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Background Professional treatment and non-professional mutual-help organizations (MHOs) play important roles in mitigating addiction relapse risk. More recently, a third tier of recovery support services has emerged that are neither treatment nor MHO that encompass an all-inclusive flexible approach combining professionals and volunteers. The most prominent of these is Recovery Community Centers (RCCs). RCC's goal is to provide an attractive central recovery hub facilitating the accrual of recovery capital by providing a variety of services (e.g., recovery coaching; medication assisted treatment [MAT] support, employment/educational linkages). Despite their growth, little is known formally about their structure and function. Greater knowledge would inform the field about their potential clinical and public health utility. Method On-site visits (2015–2016) to RCCs across the northeastern U.S. (K = 32) with semi-structured interviews conducted with RCC directors and online surveys with staff assessing RCCs': physicality and locality; operations and budgets; leadership and staffing; membership; and services. Results Physicality and locality: RCCs were mostly in urban/suburban locations (90%) with very good to excellent Walk Scores reflecting easy accessibility. Ratings of environmental quality indicated neighborhood/grounds/buildings were moderate-good attractiveness and quality. Operations: RCCs had been operating for an average of 8.5 years (SD = 6.2; range 1–33 years) with budgets (mostly state-funded) ranging from $17,000–$760,000/year, serving anywhere from a dozen to more than two thousand visitors/month. Leadership and staffing: Center directors were mostly female (55%) with primary drug histories of alcohol (62%), cocaine (19%), or opioids (19%). Most, but not all, directors (90%) and staff (84%) were in recovery. Membership: A large proportion of RCC visitors were male (61%), White (72%), unemployed (50%), criminal-justice system-involved (43%) and reported opioids (35%) or alcohol (33%) as their primary substance. Roughly half were in their first year of recovery (49%), but about 20% had five or more years. Services: RCCs reported a range of services including social/recreational (100%), mutual-help (91%), recovery coaching (77%), and employment (83%) and education (63%) assistance. Medication-assisted treatment (MAT) support (43%) and overdose reversal training (57%) were less frequently offered, despite being rated as highly important by staff. Conclusions RCCs are easily accessible, attractive, mostly state-funded, recovery support hubs providing an array of services to individuals in various recovery stages. They appear to play a valued role in facilitating the accrual of social, employment, housing, and other recovery capital. Research is needed to understand the relative lack of opioid-specific support and to determine their broader impact in initiating and sustaining remission and cost-effectiveness.

This study examines racial/ethnic differences in perceived need for mental health treatment, barriers to treatment receipt, and reasons for dropout. Data are from the Collaborative Psychiatric Epidemiology Studies, a pooled dataset from three U.S. nationally-representative adult samples. Among respondents with a 12-month psychiatric disorder who received no treatment (N = 1417), Asians and Latinos reported lower perceived need than Blacks and Whites, and Latinos reported the fewest attitudinal barriers. Among those with a 12-month disorder who dropped out of treatment, Asians and Latinos gave more reasons for dropping out. Significant interactions of race/ethnicity with other characteristics identified subpopulations with high unmet need.

CONTEXT Racial/ethnic inequities are well documented in both maternal-infant health and substance use disorder treatment outcomes. OBJECTIVE To systematically review research on maternal-infant dyads affected by opioid use disorder (OUD) to evaluate for racial/ethnic disparities in health utilization or outcomes and critically assess the reporting and inclusion of race/ethnicity data. DATA SOURCES Peer-reviewed literature in MEDLINE, Embase, and Web of Science from 2000 to 2020. STUDY SELECTION Research reporting health utilization and outcomes data on dyads affected by OUD during pregnancy through the infant’s first birthday. DATA EXTRACTION We extracted data on race/ethnicity, study exposures/outcomes, how race/ethnicity data were analyzed, how authors discussed findings associated with race/ethnicity, and whether racism was mentioned as an explanation for findings. RESULTS Of 2023 articles reviewed, 152 quantitative and 17 qualitative studies were included. Among quantitative studies, 66% examined infant outcomes (n = 101). Three articles explicitly focused on evaluating racial/ethnic differences among dyads. Among quantitative studies, 112 mentioned race/ethnicity, 63 performed analyses assessing for differences between exposure groups, 27 identified racial/ethnic differences, 22 adjusted outcomes for race/ethnicity in multivariable analyses, and 11 presented adjusted models stratified by race/ethnicity. None of the qualitative studies addressed the role that race, ethnicity, or racism may have had on the presented themes. CONCLUSIONS Few studies were designed to evaluate racial/ethnic inequities among maternal-infant dyads affected by OUD. Data on race/ethnicity have been poorly reported in this literature. To achieve health equity across perinatal OUD, researchers should prioritize the inclusion of marginalized groups to better address the role that structural racism plays.

OBJECTIVES Research has enhanced our understanding of opioid misuse prevalence and consequences, but few studies have examined recovery from opioid problems. Estimating national recovery prevalence and characterizing individuals who have resolved opioid problems can inform policy and clinical approaches to address opioid misuse. METHODS We conducted a cross-sectional investigation of a nationally-representative sample of US adults who reported opioid problem resolution (OPI). For reference, OPI was compared with an alcohol problem resolution group (ALC). Analyses estimated OPI/ALC prevalence, differences in treatment/recovery service use, and psychological well-being, within 2 recovery windows

Background: Despite equivalent or lower lifetime and past-year prevalence of mental disorder among racial/ethnic minorities compared to non-Latino Whites in the United States, evidence suggests that mental disorders are more persistent among minorities than non-Latino Whites. But, it is unclear how nativity and socioeconomic status contribute to observed racial/ethnic differences in prevalence and persistence of mood, anxiety, and substance disorders. Method: Data were examined from a coordinated series of four national surveys that together assessed 21,024 Asian, non-Latino Black, Latino, and non-Latino White adults between 2001 and 2003. Common DSM-IV mood, anxiety, and substance disorders were assessed using the Composite International Diagnostic Interview. Logistic regression analyses examined how several predictors (e.g., race/ethnicity, nativity, education, income) and the interactions between those predictors were associated with both 12-month disorder prevalence and 12-month prevalence among lifetime cases. For the second series of analyses, age of onset and time since onset were used as additional control variables to indirectly estimate disorder persistence. Results: Non-Latino Whites demonstrated the highest unadjusted 12-month prevalence of all disorder types (p

Objective Alcohol and other drug (AOD) use disorders impose a prodigious personal and societal burden. While most remit, little is known about the achievements accrued as people accomplish and sustain addiction recovery. Greater knowledge regarding the nature and prevalence of such achievements, when such achievements occur, what factors influence accrual of achievements, and how such achievements relate to other indices of functioning would support treatment and policy planning, and may instill hope for individuals and families seeking AOD problem resolution. Methods Nationally representative, cross-sectional survey of United States (US) population of persons who have overcome an AOD problem (N = 2,002), assessing individual factors and achievements in 4 domains: self-improvement; family engagement; civic, and economic participation. Logistic and linear regression models tested theorized associations among variables. Results Most (80.1%) achieved at least one achievement associated with the 4 domains. A linear monotonic relationship was observed with greater achievements accruing with greater time in recovery. Accrual of achievements after AOD problem resolution was related to racial minority status, more education, earlier age of substance use initiation, illicit drugs as primary substance used, more years since resolving AOD problem, more psychiatric diagnoses, lower psychological distress, and regular 12-step program attendance. Multiple regression analyses found greater total achievements were independently associated with greater self-esteem, happiness, quality of life, and recovery capital. Conclusions Most individuals achieve an increasing number of achievements with time since AOD problem resolution, and these are associated with gains in measures of well-being that may support ongoing AOD problem remission, and recovery. (PsycInfo Database Record (c) 2021 APA, all rights reserved).

BACKGROUND: Despite their proven efficacy, medications for opioid use disorder (MOUD) are underutilized. Negative beliefs and attitudes toward MOUD are quite common, yet rapidly expanding recovery community centers (RCCs) may offer a promising venue for fostering MOUD support as they operate under the maxim, “many pathways [to recovery], all should be celebrated” and are utilized mainly by those with opioid use disorder. The current study provides a first look at MOUD attitudes and their correlates in RCC attendees. METHODS: The study conducted a cross-sectional survey (N=320) of recovering adults attending 31 RCCs across New England, assessing demographic, treatment, and recovery-relevant factors, as well attitudes (positive vs. negative) toward the use of agonist and antagonist MOUD. The study used frequencies and confidence intervals to obtain prevalence estimates for positive and negative attitudes toward agonist and antagonist MOUD, and to examine differences between them. Spearman correlations identified correlates of MOUD attitudes (at p < 0.10), and significant correlates were assessed for unique contributions via multivariable logistic regression. RESULTS: Positive attitudes were common and more prevalent than negative attitudes for both agonist (positive: 71.4 [66.1, 76.3]%; negative: 28.6 [23.7, 33.9]%) and antagonist (positive: 76.5 [71.4, 81.1]%; negative: 23.5 [18.9, 28.6]%) MOUD, which did not differ. The study identified several correlates of MOUD attitudes at the p < 0.10 level, but only four variables emerged as unique predictors controlling for other correlates. Lifetime history of agonist MOUD treatment was uniquely associated with positive agonist attitudes (p=0.008), whereas greater social support for recovery was associated with positive antagonist attitudes (p=0.007). Lower educational attainment was uniquely associated with negative antagonist attitudes (p=0.005), and a greater degree of spirituality was related to negative attitudes toward both agonists (p=0.005) and antagonists (p=0.01). CONCLUSIONS: Findings reveal very high rates of positive MOUD attitudes among RCC participants, highlighting the potential for this growing tier of recovery support to foster acceptance and peer support for medication-facilitated recovery pathways. Correlates of attitudes further reveal opportunities for facilitating MOUD acceptance within and beyond the RCC network.

Background Alcohol and other drug (AOD) problems confer a global, prodigious burden of disease, disability, and premature mortality. Even so, little is known regarding how, and by what means, individuals successfully resolve AOD problems. Greater knowledge would inform policy and guide service provision. Method Probability-based survey of US adult population estimating: 1) AOD problem resolution prevalence; 2) lifetime use of “assisted” (i.e., treatment/medication, recovery services/mutual help) vs. “unassisted” resolution pathways; 3) correlates of assisted pathway use. Participants (response = 63.4% of 39,809) responding “yes” to, “Did you use to have a problem with alcohol or drugs but no longer do?” assessed on substance use, clinical histories, problem resolution. Results Weighted prevalence of problem resolution was 9.1%, with 46% self-identifying as “in recovery”; 53.9% reported “assisted” pathway use. Most utilized support was mutual-help (45.1%,SE = 1.6), followed by treatment (27.6%,SE = 1.4), and emerging recovery support services (21.8%,SE = 1.4), including recovery community centers (6.2%,SE = 0.9). Strongest correlates of “assisted” pathway use were lifetime AOD diagnosis (AOR = 10.8[7.42–15.74], model R2 = 0.13), drug court involvement (AOR = 8.1[5.2-12.6], model R2 = 0.10), and, inversely, absence of lifetime psychiatric diagnosis (AOR = 0.3[0.2–0.3], model R2 = 0.10). Compared to those with primary alcohol problems, those with primary cannabis problems were less likely (AOR = 0.7[0.5–0.9]) and those with opioid problems were more likely (AOR = 2.2[1.4-3.4]) to use assisted pathways. Indices related to severity were related to assisted pathways (R2 Conclusions Tens of millions of Americans have successfully resolved an AOD problem using a variety of traditional and non-traditional means. Findings suggest a need for a broadening of the menu of self-change and community-based options that can facilitate and support long-term AOD problem resolution.

Background: It has been long established that achieving recovery from an alcohol or other drug use disorder is\ud associated with increased biobehavioral stress. To enhance the chances of recovery, a variety of psychological,\ud physical, social, and environmental resources, known as “recovery capital”, are deemed important as they can\ud help mitigate this high stress burden. A 50-item measure of recovery capital was developed (Assessment of\ud Recovery Capital [ARC]), with 10 subscales; however, a briefer version could enhance further deployment in\ud research and busy clinical/recovery support service settings. To help increase utility of the measure, the goal of\ud the current study was to create a shorter version using Item Response Theory models.\ud Method: Items were pooled from the original treatment samples from Scotland and Australia (N=450) for scale\ud reduction. A reduced version was tested in an independent sample (N =123), and a Receiver Operating\ud Characteristic Curve was constructed to determine optimal cut-off for sustained remission (> 12 months abstinence).\ud Results: An abbreviated 10-item measure of recovery capital captured item representation from all 10 original\ud subscales, was invariant across participant’s locality and gender, had high internal consistency (α= .90),\ud concurrent validity with the original measure (rpb =.90), and predictive validity with sustained remission using\ud a cut-off score of 47.\ud Conclusion: The brief assessment of recovery capital 10-item version (BARC-10) concisely measures a single\ud unified dimension of recovery capital that may have utility for researchers, clinicians, and recovery support\ud services.

Research shows that digital social network sites (SNSs) may be valuable platforms to effect health behavior change. Little is known specifically about their ability to help address alcohol and other drug problems. This gap is noteworthy, given that individuals are already participating in existing, recovery-specific SNSs (hereafter referred to as recovery SNSs): online communities with the functionality of conventional SNSs (e.g., Facebook) that focus on substance use disorder (SUD) recovery. For example, InTheRooms.com (ITR) is a large, well-known recovery SNS that is available for free 24 hr/day via website and mobile smartphone applications. It offers recovery tools within a digital social milieu for over 430,000 registered users. To augment the knowledge base on recovery SNS platforms, we conducted an online survey of 123 ITR participants (M = 50.8 years old; 56.9% female; 93.5% White; M = 7.3 years of abstinence, range of 0-30 years; 65% cited alcohol as their primary substance). Respondents engaged with ITR, on average, for about 30 min/day several times each week. Daily meditation prompts and live online video meetings were the most commonly utilized resources. Participants generally endorsed ITR as a helpful platform, particularly with respect to increased abstinence/recovery motivation and self-efficacy. Compared to individuals abstinent for 1 or more years, those abstinent less than 1 year (including nonabstinent individuals) showed similar rates of engagement with ITR activities and similar levels of perceived benefit. Our findings suggest that longitudinal studies are warranted to examine the clinical utility of ITR and other recovery SNSs as SUD treatment adjuncts and/or recovery self-management tools. (PsycINFO Database Record

Background Mood disorders (MDs) are pervasive and debilitating psychiatric conditions. Many helpful psychological and psychopharmacological treatments exist, but MD's prevalence and chronicity often means relying purely on professional care can create financial strain on individuals and healthcare systems. Also, many individuals respond only partially to professionally-delivered medical/pharmacological interventions or are unable to tolerate or adhere to them. Peer-led mutual-help organizations (MHOs) have emerged and grown in the U.S. to extend and potentiate professional efforts or otherwise address needs unmet by professional care. The Depression and Bipolar Support Alliance (DBSA) is the largest of these, but beyond observational evidence, little is known about participation or benefits. Greater knowledge could inform the field regarding clinical and public health utility of peer-driven efforts. Method Community-based cross-sectional comparative investigation of MD individuals attending (N = 202) or not attending (N = 105) DBSA. Measures included demographics, clinical characteristics and clinical service use, and indices of symptomatology, functioning, quality of life (QOL), and psychological well-being. Results Compared to non-DBSA participants, DBSA participants were more likely to be male and white and trended toward greater religious affiliation (p = 0.05). DBSA participants attended meetings about twice per month with two-thirds attending for more than one year. The DBSA cohort had a much higher proportion with bipolar I disorder and reported more lifetime and past 90-day use of acute, intensive, medical services and medications. There were no between-group differences on indices of QOL or psychological well-being, but within the DBSA group, greater DBSA attendance and involvement was associated with greater QOL and well-being, and less functional impairment. Limitations Cross-sectional design and regional sampling frame with unknown generalizability to national DBSA membership. Conclusion Given the grave impact of MDs and that DBSA is freely available it may fill an important clinical and public health need by attracting and engaging MD individuals with greater functional instability and impairment. The positive association found between greater active DBSA participation and improvements in functioning and well-being, while promising, requires longitudinal investigation to formally establish the causal direction of effects.

Alcohol and other drug (AOD) use disorders exact a prodigious annual economic toll in the United States (U.S.), driven largely by lost productivity due to illness-related absenteeism, underemployment, and unemployment. While recovery from AOD disorders is associated with improved health and functioning, little is known specifically about increases in productivity due to new or resumed employment and who may continue to struggle. Also, because employment can buffer relapse risk by providing structure, meaning, purpose, and income, greater knowledge in this regard would inform relapse prevention efforts as well as employment-related policy. We conducted a cross-sectional, nationally representative survey of the U.S. adult population assessing persons who reported having resolved an AOD problem (n = 2002). Weighted employment, unemployment, retirement, and disability statistics were compared to the general U.S. population. Logistic and linear regression models tested for differences in employment and unemployment among demographic categories and measures of well-being. Compared to the general U.S. population, individuals who had resolved an AOD problem were less likely to be employed or retired, and more likely to be unemployed and disabled. Certain recovering subgroups, including those identifying as black and those with histories of multiple arrests, were further disadvantaged. Conversely, certain factors, such as a higher level of education and less prior criminal justice involvement were associated with lower unemployment risk. Despite being in recovery from an AOD problem, individuals continue to struggle with obtaining employment, particularly black Americans and those with prior criminal histories. Given the importance of employment in addiction recovery and relapse prevention, more research is needed to identify employment barriers so that they can be effectively addressed.

The ecology of the emergence of psycho-pathology in early childhood is often approached by the analysis of a limited number of contextual risk factors. In the present study, we provide a comprehensive analysis of ecological risk by conducting a canonical correlation analysis of 13 risk factors at child age 2 and seven narrow-band scales of internalizing and externalizing problem behaviors at child age 4, using a sample of 364 geographically and ethnically diverse, disadvantaged primary caregivers, alternative caregivers, and preschool-age children. Participants were recruited from Special Supplemental Nutrition Program for Women, Infants, and Children sites and were screened for family risk. Canonical correlation analysis revealed that (1) a first latent combination of family and individual risks of caregivers predicted combinations of child emotional and behavioral problems, and that (2) a second latent combination of contextual and structural risks predicted child somatic complaints. Specifically, (1) the combination of chaotic home, conflict with child, parental depression, and parenting hassles predicted a co-occurrence of internalizing and externalizing behaviors, and (2) the combination of father absence, perceived discrimination, neighborhood danger, and fewer children living in the home predicted child somatic complaints. The research findings are discussed in terms of the development of psychopathology, as well as the potential prevention needs of families in high-risk contexts.

The concept of "recovery" has become the organizing paradigm in many middle and high income countries globally with a goal of orienting services in cost effective ways to help sufferers achieve and maintain long term remission. Despite this focus, little is known from an epidemiological and public health perspective about the prevalence, pathways, and predictors of recovery, and the changes that ensue in quality of life and functioning with time in recovery. Using data from the recent National Recovery Study, this talk reviewed a variety of findings on all of these aspects of recovery from significant alcohol and other drug problems.