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Thompson RA, Johnson D, Ashworth M, Stott M. Establishing Quality and Outcome Measures for Recovery Housing: A Tiered Approach Supporting Service Evolution. Community Ment Health J 2024; 60:681-690. [PMID: 38270727 PMCID: PMC11001738 DOI: 10.1007/s10597-023-01219-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/22/2023] [Accepted: 12/15/2023] [Indexed: 01/26/2024]
Abstract
With over one-hundred thousand drug overdose deaths in 2021, substance use disorder (SUD) is a public health crisis in the United States. Medical stabilization has been the predominant focus of SUD interventions despite low levels of retention. Consequently, national quality measures for SUD care outside the clinical continuity of care are limited. The expansion of recovery support services addressing social drivers of health outside clinical settings is needed. The current SUD quality measures are not applicable nor feasible for recovery support service providers with limited resource capacities, like the estimated 17,900 recovery housing providers nationwide. Despite widespread support for recovery housing and its documented effectiveness, no universal set of measures has been developed for widespread adoption. In this brief, a matrix of quality measures are proposed to meet the needs of recovery housing providers with various capacities to support service evolution and improve equitable SUD treatment and recovery care.
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Affiliation(s)
- Robin A Thompson
- Fletcher Group, Inc., 601 Meyers Baker Road, Suite 238, London, KY, 40741, USA.
| | - David Johnson
- Fletcher Group, Inc., 601 Meyers Baker Road, Suite 238, London, KY, 40741, USA
| | - Madison Ashworth
- Fletcher Group, Inc., 601 Meyers Baker Road, Suite 238, London, KY, 40741, USA
| | - Milena Stott
- Fletcher Group, Inc., 601 Meyers Baker Road, Suite 238, London, KY, 40741, USA
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Jason LA, Light JM, Bobak T, Bell J. Effects of strength of relationship ties in recovery homes: A conundrum. THE INTERNATIONAL JOURNAL OF DRUG POLICY 2024; 126:104360. [PMID: 38382353 PMCID: PMC11056307 DOI: 10.1016/j.drugpo.2024.104360] [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: 10/30/2023] [Revised: 02/11/2024] [Accepted: 02/12/2024] [Indexed: 02/23/2024]
Abstract
Recovery homes are a widespread source of support for those attempting to maintain abstinence. For those who are able to remain in these settings for at least 6 months, outcomes tend to be favorable; however, many leave prematurely. There is a need to better understand the social integration processes that play a major role in giving recovery home residents access to available recovery-related social capital that is associated with better outcomes. The current study involved Oxford House recovery homes in 3 states and examined the strength of relationship ties among house members. We found that those who associated with peers who have higher recovery scores tend to improve their own recovery scores over time. However, we also found that those with higher recovery scores tended to create "strong" ties with similarly high-scoring alters; likewise lower-scoring individuals preferentially formed strong ties with each other. These findings suggest a conundrum: recovery home residents most in need of relational support from more recovered housemates are the least likely to obtain it. We discuss possible pathways to creating more ties between high and low-recovered residents.
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Affiliation(s)
| | | | - Ted Bobak
- University of Washington, Seattle, USA
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3
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Gallardo KR, Wilkerson JM, Stewart HLN, Zoschke IN, Fredriksen Isaacs C, McCurdy SA. "Being here is saving my life": Resident experiences of living in recovery residences for people taking medication for an opioid use disorder. JOURNAL OF SUBSTANCE USE AND ADDICTION TREATMENT 2024; 158:209242. [PMID: 38061632 DOI: 10.1016/j.josat.2023.209242] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/07/2023] [Revised: 08/11/2023] [Accepted: 11/30/2023] [Indexed: 12/25/2023]
Abstract
INTRODUCTION Medications for opioid use disorder (MOUD) are an effective treatment for addressing opioid use disorder. Despite MOUD's demonstrated effectiveness, MOUD-related stigma is prevalent throughout many recovery communities and subsequently limits persons taking MOUD access to recovery supports, including recovery housing. While recovery residences that serve people taking MOUD could be a critical recovery support, they are limited in number and understudied. METHODS We conducted in-depth interviews with 47 residents in medication-assisted recovery (MAR) living in 11 Texas-based recovery residences serving people taking MOUD to characterize residents' experiences and understand the impact that these homes had on their recovery. RESULTS We found that many participants could not previously access recovery housing and other recovery supports due to MOUD-related stigma, thus recovery homes that supported people in MAR were considered a groundbreaking opportunity. Recovery residences provided participants with a space in which they did not feel judged for taking MOUD, which facilitated participants' connections with their fellow housemates. Subsequently, participants no longer had to hide their MAR pathway and could be transparent about taking MOUD among their recovery residence community. Last, recovery homes provided a supportive environment in which participants' internalized MOUD-related stigma could evolve into acceptance of their MAR pathway. CONCLUSIONS Recovery residences that serve people in MAR provide a supportive, safe, nonjudgmental recovery environment in which residents develop relationships with other peers taking MOUD, share openly about their MAR, and are empowered to embrace their recovery pathway. These findings highlight the need for more recovery residences that are supportive of people taking MOUD as part of their recovery.
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Affiliation(s)
- Kathryn R Gallardo
- The University of Texas Health Science Center at Houston, School of Public Health, United States of America.
| | - J Michael Wilkerson
- The University of Texas Health Science Center at Houston, School of Public Health, United States of America
| | - Hannah L N Stewart
- The University of Texas Health Science Center at Houston, School of Public Health, United States of America
| | - I Niles Zoschke
- The University of Texas Health Science Center at Houston, School of Public Health, United States of America
| | - Cameron Fredriksen Isaacs
- The University of Texas Health Science Center at Houston, School of Public Health, United States of America
| | - Sheryl A McCurdy
- The University of Texas Health Science Center at Houston, School of Public Health, United States of America
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Subbaraman MS, Mahoney E, Witbrodt J, Karriker-Jaffe KJ, Mericle AA, Polcin DL. Multilevel Effects of Environmental and Neighborhood Factors on Sober Living House Resident 12-Month Outcomes. J Stud Alcohol Drugs 2023; 84:832-841. [PMID: 37449949 PMCID: PMC10765980 DOI: 10.15288/jsad.22-00307] [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: 08/26/2022] [Accepted: 04/07/2023] [Indexed: 07/18/2023] Open
Abstract
OBJECTIVE Sober living houses (SLHs) are abstinence-based environments designed for individuals in recovery to live with others in recovery. Research shows that SLHs help some individuals maintain recovery and that certain SLH-related factors may be particularly protective. Here we assess how SLH housing and neighborhood characteristics are related to abstinence and psychiatric symptoms over time. METHOD Baseline, 6-month, and 12-month data were collected from 557 SLH residents. Multilevel mixed models tested associations between house and neighborhood characteristics and individual-level percent days abstinent (PDA) and the number of psychiatric symptoms (measured with the Psychiatric Diagnostic Screening Questionnaire [PDSQ]) as outcomes. Final models adjusted for sex, age, and race/ethnicity; ratings of house characteristics; and objective measurements of neighborhood-level exposures. RESULTS Both PDA and PDSQ improved significantly (ps ≤ .05) over time in both unadjusted and adjusted models. More self-help groups and fewer alcohol outlets within one mile were significantly protective for PDA, whereas walkability was significantly related to worse PDA and PDSQ (ps ≤ .05). For house-level factors, better ratings of house maintenance were related to significantly fewer psychiatric symptoms, whereas higher scores on SLH's safety measures and personal or residence identity were related to more psychiatric symptoms (ps ≤ .05). No house-level factor was significantly related to PDA. CONCLUSIONS Neighborhood-level factors such as increased availability of self-help groups and fewer nearby alcohol outlets may increase abstinence among individuals living in SLHs. House-level factors related to better maintenance may also facilitate improved mental health.
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Affiliation(s)
| | - Elizabeth Mahoney
- Behavioral Health and Recovery Studies, Public Health Institute, Oakland, California
| | - Jane Witbrodt
- Behavioral Health and Recovery Studies, Public Health Institute, Oakland, California
- Alcohol Research Group, Emeryville, California
| | - Katherine J. Karriker-Jaffe
- Center on Behavioral Health Epidemiology, Implementation & Evaluation Research, RTI International, Berkeley, California
| | - Amy A. Mericle
- Behavioral Health and Recovery Studies, Public Health Institute, Oakland, California
- Alcohol Research Group, Emeryville, California
| | - Douglas L. Polcin
- Behavioral Health and Recovery Studies, Public Health Institute, Oakland, California
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Thompson RA, Johnson D, Whitter M, Ashworth M, Fletcher E. State-Level Support for Recovery Housing: Results from a National Collaborative Study of U.S. Single State Agencies. J Psychoactive Drugs 2023:1-9. [PMID: 37720982 DOI: 10.1080/02791072.2023.2253811] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2023] [Accepted: 08/09/2023] [Indexed: 09/19/2023]
Abstract
Single State Agencies (SSAs) are responsible for managing the publicly funded alcohol and other drug prevention, treatment, and recovery service system. Recovery housing (RH) is an important recovery support service (RSS) for individuals experiencing substance use disorder (SUD). Despite its effectiveness, information on state utilization and support is limited. To assess state-level support for RH and its incorporation within the SSA-managed SUD service systems, we administered a survey with SSAs in the 50 United States and the District of Columbia. In total, 48 out of the 51 SSAs responded, yielding a 94% response rate. Findings indicate strong state-level support for RH in terms of it being an integral RSS (98%), part of state-level strategic plans (73%) and prioritized for funding (87.5%). States are making progress to formalize RH with 68% reporting RH had been defined formally or within their agency. However, activities around understanding the capacity and need for RH are limited, with 44% indicating a needs assessment had not been conducted. At the same time, states perceive RH as a priority RSS, with growing recognition of its positive impact on long-term SUD recovery. This research identifies the opportunities for stakeholders to further evolve and expand RH at the federal, state, and local levels.
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Affiliation(s)
| | | | - Melanie Whitter
- National Association of State Alcohol and Drug Abuse Directors, Washington, DC, USA
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Soto-Nevarez A, Abo M, Hudson M, Bobak T, Jason LA. Lived experiences of Oxford House residents prescribed medication-assisted treatment. JOURNAL OF COMMUNITY PSYCHOLOGY 2023; 51:2828-2844. [PMID: 36994805 DOI: 10.1002/jcop.23038] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/21/2021] [Revised: 03/17/2023] [Accepted: 03/20/2023] [Indexed: 06/19/2023]
Abstract
Qualitative studies have examined the recovery experiences of individuals prescribed medication-assisted treatment (MAT), including their experiences within treatment facilities. However, the literature lacks qualitative studies exploring the recovery process of individuals prescribed MAT while living in recovery housing, such as Oxford House (OH). The purpose of this study was to explore how OH residents, who are prescribed MAT, make sense of recovery. The fact that OHs are drug-free recovery housing is what makes the issue of using MATs potentially contentious in these settings. Interpretative phenomenological analysis (IPA) was used to document the lived experiences of individuals prescribed MAT in OH. The sample included: five women and three men, prescribed either methadone or Suboxone, that were living in an OH in the United States. Participants were interviewed on four topics: their recovery process, their transition to OH, and their experience living in and outside of an OH. Analysis of results followed the recommendations for IPA from Smith, Flowers, and Larkin. Four general themes emerged from the data: Recovery Process, Managing Logistics of MAT Utilization, Personal Development, and Familial Values. In conclusion, individuals prescribed MAT did benefit from living in an OH to manage their recovery as well as stay compliant with their medication.
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Affiliation(s)
| | - Mary Abo
- Center for Community Research, DePaul University, Chicago, Illinois, USA
| | - Mackenzie Hudson
- Center for Community Research, DePaul University, Chicago, Illinois, USA
| | - Ted Bobak
- Center for Community Research, DePaul University, Chicago, Illinois, USA
| | - Leonard A Jason
- Center for Community Research, DePaul University, Chicago, Illinois, USA
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7
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Ashworth M, Thompson R, Fletcher E, Clancy GL, Johnson D. Recovery housing predictors of closure risk during COVID-19. JOURNAL OF SUBSTANCE USE 2022. [DOI: 10.1080/14659891.2022.2144505] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Affiliation(s)
- Madison Ashworth
- Department of Research and Evaluation, Fletcher Group, Inc, London, KY, USA
- Department of Economics, University of Wyoming, Laramie WY, USA
| | - Robin Thompson
- Department of Research and Evaluation, Fletcher Group, Inc, London, KY, USA
| | - Ernest Fletcher
- Department of Research and Evaluation, Fletcher Group, Inc, London, KY, USA
| | - Grace L. Clancy
- Department of Research and Evaluation, Fletcher Group, Inc, London, KY, USA
| | - David Johnson
- Department of Research and Evaluation, Fletcher Group, Inc, London, KY, USA
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Jason LA, Cotler J, Islam MF, Harvey R, Olson B. Policy and Scientific Implications of Compromised Replications. ALCOHOLISM TREATMENT QUARTERLY 2022. [DOI: 10.1080/07347324.2022.2074812] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Affiliation(s)
- Leonard A. Jason
- DePaul University, Center for Community Research, Chicago, IL, USA
| | - Joseph Cotler
- DePaul University, Center for Community Research, Chicago, IL, USA
| | | | - Ronald Harvey
- Departments of Philosophy and Psychology, American University in Bulgaria, Blagoevgrad, Bulgaria
| | - Bradley Olson
- College of Psychology and Behavioral, National Louis University, Chicago, IL, USA
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Chiaramonte D, Clements KA, López‐Zerón G, Ayeni OO, Farero AM, Ma W, Sullivan CM. Examining contextual influences on the service needs of homeless and unstably housed domestic violence survivors. JOURNAL OF COMMUNITY PSYCHOLOGY 2022; 50:1831-1853. [PMID: 34146356 PMCID: PMC8684560 DOI: 10.1002/jcop.22637] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 10/01/2020] [Revised: 05/09/2021] [Accepted: 05/11/2021] [Indexed: 06/12/2023]
Abstract
Domestic violence (DV) is a leading cause of homelessness for women, yet many DV agencies are just beginning to focus on helping clients stabilize their housing situations. The purpose of this study was to better understand the contexts and service needs of unstably housed and homeless DV survivors, to promote more efficient and successful service matching from DV agencies. We examined whether DV survivors could be grouped by particular features, histories, and contextual factors, and how these group differences impacted what they needed from DV agencies. The sample included 406 homeless and unstably housed DV survivors who had recently sought DV services. Latent class analysis supported the identification of four distinct classes: (1) highest disadvantages service seeker, (2) moderate disadvantages-criminal legal system service seeker, (3) moderate disadvantages service seeker, and (4) lower disadvantages service seeker. Additionally, we were able to profile each class, and test the types of services survivors in each class needed from agencies.
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Affiliation(s)
- Danielle Chiaramonte
- Department of PsychiatryYale University School of MedicineNew HavenConnecticutUSA
| | | | | | | | - Adam M. Farero
- Psychology DepartmentMichigan State UniversityEast LansingMichiganUSA
| | - Wenjuan Ma
- Center for Statistical Training and ConsultationMichigan State UniversityEast LansingMichiganUSA
| | - Cris M. Sullivan
- Psychology DepartmentMichigan State UniversityEast LansingMichiganUSA
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10
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Jason LA, Bobak T, Islam M, Guerrero M, Light JM. Social integration in recovery living environments: A dynamic network approach. JOURNAL OF COMMUNITY PSYCHOLOGY 2022; 50:1616-1625. [PMID: 34709666 PMCID: PMC8916960 DOI: 10.1002/jcop.22739] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/22/2021] [Accepted: 10/08/2021] [Indexed: 06/13/2023]
Abstract
Oxford Houses (OHs) are a large network of self-run community-based settings for individuals with substance use disorders. This present study explored a model based on conceptualizing recovery home social systems as dynamic multirelational (multiplex) social networks. The model is developed from data obtained from 42 OH recovery homes in three parts of the US, addressing whole networks of friendship, close friendship, and willingness to loan money. Findings indicated that close friend and loan relationships mutually reinforced each other over time as they coevolved. These types of insights can help community psychologists to better understand complex network dynamics in community-based settings.
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Affiliation(s)
| | - Ted Bobak
- DePaul University, Chicago, Illinois, USA
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11
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Ashworth M, Thompson R, Fletcher E, Clancy GL, Johnson D. Financial landscape of recovery housing in the United States. J Addict Dis 2022; 40:538-541. [PMID: 35212253 DOI: 10.1080/10550887.2022.2036575] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
Recovery housing provides substance-free living environments that use peer-support to empower individuals in recovery from substance use disorder. This study estimated the total revenue of the recovery housing industry from recovery houses, nationwide. Using survey data collected in June and July of 2020, we calculate the total revenue of the recovery housing industry and determine the share of revenue that comes from different sources for rural and nonrural houses. We find that individual recovery houses operate with an annual revenue of $250,000 and the whole industry accounts for $4.5 billion annually. COVID-19 has reduced industry revenue by 4%. Rural and nonrural houses differ significantly in their sources of revenue. Our results suggest that COVID-19 reduced the size of the recovery housing industry. Houses in nonrural regions may need more federal support due to the relatively high reliance on resident fees, which may be unreliable during COVID-19.
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Affiliation(s)
- Madison Ashworth
- Fletcher Group, Inc, London KY, USA.,Department of Economics, University of Wyoming, Laramie, WY, USA
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12
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Mericle AA, Slaymaker V, Gliske K, Ngo Q, Subbaraman MS. The role of recovery housing during outpatient substance use treatment. J Subst Abuse Treat 2022; 133:108638. [PMID: 34657785 PMCID: PMC8748296 DOI: 10.1016/j.jsat.2021.108638] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2021] [Revised: 08/20/2021] [Accepted: 09/28/2021] [Indexed: 02/03/2023]
Abstract
BACKGROUND Recovery housing generally refers to alcohol- and drug-free living environments that provide peer support for those wanting to initiate and sustain recovery from alcohol and other drug (AOD) disorders. Despite a growing evidence base for recovery housing, relatively little research has focused on how recovery housing may benefit individuals accessing outpatient substance use treatment. METHODS Using administrative and qualitative data from individuals attending an outpatient substance use treatment program in the Midwestern United States that provides recovery housing in a structured sober living environment, this mixed methods study sought to: (1) determine whether individuals who opted to live in structured sober living during outpatient treatment (N = 138) differed from those who did not (N = 842) on demographic, clinical, or service use characteristics; (2) examine whether living in structured sober living was associated with greater likelihood of satisfactory discharge and longer lengths of stay in outpatient treatment; and (3) explore what individuals (N = 7) who used the structured sober living during outpatient treatment were hoping to gain from the experience. RESULTS Factors associated with the use of recovery housing during outpatient treatment in multivariate models included gender, age, and receiving more services across episodes of care. Living in structured sober housing was associated with greater likelihood of satisfactory discharge and longer length of stays in outpatient treatment. Focus group participants reported needing additional structure and recovery support, with many noting that structure and accountability, learning and practicing life, coping, and other recovery skills, as well as receiving social and emotional support from others were particularly beneficial aspects of the sober living environment. CONCLUSIONS Findings underscore the importance of safe and supportive housing during outpatient substance use treatment as well as the need for future research on how housing environments may affect engagement, retention, and outcomes among individuals accessing outpatient substance use treatment.
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Affiliation(s)
- Amy A. Mericle
- Correspondence can be sent to Dr. Mericle at the Alcohol Research Group: 6001 Shellmound St., Suite 450, Emeryville, CA 94608, 510-898-5840 (phone),
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13
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Majer JM, Jason LA, Bobak TJ. An examination of abstinence social support among recovery home residents with psychiatric comorbidity. Drug Alcohol Depend 2021; 228:108971. [PMID: 34508961 PMCID: PMC8595772 DOI: 10.1016/j.drugalcdep.2021.108971] [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] [Received: 06/21/2021] [Revised: 08/12/2021] [Accepted: 08/14/2021] [Indexed: 10/20/2022]
Abstract
BACKGROUND Although social support is a resource that helps persons in their recovery from substance use disorders, it is not clear whether specific types buffer the effects of stress and optimize outcomes for those with psychiatric comorbidity. This investigation examined two types of social support in relation to lengths of stay to identify mechanisms related to retention among individuals with psychiatric comorbidity living in community-based settings. METHODS Baseline rates of social support (abstinence specific and general types) and stress were examined in relation to follow-up lengths of stay (at four-months and beyond) among individuals (N = 368) with psychiatric comorbidity (n = 90) and no psychiatric comorbidity (n = 278) living in community-based settings (Oxford Houses) in the U.S. The psychiatric severity index of the Addiction Severity Index was used as a proxy measure of psychiatric comorbidity. Moderated mediation analyses were conducted to test the potential mediating effects of abstinence social support and general social support on the relationship between stress and lengths of stay, and whether these were influenced by psychiatric comorbidity. RESULTS A full mediating effect was observed for abstinence social support for residents with psychiatric comorbidity, whereas a partial mediating effect for general social support was observed for all residents. CONCLUSIONS Findings demonstrate qualities of social support have differential effects, substantiating the notion that specific components of social support optimize outcomes for those with psychiatric comorbidity living in recovery homes.
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Affiliation(s)
- John M. Majer
- Social and Behavioral Sciences Department, Harry S. Truman College, 1145 W. Wilson Ave., Chicago, IL 60640 USA
| | - Leonard A. Jason
- Center for Community Research, DePaul University, 990 W. Fullerton Ave., Suite 3100, Chicago, IL 60614 USA
| | - Ted J. Bobak
- Center for Community Research, DePaul University, 990 W. Fullerton Ave., Suite 3100, Chicago, IL 60614 USA
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Jason LA, Lynch G, Bobak T, Light JM, Doogan NJ. Dynamic Interdependence of Advice Seeking, Loaning, and Recovery Characteristics in Recovery Homes. JOURNAL OF HUMAN BEHAVIOR IN THE SOCIAL ENVIRONMENT 2021; 32:663-678. [PMID: 36034076 PMCID: PMC9400817 DOI: 10.1080/10911359.2021.1947930] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Abstract
Recovery homes in the US provide stable housing for over 200,000 individuals with past histories of homelessness, psychiatric co-morbidity and criminal justice involvement. We need to know more about how these settings help those remain in recovery. Our study measured advice seeking and willingness-to-loan relationships and operationalized them as a dynamic multiplex social network-multiple, simultaneous interdependent relationships--that exist within 42 Oxford House recovery homes over time. By pooling relationship dynamics across recovery houses, a Stochastic Actor-Oriented Modeling (SAOM) framework (Snijders et al., 2010) was used to estimate a set of parameters governing the evolution of the network and the recovery attributes of the nodes simultaneously. Findings indicated that advice and loan relationships and recovery-related attitudes were endogenously interdependent, and these results were affected exogenously by gender, ethnicity, and reason for leaving the recovery houses. Prior findings had indicated that higher advice seeking in recovery houses was related to higher levels of stress with more negative outcomes. However, the current study found that recovery is enhanced over time if advice was sought from residents with higher recovery scores. Our study shows that social embedding, i.e. one's position in relationship networks, affects recovery prospects. More specifically, the formation of ties with relatively more recovered residents as an important predictor of better outcomes.
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Jason LA, Harvey R. Recovery homes provide inexpensive and accessible community-based support. J Prev Interv Community 2021; 50:117-123. [PMID: 34157241 DOI: 10.1080/10852352.2021.1934949] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
Substance abuse disorders (SUDs) create significant and pervasive health and economic burdens in the U.S. and the world. After primary treatment has ended, supportive social environments are critically important to prevent relapse and to sustain long-term sobriety. Although approaches to SUDs and treatment vary internationally, studies in the United States indicate that a major risk factor for SUD relapse are lack of social environments to support sustained remission from substance use after primary treatment has ended. Evidence suggests that abstinence is enhanced when individuals are embedded in drug-free settings that support abstinence. Longabaugh, Beattie, Noel, and Stout proposed a theory of social support that engages two processes: general social support, which affectspsychological functioning, and abstinence-specific social support, which supports ongoing abstinence from substance use.
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Affiliation(s)
- Leonard A Jason
- Center for Community Research, DePaul University, Chicago, Illinois, USA
| | - Ronald Harvey
- American University in Bulgaria, Blagoevgrad, Bulgaria
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Walt L, Lupei M, Jason LA. Former substance abusing women, interpersonal relationships and social cognition: Social comparison & sober housemate harmony predict women's abstinence-specific efficacy. J Prev Interv Community 2021; 50:137-150. [PMID: 34132160 DOI: 10.1080/10852352.2021.1934942] [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] [Indexed: 10/21/2022]
Abstract
The Relational Theory of Addiction hypothesizes that women's substance abuse SUD development and (SA) recovery experiences differ from men's because of women's tendency to form nested self-concepts and increased relative desire for close interpersonal connections. We suggest that these two differences may have a dynamic and complex influence on recovery success, particularly for women living in group sober homes. This project uses Relational and Social Cognitive Theories as theoretical springboards to investigate the link between Tendency to Engage in Automatic Negatively Affected Social Comparisons (TEANSAC) and Sober Housemate Harmony (SHH) on women's individual perceptions of Abstinence Specific Self-Efficacy (ASSE). We administered short surveys to women (N = 25) that had recently left inpatient SA treatment and were currently living in a group sober home to assess TEANSAC, SHH and ASSE. Results illustrated that higher TEANSAC scores predicted lower ASSE scores. However, SHH did not predict ASSE scores. Finally, an interaction effect was found in which SHH moderated the relationship between TEANSAC and ASSE. Specifically, we found that highly harmonious sober homes may buffer against the negative effects of increased TEANSAC scores. This project suggests that social cognitive and interpersonal variables may be important factors to consider for women's long-term recovery success.
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Affiliation(s)
- Lisa Walt
- American Hospital Association, Chicago, IL, USA
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17
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Majer JM, Bobak TJ, Jason LA. Psychiatric severity and stress among recovery home residents utilizing medication assisted treatment: a moderated mediation analysis of homophily. ADVANCES IN DUAL DIAGNOSIS 2021. [DOI: 10.1108/add-07-2020-0011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Purpose
The purpose of this study is to examine the relationship between psychiatric severity and stress among persons utilizing medication assisted treatment (MAT), and there is a need to identify resources that promote resilience against these risk factors. Although recovery homes might complement pharmacological interventions for persons using MAT, a lack of homophily (e.g. similar experiences) among residents could produce stress and increase psychiatric severity. The purpose of this paper is to examine stress and psychiatric severity in relation to recovery outcomes, and whether homophily moderated these relationships.
Design/methodology/approach
A cross-sectional analysis was conducted among recovery home residents who were recruited from the USA, including those using (n = 40) and not using (n = 132) MAT. Participants’ levels of psychiatric severity, stress, abstinence self-efficacy and quality of life were assessed in addition to whether residents using MAT were living with at least one other resident who used MAT. Moderated mediation analyses were conducted to examine whether homophily among residents using MAT would moderate the mediating effects of stress on the relationships between psychiatric severity and recovery outcomes (abstinence-self efficacy, quality of life).
Findings
Mediating effects were observed but they were significant only through homophily. Although stress increased the negative effects of psychiatric severity among residents using MAT, significantly lesser effects were observed among those living with residents using MAT.
Practical implications
Although psychiatric (problem) severity and stress threaten recovery for persons with substance use disorders, little is known how they impact recovery among those living in community-based settings such as recovery homes. In addition, there is a need to identify community resources that would complement MAT protocols, as patients who use MAT face unique stressors related to their sense of shared interests and experiences (i.e. homophily) when developing social bonds with others in recovery.
Social implications
This study suggests the social networks within recovery homes reduce the effects of psychiatric severity and stress, and that these effects are lessened for residents who use MAT when they live with others who also use MAT.
Originality/value
Little is known about recovery home residents who use MAT and have high psychiatric severity. Findings suggest homophily among persons using MAT living in recovery homes who have high psychiatric severity can promote resilience.
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Jason LA, Guerrero M, Salomon-Amend M, Lynch G, Stevens E, Light JM, Stoolmiller M. Advice seeking and loaning of money related to relapse in recovery homes. JOURNAL OF COMMUNITY & APPLIED SOCIAL PSYCHOLOGY 2021; 31:39-52. [PMID: 34113065 DOI: 10.1002/casp.2486] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
Recovery homes help individuals who have completed substance use treatment programs re-integrate back into the community. However, it is unclear what factors determine who will succeed in these settings and how these factors may be reinforced or undermined by the social interactions and social networks between residents living in the Oxford House recovery homes. In an effort to better understand these factors, the current study evaluated (a) the extent to which the density of social networks (i.e., friendship, willingness to loan money, and advice-seeking relationships) is associated with social capital (i.e., sense of community, quality of life, hopefulness, self-efficacy), and (b) whether the density of social networks predicts relapse over time. Among the findings, willingness to loan money was positively associated with all four individual-level social capital variables, suggesting that availability of instrumental resources may be important to ongoing recovery. To test whether these house-level social network factors then support recovery, a survival analysis was conducted, finding associations between relapse risk and the network densities over a 28-month span. In particular, more dense advice-seeking networks were associated with higher rates of relapse, suggesting that the advice-seeking might represent a sign of organisational house problems, with many residents unsure of issues related to their recovery. In contrast, more dense loaning networks were associated with less relapse, so willingness to lend money could be measuring a willingness to help those in need. The implications of these findings are discussed.
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Affiliation(s)
- Leonard A Jason
- Center for Community Research, DePaul University, Chicago, Illinois
| | - Mayra Guerrero
- Center for Community Research, DePaul University, Chicago, Illinois
| | | | - Gabrielle Lynch
- Center for Community Research, DePaul University, Chicago, Illinois
| | - Ed Stevens
- Center for Community Research, DePaul University, Chicago, Illinois
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Jason LA, Majer JM, Bobak T, O'Brien J. Medication assisted therapy and recovery homes. J Prev Interv Community 2021; 50:178-190. [PMID: 34116624 DOI: 10.1080/10852352.2021.1934940] [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] [Indexed: 10/21/2022]
Abstract
There is a need to better understand improved recovery supportive services for those on Medication Assisted Treatment (MAT) for opioid use disorder (OUD) and, at the same time, enhance the available treatment interventions and positive long-term outcomes for this vulnerable population. A growing empirical literature supports the assertion that improved access to housing and recovery support is a low-cost, high-potential opportunity that could help former substance users who are utilizing MAT to sustain their recovery. Recovery home support could serve the populations that need them most, namely servicing a significant number of the enrolled in MAT programs. The two largest networks of recovery homes are staff run Traditional Recovery Homes (TRH) and self-run Oxford House Recovery Homes (OH). There is a need to better understand how substance users on MAT respond to recovery homes, as well as how those in recovery homes feel toward those on MAT and how any barriers to those utilizing MAT may be reduced. Recovery may be an outcome of the transactional process between the recovering individual and his/her social environment. In particular, how recovery houses can help people on MAT attain long-term recovery.
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Affiliation(s)
- Leonard A Jason
- Center for Community Research, DePaul University, Chicago, Illinois, USA
| | - John M Majer
- Department of Social and Behavioral Sciences, Harry S. Truman College, Chicago, Illinois, USA
| | - Ted Bobak
- Center for Community Research, DePaul University, Chicago, Illinois, USA
| | - Jack O'Brien
- Center for Community Research, DePaul University, Chicago, Illinois, USA
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20
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Recovery Housing Program for Drug Addicts: Work Patterns, Substance Abuse, and Housing Situation After a 6-Month Follow-up. ADDICTIVE DISORDERS & THEIR TREATMENT 2021. [DOI: 10.1097/adt.0000000000000273] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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21
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Jason LA, Guerrero M, Salomon-Amend M, Light JM, Stoolmiller M. Personal and Environmental Social Capital Predictors of Relapse Following Departure from Recovery Homes. DRUGS (ABINGDON, ENGLAND) 2021; 28:504-510. [PMID: 34720462 PMCID: PMC8549579 DOI: 10.1080/09687637.2020.1856787] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/18/2020] [Revised: 11/11/2020] [Accepted: 11/23/2020] [Indexed: 10/22/2022]
Abstract
Substance use recovery homes represent the largest residential, community-based post-treatment option for those with substance use disorders in the United States. It is still unclear what unique factors predict relapse after residents leave such homes. This study presents results of a longitudinal study of 497 residents who departed from 42 Oxford House recovery houses. We hypothesized that the predictors of post-departure relapse would be a multi-item measure of latent recovery, length of stay, and reason for departure from the home (voluntary vs. involuntary). Predictor effects were estimated as part of a two-step model with two outcomes: (a) lack of follow-up data after departure from the house, and (b) the likelihood of relapse. Determinants of missing follow-up data included less education, less time in residence, and involuntary departure. Relapse was more likely for individuals who were younger, had involuntarily left the house, and had lower values on the latent recovery factor. The implications of these important factors related to relapse following departure from residential recovery home settings are discussed.
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22
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Xuan Z, Choi J, Lobrutto L, Cunningham T, de Martell SC, Cance J, Silverstein M, Yule AM, Botticelli M, Steiker LH. Support Services for Young Adults With Substance Use Disorders. Pediatrics 2021; 147:S220-S228. [PMID: 33386325 PMCID: PMC9034746 DOI: 10.1542/peds.2020-023523e] [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] [Accepted: 10/23/2020] [Indexed: 11/24/2022] Open
Abstract
In summarizing the proceedings of a longitudinal meeting of experts in substance use disorders (SUDs) among young adults, this special article reviews principles of care concerning recovery support services for this population. Young adults in recovery from SUDs can benefit from a variety of support services throughout the process of recovery. These services take place in both traditional clinical settings and settings outside the health system, and they can be delivered by a wide variety of nonprofessional and paraprofessional individuals. In this article, we communicate fundamental points related to guidance, evidence, and clinical considerations about 3 basic principles for recovery support services: (1) given their developmental needs, young adults affected by SUDs should have access to a wide variety of recovery support services regardless of the levels of care they need, which could range from early intervention services to medically managed intensive inpatient services; (2) the workforce for addiction services for young adults benefits from the inclusion of individuals with lived experience in addiction; and (3) recovery support services should be integrated to promote recovery most effectively and provide the strongest possible social support.
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Affiliation(s)
- Ziming Xuan
- Department of Community Health Sciences, Boston University School of Public Health, Boston, Massachusetts;
| | - Jasmin Choi
- Department of Community Health Sciences, Boston University School of Public Health, Boston, Massachusetts
| | - Lara Lobrutto
- Department of Community Health Sciences, Boston University School of Public Health, Boston, Massachusetts
| | - Tiffany Cunningham
- Steve Hicks School of Social Work, The University of Texas at Austin, Austin, Texas
| | | | - Jessica Cance
- RTI International, Research Triangle Park, North Carolina
| | - Michael Silverstein
- Department of Pediatrics, Boston Medical Center, Boston, Massachusetts.,Grayken Center for Addiction Medicine, Boston Medical Center, Boston, Massachusetts
| | - Amy M Yule
- Department of Psychiatry, Boston Medical Center and Boston University School of Medicine, Boston, Massachusetts
| | - Michael Botticelli
- Grayken Center for Addiction Medicine, Boston Medical Center, Boston, Massachusetts
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Guerrero M, Jason LA. Social Network Cohesion among Veterans Living in Recovery Homes. MILITARY BEHAVIORAL HEALTH 2020; 9:55-68. [PMID: 34109074 PMCID: PMC8184014 DOI: 10.1080/21635781.2020.1796859] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
Recovery homes for individuals with substance use disorders (SUD) called Oxford House (OH) have been shown to improve the prospects of a successful recovery across different sub-populations, and these homes may be particularly beneficial for veterans in recovery. An estimated 18% of OH residents are veterans; however, not much is known about their experiences living in these homes. Participants included 85 veterans and non-veterans living in 13 OHs located in different regions of the United States. Using social network analysis and multi-level modeling, we investigated whether the social networks of veterans residing with other veterans were more cohesive compared to veterans living with only non-veterans. Results indicated that veterans residing with other veterans had stronger relationships with other OH residents compared to veterans that reside with all non-veterans. The implications for theory and practice are discussed. Further research is needed to determine if greater social network cohesion leads to better recovery outcomes for veterans.
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Affiliation(s)
- Mayra Guerrero
- Center for Community Research, DePaul University, Chicago, IL
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24
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Majer JM, Jason LA, Norris J, Hickey P, Jeong H, Bobak TJ. Medications for Opioid Use Disorder Utilization Among Oxford House Residents. Community Ment Health J 2020; 56:925-932. [PMID: 31993842 DOI: 10.1007/s10597-020-00558-y] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/23/2019] [Accepted: 01/24/2020] [Indexed: 02/02/2023]
Abstract
Medications for opioid use disorder (MOUD) and recovery homes that have traditionally served those not taking medications for their recovery are important resources for treating opioid use disorder. However, little is known whether such recovery homes are a good fit for persons utilizing MOUD, and whether residents' characteristics such as drug histories and the composition of recovery homes in terms MOUD and non-MOUD residents are related to attitudes toward MOUD. The present investigation examined characteristics of persons utilizing MOUD, and attitudes regarding MOUD utilization among residents living in recovery homes (Oxford Houses, OH) in the U.S. consisting of MOUD and non-MOUD residents. Residents living with others who were utilizing MOUD reported more favorable attitudes than residents who were not living with such residents, but this was observed only among residents whose primary drug of choice involved heroin or opioids. There were no significant differences observed in terms of abstinence rates, involvement in 12-step groups, or previous MOUD treatments between residents utilizing or not utilizing MOUD. Findings suggest that persons utilizing MOUD benefit by recovery homes such as OHs whose residents have favorable attitudes toward MOUD, especially when living with fellow residents who utilize MOUD.
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Affiliation(s)
- John M Majer
- Social Science Department, Harry S. Truman College, 1145 W. Wilson Ave., Chicago, IL, 60640, USA.
| | - Leonard A Jason
- Center for Community Research, DePaul University, 990 W. Fullerton Ave., Chicago, IL, 60614, USA
| | - Joshua Norris
- Center for Community Research, DePaul University, 990 W. Fullerton Ave., Chicago, IL, 60614, USA
| | - Patrick Hickey
- Social Science Department, Harry S. Truman College, 1145 W. Wilson Ave., Chicago, IL, 60640, USA
| | - Hayoung Jeong
- Social Science Department, Harry S. Truman College, 1145 W. Wilson Ave., Chicago, IL, 60640, USA
| | - Ted J Bobak
- Center for Community Research, DePaul University, 990 W. Fullerton Ave., Chicago, IL, 60614, USA
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Jason LA, Guerrero M, Lynch G, Stevens E, Salomon-Amend M, Light JM. Recovery home networks as social capital. JOURNAL OF COMMUNITY PSYCHOLOGY 2020; 48:645-657. [PMID: 31730723 PMCID: PMC7103531 DOI: 10.1002/jcop.22277] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/19/2019] [Revised: 10/18/2019] [Accepted: 10/21/2019] [Indexed: 06/10/2023]
Abstract
Ensuring recovery home residents' social integration into a home environment is important for preventing early dropout and facilitating sustained recovery. Social capital theory may provide an explanation for how recovery homes may protect residents and improve recovery rates. However, little is known about how social capital in recovery home environments is structured and accessed. Recovery homes may increase social capital by sharing bonds through friendships, lending money, and advice-seeking. The current study describes social network cross sectional data obtained from a study of 42 Oxford House recovery homes, in three locations in the US (North Carolina, Texas, and Oregon). The residents rated each member of their house on the dimensions of friendship, money loaning, and advice seeking to assess how each resident views one another on these dimensions. The research used baseline data from a larger longitudinal study, and although some data were presented for the full sample (APL, isolates, mean reciprocity and density), the results primarily focused on case studies for three of the participating Oxford Houses-with examples of low, median, and high "connected" houses respectively. Standard measures of network structures were calculated for each home. Although all Oxford Houses follow the same house rules, they were found to vary in network structure. Findings indicated a considerable range of interconnectedness among residents in these houses, with friendship being the most common relationship, willingness to lend money less common, and advice-seeking the least common. The findings on friendship, willingness to lend, and advice-seeking provide promising leads about what occurs among the social networks within these complex eco-systems, and may provide ways to better understand and facilitate resident social integration into these settings.
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Affiliation(s)
- Leonard A Jason
- Center for Community Research, DePaul University, Chicago, Illinois
| | - Mayra Guerrero
- Center for Community Research, DePaul University, Chicago, Illinois
| | - Gabrielle Lynch
- Center for Community Research, DePaul University, Chicago, Illinois
| | - Ed Stevens
- Center for Community Research, DePaul University, Chicago, Illinois
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Jason LA, Stevens E, Kassanits J, Reilly A, Bobak T, Guerrero M, Doogan NJ. Recovery homes: A social network analysis of Oxford Houses for Native Americans. J Ethn Subst Abuse 2020; 19:174-189. [PMID: 30183538 PMCID: PMC6401329 DOI: 10.1080/15332640.2018.1489748] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Abstract
Social network data were collected among residents of an Oxford House (OH) recovery home, which was located on Suquamish Tribal territory. Data were collected on the social connections of eight male residents (including four Native Americans and four non-Native Americans) using a social network instrument. A number of social network relationship types were examined, including friendship, trust, and mentorship. Social network data assessed included diameter, reciprocity, the average path length, cohesion, density, transitivity, and centrality. Findings indicated that the OH provided residents a well-integrated network with multiple sources of friendship, trust, and mentors. This is of importance as recovery from substance abuse is facilitated when recovering individuals are provided stable and well-functioning networks that foster social support, access to resources, and mentorship.
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Affiliation(s)
| | - Ed Stevens
- DePaul University, Chicago, Illinois, USA
| | | | | | - Ted Bobak
- DePaul University, Chicago, Illinois, USA
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27
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Kassanits J, Bobak TJ, Stevens E, Guerrero M, Light J, Jason LA. The relationship of Oxford Houses across heterogeneous house and setting characteristics. THE AMERICAN JOURNAL OF ORTHOPSYCHIATRY 2020; 90:324-327. [PMID: 31916801 DOI: 10.1037/ort0000437] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Oxford Houses (OH) are democratically run, self-funded, substance-use recovery homes that operate across the United States and internationally. Previous research shows the OHs are present in diverse neighborhoods. The current study examined the neighborhoods of 42 OHs located in Oregon, Texas, and North Carolina to better quantify and understand house and neighborhood characteristics that are related to relapse rates. Independent variables were participants' length of stay in OH, wages earned from employment, and income/education neighborhood characteristics. Neighborhood characteristics were related to relapse rates, with higher relapse rates occurring in neighborhoods with lower income and education levels. This finding supports the OH organization's premise that while OHs may work across community settings, they perform better in neighborhoods with higher average income and education levels. (PsycInfo Database Record (c) 2020 APA, all rights reserved).
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Affiliation(s)
| | - Ted J Bobak
- Center for Community Research, DePaul University
| | - Ed Stevens
- Center for Community Research, DePaul University
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28
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Perry AE, Martyn‐St James M, Burns L, Hewitt C, Glanville JM, Aboaja A, Thakkar P, Santosh Kumar KM, Pearson C, Wright K. Interventions for female drug-using offenders. Cochrane Database Syst Rev 2019; 12:CD010910. [PMID: 31834635 PMCID: PMC6910124 DOI: 10.1002/14651858.cd010910.pub3] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
BACKGROUND This review represents one in a family of three reviews focusing on the effectiveness of interventions in reducing drug use and criminal activity for offenders. OBJECTIVES To assess the effectiveness of interventions for female drug-using offenders in reducing criminal activity, or drug use, or both. SEARCH METHODS We searched 12 electronic bibliographic databases up to February 2019. SELECTION CRITERIA We included randomised controlled trials (RCTs). DATA COLLECTION AND ANALYSIS We used standard methodological procedures expected by Cochrane. MAIN RESULTS We included 13 trials with 2560 participants. Interventions were delivered in prison (7/13 studies, 53%) and community (6/13 studies, 47%) settings. The rating of bias was affected by the lack of clear reporting by authors, and we rated many items as 'unclear'. In two studies (190 participants) collaborative case management in comparison to treatment as usual did not reduce drug use (risk ratio (RR) 0.65, 95% confidence interval (CI) 0.20 to 2.12; 1 study, 77 participants; low-certainty evidence), reincarceration at nine months (RR 0.71, 95% CI 0.32 to 1.57; 1 study, 77 participants; low-certainty evidence), and number of subsequent arrests at 12 months (RR 1.11, 95% CI 0.83 to 1.49; 1 study, 113 participants; low-certainty evidence). One study (36 participants) comparing buprenorphine to placebo showed no significant reduction in self-reported drug use at end of treatment (RR 0.57, 95% CI 0.27 to 1.20) and three months (RR 0.58, 95% CI 0.25 to 1.35); very low-certainty evidence. No adverse events were reported. One study (38 participants) comparing interpersonal psychotherapy to a psychoeducational intervention did not find reduction in drug use at three months (RR 0.67, 95% CI 0.30 to 1.50; low-certainty evidence). One study (31 participants) comparing acceptance and commitment therapy (ACT) to a waiting list showed no significant reduction in self-reported drug use using the Addiction Severity Index (mean difference (MD) -0.04, 95% CI -0.37 to 0.29) and abstinence from drug use at six months (RR 2.89, 95% CI 0.73 to 11.43); low-certainty evidence. One study (314 participants) comparing cognitive behavioural skills to a therapeutic community programme and aftercare showed no significant reduction in self-reported drug use (RR 0.86, 95% CI 0.58 to 1.27), re-arrest for any type of crime (RR 0.73, 95% CI 0.52 to 1.03); criminal activity (RR 0.80, 95% CI 0.63 to 1.03), or drug-related crime (RR 0.95, 95% CI 0.68 to 1.32). A significant reduction for arrested (not for parole) violations at six months follow-up was significantly in favour of cognitive behavioural skills (RR 0.43, 95% CI 0.25 to 0.77; very low-certainty evidence). A second study with 115 participants comparing cognitive behavioural skills to an alternative substance abuse treatment showed no significant reduction in reincarceration at 12 months (RR 0.70, 95% CI 0.43 to 1.12; low certainty-evidence. One study (44 participants) comparing cognitive behavioural skills and standard therapy versus treatment as usual showed no significant reduction in Addiction Severity Index (ASI) drug score at three months (MD 0.02, 95% CI -0.05 to 0.09) and six months (MD -0.02, 95% CI -0.09 to 0.05), and incarceration at three months (RR 0.46, 95% CI 0.04 to 4.68) and six months (RR 0.51, 95% CI 0.20 to 1.27); very low-certainty evidence. One study (171 participants) comparing a single computerised intervention versus case management showed no significant reduction in the number of days not using drugs at three months (MD -0.89, 95% CI -4.83 to 3.05; low certainty-evidence). One study (116 participants) comparing dialectic behavioural therapy and case management (DBT-CM) versus a health promotion intervention showed no significant reduction at six months follow-up in positive drug testing (RR 0.67, 95% CI 0.43 to 1.03), number of people not using marijuana (RR 1.23, 95% CI 0.95 to 1.59), crack (RR 1.00, 95% CI 0.87 to 1.14), cocaine (RR 1.02, 95% CI 0.93 to 1.12), heroin (RR 1.05, 95% CI 0.98 to 1.13), methamphetamine (RR 1.02, 95% CI 0.87 to 1.20), and self-reported drug use for any drug (RR 1.20, 95% CI 0.92 to 1.56); very low-certainty evidence. One study (211 participants) comparing a therapeutic community programme versus work release showed no significant reduction in marijuana use at six months (RR 1.03, 95% CI 0.19 to 5.65), nor 18 months (RR 1.00, 95% CI 0.07 to 14.45), heroin use at six months (RR 1.59, 95% CI 0.49 to 5.14), nor 18 months (RR 1.92, 95% CI 0.24 to 15.37), crack use at six months (RR 2.07, 95% CI 0.41 to 10.41), nor 18 months (RR 1.64, 95% CI 0.19 to 14.06), cocaine use at six months (RR 1.09, 95% CI 0.79 to 1.50), nor 18 months (RR 0.93, 95% CI 0.64 to 1.35). It also showed no significant reduction in incarceration for drug offences at 18 months (RR 1.45, 95% CI 0.87 to 2.42); with overall very low- to low-certainty evidence. One study (511 participants) comparing intensive discharge planning and case management versus prison only showed no significant reduction in use of marijuana (RR 0.79, 95% CI 0.53 to 1.16), hard drugs (RR 1.12, 95% CI 0.88 to 1.43), crack cocaine (RR 1.08, 95% CI 0.75 to 1.54), nor positive hair testing for marijuana (RR 0.75, 95% CI 0.55 to 1.03); it found a significant reduction in arrests (RR 0.19, 95% CI 0.04 to 0.87), but no significant reduction in drug charges (RR 1.07, 95% CI 0.75 to 1.53) nor incarceration (RR 1.09, 95% CI 0.86 to 1.39); moderate-certainty evidence. One narrative study summary (211 participants) comparing buprenorphine pre- and post-release from prison showed no significant reduction in drug use at 12 months post-release; low certainty-evidence. No adverse effects were reported. AUTHORS' CONCLUSIONS The studies showed a high degree of heterogeneity for types of comparisons, outcome measures and small samples. Descriptions of treatment modalities are required. On one outcome of arrest (no parole violations), we identified a significant reduction when cognitive behavioural therapy (CBT) was compared to a therapeutic community programme. But for all other outcomes, none of the interventions were effective. Larger trials are required to increase the precision of confidence about the certainty of evidence.
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Affiliation(s)
- Amanda E Perry
- University of YorkDepartment of Health SciencesHeslingtonYorkUKYO105DD
| | - Marrissa Martyn‐St James
- University of SheffieldSchool of Health and Related Research (ScHARR)Regent Court, 30 Regent StreetSheffieldSouth YorkshireUKS1 4DA
| | - Lucy Burns
- University of YorkDepartment of Health SciencesHeslingtonYorkUKYO105DD
| | - Catherine Hewitt
- University of YorkDepartment of Health SciencesHeslingtonYorkUKYO105DD
| | - Julie M Glanville
- York Health Economics ConsortiumMarket SquareUniversity of York, HeslingtonYorkUKYO10 5NH
| | - Anne Aboaja
- Tees, Esk and Wear Valleys NHS Foundation TrustMiddlesbroughUKTS4 3AF
| | | | | | - Caroline Pearson
- University of YorkDepartment of Health SciencesHeslingtonYorkUKYO105DD
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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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30
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Perry AE, Martyn‐St James M, Burns L, Hewitt C, Glanville JM, Aboaja A, Thakkar P, Santosh Kumar KM, Pearson C, Wright K, Swami S. Interventions for drug-using offenders with co-occurring mental health problems. Cochrane Database Syst Rev 2019; 10:CD010901. [PMID: 31588993 PMCID: PMC6778977 DOI: 10.1002/14651858.cd010901.pub3] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
BACKGROUND This review represents one from a family of three reviews focusing on interventions for drug-using offenders. Many people under the care of the criminal justice system have co-occurring mental health problems and drug misuse problems; it is important to identify the most effective treatments for this vulnerable population. OBJECTIVES To assess the effectiveness of interventions for drug-using offenders with co-occurring mental health problems in reducing criminal activity or drug use, or both.This review addresses the following questions.• Does any treatment for drug-using offenders with co-occurring mental health problems reduce drug use?• Does any treatment for drug-using offenders with co-occurring mental health problems reduce criminal activity?• Does the treatment setting (court, community, prison/secure establishment) affect intervention outcome(s)?• Does the type of treatment affect treatment outcome(s)? SEARCH METHODS We searched 12 databases up to February 2019 and checked the reference lists of included studies. We contacted experts in the field for further information. SELECTION CRITERIA We included randomised controlled trials designed to prevent relapse of drug use and/or criminal activity among drug-using offenders with co-occurring mental health problems. DATA COLLECTION AND ANALYSIS We used standard methodological procedures as expected by Cochrane . MAIN RESULTS We included 13 studies with a total of 2606 participants. Interventions were delivered in prison (eight studies; 61%), in court (two studies; 15%), in the community (two studies; 15%), or at a medium secure hospital (one study; 8%). Main sources of bias were unclear risk of selection bias and high risk of detection bias.Four studies compared a therapeutic community intervention versus (1) treatment as usual (two studies; 266 participants), providing moderate-certainty evidence that participants who received the intervention were less likely to be involved in subsequent criminal activity (risk ratio (RR) 0.67, 95% confidence interval (CI) 0.53 to 0.84) or returned to prison (RR 0.40, 95% CI 0.24 to 0.67); (2) a cognitive-behavioural therapy (one study; 314 participants), reporting no significant reduction in self-reported drug use (RR 0.78, 95% CI 0.46 to 1.32), re-arrest for any type of crime (RR 0.69, 95% CI 0.44 to 1.09), criminal activity (RR 0.74, 95% CI 0.52 to 1.05), or drug-related crime (RR 0.87, 95% CI 0.56 to 1.36), yielding low-certainty evidence; and (3) a waiting list control (one study; 478 participants), showing a significant reduction in return to prison for those people engaging in the therapeutic community (RR 0.60, 95% CI 0.46 to 0.79), providing moderate-certainty evidence.One study (235 participants) compared a mental health treatment court with an assertive case management model versus treatment as usual, showing no significant reduction at 12 months' follow-up on an Addictive Severity Index (ASI) self-report of drug use (mean difference (MD) 0.00, 95% CI -0.03 to 0.03), conviction for a new crime (RR 1.05, 95% CI 0.90 to 1.22), or re-incarceration to jail (RR 0.79, 95% CI 0.62 to 1.01), providing low-certainty evidence.Four studies compared motivational interviewing/mindfulness and cognitive skills with relaxation therapy (one study), a waiting list control (one study), or treatment as usual (two studies). In comparison to relaxation training, one study reported narrative information on marijuana use at three-month follow-up assessment. Researchers reported a main effect < .007 with participants in the motivational interviewing group, showing fewer problems than participants in the relaxation training group, with moderate-certainty evidence. In comparison to a waiting list control, one study reported no significant reduction in self-reported drug use based on the ASI (MD -0.04, 95% CI -0.37 to 0.29) and on abstinence from drug use (RR 2.89, 95% CI 0.73 to 11.43), presenting low-certainty evidence at six months (31 participants). In comparison to treatment as usual, two studies (with 40 participants) found no significant reduction in frequency of marijuana use at three months post release (MD -1.05, 95% CI -2.39 to 0.29) nor time to first arrest (MD 0.87, 95% CI -0.12 to 1.86), along with a small reduction in frequency of re-arrest (MD -0.66, 95% CI -1.31 to -0.01) up to 36 months, yielding low-certainty evidence; the other study with 80 participants found no significant reduction in positive drug screens at 12 months (MD -0.7, 95% CI -3.5 to 2.1), providing very low-certainty evidence.Two studies reported on the use of multi-systemic therapy involving juveniles and families versus treatment as usual and adolescent substance abuse therapy. In comparing treatment as usual, researchers found no significant reduction up to seven months in drug dependence on the Drug Use Disorders Identification Test (DUDIT) score (MD -0.22, 95% CI -2.51 to 2.07) nor in arrests (RR 0.97, 95% CI 0.70 to 1.36), providing low-certainty evidence (156 participants). In comparison to an adolescent substance abuse therapy, one study (112 participants) found significant reduction in re-arrests up to 24 months (MD 0.24, 95% CI 0.76 to 0.28), based on low-certainty evidence.One study (38 participants) reported on the use of interpersonal psychotherapy in comparison to a psychoeducational intervention. Investigators found no significant reduction in self-reported drug use at three months (RR 0.67, 95% CI 0.30 to 1.50), providing very low-certainty evidence. The final study (29 participants) compared legal defence service and wrap-around social work services versus legal defence service only and found no significant reductions in the number of new offences committed at 12 months (RR 0.64, 95% CI 0.07 to 6.01), yielding very low-certainty evidence. AUTHORS' CONCLUSIONS Therapeutic community interventions and mental health treatment courts may help people to reduce subsequent drug use and/or criminal activity. For other interventions such as interpersonal psychotherapy, multi-systemic therapy, legal defence wrap-around services, and motivational interviewing, the evidence is more uncertain. Studies showed a high degree of variation, warranting a degree of caution in interpreting the magnitude of effect and the direction of benefit for treatment outcomes.
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Affiliation(s)
- Amanda E Perry
- University of YorkDepartment of Health SciencesHeslingtonYorkUKYO105DD
| | - Marrissa Martyn‐St James
- University of SheffieldSchool of Health and Related Research (ScHARR)Regent Court, 30 Regent StreetSheffieldSouth YorkshireUKS1 4DA
| | - Lucy Burns
- University of YorkDepartment of Health SciencesHeslingtonYorkUKYO105DD
| | - Catherine Hewitt
- University of YorkDepartment of Health SciencesHeslingtonYorkUKYO105DD
| | - Julie M Glanville
- York Health Economics ConsortiumMarket SquareUniversity of York, HeslingtonYorkUKYO10 5NH
| | - Anne Aboaja
- Tees, Esk and Wear Valleys NHS Foundation TrustMiddlesbroughUKTS4 3AF
| | | | | | - Caroline Pearson
- University of YorkDepartment of Health SciencesHeslingtonYorkUKYO105DD
| | | | - Shilpi Swami
- University of YorkDepartment of Health SciencesHeslingtonYorkUKYO105DD
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Jason LA, Stevens EB, Doogan NJ, Light JM. An Empirically-based Theory of the Relationships Among Social Embeddedness, Economic Viability, Learned Recovery Skills and Perceived Quality of Life in Recovery Homes. ALCOHOLISM TREATMENT QUARTERLY 2019; 38:126-142. [PMID: 32863558 PMCID: PMC7453633 DOI: 10.1080/07347324.2019.1633977] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2023]
Abstract
Key characteristics of recovery homes include governance style (which can play a central role in structuring recovery mechanisms), social embeddedness (e.g., social relationships within the home), economic viability (e.g., the individual's ability to be self-supporting), and learned recovery skills (such as coping with stress, avoiding putting one's self in risky situations, etc.). These domains can have important associations with perceived quality of life (measured across physical, psychological, social relationships, and environmental domains). The current study investigated relationships among these key "active ingredients" (Moos, 2007) of recovery homes. In addition, we present dynamic model consistent with these observed relationships, to illustrate how relevant mechanisms interact over time to and affect system evolution. Data were collected from recovery home residents in three states. Findings supported our overall hypotheses indicating that social embeddedness, stress, and self-efficacy were related to quality of life, and policy and treatment-design implications are further examined by simulating system dynamics.
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Doogan NJ, Light JM, Stevens EB, Jason LA. Quality of life as a predictor of social relationships in Oxford House. J Subst Abuse Treat 2019; 101:79-87. [PMID: 31174717 DOI: 10.1016/j.jsat.2019.03.006] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2018] [Revised: 02/06/2019] [Accepted: 03/20/2019] [Indexed: 10/27/2022]
Abstract
Improved access to housing and recovery support is a low-cost, high-potential opportunity to help people recovering from alcohol and substance use sustain their recoveries. Oxford House (OH) recovery homes represent a recovery-favorable social environment for at least some people, but it is still unclear which resident characteristics and relational dynamics affect the social integration of residents. In the current study, OH residents in three geographic locations completed a social network instrument and self-rated their quality of life (QOL). The instruments were administered to the current (per wave) residents of 42 OHs at three time points over a period of a year. Findings indicated that those with a higher QOL were more likely to form friendships with those with a lower QOL than with their similar QOL peers, and vice versa. This finding would not have been predicted based on relationship mechanisms typical of broader social contexts, where homophily (similarity-based assortativity) is common. The self-governance model that characterizes OH residences, in which success among residents is necessarily viewed as mutually dependent and therefore mutually beneficial, seems a likely explanation for our result. Specifically, and aligned with current knowledge about what works in peer oriented recovery, our results suggest the governance mechanisms of OH favor relationships between those more stable in their recovery and those who are at a higher risk of dropout or relapse. This study reveals a potential research avenue examining an important ingredient for the effectiveness of OH.
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Affiliation(s)
- Nathan J Doogan
- Ohio Colleges of Medicine Government Resource Center, The Ohio State University, 150 Pressey Hall, 1070 Carmack Road, Columbus, OH 43210, United States of America
| | - John M Light
- Oregon Research Institute, 1776 Millrace Dr., Eugene, OR 97403, United States of America
| | - Edward B Stevens
- Center for Community Research, DePaul University, 990 W. Fullerton Ave., Chicago, IL 60614-3504, United States of America
| | - Leonard A Jason
- Center for Community Research, DePaul University, 990 W. Fullerton Ave., Chicago, IL 60614-3504, United States of America.
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Chamberlain A, Nyamu S, Aminawung J, Wang EA, Shavit S, Fox AD. Illicit substance use after release from prison among formerly incarcerated primary care patients: a cross-sectional study. Addict Sci Clin Pract 2019; 14:7. [PMID: 30782211 PMCID: PMC6381679 DOI: 10.1186/s13722-019-0136-6] [Citation(s) in RCA: 27] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2018] [Accepted: 02/11/2019] [Indexed: 01/05/2023] Open
Abstract
Background More than 80% of people in jail or prison report having used illicit substances in their lifetimes. After release from incarceration, resumption of substance use carries risks, including parole revocation, exacerbation of mental health conditions, transmission of infectious diseases, and drug overdose. Methods This cross-sectional study used baseline data from the Transitions Clinic Network (TCN, www.transitionsclinic.org), a multi-site prospective longitudinal cohort study of post-incarceration medical care. We investigated substance use among adults, with at least one chronic health condition or age ≥ 50 years, who had been recently released from incarceration and initiated care at a TCN site. Our primary outcome was any self-reported illicit substance use (heroin or other opioids, cocaine, cannabis, amphetamines, hallucinogens, MDMA, or illicit use of prescription medications) following release from incarceration. Alcohol use post-release was a secondary outcome. Using multivariable logistic regression, we also explored factors associated with illicit substance use. Results Among 751 participants, median age was 47; participants were mostly male (85%), non-white (47% black, 30% Hispanic), and on parole (80%). The proportion of participants reporting any illicit substance use and any alcohol use soon after release from incarceration was 18% and 23%, respectively. In multivariable regression, variables significantly associated with post-release illicit substance use were male gender (aOR = 3.91, 95% CI: 1.73–8.81), housing with friends or family (aOR = 3.33, 95% CI: 1.20–9.28), years incarcerated during latest prison term (aOR = 0.93, 95% CI: 0.89–0.98), weeks elapsed before engagement with TCN (aOR = 1.07, 95% CI: 1.03–1.10), being on parole (aOR = 0.58, 95% CI: 0.34–0.99), and having a drug use disorder (aOR = 2.27, 95% CI: 1.40–3.68). Conclusions Among individuals seeking medical care after release from incarceration, self-reported substance use was lower than previously reported estimates of post-incarceration substance use. Known risk factors, such as male gender and having a drug use disorder, were associated with illicit substance use, as were novel risk factors, such as less supervised housing. Though illicit substance use post-incarceration can carry severe consequences, treatment and surveillance interventions should be targeted toward individuals with greatest risk.
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Affiliation(s)
| | - Sylviah Nyamu
- Mount Sinai St.Luke's and Mount Sinai West Hospitals, New York, NY, 10019, USA
| | | | - Emily A Wang
- Yale University School of Medicine, New Haven, CT, 06520, USA
| | - Shira Shavit
- University of California-San Francisco, San Francisco, CA, 94103, USA
| | - Aaron D Fox
- Albert Einstein College of Medicine, Bronx, NY, 10461, USA. .,Montefiore Medical Center, 111 E. 210th Street, Bronx, NY, 10467, USA.
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Mericle AA, Hemberg J, Stall R, Carrico AW. Pathways to Recovery: Recovery housing models for men who have sex with men (MSM). ADDICTION RESEARCH & THEORY 2019; 27:373-382. [PMID: 31213965 PMCID: PMC6581469 DOI: 10.1080/16066359.2018.1538409] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/12/2018] [Revised: 10/15/2018] [Accepted: 10/16/2018] [Indexed: 06/09/2023]
Abstract
BACKGROUND & AIMS Gay, bisexual, and other men who have sex with men (MSM) face distinct recovery challenges. This mixed-methods study examines the service needs and help-seeking pathways of MSM (N=25) living in a group of recovery residences operated in Texas, one of which is a home specifically designated for gay and bisexual men. METHODS Upon intake, adult MSM were recruited to complete an interview assessing the extent of their service needs as well as their recovery goals and expectations about their stay. Men were recruited regardless of whether they moved into the home designated for gay and bisexual men or into another one of the men's homes. RESULTS MSM in the sample reported high rates of health conditions, depression, victimization, and sex risk behaviors. A greater number of them entering the gay and bisexual men's home reported being in recovery from amphetamine use, having a chronic medical problem, and being physically assaulted as an adult. The majority of MSM, regardless of home type, were seeking emotional and social support as well as accountability in their recovery home experience, but MSM in the gay and bisexual men's home talked about emotion and social support most frequently and within the context of emotional safety. CONCLUSIONS MSM entering recovery housing have complex service needs. Recovery housing may play an important role in supporting recovery among MSM. Residences specifically for them could be tailored to address their unique needs by fostering connections to other sexual minorities in recovery and facilitating social identity transformation.
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Affiliation(s)
- Amy A. Mericle
- Alcohol Research Group, Public Health Institute, Emeryville, CA, USA
| | - Jordana Hemberg
- Alcohol Research Group, Public Health Institute, Emeryville, CA, USA
| | - Ronald Stall
- Department of Behavioral and Community Health Sciences in the School of Public Health, University of Pittsburgh, Pittsburgh, PA, USA
| | - Adam W. Carrico
- Miller School of Medicine Department of Public Health Sciences, University of Miami, Miami, FL, USA
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Chavira D, Lopez-Tamayo R, Jason LA. Factors Associated with Community Corrections Involvement among Formerly Incarcerated People in Recovery. CRIMINAL JUSTICE POLICY REVIEW 2018; 29:909-924. [PMID: 30739989 PMCID: PMC6366846 DOI: 10.1177/0887403416644012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Abstract
The current study examined whether current community supervision status was associated with differences in demographic characteristics, lifetime substance use patterns, and criminal history among a sample of formerly incarcerated individuals with a history of substance use problems. Results of multivariate analyses revealed participants on community supervision were more likely to have graduated from high school or earned a GED (OR = 1.60; 95% CI [0.15, 17.24]) and were less likely to have a history of psychiatric hospitalization (OR = .88; 95% CI = [0.08, 9.35]). These characteristics may be proxies for social and emotional functioning that influence eligibility for community supervision. Despite these apparent advantages, the community supervision group did not significantly differ from the formerly incarcerated group without current justice involvement on lifetime substance use patterns or criminal history, suggesting formerly incarcerated individuals with substance use disorders may require more intensive interventions to promote existing strengths.
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Mericle AA, Carrico AW, Hemberg J, Stall R, Polcin DL. Improving Recovery Outcomes among MSM: The Potential Role of Recovery Housing. JOURNAL OF SUBSTANCE USE 2018; 24:140-146. [PMID: 31213946 PMCID: PMC6581465 DOI: 10.1080/14659891.2018.1523966] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2018] [Revised: 08/09/2018] [Accepted: 09/10/2018] [Indexed: 10/28/2022]
Abstract
BACKGROUND Gay, bisexual, and other men who have sex with men (MSM) face unique recovery challenges. Recovery housing may play an important role in improving outcomes among MSM, but little is known about their experiences in these settings. METHODS This study examined 3-month outcomes among MSM (N=22) living in a group of recovery residences in Texas, one of which is a home specifically designated for gay and bisexual men. Upon intake, adult MSM were recruited to participate in the study, which involved a baseline and 3-month phone interview and allowing study staff to access records maintained by the program about their stay. RESULTS At follow-up, only two (9.1%) reported used of any substances in the past 30 days. The vast majority (73%) had attended outpatient substance use treatment in the past three months, and 86% reported working for pay during the past 30 days. All participants reported attending four or more 12-step meetings in the past 30 days. Use of dysfunctional coping strategies significantly decreased, however so did scores on health-related quality of life. CONCLUSIONS MSM have complex treatment needs. Recovery housing may help improve outcomes among MSM by bridging formal substance use treatment with community-based recovery support.
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Affiliation(s)
- Amy A Mericle
- Alcohol Research Group at the Public Health Institute, Emeryville, CA, USA
| | - Adam W Carrico
- Miller School of Medicine Department of Public Health Sciences, University of Miami, Miami, FL, USA
| | - Jordana Hemberg
- Alcohol Research Group at the Public Health Institute, Emeryville, CA, USA
| | - Ronald Stall
- Department of Behavioral and Community Health Sciences in the School of Public Health, University of Pittsburgh, Pittsburgh, PA, USA
| | - Douglas L Polcin
- Alcohol Research Group at the Public Health Institute, Emeryville, CA, USA
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Mericle AA, Kaskutas LA, Polcin DL, Karriker-Jaffe KJ. Independent and Interactive Effects of Neighborhood Disadvantage and Social Network Characteristics on Problem Drinking after Treatment. JOURNAL OF SOCIAL AND CLINICAL PSYCHOLOGY 2018; 37:1-21. [PMID: 29657357 DOI: 10.1521/jscp.2018.37.1.1] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/18/2023]
Abstract
Socioecological approaches to public health problems like addiction emphasize the importance of person-environment interactions. Neighborhood and social network characteristics may influence the likelihood of relapse among individuals in recovery, but these factors have been understudied, particularly with respect to conceptualizing social network characteristics as moderators of neighborhood disadvantage. Drawing from a larger prospective study of individuals recruited from outpatient treatment (N=451) and interviewed 1, 3, 5, and 7 years later, the aim of this study was to examine the independent and interactive effects of neighborhood and social network characteristics on continued problem drinking after treatment. Models using generalized estimating equations controlling for demographic and other risk factors found the number of heavy drinkers in one's network increases risk of relapse, with the effects being significantly stronger among those living in disadvantaged neighborhoods than among those in non-disadvantaged neighborhoods. No independent effects were found for neighborhood disadvantage or for the number of network members supporting reduced drinking. Future research is needed to examine potential protective factors in neighborhoods which may offset socioeconomic disadvantage as well as to investigate the functions that network members serve in helping to improve long-term treatment outcomes.
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Abstract
There have been few efforts to systematically develop reliable and valid measures of social networks, particularly in studies dealing with individuals having substance use disorders. In the current study, individuals living in recovery homes called Oxford Houses completed a 6-item measure of social networks. The Cronbach's alpha was .85 and a confirmatory factor analysis found excellent fit statistics with all items having substantial (> .70) load factors. In addition, the measure was independent of age, sex, and ethnicity and significantly related to length of stay in the recovery homes and quality of life. The authors have found that this instrument works well as an ego network with adequate psychometric properties and empirical relations to other recovery variables.
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Affiliation(s)
- Leonard A Jason
- Center for Community Research, DePaul University, Chicago, Illinois, USA
| | - Ed Stevens
- Center for Community Research, DePaul University, Chicago, Illinois, USA
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Mericle AA, Polcin DL, Hemberg J, Miles J. Recovery Housing: Evolving Models to Address Resident Needs. J Psychoactive Drugs 2017; 49:352-361. [PMID: 28657823 DOI: 10.1080/02791072.2017.1342154] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
Recovery housing is a service delivery modality that simultaneously addresses the social support and housing needs of those in recovery from substance use disorders. This article describes a group of recovery homes in Texas (N = 10) representing a lesser-studied type of recovery housing, one which explicitly bridges treatment and peer support by providing a variety of recovery support services. All residents meet with a recovery coach, undergo regular drug screening, and have access to intensive outpatient treatment-a program that was developed specifically to support the needs of residents in the homes. Unlike the Oxford HouseTM model and California sober living houses, which are primarily financed through resident fees, these homes are supported through a mix of resident fees as well as private and public insurance. While adhering to some aspects of the social model of recovery, none of these homes would meet criteria to be considered a true social model program, largely because residents have a limited role in the governance of the homes. Residences like the ones in this study are not well-represented in the literature and more research is needed.
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Affiliation(s)
- Amy A Mericle
- a Research Scientist , Alcohol Research Group, Public Health Institute , Emeryville , CA , USA
| | - Douglas L Polcin
- b Senior Scientist , Alcohol Research Group, Public Health Institute , Emeryville , CA , USA
| | - Jordana Hemberg
- c Research Associate , Alcohol Research Group, Public Health Institute , Emeryville , CA , USA
| | - Jennifer Miles
- d Doctoral Candidate , The Heller School for Social Policy and Management, Brandeis University , Waltham , MA , USA
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Simpson TL, Lehavot K, Petrakis IL. No Wrong Doors: Findings from a Critical Review of Behavioral Randomized Clinical Trials for Individuals with Co-Occurring Alcohol/Drug Problems and Posttraumatic Stress Disorder. Alcohol Clin Exp Res 2017; 41:681-702. [PMID: 28055143 DOI: 10.1111/acer.13325] [Citation(s) in RCA: 62] [Impact Index Per Article: 8.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2016] [Accepted: 01/03/2017] [Indexed: 12/20/2022]
Abstract
Prior reviews of behavioral treatments for individuals with comorbid alcohol and drug use disorders (substance use disorder SUD) and posttraumatic stress disorder (PTSD) have not systematically considered whether comparison conditions are matched to target treatments on time and attention. A systematic literature search using PubMed MESH terms for alcohol and substance use disorders, PTSD, and treatment identified relevant behavioral randomized clinical trials (RCTs) that evaluated PTSD-oriented exposure-based treatments, addiction-focused treatments, and coping-based treatments that do not involve exposure to trauma memories. Information pertaining to within-subject changes over time and between-subject differences, quality of control condition, recruitment efficiency, and assessment and treatment retention was synthesized. Alcohol and drug outcomes were described separately when possible. Twenty-four behavioral RCTs were identified: 7 exposure based, 6 addiction focused, and 11 coping based. Seven studies included SUD intervention comparison conditions matched to the target intervention on time and attention. Most of the 24 studies found that participants in both the experimental and control conditions improved significantly over time on SUD and PTSD outcomes. No study found significant between-group differences in both SUD and PTSD outcomes favoring the experimental treatment. Despite greater treatment dropout, there was greater improvement in some PTSD outcomes for exposure-based interventions than the control conditions, including when the control conditions were matched for time and attention. Addiction-focused and coping-based interventions did not generally show an advantage over comparably robust controls, although some coping-based interventions yielded better drug use outcomes than control conditions. When available, interventions that integrate exposure-based PTSD treatment and behavioral SUD treatment are recommended as they are associated with better PTSD outcomes than SUD care matched for time and attention. However, the results of this critical review also suggest that people with SUD/PTSD can benefit from a variety of treatment options, including standard SUD care.
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Affiliation(s)
- Tracy L Simpson
- Center of Excellence in Substance Abuse Treatment and Education (CESATE), VA Puget Sound Health Care, Seattle, Washington.,Department of Psychiatry & Behavioral Sciences, University of Washington, Seattle, Washington
| | - Keren Lehavot
- Department of Psychiatry & Behavioral Sciences, University of Washington, Seattle, Washington.,Health Services Research & Development (HSR&D), Center of Innovation for Veteran-Centered and Value-Driven Care, VA Puget Sound Health Care, Seattle, Washington.,Department of Health Services, University of Washington, Seattle, Washington
| | - Ismene L Petrakis
- Mental Illness Research, Education and Clinical Centers (MIRECC) VA Connecticut Health Care System, West Haven, Connecticut.,Department of Psychiatry, Yale University, New Haven, Connecticut
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May EM, Hunter BA, Jason LA. METHODOLOGICAL PLURALISM AND MIXED METHODOLOGY TO STRENGTHEN COMMUNITY PSYCHOLOGY RESEARCH: AN EXAMPLE FROM OXFORD HOUSE. JOURNAL OF COMMUNITY PSYCHOLOGY 2017; 45:100-116. [PMID: 28839344 PMCID: PMC5565162 DOI: 10.1002/jcop.21838] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
This article evaluates how a plurality of research methods has served a research program that has functioned in a much-needed area of research: the role of housing and recovery residences in addiction recovery. The review focuses on one mutually supportive recovery residence model, called Oxford House, which represents more than 1,700 democratic, self-governing residences. To date, there has been no comprehensive evaluation of the research methods used with Oxford House or any other recovery residence. In this article, research methods, including study designs and data analyses, are summarized for 114 peer-reviewed empirical studies that included data on Oxford Houses or Oxford House residents. This review of a pluralistic research program can inform community researchers about the value of recovery residences, the many ways in which recovery residences may be assessed, and the benefits of using multiple methods. Implications for future recovery residence research are discussed.
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Tuten M, Shadur JM, Stitzer M, Jones HE. A Comparison of Reinforcement Based Treatment (RBT) versus RBT plus Recovery Housing (RBT RH). J Subst Abuse Treat 2016; 72:48-55. [PMID: 27693108 DOI: 10.1016/j.jsat.2016.09.001] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2016] [Revised: 08/26/2016] [Accepted: 09/04/2016] [Indexed: 10/21/2022]
Abstract
OBJECTIVES Reinforcement-based treatment (RBT) plus recovery housing (RBTRH) improves outcomes for individuals with opioid use disorders. No studies have examined the efficacy of RBT in the absence of abstinent-contingent housing. METHODS We compared highly similar participants from a study of outpatient RBT (RBT, n=55) and the RBTRH (n=80) arm of a randomized trial wherein participants received abstinent-contingent payment for recovery housing sponsored by the research program. Abstinence and employment outcomes were assessed at one, three, and six months. Regression was used to identify predictors of abstinence. Sensitivity analyses explored the impact of housing on outcomes. RESULTS RBT and RBTRH participants had similar abstinence and employment outcomes. Predictors of abstinence in the sample included recovery housing residence and employment. However, a distinct RBT sub-group emerged, as 33% of the sample accessed self-pay RH (RBTSPRH). Sensitivity analyses compared the two RH groups (self-pay and program-supported) to RBT outpatient treatment (RBT). The RBTSPRH and RBTRH groups had similar abstinence outcomes, and both groups had superior abstinence outcomes compared to RBT. The RBTSPRH group had the most sustained effects relative to RBT, including higher abstinence rates, and more favorable employment outcomes at six months (ps<.05). The RBTSPRH group reported more days of employment compared to both the RBT and RBTRH groups at three months (ps<.05). CONCLUSIONS Findings highlight the importance of recovery housing for promoting improved outcomes among RBT participants. Research is needed to explore the aspects of recovery housing versus outpatient treatment that are associated with improved outcomes in the population.
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Affiliation(s)
- Michelle Tuten
- University of Maryland School of Social Work, 525 West Redwood Street, Baltimore, MD 21201, USA; Johns Hopkins University, School of Medicine, Department of Psychiatry and Behavioral Sciences, Bayview Medical Center, G Building, Baltimore, MD 21224, USA.
| | - Julia M Shadur
- University of Maryland at College Park, Department of Psychology, Center for Addictions, Personality, and Emotion Research, 2103 Cole Field House, College Park, MD 20742, USA.
| | - Maxine Stitzer
- Johns Hopkins University, School of Medicine, Department of Psychiatry and Behavioral Sciences, Bayview Medical Center, G Building, Baltimore, MD 21224, USA.
| | - Hendrée E Jones
- The University of North Carolina at Chapel Hill, Department of Obstetrics and Gynecology, School of Medicine, Horizons Program, 127 Kingston Drive, Chapel Hill, NC 27514, USA; Johns Hopkins University, School of Medicine, Department of Psychiatry and Behavioral Sciences, Bayview Medical Center, G Building, Baltimore, MD 21224, USA
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Substance Abuse Treatment Patients in Housing Programs Respond to Contingency Management Interventions. J Subst Abuse Treat 2016; 72:97-102. [PMID: 27492676 DOI: 10.1016/j.jsat.2016.07.001] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2016] [Revised: 06/21/2016] [Accepted: 07/11/2016] [Indexed: 11/20/2022]
Abstract
Use of homeless and transitional housing (e.g., recovery homes) programs can be associated with success in substance abuse treatment, perhaps because many of these programs encourage or mandate sobriety. In this study, we examined whether contingency management (CM) protocols that use tangible incentives for submission of drug-free specimens or other specific behaviors are effective for treatment-seeking substance abusers whose behavior may also be shaped by housing programs. Of 355 participants in randomized trials of CM, 56 (16%) reported using transitional housing during the 12-week treatment period. Main and interaction effects of housing status and treatment condition were evaluated for the primary substance abuse treatment outcomes: a) longest duration of abstinence from alcohol, cocaine, and opioids, b) percentage of samples submitted that were negative for these substances, and c) treatment retention. After controlling for demographic and clinical characteristics, those who accessed housing programs submitted a higher percentage of negative samples (75%) compared to those who did not access housing programs (67%). Housing status groups did not differ in terms of longest duration of abstinence (accessed housing: M=3.1 weeks, SE=0.6; did not access housing: M=3.9 weeks, SE=0.3) or retention in substance abuse treatment (accessed housing: M=6.4 weeks, SE=0.6; did not access housing: M=6.6 weeks, SE=0.3). Regardless of housing status, CM was associated with longer durations of abstinence and treatment retention. No interactive effects of housing and treatment condition were observed (p>.05). Results suggest that those who accessed housing programs during substance abuse treatment benefit from CM to a comparable degree as their peers who did not use such programs. These effects suggest that CM remains appropriate for those accessing housing in community-based programs.
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Callahan S, Jason LA, Robinson L. Reducing Economic Disparities for Female Offenders: The Oxford House Model. ALCOHOLISM TREATMENT QUARTERLY 2016; 34:292-302. [PMID: 27594760 PMCID: PMC5004742 DOI: 10.1080/07347324.2016.1182814] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
BACKGROUND In the past 30 years the rate of increase in incarceration for females who abuse substances has outpaced that of men. Women have increased health and economic disparities, and face barriers to economic mobility, increasing their risk of returning to the criminal justice system. Past research suggests that there is a positive relationship between living in Oxford House and employment wages, yet the impact of having a criminal history on this relationship was unknown. METHOD This study used a nationwide sample of 136 women living in Oxford Houses in a regression analysis with length of stay in Oxford House predicting employment wages, and moderated by criminal history. RESULTS There was a positive relationship between length of stay and wages. Criminal history modified the association between length of stay and wages, and length of stay had a significantly greater impact on wages for women with criminal convictions. IMPLICATIONS The findings provide a contribution to alcohol and drug abuse and economic literature by identifying a setting that decreases economic disparities for formerly incarcerated women. Results can inform future policy, research, and the development of gender sensitive aftercare programs that address the needs of women, assisting transitioning women in reentering mainstream society, and increasing their chances of obtaining and retaining employment.
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Affiliation(s)
- Sarah Callahan
- DePaul University, Center for Community Research, Chicago, Illinois, USA
| | - Leonard A Jason
- DePaul University, Center for Community Research, Chicago, Illinois, USA
| | - LaVome Robinson
- DePaul University, Center for Community Research, Chicago, Illinois, USA
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Majer JM, Chapman HM, Jason LA. Comparative Analysis of Treatment Conditions upon Psychiatric Severity Levels at Two Years Among Justice Involved Persons. ADVANCES IN DUAL DIAGNOSIS 2016; 9:38-47. [PMID: 27158265 PMCID: PMC4854532 DOI: 10.1108/add-07-2015-0015] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
PURPOSE The aim of this investigation was to compare the effects of two types of community-based, residential treatment programs among justice involved persons with dual diagnoses. DESIGN/METHODOLOGY A randomized clinical trial examined treatment conditions among justice involved persons with substance use disorders who reported high baseline levels of psychiatric severity indicative of diagnosable psychiatric comorbidity. Participants (n = 39) were randomly assigned to one of three treatment conditions upon discharge from inpatient treatment for substance use disorders: a professionally staffed, integrated residential treatment setting (therapeutic community), a self-run residential setting (Oxford House), or a treatment-specific aftercare referral (usual care). Levels of psychiatric severity, a global estimate of current psychopathological problem severity, were measured at two years as the outcome. FINDINGS Participants randomly assigned to residential conditions reported significant reductions in psychiatric severity whereas those assigned to the usual care condition reported significant increases. There were no significant differences in psychiatric severity levels between residential conditions. RESEARCH LIMITATIONS/IMPLICATIONS Findings suggest that cost-effective, self-run residential settings such as Oxford Houses provide benefits comparable to professionally-run residential integrated treatments for justice involved persons who have dual diagnoses. SOCIAL IMPLICATIONS Results support the utilization of low-cost, community-based treatments for a highly marginalized population. ORIGINALITY/VALUE Little is known about residential treatments that reduce psychiatric severity for this population. Results extend the body of knowledge regarding the effects of community-based, residential integrated treatment and the Oxford House model.
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Majer JM, Chapman HM, Jason LA. Abstinence Self-Efficacy and Substance Use at 2 Years: The Moderating Effects of Residential Treatment Conditions. ALCOHOLISM TREATMENT QUARTERLY 2016; 34:386-401. [PMID: 28484303 DOI: 10.1080/07347324.2016.1217708] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
The relationship between abstinence self-efficacy and substance use at 2 years was examined among a sample (N = 470) of persons with substance use disorders and recent incarceration histories. Participants were assigned to residential (therapeutic community/TC or Oxford House) or nonresidential (usual care) conditions. The authors hypothesized abstinence self-efficacy would predict decreased substance use, and residential treatments would moderate this relationship. A conditional effect was observed, with low levels of abstinence self-efficacy predicting significant increases in substance use in the TC and usual care conditions. Supplemental analyses revealed significant decreases in substance use over time among participants in the Oxford House condition, and a significant conditional effect (gender x treatment condition) in relation to substance use. Findings point to the need for researchers to examine factors that mitigate the relationship between abstinence self-efficacy and substance use outcomes, and for treatment providers to consider the Oxford House model for this population.
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Affiliation(s)
- John M Majer
- Harry S. Truman College, Social Science Department, Chicago, Illinois, USA
| | | | - Leonard A Jason
- Center for Community Research, DePaul University, Chicago, Illinois, USA
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Perreault M, Milton D, Komaroff J, Lévesque GP, Perron C, Wong K. Resident perspectives on a Montreal peer-run housing project for opioid users. JOURNAL OF SUBSTANCE USE 2015. [DOI: 10.3109/14659891.2015.1029022] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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Law FM, Guo GJ. The impact of reality therapy on self-efficacy for substance-involved female offenders in Taiwan. INTERNATIONAL JOURNAL OF OFFENDER THERAPY AND COMPARATIVE CRIMINOLOGY 2015; 59:631-653. [PMID: 24420638 DOI: 10.1177/0306624x13518385] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Abstract
This study aimed to fulfill a twofold purpose. First, a 12-session reality therapy drug treatment program to enhance substance-involved females' self-efficacy in three aspects, which have been demonstrated to be essential to recovery, was designed and implemented. Second, to test the effectiveness of the treatment program, the Index of Sense of Self-Efficacy Scale was developed and validated using Principal Component Analysis and Confirmatory Factor Analysis. The participants in the drug treatment program were 40 incarcerated substance-involved female offenders, who were randomly assigned to equal-sized experimental and control groups. The results of the study, obtained by ANCOVA analysis, showed significant differences in the post-test scores for sense of self-efficacy in decision making, action-planning, and coping and social skills for the members of the two groups.
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Affiliation(s)
| | - Gwo Jen Guo
- National Changhua University of Education, Taiwan, Republic of China
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Timpo P, Price T, Salina D, Witek C, Pommer N, Jason LA. Women Leaders in Oxford House. JOURNAL OF ADDICTIVE BEHAVIORS, THERAPY & REHABILITATION 2014; 3. [PMID: 25419529 DOI: 10.4172/2324-9005.1000119] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
This qualitative study examined women assuming leadership roles in Oxford Houses, which are communal, democratically run recovery settings for substance use disorder. Semi-structured interviews were conducted with 10 women Oxford House leaders who shared their thoughts and experiences on leadership. Several themes emerged from qualitative data analysis, most notably that stepping up and accepting a leadership role in Oxford House had a positive effect on self-esteem, which is vital to women with a history of substance abuse. Barriers to leadership were also identified such as negative interpersonal relationships with other women. A number of methods mentioned to increase the number of women leaders included: developing workshops, providing positive encouragement, and accessing existing female role models. The implications of this study are discussed.
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Affiliation(s)
| | - Temple Price
- Wellesley College, 106 Central Street, Wellesley, MA, USA
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Jason LA, Olson BD, Harvey R. Evaluating Alternative Aftercare Models for Ex-Offenders. JOURNAL OF DRUG ISSUES 2014; 45:53-68. [PMID: 25641984 DOI: 10.1177/0022042614552019] [Citation(s) in RCA: 41] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
This study examined the role played by aftercare following (mainly) inpatient community-based treatment in the outcomes of criminal ex-offenders with substance use disorders. Two hundred and seventy individuals who had been released from the criminal justice system were randomly assigned to either a Therapeutic Community (TC), recovery homes called Oxford Houses (OHs), or usual care settings (UA). The OHs and TCs are residential settings that emphasized socialization and abstinence from drugs and alcohol, but OHs do not include the formal therapeutic change interventions common to TCs, nor did they include any on-site access to drug abuse or health care professionals. UA involved what occurred naturally after completing treatment, which included staying with friends or family members, their own house or apartment, homeless shelters, or other settings. Longer lengths of stay in either the TCs or OHs were associated with increased employment, and reduced alcohol and drug use. Those assigned to the OH condition received more money from employment, worked more days, achieved higher continuous alcohol sobriety rates, and had more favorable cost-benefit ratios.
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