Current and Previous Residents of Self-Governed Recovery Homes: Characteristics of Long-Term Recovery

Environmental and social factors are increasingly recognized as critical aspects of recovery from alcohol and other drug abuse over the long term. This study surveyed with quantitative and qualitative methodology current (n = 79) and previous (alumni) adult residents (n = 29) of self-governed, mutually supportive recovery homes for alcohol and other drug abuse. Both groups perceived their recovery environment positively, maintained stable employment, and experienced improvements in their family relationships since being in the recovery homes. Alumni and current residents tended to stay very involved in recovery activities. Alumni were also highly involved in their previous recovery communities, and were in more beneficial circumstances than current residents based on survey results. Implications for future research are discussed.     

Attitudes Toward Addiction,Methadone Treatment,and Recovery Among HIV-Infected Ukrainian Prisoners Who Inject Drugs: Incarceration Effects and Exploration of Mediators

In this study, we use data from a survey conducted in Ukraine among 196 HIV-infected people who inject drugs, to explore attitudes toward drug addiction and methadone maintenance therapy (MMT), and intentions to change drug use during incarceration and after release from prison. Two groups were recruited: Group 1 (n = 99) was currently incarcerated and Group 2 (n = 97) had been recently released from prison. This paper’s key finding is that MMT treatment and addiction recovery were predominantly viewed as mutually exclusive processes. Group comparisons showed that participants in Group 1 (pre-release) exhibited higher optimism about changing their drug use, were less likely to endorse methadone, and reported higher intention to recover from their addiction. Group 2 participants (post-release), however, reported higher rates of HIV stigma. Structural equation modeling revealed that in both groups, optimism about recovery and awareness of addiction mediated the effect of drug addiction severity on intentions to recover from their addiction.     

How important is treatment? One‐year outcomes of treated and untreated alcohol‐dependent individuals

Aims To compare representative treatment and untreated samples of alcohol‐dependent individuals in rates of abstinence and non‐problematic use at 1‐year follow‐up. Participants and design A total of 482 alcohol‐dependent adults in a northern California county identified through a probability survey of problem drinkers in the general population (n = 111) or a survey of consecutive admissions to public and private substance abuse programs (n = 371) were interviewed in person at baseline and by telephone at 1 year. Measurements Logistic regression models were used to predict 30‐day abstinence and 12‐month non‐problematic alcohol use. Results At follow‐up, alcohol‐dependent individuals in the treatment sample had higher abstinence rates and non‐problematic use outcomes than those in the untreated general population sample. In logistic regression models of the merged samples, being in the treatment sample was related strongly and positively to abstinence and non‐problematic use. Having more drug users and heavy drinkers in one's social network, higher psychiatric comorbidity, and more social consequences were inversely related to abstinence and non‐problematic use in the treatment sample. The number of drug users and heavy drinkers in one's social network was also inversely related to abstinence in both the treatment and untreated general population samples. Results predicting non‐problematic use were similar. Conclusions These results are consistent with other studies that examine treatment effectiveness in the absence of a controlled trial. Although natural recovery also occurs, alcohol‐dependent individuals benefit from treatment. Co‐occurring psychiatric problems continue to be major barriers to treatment effectiveness. An emphasis on changing social networks to be conducive to recovery could heighten both clinical effectiveness and prevention efforts within communities.     

Recovery Networks and Community Connections: Identifying Connection Needs and Community Linkage Opportunities in Early Recovery Populations

There is a consistent evidence base showing that recovery pathways are initiated and enhanced by positive social networks and the underlying changes in social identity that is associated with the transition from stigmatized and excluded groups to positive and prosocial groups. There is also a growing literature that focuses on community engagement as a vital ingredient of recovery journeys, with engagement in recreational activities, training and employment, volunteering, and mutual aid and other peer activities seen as important components of a Recovery-Oriented System of Care (ROSC). The mechanism for identifying such community assets that has been widely used is Asset-Based Community Development (ABCD), and the process for engaging people in such groups is known as Assertive Linkage. The current article introduces two innovative research methods—social identity mapping (SIM)—and Assertive Linkage and ABCD to create a model for identifying individuals in early recovery in need of community support and strong linkage approaches. The resulting “ice cream cone” model of assertive community connections provides a practical framework for implementing one aspect of generating a ROSC, building individual recovery capital through positive networks and building community assets, underpinned by the idea of recovery capital as a metric that can be quantified and used as the basis for recovery support and planning.     

Predictors of Flexibility in Social Identity Among People Entering a Therapeutic Community for Substance Abuse

One of the key aspects of recovery from substance dependence is making a transition from a social network supportive of substance use to one that supports recovery. This study assessed this transition in social identity in an adult therapeutic community (TC) at baseline and 2 weeks into treatment. Where residents increased identification with the TC, and reduced social identification with using groups, retention in treatment improved. As retention is a proxy measure of positive outcomes, this pilot suggests that facilitating residents' positive identification with the community in the first weeks of treatment may be central to retaining residents and improving treatment outcomes.     

Factors affecting the stability of social networks during early recovery in ex-offenders

Background: Few studies have considered the retention of the individuals (alters) comprising the social networks of people in recovery. Objective: The purpose of this study was to describe factors predicting whether alters were retained 6 months after participants completed treatment. Method: The Important Person Inventory was given to 270 ex-offenders (224 men, 46 women) transitioning from treatment to Oxford House residences, Safe Haven therapeutic communities, or to usual aftercare. A 6-month follow-up was completed by 176 participants (137 men, 39 women). Results: We found that alters who were related to the participant, did not use drugs, were embedded in smaller networks, and had more frequent contact with the participant were significantly more likely to be retained as important people over 6 months. The alters’ drinking and criminal history were not significantly predictive of retention in the network. Conclusions: Certain characteristics of important people are related to their retention in a social network. Understanding these relationships and the extent to which the network change that occurs is aligned with abstinence-supporting networks is essential for creating effective social interventions for persons in recovery.     

The Role of Ego Networks in Studies of Substance Use Disorder Recovery

Those who study treatment and recovery from alcohol use disorder (AUD) and substance use disorder (SUD) generally agree that an individual’s social context affects his or her success (or failure) in recovery. Recently, as the use of social network analysis has increased, studies on SUD recovery and treatment have adopted ego networks as a research tool. This review aims to tie together a thread of research for an efficient and effective summary. The authors selected peer-reviewed articles on individuals receiving treatment an intervention for SUD or AUD that used ego network measures of individual social networks. Ego networks have been studied as treatment outcomes, predictors of treatment outcomes in general, and how an individual’s ego network might be used to predict what specific treatment is most likely to succeed. The authors discuss relevant findings of studies using ego networks, the strengths and weaknesses of ego network approaches, and how future studies may benefit from the use of ego networks.     

Maintenance factors of recovery from alcohol dependence in treated and untreated individuals

BACKGROUND: Research on natural recovery from alcohol dependence has focused mainly on triggering mechanisms of the remission process. Only a few studies have considered maintenance factors of natural recovery. METHODS: In the present study, 93 natural remitters and 42 self-help group participants were compared. Both groups remitted from alcohol dependence according to DSM-IV criteria. Several alcohol-related variables and maintenance factors of the remission process were assessed in a personal interview by using standardized questionnaires. RESULTS: Logistic regression analysis that focused on maintenance factors showed that, independent from direct self-help group context, self-help group attendees informed more individuals about their former alcohol problems and sought social support more often as a coping strategy to deal with craving. No further group differences could be identified. CONCLUSIONS: Self-help group participants revealed a higher social engagement to maintain their recovery. Besides this major difference, data support the assumption that more commonalities than differences exist within successful recoveries from alcohol dependence, independent of help-seeking status.     

Surrender and Recovery

Abstract

One year following treatment at a Minnesota-model center, alcoholics (N= 29) reported on the status of their recovery in this pilot study. On the basis of a median split on a Surrender scale, we formed two groups, High Surrender (n= 15) and Low Surrender (n= 14). Those in the High Surrender group had the higher quality of recovery, as measured by the Speer Recovery Scale. Implications for treatment are discussed.     

Relationship Between Age and Drinking Patterns and Drinking Problems Among Japanese, Japanese-Americans, and Caucasians

Comparing alcohol consumption patterns by age and gender among Japanese in Japan and Japanese-Americans and Caucasians in the United States, this study examined the associations between age and both heavy drinking and social problems using logistic regression for each ethnic group of male current drinkers. As reported in previous studies of Caucasians, men drink more alcohol than women, older respondents are more likely than younger ones to be abstainers, and the percentages of heavier drinkers and problem drinkers are higher among the young than among older people. Although Japanese-Americans reported consuming less alcohol than Caucasians, their drinking patterns by age were similar:among both United States populations, younger respondents are at higher risk for drinking problems than older respondents, even when alcohol consumption and sociodemographic variables are controlled by logistic regression. However, this association of age and drinking patterns and drinking problems is not universal. Japanese men consumed more alcohol and had a higher proportion of heavier drinkers in the middle age groups; the association between age and drinking problems also varied in this group. In addition to aging, sociocultural factors such as drinking norms probably account for the differences in drinking behavior among different age groups. This study may stimulate further cross-cultural comparison of drinking patterns and problems.     

The role of functional social support in treatment retention and outcomes among outpatient adult substance abusers

Aims The goals of this study were: (1) to compare patients with high and low functional social support at intake and 6 months later on various risk factors; (2) to test the stress‐buffering role of functional social support on treatment outcomes, and (3) to determine whether levels of functional social support at intake predicted treatment retention. Design Consecutive admissions to an outpatient treatment program were assessed at intake (n = 206) and at 6 month follow‐up (n = 172) using the Addition Severity Index (ASI). Patients completed questionnaires pertaining to social support, stress and psychological functioning both at intake and at 6 months. Findings Both high and low social support groups experienced marked declines in negative affect and in the severity of substance abuse over time. There were some group differences: for example, symptoms of depression and psychological distress were higher among patients with low social support at intake and at 6 months. Patients with low social support at intake reported higher severity of alcohol and drug abuse at 6 months. Hierarchical regression analyses showed that functional social support was a modest predictor of reductions in the severity of alcohol abuse at follow‐up, after controlling for the number of days in treatment. Higher levels of social support explained a modest (6%) proportion of the variance in alcohol‐related outcomes, but did not predict reductions in drug abuse. Survival analysis demonstrated that the rate of dropping out of treatment was significantly higher for patients with low social support. Conclusions Higher functional social support at intake is a positive predictor of retention in treatment, and a modest predictor of reductions in alcohol intake, but not in drug use. Overall, social support accounts for a small percentage of the variance in drug/alcohol‐related outcomes, underscoring the need for further research into variables accounting for treatment success and failure.     

Personality Disorder Factors Predict Recovery of Employment Functioning Among Treated Cocaine Abusers

Background: Identifying treatments that produce specific benefits in nondrug psychosocial functioning areas such as employment functioning has been illusive. Examination of dimensions of clinical status that moderate such effects may be useful in planning more effective interventions. Objectives: The purpose of this study is to determine if life stress and four dimensions of personality and psychopathology previously found to predict early post-treatment relapse in diverse groups of substance abusers, predict less recovery in employment functioning among 240 cocaine dependent males after completion of residential treatment. Methods: Latent growth curve analysis was used to determine if antisocial, avoidant, dependent, paranoid-delusional personality dimensions, and life event stress predict employment problem severity evident at drug treatment discharge and change in employment problems over three 3-month follow-up intervals. Results: Individuals with higher employment severity at intake and those who spent less time in treatment tended to have greater employment problems at the predischarge. Two covariates were significant predictors of the linear growth component, and the set of covariates explained approximately 18% of the variation in the linear growth rates. Individuals with higher paranoid/delusional scores and lower educational attainment experienced less improvement in their employment status over follow-up. Conclusions: Current findings appear consistent with those of McLellan and colleagues who found that greater psychiatric severity predicts poor response to treatment across multiple psychosocial outcomes including employment status. Clinical Significance: More intensive and long-term psychiatric treatment and vocational-educational rehabilitative services may be required for improvement in employment functioning among those with relatively severe psychopathology.     

Evaluation of a program designed to help family and significant others to motivate resistant alcoholics into recovery

Little empirical work has been done in the alcohol field on the issue of motivating reticent people into treatment. This study explored the impact of a program that involved counseling an alcoholic's social network to eventually confront the alcoholic in urging him or her to seek treatment. Twenty-four social networks (relatives plus significant others) participated in this study and of these, seven formally confronted the alcoholic. Social networks were not randomized to confronting vs nonconfronting conditions, although the comparison groups were equivalent on several important dimensions. Results indicate that alcoholics who were confronted were significantly more likely to enter an alcohol detox or rehabilitation program and to remain continuously abstinent than were nonconfronted alcoholics. This study suggests that the alcoholic's social network can be helped to become highly influential in motivating the alcoholic to seek treatment.     

The impact of drug use in social networks of patients with substance use and bipolar disorders

In this exploratory analysis, we assessed the effect of drug use among social-network members on recovery from drug dependence in patients with co-occurring bipolar disorder. Patients (n = 57) enrolled in a group therapy study completed assessments over 15 months. Patients with zero to one drug users in their social networks at intake had few days of drug use during treatment and follow-up, whereas those with ≥ 2 drug users had significantly more days of drug use. Multivariate analysis showed that patients who consistently named multiple drug users in their social networks had a marked increase in drug use over 15 months, while those who never or occasionally named multiple drug users had a small decline in drug use over time. Multiple drug users in social networks of treatment-seeking drug-dependent patients with co-occurring bipolar disorder may indicate poor drug use outcomes; efforts to reduce the association with drug users may be useful. This clinical trial has been registered in a public trials registry at clinicaltrials.gov (identifier is NCT00227838).     

‘I'm older and more interested in my community’: Older people's contributions to social capital

Aim: To explore and compare older people's contributions to social capital in a large rural community. Methods: Data were collected from a large representative sample (n= 1431), through a social capital questionnaire. The survey was cross‐sectional and measured frequency of participation across different age cohorts in informal social activities, group activities and community and civic activities. Results: Age and life stage pattern proved to be a factor in determining the types of activities people were involved in. While younger people were more involved in social participation that involved public places or group and sporting events, older people, particularly those in the retirement age group of 60–69 were more involved in community and civic activities. Conclusion: Older people living in non‐metropolitan areas are not only recipients of social capital. Their considerable involvement in volunteer groups, service clubs, church groups and local government demonstrates significant involvement in civic and community life.     

Exploring Meanings of Adolescent and Young Adult Alcohol/Other Drug Use: Perspectives of Students in Recovery

This study addresses the meanings of alcohol/other drug use for those who, during adolescence, moved beyond experimentation to dysfunctional levels of use. Interviews were conducted with 12 students in recovery from alcohol/other drug dependency, all currently participating in a university-based recovery program. Interpretive phenomenological analyses of the interviews revealed that meanings ascribed to use were extensive, complex, and intertwining. Students viewed their alcohol/other drug use in negative ways—as an escape, as a mask to feelings, and as leading to a double life. Yet they also saw it as normative, developmentally significant, and as an integral part of their social interactions.     

MOS-SF-36 in Evaluating Health-Related Quality of Life in Alcohol-Dependent Patients

Previous studies that have examined the effects of specific aspects of 12-step participation and social network composition on abstinence have focused mostly on alcohol-related outcomes and have screened out drug dependent persons. This article explores whether these predictors differentially affect abstinence based on DSM-III-R substance dependence disorder (alcohol dependence, drug dependence, and both alcohol and drug dependence). A heterogeneous community sample of treatment seekers (N = 302) randomized to day treatment programs were followed at 6 and 12 months. Bivariate and multivariate regression models were used to test whether engagement in 12-step practices and social network influences to drink or use drugs predicted total abstinence from alcohol and drugs differentially by dependence disorder. Chi-square automatic interaction detector (CHAID) segmentation analyses were then conducted to identify the specific 12-step activities and social network thresholds that best distinguished higher rates of abstinence in each dependence category. Results showed that the number of 12-step meetings attended and number of prescribed 12-step activities engaged in similarly predicted abstinence for alcoholics, drug addicts, and those dependent on both alcohol and drugs. However, specific activities were associated with abstinence differentially by dependence disorder. While many activities differentiated abstinence for drug addicts and those dependent on both alcohol and drugs, for alcoholics only two Alcoholics Anonymous (AA) activities distinguished abstinence (having a sponsor and doing service). Key predictors of abstinence (CHAID) varied by follow-up and dependence disorder, except for doing service in AA and/or Narcotics Anonymous, which was the only specific 12-step activity that was a best predictor of abstinence in all three categories one year following treatment. Thus, “giving back” to one's peer community through service work, an important 12-step belief, seems to be universally valuable later in recovery. As for social network influences, a multivariate regression model showed that having a higher proportion of abstinent individuals in the network was associated with abstinence for alcoholics at 6 months only and for drug dependent persons at 12 months only. CHAID models supported these results and provided specific thresholds for 12-step measures (e.g., >20 meetings for alcoholics, 2 or more nondrinkers in the social network, 3 or more persons supporting reduction for those dependent on both alcohol and drugs, and having 2 or more nondrinkers for those dependent on drugs only). These results support the value of treatment providers prioritizing certain 12-step-related practices and social network changes based on their client dependence profiles. Early on, those with an alcohol diagnosis need to make a commitment to meetings and obtain a sponsor; also, they need to place themselves in a network that encourages sobriety. Early on, those who are drug-dependent-only especially need to become connected with 12-step programs to the extent that they consider themselves a member, and, later, saturate themselves in a highly supportive and predominantly nondrinking environment. Alcohol and drug dependent clients need more intense ongoing 12-step involvement (sponsor and meetings) as well as having nondrinking individuals and people supportive of abstinence in their network. For all clients, doing service is especially important at the longer 12-month posttreatment timeframe.     

The efficacy of single-session motivational interviewing in reducing drug consumption and perceptions of drug-related risk and harm among young people: results from a multi-site cluster randomized trial

Aim To test whether a single session of motivational interviewing (discussing alcohol, tobacco and illicit drug use) would lead successfully to reduction in use of these drugs or in perceptions of drug‐related risk and harm among young people. Design Cluster randomized trial, allocating 200 young people in the natural groups in which they were recruited to either motivational interviewing (n = 105) or non‐intervention education‐as‐usual control condition (n = 95). Setting Ten further education colleges across inner London. Participants Two hundred young people (age range 16–20 years) currently using illegal drugs, with whom contact was established through peers trained for the project. Intervention The intervention was adapted from the literature on motivational interviewing in the form of a 1‐hour single‐session face‐to‐face interview structured by a series of topics. Measurements Changes in self‐reported cigarette, alcohol, cannabis and other drug use and in a range of drug‐specific perceptions and other indicators of risk and harm. Measurement at recruitment and follow‐up interview 3 months later. Findings A good follow‐up rate (89.5%; 179 of 200) was achieved. In comparison to the control group, those randomized to motivational interviewing reduced their of use of cigarettes, alcohol and cannabis, mainly through moderation of ongoing drug use rather than cessation. Effect sizes were 0.37 (0.15–0.6), 0.34 (0.09–0.59) and 0.75 (0.45–1.0) for reductions in the use of cigarettes, alcohol and cannabis, respectively. For both alcohol and cannabis, the effect was greater among heavier users of these drugs and among heavier cigarette smokers. The reduced cannabis use effect was also greater among youth usually considered vulnerable or high‐risk according to other criteria. Change was also evident in various indicators of risk and harm, but not as widely as the changes in drug consumption. Conclusions This study provides the first substantial evidence of non‐treatment benefit to be derived among young people involved in illegal drug use in receipt of motivational interviewing. The targeting of multiple drug use in a generic fashion among young people has also been supported.     

University Students in Recovery: Implications of Different Types of Recovery Identities and Common Challenges

Students who are in recovery from alcohol and other drug addictions face special challenges in a university setting, yet we know little about how they negotiate recovery maintenance within this context. This study focuses on recovery identity, exploring how the negotiation of recovery maintenance differs depending on the type of identity. The 15 students in the study were all in recovery from alcohol and other drug abuse. They entered the university and the campus recovery program either in the fall of 2002 or fall of 2003. Semistructured interviews were conducted multiple times during their first academic year, and for some students, at the end of their second year. Qualitative analyses indicated that the college experience differs in some ways with the type of recovery identity, but also that certain challenges are salient for all students. Implications are discussed for program development and for practitioners who work with recovering students on college campuses.