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Long COVID shares a number of clinical features with myalgic encephalomyelitis/chronic fatigue syndrome (ME/CFS), including post-exertional malaise, severe fatigue, and neurocognitive deficits. Utilizing validated assessment tools that accurately and efficiently screen for these conditions can facilitate diagnostic and treatment efforts, thereby improving patient outcomes. In this study, we generated a series of random forest machine learning algorithms to evaluate the psychometric properties of the DePaul Symptom Questionnaire-Short Form (DSQ-SF) in classifying large groups of adults with Long COVID, ME/CFS (without Long COVID), and healthy controls. We demonstrated that the DSQ-SF can accurately classify these populations with high degrees of sensitivity and specificity. In turn, we identified the particular DSQ-SF symptom items that best distinguish Long COVID from ME/CFS, as well as those that differentiate these illness groups from healthy controls., Competing Interests: Declaration of conflicting interestsThe authors declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Recovery homes are a widespread source of support for those attempting to maintain abstinence. For those who are able to remain in these settings for at least 6 months, outcomes tend to be favorable; however, many leave prematurely. There is a need to better understand the social integration processes that play a major role in giving recovery home residents access to available recovery-related social capital that is associated with better outcomes. The current study involved Oxford House recovery homes in 3 states and examined the strength of relationship ties among house members. We found that those who associated with peers who have higher recovery scores tend to improve their own recovery scores over time. However, we also found that those with higher recovery scores tended to create "strong" ties with similarly high-scoring alters; likewise lower-scoring individuals preferentially formed strong ties with each other. These findings suggest a conundrum: recovery home residents most in need of relational support from more recovered housemates are the least likely to obtain it. We discuss possible pathways to creating more ties between high and low-recovered residents., Competing Interests: Declaration of competing interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2024 Elsevier B.V. All rights reserved.)

There is limited information on the specific impacts of Long COVID in youth. Long COVID presents as persisting or new symptoms following initial COVID-19 infection. The aim of this study was to better understand how children and their families describe their experiences seeking diagnosis and support following the onset of symptoms of Long COVID. Six children and five caregivers located in the United States participated in this study. Study procedures included an online video interview with caregiver-child dyads. Interview transcriptions were then analyzed using a conventional approach to content analysis, with two independent coders generating themes. Eight themes emerged from this analysis including the severity of illness and symptomatology, difficulty surrounding the diagnostic process and not being believed, the impact on family and social connections, poor school functioning, positive coping, subsequent positive medical experiences, mental health, and knowledge of the medical field and healthcare experience. Themes revealed difficulty for youth and families in navigating the medical system and functioning in areas of daily life as well as areas of positive experiences related to coping and medical involvement. These findings also highlighted areas of needed improvement for the medical community and for research on Long COVID in youth.

A subset of patients with post-COVID-19 condition (PCC) fulfill the clinical criteria of myalgic encephalomyelitis/chronic fatigue syndrome (ME/CFS). To establish the diagnosis of ME/CFS for clinical and research purposes, comprehensive scores have to be evaluated. We developed the Munich Berlin Symptom Questionnaires (MBSQs) and supplementary scoring sheets (SSSs) to allow for a rapid evaluation of common ME/CFS case definitions. The MBSQs were applied to young patients with chronic fatigue and post-exertional malaise (PEM) who presented to the MRI Chronic Fatigue Center for Young People (MCFC). Trials were retrospectively registered (NCT05778006, NCT05638724). Using the MBSQs and SSSs, we report on ten patients aged 11 to 25 years diagnosed with ME/CFS after asymptomatic SARS-CoV-2 infection or mild to moderate COVID-19. Results from their MBSQs and from well-established patient-reported outcome measures indicated severe impairments of daily activities and health-related quality of life.    Conclusions: ME/CFS can follow SARS-CoV-2 infection in patients younger than 18 years, rendering structured diagnostic approaches most relevant for pediatric PCC clinics. The MBSQs and SSSs represent novel diagnostic tools that can facilitate the diagnosis of ME/CFS in children, adolescents, and adults with PCC and other post-infection or post-vaccination syndromes. What is Known: • ME/CFS is a debilitating disease with increasing prevalence due to COVID-19. For diagnosis, a differential diagnostic workup is required, including the evaluation of clinical ME/CFS criteria. • ME/CFS after COVID-19 has been reported in adults but not in pediatric patients younger than 19 years. What is New: • We present the novel Munich Berlin Symptom Questionnaires (MBSQs) as diagnostic tools to assess common ME/CFS case definitions in pediatric and adult patients with post-COVID-19 condition and beyond. • Using the MBSQs, we diagnosed ten patients aged 11 to 25 years with ME/CFS after asymptomatic SARS-CoV-2 infection or mild to moderate COVID-19., (© 2023. The Author(s).)

Purpose: Myalgic encephalomyelitis/chronic fatigue syndrome (ME/CFS) is a chronic disease characterized by substantial fatigue, postexertional malaise, unrefreshing sleep, and orthostatic intolerance, among other symptoms. Specific risk factors for the development of ME/CFS have not been adequately characterized. It has been suggested that ME/CFS is a connective tissue disorder and that joint hyperflexibility is a risk factor for the development of ME/CFS., Methods: The goal of this study was to examine whether joint hyperflexibility is a risk factor for the development of ME/CFS after infectious mononucleosis (IM). This study was part of a prospective cohort study. College students were studied for the development of IM and were followed up for the development of ME/CFS 6 months later. Participants in the cohort for the present study included 53 students who met criteria for ME/CFS 6 months after IM and 66 recovered control subjects who had modified Beighton scores (a measure of joint hyperflexibility) available., Findings: No connection was found between joint hyperflexibility and the development of ME/CFS after IM. Differences in joint hyperflexibility (as measured by using the modified Beighton score) in the ME/CFS group and the control group were not statistically significant. Female subjects had significantly higher Beighton scores compared with male subjects., Implication: After IM, no relationship was found between joint hyperflexibility and the development of ME/CFS., Competing Interests: Declaration of competing interest None of the authors have any associations that may pose a conflict of interest (including but not limited to pharmaceutical stock ownership, consultancy, advisory board membership, relevant patents, or research funding) for at least the 2 years before manuscript submission. The sponsor had no role in study design, in the collection, analysis and interpretation of data; in the writing of the report; and in the decision to submit the article for publication., (Copyright © 2024 Elsevier Inc. All rights reserved.)

Individuals with Myalgic Encephalomyelitis/Chronic Fatigue Syndrome (ME/CFS) often experience autonomic symptoms. In the present study, we evaluated 193 adults seeking treatment for ME/CFS, who were recruited from an outpatient clinic. The participants completed a head-up tilt table test to assess two common types of orthostatic intolerance, namely, postural orthostatic tachycardia syndrome (POTS) and orthostatic hypotension (OH). During the tilt test, 32.5% of the participants demonstrated POTS or OH. The participants with either of these two common types of orthostatic intolerance were found to have more problems with sleep and post-exertional malaise as assessed by the DePaul Symptom Questionnaire; these patients also reported more physical and health function limitations. The implications of the findings are discussed.

Objective: Suicide rates among African American adolescents have increased exponentially in recent years. The socioecological stressors that can increase suicide risk for African American adolescents, in conjunction with unique suicide risk manifestations within this group, require culturally sensitive preventive interventions. This study examines the efficacy of the Adapted-Coping With Stress course (A-CWS), a culturally tailored preventive intervention, to reduce suicidal ideation in African American adolescents, utilizing a randomized controlled design., Method: Participants included 410 ninth-grade students in a large Midwestern city; most students identified as Black/African American. Participants were randomly assigned to either the A-CWS intervention or standard care control condition. All participants were assessed at baseline, immediately postintervention, and 6 and 12 months postintervention., Results: Treatment effects were examined using latent growth models comparing suicidal ideation trajectories in control and intervention conditions. Analyses were conducted using both intention-to-treat and treatment-as-received samples (i.e., intervention condition participants who attended at least 80% of sessions). In both intention-to-treat and treatment-as-received analyses, there was a significant treatment effect: Individuals in the A-CWS intervention condition with higher baseline ideation evidenced a superior reduction in suicidal ideation over the course of the study, relative to their counterparts in the standard care control condition., Conclusion: Findings indicate that the A-CWS preventive intervention is efficacious in reducing suicidal ideation among African American adolescents with higher levels of baseline suicidal ideation and that effects sustain over time, with the strongest effect evidenced 12 months postintervention. (PsycInfo Database Record (c) 2024 APA, all rights reserved).

Aim: It is unclear if individuals with Myalgic Encephalomyelitis/Chronic Fatigue Syndrome (ME/CFS) with family histories of ME/CFS differ from those with ME/CFS without this family history. To explore this issue, quantitative data from patients with ME/CFS and controls were collected, and we examined those with and without family histories of ME/CFS., Methods: The samples included 400 patients with ME/CFS, and a non-ME/CFS chronic illness control group of 241 patients with multiple sclerosis (MS) and 173 with post-polio syndrome (PPS)., Results: Confirming findings from prior studies, those with ME/CFS were more likely to have family members with ME/CFS than controls. We found family histories of ME/CFS were significantly higher (18%) among the ME/CFS group than the non-ME/CFS controls (3.9%). In addition, patients with ME/CFS who had family histories of ME/CFS were more likely to have gastrointestinal symptoms than those with ME/CFS without those family histories., Conclusions: Given the recent reports of gastrointestinal difficulties among those with ME/CFS, our findings might represent one predisposing factor for the emergence of ME/CFS., Competing Interests: Conflicts of interest The authors declare that they have no conflicts of interest.

The exit from active substance use presents barriers to achieving and maintaining health, especially as individuals lack the economic resources to afford healthcare access. Treatment settings that strengthen resources may support stability in recovery and influence health. Analyzing a sample of recovery home residents over two years (N = 494), the current study assessed individually held resources (e.g., wages, employment) and the average economic conditions of a resident's house (e.g., house employment rate) to understand their association with self-reported health status. Employment status, but not wages or transportation access, was associated with reported health scores. The average employment rate of a recovery home was also positively correlated with the health of its residents. Results indicate the need to address employment and other economic issues which plague recovering individuals. Community aftercare settings may offer such a pathway through affordable housing, employment opportunities, and supportive relationships.

Purpose: Myalgic encephalomyelitis/chronic fatigue syndrome (ME/CFS) is a chronic condition with a constellation of symptoms presenting as severe and profound fatigue of ≥ 6 months not relieved by rest. ME/CFS affects health-related quality of life (HRQoL), which can be measured using multi-attribute health state utility (HSU) instruments. The aims of this study were to quantify HSUs for people living with ME/CFS, and to identify an instrument that is preferentially sensitive for ME/CFS., Methods: Cross-sectional national survey of people with ME/CFS using the AQoL-8D and EQ-5D-5L. Additional questions from the AQoL-8D were used as 'bolt-ons' to the EQ-5D-5L (i.e., EQ-5D-5L-Psychosocial). Disability and fatigue severity were assessed using the De Paul Symptom Questionnaire-Short Form (DSQ-SF). HSUs were generated using Australian tariffs. Mean HSUs were stratified for sociodemographic and clinical factors. Bland-Altman plots were used to compare the three HSU instruments., Results: For the 198 participants, mean HSUs (95% confidence intervals) were EQ-5D-5L: 0.46 (0.42-0.50); AQoL-8D: 0.43 (0.41-0.45); EQ-5D-5L-Psychosocial: 0.44 (0.42-0.46). HSUs were substantially lower than population norms: EQ-5D-5L: 0.89; AQoL-8D: 0.77. As disability and fatigue severity increased, HSUs decreased in all three instruments. Bland-Altman plots revealed interchangeability between the AQoL-8D and EQ-5D-5LPsychosocial. Floor and ceiling effects of 13.5% and 2.5% respectively were observed for the EQ-5D-5L instrument only., Conclusions: ME/CFS has a profound impact on HRQoL. The AQoL-8D and EQ-5D-5L-Psychosocial can be used interchangeably: the latter represents a reduced participant burden., (© 2023. The Author(s).)

There have been multiple efforts to evaluate the contributions of the field of Community Psychology, and one of the more popular methods has involved gathering citations and articles published in Community Psychology journals. In recent years, several sites have gathered citation analysis and article publication rates so that it is now relatively easy to summarize settings and scholar rankings. In the current study, articles published in the two major journals of the field of Community Psychology over the past five decades were evaluated for these publications and citations. Findings indicated that several of the settings with highest publication and citation rates have not developed Community Psychology graduate programs, thus indicating that many publishing authors are in settings without formal graduate programs in Community Psychology. The benefits and limitations of this method of ranking programs and individuals are reviewed., (© 2023 Wiley Periodicals LLC.)

Since 1969, Myalgic Encephalomyelitis/Chronic Fatigue Syndrome (ME/CFS) has been classified as a neurological disease in the International Classification of Diseases by the World Health Organization. Although numerous studies over time have uncovered organic abnormalities in patients with ME/CFS, and the majority of researchers to date classify the disease as organic, many physicians still believe that ME/CFS is a psychosomatic illness. In this article, we show how detrimental this belief is to the care and well-being of affected patients and, as a consequence, how important the education of physicians and the public is to stop misdiagnosis, mistreatment, and stigmatization on the grounds of incorrect psychosomatic attributions about the etiology and clinical course of ME/CFS.

Spiritually-based interventions in the form of 12-step programs are frequently offered as a part of substance use treatment programs in the United States. Programs based in the 12 steps guarantee that by working their program, an individual will undergo a process of transformation labeled a spiritual awakening. However, the impact of this experience on recovery factors and treatment adherence is unclear. The current study investigated adult residents ( n = 115) who experienced a spiritual awakening attributed to 12-step group affiliation during their stay at residential aftercare facilities for substance use disorder. Self-efficacy and hope were greater for individuals who experienced a spiritual awakening versus those persons who did not experience awakening. Awakening was associated with greater affiliation to AA and decreased negative exit from the facility. Results revealed the potential for an awakening to improve treatment behavior and outcomes in a residential environment, as well as benefit an individual's personal recovery resources. Further theoretical and clinical implications are discussed.

Myalgic Encephalomyelitis/Chronic Fatigue Syndrome (ME/CFS) is a devastating disease affecting millions of people worldwide. Due to the 2019 pandemic of coronavirus disease (COVID-19), we are facing a significant increase of ME/CFS prevalence. On May 11th to 12th, 2023, the second international ME/CFS conference of the Charité Fatigue Center was held in Berlin, Germany, focusing on pathomechanisms, diagnosis, and treatment. During the two-day conference, more than 100 researchers from various research fields met on-site and over 700 attendees participated online to discuss the state of the art and novel findings in this field. Key topics from the conference included: the role of the immune system, dysfunction of endothelial and autonomic nervous system, and viral reactivation. Furthermore, there were presentations on innovative diagnostic measures and assessments for this complex disease, cutting-edge treatment approaches, and clinical studies. Despite the increased public attention due to the COVID-19 pandemic, the subsequent rise of Long COVID-19 cases, and the rise of funding opportunities to unravel the pathomechanisms underlying ME/CFS, this severe disease remains highly underresearched. Future adequately funded research efforts are needed to further explore the disease etiology and to identify diagnostic markers and targeted therapies., Competing Interests: Declaration of Competing Interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2023 The Authors. Published by Elsevier B.V. All rights reserved.)

Public health and welfare systems request documentation on approaches to diagnose, treat, and manage myalgic encephalomyelitis and assess disability-benefit conditions. Our objective is to document ME patients' experiences with services/interventions and assess differences between those meeting different diagnostic criteria, importantly the impact of post-exertional malaise. We surveyed 660 fatigue patients in Norway using respondent-driven sampling and applied validated DePaul University algorithms to estimate Canadian and Fukuda criteria proxies. Patients on average perceived most interventions as having low-to-negative health effects. Responses differed significantly between sub-groups for some key interventions. The PEM score was strongly associated with the experience of most interventions. Better designed and targeted interventions are needed to prevent harm to the patient group. The PEM score appears to be a strong determinant and adequate tool for assessing patient tolerance for certain interventions. There is no known treatment for ME, and "do-no-harm" should be a guiding principle in all practice., Competing Interests: Declaration of conflicting interestsThe authors declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Objectives: Studies have demonstrated immune dysfunction in adolescents with Myalgic Encephalomyelitis/Chronic Fatigue Syndrome (ME/CFS); however, evidence is varied. The current study used network analysis to examine relationships between cytokines among a sample of pediatric participants with ME/CFS., Methods: 10,119 youth aged 5-17 in the Chicagoland area were screened for ME/CFS; 111 subjects and controls were brought in for a physician examination and completed a blood draw. Youth were classified as controls (Cs, N = 43), ME/CFS (N = 23) or severe (S-ME/CFS, N = 45). Patterns of plasma cytokine networks were analyzed., Results: All participant groups displayed a primary network of interconnected cytokines. In the ME/CFS group, inflammatory cytokines IL-12p70, IL-17A, and IFN-γ were connected and included in the primary membership, suggesting activation of inflammatory mechanisms. The S-ME/CFS group demonstrated a strong relationship between IL-17A and IL-23, a connection associated with chronic inflammation. The relationships of IL-6 and IL-8 in ME/CFS and S-ME/CFS participants also differed from Cs. Together, these results indicate pro-inflammatory responses in our illness populations., Discussion: Our data imply biological differences between our three participant groups, with ME/CFS and S-ME/CFS participants demonstrating an inflammatory profile. Examining co-expression of cytokines may aid in the identification of a biomarker for pediatric ME/CFS.

Qualitative studies have examined the recovery experiences of individuals prescribed medication-assisted treatment (MAT), including their experiences within treatment facilities. However, the literature lacks qualitative studies exploring the recovery process of individuals prescribed MAT while living in recovery housing, such as Oxford House (OH). The purpose of this study was to explore how OH residents, who are prescribed MAT, make sense of recovery. The fact that OHs are drug-free recovery housing is what makes the issue of using MATs potentially contentious in these settings. Interpretative phenomenological analysis (IPA) was used to document the lived experiences of individuals prescribed MAT in OH. The sample included: five women and three men, prescribed either methadone or Suboxone, that were living in an OH in the United States. Participants were interviewed on four topics: their recovery process, their transition to OH, and their experience living in and outside of an OH. Analysis of results followed the recommendations for IPA from Smith, Flowers, and Larkin. Four general themes emerged from the data: Recovery Process, Managing Logistics of MAT Utilization, Personal Development, and Familial Values. In conclusion, individuals prescribed MAT did benefit from living in an OH to manage their recovery as well as stay compliant with their medication., (© 2023 Wiley Periodicals LLC.)

Suicide rates among African American adolescents have increased dramatically. Suicidal ideation is associated with both suicide attempts and completions, thus understanding ideation patterns and predictors in African American adolescents is critical to informing prevention efforts. This study recruited 160 African American ninth grade students. Participants were those students randomized to the control condition of a randomized controlled preventive intervention. Of the 160 participants, 99 completed all assessment points and were included in latent transition analyses. We assessed participants four times: baseline then again at 6-, 12-, and 18-month postbaseline. Constructs of interest for this study included suicidal ideation, depression, hopelessness, and community violence exposure. A 2-class model (i.e., low ideation [LI] and high ideation [HI]) characterized ideation at each time point. A total of 86%-90% of participants were in the LI class in any given time point and 27.3% of participants were in the HI class at least once. Participants in the LI class tended to stay in that class, whereas those in the HI class often transitioned to the LI group. Depression and hopelessness, but not exposure to community violence, predicted HI class membership. Findings suggest that (a) most African American adolescents may experience suicide ideation at some point in time, (b) a concerning proportion of African American adolescents may experience high ideation, (c) high ideation is often time-limited, and (d) depression and hopelessness predict high ideation., (© 2023 The Authors. American Journal of Community Psychology published by Wiley Periodicals LLC on behalf of Society for Community Research and Action.)

The effect of the Adapted-Coping with Stress (A-CWS) intervention on social support coping was examined, using a randomized controlled trial design. The participants were 410 ninth-grade students (ages 14 to 16 years and mostly African American) living in low-resourced neighborhoods. Participants were randomly assigned 1:1 to either the A-CWS intervention or a standard care control condition. All participants were assessed at their schools before implementation of the intervention, at intervention completion, and again at 6- and 12-month post-intervention. Engagement in social support coping was examined in both intention-to-treat and treatment-as-received samples (i.e., intervention participants who attended at least 12 A-CWS treatment sessions and participants in the standard care control condition), using latent growth models. In intention-to-treat analyses, no significant treatment effects were identified. In treatment-as-received analyses, results revealed a significant association between social support coping and treatment condition; levels of social support coping decreased over time in the control condition, but they remained relatively stable in the treatment condition. The results indicate adequate intervention adherence and efficacy of the A-CWS to sustain social support coping within a sample of youth at high risk for stress exposure and associated disorders.Clinical Trial Registration: clinicaltrials.gov identifier: NCT0395445., (© 2022. Society for Prevention Research.)

Purpose: Myalgic encephalomyelitis/chronic fatigue syndrome (ME/CFS) is an illness characterized by a variety of symptoms including post-exertional malaise, unrefreshing sleep, and cognitive impairment. A variety of case definitions (e.g., the Canadian Consensus Criteria (CCC), the Myalgic Encephalomyelitis International Consensus Criteria (ME-ICC), and the Institute of Medicine (IOM) criteria) have been used to diagnose patients. However, these case definitions are consensus-based rather than empirical., Materials and Methods: The aim of the current study was to evaluate the validity of the aforementioned case definitions by factor analyzing a large, international sample ( N  = 2308) of ME/CFS symptom data. We performed primary and secondary exploratory factor analyses on the DePaul Symptom Questionnaire's 54-item symptom inventory. These results were compared to the CCC, the ME-ICC, and the IOM criteria., Results: We identified seven symptom domains, including post-exertional malaise, cognitive dysfunction, and sleep dysfunction. Contrary to many existing case criteria, our analyses did not identify pain as an independent factor., Conclusions: Although our results implicate a factor solution that best supports the CCC, revisions to the criteria are recommended.Implications for rehabilitationME/CFS is a chronic illness with no consensus regarding case diagnostic criteria, which creates difficulty for patients seeking assistance and disability benefits.The current study compared three commonly used case definitions for ME/CFS by factor analyzing symptomological data from an international sample of patients.Our results suggest three primary and four secondary symptom domains which differed from all three case definitions.These findings could help reduce barriers to care for those disabled with ME/CFS by guiding the development of an empirically-based case definition.

Background: Myalgic encephalomyelitis (ME)/chronic fatigue syndrome (CFS) is a complex, heterogenous disease. It has been suggested that subgroups of people with ME/CFS exist, displaying a specific cluster of symptoms. Investigating symptom-based clusters may provide a better understanding of ME/CFS. Therefore, this study aimed to identify clusters in people with ME/CFS based on the frequency and severity of symptoms., Methods: Members of the Dutch ME/CFS Foundation completed an online version of the DePaul Symptom Questionnaire version 2. Self-organizing maps (SOM) were used to generate symptom-based clusters using severity and frequency scores of the 79 measured symptoms. An extra dataset (n = 252) was used to assess the reproducibility of the symptom-based clusters., Results: Data of 337 participants were analyzed (82% female; median (IQR) age: 55 (44-63) years). 45 clusters were identified, of which 13 clusters included ≥ 10 patients. Fatigue and PEM were reported across all of the symptom-based clusters, but the clusters were defined by a distinct pattern of symptom severity and frequency, as well as differences in clinical characteristics. 11% of the patients could not be classified into one of the 13 largest clusters. Applying the trained SOM to validation sample, resulted in a similar symptom pattern compared the Dutch dataset., Conclusion: This study demonstrated that in ME/CFS there are subgroups of patients displaying a similar pattern of symptoms. These symptom-based clusters were confirmed in an independent ME/CFS sample. Classification of ME/CFS patients according to severity and symptom patterns might be useful to develop tailored treatment options., (© 2023. The Author(s).)

Importance: Early and accurate diagnosis and treatment of Long COVID, clinically known as post-acute sequelae of COVID-19 (PASC), may mitigate progression to chronic diseases such as myalgic encephalomyelitis/chronic fatigue syndrome (ME/CFS). Our objective was to determine the utility of the DePaul Symptom Questionnaire (DSQ) to assess the frequency and severity of common symptoms of ME/CFS, to diagnose and monitor symptoms in patients with PASC., Methods: This prospective, observational cohort study enrolled 185 people that included 34 patients with PASC that had positive COVID-19 test and persistent symptoms of >3 months and 151 patients diagnosed with ME/CFS. PASC patients were followed over 1 year and responded to the DSQ at baseline and 12 months. ME/CFS patients responded to the DSQ at baseline and 1 year later. Changes in symptoms over time were analyzed using a fixed-effects model to compute difference-in-differences estimates between baseline and 1-year follow-up assessments., Participants: Patients were defined as having PASC if they had a previous positive COVID-19 test, were experiencing symptoms of fatigue, post-exertional malaise, or other unwellness for at least 3 months, were not hospitalized for COVID-19, had no documented major medical or psychiatric diseases prior to COVID-19, and had no other active and untreated disease processes that could explain their symptoms. PASC patients were recruited in 2021. ME/CFS patients were recruited in 2017., Results: At baseline, patients with PASC had similar symptom severity and frequency as patients with ME/CFS and satisfied ME/CFS diagnostic criteria. ME/CFS patients experienced significantly more severe unrefreshing sleep and flu-like symptoms. Five symptoms improved significantly over the course of 1 year for PASC patients including fatigue, post-exertional malaise, brain fog, irritable bowel symptoms and feeling unsteady. In contrast, there were no significant symptom improvements for ME/CFS patients., Conclusion and Relevance: There were considerable similarities between patients with PASC and ME/CFS at baseline. However, symptoms improved for PASC patients over the course of a year but not for ME/CFS patients. PASC patients with significant symptom improvement no longer met ME/CFS clinical diagnostic criteria. These findings indicate that the DSQ can be used to reliably assess and monitor PASC symptoms., Competing Interests: The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest., (Copyright © 2023 Oliveira, Jason, Unutmaz, Bateman and Vernon.)

Suicide is an urgent concern for people with chronic illnesses, particularly for those with myalgic encephalomyelitis/chronic fatigue syndrome (ME/CFS). Prior work has examined suicide risk in this illness, but few studies have examined specific risk factors. This study uses binary logistic regression to identify physical, social, and demographic risk and protective factors for suicidal ideation in ME/CFS ( N  = 559). The results indicate sleep-related symptoms, stigma, disability status, physical functioning, and marital status as risk factors for suicidal ideation in this group. These findings highlight the importance of education, de-stigmatization, and the search for effective disease-modifying treatments for ME/CFS.

Aim: Youth who have not recovered from COVID-19 have been referred to as having Post-Acute Sequelae of SARS-CoV-2 Infection (PASC). The goal of this study was to better understand which symptoms persisted since onset of infection and how these symptoms compare to symptoms experienced by those with myalgic encephalomyelitis/chronic fatigue syndrome (ME/CFS)., Method: A sample of 19 parents who had a child with PASC were recruited using social media to fill out a questionnaire detailing symptoms at two time points. The first time point included their child's current symptoms and the second captured symptoms at initial infection. These participants were compared to a sample of 19 youth with ME/CFS., Results: Findings indicated significant decreases among several immune, neuroendocrine, pain, post-exertional malaise (PEM), and COVID-19 Centers for Disease Control and Prevention (CDC) domain symptoms from time of acute infection to time of current reporting. Fatigue remained at a high level as did several symptoms within the sleep and PEM domains. Participants with ME/CFS had overall worse symptomatology when compared to participants with PASC, especially in the neurocognitive domain., Conclusion: Most symptoms of those with PASC decline over time, but several remain at high levels, including fatigue. These findings are helpful in better understanding common symptom presentation profiles for youth with PASC and can be used to more adequately tailor diagnostic criteria and treatment strategies for youth., Competing Interests: Disclosure of Interest: The authors report no conflict of interest.

Although social support is commonly investigated in the context of substance recovery, researchers have widely neglected its multilevel nature, thus limiting what we know about its measurement across levels of observation. The current study used multilevel confirmatory factor analyses (MCFA) on 229 individuals living in 42 recovery homes to investigate the structure of single factor of social support at the individual and house-levels. Multilevel structural equation model (MSEM) was then conducted to examine whether the social support factor was associated with stress at the individual and house-levels. MCFA results showed that within individuals, all social support measures were significant and positive while at the house-level, there were a few discrepancies (e.g., IP was negative). Stress was significantly negatively related to the social support factor at the individual-level, but this association was positive at the house-level. These findings suggest that on an individual-level, a person's perception and source of social support is particularly important -even if the source of support comes from someone who is not abstinent. On a house-level, social support is more sensitive to outside influences than within individuals. Implications for future research and substance use interventions targeting social support are discussed., Competing Interests: Declaration of Conflict of Interests No conflict declared.

This study aimed to explore whether there are differences between Oxford House recovery home residents with psychiatric comorbidity in their ability to form, maintain, and dissolve loaning ties and seek advice, when compared to Oxford House residents without comorbidity, and if differences do exist, are those ties mono- or bi-directional. Findings indicated unique interdependencies among individuals with psychiatric comorbidity for advice seeking, loaning, and recovery factor scores. The results of this investigation are consistent with the dynamic systems theory conceptions of community-based recovery. Recovery homes provide access to social capital, via the residents' social network, by facilitating recovery-oriented social exchanges, which can lead to changes to the recovery home social dynamics. Upon interpreting the results of this study, components from a dynamic systems theory emerged (e.g., explaining the processes that preserve or undermine the development, maintenance, and dissolution of a network); and provided a framework for interpreting the loaning, advice-seeking, and the latent recovery factor networks and their relationship with psychiatric comorbidity. A deeper understanding of the interplay among these dynamics is described providing an understanding of how Oxford House recovery homes promote long-term recovery in a shared community setting for those with high psychiatric comorbidity.

Background : The aim of this research was to examine the psychometrics of a short form version of the multidimensional Involvement in Alcoholics Anonymous scale (IAA-SF) by assessing the factor structure, internal consistency, and predictive validity. While there are several existing measures of involvement in Alcoholics Anonymous, many are either unidimensional or are limited in their ability to gather variation in the level of involvement in the different dimensions of 12-step programs. Objective : To achieve our aim, we used exploratory and principal axis factor analysis, correlation, and logistic regression with two unique and diverse samples. Longitudinal data were collected from a northern Illinois sample of 110 post-treatment adults, and cross-sectional data were from a random sample of 296 recovery home residents in the United States. Results : Results from the first sample suggested three exploratory factors (Principles Involvement, Social Involvement, and Spiritual Involvement) that were concordant with the proposed conceptualization and were then confirmed in the second sample. A 2nd order factor of global involvement was also found. All subscales demonstrated good to excellent internal consistency and were moderately associated with AA affiliation. Global and social involvement predicted greater odds of abstinence 2 years later, but principles and spiritual involvement did not. Conclusion : Overall results suggest the IAA- SF is a valid and reliable 12-item instrument for assessing involvement in the AA program, and the differential prediction suggests potential utility for a multidimensional approach to 12-step involvement.

Background: There is limited information on which acute factors predict more long-term symptoms from COVID-19., Objective: Our objective was to conduct an exploratory factor analysis of self-reported symptoms at two time points of Long COVID-19., Methods: Data from patients with Long COVID-19 were collected at the initial two weeks of contracting SARS CoV-2 and the most recent two weeks, with a mean duration of 21.7 weeks between the two-time points. At time point 2, participants also completed the Coronavirus Impact Scale (CIS), measuring how the COVID-19 pandemic affected various dimensions of their lives (e.g., routine, access to medical care, social/family support, etc.)., Results: At time 1, a three-factor model emerged consisting of Cognitive Dysfunction, Autonomic Dysfunction and Gastrointestinal Dysfunction. The analysis of time 2 resulted in a three-factor model consisting of Cognitive Dysfunction, Autonomic Dysfunction, and Post-Exertional Malaise. Using factor scores from time 1, the Autonomic Dysfunction and the Gastrointestinal Dysfunction factor scores significantly predicted the CIS summary score at time two. In addition, the same two factor scores at time 1 predicted the occurrence of myalgic encephalomyelitis/chronic fatigue syndrome at time 2., Conclusion: Cognitive and Autonomic Dysfunction emerged as factors for both time points. These results suggest that healthcare workers might want to pay particular attention to these factors, as they might be related to later symptoms and difficulties with returning to pre-illness family life and work functioning.

This study sought to ascertain the prevalence of Myalgic Encephalomyelitis/Chronic Fatigue Syndrome (ME/CFS) among a sample of 465 patients with Long COVID. The participants completed three questionnaires: (1) a new questionnaire measuring both the frequency and severity of 38 common symptoms of COVID and Long COVID, (2) a validated short form questionnaire assessing ME/CFS, and (3) a validated questionnaire measuring post-exertional malaise. The population was predominantly white, female, and living in North America. The mean duration since the onset of COVID-19 symptoms was 70.5 weeks. Among the 465 participants, 58% met a ME/CFS case definition. Of respondents who reported that they had ME/CFS only 71% met criteria for ME/CFS and of those who did not report they had ME/CFS, 40% nevertheless did meet criteria for the disease: both over-diagnosis and under-diagnosis were evident on self-report. This study supports prior findings that ME/CFS occurs with high prevalence among those who have persistent COVID-19 symptoms.

Objectives: Myalgic Encephalomyelitis/Chronic Fatigue Syndrome (ME/CFS) is often reported to be caused by an infectious agent. However, it is unclear whether one infectious agent might be the cause or whether there might be many different infectious agents. The objective of this study was to identify self-reported infectious illnesses associated with the onset of ME/CFS., Methods: The present study involved data from multiple sites in several countries. 1773 individuals diagnosed with either ME, CFS or ME/CFS provided qualitative data concerning infectious triggers which were coded and classified for analysis., Results: 60.3% of patients report a variety of infectious illnesses some time before onset of ME/CFS. The most frequently reported infectious illness was Mononucleosis, which occurred in 30% of infections. However, over 100 other infectious illnesses were mentioned., Discussion: The findings suggest that many infectious agents might be associated with the onset of ME/CFS.

Substance use disorders are increasingly prevalent among veterans in the United States. Veterans in recovery face unique challenges, such as high rates of psychiatric comorbidities, difficulties adjusting to civilian life, and inadequate housing and mental health services. While prior research has explored veterans' experiences in recovery, studies have not implemented a multilevel perspective in their analyses. The current qualitative study examined how individual veteran experiences intersect with interpersonal and systemic factors. Semistructured focus groups were conducted with veterans who were former or current residents of recovery homes (N = 20). Thematic analysis was utilized to explore veterans' personal experiences through the CHIME-D framework (connectedness, hope & optimism, identity, meaning in life, empowerment, and difficulties). The data were further analyzed within a socioecological model (intrapersonal, interpersonal, and community). Each component of the CHIME-D framework was salient across all focus groups, with connectedness, empowerment, and difficulties being the most prominent themes that occurred across all socioecological levels. Results suggest that recovery initiatives can effectively assist veterans by promoting empowerment, facilitating social connections, and addressing cooccurring difficulties across multiple socioecological contexts. Additionally, treatment programs should encourage veterans to take on meaningful roles in their communities. Future research should continue to explore veterans' recovery experiences using a socioecological model., (© 2022 Society for Community Research and Action.)

Study samples of patients with myalgic encephalomyelitis/chronic fatigue syndrome (ME/CFS) have primarily involved White subjects, so the literature on ethnic differences is sparse. The current study identified a sample of 19 Black patients diagnosed with ME/CFS and compared them with White patients with ME/CFS, as well as with healthy controls. The studies used a similar psychometrically sound assessment tool to assess symptoms in all subjects. Findings indicated there were significant differences between patients with ME/CFS versus controls, but few differences between patients who identified as Black or White. The results suggest there might be few symptom differences between patients with ME/CFS in these two ethnic groups. The implications of these findings are discussed.

Some individuals infected with SARS CoV-2 have developed Post-Acute Sequelae of SARS CoV-2 infection (PASC) or what has been referred to as Long COVID. Efforts are underway to find effective treatment strategies for those with Long COVID. One possible approach involves alternative medical interventions, which have been widely used to treat and manage symptoms of a variety of medical problems including post-viral infections. Meditation has been found to reduce fatigue and unrefreshing sleep, and for those with post-viral infections, it has enhanced immunity, and reduced inflammatory-driven pathogenesis. Our article summarizes the literature on what is known about mindfulness meditation interventions, and reviews evidence on how it may apply to those with Long COVID and Myalgic Encephalomyelitis/Chronic Fatigue Syndrome (ME/CFS). Evidence is reviewed suggesting effective and sustainable outcomes may be achieved for symptomatology and underlying pathology of post-viral fatigue (PASC and ME/CFS)., Competing Interests: The authors report no conflicts of interest in this work., (© 2022 Porter and Jason.)

Objectives: The Institute of Medicine (IOM 2015. Beyond Myalgic Encephalomyelitis/Chronic Fatigue Syndrome: Redefining an Illness. Washington: The National Academies Press) suggested new criteria for Myalgic Encephalomyelitis/Chronic Fatigue Syndrome (ME/CFS), which requires an endorsement of either neurocognitive impairment or orthostatic intolerance (OI) in addition to other core symptoms. While some research supports the inclusion of OI as a core symptom, others argue that overlap with neurocognitive impairment does not justify the either/or option. The current study assessed methods of operationalizing OI using items from the DePaul Symptom Questionnaire (DSQ-1 and -2) as a part of the IOM criteria. Evaluating the relationship between OI and neurocognitive symptoms may lead to a better understanding of diagnostic criteria for ME/CFS., Methods: Two-hundred and forty-two participants completed the DSQ. We examined how many participants met the IOM criteria while endorsing different frequencies and severities of various OI symptoms., Results: Neurocognitive impairment was reported by 93.4% of respondents. OI without concurrent neurocognitive symptoms only allowed for an additional 1.7-4.5% of participants to meet IOM criteria., Conclusions: Neurocognitive symptoms and OI overlap in ME/CFS, and our results do not support the IOM's inclusion of neurocognitive impairment and OI as interchangeable symptoms. Furthermore, our findings highlight the need for a uniform method of defining and measuring OI via self-report in order to accurately study OI as a symptom of ME/CFS., Competing Interests: Competing interests: Authors state no conflict of interest., (© 2022 Walter de Gruyter GmbH, Berlin/Boston.)

Objective We sought to identify the general health of college students. Participants A total of 4402 university freshmen and sophomores were recruited to report their general health through an online questionnaire. Methods Responses from the DePaul Symptom Questionnaire were analyzed. We then conducted latent class analyses to evaluate 54 different symptoms among participants. Results A four class solution was identified, consisting of a group of asymptomatic students (35.65%), a second group of students reporting mild fatigue and sleep symptoms (38.87%), a third group reporting moderate sleep and fatigue symptoms (20.36%), and a group reporting moderate and severe complaints on the majority of symptoms (5.11%). Female students had 2.07 times the relative risk of the severe symptom class of men. Indigenous students have 2.88 times the relative risk of occupying the severe symptom class than non-indigenous students. Conclusions The results suggest that about 5% of college students have varied symptoms of a moderate to severe degree. Future research is needed to better assess whether there are biological associations with these self-report findings, as well as to determine longer-term implications of these symptoms.

The study examined how friendships among women in recovery from substance use disorders are related to individual resources (e.g., social support, self-esteem, and hope) and empowerment (e.g., power and optimism). Findings from a path analysis of 244 women in recovery revealed that friendships among women were positively related to individual resources; that is, the stronger the relationships with other women, the higher women perceived their resources to be. Further, individual-level resources mediated the relations between friendships and empowerment, with higher levels of individual resources related to higher levels of empowerment constructs of power and optimism. Results point to the importance of developing and sustaining empowering relationships for women in recovery. Findings have implications for gender-specific treatment practices and recommendations impacting substance use recovery outcomes.

Myalgic Encephalomyelitis/Chronic Fatigue Syndrome (ME/CFS) is a chronic disease with the hallmark symptom of post-exertional malaise. Evidence for physiological causes is converging, however, currently no diagnostic test or biomarker is available. People with ME/CFS experience stigmatization, including the perception that the disease is psychosomatic. In a sample of 499 participants with self-diagnosed ME/CFS, we investigated perceived stigma as a pathway through which perceived others' causal attributions relate to lower satisfaction with social roles and activities and functional status. Higher perceived attributions by others to controllable and unstable causes predicted lower health-related and social outcomes via higher perceived stigma.

Metabolic pathways related to energy production, amino acids, nucleotides, nitrogen, lipids, and neurotransmitters in myalgic encephalomyelitis/chronic fatigue syndrome (ME/CFS) may contribute to the pathophysiology of ME/CFS. 4501 Northwestern University college students were enrolled in a prospective, longitudinal study. We collected data before illness, during infectious mononucleosis (IM), and at a 6 month follow-up for those who recovered ( N = 18) versus those who went on to develop ME/CFS 6 months later ( N = 18). Examining pre-illness blood samples, we found significant detectable metabolite differences between participants fated to develop severe ME/CFS following IM versus recovered controls. We identified glutathione metabolism, nucleotide metabolism, and the TCA cycle (among others) as potentially dysregulated pathways. The pathways that differed between cases and controls are essential for proliferating cells, particularly during a pro-inflammatory immune response. Performing a series of binary logistic regressions using a leave-one-out cross-validation (LOOCV), our models correctly classified the severe ME/CFS group and recovered controls with an accuracy of 97.2%, sensitivity of 94.4%, and specificity of 100.0%. These changes are consistent with the elevations in pro-inflammatory cytokines that we have reported for patients fated to develop severe ME/CFS 6 months after IM.

This article explores the potential of using systems methods for better conceptualizing the unexpected and complex sets of hurdles and opportunities that practicing psychologists frequently encounter. Examples are provided involving two distinct types of important clinical issues: 1) understanding how individuals maintain recovery from substance use disorders following treatment and 2) better understanding patients with chronic, unexplained post-viral illnesses. Traditional research methods used to explore these types of intricate social and medical issues have often lacked sophisticated dynamic systems-based perspectives, which could provide new insights into understanding how patient treatment gains can be maintained and how unexplained post-viral illnesses can be better understood. Our examples will demonstrate that systems-oriented approaches have the potential to provide psychologists unique opportunities to capture a fuller and richer depiction of a variety of clinical and community topics and thus provide new lenses that ultimately could provide better care for our patients.

Objectives: Individuals with myalgic encephalomyelitis (ME) and chronic fatigue syndrome (CFS) experience debilitating symptoms, including post-exertional malaise, an intensification of symptoms after physical or cognitive exertion. Previous studies found differences in the activity levels and patterns of activity among individuals with ME and CFS, compared to healthy controls; however, limited research exists on the activity levels of pediatric patients. The objective of this study was to examine differences in activity between healthy children and youth with ME and CFS., Methods: The present study examines the objective (i.e., ActiGraphy) and self-reported levels of activity among children (ages 5 to 17) enrolled in a community-based study of pediatric CFS., Results: Children with ME and CFS evidenced lower activity levels than healthy control children. Moreover, participants with ME and CFS evidenced increased nighttime activity and delayed initiation of daytime activity. Participants' self-reported activity data significantly correlated with their ActiGraph data, suggesting that children with ME and CFS are able to accurately describe their activity level., Discussion: This study highlights differences in activity level and diurnal/nocturnal activity patterns between healthy children and those with ME and CFS. These differences should be considered in identifying appropriate supports and accommodations for children with ME and CFS.

There is a need to better understand improved recovery supportive services for those on Medication Assisted Treatment (MAT) for opioid use disorder (OUD) and, at the same time, enhance the available treatment interventions and positive long-term outcomes for this vulnerable population. A growing empirical literature supports the assertion that improved access to housing and recovery support is a low-cost, high-potential opportunity that could help former substance users who are utilizing MAT to sustain their recovery. Recovery home support could serve the populations that need them most, namely servicing a significant number of the enrolled in MAT programs. The two largest networks of recovery homes are staff run Traditional Recovery Homes (TRH) and self-run Oxford House Recovery Homes (OH). There is a need to better understand how substance users on MAT respond to recovery homes, as well as how those in recovery homes feel toward those on MAT and how any barriers to those utilizing MAT may be reduced. Recovery may be an outcome of the transactional process between the recovering individual and his/her social environment. In particular, how recovery houses can help people on MAT attain long-term recovery.

The Relational Theory of Addiction hypothesizes that women's substance abuse SUD development and (SA) recovery experiences differ from men's because of women's tendency to form nested self-concepts and increased relative desire for close interpersonal connections. We suggest that these two differences may have a dynamic and complex influence on recovery success, particularly for women living in group sober homes. This project uses Relational and Social Cognitive Theories as theoretical springboards to investigate the link between Tendency to Engage in Automatic Negatively Affected Social Comparisons (TEANSAC) and Sober Housemate Harmony (SHH) on women's individual perceptions of Abstinence Specific Self-Efficacy (ASSE) . We administered short surveys to women ( N  = 25) that had recently left inpatient SA treatment and were currently living in a group sober home to assess TEANSAC, SHH and ASSE. Results illustrated that higher TEANSAC scores predicted lower ASSE scores. However, SHH did not predict ASSE scores. Finally, an interaction effect was found in which SHH moderated the relationship between TEANSAC and ASSE. Specifically, we found that highly harmonious sober homes may buffer against the negative effects of increased TEANSAC scores. This project suggests that social cognitive and interpersonal variables may be important factors to consider for women's long-term recovery success.

Recovery homes are a widespread community resource that might be utilized by some individuals with substance use disorders (SUD) and COVID-19. A growing collection of empirical literature suggests that housing can act as a low-cost recovery support system which could be effective in helping those with SUD sustain their recovery. Such settings could be already housing many residents affected by COVID-19. Many of these residents are at high risk for COVID-19 given their histories of SUD, homelessness, criminal justice involvement, and psychiatric comorbidity. Stable housing after treatment may decrease the risk of relapse to active addiction, and these types of settings may have important implications for those with housing insecurity who are at risk for being infected with COVID-19. Given the extensive network of community-based recovery homes, there is a need to better understand individual- and organizational-level responses to the COVID-19 pandemic among people in recovery homes as well as those managing and making referrals to the houses. At the present time, it is unclear what the effects of COVID-19 are on recovery home membership retention or dropout rates. This article attempts to provide a better understanding of the possible impact of COVID-19 on the infected and on recovery resources in general.

Substance abuse disorders (SUDs) create significant and pervasive health and economic burdens in the U.S. and the world. After primary treatment has ended, supportive social environments are critically important to prevent relapse and to sustain long-term sobriety. Although approaches to SUDs and treatment vary internationally, studies in the United States indicate that a major risk factor for SUD relapse are lack of social environments to support sustained remission from substance use after primary treatment has ended. Evidence suggests that abstinence is enhanced when individuals are embedded in drug-free settings that support abstinence. Longabaugh, Beattie, Noel, and Stout proposed a theory of social support that engages two processes: general social support, which affectspsychological functioning, and abstinence-specific social support, which supports ongoing abstinence from substance use.

The purpose of the present study was to identify correlates of employment among men in substance use recovery, including recovery-related discrimination and social support. A cross-sectional sample of men ( N  = 164) who lived in sober living homes located across the United States participated in the present study. Data were collected online and through mailed surveys. No socio-demographic variables were associated with employment status. Discriminant Analysis (DA) was conducted to understand how recovery-related discrimination and social support contributed to group separation (employed vs. not employed). Results from this analysis suggested that recovery-related discrimination was the driving force in classification, as men who were not employed had much higher recovery-related discrimination than men who were employed. Men who were not employed also had lower social support scores than men who were employed. Stigma and discrimination may play a large role in employment among former and current substance users. Treatment providers should discuss the impact of stigma on individuals while they are in treatment. However, additional research is needed to more fully understand the relations among discrimination, social support, and employment.

This study examines the effects that substance-using family members have on those working to maintain recovery from substance use disorder. Participants ( N  = 229) were recruited from Oxford Houses (OH) across North Carolina, Texas, and Oregon. A stepwise linear regression with variables including abstinence self-efficacy, gender, substance use, attendance of Alcoholics Anonymous, and conflict with family and non-family was run to examine associations between the amount of substance using family members in the participant's social network. The abstinence self-efficacy mean score, gender, and days of serious conflict with non-family members were significantly associated with total number of substance-using family members in a participant's social network. These results may indicate that OH's serve as a buffer between substance using family members and one's abstinence self-efficacy. It remains unclear if individuals are at an increased risk of relapse from this familial influence when perceived abstinence self-efficacy drops. If so, OH residents could benefit from interventions that help them maintain their perceived abstinence self-efficacy.

Oxford Houses (OHs) are a large network of self-run community-based settings for individuals with substance use disorders. This present study explored a model based on conceptualizing recovery home social systems as dynamic multirelational (multiplex) social networks. The model is developed from data obtained from 42 OH recovery homes in three parts of the US, addressing whole networks of friendship, close friendship, and willingness to loan money. Findings indicated that close friend and loan relationships mutually reinforced each other over time as they coevolved. These types of insights can help community psychologists to better understand complex network dynamics in community-based settings., (© 2021 Wiley Periodicals LLC.)

It is estimated that nearly 20 million adults in the United States have a substance use disorder (SUD), and 8.4 million of those adults have a comorbid mental disorder. Roughly half of those adults with a SUD and a psychiatric comorbidity fail to receive adequate treatment for either the SUD or the mental disorder (combined or separately). However, this sub-population has shown positive treatment outcomes (e.g., improved quality of life and increased length of stay in a recovery home) when allotted the proper resources to treat the overlapping symptomologies associated with their multiple diagnoses. Many individuals with SUD and psychiatric comorbidity receive community-based support from recovery residences, a ubiquitous form of aftercare treatment in the United States. The aim of the present study was to investigate the relationship between psychiatric severity index scores (a proxy for psychiatric comorbidity that measures social functioning, impairment, symptoms, and behavior), length of stay in Oxford Houses (OHs), and quality of life. The present study found a significant negative relationship between length of stay and psychiatric severity scores, and between psychiatric severity scores and quality of life scores. Psychiatric severity was observed to predict decreased quality of life, while length of stay predicted decreased psychiatric severity. Psychiatric severity mediated the relationship between length of stay and quality of life based on house composition., (© 2021. The Author(s), under exclusive licence to Springer Science+Business Media, LLC, part of Springer Nature.)

Recovery homes in the US provide stable housing for over 200,000 individuals with past histories of homelessness, psychiatric co-morbidity and criminal justice involvement. We need to know more about how these settings help those remain in recovery. Our study measured advice seeking and willingness-to-loan relationships and operationalized them as a dynamic multiplex social network-multiple, simultaneous interdependent relationships--that exist within 42 Oxford House recovery homes over time. By pooling relationship dynamics across recovery houses, a Stochastic Actor-Oriented Modeling (SAOM) framework (Snijders et al., 2010) was used to estimate a set of parameters governing the evolution of the network and the recovery attributes of the nodes simultaneously. Findings indicated that advice and loan relationships and recovery-related attitudes were endogenously interdependent, and these results were affected exogenously by gender, ethnicity, and reason for leaving the recovery houses. Prior findings had indicated that higher advice seeking in recovery houses was related to higher levels of stress with more negative outcomes. However, the current study found that recovery is enhanced over time if advice was sought from residents with higher recovery scores. Our study shows that social embedding, i.e. one's position in relationship networks, affects recovery prospects. More specifically, the formation of ties with relatively more recovered residents as an important predictor of better outcomes.