What Is Recovery?

Oral versus long-acting injectable antipsychotics in schizophrenia spectrum disorders: A systematic review of patients' subjective experiences

Schizophrenia spectrum disorders significantly impact daily functioning, with antipsychotic medications regarded as the gold standard treatment. However, their efficacy is often limited by side effects and adherence rates. Understanding patient perspectives and subjective experiences, particularly regarding oral versus long-acting injectable (LAI) antipsychotics, is crucial for improving medication outcomes and patient-tailored treatments. A systematic review of qualitative studies was conducted following the ENTREQ guidelines. Data were extracted from PubMed, Scopus, and PsycInfo, with thematic synthesis used to identify key themes in patient-reported experiences. Thirty-nine studies (1.477 patients) were included and analyzed, revealing three core themes: (1) perception and experience of medication, (2) social dynamics and influence, and (3) trust and communication with healthcare providers. Side effects and lack of information were often mentioned by patients. While LAI antipsychotics were linked to symptom stability and functional improvements, many patients lacked adequate information about their effects, contributing to adherence difficulties. Stigma and negative beliefs were common across both oral and LAI formulations, thus determining significant barriers to medication adherence. This review emphasizes that patients' experiences with antipsychotic medications are shaped by three key factors: the environment, the therapeutic relationship, and the drug itself. Two critical areas warrant particular attention: psychoeducation and stigma. Bridging psychoeducational gaps and addressing stigma could significantly enhance treatment adherence and outcomes. Additionally, greater emphasis on providing comprehensive and accurate information about antipsychotic treatment options is essential to support patient-centred care and informed decision-making.

"You are helping from the heart not just from the head": a systematic review and qualitative evidence synthesis of the experiences of peer workers working with people experiencing homelessness and substance use

BACKGROUND

Increasingly, substance use and homelessness services have peer workers, those with lived or living experience of substance use and homelessness, who provide support to those experiencing similar challenges. While research regarding the effectiveness of such peer workers in helping others achieve better outcomes is growing, little is known about their experiences in this role.

METHODS

A systematic review and qualitative evidence synthesis was conducted to better understand the experiences of peer workers who have lived/living experience of substance use and homelessness who are providing support to those experiencing similar challenges within substance use and homelessness settings. Nine electronic databases were searched for primary qualitative research published from 1990. Studies meeting the inclusion criteria were quality assessed using the Critical Appraisal Skills Programme checklist. Data from included studies were extracted, entered into NVivo, and analysed using a thematic synthesis approach.

RESULTS

Nine studies were identified, published from 2006 from three countries with 272 participants. Three themes were identified: peer workers' reflections on the key components of their role; peer work as enabling individual growth and recovery; and destabilising challenges peer worker growth and recovery.. Peer workers described many essential qualities, and their lived experience was valued as a way of enabling deeper trust and empathy with the people they supported. Strong relationships with other peer workers were described as important. Many benefits to the peer workers were described, including positive life changes and increased responsibility. Challenges were also identified, with professional boundaries causing particular tensions.

CONCLUSIONS

This qualitative evidence synthesis provides unique insight into the experiences of peer workers who are working at the intersection of homelessness and substance use. Their experiences highlight the real benefits that peer workers have, whilst working in challenging situations in often precarious contracts. Such insights can inform the employment of peer workers. Those employing peer workers should prioritise clear job descriptions encompassing specific peer qualities, training and education opportunities, and peer-to-peer, professional, and organisational support.

Frontal Brain N-Acetylaspartate at Treatment Entry is Related to Future World Health Organization Risk Drinking Levels in Individuals With Alcohol Use Disorder

OBJECTIVE

The purpose of this study was to assess the viability of regional brain metabolite levels of individuals with alcohol use disorder (AUD) at treatment entry as a biomarker of posttreatment levels of alcohol use, categorized according to the World Health Organization risk drinking levels (WHO-RDL).

METHOD

Eighty-five individuals initiating treatment for AUD (16 ± 13 days after last alcohol consumption) and 45 light/nondrinking controls completed a 1.5T proton multislice magnetic resonance spectroscopic imaging study. N-acetylaspartate (NAA), a marker of neuronal viability, and other metabolites were quantitated for cortical gray matter, white matter, and select subcortical regions. Individuals with AUD were classified according to their posttreatment alcohol consumption as abstainers (n = 42), low-risk (n = 20), or higher risk (n = 23) participants based on the WHO-RDL taxonomy.

RESULTS

Within frontal gray matter, higher risk participants exhibited significantly lower NAA levels than light/nondrinking controls and abstainers but did not differ from low-risk participants. Higher risk participants had significantly lower NAA concentration in frontal white matter than all groups who did not significantly differ from one another. Higher risk participants showed significantly lower parietal white matter NAA than light/nondrinking controls and abstainers; low-risk and higher risk participants did not differ from one another. Across higher risk and low risk, lower frontal gray matter and white matter NAA were related to shorter periods of abstinence before first posttreatment alcohol consumption and longer posttreatment duration of alcohol resumption. There were no significant group differences in myo-inositol or choline- or creatine-containing compound concentrations.

CONCLUSIONS

Frontal and parietal lobar NAA concentrations, near treatment entry, are associated with WHO-RDL categorized posttreatment alcohol consumption levels and may serve as predictive biomarkers of clinical outcomes following treatment for AUD.

Understanding pathways to recovery from alcohol use disorder in a Black community

Introduction

Black Americans suffer a range of health disparities rising from a long history of structural inequities and racism. Black individuals experience alcohol use disorder (AUD) at rates comparable to the general population, yet they suffer more negative consequences due to alcohol use such as illnesses, injuries, criminal-legal involvement, and social problems. The barriers they face challenge their ability to achieve recovery. However, the recovery needs of the Black population and the potential impact of racial disparities on pathways to recovery have not been examined.

Methods

We conducted semi-structured interviews with 37 participants in the Black-majority city of Detroit, Michigan, who identified as Black or African American and in recovery from AUD. Participants were 50 years old on average, 40% were women, and they reported being in recovery from alcohol for 8.4 years on average. We built upon a priori codes, using a framework analysis approach, to identify and code thematic domains related to recovery pathways.

Results

We identified four overarching themes. (1) Delayed recovery initiation largely due to systemic challenges and a lack of knowledge about recovery, resulting in the belief that recovery was not possible. (2) Once initiating recovery, many reported getting stuck in chronic early recovery due to relapse cycles that regularly involved system and individual challenges coupled with inadequate support. (3) Use of blended recovery pathways, some common in the recovery literature (e.g., Alcoholics Anonymous), and some more prevalent in Black communities (e.g., religion/spirituality). (4) The facilitators of recovery vary by recovery stage; for example, receiving support was crucial in early recovery while providing support was important for sustained recovery.

Discussion

Participants' stories emphasized the burdens experienced by this low-income Black community at personal, interpersonal, environmental and societal levels. They directly connected these burdens with the difficult mission of achieving and sustaining recovery from alcohol problems. Some challenges and recovery pathways were common in the broader population, and some, such as the impact of racism, were unique to this Black population. The results have meaningful implications for clinical treatment and recovery support improvements, to advance the recovery journeys of Black individuals with AUD.

Changes in the trajectories of drug-free friendships and substance use among a cohort of individuals with multiple substance use disorders

Aims: We used reports (n = 208) of drug-free friendships and alcohol and drug use by people diagnosed with substance use disorder in order to investigate their annual change trajectories across 4 years after treatment and the association between these trajectories and debut age and gender. Methods: The participants were recruited from the Stavanger region, Norway. Using cross-sectional analysis, we first examined the relationship between "alcohol and drug use" and "drug-free friendships" across the five follow-ups. We tested whether these associations were significant using chisquare chi-squared tests. Second, we developed three latent growth curve models examining the association between "alcohol and drug use" and "drug-free friendships". Results: Our analysis displays a stable drug-free friendships pattern across follow-ups. Only in the fourth follow-up was there a significant association between lower "alcohol and drug use" and having "drug-free friendships" (χ2 = 18.27, df = 8, p < .05). In model 1, we found no association between gender, debut age, and alcohol and drug use; model 2 had significant variance on intercept but not on slope; model 3 had good fit (χ2 = 44.33, df = 39, comparative fit index = 0.98, root mean square error of approximation = 0.027). However, we did not find any significant regression path between the "alcohol and drug use" and "drug-free friendships" slopes. Conclusions: Drug-free relationships were in the studied cohort group found to have little influence on reducing alcohol and drug use, while debut age and gender were unrelated to use trajectories across 4 years. We suggest that future research should focus on the frequency and quality of drug-free friendships and participants' friendship assessments because previous research has found such relationships to facilitate recovery.

Recovery Capital Is Associated with a Greater Likelihood of NIAAA-Defined Recovery for Adults with Prior Alcohol Problems

Background: The National Institute on Alcohol Abuse and Alcoholism (NIAAA) finalized a definition of alcohol use disorder (AUD) recovery requiring (1) remission from DSM-5 AUD symptoms except craving and (2) cessation of heavy drinking. The literature suggests that recovery capital, which encapsulates the resources that influence substance use recovery, is an important determinant of AUD recovery outcomes. However, little research has examined potential relationships between recovery capital and the NIAAA recovery definition. Objectives: This study examined associations between recovery capital and NIAAA-defined recovery. Data were drawn from a project that developed and tested a new recovery capital measure, the Multidimensional Inventory of Recovery Capital. Participants self-identifying as having resolved a prior alcohol problem for at least 30 days (N = 477, 49% cisgender female, Mage = 42.6 years) completed surveys assessing recovery capital, heavy drinking (per NIAAA guidelines), and DSM-5 AUD symptoms. Logistic regression modeling examined associations between recovery capital scores and the odds of meeting the NIAAA recovery criteria. Results: Most of the sample (80.3%) met both NIAAA recovery criteria. Total recovery capital scores were associated with greater odds of NIAAA recovery (OR = 1.61; p = .001). When examined separately, individual recovery capital domains were differentially associated with NIAAA recovery depending on recovery duration. Conclusion: Overall, findings suggest that greater recovery capital may be linked to a greater likelihood of meeting NIAAA recovery criteria.

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.

Combined pharmacological and psychosocial interventions for alcohol use disorder

BACKGROUND

Alcohol use disorder (AUD) is a mental disorder characterised by a strong desire to consume alcohol and impaired control of alcohol use, with devastating consequences. Many people with AUD do not respond to psychosocial or pharmacological interventions when these are provided alone. Combining these interventions may improve the response to treatment, though evidence remains limited.

OBJECTIVES

To assess the effects of combined pharmacological and psychosocial interventions for the treatment of AUD in adults.

SEARCH METHODS

We searched CENTRAL, MEDLINE, Embase, three other databases, and two trials registers in November 2023, without language restrictions.

SELECTION CRITERIA

We included randomised controlled trials (RCTs) comparing combined pharmacological and psychosocial interventions versus pharmacological or psychosocial interventions alone, or no intervention/treatment as usual (TAU), in adults with AUD. Our primary outcomes were continuous abstinent participants, frequency of use (measured as heavy drinkers, percentages of abstinent days, heavy-drinking days), amount of use (number of drinks per drinking day), adverse events, serious adverse events, dropouts from treatment, and dropouts due to adverse events.

DATA COLLECTION AND ANALYSIS

We assessed risk of bias using Cochrane's RoB 1 tool, performed random-effects meta-analyses, and evaluated the certainty of evidence according to the GRADE approach.

MAIN RESULTS

We included 21 RCTs (4746 participants). The most studied pharmacological and psychosocial interventions were naltrexone (81.0%) and cognitive behavioural therapy (66.7%), respectively. Most participants were men (74%), aged about 44 years, with AUD, without comorbid mental disorders or other substance use disorders; 15 RCTs detoxified participants before treatment. We judged 28.5% of the studies as at low risk of bias for random sequence generation, allocation concealment, performance bias for objective and subjective outcomes, and detection bias for subjective outcomes; all studies were at low risk of detection bias for objective outcomes; 85.7% of studies were at low risk of attrition bias; 14.2% of studies were at low risk of reporting bias. 1) Compared to psychosocial intervention alone, combined pharmacological and psychosocial interventions probably reduce the number of heavy drinkers (above the clinically meaningful threshold (MID) of 2%; absolute difference (AD) -10%, 95% confidence interval (CI) -18% to -2%; risk ratio (RR) 0.86, 95% CI 0.76 to 0.97; 8 studies, 1609 participants; moderate-certainty evidence). They may increase continuous abstinent participants (MID 5%; AD 5%, 95% CI 1% to 11%; RR 1.17, 95% CI 1.02 to 1.34; 6 studies, 1184 participants; low-certainty evidence). They probably have little to no effect on: • the rate of abstinent days (MID 8%; mean difference (MD) 4.16, 95% CI 1.24 to 7.08; 10 studies, 2227 participants); • serious adverse events (MID 1%; AD -2%, 95% CI -3% to 0%; RR 0.20, 95% CI 0.03 to 1.12; 4 studies; 524 participants); • dropouts from treatment (MID 10%; AD -3%, 95% CI -5% to 0%; RR 0.89, 95% CI 0.79 to 1.01; 15 studies, 3021 participants); and • dropouts due to adverse events (MID 5%; AD 2%, 95% CI 0% to 5%; RR 1.91, 95% CI 1.04 to 3.52; 8 studies, 1572 participants) (all moderate-certainty evidence). They may have little to no effect on: • heavy-drinking days (MID 5%; MD -3.49, 95% CI -8.68 to 1.70; 4 studies, 470 participants); • number of drinks per drinking day (MID 1 drink; MD -0.57, 95% CI -1.16 to 0.01; 7 studies, 805 participants); and • adverse events (MID 30%; AD 17%, 95% CI -5% to 46%; RR 1.25, 95% CI 0.93 to 1.68; 4 studies, 508 participants) (all low-certainty evidence). 2) Compared to pharmacological intervention alone, combined pharmacological and psychosocial interventions may have little to no effect on: • the rate of abstinent days (MID 8%; MD -1.18, 95% CI -4.42 to 2.07; 2 studies, 1158 participants); and • dropouts from treatment (MID 10%; AD 1%, 95% CI -10 to 14%; RR 0.98, 95% CI 0.65 to 1.47; 3 studies, 1246 participants) (all low-certainty evidence). We are uncertain about their effect on: • continuous abstinent participants (MID 5%; AD 3%, 95% CI -5% to 18%; RR 1.22, 95% CI 0.62 to 2.40; 1 study, 241 participants); • the number of heavy drinkers (MID 2%; AD 2%, 95% CI -4% to 8%; RR 1.03, 95% CI 0.94 to 1.12; 1 study, 917 participants); • the number of drinks per drinking day (MID 1 drink; MD -2.40, 95% CI -3.98 to -0.82; 1 study, 241 participants); and • dropouts due to adverse events (MID 5%; AD -1%, 95% CI -3% to 6%; RR 0.61, 95% CI 0.14 to 2.72; 2 studies, 1165 participants) (all very low-certainty evidence). 3) We are uncertain about the effect of combined pharmacological and psychosocial interventions, when compared to TAU, on: • the number of heavy drinkers (MID 2%; AD -5%, 95% CI -13% to 2%; RR 0.93, 95% CI 0.83 to 1.03; 1 study, 616 participants); • the rate of abstinent days (MID 8%; MD 3.43, 95% CI -1.32 to 8.18; 1 study, 616 participants); • dropouts from treatment (MID 10%; AD 0%, 95% CI -10% to 15%; RR 0.98, 95% CI 0.58 to 1.65; 2 studies, 696 participants); and • dropouts due to adverse events (MID 5%; AD 3%, 95% CI 0% to 15%; RR 2.97, 95% CI 0.70 to 12.67; 1 study, 616 participants) (all very low-certainty evidence). The certainty of evidence ranged from moderate to very low, downgraded mainly due to risk of bias and imprecision.

AUTHORS' CONCLUSIONS

As implications for practice, our findings indicate that adding pharmacological to psychosocial interventions is safe and helps people with AUD recover. These conclusions are based on low- to moderate-certainty evidence. Given the few studies and very low-certainty evidence, any benefits of adding psychosocial to pharmacological interventions or comparing the combined intervention to TAU are less clear. As implications for research, further studies should investigate the effects of the combined intervention compared to pharmacotherapy or TAU.

Advancing peer support workforce research: Insights and recommendations through the lens of professionalization

Over the past two decades, peer support providers have increasingly formalized their roles in the addiction treatment workforce through credentialing and professionalization efforts. Despite these advancements, misconceptions regarding their professional identity persist and contribute to challenges such as burnout and high turnover. This commentary underscores the importance of viewing the peer workforce as an emerging profession using a lens that has previously been applied to other healthcare service roles. We outline key milestones in the peer workforce's professional development and ongoing labor advocacy efforts by state and national organizations. We call for a comprehensive research agenda that addresses workforce outcomes, workplace dynamics, and role competencies. Such efforts are crucial for advancing the recognition and support of peers as an integral component of the behavioral healthcare workforce.

Problem Recognition as A Discrete Concept for Change Processes in Problematic Alcohol Use

Purpose of review

Alcohol problem recognition reflects the extent to which a person with any level of problematic alcohol use (PAU), including hazardous alcohol use, acknowledges the associated risks/harms as potentially/actually problematic with a relative degree of objectivity. Notably, alcohol problem recognition is typically low amongst people with PAU not engaged in treatment or support. This review evaluates existing PAU problem recognition measures and related concepts such as ambivalence, readiness to change, motivation, cognitive biases and other self-evaluative appraisal processes.

Recent findings

Alcohol problem recognition has been operationalised via various measures but is often conflated with other related but theoretically distinct concepts. Limited conceptual work examines the nature of problem recognition as a discrete concept and its function in relation to behaviour change outcomes and key variables.

Summary

Problem recognition is proposed as an important theoretically distinct process that warrants further conceptual development and testing for advancing understanding of change processes across the PAU spectrum.

A within-person investigation of recovery identity following substance use disorder: examining the impact of recovery-focused social contexts

Background

The social identity model of recovery (SIMOR) posits that adopting a recovery identity is vital for achieving favorable recovery outcomes. Until now, no studies have investigated recovery identity as a dynamic construct, although recent findings suggest it fluctuates from one day to the next. The present study examines the within-person association between recovery identity and sense of meaningfulness-an aspect of holistic recovery wellbeing. Because recovery-focused social contexts exist to support individuals' recovery wellbeing, we assessed the moderating impact of two such contexts (recovery community centers [RCCs] and recovery meetings) as same-day moderators.

Methods and materials

91 RCC visitors across Pennsylvania completed daily diary surveys for 10 evenings. Daily measures of recovery identity, meaningfulness, recovery meeting and RCC attendance were analyzed in a multilevel Tobit model (to address right-censoring in the outcome data).

Results

Results indicated both day-level recovery identity (b = 0.79, SE = 0.04, p < 0.001) and person-level recovery identity (b = 0.94, SE = 0.11, p < 0.001) were positively associated with daily meaningfulness. Although the day-level interaction with RCC attendance was not significant (b = -0.11, SE = 0.14, p = n.s.), the interaction with recovery meeting attendance was (b = -0.27, SE = 0.13, p = 0.039), suggesting that meeting attendance buffered the effect of recovery identity on meaningfulness. A simple slopes analysis indicated that the relationship of recovery identity with meaningfulness was still statistically significant and positive in both cases (attended: b = 0.56, SE = 0.08, p < 0.001; not attended: b = 0.87, SE = 0.06, p < 0.001).

Conclusion

These results suggest that people reporting stronger recovery identity also reported greater day-to-day meaningfulness. Further, on any given day for an individual, meaningfulness was higher on days recovery identity was stronger than usual for that individual, and lower on days when recovery identity was weaker. Meeting attendance reduced this effect, suggesting that meeting attendance may be especially helpful to recovery on days when recovery identity is low.

The phenotype of recovery XII: A reinforcer pathology perspective on associations between delay discounting and pain catastrophizing in substance use disorder recovery

BACKGROUND

Substance use disorder (SUD) and pain are highly comorbid conditions and several pain indices (e.g., pain intensity) are associated with an increased risk of relapse. However, the cognitive-emotional experience of pain (i.e., pain catastrophizing) is understudied in SUD recovery. Further, how the association between pain catastrophizing and delay discounting - a posited biomarker of addiction, impacts multidimensional aspects of SUD recovery, including remission and quality of life (QOL), has yet to be examined.

METHODS

Individuals (n = 170) in SUD recovery reporting pain were asked about their chronic pain status, completed the Brief Pain Inventory, the Pain Catastrophizing Scale, an Adjusting Amount Delay Discounting Task, and the World Health Organization QOL-BREF scale. Univariate logistic and linear regressions examined associations between delay discounting and several pain indices with remission and QOL. Mediation analyses were investigated whether pain catastrophizing mediates the relationship between delay discounting and 1) sustained remission and 2) QOL.

RESULTS

Significant negative associations were found between delay discounting (p < .001) and pain catastrophizing (p = .001) with sustained remission. Pain catastrophizing significantly mediated the relationship between delay discounting and physical QOL (p = .044), psychological QOL (p = .009), social (p = .018), and environmental QOL (p = .014). Pain catastrophizing did not mediate the relationship between DD and sustained remission.

CONCLUSION

Individuals with greater DD exhibited greater pain catastrophizing, contributing to poorer QOL in SUD recovery. Our findings support that a Reinforcer Pathology framework is useful to understanding the cognitive-emotional experience of pain within the context of SUD recovery. Interventions that target both delay discounting and maladaptive cognitive and emotional responses to pain may lessen the negative impact of pain on SUD recovery and improve SUD outcomes.

The impact of integrated care on clinical outcomes in patients with alcohol-associated liver disease: Early outcomes from a multidisciplinary clinic

BACKGROUND

We analyzed early outcomes regarding the impact of our integrated alcohol-associated liver disease (ALD) clinic on patients with ALD and alcohol use.

METHODS

We conducted a retrospective study of patients with ALD who were evaluated in our integrated clinic from May 1, 2022, to December 31, 2023. Primary outcomes included differences in baseline clinical/demographic data between patients who accepted versus declined an appointment and changes in the severity of ALD, alcohol consumption, functional status, hospital utilization, and remission in alcohol use disorder for evaluated patients.

RESULTS

Patients who declined appointments (n=66) had higher median no-show rates (15.0 [8.0,30.0] vs. 8.5 [3.25,15.0], p<0.001), social vulnerability index (0.53 [0.26,0.79] vs. 0.38 [0.17,0.63], p=0.033), and proportions of cirrhosis (78.8% vs. 59.8%, p=0.017) versus evaluated patients. Comparison of baseline to first follow-up visit for evaluated patients (n=102) demonstrated significant reductions in median AST (59.5 [41.75, 89] vs. 44.5 [33.5, 56.25], p<0.001), alanine-aminotransferase (33.5 [20,45.25] vs. 26.5 [18.75,33.0], p=0.017), total bilirubin (1.6 [0.7,3.3] vs. 1 [0.5,1.9], p=0.001), phosphatidylethanol (263 [35, 784] vs. 0 [0, 163], p<0.001), MELD-3.0 and Sodium scores for patients with alcohol-associated hepatitis and cirrhosis (16 [11, 18.75] vs. 12 [9, 14], p<0.001), 14 [9.25, 17.75] vs. 11 [8.5, 14], p<0.001), and Child-Turcotte-Pugh scores for patients with cirrhosis (9 [6, 10.5] vs. 7 [6, 9], p<0.001). The proportion of patients with active-severe alcohol use disorder significantly decreased (85.2% vs. 51.9%, p<0.001). Additionally, patients had significant reductions in emergency department utilization (incidence rate ratio of 0.64 emergency department visits/month (p=0.002) and 0.71 hospital admissions/month (p=0.025). However, after considering the false discovery rate, the reduction in hospitalization admissions/month was not statistically significant (False Discovery Rate adjusted p=0.056).

CONCLUSIONS

Our integrated approach led to reductions in liver injury, degree of liver decompensation, alcohol use, and ED utilization, and remission in AUD in a population of both non-transplant ALD and post-transplant patients.

Exploring heterogeneity in recovery from substance use disorder following mindfulness-based relapse prevention: A latent profile analysis

INTRODUCTION

Substance use disorder (SUD) recovery is heterogeneous. Yet, over the last 50 years, substance use treatment providers and researchers have often defined success as sustained abstinence from substance use. An often overlooked but equally valid pathway to recovery for persons with SUD is non-abstinent recovery. However, most of the literature on non-abstinent recovery exists for individuals with alcohol use disorder (AUD) with few studies of non-abstinent recovery for other types of SUD. Literature exploring the mechanisms that lead to non-abstinent recovery is also lacking. As such, the current study aimed to examine recovery profiles for individuals (N = 454) recruited in two randomized clinical trials comparing mindfulness-based relapse prevention with cognitive-behavioral relapse prevention and/or treatment as usual.

METHODS

Latent profile analysis empirically derived profiles of recovery following outpatient aftercare SUD treatment. Multinomial logistic regression examined associations between treatment assignment and recovery profile, including potential psychological mediators (e.g., mindfulness) and contextual moderators (e.g., annual household income).

RESULTS

Analyses supported four recovery profiles: (1) low-functioning frequent substance use; (2) low-functioning infrequent substance use; (3) high-functioning frequent substance use; (4) high-functioning infrequent substance use. There were no significant interaction effects of race or ethnicity by treatment type, or household income by treatment type, in predicting recovery profiles. Trait mindfulness, craving, and psychological flexibility failed to mediate the association between treatment assignment and recovery profile; however, there were statistically significant differences in trait mindfulness with individuals expected to be classified in the low-functioning infrequent substance use profile showing significantly lower levels of trait mindfulness compared to individuals in the two high-functioning profiles.

CONCLUSIONS

Findings suggest that recovery from SUD is heterogeneous, and profiles of recovery based on dimensions of substance use and functioning can be identified across a variety of SUD, including among people with co-occurring SUD. Additionally, trait mindfulness appears to be a differentiating factor across recovery profiles. Further research is needed to explore how psychological and social factors may moderate and influence both abstinent and non-abstinent forms of recovery.

Public perceptions of opioid misuse recovery and related resources in a nationally representative sample of United States adults

AIMS

To understand how the US public defines recovery from opioid misuse and the recovery-related resources it views as most helpful, and to compare differences by opioid misuse history and demographic characteristics.

DESIGN

Observational study of data from the nationally representative AmeriSpeak® Panel survey administered in October/November 2021.

SETTING

United States.

PARTICIPANTS

6515 adults (≥ 18 years).

MEASUREMENTS

Respondents ranked 10 definitions of recovery (religious in nature; spiritual in nature; physical/mental in nature; contributing to society; enhanced quality of life; seeking professional help; having a sense of purpose; moderate/controlled substance use; no drug use; abstaining from all substance use) and 9 resources that might contribute to recovery (primary care physician; intensive inpatient program; residential rehabilitation program; self-help group; therapist/psychologist/social worker; prescribed medication; talking to family/friends; spiritual/natural healer; faith-based organization). We explored differences in rankings by opioid misuse history (personal vs. family/friend vs. no history) and demographic characteristics (race, sex, age) using multivariable ordinal logistic regression.

FINDINGS

Seeking professional help was the most endorsed recovery definition overall [mean (M) = 6.97, standard error (SE) = 0.03]. Those with personal opioid misuse history ranked enhanced quality of life (B = 0.16, P = 0.049) and having a sense of purpose (B = 0.16, P = 0.029) significantly higher, and ranked abstaining from substance use (B = -0.20, P = 0.009) significantly lower as recovery definitions than those without a history of opioid misuse. Compared with White respondents, Black (B = 0.60, P < 0.001) and Hispanic (B = 0.55, P < 0.001) respondents defined recovery as more religious in nature. Residential rehabilitation program was identified as the most helpful resource for recovery (M = 7.16, SE = 0.02), while prescribed medication received a relatively low ranking overall (M = 4.05, SE = 0.03). Those with family/friend opioid misuse history ranked prescribed medication as less helpful than others (B = -0.14, P = 0.003).

CONCLUSIONS

The general US public's views around recovery from opioid misuse appear to focus on abstinence and formal treatment receipt, while people with a history of opioid misuse place less emphasis on abstinence and greater emphasis on other aspects of well-being.

Experiences at recovery community centers predict holistic recovery outcomes: a daily diary assessment of RCC helpfulness, meaningfulness, and recovery identity

Introduction

Recovery community centers (RCCs) offer various support services to people in addiction recovery, such as hosting mutual help meetings and sober social activities and providing employment support and recovery coaching. To date, very little is known about RCCs and their relationship with recovery outcomes, as well as how RCCs may vary in helpfulness from visit to visit. This study used a daily diary approach to assess the intraindividual variation of daily RCC helpfulness, and whether RCC helpfulness predicted the holistic recovery indices of daily meaningfulness and recovery identity.

Methods and materials

RCC attendees (analytical N = 88) from RCCs in Pennsylvania completed daily diary assessments using a smartphone application, for 10 consecutive days. If participants reported that they had spent time at the RCC that day, they then reported the perceived helpfulness of the RCC visit using 7 items. Participants also reported their daily meaningfulness and recovery identity. Ultimately, participants visited their RCC on 247/799 (30.9%) of all reported study days. Multilevel models were used to assess the hypotheses.

Results

Participants generally reported that their RCC visits were very helpful (M = 87.13 [scale of 0-100], SD = 13.26). Nearly half of the variation in RCC helpfulness was attributable to intraindividual variation (ICC = 0.51). Multilevel models revealed that both interindividual and intraindividual RCC experiences predicted increased holistic recovery outcomes, over the prior day. Individuals' mean levels of perceived RCC helpfulness, as well as person-mean-centered RCC daily helpfulness, positively predicted daily meaningfulness and recovery identity.

Conclusion

RCCs predict the holistic recovery outcomes of meaningfulness and recovery identity outcomes on the particular days that the RCCs are visited, and for the individuals who find RCCs more helpful overall. This study offers preliminary evidence to suggest that RCCs are appropriate recipients of public funding intended to support recovery in US communities.

Awareness of peers in recovery and of a campus collegiate recovery community at a university in the southeastern United States

Objective: Little is known about the extent of student awareness about collegiate recovery communities (CRCs) and of peers in recovery. Participants: A convenience sample of 237 undergraduate students from a diverse major at a private university participated in an anonymous online survey in Fall 2019. Methods: Participants reported whether they knew about the local CRC, whether they knew a peer in recovery, sociodemographic characteristics, and other information. Multivariable modified Poisson regression models were fitted to estimate correlates of awareness of the CRC and of peers in recovery. Results: Overall, 34% were aware of the CRC and 39% knew a peer in recovery. The latter was associated with being a member of Greek life, a junior or senior, using substances regularly, and personally being in recovery. Conclusions: Future research should explore ways to increase awareness of CRCs and assess the role of connections between students in recovery and peers across campus.

Key Terms and Concepts in Alcohol Use and Problems: A Critical Evaluation

Objective

Alcohol use is linked to a wide and complex range of individual and societal harms. Decisions on whether and how to address alcohol-related harms are shaped by the way in which such problems are understood, particularly through the use of language and concepts in professional and lay discourse. However, all terms and concepts have a complex set of implications which vary by context. For example, some language, particularly that associated with a historically dominant 'alcoholism' model, may be clearly harmful in some contexts (eg, via public stigma) and potentially valuable in others (eg, via facilitating recovery processes), or hold 'mixed blessings'. Careful empirical attention is required to assess the implications of key terms and concepts used in efforts to understand and address alcohol use and problems amongst the public, researchers, policy makers and practitioners.

Methods

We take an author-led and empirically informed approach to critically evaluate common terms and concepts to describe alcohol use and related constructs.

Results

We identify how alcohol-related framing and discourse is highly relevant to alcohol-related outcomes via key issues including stigma, public health goals, political and commercial interests.

Conclusions

Recommendations are made for key partners to consider in the use and evolution of key terms and concepts relating to the broad spectrum of alcohol use and problems.

A Qualitative Exploration of the Process and Experience of Change in Moving on in My Recovery: An Acceptance and Commitment Therapy Based Recovery Group for Substance Use Disorder

Moving on in my recovery (MOIMR) is a new, acceptance and commitment therapy (ACT) based group intervention to support recovery from substance use disorder. It was co-developed by, and is co-facilitated with, people in recovery. This study used a grounded theory model to understand the process of change experienced by individuals who completed the group programme. Ten individuals who were abstinent from substances following their participation in MOIMR were interviewed. The model that emerged depicted a chronological series of processes that centred around a core category of gains derived from approaching their emotional vulnerability by leaning in to discomfort (e.g., difficult internal experiences like thoughts, emotions, and physical sensations) whilst pursuing activities that aligned to what mattered to them. Initial key processes indicated that participants experienced a degree of suffering from substance use prior to engagement. Group safety was a key element in fostering connection, normalisation, and cohesion, combined with psychological understanding being significantly derived from those with a lived experience of substance misuse and addiction. Later processes reflecting core ACT mechanisms such as letting go, value-guided action, and acceptance of difficult internal experiences took time to develop; many participants reported completing MOIMR more than once as a means of understanding these components. Limitations, along with implications for clinical practice and future research are discussed.

Development and initial testing of mindful journey: a digital mindfulness-based intervention for promoting recovery from Substance use disorder

BACKGROUND/OBJECTIVES

There is a great unmet need for accessible adjunctive interventions to promote long-term recovery from substance use disorder (SUD). This study aimed to iteratively develop and test the initial feasibility and acceptability of Mindful Journey, a novel digital mindfulness-based intervention for promoting recovery among individuals with SUD.

PATIENTS/MATERIALS

Ten adults receiving outpatient treatment for SUD.

METHODS

Phase 1 (n = 5) involved developing and testing a single introductory digital lesson. Phase 2 included a separate sample (n = 5) and involved testing all 15 digital lessons (each 30- to 45-minutes) over a 6-week period, while also receiving weekly brief phone coaching for motivational/technical support.

RESULTS

Across both phases, quantitative ratings (rated on a 5-point scale) were all at or above a 4 (corresponding with 'agree') for key acceptability dimensions, such as usability, understandability, appeal of visual content, how engaging the content was, and helpfulness for recovery. Additionally, in both phases, qualitative feedback indicated that participants particularly appreciated the BOAT (Breath, Observe, Accept, Take a Moment) tool for breaking down mindfulness into steps. Qualitative feedback was used to iteratively refine the intervention. For example, based on feedback, we added a second core mindfulness tool, the SOAK (Stop, Observe, Appreciate, Keep Curious), and we added more example clients and group therapy videos. In Phase 2, 4 out of 5 participants completed all 15 lessons, providing initial evidence of feasibility. Participants reported that the phone coaching motivated them to use the app. The final version of Mindful Journey was a smartphone app with additional features, including brief on-the-go audio exercises and a library of mindfulness practices. Although, participants used these additional features infrequently.

CONCLUSIONS

Based on promising initial findings, future acceptability and feasibility testing in a larger sample is warranted. Future versions might include push notifications to facilitate engagement in the additional app features.

How recovery definitions vary by service use pathway: Findings from a national survey of adults

OBJECTIVE

How people define recovery may affect their recovery goals, service use, and ultimately their outcomes. We examined recovery definitions among adults in recovery from an alcohol use disorder (AUD) who had different service use histories.

METHOD

We analyzed online survey data from 1,492 adults with resolved lifetime AUD in "treated recovery" (any use of specialty services, such as inpatient or outpatient rehabilitation; n = 375), "assisted recovery" (any use of lay services, such as mutual-help groups, and no use of specialty services; n = 174), or "independent recovery" (no use of specialty or lay services; n = 943). Surveys assessed recovery definitions using the 39-item What Is Recovery? (WIR) scale. We compared endorsement of WIR domains and individual recovery elements across groups using survey-weighted chi-square tests and logistic regression.

RESULTS

Endorsement of WIR scale domains was significantly lower among the independent than treated and assisted groups, but few differences emerged between the treated and assisted groups. Two recovery elements were endorsed by approximately equivalent majorities of all groups: "being honest with myself" (92.7%-94.8%) and "taking care of my physical health" (87.4%-90.9%). Five additional elements were similarly endorsed by large majorities (≥ 85%) in each group, albeit at lower levels in the independent group.

CONCLUSIONS

People who have experienced AUD and have not obtained alcohol services may have a narrower definition of recovery compared to those accessing treatment or attending mutual-help groups. This suggests a need to broaden alcohol services to better match varied recovery definitions; however, some highly endorsed elements suggest commonalities across recovery pathways. (PsycInfo Database Record (c) 2024 APA, all rights reserved).

Evaluating the effectiveness of recovery-oriented interventions for youth who vape nicotine: a systematic review protocol

INTRODUCTION

The increase in nicotine vaping among youth has emerged as a critical public health concern. Vaping among youth is linked to adverse health outcomes, including nicotine addiction, cardiovascular and pulmonary diseases and mental health challenges. Recently, there has been a growing demand for research to expand on treatments to enhance the recovery process from vaping nicotine in youth. To this date, no comprehensive review identifies all interventions available for vaping recovery and compares their effectiveness in youth. This proposed systematic review seeks to identify all recovery-oriented interventions for youth aged 10-24 that facilitate vaping recovery and evaluate the measured effectiveness. This review will serve to support healthcare practitioners, nurses and policymakers to further understand recovery interventions and aid in improving vaping recovery among youth.

METHOD AND ANALYSIS

This protocol, registered with PROSPERO, adheres to the Preferred Reporting Items for Systematic Reviews and Meta-Analysis Protocol (PRISMA-P) framework, and the final review will adhere to the Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) guidelines to ensure quality and replicability. The review will comprise studies including youth aged 10-24 engaging in nicotine vaping. A comprehensive search will be conducted across MEDLINE, Embase, PsycINFO, Scopus and CINAHL, with no restrictions on the date range due to the recency of the topic. Two independent reviewers will screen the identified research for eligibility at the title and abstract levels, with any disagreements resolved by a third reviewer. The review will include randomised control trials and quasi-experimental studies. Full-text review and data extraction will be standardised and completed by the primary researcher. Additionally, studies will be assessed for quality and potential biases.

ETHICS AND DISSEMINATION

Given that this is a review of existing literature, no ethics approval is required. The focus on youth necessitates careful consideration of ethical standards. This review is committed to contributing responsibly to public health knowledge regarding youth vaping recovery. The results from this review will be disseminated through publication in an open-access, peer-reviewed journal and likely through posters and presentations at scientific conferences.

PROSPERO REGISTRATION NUMBER

CRD42024543994.

Beyond the 5-year recovery mark: Perspectives of researchers with lived and living experience on public engagement and discourse

There has been growing attention toward including people with lived and living experience (PWLLE) with substance use, substance use disorders, and recovery in public-facing activities. The goals of including PWLLE in sharing their perspectives often include demonstrating that recovery is possible, destigmatizing and humanizing people who have substance use experiences, and leveraging their lived experience to illuminate a particular topic or issue. Recently, the National Council for Mental Wellbeing issued a set of guidelines entitled, "Protecting Individuals with Lived Experience in Public Disclosure," which included a "Lived Experience Safeguard Scale." We offer the present commentary to bolster some of the ideas presented by the Council and to articulate suggested changes to this guidance, with the goal of reducing unintentional gatekeeping and stigma. Specifically, we offer that there are numerous problems with the recommendation to only invite people who have "five or more years of sustained recovery" to contribute to public discourse. The idea of perceived stability after five years of abstinence is not new to us or the field. We suggest that this idea excludes people who have experienced the present rapidly changing substance use landscape, people who have briefly returned to use, some young people, and people with living experience who also can valuably contribute to public discourse. We offer alternative guidelines to the National Council for Mental Wellbeing and others seeking to promote practices that are inclusive to the diversity of PWLLE.

The mindful resiliency in recovery model: empowering the transcendence of stigma

Introduction

Mindfulness-based interventions show unique promise in treating substance use disorders among marginalized populations who face heightened stigma. The Mindful Resiliency in Recovery Model is introduced as a novel theoretical framework articulating how mindfulness training can mitigate the adverse effects of stigma, enhance psychological resilience, and facilitate sustained recovery from addiction.

Methods

The current manuscript synthesizes various models of mindfulness processes, stigma, and substance use disorder recovery to propose an integrated theoretical framework on the promise of mindfulness-based interventions in supporting recovery. Further, the current manuscript draws upon empirical literature to establish preliminary support for the premises and hypotheses of the Mindful Resiliency in Recovery Model concerning the mechanisms influencing the efficacy of mindfulness-based interventions among marginalized individuals.

Results

Preliminary evidence supports the premises of the proposed model. There is evidence to suggest that specific processes like increased present-moment awareness, acceptance, decentering, reappraisal, and savoring may be especially salient in mitigating internalized stigma and fostering resiliency in recovery. There is a need for additional research on these processes, and contextual factors that may moderate their efficacy.

Discussion

The Mindful Resiliency in Recovery Model has significant implications for optimizing mindfulness-based interventions to empower marginalized individuals to transcend stigma and actualize their capacity for wellbeing in substance use disorder recovery. It provides a roadmap for future research on the mechanisms and contextual factors affecting the efficacy of mindfulness-based interventions for marginalized and stigmatized communities. It further offers guidance to clinicians utilizing mindfulness-based interventions to support individuals experiencing stigma.

Reasons for not seeking alcohol treatment among a sample of Florida adults with HIV who perceived the need for treatment

BACKGROUND

A minority of people who need alcohol treatment receive it. Unhealthy alcohol use is common among people with HIV (PWH) and can lead to negative health outcomes. The aims of this multi-methods study are to (1) quantitatively describe the prevalence, psychosocial characteristics, and demographic traits of a sample of PWH currently receiving HIV care in Florida who had a self-reported need for alcohol treatment but did not seek care and (2) qualitatively explore reasons why PWH did not seek treatment.

METHODS

PWH enrolled in the Florida Cohort Study between October 2020 and February 2023 who had drinking history (N = 487) completed a cross-sectional survey that asked if there was a time when they recognized they needed help for their drinking but did not seek it. If yes, they were asked an open-ended follow-up question about reasons why they did not seek care. Demographic and behavioral differences between those who did and did not endorse a time when they needed alcohol treatment were determined using multivariable logistic regression, while qualitative data were analyzed with thematic analysis based in the Social-Ecological Model to assess reasons for not seeking care at the individual, social, and systems levels.

RESULTS

A quarter of PWH (n = 129) with lifetime drinking indicated a time they needed care but did not seek it. Patients who endorsed a time where they perceived the need for treatment but did not seek it were more likely to endorse current at-risk drinking and a history of ever trying to reduce their drinking or formally seek professional alcohol treatment. The most common reasons participants did not seek care were individual level factors and included shame, denial, fear, wanting to do it on their own, not feeling ready, and not wanting to seek care.

CONCLUSIONS

PWH experienced barriers largely at the individual level that prevented them from seeking alcohol treatment despite a recognized need, though many eventually sought care. Providers and public health professionals should consider helping to address various barriers, particularly internal barriers, when designing interventions to help PWH seek care.

The day-level effects of recovery community center attendance on indicators of recovery wellbeing and risk

BACKGROUND

Recovery community centers (RCCs) are a relatively new resource in the recovery support landscape aimed at building their members' recovery capital. In recent years, interest in the value of RCCs has grown, however, no studies have used within-person methods to consider how RCCs may impact the day-to-day lives of their attendees. Using within-person data drawn from members of RCCs, this study examined how visiting RCCs was associated with several same-day indicators of recovery wellbeing and risk: daily sense of meaningfulness, recovery identity, negative affect, and positive affect.

METHODS

Participants were 94 visitors of six RCCs in western Pennsylvania. Daily diary methods collected 10 nightly reports of daily RCC attendance and end-of-day meaningfulness, recovery identity, negative affect, and positive affect. Multilevel modeling accounted for nesting in the intensive longitudinal data. In independent models, the study regressed meaningfulness, recovery identity, negative affect, and positive affect onto day- and person-level RCC attendance.

RESULTS

Within-person associations between RCC attendance and meaningfulness (b = 6.96, SE = 1.66, p < .001), recovery identity (b = 4.75, SE = 1.08, p < .001), and PA (b = 3.82, SE = 1.45, p < .01) were significant, although NA was not (b = -2.41, SE = 1.34, n.s.). All day- by person-level RCC attendance interactions (in preliminary models) and between-person associations were non-significant across recovery outcomes.

CONCLUSIONS

The results indicated that on days participants visited RCCs, they reported significantly higher levels of meaningfulness, recovery identity, and positive affect, although negative affect levels did not significantly differ. Also, those who attended RCCs more frequently did not generally report different levels of recovery wellbeing and risk. Taken together, results suggest visiting RCCs works on a daily basis to support interpersonal processes related to positive recovery outcomes. That RCC visits do not appear to reduce negative affect suggests that additional programs may be needed to address negative affect. The within-person design provided insight into the dynamic processes that contribute to the intrapersonal states that support recovery and a practical approach to examining whether and how RCCs might support recovery. By using individuals as their own controls, the study design provided strong counterfactual inference.

Observations of substance use treatment engagement during the period of community re-entry following residential treatment

BACKGROUND

The period of community re-entry following residential substance use treatment is associated with elevated risk for return to substance use. Although continuity of care is best practice, many individuals do not engage in follow-up treatment, struggle to engage in follow-up treatment, or continue to use substances while participating in follow-up treatment. There is a need to both characterize treatment engagement during community re-entry following residential substance use treatment as well as understand how treatment impacts substance use during this high-risk period.

METHOD

This observational study used retrospective self-report to examine treatment engagement and substance use among individuals who had exited residential substance use treatment. Participants completed a Timeline Follow-back interview reporting substance use and treatment engagement in the 30 days following residential treatment.

RESULTS

Most participants (83.1 %) reported engaging in substance use treatment following discharge. The most common treatments were Alcoholics Anonymous/Narcotics Anonymous (61.1 %), medication for addiction treatment (40 %), and outpatient therapy (29.2 %). Participants were less likely to use substances on a day in which they engaged in outpatient therapy (OR = 0.32, 95 % CI [0.12, 0.90], p = 0.030) and more likely on days they engaged in medication treatment (OR = 21.49, 95 % CI [1.46, 316.74], p = 0.025).

CONCLUSION

Findings characterize engagement in substance use treatment in the month following residential treatment. Treatment engagement was common during community re-entry; however, only outpatient therapy was found to reduce substance use during this high-risk period. Findings may inform intervention efforts during the high-risk period of community re-entry.

Agreement for Recovery: First Spanish Consensus on the Concept of Alcohol Addiction Recovery

INTRODUCTION

Current literature does not dispose from a widely accepted definition of recovery in alcohol use disorder (AUD), and most proposals originate from anglophone countries. This study introduces a pioneering consensus in Spain on the definition of recovery in AUD.

METHOD

The Delphi method was used. The expert panel, comprising 54 multidisciplinary professionals from the Community of Madrid.

RESULTS

A high level of consensus (≥80% agreement) was reached for 45% of the items and majority (≥60%) for 84%. Recovery is understood as a dynamic, personalized, and voluntary process, potentially enduring throughout one's lifespan. It entails a transformative lifestyle shift aimed at achieving a significant improvement in overall quality of life, encompassing physical and mental health, interpersonal relationships, and environmental factors. The journey of recovery is marked by heightened psychological well-being, is characterized by empowerment, personal growth, existential purpose, and positive identity reconstruction. Recovery is supported by substance use management, requires proactive individual agency and involves both personal and societal responsibilities.

CONCLUSIONS

This study represents a milestone as it is the first consensus in the Community of Madrid on the meaning of recovery in AUD. The proposed definition of recovery could be a potential reference for similar regions within Spain or even for other countries with cultural similarities. The elucidation of a clear framework of recovery provides a solid basis for future research efforts and clinical interventions in the Spanish AUD landscape.

Self-Reported Sobriety Labels: Perspectives from Alumni of Inpatient Addiction Treatment

Background

There is a lack of consensus in the addiction field as to how to refer to alumni of residential treatment who no longer use substances or who reduce their use. In the literature, this label and broader identity are typically discussed in technical (amount and frequency of use) or social terms (environment and social network changes).

Objective

The current paper seeks to simplify the discussion by focusing on personal labels without complex technical or social considerations. Alumni of an inpatient addiction treatment facility were asked how they refer to themselves regarding their sobriety status post-discharge.

Methods

Forty-nine patients were contacted 3 months post-discharge from a residential inpatient addiction treatment (men = 67%; Mage = 47.75 years). The patients completed a post-discharge assessment that was conducted by a trained research assistant over a 20-minute video call. The current study focused on a "sobriety label" measure in which patients indicated what they want to be called. Patients also explained why they chose their answer in an open-ended question.

Results

Most patients identified as in recovery (n = 29; 59.18%) followed by a sober person (n = 7; 14.29%) and four other responses. No alum selected the in remission option, which is notably a common way to refer to patients who no longer use substances.

Conclusion

The current study adds a critical patient/alumni perspective to the existing body of literature and serves as a call to action for researchers to add a similar "sobriety label" measure to future assessments, studies, and batteries in effort to bring consistency to the labels, definitions, and identities that are published. This methodology of understanding how this population identifies will create uniformity in future literature and decrease the stigma surrounding addiction.

Endpoints for Pharmacotherapy Trials for Alcohol Use Disorder

Alcohol use disorder (AUD) is a debilitating disorder, yet currently approved pharmacotherapies to treat AUD are under-utilized. The three medications approved by the US Food and Drug Administration (FDA) for the indication of AUD are disulfiram, acamprosate, and naltrexone. The current landscape of pharmacotherapies for AUD suggests opportunities for improvement. Clinical trials investigating novel pharmacotherapies for AUD traditionally use abstinence-based drinking outcomes or no heavy drinking days as trial endpoints to determine the efficacy of pharmacotherapies. These outcomes are typically measured through patient self-report endorsements of their drinking. Apart from these traditional outcomes, there have been recent developments in novel endpoints for AUD pharmacotherapies. These novel endpoints include utilizing the World Health Organization (WHO) risk drinking level reductions to promote a harm-reduction endpoint rather than an abstinence-based endpoint. Additionally, in contrast to patient self-report measurements, biological markers of alcohol use may serve as objective endpoints in AUD pharmacotherapy trials. Lastly, the National Institute on Alcohol Abuse and Alcoholism (NIAAA) definition of recovery from AUD and patient-oriented outcomes offer new frameworks to consider endpoints associated with more than alcohol consumption itself, such as the provider-patient experiences with novel pharmacotherapies. These recent developments in new endpoints for AUD pharmacotherapies offer promising future opportunities for pharmacotherapy development, so long as validity and reliability measures are demonstrated for the endpoints. A greater breadth of endpoint utilization may better capture the complexity of AUD symptomatology.

Contingency Management for Drug Use Disorders: Meta-Analysis and Application of Tolin's Criteria

Several professional organizations and federal agencies recommend contingency management (CM) as an empirically supported treatment for drug use disorder. However, the release of the "Tolin criteria" warrants an updated recommendation. Using this methodology, five meta-analyses (84 studies, 11,000 participants) were reviewed. Two meta-analyses were rated moderate quality, and three were rated low or critically low quality. Comparator conditions included active treatment, placebo, treatment as usual, and no treatment. The primary outcome was abstinence. Considering only the moderate quality meta-analyses, the effect of CM versus control on posttreatment abstinence was d = 0.54 [0.43, 0.64] and follow-up abstinence was d=0.08 [0.00, 0.16]. A "strong" recommendation was provided for CM as an empirically supported treatment for drug use disorder.

What Is It Like to Be in Alcohol Addiction Recovery? A Dialectical Phenomenological Analysis

INTRODUCTION

Currently, there is no scientific consensus on the concept of alcohol addiction recovery beyond substance use control. This conceptual issue challenges the implementation of therapeutic strategies and mental health policies that are unrestricted to symptomatic remission. Aiming to contribute to its definition, this study aimed to examine the recovery experience of individuals with alcohol addiction using dialectical phenomenological psychopathology (DPP) as a theoretical and methodological framework.

METHODS

A dialectical phenomenological analysis was conducted through an examination of online interviews with eight Brazilian, São Paulo state citizens who were self-declared to be undergoing alcohol addiction recovery (or who declared that they had completely recovered).

RESULTS

Participants' reports generated eight categories that were subdivided into two groups. The first group indicated experiential elements of recovery, such as changes in self-relation, changes in interpersonal relations, and changes in time relations, giving new meanings to suffering and alcohol use, and recovery as a continuous process. The second group referred to how the participants interpreted recovery according to their worldviews: as a spiritual experience, moral reformation, and mentality change.

CONCLUSION

These categories can be understood through the lens of DPP as a process of change in the subjects' being in the world, characterized by the continued management of their existential imbalances in the dimensions of spatiality, temporality, selfhood, and intersubjectivity. The results are preliminary when it comes to conceptualizing recovery but may help future studies to develop recovery-oriented therapeutic strategies.

Reduced drug use as an alternative valid outcome in individuals with stimulant use disorders: Findings from 13 multisite randomized clinical trials

BACKGROUND AND AIMS

Total abstinence has historically been the goal of treatment for substance use disorders; however, there is a growing recognition of the health benefits associated with reduced use as a harm reduction measure in stimulant use disorders treatment. We aimed to assess the validity of reduced stimulant use as an outcome measure in randomized controlled trials (RCTs) of pharmacological interventions for stimulant use disorder.

DESIGN

We conducted a secondary analysis of a pooled dataset of 13 RCTs.

SETTING AND PARTICIPANTS

Participants were individuals seeking treatment for cocaine or methamphetamine use disorders (N = 2062) in a wide range of treatment facilities in the United States.

MEASUREMENTS

We validated reduced stimulant use against a set of clinical indicators drawn from harmonized measurements, including severity of problems caused by drug use, comorbid depression, global severity of substance use and improvement, severity of drug-seeking behavior, craving and high-risk behaviors, all assessed at the end of the trial, as well as follow-up urine toxicology. A series of mixed effect regression models was conducted to validate reduction in frequency of use against no reduction in use and abstinence.

FINDINGS

More participants reduced frequency of primary drug use than achieved abstinence (18.0% vs. 14.2%, respectively). Reduced use was significantly associated with decreases in craving for the primary drug [60.1%, 95% confidence interval (CI) = 54.3%-64.7%], drug seeking behaviors (41.0%, 95% CI = 36.6%-45.7%), depression severity (39.9%, 95% CI = 30.9%-48.3%), as well as multiple measures of global improvement in psychosocial functioning and severity of drug-related problems, albeit less strongly so than abstinence. Moreover, reduced use was associated with sustained clinical benefit at follow-up, as confirmed by negative urine tests (adjusted odds ratio compared with those with no reduction in use: 0.50, 95% CI = 0.35-0.71).

CONCLUSION

Reduced frequency of stimulant use appears to be associated with meaningful improvement in various clinical indicators of recovery. Assessment of reduced use, in addition to abstinence, could broaden the scope of outcomes measured in randomized controlled trials of stimulant use disorders and facilitate the development of more diverse treatment approaches.

Exploring the Self-Care Factors for Recovery in Alcohol Use Disorder and the Role of Peer Recovery Coaches: A Qualitative Study

Self-care is important in addiction recovery, and peer recovery coaches (PRCs) play key roles in recovery. This qualitative study explored self-care factors for individuals recovering from alcohol use disorder and the role of PRCs in supporting these individuals' self-care. Individual interviews with five PRCs and five workers in community addiction management centers in South Korea were performed. Data were analyzed using content analysis. Two categories and six subcategories were derived. The two categories were "elements of self-care: preparation and practice for a new way of life" and "the roles of PRCs: recovery facilitators with differentiated competencies." The factors identified as being involved self-care were summarized as "changing one's thought process and attitude" and "practical enactment considering the situation." The effective roles of PRCs were "sharing specific and realistic information," "providing motivation," "building empathy," and "presenting role models as mentors." This study identified self-care factors that should be included in addiction recovery programs with the participation of PRCs and also identified the roles of the PRCs. Developing and applying nursing interventions with PRCs in clinical and community nursing settings is necessary.

The interdependence of substance use, satisfaction with life, and psychological distress: a dynamic structural equation model analysis

Introduction

Longitudinal studies with annual follow-up including psychological and social variables in substance use disorder recovery are scarce. We investigated whether levels of substance use, satisfaction with life, and psychological distress fluctuate across five years in relation to having drug-free friends.

Methods

A prospective naturalistic cohort study of change trajectories in a cohort of people diagnosed with substance use disorder and using multiple substances with quarterly and annual follow-up over five years. Two-hundred-and-eight patients were recruited from substance use disorder treatment in Rogaland, Norway. Out of these, 164 participants fulfilled the inclusion criteria. We used Bayesian two-level dynamic structural equation modelling. The variable 'drug-free friends' was assessed by a self-reporting questionnaire, while psychological distress was assessed using the Symptoms Checklist 90 Revised. Satisfaction with life was assessed using the Satisfaction With Life Scale while drug use was assessed using the Drug Use Disorders Identification Test.

Results

The main findings are that higher-than-average psychological distress at a three-month lag credibly predicts higher-than-normal substance use at the concurrent time point t. Substance use and satisfaction with life seem to have synchronous trajectories over time, i.e. as the first decreases the latter increases and vice versa. During the five years after treatment, the participants mainly experienced a decrease in substance use and increase in satisfaction with life.

Conclusion

Since the participants experienced positive and negative fluctuations for several years after treatment, it seems crucial to establish a dialogue with treatment professionals in order to create functional solutions for maintaining motivation and aiding recovery.

Rehabilitation Engineering: A Narrative Review on Recent Advances in Mobility Aids in India

Mobility has been characterized as the capacity to move across an environment safely, pleasantly, elegantly, and autonomously. India's current population is 1.4 billion, out of which 2.3%, i.e., 32 million people, are suffering from some kind of disability. With the rise in the geriatric population, the incidence of non-communicable and communicable diseases also rises and presents the risk of disorders that may progress to disability. People often neglect their disability and learn to live with it, even when most of them can use rehabilitation programs in conjunction with various mobility aids. Affordable access to adequate healthcare and assistive devices is limited, contributing to the challenges faced by disabled adults. Despite the potential for many disabled individuals to engage in productive work, their employment rates remain significantly lower. Mobility aids can provide significant benefits to individuals affected by a range of medical conditions, including arthritis, cerebral palsy, developmental disabilities, diabetic ulcers and wounds, fractures or broken bones, injuries, and walking impairments resulting from brain injury or stroke. Each person is different and may require help in a certain way for their disability, so choosing the most appropriate aid is crucial for the individual's well-being. Commonly used mobility aids are canes, walking sticks, walkers, and wheelchairs, with prostheses being used less commonly. With the advent of techniques such as state-of-the-art 3D printing and challenging surgeries, various Indian tech companies, along with non-governmental organizations (NGOs), have brought about many significant changes in the world of prosthesis by making it better, affordable, and accessible.

Regional cortical brain volumes at treatment entry relates to post treatment WHO risk drinking levels in those with alcohol use disorder

BACKGROUND

Abstinence following treatment for alcohol use disorder (AUD) is associated with significant improvements in psychiatric and physical health, however, recent studies suggest resumption of low risk levels of alcohol use can also be beneficial. The present study assessed whether post-treatment levels of alcohol use were associated with cortical brain volumedifferences at treatment entry.

METHODS

Individuals seeking treatment for AUD (n=75) and light/non-drinking controls (LN, n=51) underwent 1.5T magnetic resonance imaging. The volumes of 34 bilateral cortical regions of interest (ROIs) were quantitated via FreeSurfer. Individuals with AUD were classified according to post-treatment alcohol consumption using the WHO risk drinking levels (abstainers: AB; low risk: RL; or higher risk: RH). Regional volumes for AB, RL and RH, at treatment entry, were compared to LN.

RESULTS

Relative to LN, AB demonstrated smaller volumes in 18/68 (26%), RL in 24/68 (35%) and RH in 34/68 (50%) ROIs with the largest magnitude volume differences observed between RH and LN. RH and RL reported a higher frequency of depressive disorders than AB. Among RH and RL, level of depressive and anxiety symptomatology were associated with daily number of drinks consumed after treatment.

CONCLUSIONS

Volumetric differences, at treatment entry, in brain regions implicated in executive function and salience networks corresponded with post-treatment alcohol consumption levels suggesting that pre-existing differences in neural integrity may contribute to treatment outcomes. Depressive and anxiety symptomatology was also associated with brain morphometrics and alcohol use patterns, highlighting the importance of effectively targeting these conditions during AUD treatment.

Meeting-makers make meaning: alcoholics anonymous participation and personal meaningfulness

AIMS

The central aim of this study was to determine whether intentional, voluntary alcoholics anonymous (AA) participation showed any independent association with affect, over and above that which has been observed in association with other recovery-related behaviors, such as abstinence, among individuals with a history of alcohol use disorder. Additionally, we sought to determine the nature of the affective changes associated with specific dimensions of AA participation (i.e. meeting  attendance, fellowship  involvement, 12-step  work).

METHODS

Thirty abstinent alcohol use disorder individuals were recruited and evaluated. Multivariate linear regressions were used to examine associations between dimensions of AA participation, measured using the Multidimensional Mutual-Help Assessment Scale and standardized measures of affective experiences, including the Profile of Mood States, Subjective Happiness Scale, and the Twelve Promises Scale.

RESULTS AND CONCLUSIONS

Increase in AA participation was associated with higher positive affective experiences. These associations were observed independently with AA meeting  attendance and fellowship  involvement, but not 12-step work. This study's findings suggest that greater AA meeting  attendance and fellowship  involvement are correlated with enhancements in the meta-emotional experience of personal meaningfulness. This study extends evidence on AA-related changes by considering affective improvements as a primary clinical outcome, thereby laying the foundation for subsequent, more comprehensive research into the relationship between dimensions of AA participation and recovery-related affective changes.

Behavioural self-control training versus motivational enhancement therapy for individuals with alcohol use disorder with a goal of controlled drinking: A randomized controlled trial

BACKGROUND AND AIMS

Controlled drinking (CD) is an attractive treatment goal for a large proportion of individuals with alcohol use disorder (AUD), but the availability of treatment methods supporting a goal of CD is scarce. We tested if behavioural self-control training (BSCT) was superior to motivational enhancement therapy (MET) for individuals with AUD with a treatment goal of CD.

DESIGN

Randomized controlled two-group trial. Follow-ups were conducted at 12 and 26 weeks (primary end-point) after inclusion.

SETTING

Three specialized dependency care clinics in Stockholm, Sweden.

PARTICIPANTS

Two hundred and fifty self-referred adults (52% men) fulfilling criteria of AUD (DSM-5) and a stated treatment goal of CD.

INTERVENTION AND COMPARATOR

BSCT (n = 125), a five-session treatment based on cognitive behavioural therapy versus the active comparator, MET (n = 125), containing four sessions based on Motivational Interviewing.

MEASUREMENTS

Primary outcome measure was mean weekly alcohol consumption at the 26-week follow-up, adjusted for baseline consumption.

CONCLUSIONS

A randomized controlled trial found no evidence of a difference between behavioural self-control training and motivational enhancement therapy in reducing weekly alcohol consumption. Both groups substantially reduced consumption and behavioural self-control training was superior in reducing hazardous drinking.

Evidence-Based Assessment of Substance Use Disorder

The current review describes updated information on the evidence-based assessment of substance use disorder. We offer an overview of the state of the science for substance-related assessment targets, instruments (screening, diagnosis, outcome and treatment monitoring, and psychosocial functioning and wellbeing) and processes (relational and technical) as well as recommendations for each of these three components. We encourage assessors to reflect on their own biases, beliefs, and values, including how those relate to people that use substances, and to view the individual as a whole person. It is important to consider a person's profile of symptoms and functioning inclusive of strengths, comorbidities, and social and cultural determinants. Collaborating with the patient to select the assessment target that best fits their goals and integration of assessment information in a holistic manner is critical. We conclude by providing recommendations for assessment targets, instruments, and processes as well as recommendations for comprehensive substance use disorder assessment, and describe future directions for research.

Prediction Rules Identify Which Young Adults Have Higher Rates of Heavy Episodic Drinking After Exposure to 12-Week Text Message Interventions

BACKGROUND

An alcohol text message intervention recently demonstrated effects in reducing heavy episodic drinking (HED) days at the three month follow-up in young adults with a history of hazardous drinking. An important next step in understanding intervention effects involves identifying baseline participant characteristics that predict who will benefit from intervention exposure to support clinical decision-making and guide further intervention development. To identify baseline characteristics that predict HED, this exploratory study used a prediction rule ensemble (PRE). Compared to more complex decision-tree methods (e.g., random forest), PREs have comparable performance, while generating simpler rules that can directly identify subgroups that do or do not respond to intervention.

METHODS

This secondary analysis examined data from 916 young adults who reported HED (68.5% female, mean age = 22.1, SD = 2.1), were enrolled in an alcohol text message randomized clinical trial and who completed baseline assessment and the three month follow-up. A PRE with ten fold cross-validation, which included 21 baseline variables representing sociodemographic characteristics (e.g., sex, age, race, ethnicity, college enrollment), alcohol consumption (frequency of alcohol consumption, quantity consumed on a typical drinking day, frequency of HED), impulsivity subscales (i.e., negative urgency, positive urgency, lack of premeditation, lack of perseverance, sensation seeking), readiness to change, perceived peer drinking and HED-related consequences, and intervention status were used to predict HED at the three month follow-up.

RESULTS

The PRE identified 12 rules that predicted HED at three months (R2 = 0.23) using 7 baseline features. Only two cases (0.2%) were not classified by the 12 rules. The most important features for predicting three month HED included baseline alcohol consumption, negative urgency score, and perceived peer drinking.

CONCLUSIONS

The rules provide interpretable decision-making tools that predict who has higher alcohol consumption following exposure to alcohol text message interventions using baseline participant characteristics (prior to intervention), which highlight the importance of interventions related to negative urgency and peer alcohol use.

A pilot, randomized clinical trial: Left dorsolateral prefrontal cortex intermittent theta burst stimulation improves treatment outcomes in veterans with alcohol use disorder

BACKGROUND

Transcranial magnetic stimulation (TMS) offers a promising treatment avenue to modulate brain function in alcohol use disorder (AUD). To the best of our knowledge, this pilot study is the first randomized, double-blind, sham-controlled trial to deliver intermittent theta burst stimulation to the left dorsolateral prefrontal cortex (DLPFC) among US veterans with AUD. We hypothesized that 20 sessions of real TMS are tolerable and feasible. As a secondary line of inquiry, we hypothesized that, relative to sham TMS, individuals receiving real TMS would experience greater reductions in 6-month relapse rates, anhedonia, and alcohol cue-reactivity.

METHODS

Veterans (n = 17, one woman) were enrolled in a double-blind, sham-controlled trial (2-3 sessions/day; 7-10 days; 600 pulses/session; 20 sessions). Pre- and posttreatment assessments included responses to self-report questionnaires and functional magnetic resonance imaging measures of alcohol cue-reactivity. Alcohol consumption was assessed for 6 months. Linear mixed-effects models were constructed to predict posttreatment craving, mood, and cue-reactivity.

RESULTS

Individuals who received active iTBS (n = 8) were less likely to relapse within 3 months after treatment than the sham-treated group (n = 9) (OR = 12.0). Greater reductions in anhedonia were observed following active iTBS (Cohen's d = -0.59), relative to sham (d = -0.25). Alcohol cue-reactivity was reduced following active iTBS and increased following sham within the left insula (d = -0.19 vs. 0.51), left thalamus (d = -0.28 vs. 0.77), right insula (d = 0.18 vs. 0.52), and right thalamus (d = -0.06 vs. 0.62).

CONCLUSIONS

Relative to sham, we demonstrate that 20 sessions of real left DLPFC iTBS reduced the likelihood of relapse for at least 3 months. The potential utility of this approach is underscored by observed decreases in anhedonia and alcohol cue-reactivity-strong predictors of relapse among veterans. These initial data offer a valuable set of effect sizes to inform future clinical trials in this patient population.

The Phenotype of Recovery X: Associations between delay discounting, regulatory flexibility, and remission from substance use disorder

INTRODUCTION

Delay discounting (DD) and self-regulation are important predictors of substance use disorder (SUD) outcomes. Further, regulatory flexibility (RF; i.e., selecting, monitoring, and adapting coping techniques based on contextual demands) is related to psychological resilience. However, studies have yet to examine associations among DD, RF, and remission from SUDs among individuals in recovery.

METHODS

Individuals (N = 148) in SUD recovery completed the Context Sensitivity Index (CSI), the Flexible Regulation of Emotional Expression (FREE) Scale, and the Perceived Ability to Cope with Trauma (PACT) Scale to assess RF and, an $1000 hypothetical reward Adjusting Amount Delay Discounting Task. The study considered individuals to be in remission from SUD if they did not endorse any SUD DSM-5 symptom other than craving (except tobacco use disorder) in the past three months. The study team used t-tests to examine differences in RF and DD by remission status. Univariate linear regressions were used to examine the relationship between RF and DD. Finally, mediation models examined the dynamic relationship among DD, RF, and remission status.

RESULTS

Remitted individuals (n = 82) had significantly lower DD (i.e., greater preference for larger, later rewards) rates (p < .001) and higher context sensitivity (p < .001) and coping flexibility (p < .001). The study found significant negative associations between DD and context sensitivity (p = .008), coping flexibility (p = .002), and emotion regulation flexibility (p < .001). Finally, context sensitivity (p = .023) and coping flexibility (p = .009) mediated the relationship between DD and SUD remission.

CONCLUSIONS

Results suggest that individuals in recovery with broader temporal windows can better identify contextual demands and flexibly cope, contributing to improved SUD recovery outcomes.

(Mis)understanding alcohol use disorder: Making the case for a public health first approach

'Alcohol use disorder' (AUD) is used by several contemporary conceptualizations to identify, treat and prevent problems associated with alcohol use. Such conceptualizations encompass diagnostic classifications and broader frameworks for policy and practice. However, current AUD concepts are subject to multiple tensions and limitations in capturing and responding to the complex and heterogeneous nature of alcohol problems. Further, public understandings of alcohol problems are heavily divergent from professional AUD concepts and remain embedded within an 'alcoholism' master narrative in which disease model stereotypes come with multiple costs for prevention and 'recovery'. The persistence of a problematic 'alcoholism' paradigm reflects the coalescing of multiple forces including the cognitive appeal of reductionism, motives to stigmatize and 'other', and an over-emphasis on AUD as an individually located biomedical problem. Public misperceptions of AUD as a matter of the individual, the individual's essence, and misconceived notions of responsibility and control have been bolstered by industry interests and the ascension of neuroscience and genetics, in turn diverting attention from the importance of the environmental and commercial determinants of health and the effectiveness of under-utilized public health policies. We call for multiple stakeholders to support efforts to prioritize a public health first approach to advancing AUD research, policy and treatment in order to make significant advances in AUD prevention and treatment. We offer several recommendations to assist in shifting public understanding and scientific limitations in AUD concepts and responses.

Associations between relapse and drinking behaviors in patients with alcohol use disorders: A 6-month prospective study

BACKGROUND

Habitual behaviors, rather than goal-oriented behaviors, mainly characterize drinking patterns in patients with alcohol use disorder (AUD). However, few studies have focused on the influence of drinking behavior on AUD relapse. This prospective study examined associations between drinking behavior patterns and alcohol-use relapse using the 20-item questionnaire for drinking behavior patterns (DBP-20).

METHODS

We enrolled patients with AUD and compared the cohort's demographic data and 6-month outcomes based on the DBP-20 and the Alcohol Use Disorders Identification Test between two groups (alcohol use relapse vs. abstinence). We also assessed the results for significant factors related to relapse.

RESULTS

We included 105 patients with AUD. More patients in the relapse group (n = 63) were active smokers and lived alone, while fewer took medication with cyanamide or disulfiram than those in the abstinence group (n = 42). The DBP-20 automaticity subscale score was higher in the relapse group than that in the abstinence group. Current smoker, living alone, and automatic drinking habits were significantly associated with AUD relapse.

CONCLUSIONS

Automaticity may be a risky drinking behavior that leads to future relapse in patients with AUD, justifying behavioral strategies to combat automatic drinking for relapse prevention.

A UK national study of prevalence and correlates of adopting or not adopting a recovery identity among individuals who have overcome a drug or alcohol problem

BACKGROUND

The concept of recovery has increasingly become an organizing paradigm in the addiction field in the past 20 years, but definitions of the term vary amongst interested groups (e.g. researchers, clinicians, policy makers or people with lived experience). Although professional groups have started to form a consensus, people with lived experience of alcohol or drug (AOD) problems use the term in a different way, leading to confusion in policy making in the UK. Greater knowledge about the prevalence and correlates of adopting a recovery identity amongst those who have overcome an AOD problem would inform clinical, public health, and policy communication efforts.

METHODS

We conducted a cross-sectional nationally representative survey of individuals resolving a significant AOD problem (n = 1,373). Weighted analyses estimated prevalence and tested correlates of label adoption. Qualitative analyses summarized reasons for adopting or not adopting a recovery identity.

RESULTS

The proportion of individuals currently identifying as being in recovery was 52.4%, never in recovery 28.6%, and no longer in recovery 19.0%. Predictors of identifying as being in recovery included current abstinence from AOD, formal treatment, recovery support service or mutual-help participation, and history of being diagnosed with AOD or other psychiatric disorders. Qualitative analyses found themes around not adopting a recovery identity related to low AOD problem severity, viewing the problem as resolved, or having little difficulty in stopping.

CONCLUSIONS

Despite increasing use of the recovery label and concept in clinical and policy contexts, many resolving AOD problems do not identify in this manner. These are most likely to be individuals with less significant histories of impairment secondary to AOD and who have not engaged with formal or informal treatment systems. The understanding of the term recovery in this UK population did not completely align with abstinence from alcohol or drugs.

Effects of media campaign videos on stigma and attitudes towards treatment seeking for alcohol use disorder: a randomized controlled study

BACKGROUND

Alcohol Use Disorder (AUD) is one of the most stigmatized diagnosis, and stigma imposes a major barrier to treatment seeking. There is a need to develop interventions that can reduce stigma and increase treatment seeking. Little is known about the effects of video materials. The aim of this study was to investigate effects of different videos. The primary outcome was public stigma, and secondary outcomes were: self-stigma, and motivation to change own alcohol use; talking to someone else about their alcohol use; seeking information about AUD treatment or seeking AUD treatment.

METHODS

This is a three-armed double blind randomized controlled study. The study included 655 Danish adults. Data was collected at a study webpage, and the survey could be completed anywhere with Internet access. After informed consent and completing baseline measures, participants were randomized, 1:1:1 ratio, to a video (video 1 n = 228; video 2 n = 198; video 3 n = 229). Video 1 and 2 have been used in a national mass media campaign and video 3 was recorded for use in the present study. Immediately after exposure, follow-up measures were completed. Outcomes were analyzed with mixed effects linear regression.

RESULTS

In total n = 616 completed follow-up (video 1 n = 215; video 2 n = 192; video 3 n = 209). Randomization to video 1 and 3 decreased public stigma measured with "Difference, Disdain & Blame Scales", while video 2 increased stigma. Video 2 compared to 1: 2.262 (95% CI 1.155; 3.369) p < 0.001. Video 3 compared to 1: -0.082 (95% CI -1.170; 1.006) p = 0.882. Video 3 compared to 2: -2.344 (95% CI -3.455; -1.233) p = 0.882. All videos reduced motivation to change own alcohol use. Participants with hazardous alcohol use, were more sensitive to the different videos, compared to low-risk alcohol use. Video 2 decreased motivation to seek information about treatment. No effects were seen on motivation to seek treatment, motivation to talk to someone else or self-stigma.

CONCLUSIONS

Videos can have an immediate effect on level of public stigma. Other types of interventions are needed to increase motivation and reduce self-stigma. To avoid adverse effects in future interventions, the use of theoretical frameworks and stakeholder involvement is emphasized.

Non-abstinent recovery in alcohol use disorder is associated with greater regional cortical volumes than heavy drinking

BACKGROUND

Harm-reduction (i.e., non-abstinent recovery) approaches to substance use treatment have garnered increasing attention. Reduced levels of alcohol consumption post-treatment have been associated with better psychosocial functioning and physical health, yet less is known regarding differences in brain structures associated with varying levels of alcohol consumption. This study investigated regional cortical volumes after alcohol use disorder (AUD) treatment among individuals who achieved complete abstinence and those who returned to lower and higher levels of consumption.

METHODS

Data were collected from individuals with AUD (n = 68) approximately 8 months after the initiation of treatment. Using risk drinking levels defined by the World Health Organization, participants were classified as abstaining (AB) or relapsing with low (RL) or higher (RH) levels. Data were also obtained from 34 age-matched light/non-drinking controls (LN). All participants completed a 1.5 T magnetic resonance imaging session and volumes for 34 bilateral cortical regions of interest were quantitated with FreeSurfer. Generalized linear models were used to examine group differences in cortical volume. All group findings are significant at an FDR-corrected value of 0.018.

RESULTS

Adjusting for age and intracranial volume, significant group differences were found in 13/34 cortical regions. AB showed greater volumes than RL in 2/13 regions and RH in 6/13 regions. RH demonstrated significantly smaller volumes than LN in 12/13 ROIs, whereas RL differed from LN in 9/13 regions. RH and RL differed in only two cortical regions.

CONCLUSIONS

Individuals who consumed low-risk levels of alcohol post-treatment exhibited regional cortical volumes more similar to abstainers than individuals who returned to higher-risk levels. This suggests that low-risk levels of alcohol consumption are associated with brain integrity that is comparable to that seen with complete abstinence. Given the previously demonstrated improvement in psychosocial and physical health with reduced levels of alcohol consumption post-treatment, harm reduction may be a beneficial and more attainable goal for some individuals with AUD who are seeking treatment.

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.

Understanding the Shared Meaning of Recovery From Substance Use Disorders: New Findings From the What is Recovery? Study

Background

Substance use disorder (SUD) resolution typically involves a long-term, comprehensive process of change now widely referred to as "recovery." Yet, definitions of recovery vary substantially, producing significant confusion. To support formal recovery definitions, we aimed to systematically identify recovery elements that are central to those in recovery and shared regardless of subgroup/pathway.

Methods

Data were from the What is Recovery? Study, involving a diverse, national, online survey of people in recovery (N = 9341). Surveys included a 35-item recovery measure reflecting 4 domains; participants reported whether or not each element definitely belonged in their recovery definitions. Analyses examined item endorsements overall and among 30 subgroups defined a priori (by sociodemographics, substance use characteristics, and help-seeking history) to determine where items met study-specific centrality thresholds (ie, endorsement by ⩾80% and top-10 ranking, by endorsement level). We then classified items as "core" if meeting centrality thresholds both overall and for all 30 subgroups, and "prevalent" if meeting centrality thresholds overall and for 26 to 29 subgroups.

Results

Four "core" recovery elements emerged, including a process of growth or development; being honest with oneself; taking responsibility for the things one can change; and reacting in a more balanced way. Four "prevalent" recovery elements also emerged, referencing the ability to enjoy life and handle negative feelings without substance use; abstinence and/or nonproblematic substance use; and living a life that contributes. Subgroups differing most in their endorsements included those reporting mild/moderate SUD severity; non-abstinent recovery; and no specialty treatment or mutual-help group attendance.

Conclusions

Recovery elements identified here partially reflect some stakeholder definitions, but offer greater specificity and include novel elements (eg, personal integrity). Elements may point to areas of functioning that are damaged in the addiction process and can support an addiction-free life. Findings should inform institutional recovery definitions; SUD services and research; and communications about recovery.