A Nationwide Survey Study of Recovery Community Centers Supporting People in Recovery From Substance Use Disorder.

OBJECTIVE: The medical community has become aware of its role in contributing to the opioid epidemic and must be part of its resolution. Recovery community centers (RCCs) represent a new underused component of recovery support. METHODS: This study performed an online national survey of all RCCs identified in the United States, and used US Census ZIP code tabulation area data to describe the communities they serve. RESULTS: Residents of areas with RCCs were more likely to be Black (16.5% vs 12.6% nationally, P = 0.005) and less likely to be Asian (4.7% vs 5.7%, P = 0.005), American Indian, or Alaskan Native (0.6% vs 0.8%, P = 0.03), or live rurally (8.5% vs 14.0%, P < 0.0001). More than half of RCCs began operations within the past 5 years. Recovery community centers were operated, on average, by 8.8 paid and 10.2 volunteer staff; each RCC served a median of 125 individuals per month (4-1,500). Recovery community centers successfully engaged racial/ethnic minority groups (20.8% Hispanic, 22.5% Black) and young adults (23.5% younger than 25 years). Recovery community centers provide addiction-specific support (eg, mutual help, recovery coaching) and assistance with basic needs, social services, technology access, and health behaviors. Regarding medications for opioid use disorder (MOUDs), RCC staff engaged members in conversations about MOUDs (85.2%) and provided direct support for taking MOUD (77.0%). One third (36.1%) of RCCs reported seeking closer collaboration with prescribers. CONCLUSIONS: Recovery community centers are welcoming environments for people who take MOUDs. Closer collaboration between the medical community and community-based peer-led RCCs may lead to significantly improved reach of efforts to end the opioid epidemic.

Abstinence versus moderation recovery pathways following resolution of a substance use problem: Prevalence, predictors, and relationship to psychosocial well-being in a U.S. national sample.

BACKGROUND: Many people who report resolving an alcohol or other drug (AOD) problem continue some level of substance use. Little information exists, however, regarding the prevalence of this resolution pathway, or how continued substance use after resolving an AOD problem, relative to abstinence, relates to functioning, quality of life, and happiness (i.e., well-being). Greater knowledge of the prevalence and correlates of non-abstinent AOD problem resolution could inform public health messaging and clinical guidelines, while encouraging substance use goals likely to maximize well-being and reduce risks. METHODS: We analyzed data from a nationally representative sample of individuals who endorsed having resolved an AOD problem (N = 2002). Analyses examined: (1) The prevalence of various substance use statuses coded from lowest to highest risk: (a) continuous abstinence from all AOD since problem resolution; (b) current abstinence from all AOD with some use since problem resolution; (c) current use of a substance reported as a secondary substance; (d) current use of the individual's primary substance only; or, (e) current use of a secondary and primary substance; (2) relationships between substance use status and demographic, clinical, and service use history measures; and (3) the relationship between substance use status and well-being. Weighted, controlled, regression analyses examined the influence of independent variables on substance use status. RESULTS: (1) Prevalence: In this sample, 20.3% of patients endorsed continuous abstinence; 33.7% endorsed current abstinence; 21.0% endorsed current use of a secondary substance; 16.2% endorsed current use of a primary substance; and 8.8% endorsed current use of both a secondary and a primary substance. (2) Correlates: Lower-risk substance use status was associated with the initiation of regular substance use at an older age, more years since problem resolution, and fewer lifetime psychiatric diagnoses. (3) Well-Being: Controlling for pertinent confounds, lower-risk substance use status was independently associated with greater self-esteem, happiness, quality of life and functioning, and recovery capital, as well as less psychological distress. CONCLUSIONS: About half of Americans who self-identify as having resolved an AOD problem continue to use AOD in some form. It appears that, although for many abstinence is not necessary to overcome an AOD problem, it is likely to lead to better functioning and greater well-being. Further, people appear to gravitate toward abstinence/lower risk substance use with greater time since problem resolution.

Attitudes toward opioid use disorder pharmacotherapy among recovery community center attendees.

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.

On providing smoking cessation services in alcohol and other drug treatment settings: Results from a U.S. national survey of attitudes among recovering persons.

BACKGROUND: Nicotine addiction through cigarette use is highly prevalent among individuals suffering from alcohol and other drug (AOD) problems and remains a prominent risk factor for morbidity, mortality, and healthcare utilization. Whereas most people agree that providing smoking cessation services (SCS) to this vulnerable population is vitally important, the timing of such service provision has been hotly debated, including whether such services should be excluded, available (but not offered), offered, or fully integrated into AOD treatment settings. Important stakeholders in this debate are those in recovery from AOD problems who, in addition to having often been AOD treatment patients themselves, frequently hold influential clinical, research or policy positions and thus can influence the likelihood of SCS provision. This study sought to understand the attitudes of this important stakeholder group in providing SCS in AOD treatment settings. METHOD: We assessed a national cross-sectional sample of individuals in recovery from an AOD problem (n = 1973) on whether SCS should be: a. excluded; b. available; c. offered; or d. integrated into AOD services. We estimated associations between participants' demographic, clinical, and recovery support service use history, and SCS attitude variables, using multinomial logistic regression. RESULTS: Roughly equal proportions endorsed each attitudinal position (23.5% excluded, 25% available, 24.6% offered; 26.9% integrated). Correlates of holding more positive SCS implementation attitudes were Black race; primary substance other than alcohol, greater intensity of former or recent smoking, and less mutual-help organization participation; older individuals achieving recovery between 30 and 40 years ago also had more positive attitudes toward integrating SCS. CONCLUSIONS: About half of those sampled were either against SCS inclusion in AOD settings or were in favor of making it "available" only, but not in offering it or integrating it. This oppositional pattern was accentuated particularly among those with primary alcohol problem histories and those participating in mutual-help organizations. Given the universally well-known negative health effects of smoking, understanding more about the exact reasons why certain groups of recovering persons may endorse such positions is an area worthy of further investigation, as it may uncover potential barriers to SCS implementation in AOD treatment settings.

From working on recovery to working in recovery: Employment status among a nationally representative U.S. sample of individuals who have resolved a significant alcohol or other drug problem.

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.

One-Stop Shopping for Recovery: An Investigation of Participant Characteristics and Benefits Derived From U.S. Recovery Community Centers.

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.

New kid on the block: An investigation of the physical, operational, personnel, and service characteristics of recovery community centers in the United States.

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.

Recovery From Opioid Problems in the US Population: Prevalence, Pathways, and Psychological Well-Being.

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: <1 year (early recovery) and 1 to 5 years (mid-recovery) since OPI/ALC problem resolution. RESULTS: Of those who reported alcohol or drug use problem resolution, weighted problem resolution prevalence was 5.3% for opioids (early recovery 1.2%, mid-recovery 2.2%) and 51.2% for alcohol (early recovery 7.0%, mid-recovery 11.5%). In mid-recovery, lifetime use of formal treatment, pharmacotherapy, recovery support services, mutual help, and current pharmacotherapy were more prevalent in OPI than ALC. Service utilization did not differ between early-recovery OPI and ALC. Common services used by OPI included inpatient treatment (37.8%) and state/local recovery organizations (24.4%) in mid-recovery; outpatient treatment (25.7%) and recovery community centers (27.2%) in early recovery; Narcotics Anonymous (40.2%-57.8%) and buprenorphine-naloxone (15.3%-26.7%) in both recovery cohorts. Regarding well-being, OPI reported higher self-esteem than ALC in early recovery, and lower self-esteem than ALC in mid-recovery. CONCLUSIONS: An estimated 1.2 million American adults report resolving an opioid problem. Given the service use outcomes and longer-term problem resolution of mid-recovery OPI, early-recovery OPI may require encouragement to utilize additional or more intensive services to achieve longer-term recovery. OPI beyond recovery-year 1 may need enhanced support to address deficient self-esteem and promote well-being.

Perceived discrimination in addiction recovery: Assessing the prevalence, nature, and correlates using a novel measure in a U.S. National sample.

BACKGROUND: Alcohol and other drug (AOD) problems are among the most stigmatized conditions globally diminishing help-seeking due to fear of discrimination. Discrimination is common also among people already in AOD recovery, but little is known about the prevalence and nature of perceived discrimination. Greater knowledge would inform treatment and policy. METHOD: Nationally representative cross-sectional sample of U.S. adults who reported resolving an AOD problem (final weighted sample n = 2002). Participants were asked, "Since resolving your problem with alcohol or drugs, how frequently have the following occurred because someone knew about your alcohol or drug history?". MEASURES: Item response models yielded two types of discrimination: 1. Micro discrimination (personal slights) 2. Macro discrimination (violations of personal rights); psychological distress, quality of life, and recovery capital. RESULTS: About one quarter of participants reported some type of micro discrimination (e.g., held to a higher standard) with slightly less reporting a violation of personal rights (e.g., couldn't get a job). After adjusting for addiction severity and years since problem resolution, greater micro and macro discrimination were associated with higher psychological distress (ß = .45, 95% CI = .35,.55 and ß = .59, 95% CI = .45,.73), lower quality of life (ß =-.41, 95% CI=-.57,-.26 and ß =-.49, 95% CI=-.76,-.21) and recovery capital (ß =-.33, 95% CI=-.54,-.12 and ß =-.68, 95% CI=-.97,-.40) respectively. CONCLUSIONS: Despite being in recovery, different types of discrimination are experienced. These are associated with increased distress, and lower quality of life and recovery capital. Prospective studies are needed to help clarify the exact nature and impact of such discrimination on AOD problem recurrence.

Neurophysiological and Interpersonal Correlates of Emotional Face Processing in Alcohol Use Disorder.

BACKGROUND: A growing literature suggests deficient emotional facial expression (EFE) processing among recently abstinent individuals with alcohol use disorders (AUDs). Further investigation is needed to clarify valence-related discrepancies and elucidate neural and psychosocial correlates. We examined neurobehavioral indices of EFE processing and interpersonal problems in treatment seekers with AUDs and healthy community controls (CCs). METHODS: Thirty-four individuals with AUDs and 39 CCs completed an emotion judgment task (EJT), requiring discrimination between happy, angry, and sad EFEs. A second task requiring discrimination of male and female faces with neutral expressions served as the control task (i.e., sex judgment task, SJT). Neurophysiological (i.e., N170 and P3) and behavioral measures were analyzed using generalized linear mixed models (GLMM). Interpersonal problems were assessed with the Inventory of Interpersonal Problems-64 (IIP-64). The relationship of IIP-64 and EJT performance was investigated via within-group correlations. RESULTS: Analysis of the SJT revealed no group differences in behavioral measures, N170 amplitude, or P3 latency. P3 amplitudes, however, were significantly lower in the AUD group. For the EJT, initial observations of group differences in P3 amplitude were accounted for by differences in the control task. Behavioral analyses indicated that the AUD group was significantly less accurate than the CC group. Hypothesis-driven analyses using GLMM-estimated group differences indicated that anger processing was affected to a greater degree than were other emotions. Significant EJT/IIP-64 correlations were observed for anger processing within the AUD group and were confined to IIP-64 subscales with relatively high ratings on the affiliation dimension. CONCLUSIONS: Findings provide partial support for an emotion-specific processing deficit in persons with AUDs. Anger processing was more robustly affected than other emotions and was associated with interpersonal problems characterized by being overly needy, nonassertive, and overly accommodating. Results extend prior reports and reinforce the need for comprehensive study of emotion processing and its real-world implications.

Opioid Misuse Trends in Treatment Seeking Populations: Revised Prescription Opioid Policy and Temporally Corresponding Changes.

BACKGROUND: Over the last two decades, U.S. rates of prescription opioid (PO) misuse have risen drastically. In response, federal and state governments have begun to implement new PO policies. Recent legislative changes warrant up-to-date assessments of today's misuse rates. OBJECTIVE: To explore potential changes in opioid misuse trends among substance-using treatment seekers, in temporal relation to legislative response. METHODS: Substance-use data were collected from two cross-sectional Florida-based inpatient cohorts during periods preceding (pre-policy; n = 647) and following (post-policy; n = 396) statewide PO policy initiatives. Participants provided information concerning their most frequently used drugs before treatment. PO and illicit opioid (IO) use prevalence, frequency and route of administration were examined for pre-policy vs. post-policy cohort differences. RESULTS: Relative to the pre-policy cohort, a greater percentage of the post-policy cohort reported recent misuse, daily use, and intravenous administration of POs. IO use was also more frequently reported post-policy. Non-opioid drug use prevalence did not significantly differ between cohorts. Among the opioid-using subsample, equivalent percentages of the pre- and post-policy cohorts reported the use of POs without IOs, IOs without POs, and POs/IOs concurrently. Conclusions/Importance: Florida's PO policy amendments were temporally accompanied by a higher prevalence of PO misuse and IO use among treatment-seekers assessed in this study. Whether our data reflect increased awareness of and treatment seeking for opioid use disorders or insufficient efficacy of new policies to reduce opioid misuse remains in question. Regardless, findings suggest the need for enhanced emphasis on mitigating hazardous PO-use behaviors (e.g., IV use).

The effects of acute alcohol on psychomotor, set-shifting, and working memory performance in older men and women.

A limited number of publications have documented the effects of acute alcohol administration among older adults. Among these, only a few have investigated sex differences within this population. The current project examined the behavioral effects of acute low- and moderate-dose alcohol on 62 older (ages 55-70) male and female, healthy, light to moderate drinkers. Participants were randomly assigned to one of three dose conditions: placebo (peak breath alcohol concentration [BrAC] of 0 mg/dL), low (peak BrAC of 40 mg/dL), and moderate (peak BrAC of 65 mg/dL). Tasks assessed psychomotor, set-shifting, and working memory performance. Better set-shifting abilities were observed among women, whereas men demonstrated more efficient working memory, regardless of dose. The moderate-dose group did not significantly differ from the placebo group on any task. However, the low-dose group performed better than the moderate-dose group across measures of set shifting and working memory. Relative to the placebo group, the low-dose group exhibited better working memory, specifically for faces. Interestingly, there were no sex by dose interactions. These data suggest that, at least for our study's task demands, low and moderate doses of alcohol do not significantly hinder psychomotor, set-shifting, or working memory performance among older adults. In fact, low-dose alcohol may facilitate certain cognitive abilities. Furthermore, although sex differences in cognitive abilities were observed, these alcohol doses did not differentially affect men and women. Further investigation is necessary to better characterize the effects of sex and alcohol dose on cognition in older adults.

Sex differences in drug use among polysubstance users.

BACKGROUND: Available evidence indicates women with substance use disorders may experience more rapid progression through usage milestones (telescoping). The few investigations of sex differences in treatment-seeking populations often focus on single substances and typically do not account for significant polysubstance abuse. The current study examined sex differences in a heterogeneous sample of treatment seeking polysubstance users. We examined patterns of drug use, age at drug use milestones (e.g., initial use, regular use), and progression rates between milestones. Nicotine and alcohol use were also evaluated. METHODS: Participants (n = 543; 288 women) completed personal histories of substance use, including chronicity, frequency, and regularity, as well as inventories assessing affect, and intellectual ability. RESULTS: Rates of drug use and milestone ages varied by sex and specific drug. Analyses suggested pronounced telescoping effects for pain medication and marijuana, with women progressing more rapidly through usage milestones. CONCLUSIONS: Our data were generally supportive of telescoping effects, although considerable variance in progression measures was noted. The contrast between the marked telescoping observed in pain medication use and the absence of telescoping in other opioids was of particular interest. The discrepancy in telescoping effects, despite shared pharmacologies, suggests the need for further work examining underlying psychosocial factors. These results highlight that the specific sample population, substance, and outcome measure should be carefully considered when interpreting sex differences in substance use.