How Social Relationships Influence Substance Use Disorder Recovery: A Collaborative Narrative Study

Psychological safety mediates attendance and recovery-related outcomes within the Phoenix: a sober-active community

Background

People in recovery from a substance use disorder often have difficulties forming pro-social relationships or accessing supportive communities. Providing psychological safety within recovery communities may be uniquely beneficial, yet psychological safety has mostly been studied among professional organizations and not among vulnerable populations. This program evaluation study examined associations between attendance, psychological safety, and retrospective recovery-related changes.

Methods

Participants included 204 members of The Phoenix (13% response rate) who completed a survey that addressed recovery status and current perceptions of psychological safety, with hope, connection, empowerment, motivation to stay sober, mental health and physical health at 3-months and thinking back to baseline (i.e., "thentest"). Demographic information and attendance data were also collected.

Results

Structural equation modeling found a good fit for the model (χ2 = 187.40, p = 0.23; RMSEA =0.049, GFI = 0.90, CFI = 0.98, SRMSR = 0.05.) and all path coefficients were statistically significant (p < 0.05). Participants' perceived psychological safety fully mediated the relationship between attendance and recovery-related outcomes. Attendance was also directly and positively associated with physical health.

Conclusion

Due to positive improvements in health and recovery-related outcomes mediated by psychological safety, results show benefits of attending events hosted by The Phoenix for those in recovery from substance use. Additional research should further validate the importance of psychological safety as a key mediator of the recovery process.

Leveraging Trauma Informed Care for Digital Health Intervention Development in Opioid Use Disorder

Digital health refers to the use of information and communication technologies in medicine (including smartphone apps, wearables, other non-invasive sensors, informatics and telehealth platforms) to prevent illness, deliver treatment, and promote wellness. This rapidly proliferating group of technologies has the potential to reduce harm for people with opioid use disorder (OUD) and facilitate the recovery process; however, development in this space for OUD has been slower compared to that for other medical conditions. Unique issues with OUD management surrounding patient provider relationships, interaction with the healthcare system, autonomy and trust sometimes hinder care approaches, including those in digital health. The trauma informed care framework (TIC), developed for use by organizations to support individuals who have experienced trauma, has particular applicability for digital health interventions in OUD care. This manuscript will serve as a review of TIC principles and how they can be applied to digital health interventions to increase access, equity, and empowerment for people with OUD. We will highlight representative current and pipeline digital technologies for OUD, challenges with these technologies, TIC models for OUD, and the integration of TIC principles into digital technology development to better serve people with OUD. Finally, we will posit strategies to incorporate the aforementioned principles into future research efforts. We ultimately aim to use TIC as a lens through which to develop digital technologies to help individuals with OUD while minimizing harm.

Understanding the Effect of External and Internal Assets on Hazardous/Harmful Drinking Among Chinese College Students: A Serial Mediation Model

Hazardous/harmful drinking among college students is increasingly becoming a global health concern. Previous studies have mostly paid more attention to the prevalence and risk factors of alcohol use disorder based on the public health approach, and less is understood about psychological mechanisms and protective factors of problem drinking behavior. Grounded in the framework of developmental assets, this study explored the predictive effect of external assets (i.e., social connectedness) and internal assets (i.e., self-concept clarity and drinking refusal self-efficacy) on hazardous/harmful drinking among Chinese college students. Participants were 598 college students with a mean age of 19.41 (SD = 1.21) years. The results of structural equation modeling showed that social connectedness negatively predicted college students' hazardous/harmful drinking. Moreover, our path analyses revealed a serial mediation among these variables: students with high social connectedness tended to report high self-concept clarity, which in turn increased drinking refusal self-efficacy, and consequently decreased the level of hazardous/harmful drinking. This study revealed the mechanisms underlying how external and internal assets predict risky drinking among college students. These findings made significant contributions to prevention and precision interventions for college-aged youth with drinking problems.

A systematic review of the reasons for quitting and/or reducing alcohol among those who have received alcohol use disorder treatment

Research has primarily studied reasons for quitting and/or reducing alcohol use in non-treatment samples. This systematic review aimed to characterize the reasons for quitting and/or reducing alcohol use among those who have received treatment for AUD and examine how reasons endorsed differ across measurement methods used. Articles were identified through PsycINFO, Web of Science, PubMed, and CINAHL. Twenty-one articles met inclusion criteria. Thematic coding revealed 21 unique themes in reasons for quitting and/or reducing. Common reasons included physical health issues, misalignment with personal goals, family influence, and social factors-also noted in non-treatment populations. Unique themes like hitting rock bottom and avoiding disapproval were identified, potentially linked to treatment initiation or development. The measurement approach influenced the reasons reported, highlighting the need for standardized methods. Common reasons are fundamental and are not a result of treatment, while others are unique to individuals who have received AUD treatment, which may suggest that they are critical in leading one to seek treatment or may be developed during treatment. Assessing and tailoring treatment based on these reasons may enhance outcomes. Standardizing how we measure reasons for quitting or reducing alcohol is crucial for comparing studies and improving treatment. Future research should evaluate reasons over time, assess their importance at different treatment stages, and use varied assessment strategies for comprehensive insights.

Avatar Intervention in Virtual Reality for Cannabis Use Disorder in Individuals With Severe Mental Disorders: Results From a 1-Year, Single-Arm Clinical Trial

Background

The dual diagnosis of cannabis use disorder (CUD) and severe mental disorder (SMD) results in clinically complex individuals. Cannabis use is known to have negative consequences on psychiatric symptoms, medication compliance, and disease prognosis. Moreover, the effectiveness of currently available psychotherapeutic treatments is limited in this population. In this context, our research team developed avatar intervention, an approach using virtual reality as a therapeutic tool to treat CUD in individuals with SMD.

Objective

This pilot clinical trial aimed to evaluate, until the 1-year follow-up, the efficacy of avatar intervention for CUD among 32 participants with a dual diagnosis of SMD and CUD.

Methods

Over the course of the 8 intervention sessions, participants were given the opportunity to enter a dialogue in virtual reality with an avatar representing a person with a significant role in their consumption, who was animated in real time by a therapist. The primary outcomes were the quantity of cannabis consumed and the frequency of use. Secondary outcomes included severity of problematic cannabis use, motivation for change, protective strategies for cannabis use, consequences of cannabis use, psychiatric symptoms, and quality of life. Changes in reported outcomes during the assessment periods before the intervention; postintervention; and 3, 6, and 12 months after the end of the intervention were assessed using a linear mixed-effects model.

Results

Significant reductions were observed in the quantity of cannabis consumed, and these were maintained until the 12-month follow-up visit (d=0.804; P<.001; confirmed by urine quantification). Frequency of cannabis use showed a small significant reduction at the 3-month follow-up (d=0.384; P=.03). Moreover, improvements were observed in the severity of CUD, cannabis-related negative consequences, the motivation to change cannabis use, and the strategies used to mitigate harms related to cannabis use. Finally, moderate benefits were observed for quality of life and psychiatric symptoms.

Conclusions

Overall, this unique intervention shows promising results that seem to be maintained up to 12 months after the end of the intervention. With the aim of overcoming the methodological limitations of a pilot study, a single-blind randomized controlled trial is currently underway to compare the avatar intervention for CUD with a conventional addiction intervention.

How post overdose response efforts can address social determinants of health among people who use drugs: perspectives from the New York State Department of Health (NYSDOH) Post Overdose Response Team (PORT)

Individuals who have survived an overdose often have myriad needs that extend far beyond their drug use. The social determinants of health (SDOH) framework has been underutilized throughout the opioid overdose crisis, despite widespread acknowledgment that SDOH are contributors to the majority of health outcomes. Post Overdose Response Teams (PORTs) engage with individuals who have experienced 1 or more nonfatal overdoses and bear witness to the many ways in which overdose survivors experience instability with healthcare, housing, employment, and family structure. Employing a harm reduction model, PORTs are well-positioned to reach people who use drugs (PWUD) and to address gaps in basic needs on an individualized basis, including providing social support and a sense of personal connection during a period of heightened vulnerability. The New York State Department of Health (NYSDOH) PORT program is a harm reduction initiative that utilizes law enforcement data and several public databases to obtain accurate referral information and has been active since 2019 in NYC. This PORT program offers various services from overdose prevention education and resources, referrals to health and treatment services, and support services to overdose survivors and individuals within their social network. This perspective paper provides an in-depth overview of the program and shares quantitative and qualitative findings from the pilot phase and Year 1 of the program collected via client referral data, interviews, and case note reviews. It also examines the barriers and successes the program encountered during the pilot phase and Year 1. The team's approach to addressing complex needs is centered around human connection and working toward addressing SDOH one individualized solution at a time. Application of the NYSDOH PORT model as outlined has the potential to create significant positive impacts on the lives of PWUD, while potentially becoming a new avenue to reduce SDOH-related issues among PWUD.

Racial and gender differences in relapse potential and treatment acceptance among rural residents in a substance use disorder treatment program

PURPOSE

To examine racial and gender differences in treatment acceptance and relapse potential among rural residents admitted to a substance use disorder (SUD) treatment program.

METHODS

A cross-sectional study using data collected from a sample of 1850 rural residents admitted to a South Carolina state-run SUD treatment center between the years of 2018 and 2020. Chi-square and t-tests were used to compare treatment acceptance and relapse potential by race and gender. Multivariate logistic regression analyses was conducted to further examine the relationship of race and gender with treatment acceptance and relapse potential after adjusting for potential confounding variables.

FINDINGS

Approximately 50% of participants were classified as being accepting of their treatment and committed to changing their substance use, and there were no racial or gender differences in the bivariate and multivariate analyses. Approximately 25% of participants were classified as having low/no potential risk for relapsing, and there were no racial or gender differences in the bivariate analysis. However, the adjusted odds ratio of relapsing risk were lower among White compared to Black adults [AOR = 0.49 with 95% CI (0.31-0.77)].

CONCLUSION

This study suggests there are no gender or racial differences in treatment acceptance for SUD but that Black adults are at greater risk of relapsing relative to White adults. Additional research is needed to identify factors that increase Black adults' risk for relapse to inform interventions that can improve SUD treatment outcomes in this population.

Factors Influencing Maternal Substance Use and Recovery in the Perinatal Period

BACKGROUND

Substance use disorders (SUD) in the perinatal period have risen dramatically over the past 2 decades. Substance use disorders can have deleterious effects on maternal-infant health. Recovery can improve quality of life but can be challenging for women with SUD in the perinatal period. It is important for health care providers to have an understanding of factors associated with maternal substance use and recovery.

OBJECTIVE

The purpose of this qualitative review was to identify factors influencing substance use and recovery in women with SUD in the perinatal period.

METHODS

A systematic search was conducted using the databases of CINAHL, PsycINFO, and PubMed along with a manual search of Google Scholar. The studies were assessed using criteria from the Joanna Briggs Institute's critical appraisal checklist for qualitative research.

RESULTS

Findings from 16 qualitative studies were synthesized. Six descriptive subthemes identifying factors influencing substance use and recovery were revealed: (1) Infant Care, (2) Stigma, (3) Social Settings Involving Substance Use, (4) Internalized Stigma and Mental Health Symptoms, (5) Addiction Concerns, and (6) Coping Abilities.

CONCLUSIONS

Participants described external and internal factors that influenced their substance use and recovery. The findings suggest health care providers refer women to residential addiction treatment, use destigmatizing language, promote access to peer services, and provide trauma-informed care.

Long-Acting Injectable Buprenorphine for Opioid Use Disorder: A Qualitative Analysis of Patients' Interpersonal Relationships during the First Year of Treatment

Introduction: Long-acting injectable buprenorphine (LAIB) is a new treatment for opioid use disorder. Drawing upon new materialism and the concept of social capital, this article provides a focused analysis of how LAIB affects, and is affected by, patients' relationships with other people. Methods: Data derive from a longitudinal qualitative study. Twenty-six people (18 males; 8 females) initiating LAIB were recruited from England and Wales (2020/2021) and interviewed up to six times each over a year (125 interviews in total). Interviews were audio-recorded, transcribed, and coded. Coded relationship data were summarized in Excel and analyzed via Iterative Categorization. Results: Core significant others who did not use substances offered participants important support with LAIB. Children and grandchildren provided motivation for LAIB, whilst other family relationships could be supportive and unsupportive. Participants wanted to avoid friends, peers and associates who might offer them substances, but valued sharing experiences with others in similar circumstances. Whilst some participants were unconcerned when treatment staff did not contact them, others were angry and upset. Those who did not continue LAIB or were lost from the study were more isolated at recruitment. Meanwhile, participants who remained on LAIB described increased sociability over time. Conclusions: Findings are consistent with ideas relating to new materialism (LAIB is part of an interacting network of material and non-material factors) and social capital (those with supportive relationships benefited more from LAIB). Interpersonal relationships need to be considered as part of routine care and should be reviewed with patients throughout the treatment journey.

Perinatal Health Outcomes Among Women on Community Supervision: A Scoping Review

The purpose of this scoping review is to review the extant literature regarding perinatal health outcomes for women on community supervision in the United States. PubMed, CINAHL, Scopus, PsycINFO, and Public Health were searched for peer-reviewed articles published in the United States from January 1, 1970, to March 7, 2023. After removal of duplicates and review of 1,412 article titles and abstracts, 19 articles were retrieved for full-text review; this yielded 4 studies for inclusion. Studies range in size from 10 to 292 participants (N = 405) and only two reported geographic locations. Three studies comprised probation or parole and two studies included court-mandated treatment for substance use. All studies examined outcomes during the postpartum period, such as mood disorder or substance use severity. No studies evaluated the health of women during pregnancy and/or childbirth. To enhance health equity and reduce maternal morbidity and mortality among women on community supervision, more inclusive research that examines health outcomes during the perinatal period is needed. Furthermore, there must be interventions that address the social determinants of health, racial and systemic discrimination, socioeconomic barriers, and violence that are often experienced among women with criminal justice system involvement.

Experiences of Aging with Opioid Use Disorder and Comorbidity in Opioid Treatment Programs: A Qualitative Analysis

BACKGROUND

The number of older adults entering opioid treatment programs (OTPs) to treat opioid use disorder (OUD) is increasing. However, the lived experiences of aging in OTPs have not been examined.

OBJECTIVE

To explore the aging experience with OUD and barriers to medical care for older adults who receive care in OTPs.

DESIGN

From November 2021 to July 2022, we conducted 1-to-1, semi-structured qualitative interviews in English and Spanish, audio-recorded, transcribed, systematically coded, and analyzed to identify key themes regarding the challenges of aging with OUD and managing chronic diseases.

PARTICIPANTS

Thirty-six adults aged ≥ 55 enrolled in OTPs in San Diego, California.

APPROACH

A descriptive qualitative approach was used. Major themes and subthemes were identified through thematic analysis until thematic saturation was reached.

KEY RESULTS

All participants were on methadone and had a mean age of 63.4 (SD 5.1) years; 11 (30.6%) identified as female, 14 (39%) as Hispanic/Latino, and 11 (36%) as Black, with a mean duration of methadone treatment of 5.6 years. Chronic diseases were common, with 21 (58.3%) reporting hypertension, 9 (25%) reporting untreated hepatitis C, and 32 (88.9%) having ≥ 2 chronic diseases. Three major themes emerged: (1) avoidance of medical care due to multiple intersectional stigmas, including those related to drug use, substance use disorder (SUD) treatment, ageism, and housing insecurity; (2) increasing isolation with aging and loss of family and peer groups; (3) the urgent need for integrating medical and aging-focused care with OUD treatment in the setting of increasing health and functional challenges.

CONCLUSIONS

Older adults with OUD reported increasing social isolation and declining health while experiencing multilevel stigma and discrimination. The US healthcare system must transform to deliver age-friendly care that integrates evidence-based geriatric models of care incorporated with substance use disorder treatment and addresses the intersectional stigma this population has experienced in healthcare settings.

The Effect of Peer Support on Treatment Engagement for Opioid Use Disorder

INTRODUCTION

Opioid misuse has been a growing problem in the United States that has escalated into a national public health emergency. Despite substance abuse programs that offer assistance in the treatment of opioid use disorder (OUD), keeping clients engaged in recovery treatment can be very challenging. Relapse prevention is a priority concern due to the higher risk of overdose following a period of sobriety.

AIMS

This research compares two different approaches to treatment of OUD to assess relative treatment adherence. The purpose of this research is to establish whether a peer support-based treatment methodology, combined with increased medication-assisted treatment, provided by an outpatient facility is more effective than treatment-as-usual in improving client engagement in recovery treatment.

METHODS

The research analyzed data collected over a 6-month period by a facility. The retrospective review of data compared a total of 1,570 clients enrolled in a certified recovery services (CRSs) program versus individuals engaged in treatment-as-usual program. Inclusion criteria consisted of clients with at least one diagnoses of OUD who met level of care requirements.

RESULTS

Statistical t-test analysis revealed greater engagement in recovery services among those enrolled in the CRS program.

CONCLUSIONS

The findings support the benefits of a peer support program as a treatment methodology for clients with OUD. This research will be of value in the design and development of future program policy and treatment guidelines.

The role of social connection in opioid use disorder treatment engagement

OBJECTIVE

Medications for opioid use disorder (OUD or MOUD) treatment combining pharmacotherapy with psychosocial support are effective for managing OUD. However, treatment engagement remains a challenge, with retention rates ∼30%-50%. Although social connection has been identified as important to recovery, it remains unclear whether and how social factors can bolster participation in treatment.

METHOD

Individuals receiving MOUD at three outpatient treatment programs (N = 82) and healthy community controls (N = 62) completed validated measures assessing social connection including (a) size, diversity, and embeddedness of social networks; (b) perceived social support and criticism within familial relationships; and (c) subjective social status. For those receiving MOUD, we also examined how aspects of social connection related to opioid (re)use and treatment engagement (medication adherence, group, and individual meeting attendance) assessed over ∼8 weeks/person.

RESULTS

Compared to controls, individuals receiving MOUD had smaller and less diverse and embedded social networks (Cohen's d > 0.4), and despite similar levels of perceived social support (d = 0.02), reported higher levels of social criticism (d = 0.6) and lower subjective social status (d = 0.5). Within the MOUD group, higher social network indices correlated specifically with higher therapeutic group attendance (Rs > 0.30), but not medication adherence, while higher levels of perceived criticism correlated with more frequent opioid use (R = 0.23). Results were mostly robust to control for sociodemographic variables, psychological distress/COVID-19, and treatment duration, but differed by MOUD type/program.

CONCLUSIONS

These findings highlight the potential importance of assessing an individual's social capital, promoting positive social connection, and continuing to assess the implementation and value of psychosocial support in MOUD treatment. (PsycInfo Database Record (c) 2024 APA, all rights reserved).

Psychedelic substitution: altered substance use patterns following psychedelic use in a global survey

Introduction

Recent research suggests that psychedelics may have potential for the treatment of various substance use disorders. However, most studies to date have been limited by small sample sizes and neglecting to include non-North American and European populations.

Methods

We conducted a global, cross-sectional online survey of adults (n = 5,268, 47.2% women) self-reporting past or current psychedelic use and investigated whether psychedelic use was associated with changes in use of other substances.

Results

Nearly three-quarters (70.9%; n = 3,737/5,268) reported ceasing or decreasing use of one or more non-psychedelic substances after naturalistic psychedelic use. Among those with previous use, 60.6% (n = 2,634/4,344) decreased alcohol use, 55.7% (n = 1,223/2,197) decreased antidepressant use, and 54.2% (n = 767/1,415) decreased use of cocaine/crack. Over a quarter of the sample indicated that their decrease in substance use persisted for 26 weeks or more following use of a psychedelic. Factors associated with decreased use included a motivation to either decrease one's substance use or self-treat a medical condition. Importantly, 19.8% of respondents also reported increased or initiated use of one or more other substances after psychedelic use, with illicit opioids (14.7%; n = 86/584) and cannabis (13.3%; n = 540/4,064) having the highest proportions. Factors associated with increased substance use included having a higher income and residing in Canada or the US.

Discussion

Although limited by cross-sectional study design, this large observational study will help inform future studies aiming to investigate the relationship between substance use patterns and psychedelic use.

Characterizing Social Connectedness and Associated Mental Health Symptoms among Sexual Minority Men Enrolled in a Substance Use Recovery Support Program

BACKGROUND

Sexual minority men (SMM; gay, bisexual, and other men who have sex with men) report higher rates of substance use compared to other populations. Social connectedness is a critical component for promoting and maintaining recovery from substance use disorders. However, the degree of social connectedness among SMM who report substance use is largely unknown.

OBJECTIVES

We examined substance use, social connectedness (past 30-d participation in formal recovery support, past 30-d interaction with supportive family/friends, relationship satisfaction, and types of support) and mental health among SMM at the time of their enrollment in a behavioral substance use program from September 2019 to October 2021.

RESULTS

Of the107 SMM, 80% of the sample reported past 30-d illicit substance use, with methamphetamine representing the most commonly reported drug used (53%). Participants used a variety of social connections for support, including self-help groups (44% voluntary; 5% religious-affiliated; 20% other) and family/friends (81%). Importantly, 15% reported they had no one to turn to when having trouble and 36% were either dissatisfied or very dissatisfied with their relationships. Participants who endorsed significant depressive (58%) and anxiety (70%) symptoms were more likely to endorse relationship dissatisfaction than participants who did not endorse symptoms (p < 0.01).

CONCLUSIONS

One-third of SMM enrolled in a substance use recovery program expressed relationship dissatisfaction, particularly those struggling with depression or anxiety. Future research and programming should examine ways of leveraging existing social connectedness or forging new social supports to enhance mental health and substance use recovery for SMM using substances.

Investigating Substance Use via Reddit: Systematic Scoping Review

BACKGROUND

Reddit's (Reddit Inc) large user base, diverse communities, and anonymity make it a useful platform for substance use research. Despite a growing body of literature on substance use on Reddit, challenges and limitations must be carefully considered. However, no systematic scoping review has been conducted on the use of Reddit as a data source for substance use research.

OBJECTIVE

This review aims to investigate the use of Reddit for studying substance use by examining previous studies' objectives, reasons, limitations, and methods for using Reddit. In addition, we discuss the implications and contributions of previous studies and identify gaps in the literature that require further attention.

METHODS

A total of 7 databases were searched using keyword combinations including Reddit and substance-related keywords in April 2022. The initial search resulted in 456 articles, and 227 articles remained after removing duplicates. All included studies were peer reviewed, empirical, available in full text, and pertinent to Reddit and substance use, and they were all written in English. After screening, 60 articles met the eligibility criteria for the review, with 57 articles identified from the initial database search and 3 from the ancestry search. A codebook was developed, and qualitative content analysis was performed to extract relevant evidence related to the research questions.

RESULTS

The use of Reddit for studying substance use has grown steadily since 2015, with a sharp increase in 2021. The primary objective was to identify tendencies and patterns in various types of substance use discussions (52/60, 87%). Reddit was also used to explore unique user experiences, propose methodologies, investigate user interactions, and develop interventions. A total of 9 reasons for using Reddit to study substance use were identified, such as the platform's anonymity, its widespread popularity, and the explicit topics of subreddits. However, 7 limitations were noted, including the platform's low representativeness of the general population with substance use and the lack of demographic information. Most studies use application programming interfaces for data collection and quantitative approaches for analysis, with few using qualitative approaches. Machine learning algorithms are commonly used for natural language processing tasks. The theoretical, methodological, and practical implications and contributions of the included articles are summarized and discussed. The most prevalent practical implications are investigating prevailing topics in Reddit discussions, providing recommendations for clinical practices and policies, and comparing Reddit discussions on substance use across various sources.

CONCLUSIONS

This systematic scoping review provides an overview of Reddit's use as a data source for substance use research. Although the limitations of Reddit data must be considered, analyzing them can be useful for understanding patterns and user experiences related to substance use. Our review also highlights gaps in the literature and suggests avenues for future research.

Investigating the role of interpersonal relationships on low-income SUD patients' recovery: a qualitative analysis of various stakeholders in New York State

Background

While positive impacts of recovery capital and social capital in facilitating substance use disorder (SUD) recovery is increasingly documented, research has shown that low-income and marginalized individuals have lower social capital and may rely on different networks. A more comprehensive approach is needed to understand the social capital of low-income individuals with SUD and how these relationships impact their treatment and recovery.

Methods

Qualitative data were gathered through semi-structured interviews and analyzed employing thematic analysis. Participants included individuals with SUD (n=10), clinicians (n=12), and policy leaders (n=13).

Results

Three themes emerged: 1) Patients' positive and negative interpersonal relationships with friends and family influenced decisions to seek treatment; 2) strong patient-provider relationships, often defined by the quality of SUD providers and treatment settings, were perceived as crucial for staying in treatment; and 3) justice involvement facilitated treatment access yet deteriorated treatment engagement. Themes emphasized social and structural factors that inhibit patients from fostering support and treatment engagement.

Conclusions

Our study underscores the importance of interpersonal relationships in SUD treatment-seeking and recovery and the need for positive interactions across the care continuum within broader social networks. Opportunities for positive interpersonal relationships include increasing access to language-concordant treatment; provider training to enhance cultural humility and patient-provider relationships; and mechanisms that improve interpersonal relationships between patients, parole officers, and other justice system members. Accentuating the role of interpersonal relationships and expanding social support interventions can pave the way for structural changes that improve recovery by harnessing different types of social capital.

A Mixed-Methods Examination of Language Used by College Students to Describe Alcohol Recovery

Given that approximately 5% of the U.S. population is currently attending college, research is needed to better understand the language that college students use to describe alcohol recovery regardless of their current drinking behavior. College student perceptions of alcohol recovery are important, given that students may experience an alcohol use disorder themselves or may encounter others with an alcohol use disorder. Research on college student perceptions of alcohol recovery in the literature is scarce but is needed to better understand the alcohol recovery process. The current mixed-methods study examines language that college students use to describe alcohol recovery based on findings from two focus group interviews. The focus groups were conducted with college students who reported using alcohol at least once in their lifetime. All participants (N = 18) were asked questions regarding language perceived to be associated with alcohol recovery. Data were examined within a thematic analysis framework. The three central themes related to alcohol recovery that emerged in the study were harm reduction-based recovery, abstinence-based recovery, and social correlates of recovery. College students rated the terms "recovered," "drinking reduction," and "sobriety" as being highly representative of being in recovery, whereas the terms "bars" and "light drinker" were identified as not being representative of recovery. A better understanding of these themes will help the field understand the language that college students use to describe alcohol recovery.

Exploring dog ownership in the lives of people with substance use disorder: a qualitative study

BACKGROUND

Recovery from substance use is commonly seen as a process of integrating social relationships and creating a sense of meaning in one's life. Dog owners describe a close relationship with their dog that impacts many aspects of their everyday life. Yet for individuals with substance use disorder (SUD), little is known about how dog ownership could affect their lives. The aim of this study was to explore how people living with SUD experience and describe their everyday life when owning a dog.

METHOD

Eight semi-structured in-depth individual interviews were conducted with people having personal experience of living with SUD and owning a dog. Data were gathered and analysed using qualitative content analysis.

RESULTS

The analysis yielded four categories, reflecting different aspects of dog ownership. Living with SUD and owning a dog was primarily something positive in their life. People increased their social connections personally and within society. They felt a belonging which gave a sense of agency and purpose, and they developed structure in their day and boundaries to their environment. Dog ownership, however, could hinder access to services which was found to be challenging for some participants.

CONCLUSIONS

The owning of a dog can lead to changes that parallel those of a recovery process. This finding adds to the research on the connection that dogs can provide and shows how pertinent this can be particularly for vulnerable persons such as those with SUD.

Experiences of psilocybin treatment for clinical conditions: A qualitative meta-synthesis

There is increasing clinical interest in the use of psilocybin. There is emerging evidence of the efficacy of psilocybin for the treatment of a range of clinical conditions. Mental health nurses have a unique set of skills for caring for people who are hallucinating. To expand these skills to meet the developing clinical interest in the therapeutic use of psilocybin, it is helpful to understand the experience from the perspective of the person being treated with psilocybin. A qualitative meta-synthesis was conducted to examine how those with psilocybin described their experiences to identify whether its effects are similar across different health conditions. Ten studies were included in the review. The health conditions studied were cancer, depression, HIV, substance use disorder, smoking cessation and trauma. The synthesis of findings identified three themes that were common across the studies despite the health condition: acceptance, connection and transformation. The review provides helpful insights into how people experience psilocybin and its effects on their health condition.

Buprenorphine adherence and illicit opioid use among patients in treatment for opioid use disorder

Background: Buprenorphine is a partial mu opioid agonist medication that has been shown to decrease non-prescribed opioid use, cravings, and opioid related morbidity and mortality. There is an assumption that full adherence is needed to achieve ideal treatment outcomes, and that non-adherence is associated with ongoing opioid use. However, literature documenting the strength of that assertion is lacking.Objectives: Evaluate the association between daily buprenorphine adherence and illicit opioid use.Methods: Secondary analysis of a 12-week randomized controlled trial of adults with opioid use disorder who recently initiated buprenorphine. Weekly study visits included self-report of daily buprenorphine adherence over the past 7 days (Timeline Follow Back method) and urine drug tests (UDT). A log-linear regression model accounting for clustering by participant was used to assess the association between buprenorphine adherence and illicit opioid use. Buprenorphine adherence was measured as a continuous variable (0-7 days).Results: Among 78 participants (56 men, 20 women, 2 nonbinary) with 737 visits, full 7-day adherence was reported at 70% of visits. The predominant form of non-adherence was missed doses (92% of cases). Each additional day of adherence was associated with an 8% higher rate of negative UDT for illicit opioids (RR = 1.08; 95% CI:1.03-1.13, p = .0002).Conclusion: In this sample of participants starting buprenorphine, missed doses were not uncommon. Fewer missed days was significantly associated with a lower risk of illicit opioid use. These findings suggest that efforts to minimize the number of missed days of buprenorphine are beneficial for treatment outcomes.

Epistemic citizenship under structural siege: a meta-analysis drawing on 544 voices of service user experiences in Nordic mental health services

This paper presents a meta-analysis, drawing exclusively on qualitative research (n = 38), which contributes to findings on mental health service user experiences of received provisions and/or encounters in contemporary social and mental health services in the Nordic countries. The main objective is to identify facilitators of, and barriers to, various notions of service user involvement. Our findings provide empirical evidence regarding service users' experiences of participation in their encounters with mental health services. We identified two overarching themes, professional relations and the regulative framework and current rule and norm system, in the reviewed literature concerning facilitators and hindrances of user involvement in mental health services. By including the interrelated policy concept of 'active citizenship' and theoretical concept of 'epistemic (in)justice' in the analyses, the results provide foundations for broader exploration and problematization of the policy ideals of what we call 'epistemic citizenship' and contemporary practices in Nordic mental health organizations. Our conclusions include suggestions that linking micro-level experiences to organizational macro-level circumstances opens up avenues for further research on service user involvement.

Smartphone Apps for Problem Gambling: A Review of Content and Quality

Purpose of review

Problem gambling can have profound consequences for affected individuals, yet only a small proportion of people with problem gambling seek treatment. Mobile phone applications (apps) may provide an effective and scalable therapeutic option. The purpose of this study was to evaluate publicly available mobile apps aimed at improving problematic gambling behavior.

Recent findings

To date, there are no published studies that have evaluated the quality of publicly available smartphone apps for problem gambling in the US. There is thus a significant gap in knowledge of existing apps for addressing problem gambling.

Summary

This study included a review of 14 problem-gambling-specific apps. Apps that incorporated cognitive-behavioral therapy concepts and in-app communities were associated with better aesthetics and information quality scores. Additionally, in-app communities were associated with better engagement scores. Our results highlight the importance of evidence-based and engaging features in apps designed to help people with problem gambling.

Leveraging Digital Technology to Support Pregnant and Early Parenting Women in Recovery from Addictive Substances: A Scoping Review

Little is known about digital health interventions used to support treatment for pregnant and early parenting women (PEPW) with substance use disorders (SUD).

METHODS

Guided by the Arksey and O'Malley's Scoping Review Framework, empirical studies were identified within the CINAHL, PsycInfo, PubMed, and ProQuest databases using subject headings and free-text keywords. Studies were selected based on a priori inclusion/exclusion criteria, and data extraction and descriptive analysis were performed.

RESULTS

A total of 27 original studies and 30 articles were included. Varying study designs were used, including several feasibility and acceptability studies. However, efficacious findings on abstinence and other clinically important outcomes were reported in several studies. Most studies focused on digital interventions for pregnant women (89.7%), suggesting a dearth of research on how digital technologies may support early parenting women with SUD. No studies included PEPW family members or involved PEPW women in the intervention design.

CONCLUSIONS

The science of digital interventions to support treatment for PEPW is in an early stage, but feasibility and efficacy results are promising. Future research should explore community-based participatory partnerships with PEPW to develop or tailor digital interventions and include family or external support systems to engage in the intervention alongside PEPW.

The development and validation of the pandemic medication-assisted treatment questionnaire for the assessment of pandemic crises impact on medication management and administration for patients with opioid use disorders

Pandemic and the globally applied restriction measures mainly affect vulnerable population groups, such as patients with opioid use disorders. Towards inhibiting SARS-Cov-2 spread, the medication-assisted treatment (MAT) programs follow strategies targeting the reduction of in-person psychosocial interventions and an increase of take-home doses. However, there is no available instrument to examine the impact of such modifications on diverse health aspects of patients under MAT. The aim of this study was to develop and validate the PANdemic Medication-Assisted Treatment Questionnaire (PANMAT/Q) to address the pandemic effect on the management and administration of MAT. In total, 463 patients under ΜΑΤ participated. Our findings indicate that PANMAT/Q has been successfully validated exerting reliability and validity. It can be completed within approximately 5 min, and its implementation in research settings is advocated. PANMAT/Q could serve as a useful tool to identify the needs of patients under MAT being at high risk of relapse and overdose.

Adolescents' lived experiences of substance abuse in the Greater Giyani Municipality

BACKGROUND

 Adolescence is a unique and distinct stage of development that involves changes in the physical, psychological and social aspects of adolescents. It is a critical transition into adulthood whereby heightened risk-taking and sensation-seeking takes place, such as substance abuse. In a South African context, this transition sometimes occurs under economic stress, poverty, unemployment, high levels of crime and political instability. This can place adolescents at risk of substance abuse.

OBJECTIVES

 To explore and describe the lived experiences of adolescents abusing substances in the Greater Giyani Municipality in the Limpopo province, South Africa.

METHOD

 A qualitative, exploratory, descriptive and contextual research design with a phenomenological approach was used. Data were collected through individual, in-depth, phenomenological interviews and field notes. Thematic coding was utilised to analyse the collected data, and literature was reviewed to support the findings. Moreover, measures to ensure trustworthiness and ethical principles were applied throughout the research process.

RESULTS

 Five themes were identified: substance abuse behaviour among adolescents, adolescents' motivation for continuing substance abuse, the effects of substance abuse on the lives of adolescents, factors affecting adolescents' discontinuation of substance abuse and a need to discontinue substance abuse.

CONCLUSION

 The study concluded that adolescents abusing substances in the Greater Giyani, Limpopo province, experience loss of control, broken relationships, poor academic performance, stigma attached to mental illness and negative emotions. The adolescents foresaw their future as uncertain and without direction. It is recommended that mental healthcare professionals introduce and implement interventions that will assist the adolescents who abuse substances in the Greater Giyani, Limpopo province.Contribution: The findings in this study could add knowledge in developing and implementing of strategies for psychiatric nurses to support adolescents abusing substances in the Greater Giyani, Limpopo province.

Collective Motivational Interviewing for Individuals with Drug Use Problems: A Pre-Post-Follow-Up, Uncontrolled Pilot Study

Collective motivational interviewing (CMI) is a novelty motivational approach which optimises the motivational interviewing (MI) for individuals from collectivistic cultures. While MI has been empirically tested as an effective intervention for addictive disorders and has had a positive effect on facilitating lifestyle changes, CMI has retained the potency of MI as an individualistic intervention, and it further invites the social network resources to strengthen the level of motivation and cultivate a joint change partnership. This pilot study was the first clinical study of CMI to work with individuals with drug use problems (IDUPs) by involving concerned significant others (CSOs) in the three-session intervention, and the fidelity control was assessed by the Collective Motivational Interviewing Treatment Integrity (CMITI) scale. This pre-post−follow-up and uncontrolled feasibility study was conducted between 2017 and 2019, with dyads of 20 IDUPs and their CSOs. The potential impacts of CMI were examined by measures at baseline, post-intervention, and 1-month and 3-month post-intervention. All clinical sessions were audio-recorded, and four cases were randomly selected for fidelity review by two trained coders. The normality of data at the baseline was checked by a Shapiro−Wilk test. Non-parametric Wilcoxon-signed-rank test and repeated-measures ANOVA were employed for quantitative analysis. The results showed that six IDUPs had reduced drug use, and ten maintained drug abstinence with the support of CSOs, whereas four IDUPs remained unchanged or increased drug use. Overall, at the 3-month follow-up, drug use was reduced (p > 0.05), social support was strengthened (p < 0.05), and the IDUPs’ motivation for change was enhanced (p < 0.05). However, the small sample sizes, non-random sampling, and lack of control group may limit the generalizability and confirmation of the outcomes and of the “real effects”. This finding of the study suggests that the CMI is a feasible and acceptable therapeutic tool to motivate IDUPs with the support of CSOs to achieve mutually agreed-upon goals. Further development and evaluation with robust methodology are warranted.

A Systematic Review of Treatment Maintenance Strategies in Token Economies: Implications for Contingency Management

Contingency management (CM) interventions are based on operant principles and are effective in promoting health behaviors. Despite their success, a common criticism of CM is that its effects to not persist after the intervention is withdrawn. Many CM studies evaluate posttreatment effects, but few investigate procedures for promoting maintenance. Token economy interventions and CM interventions are procedurally and conceptually similar. The token economy literature includes many studies in which procedures for promoting postintervention maintenance are evaluated. A systematic literature review was conducted to synthesize the literature on treatment maintenance in token economies. Search procedures yielded 697 articles, and application of inclusion/exclusion criteria resulted in 37 articles for review. The most successful strategy is to combine procedures. In most cases, thinning or fading was combined with programmed transfer of control via social reinforcement or self-management. Social reinforcement and self-monitoring procedures appear to be especially important, and were included in 70% of studies involving combined approaches. Thus, our primary recommendation is to incorporate multiple maintenance strategies, at least one of which should facilitate transfer of control of the target behavior to other reinforcers. In addition, graded removal of the intervention, which has also been evaluated to a limited extent in CM, is a reasonable candidate for further development and evaluation. Direct comparisons of maintenance procedures are lacking, and should be considered a research priority in both domains. Researchers and clinicians interested in either type of intervention will likely benefit from ongoing attention to developments in both areas.

The physical and developmental outcomes of children whose mothers are substance abusers: Analysis of associated factors and the impact of early intervention

Background/objectives

Maternal illicit drug use is associated with negative physical and developmental outcomes for their born children. We aim to find out the incidence of different developmental problems in a cohort of Chinese children born to drug-abusing mothers, compare the physical health and developmental outcomes of the subjects recruited in the Integrated Program to the Comprehensive Child Development Service (CCDS), and to study the potential factors on their associations.

Methods

A retrospective longitudinal cohort study with frequent clinical assessments of the children's physical and developmental outcomes in a HKSAR's regional hospital from birth until 5 years old. 123 Children in Integrated Program were compared with 214 children in CCDS between 1 January 2008 and 28 February 2019. Cox regression analysis was performed to determine the possible factors associated with the developmental outcomes.

Results

Developmental delay was detected in 129 children (38.9%). CCDS group has significantly higher incidence of cognitive delay (p = < 0.001), language delay (p = < 0.001), motor delay (p = < 0.001), social delay (p = 0.002), and global delay (p = 0.002). On Cox multivariable regression analysis, integrated program (HRadj 0.53, 95% C. I. 0.34-0.84), social support (HRadj 0.45, 95% C.I. 0.25-0.80), and maternal abstinence from drug use up to 2-year post-delivery (HRadj 0.62, 95% C.I. 0.40-0.95) were significant protective factors, while male gender (HRadj 1.73, 95% C.I. 1.18-2.54) was a significant risk factor.

Conclusion

CCDS achieves early engagement of drug-abusing expectant mothers during pregnancy, and an early integrated program with multidisciplinary collaboration was an independent factor in improving the developmental outcomes of these vulnerable children.

Exploring how greenspace programmes might be effective in supporting people with problem substance use: a realist interview study

BACKGROUND

Greenspace programmes are health projects run outside in nature, typically with the aim of improving mental health. Research suggests that programmes may also be effective in supporting people with problem substance use (PSU), but there is limited understanding of the key components that make them successful for this client group. Previous work has claimed that a realist-informed intervention framework for greenspace programmes for mental health could be transferable to programmes that support people with PSU, and that this could provide insight into the causal processes within programmes. However, this claim is yet to be explored in depth. The aim of this study was to further test, refine, and consolidate the proposed framework to show how greenspace programmes could support people with PSU.

METHODS

Using a realist approach, 17 participants (8 programme staff; 9 wider stakeholders) were interviewed about contexts, mechanisms, and outcomes (CMOs) relative to greenspace programmes for mental health and PSU. Semi-structured interviews were used since they facilitated exploration of the proposed framework but were flexible enough to allow identification of new CMOs for framework refinement. Interviews were audio-recorded, fully transcribed, and analysed inductively and deductively against the proposed framework.

RESULTS

Findings supported the proposed framework and indicated that greenspace programmes support people with poor mental health and PSU due to: feelings of escape; space to reflect; physical activity; self-efficacy; feelings of purpose; relationships; and shared experiences. However, data showed that programmes must also consider: explicit intervention focus to ensure adequate support for clients; existing challenges with funding and stakeholder buy-in; and the impact of COVID-19. Findings allowed development of a refined framework that shows how greenspace programmes can support people with PSU.

CONCLUSION

The findings of this project are theoretically novel and have practical relevance for those designing greenspace programmes by providing recommendations on how to optimise, tailor, and implement future interventions. Findings could be particularly relevant for academic researchers, multidisciplinary health professionals, and for those working in the third sector, developing and delivering greenspace programmes for people to improve their mental health and to support them with PSU.

Levels of impulsivity in individuals with cannabis use disorder

INTRODUCTION

Substance use disorder consists of the presence of cognitive, behavioral, and physiological symptoms, indicating continuous use of one or more substances by the individual. The literature points to the existence of a relationship between impulsive behavior, in which individuals tend to act thoughtlessly and with a lower level of planning, and consumption of substances including cannabis.

OBJECTIVES

To examine the presence and severity of impulsivity in individuals with cannabis use disorder and investigate associations between sociodemographic and clinical characteristics and impulsivity.

METHOD

Participants completed a sociodemographic data sheet and the Barratt Impulsiveness Scale (BIS-11). A total of 122 subjects with a diagnosis of cannabis use disorder participated, with a mean age of 34.46 years (standard deviation = 9.62).

RESULTS

The prevalence of high levels of impulsivity in the sample ranged from 30 to 33%; the BIS-11 total score was significantly associated with cohabitation and alcohol use. The BIS-11 scores for motor impulsivity and attentional impulsivity were also associated with consumption of alcohol. No associations were found between impulsivity and the variables age, education, use of tobacco, or use of cocaine/crack.

CONCLUSION

This study contributes to understanding of substance dependence, especially cannabis. It found presence of impulsive behavior among individuals with cannabis use disorder, which is corroborated by reports in the literature.

Examining the role of social support in treatment for co-occurring substance use disorder and posttraumatic stress disorder

Objective

Social support may be a critical mechanism in the treatment of co-occurring substance use disorder (SUD) and posttraumatic stress disorder (PTSD). However, no studies have examined how social support changes as a function of treatment or predicts treatment outcome in a Veteran population with co-occurring SUD and PTSD.

Method

The current study is a secondary analysis that examined social support over the course of treatment for co-occurring SUD and PTSD (N = 81). Analyses were conducted to examine if a) social support predicts change in substance use and PTSD symptoms, respectively, over the course of treatment and during follow-up, and b) substance use and PTSD symptoms, respectively, predicts change in social support over treatment and during follow-up.

Results

The findings revealed that between-person social support moderated decreases in substance use (B = -0.17, SE = 0.07, p = 0.017) and PTSD symptom severity (B = -0.12, SE = 0.05, p = 0.009) during treatment but not during follow-up. Within-person substance use and PTSD symptom severity predicted social support but substance use and PTSD symptoms did not moderate changes in social support during treatment or follow-up.

Conclusions

The findings highlight the critical role of social support during treatment in enhancing outcomes for individuals with co-occurring SUD and PTSD.

Relentless Stigma: A Qualitative Analysis of a Substance Use Recovery Needs Assessment

Substance use disorders (SUD) pose emotional, mental, and physical threats to persons worldwide. There is a paucity of research focused on capturing individual perspectives on supports and barriers to recovery from a SUD. This need has been identified in areas of Minnesota where a gap in evidence-based substance use support exists. A team of interdisciplinary professionals distributed a qualitative survey assessing supports and barriers to SUD recovery within recovery circles in order to inform the efforts of local organizations. This paper and online access survey was adapted from an existing survey created by Faces and Voices of Recovery. The online survey was accessed by a link and distributed to persons in recovery across Minnesota over 7 months. Data from this survey were analyzed through a consensual qualitative research (CQR) coding method. Notable themes emerged in the following domains: healthcare, environment, individual, and community. Community-wide stigma was an overarching concern, and the study yielded unique insights into stigma within healthcare and the community at-large. Barriers and support to recovery were reported. Barriers included experiencing high levels of stigma and identifying a need for community education on SUDs and recovery. Support included local recovery groups, peer recovery support, and access to healthcare and medication. Our findings illuminate the needs of the recovery community from the perspective of individuals with lived experience and will inform local organizations in specifying resources to help meet the identified needs. This survey may also be adapted and used around the world to inform substance use prevention, treatment, and recovery programing.

Social recovery in substance use disorder: A metasynthesis of qualitative studies

ISSUES

In substance use disorder, connection to social communities plays a significant role in the recovery process. The aim here has been to identify and synthesise the qualitative research examining the process of social recovery from a first-person perspective and how social communities assist in this process.

APPROACH

Metasynthesis using the following databases: CINAHL, Embase, MEDLINE, PsycINFO, Scopus, SocIndex and Web of Science. The search returned 6913 original articles, of which 18 met the following criteria: examining the experience of social recovery from a first-person perspective and how social communities support this process, age of 18+, recovery of at least 12 months, in an English-language peer-reviewed journal. Review protocol registration: PROSPERO (CRD42020190159).

KEY FINDINGS

The persons in recovery emphasised communities that they perceived as being safe and non-stigmatising. These are qualities that contributed to positive self-change, and these communities were perceived as suitable arenas in which to confront responsibility and trust. Additionally, participants found that their relationship skills were improving due to the new social bonds forged in these communities. A sense of citizenship was gained along with a regaining of social dignity through voluntary work and giving back to society.

IMPLICATIONS

The pivotal role of the social community identified in this review underscores the importance of recognising and supporting persons in recovery's needs when connecting with such communities CONCLUSION: We propose a four-stage model to guide research into social recovery from a first-person perspective and how social communities support this process.

Examining Recovery Status Trends over 7-Years for Men and Women Clients of a Substance Use Disorder Recovery Housing Program

Adults who are homeless and/or involved in the criminal justice system have significantly higher risks of substance use disorders (SUD)s and they may have increased difficulty initiating and maintaining traditional SUD treatments. To address the needs of adults with SUDs who are homeless/criminal justice system involved the Recovery Kentucky programs were established. This study examined outcomes for this recovery housing program among an unduplicated statewide sample of men ( n=672) and women ( n = 732) clients who entered the Recovery Kentucky program and who were followed-up about 12 months after program entry across a 7-year period. Low, but similar rates of problem alcohol or illicit drug use at follow-up were found across the 7-year period. Men had higher rates of return to use than women. Further, about 40% of the clients had at least one recovery status vulnerability factor at follow-up each year of the study with no differences by gender.

Trust and collaboration between patients and staff in SUD treatment: A qualitative study of patients’ reflections on inpatient SUD treatment four years after discharge

Background and aim: Substance use disorder (SUD) is multifactorial, complex, and involves the severe problematic use of alcohol, prescription drugs, and other substances. People with SUD have long histories of perceived stigma, marginalisation, exclusion, social isolation, and shame. Moreover, patients with SUD are often treated as untrustworthy and incapable of actively participating in their treatment planning, even by healthcare and social services workers. Methods: Through in-depth interviews with former patients who have undergone SUD treatment, we explored their reflections on the treatment content. Interpretative phenomenological analysis revealed that some informants experienced aspects of the treatment as valuable, whereas others considered the same treatment useless or harmful. Results: Essential aspects of treatment were developing self-esteem and optimism about the future, developing strategies for coping with stress and challenging emotions and situations, developing relationships with family and friends, and preparing for life after inpatient treatment. Relationships with staff were described as crucial in all parts of the treatment. Conclusion: In conclusion, we suggest that a transition to a more collaborative treatment philosophy would be ethically and professionally valuable for providing support and treatment and enhancing patients’ perceptions of empowerment, inclusion, participation, and well-being on their terms, in cooperation with supportive others.

A Comprehensive Approach to Understanding Substance Use Disorder and Recovery: Former Patients’ Experiences and Reflections on the Recovery Process Four Years After Discharge from SUD Treatment

This article concerns people who have developed a substance use disorder (SUD) and sought treatment. SUD is understood as a biopsychosocial disorder. People who want to stop using substances or wish to increase their wellbeing while using substances need to undergo a recovery process. We conducted qualitative interviews with 11 former patients four years after discharge from inpatient SUD treatment in the Tyrili Foundation to explore their experiences and reflections on SUD and the recovery process. The findings indicated that recovery processes are complex, and feelings of wellbeing and success vary over time. Several interrelated aspects of life were essential for seeking a better life: Understanding own substance use; Feeling safe; Understanding the impact of close relationships; and Perceptions of participation and belonging. The informants emphasised the need for access to professional and social support during the recovery process, which, for some, will last for many years. Receiving such support is not understood as a defeat, and each person’s resources and vulnerabilities should be recognized and acknowledged. SUD and recovery should be understood using the same coherent approach—as an interplay between biological and psychological factors and social, political and cultural contexts.

Differential impacts of economic and demographic variables on substance use patterns during the COVID-19 pandemic

Background: The COVID-19 pandemic and subsequent economic crisis has provided a unique opportunity to investigate the effects of economic shifts on substance use. Existing literature on this relationship is limited and conflicting, warranting further exploration.Objective: This study aimed to identify relationships between socioeconomic status (SES), demographic variables, and substance use patterns before and after government-mandated business closures due to COVID-19.Methods: Participants were recruited based on self-reported substance use through Amazon's Mechanical Turk (MTurk). Qualifying participants (N = 315, 43% female, mean age = 35.35) reported their substance use and SES for two-week periods before and after pandemic-related business closures. Regression models analyzed relationships between substance use and study variables.Results: Regression models found that, during COVID-19 closures, greater financial strain predicted decreased benzodiazepine (β = -1.12) and tobacco (β = 1.59) use. Additionally, certain predictor variables (e.g., participants' age [β = 1.22], race [β = -4.43], psychiatric disorders including ADHD [β = -2.73] and anxiety [β = 1.53], and concomitant substance use [β = 3.38]) predicted changes in substance use patterns; however, the directionality of these associations varied across substances.Conclusion: Specific substance use patterns were significantly and differentially impacted by economic strain, psychiatric diagnoses, and concomitant substance use. These results can help direct harm reduction efforts toward populations at greatest risk of harmful substance use following the pandemic.

Exploring the experiences of clients receiving opioid use disorder treatment at a methadone clinic in Kenya: a qualitative study

BACKGROUND

Assessing the experiences of individuals on methadone treatment is essential to help evaluate the treatment program's effectiveness. This study aimed to explore the experiences of patients receiving methadone treatment at a clinic in Nairobi, Kenya.

METHOD

This study employed an exploratory qualitative study design. Through purposive sampling, participants were enrolled from individuals attending a methadone clinic for at least 2 years. Semi-structured individual interviews were used to collect data on substance use and experience before methadone treatment and experiences after starting methadone treatment, including benefits and challenges. Interviews were transcribed, and NVIVO 12 software was used to code the data using the preidentified analytical framework. Thematic analyses were utilized to identify cross-cutting themes between these two data sets. Seventeen participants were enrolled.

RESULTS

Seventeen participants were enrolled comprising 70% males, with age range from 23 to 49 years and more than half had secondary education. The interview data analysis identified four themes, namely: (a) the impact of opioid use before starting treatment which included adverse effects on health, legal problems and family dysfunction; (b) learning about methadone treatment whereby the majority were referred from community linkage programs, family and friends; (c) experiences with care at the methadone treatment clinic which included benefits such as improved health, family reintegration and stigma reduction; and (d) barriers to optimal methadone treatment such as financial constraints.

CONCLUSION

The findings of this study show that clients started methadone treatment due to the devastating impact of opioid use disorder on their lives. Methadone treatment allowed them to regain their lives from the adverse effects of opioid use disorder. Additionally, challenges such as financial constraints while accessing treatment were reported. These findings can help inform policies to improve the impact of methadone treatment.

Affective Neuroscience Contributions to the Treatment of Addiction: The Role of Social Instincts, Pleasure and SEEKING

Addiction is an illness prevalent in the worldwide population that entails multiple health risks. Because of the nature of addictive disorders, users of drugs seldom look for treatment and when they do, availability can be difficult to access. Permanence in treatment and its outcomes vary from case to case. Most models work from a multidisciplinary approach that tackles several dimensions of addictive disorders. However, the different etiological factors claim for a personalized treatment to enhance opportunities for better results. Problems in relationships with others play an important role in the etiology and the recovery process of addiction. This paper focuses on the social-environmental causes of addiction based on an affective neuroscience approach that attempts to integrate the interplay between social instincts, pleasure, and the SEEKING system in addiction. To advance toward better treatment strategies, it is pertinent to understand the limitations of the current multidisciplinary models. Acknowledging the social nature of the human brain may help to identify the quality of different types of traumatic early life experiences in drug users and how to address them in what may become a neuropsychoanalytic treatment of addiction.

Former inpatients’ narratives of substance use four years after substance use disorder treatment: A qualitative follow-up study

Aim: The aim of this study was to explore the narratives of former substance use disorder (SUD) inpatients about substance use after their discharge from long-term SUD treatment in 2017. Method: We conducted semi-structured in-depth interviews with 11 former inpatients of SUD treatment. The data were analysed using a qualitative, thematic analysis model. Findings: During the analysis, two main themes emerged pertaining to participant reflections on substance use – their experience of non-problematic substance use (that is, substance use without declining into pre-treatment levels of misuse behaviours) and problematic substance use (that is, substance use associated with destructive patterns). All participants except one had engaged in substance use after their discharge three to four years ago. The commonly used substance was alcohol, which also appeared to be the most common substance for which there was consensus among the informants regarding non-problematic use. Conclusions: Most of the participants continued to use substances in some way, and some reported that such use did not affect them negatively. Healthcare providers and therapists in SUD treatment should avoid defining a relapse or failed treatment outcome in concrete terms. What is perceived as an actual relapse or a failed treatment outcome is highly subjective. Furthermore, complete sobriety might not necessarily be the best or the only way to measure the SUD treatment stay. An improvement in the quality of life and well-being, even when core symptoms are still present, may be considered a successful treatment outcome.

Strategies Adopted by Addiction Facilities during the Coronavirus Pandemic to Support Treatment for Individuals in Recovery or Struggling with a Substance Use Disorder: A Scoping Review

This review aimed to identify and synthesize strategies and actions adopted by addiction facilities to support and maintain treatment during the coronavirus disease 2019 (COVID-19) pandemic. A scoping review was conducted using the following information sources: Virtual Health Library, SCOPUS, Web of Science, PubMed, CINAHL, and Latin American and Caribbean Health Science Literature. From a total of 971 articles, 28 studies were included. The strategies to maintain the care offer were telehealth/telemedicine, counselling/screening, 24-h telephone, webinars, conducting group therapy and support among users, adaptation for electronic health records, increased methadone/naloxone dispensing, restriction in the number of medication dispensing/day, and electronic prescription and home delivery medications. These strategies can be used to support health professionals in addressing the impact of the pandemic on the treatment of those in recovery or struggling with a substance use disorder when in-person treatment is not possible.

Patient Assessments of the Factors Facilitating and Impeding User Involvement During the First Phase of Substance Abuse Treatment

User involvement in the first phase of treatment is essential for treatment satisfaction among patients with substance use disorders (SUDs). This study explores how patients perceive the first phase of specialized SUD treatment and identifies what promotes and inhibits user involvement. We used a qualitative approach, and semi-structured interviews were conducted with 14 informants admitted to a substance abuse treatment unit in central Norway. The analysis was inspired by a phenomenographical analysis approach, and 4 categories were identified as the core experiences of user involvement during the first phase of SUD treatment: (a) a new hold on life, (b) missing information, (c) the importance of a sense of community, and (d) ambivalence about the usefulness of the treatment. Overlapping elements with Aaron Antonovsky's theoretical framework of salutogenesis were used to support the main findings. The study indicates that activating personal resources (eg, the ability to envision a different life), conveying information in a matter sensitive to patients' current cognitive state, a sense of community, and therapeutic alliance are essential factors to promote user involvement in the first phase of specialized SUD treatment. Based on the findings, we suggest a salutogenesis approach to promote user involvement and provide several ways to employ this approach in the crucial first phase of specialized SUD treatment.

Service User Experiences of How Flexible Assertive Community Treatment May Support or Inhibit Citizenship: A Qualitative Study

The aim of this study was to explore and describe service user experiences of how receiving services from a Flexible Assertive Community Treatment (FACT) team may support or inhibit citizenship. Within a participatory design, individual interviews with 32 service users from five Norwegian FACT teams were analyzed using thematic, cross-sectional analysis. The findings showed that FACT may support citizenship by relating to service users as whole people, facilitating empowerment and involvement, and providing practical and accessible help. Experiences of coercion, limited involvement and authoritarian aspects of the system surrounding FACT had inhibited citizenship for participants in this study.

Part I: Dynamics of Recovery: A Meta-Synthesis Exploring the Nature of Mental Health and Substance Abuse Recovery

Recovery-oriented care has become a leading vision across countries. To develop services and communities in more recovery-oriented directions, enhanced understandings of recovery in terms of personal and social contexts are important prerequisites. The aim of this study is to explore the nature and characteristics of the experiences of recovery. The method used is a form of qualitative meta-synthesis that integrates the findings from multiple qualitative studies published by one research group. Twenty-eight empirical papers with a focus on recovery as personal and contextual experiences were included in this meta-synthesis. Five meta-themes were developed: (a) being normal, (b) respecting and accepting oneself, (c) being in control, (d) recovery as intentional, and (e) recovery as material and social. The themes describe how recovery encompasses dynamics between personal experiences and contextual dimensions. This meta-synthesis consolidated an understanding of recovery as dynamics of the self and others, and as dynamics of the self and material resources. This understanding of recovery suggests the need to work not only with the person, but also with families, networks, social systems, and local communities, thus developing mental health and substance abuse services in more collaborative, open-ended, and context-sensitive directions.

Alternative use of buprenorphine among people who use opioids in three U.S. Cities

Background: Buprenorphine is an effective treatment for opioid use disorder, yet some persons are concerned with its "alternative use" (i.e., any use unintended by the prescriber). There is limited evidence on the factors associated with alternative use of buprenorphine (AUB); in this study, we examined correlates of recent (past 6 months) AUB. Methods: Multivariable logistic regression was used to analyze survey data from a multi-site, cross-sectional study of people who use drugs (PWUD) (N = 334) in Baltimore, Maryland; Boston, Massachusetts; and Providence, Rhode Island. Results: One-fifth (20%) of the sample reported recent AUB. In adjusted analyses, significant negative correlates of AUB were female gender (adjusted odds ratio [aOR] 0.48, 95% confidence intervals [CI] 0.24-0.95), recent emergency room visit (aOR 0.45, 95% CI 0.23-0.89), and recent injection drug use (aOR 0.41, 95% CI 0.19-0.88). Significant positive correlates were alternative use of other prescription opioids (aOR 8.32, 95% CI 4.22-16.38), three or more overdoses in the past year (aOR 3.74, 95% CI 1.53-9.17), recent buprenorphine use as prescribed (aOR 2.50, 95% CI 1.12-5.55), and recent residential rehabilitation treatment (aOR 3.71, 95% CI 1.50-9.16). Conclusions: Structural and behavioral correlates of AUB may help identify PWUD at high risk of overdose with unmet treatment needs.

Experimental (Re)structuring: The Clinical Trial as Turning Point Among Medical Research Participants

Amid the growth of addiction medicine randomized controlled trials (RCTs), scholars have begun examining participants' study experiences, highlighting facilitators and barriers to enrollment. However, this work can overlook the interplay between trial participation and social-structural dimensions among people with substance use disorders linked to the social nature of use, socioeconomic marginalization, and time demands of substance procurement and use. To effectively conduct RCTs with this unique population, it is necessary to examine the broader social context of study participation. We conducted nested qualitative interviews with 22 participants involved in an RCT testing a treatment for alcohol and opioid use disorders in HIV clinics. Thematic analyses revealed social-structural circumstances shaping RCT participation as well as how participation constitutes a turning point, prompting individuals to reconfigure social networks, reorient to spatial environments, and reorganize day-to-day life-with implications for how substance use disorder RCTs should be approached by researchers.