (GRAC-GRE), Department of Psychiatry, Clinical Institute of Neuroscience, Psychiatry and Psychology Service, Hospital Clínic i Universitari de Barcelona, Barcelona, Spain
- Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain
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Smith DC, Reinhart CA, Begum S, Kosgolla J, Kelly JF, Bergman BB, Basic M. Coming of age in recovery: The prevalence and correlates of substance use recovery status among adolescents and emerging adults. PLoS One 2023; 18:e0295330. [PMID: 38113212 PMCID: PMC10729970 DOI: 10.1371/journal.pone.0295330] [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: 03/29/2023] [Accepted: 11/20/2023] [Indexed: 12/21/2023] Open
Abstract
BACKGROUND AND AIMS To date, no epidemiological survey has estimated the prevalence of adolescents identifying as being in recovery. This is necessary for planning and identifying the needs of youth with current and remitted substance use disorders. This study estimated the prevalence of recovery status in a large statewide epidemiological survey administered between January and March 2020. PARTICIPANTS Participants were high school students in 9th through 12th grades throughout Illinois. MEASUREMENTS Youth were asked if they were in recovery and if they had resolved problems with substances. Youth who reported recovery and problem resolving dual status (DS), recovery only (RO), and problem resolution only (PRO) were compared to propensity score matched control groups who reported neither status (neither/nor; NN). Outcomes included alcohol use, binge alcohol use, cannabis use, and prescription drug use in the past 30 days. FINDINGS Prevalence estimates were 884 (1.4%) for DS, 1546 (2.5%) for PRO, and 1,811 (2.9%) for RO. Relative to propensity matched control samples, all three groups had significantly lower odds of prescription drug use. The PRO group had lower odds of past month cannabis use. There were no significant differences for either alcohol outcome. CONCLUSIONS Prevalence estimates of youth in recovery are slightly lower than those of adults in recovery, and estimates should be replicated. Youth in recovery and those resolving problems have numerous behavioral health needs, and relative to matched controls, have even odds for past 30-day alcohol use. These findings compel us to further define recovery for adolescents and emerging adults to allow for improving treatments and epidemiological research.
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Affiliation(s)
- Douglas C. Smith
- Center for Prevention Research and Development (CPRD), School of Social Work, University of Illinois Urbana-Champaign, Urbana, Illinois, United States of America
| | - Crystal A. Reinhart
- Center for Prevention Research and Development (CPRD), School of Social Work, University of Illinois Urbana-Champaign, Urbana, Illinois, United States of America
| | - Shahana Begum
- Center for Prevention Research and Development (CPRD), School of Social Work, University of Illinois Urbana-Champaign, Urbana, Illinois, United States of America
| | - Janaka Kosgolla
- Center for Prevention Research and Development (CPRD), School of Social Work, University of Illinois Urbana-Champaign, Urbana, Illinois, United States of America
| | - John F. Kelly
- Recovery Research Institute, Massachusetts General Hospital & Harvard Medical School, Boston, Massachusetts, United States of America
| | - Brandon B. Bergman
- Recovery Research Institute, Massachusetts General Hospital & Harvard Medical School, Boston, Massachusetts, United States of America
| | - Marni Basic
- Center for Prevention Research and Development (CPRD), School of Social Work, University of Illinois Urbana-Champaign, Urbana, Illinois, United States of America
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Jemberie WB, Snellman F, Eriksson M, Hammarberg A. 'Ageing with an alcohol problem is not what I envision': reclaiming agency in shaping personal ageing trajectory and recovery from alcohol problems. BMC Geriatr 2023; 23:866. [PMID: 38104085 PMCID: PMC10724916 DOI: 10.1186/s12877-023-04573-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2023] [Accepted: 12/05/2023] [Indexed: 12/19/2023] Open
Abstract
BACKGROUND Eliciting and understanding older persons' descriptions of their resources for healthy ageing and the interaction of these resources with alcohol use and alcohol problems can facilitate health promotion. It can also inform clinicians when identifying areas of recovery capital that present risks and strength for older people seeking alcohol treatment. The objective of this study was to illuminate the experiences and perspectives of older persons on ageing, alcohol use, treatment, and recovery from alcohol problems, as well as their understanding of healthy ageing. METHODS Eight men and two women, aged 61 to 73 years, with moderate drinking as a treatment goal and treated at an outpatient alcohol clinic in Sweden, participated in semi-structured audio-recorded virtual interviews. A qualitative content analysis examined the transcribed interviews. RESULTS Three themes were identified: "Tipping the balance", "Staying behind a veil" and "Lifting the vail". First, participants understood healthy ageing as a personal and multidimensional process that involved actively expanding, maintaining or adjusting to the resources needed to lead an active and meaningful life while preserving autonomy, dignity and independence for as long as possible. Second, most participants viewed moderate alcohol use as a contributor to healthy ageing. They sought treatment when their drinking became unsustainable and an immediate threat to their healthy ageing resources. Stigma, ambivalence and a lack of treatment options, however, contributed to delayed treatment. Third, the participants responded to treatment approaches that elicited their concern, incorporated their expertise and treatment and life goals, appreciated their autonomy and agency, and considered them partners in goal setting and decision making. Reduced drinking helped participants regain their agency and improved their healthy ageing capital which in turn catalyzed continuing recovery. CONCLUSIONS Older persons in non-abstinent recovery perceive healthy ageing and alcohol recovery as personal and interacting multidimensional processes involving their agency to improve biopsychosocial functioning. Treatment approaches that recognize older persons' desire for healthy ageing, incorporate their treatment goals and respect their autonomy are likely to be acceptable and effective.
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Affiliation(s)
- Wossenseged Birhane Jemberie
- Department of Social Work, Umeå University, 901 87, Umeå, Sweden.
- Centre for Demography and Aging Research (CEDAR), Umeå University, Umeå, Sweden.
- The Swedish National Graduate School for Competitive Science On Aging and Health (SWEAH), Faculty of Medicine, Lund University, Lund, Sweden.
| | - Fredrik Snellman
- Department of Social Work, Umeå University, 901 87, Umeå, Sweden
| | - Malin Eriksson
- Department of Social Work, Umeå University, 901 87, Umeå, Sweden
| | - Anders Hammarberg
- Centre for Psychiatry Research, Department of Clinical Neuroscience, Karolinska Institutet and Stockholm Health Care Services, Region Stockholm, Stockholm, Sweden
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Day E, Manitsa I, Farley A, Kelly JF. A UK national study of prevalence and correlates of adopting or not adopting a recovery identity among individuals who have overcome a drug or alcohol problem. Subst Abuse Treat Prev Policy 2023; 18:68. [PMID: 37978529 PMCID: PMC10657010 DOI: 10.1186/s13011-023-00579-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2023] [Accepted: 11/09/2023] [Indexed: 11/19/2023] Open
Abstract
BACKGROUND The concept of recovery has increasingly become an organizing paradigm in the addiction field in the past 20 years, but definitions of the term vary amongst interested groups (e.g. researchers, clinicians, policy makers or people with lived experience). Although professional groups have started to form a consensus, people with lived experience of alcohol or drug (AOD) problems use the term in a different way, leading to confusion in policy making in the UK. Greater knowledge about the prevalence and correlates of adopting a recovery identity amongst those who have overcome an AOD problem would inform clinical, public health, and policy communication efforts. METHODS We conducted a cross-sectional nationally representative survey of individuals resolving a significant AOD problem (n = 1,373). Weighted analyses estimated prevalence and tested correlates of label adoption. Qualitative analyses summarized reasons for adopting or not adopting a recovery identity. RESULTS The proportion of individuals currently identifying as being in recovery was 52.4%, never in recovery 28.6%, and no longer in recovery 19.0%. Predictors of identifying as being in recovery included current abstinence from AOD, formal treatment, recovery support service or mutual-help participation, and history of being diagnosed with AOD or other psychiatric disorders. Qualitative analyses found themes around not adopting a recovery identity related to low AOD problem severity, viewing the problem as resolved, or having little difficulty in stopping. CONCLUSIONS Despite increasing use of the recovery label and concept in clinical and policy contexts, many resolving AOD problems do not identify in this manner. These are most likely to be individuals with less significant histories of impairment secondary to AOD and who have not engaged with formal or informal treatment systems. The understanding of the term recovery in this UK population did not completely align with abstinence from alcohol or drugs.
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Affiliation(s)
- Ed Day
- Institute for Mental Health, School of Psychology, University of Birmingham, Edgbaston, B152TT, UK.
| | - Ifigeneia Manitsa
- Institute for Mental Health, School of Psychology, University of Birmingham, Edgbaston, B152TT, UK
| | - Amanda Farley
- Institute for Applied Health Research, University of Birmingham, Edgbaston, B152TT, UK
| | - John F Kelly
- Recovery Research Institute, Center for Addiction Medicine, Department of Psychiatry, Massachusetts General Hospital, Boston, MA, USA
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Bormann NL, Weber AN, Arndt S, Lynch A. Improvements in recovery capital are associated with decreased alcohol use in a primary opioid use disorder treatment-seeking cohort. Am J Addict 2023; 32:547-553. [PMID: 37132067 DOI: 10.1111/ajad.13431] [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: 12/17/2022] [Revised: 03/23/2023] [Accepted: 04/20/2023] [Indexed: 05/04/2023] Open
Abstract
BACKGROUND AND OBJECTIVES Comorbid substance use can negatively impact multiple aspects of treatment for patients with an opioid use disorder (OUD). We investigated if treatment for OUD led to improvements in patients' recovery capital (RC) overtime, and whether there were associated changes in co-occurring alcohol use. METHODS Participants (n = 133) were patients with OUD seeking outpatient treatment, who completed the Assessment of Recovery Capital (ARC) and reported drinking days per 30-day period thrice over the 6-month study. No specific treatments targeting alcohol were used. Two different models were employed to assess changes in total ARC score and adjusted odds ratio (aOR) for past 30-day abstinence. RESULTS Baseline mean ARC scores were 36.6 and significantly increased to mean score of 41.2 at study end. Ninety-one participants (68.4%) reported no alcohol use at baseline, and 97 (78.9%) reported no use in the previous 30 days at study endpoint. For each increase in ARC, there was an aOR 1.07 (confidence interval [CI]: 1.02-1.13) for past 30-day abstinence. Considering ARC standard deviation of 10.33 over all measurements, this equates to an aOR of 2.10 (CI: 1.22-3.62) for past 30-day abstinence. DISCUSSION AND CONCLUSIONS We saw significantly increased aOR for past 30-day abstinence as RC improved in an OUD treatment-seeking population. This difference was not caused by differences in ARC between study completers and noncompleters. SCIENTIFIC SIGNIFICANCE Showcases how RC growth may be protective of past 30-day alcohol use in an OUD cohort and adds specific aOR for abstinence per ARC increase.
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Affiliation(s)
- Nicholas L Bormann
- Department of Psychiatry, Indiana University, Indianapolis, Indiana, USA
| | - Andrea N Weber
- Department of Psychiatry, University of Iowa, Iowa City, Iowa, USA
- Department of Internal Medicine, University of Iowa, Iowa City, Iowa, USA
| | - Stephan Arndt
- Department of Psychiatry, University of Iowa, Iowa City, Iowa, USA
- Department of Biostatistics, University of Iowa, Iowa City, Iowa, USA
| | - Alison Lynch
- Department of Psychiatry, University of Iowa, Iowa City, Iowa, USA
- Department of Family Medicine, University of Iowa, Iowa City, Iowa, USA
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Bormann NL, Weber AN, Miskle B, Arndt S, Lynch AC. Recovery Capital Correlates With Less Methamphetamine Use and Crime in the Community. J Addict Med 2023; 17:e361-e366. [PMID: 37934526 DOI: 10.1097/adm.0000000000001200] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/18/2023]
Abstract
OBJECTIVES Reentry postcorrectional involvement is a high-risk time for patients with a history of addiction. We investigated whether participation in an addiction medicine clinic with active case management led to improvements in patients' recovery capital and whether there were associated changes in criminal activity and co-occurring methamphetamine or alcohol use. METHODS Participants (n = 136) were patients with an opioid or stimulant use disorder who had Department of Corrections involvement in the preceding year, who completed the Assessment of Recovery Capital (ARC) and reported criminal activity and days of methamphetamine or alcohol use twice over a 6-month study. Three logistic regression models were used to assess changes in total ARC with criminal activity, alcohol use, and methamphetamine use over the previous 30 days. RESULTS Baseline mean (SD) ARC scores were 34.1 (11.1) and increased to a mean (SD) score of 40.3 (9.4) at study end. A 1-SD shift in ARC was significantly protective across outcomes, with adjusted odds ratios of 0.32, 0.18, and 0.34 for any past 30-day criminal activity, alcohol use, or methamphetamine use. There was no significant difference in baseline ARC, crimes committed, days of alcohol use, or days of methamphetamine use for study completers versus noncompleters; however, unmeasured confounders may have had a differential impact on retention. CONCLUSIONS Recovery capital provides an additional framework to help address patients' substance use and criminal activity in a multifaceted way, which is especially important in the postincarceration community. Recovery capital is dynamic and has multiple areas to target psychosocial interventions.
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Affiliation(s)
- Nicholas L Bormann
- From the Department of Psychiatry, Indiana University, Indianapolis, IN (NLB); Department of Psychiatry, University of Iowa, Iowa City, IA (ANW, BM, SA, ACL); Department of Internal Medicine, University of Iowa, Iowa City, IA (ANW); Department of Pharmacy, University of Iowa, Iowa City, IA (BM); Department of Biostatistics, University of Iowa, Iowa City, IA (SA); Department of Family Medicine, University of Iowa, Iowa City, IA (ACL)
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Bormann NL, Weber AN, Miskle B, Arndt S, Lynch AC. Recovery Capital Gains May Precede Craving Reduction in Opioid Use Disorder. Subst Abuse Rehabil 2023; 14:113-118. [PMID: 37818109 PMCID: PMC10561754 DOI: 10.2147/sar.s433350] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2023] [Accepted: 10/03/2023] [Indexed: 10/12/2023] Open
Abstract
Purpose Cravings for drugs and alcohol have been significantly associated with worse treatment outcomes. We investigated if improvements in recovery capital (RC) (eg, a measure of social capital/network, financial resources, education, and cultural factors) over time were associated with decreased reported cravings. Patients and Methods The original cohort consisted of 133 participants (63 females) with opioid use disorder seeking outpatient treatment, who completed the Assessment of Recovery Capital (ARC) (range 0 to 50) and the Brief Addiction Monitor (BAM) thrice over the 6-month study. Intervention was medication and case management. Analysis included one-way mixed models testing change over time for ARC total scores and single question craving rating (5-point Likert scale). Cross-lagged panel estimates used structural equation models with variables z-scored, allowing for path coefficient evaluation as standard deviations (sd). Results Total ARC significantly increased over the study (χ2 = 33.77, df = 2, p < 0.0001), with baseline of 36.6 (n = 114, sd = 11.1) and 6-month of 41.2 (n = 107, sd = 9.5). Craving also changed significantly (χ2 = 8.51, df = 2, p < 0.015), with baseline of 1.1 (n = 101, sd = 1.2) and 6-month of 0.9 (n = 107, sd = 1.1). The cross-lag from baseline RC to 3-month craving was significant (β = -0.28, SE = 0.11, z = -2.53, p < 0.011). The converse was not true; baseline craving did not affect later RC. Results were similarly significant when comparing 3-month to 6-month. The majority of sample was on buprenorphine. Conclusion As RC improves, the reported cravings at both 3- and 6-month study time points are significantly reduced. When evaluated inversely, there was not a significant association with baseline cravings and follow-up RC. Significant path coefficients provide an estimation of a directional effect from increased RC towards craving reduction.
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Affiliation(s)
- Nicholas L Bormann
- Psychiatry and Psychology, Mayo Clinic Health System, Albert Lea, MN, USA
| | - Andrea N Weber
- Psychiatry, University of Iowa, Iowa City, Iowa, USA
- Internal Medicine, University of Iowa, Iowa City, Iowa, USA
| | - Benjamin Miskle
- Psychiatry, University of Iowa, Iowa City, Iowa, USA
- Pharmacy, University of Iowa, Iowa City, Iowa, USA
| | - Stephan Arndt
- Psychiatry, University of Iowa, Iowa City, Iowa, USA
- Biostatistics, University of Iowa, Iowa City, Iowa, USA
| | - Alison C Lynch
- Psychiatry, University of Iowa, Iowa City, Iowa, USA
- Family Medicine, University of Iowa, Iowa City, Iowa, USA
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Vanyukov MM. Stigmata that are desired: Contradictions in addiction. ADDICTION RESEARCH & THEORY 2023; 32:83-92. [PMID: 38523739 PMCID: PMC10957146 DOI: 10.1080/16066359.2023.2238603] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/06/2023] [Accepted: 07/17/2023] [Indexed: 03/26/2024]
Abstract
Many experts in the etiology, assessment, and treatment of substance use/addiction view stigma and stigmatization - negatively branding addiction and substance users - as obstacles to the solution of the substance misuse problem. Discussions on this topic impact research and policy, and result in oft-repeated calls to remove the stigma from substance use and users. The goal of the article is to analyze the stigmatization concept as applied to substance use/addiction. It is widely accepted in the literature that stigmatization negatively affects substance users because addiction stigma interferes in both seeking and receiving professional care. It is argued that the societal disapproval of substance use/addiction is inappropriate because it is a mental disorder, involving biological processes. Nonetheless, neither those processes nor negative attitudes to substance use affirm the concept of stigmatization as currently applied. This concept conflates potential mistreatment and malpractice with the prosocial justified societal disapproval of a lethally dangerous behavior. Consequently, the stigmatization concept suffers from internal contradictions, is either misleading or redundant, and may do more harm than the supposed mistreatment of substance users that stigmatization connotes. On the contrary, the justified disapproval of harmful behavior may be a factor raising individual resistance to substance use. Instead of mitigating the effects of that disapproval, it may need to be capitalized on. If it is employed explicitly, conscientiously, and professionally, its internalization may be one of the resistance mechanisms needed to achieve any progress in the still elusive prevention of substance use and addiction.
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Affiliation(s)
- Michael M Vanyukov
- Departments of Pharmaceutical Sciences, Psychiatry, and Human Genetics, University of Pittsburgh, Pittsburgh PA, USA
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Gavriel-Fried B, Lev-el N, Kraus SW. The Holistic Recovery Capital in Gambling Disorder index: A pilot study. J Behav Addict 2022; 11:600-606. [PMID: 35895478 PMCID: PMC9295245 DOI: 10.1556/2006.2022.00040] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/23/2021] [Revised: 05/25/2021] [Accepted: 05/15/2022] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND AND AIMS Recovery is a challenge for individuals coping with a gambling disorder (GD). Recovery capital (RC) is a conceptual framework describing positive external and internal (e.g., human, social, community and financial) resources that promote recovery. Negative RC relates to external and internal obstacles to recovery. To date, no scale has captured both positive and negative RC items in the gambling field. Based on the RC framework, this pilot study aimed to develop The Holistic Recovery Capital in Gambling Disorder (HRC-GD) instrument, and to explore its associations with recovery status, measures of psychopathology and happiness. We hypothesized that higher HRC-GD scores will be positively related to recovery and subjective happiness, but negatively linked to depression, anxiety, and gambling severity. METHOD Recovered and non-recovered individuals with a lifetime DSM-5 GD (n = 164) completed the HRC-GD instrument, the DSM-5 GD diagnostic criteria, and measures of depression, anxiety, and subjective happiness. RESULTS Through a process of item reduction, which included a principal components analysis, 19 items were retained. Since exploratory factor analysis (EFA) yielded uninterpretable findings, an index score reflecting human, financial, community, and social resources and obstacles was calculated. HRC-GD index scores were negatively correlated with anxiety, depression, and GD symptom severity, but positively related with subjective happiness. Index scores were significantly associated with recovery status. CONCLUSIONS The HRC-GD index holds promise as a new tool for measuring RC in GD. Additional research is needed to validate this index using larger and more ethnically and gender diverse clinical and community samples of individuals with GD.
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Affiliation(s)
- Belle Gavriel-Fried
- The Bob Shapell School of Social Work, Tel Aviv University, Israel,Corresponding author. Tel.: +971+36409151. E-mail:
| | - Niva Lev-el
- The Bob Shapell School of Social Work, Tel Aviv University, Israel
| | - Shane W. Kraus
- Department of Psychology, University of Nevada, Las Vegas, NV, USA
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Subbaraman MS. A commentary on "Abstinence versus moderation recovery pathways following resolution of a substance use problem". Alcohol Clin Exp Res 2022; 46:705-706. [PMID: 35352355 DOI: 10.1111/acer.14820] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2022] [Accepted: 03/24/2022] [Indexed: 11/29/2022]
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