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Background: Mutual‐help organizations (MHOs) are effective community‐based, recovery support options for individuals with alcohol and other drug use disorders (i.e., substance use disorder; SUD). Greater understanding of second‐wave MHOs, such as SMART Recovery, can help build on existing research that has focused primarily on 12‐step MHOs, such as Alcoholics Anonymous, to inform scientific, practice, and policy recommendations. Methods: We conducted a secondary analysis of the National Recovery Study, a representative sample of US adults who resolved a substance use problem (N = 1984). Using survey‐weighted estimates, we examined descriptive statistics for any lifetime, weekly lifetime, and past 90‐day MHO attendance; we compared rates of 12‐step and second‐wave MHO attendance over time by descriptively examining distributions for calendar year of the first meeting attended. We also used two logistic regression models to examine demographic, substance use, clinical, and recovery‐related correlates of weekly lifetime attendance separately for 12‐step (n = 692) and second‐wave MHOs (n = 32). Results: For any attendance, 41.4% attended a 12‐step MHO and 2.9% a second‐wave MHO; for weekly attendance, 31.9% attended a 12‐step MHO, and 1.7% a second‐wave MHO. Two‐thirds (64%) of initial second‐wave attendance occurred between 2006 and 2017 compared to 22% of initial 12‐step attendance during this time frame. Significant correlates of weekly 12‐step MHO attendance included histories of SUD treatment and arrest. Significant correlates of weekly second‐wave MHO attendance included Black identity (vs. White) and history of SUD medication. Conclusions: Attendance at second‐wave MHOs is far less common than 12‐step MHOs, but appears to be on the rise. Observed correlates of second‐wave MHO attendance should be replicated in larger second‐wave MHO samples before integrating these findings into best practices. Enhanced linkages from clinical and criminal justice settings to both second‐wave and 12‐step groups may help to "broaden the base" of MHOs. [ABSTRACT FROM AUTHOR]

Background: Primary care settings like federally qualified health centers (FQHC) are optimal locations to identify individuals with substance use disorders (SUD) and link them to SUD treatment, yet successful linkage has proven difficult. Recovery management checkups for primary care (RMC‐PC) is a promising method for increasing linkage to care, engagement in treatment, and reducing substance use. Methods: Participants (n = 266) who received screening, brief intervention, and referral to treatment (SBIRT) at four FQHC sites and needed SUD treatment were randomized to receive SBIRT only or SBIRT+RMC‐PC. All participants received SBIRT prior to randomization as part of usual care while those in the experimental group also received quarterly checkups. All participants completed research interviews at enrollment and 3, 6, 9, and 12 months post‐enrollment. The primary outcome was whether participants received any days of SUD treatment. Key secondary outcomes were days of SUD treatment (total and by SUD level of care), days of alcohol or drug abstinence, and a reduction in days of specific substance use, all based on self‐report. Results: Relative to participants receiving SBIRT only, participants assigned to SBIRT+RMC‐PC were significantly more likely to have received any SUD treatment over 12 months (adjusted odds ratio [AOR] = 3.85) and more days of SUD treatment over 12 months (Cohen's effect size d = +0.41). The SBIRT+RMC‐PC group also reported significantly more days of abstinence over 12 months (d = +0.30), fewer days of alcohol use (d = −0.20) and cannabis use (d = −0.20), and lower combined substance use frequency (d = −0.25). Days of treatment were found to positively mediate the direct effect of SBIRT+RMC‐PC on days of abstinence. Conclusion: This study provides further evidence of the effectiveness of the "referral to treatment" component of SBIRT when combined with RMC for patients in primary care settings, including those with drug use problems. Moreover, results demonstrate the value of repeated checkups on longer‐term treatment and substance use outcomes. [ABSTRACT FROM AUTHOR]

This paper documents the development of a programme component within an alcohol and other drugs residential service. Designed to improve relational competence, this pilot component was designed to have multiple levels of function: from the specific, for example, stimulating residents to formulate and monitor relationally oriented goals, to the more pacific, for example, embedding relationally focused learning as an ongoing rehabilitative concern. Development of the component began with a literature review. After finalising a set of relationship types (friends, siblings, etc.), this review identified three domains: 'values', 'knowledge' and 'skills'. To create an initial draft, these categories were populated by items selected from a multi‐stage inspection of the relevant literature. This draft was then reviewed by multiple stakeholder groups. Feedback from these consultations resulted in substantial modifications to the initial draft. In addition to the component having a broad‐spectrum interventive purpose, the authors propose that this component could play a role in (i) pre‐admission assessment and (ii) programme evaluation insofar as data concerning individual residents are aggregated and analysed. [ABSTRACT FROM AUTHOR]

Assertive Community Treatment (ACT) is a multidisciplinary treatment approach to support people with severe mental illnesses (SMI) in their recovery. While the majority of ACT recipients report co‐morbid substance use issues, limited reviews have evaluated the impact of receiving ACT services on substance use outcomes. The purpose of this systematic review was to evaluate the impact of ACT involvement on substance use outcomes among people with SMI. A systematic literature search was conducted including articles published prior to April 2021. Twenty‐nine studies were included in this review. Of them, 15 studies implemented a controlled design (six studies demonstrated high quality) and 14 studies implemented a cohort design. From a synthesis of the reviewed studies, five areas of changes associated with substance use emerged including reduced alcohol and drug use severity, lower prevalence of alcohol and drug use, increased stage of change in substance use treatment, and fewer days of hospitalization and intoxication. Thus, future studies should examine the integration of substance use treatment services as part of ACT interventions for opportunities to enhance recovery outcomes among individuals with SMI. [ABSTRACT FROM AUTHOR]

People with a migration background and ethnic minorities (MEM) with substance use problems are confronted with stigma due to their ethnicity and substance use. This study explores how living with multiple stigmatized identities impacts substance use recovery among MEM. We conducted 34 in‐depth interviews with a diverse sample of MEM with substance use problems in Flanders, Belgium. A Qualitative Content Analysis using Earnshaw's stigma framework revealed that their recovery processes are challenged by accumulated stigma based on different intersectional statuses, namely ethnicity, substance use, psychological problems, criminal histories, poverty, unemployment and gender. These stigmas can negatively influence their well‐being, increase problem substance use and act as a barrier to recovery capital. While stigma moderators, which determine how stigma unfolds within society, were spread across the micro‐to‐macro continuum (from personal to social, community and macro‐cultural features), mediators that influence the role of stigma in recovery were mainly psychosocial. Hence, prevention and intervention strategies should be aimed at reducing stigma on the macro, meso and micro level, while individuals and communities can limit the impact of public stigma on recovery through constructive personal and collective coping and action mechanisms. [ABSTRACT FROM AUTHOR]

A new document from the National Association of State Alcohol and Drug Abuse Directors (NASADAD) and the National Council for Mental Wellbeing released last month highlights the best practices for treatment of adolescent substance use disorders (SUDs). Replete with many links, the document will help not only treatment providers but also policymakers, schools, and more. The document is researched and footnoted. [ABSTRACT FROM AUTHOR]

Background and Aims: Recovery management checkups (RMC) have established efficacy for linking patients to substance use disorder (SUD) treatment. This study tested whether using RMC in combination with screening, brief intervention, and referral to treatment (SBIRT), versus SBIRT alone, can improve linkage of primary care patients referred to SUD treatment. Design: A randomized controlled trial of SBIRT as usual (n = 132) versus SBIRT plus recovery management checkups for primary care (RMC‐PC) (n = 134) with follow‐up assessments at 3 months post‐baseline. Setting: Four federally qualified health centers in the United States serving low‐income populations. Participants: Primary care patients (n = 266, 64% male, 80% Black, mean age, 48.3 [range, 19–53]) who were referred to SUD treatment after SBIRT. Interventions: SBIRT alone (control condition) compared with SBIRT + RMC‐PC (experimental condition). Measurement The primary outcome was any days of SUD treatment in the past 3 months. Key secondary outcomes were days of SUD treatment overall and by level of care, days of alcohol and other drug (AOD) abstinence, and days of using specific substances, all based on self‐report. Findings At 3‐month follow‐up, those assigned to SBIRT + RMC‐PC (n = 134) had higher odds of receiving any SUD treatment (46% vs 20%; adjusted odds ratio = 4.50 [2.49, 8.48]) compared with SBIRT only, including higher rates of entering residential and intensive outpatient treatment. They also reported more days of treatment (14.45, vs 7.13; d = +0.26), more days abstinent (41.3 vs 31.9; d = +0.22), and fewer days of using alcohol (27.14, vs 36.31; d = −0.25) and cannabis (19.49, vs 28.6; d = −0.20). Conclusions: Recovery management checkups in combination with screening, brief intervention, and referral to treatment are an effective strategy for improving linkage of primary care patients in need to substance use disorder treatment over 3 months. [ABSTRACT FROM AUTHOR]

Background: Connecting patients to treatment for a substance use disorder (SUD) that satisfies their needs is often complicated by confounding factors. A reliable measurement of patients' underlying stress level may be helpful because it often reflects many of the same confounders as their SUD. Whereas cortisol levels reflect physiological responses to stress, patients' cortisol levels during recovery from an SUD may serve as biomarkers for stressors that result in poor treatment outcomes, including early discontinuation of treatment. However, further exploration of the relationship between patients' cortisol levels and their treatment outcomes is needed for this approach to be clinically useful. Methods: We enrolled participants from an abstinence‐based, male‐only, residential alcohol and drug recovery program to examine the relationship between salivary cortisol, stress exposure, ACEs, and treatment retention. Results: Participants who remained in the program <90 days had significantly higher initial cortisol levels than those who remained ≥90 days (0.62 ± 0.074 μg/dl vs. 0.36 ± 0.037 μg/dl). Kaplan–Meier curves differed significantly when we grouped participants according to whether their cortisol level was below or above the overall average of 0.49 ± 0.044 μg/dl, with the median numbers of days before discontinuing being 110 and 60, respectively. A Cox proportional hazards model indicated that elevated salivary cortisol (with increases in μg/dl), marital/relationship status, and adverse childhood experiences (ACEs) score correlated significantly with hazards of discontinuing the program (hazard ratios for the three factors were 3.49, 2.39, and 1.50, respectively). Discussion: Cortisol level may predict, at least partially, SUD treatment program retention regardless of individuals' numerous confounding factors or the substance used. If this approach is validated, it could enable providers to consider patients' cortisol levels at the time of admission to treatment to facilitate their retention in treatment and thereby enhance their recovery. [ABSTRACT FROM AUTHOR]

Relapse rates for substance use disorders (SUDs) after treatment are as high as 50%. Evidence suggests that social and structural determinants of recovery influence these outcomes. Important domains to consider include economic stability, educational access and quality, healthcare access and quality, neighborhood and built environment, and social and community context are the major domains of social determinants of health. All these factors influence people's ability to reach their highest health potential. However, race and racial discrimination often compound the negative effects of these factors on substance use treatment outcomes. Moreover, research is urgently needed to examine the specific mechanisms through which these issues influence SUD and SUD outcomes. [ABSTRACT FROM AUTHOR]

The article discusses the relationship between cortisol levels and substance use disorders which are often conceptualized as chronic stress disorders. Topics include examines the dysregulated HPA axis function has been associated with relapse risk across multiple abused substances, including alcohol.

A poll conducted by the American Psychiatric Association (APA) last month found that 73% of the 2,201 respondents would refer a loved one with a substance use disorder (SUD) to treatment. The results also showed that 71% would know how to get a friend or family member with an SUD help. [ABSTRACT FROM AUTHOR]

Purpose: This qualitative study explored themes about barriers to substance use treatment for women who experience intimate partner violence (IPV) and opioid use in rural Vermont. The goal was to collect descriptive information to aid in the development of intervention ideas to facilitate better treatment access for women in this situation. Methods: One‐on‐one telephone interviews with 33 rural Vermont women who experienced both IPV and opioid use took place between February and August 2019. Findings: There were 5 main themes that emerged as barriers to accessing needed services: (1) geographic isolation and transportation difficulties, (2) inaccessibility of existing services, (3) lack of integrated substance use treatment and domestic violence services, (4) social isolation, and (5) amplification of stigma in small rural communities. Conclusions: Improved access to care and increased collaboration between IPV and substance use service providers are required to better serve rural communities in which IPV and opioid use disorder are concurrent problems. [ABSTRACT FROM AUTHOR]

An editorial is presented on recovery-orientated practice destined to reach drug and alcohol services in Australia. Topics include recovery orientated practice as it becomes the language of mental health services; natural leaning toward a strengths-based approach with a familiarity of language that supports recovery; and involvement and relationship of the lived experience journeying the various pathways of recovery.

Objective: To examine the economic and fiscal impact of a faith‐based long‐term residential addiction recovery program for homeless men on the state and local economy. Design: This descriptive study used entry, within‐program, and exit data to determine the program's fiscal and economic impact. Sample: The population consisted of 5,122 homeless men at an inner‐city mission in Baltimore City from 2006 to 2019. Measurements: To compare costs and savings at different program intervals, economists examined program data before, during, and following completion of the program. Data were analyzed using the IMPLAN input‐output model. Results: The study revealed that each man who participates in the residential recovery program for 1 year produces a total savings of $14,263 to state and county governments. Each man who successfully completes the program saves state and county governments over $5,000 per year post graduation. Each man who works for 1 year following graduation and reallocates his spending from illicit drugs to goods and services in the economy supports 1.5 jobs and generates over $240,000 in additional revenue and economic output. Conclusion: The findings from this study support the value of this faith‐based residential program in promoting economic productivity in the surrounding state and region. [ABSTRACT FROM AUTHOR]

Substance‐related disorders can adversely impact quality of life. This study assessed a 12 step program on health‐related quality of life for Iranian individuals seeking to recover from substance use. The study used a quasi‐experimental, two group, three stage, pre‐ and post‐test design and collected data at baseline, and at 1 and 3 months' post‐intervention. The treatment group comprised 35 participants in a 12 step program with a non‐equivalent comparison group of individuals admitted to addiction treatment centers. Physical and mental health quality‐of‐life domains were assessed using the Short Form 36 Health Survey Questionnaire. The treatment group improved in all aspects of health‐related quality of life. The treatment group improved compared to the comparison group for two of eight quality of life dimensions – physical functioning and role limitations due to emotional problems – at 1 month post‐intervention. There were additional improvements at 3 months' follow up in six of eight quality‐of‐life subscales compared to the comparison group. The benefits to quality of life related to mental health recovery extended beyond the treatment program, indicating that the program principles were effectively implemented in daily life. [ABSTRACT FROM AUTHOR]

Changes in identity are critical to managing transitions to recovery from substance and alcohol addictions. Identity change is particularly important for mothers, whose recovery processes are often in the context of critical but complex family relationships and societal expectations. But research and practice often underestimate the relational dimensions that promote or inhibit changes in one's identity during recovery. Here we analyze data from a study that involved interviews with 30 formerly incarcerated women participating in a community‐based substance use treatment program in the Midwest. Drawing from Constructivist Grounded Theory Methods, our analysis identified three factors shaping levels of engagement with family members: (1) the relational consequences of a shared past; (2) ascribing permanence to the old identity of "addict" versus the ability to see women's capacity to change; and (3) the current provision of caregiving support to participants' children. Our analysis supports and extends existing research by highlighting how family can both promote and inhibit a recovery identity process. We discuss potential implications for theorizing "recovery" and "identity" as relational and identify key elements to support practices more attuned to the hidden complexity of family support. [ABSTRACT FROM AUTHOR]

Background: Recovery community centers (RCCs) are the "new kid on the block" in providing addiction recovery services, adding a third tier to the 2 existing tiers of formal treatment and mutual‐help organizations (MHOs). RCCs are intended to be recovery hubs facilitating "one‐stop shopping" in the accrual of recovery capital (e.g., recovery coaching; employment/educational linkages). Despite their growth, little is known about who uses RCCs, what they use, and how use relates to improvements in functioning and quality of life. Greater knowledge would inform the field about RCC's potential clinical and public health utility. Methods: Online survey conducted with participants (N = 336) attending RCCs (k = 31) in the northeastern United States. Substance use history, services used, and derived benefits (e.g., quality of life) were assessed. Systematic regression modeling tested a priori theorized relationships among variables. Results: RCC members (n = 336) were on average 41.1 ± 12.4 years of age, 50% female, predominantly White (78.6%), with high school or lower education (48.8%), and limited income (45.2% <$10,000 past‐year household income). Most had either a primary opioid (32.7%) or alcohol (26.8%) problem. Just under half (48.5%) reported a lifetime psychiatric diagnosis. Participants had been attending RCCs for 2.6 ± 3.4 years, with many attending <1 year (35.4%). Most commonly used aspects were the socially oriented mutual‐help/peer groups and volunteering, but technological assistance and employment assistance were also common. Conceptual model testing found RCCs associated with increased recovery capital, but not social support; both of these theorized proximal outcomes, however, were related to improvements in psychological distress, self‐esteem, and quality of life. Conclusions: RCCs are utilized by an array of individuals with few resources and primary opioid or alcohol histories. Whereas strong social supportive elements were common and highly rated, RCCs appear to play a more unique role not provided either by formal treatment or by MHOs in facilitating the acquisition of recovery capital and thereby enhancing functioning and quality of life. [ABSTRACT FROM AUTHOR]

The article focuses on the definitions of drug addiction that characterized by compulsive drug seeking and use despite adverse consequences. It mentions a nationally representative sample of U.S. adults that used to identify more individuals who reported successful resolution of a significant alcohol or other drug (AOD) problem.

Background and Aims: Use of non‐judgmental, respectful and uniform language to describe individuals with substance use disorders (SUD) is recommended to reduce stigma. However, existing research concerning the use of labels for substance use has largely focused on perspectives of treatment providers and the general public, and to a lesser degree of those in long‐term recovery. This study aimed to examine and compare labels that individuals who use heroin and are initiating SUD treatment (1) use to describe themselves and when speaking with others who use drugs, with family and with treatment providers, and (2) prefer to be called and never want to be called. Design and Setting This was a cross‐sectional survey study using a convenience sample of individuals initiating an in‐patient managed withdrawal program in Massachusetts, USA. Participants: Between October 2017 and May 2018, 263 participants were enrolled. Measures: Participants completed a survey about (1) what labels they used to refer to self and when talking with others who use drugs, with providers, families and at 12‐Step meetings and (2) to identify which label they preferred least and most for others to use when referring to them. Findings More than 70% of participants used the term 'addict' to describe themselves and when speaking with others. However, use of 'addict' varied by context, and was most common at 12‐Step programs. Fewer than 15% reported using 'user' or slang terms, most commonly 'junkie', in any communications. The most‐preferred label for others to call them was 'person who uses drugs', while the most common label that participants never wanted to be called was 'heroin misuser' or 'heroin‐dependent'. Conclusion: Label preferences by individuals who use heroin and are in early recovery are consistent with general guidelines about use of first‐person language and suggest avoidance of language indicative of drug misuse or dependence. [ABSTRACT FROM AUTHOR]