Publications by Year: 2018

J. F. Kelly, A. W. Abry, C. M. Milligan, B.G. Bergman, and B. B. Hoeppner. 2018. “ On being "in recovery": A national study of prevalence and correlates of adopting or not adopting a recovery identity among individuals resolving drug and alcohol problems.” Psychology of Addictive Behaviors, 32, 6, Pp. 595-604. Publisher's VersionAbstract
The concept of recovery has become an organizing paradigm in the addiction field globally. Although a convenient label to describe the broad phenomena of change when individuals resolve significant alcohol or other drug (AOD) problems, little is known regarding the prevalence and correlates of adopting such an identity. Greater knowledge would inform clinical, public health, and policy communication efforts. We conducted a cross-sectional nationally representative survey (N = 39,809) of individuals resolving a significant AOD problem (n = 1,995). Weighted analyses estimated prevalence and tested correlates of label adoption. Qualitative analyses summarized reasons for prior recovery identity adoption/nonadoption. The proportion of individuals currently identifying as being in recovery was 45.1%, never in recovery 39.5%, and no longer in recovery 15.4%. Predictors of identifying as being in recovery included formal treatment and mutual-help participation, and history of being diagnosed with AOD or other psychiatric disorders. Qualitative analyses regarding reasons for no/prior recovery identity found themes related to low AOD problem severity, viewing the problem as resolved, or having little difficulty of stopping. Despite increasing use of the recovery label and concept, many resolving AOD problems do not identify in this manner. These appear to be individuals who have not engaged with the formal or informal treatment systems. To attract, engage, and accommodate this large number of individuals who add considerably to the AOD-related global burden of disease, AOD public health communication efforts may need to consider additional concepts and terminology beyond recovery (e.g., "problem resolution") to meet a broader range of preferences, perspectives and experiences.
J. F. Kelly, M. C. Greene, and B.G. Bergman. 2018. “ Beyond abstinence: Changes in indices of quality of life with time in recovery in a nationally-representative sample of us adults.” Alcoholism: Clinical and Experimental Research , 42, 4, Pp. 770-780. Publisher's VersionAbstract


Alcohol and other drug (AOD) treatment and recovery research typically have focused narrowly on changes in alcohol/drug use (e.g., "percent days abstinent") with little attention on changes in functioning or well-being. Furthermore, little is known about whether and when such changes may occur, and for whom, as people progress in recovery. Greater knowledge would improve understanding of recovery milestones and points of vulnerability and growth.


National, probability-based, cross-sectional sample of U.S. adults who screened positive to the question, "Did you used to have a problem with alcohol or drugs but no longer do?" (Response = 63.4% from 39,809; final weighted sample n = 2,002). Linear, spline, and quadratic regressions tested relationships between time in recovery and 5 measures of well-being: quality of life, happiness, self-esteem, recovery capital, and psychological distress, over 2 temporal horizons: the first 40 years and the first 5 years, after resolving an AOD problem and tested moderators (sex, race, primary substance) of effects. Locally Weighted Scatterplot Smoothing regression was used to explore turning points.


In general, in the 40-year horizon there were initially steep increases in indices of well-being (and steep drops in distress), during the first 6 years, followed by shallower increases. In the 5-year horizon, significant drops in self-esteem and happiness were observed initially during the first year followed by increases. Moderator analyses examining primary substance found that compared to alcohol and cannabis, those with opioid or other drugs (e.g., stimulants) had substantially lower recovery capital in the early years; mixed race/native Americans tended to exhibit poorer well-being compared to White people; and women consistently reported lower indices of well-being over time than men.


Recovery from AOD problems is associated with dynamic monotonic improvements in indices of well-being with the exception of the first year where self-esteem and happiness initially decrease, before improving. In early recovery, women, certain racial/ethnic groups, and those suffering from opioid and stimulant-related problems appear to face ongoing challenges that suggest a need for greater assistance.

J. F. Kelly, J. V. Cristello, and B.G. Bergman. 2018. “ Brief interventions to facilitate adolescent mutual-help involvement.” In Brief interventions for adolescent alcohol and substance abuse, edited by P Monti, S. M. Colby, and T. O'Leary-Tevyaw, 2nd ed. New York, NY: Guilford Press.
B.G. Bergman, J. F. Kelly, N. Fallah-Sohy, and S. Makhani. 2018. “ Emerging adults, mutual-help organizations, and addiction recovery: What does the science tell us?” In Emerging adults in substance use disorder treatment, edited by D.C. Smith, Pp. 167-195. New York, NY: Oxford University Press.
J. F. Kelly, B.G. Bergman, and C. L. O'Connor. 2018. “ Evidence-based treatment of addictive disorders: An overview.” In Integrating psychological and pharmacological treatments for addictive disorders, edited by J MacKillop, G. A. Kenna, L. Leggio, and L. A. Ray, Pp. 54-74. New York, NY: Routledge.
B.G. Bergman, M. C. Greene, B. B. Hoeppner, and J. F. Kelly. 2018. “ Expanding the reach of alcohol and other drug services: Prevalence and correlates of US adult engagement with online technology to address substance problems.” Addictive Behaviors, 87, Pp. 74-81. Publisher's VersionAbstract
Online technologies are well integrated into the day-to-day lives of individuals with alcohol and other drug (i.e., substance use) problems. Interventions that leverage online technologies have been shown to enhance outcomes for these individuals. To date, however, little is known about how those with substance use problems naturally engage with such platforms. In addition, the scientific literatures on health behavior change facilitated by technology and harms driven by technology engagement have developed largely independent of one another. In this secondary analysis of the National Recovery Study (NRS), which provides a geo-demographically representative sample of US adults who resolved a substance use problem, we examined a) the weighted prevalence estimate of individuals who engaged with online technologies to "cut down on substance use, abstain from substances, or strengthen one's recovery" (i.e., recovery-related use of online technology, or ROOT), b) clinical/recovery correlates of ROOT, controlling for demographic covariates, and c) the unique association between ROOT and self-reported history of internet addiction. Results showed one in ten (11%) NRS participants reported ROOT. Significant correlates included greater current psychological distress, younger age of first substance use, as well as history of anti-craving/anti-relapse medication, recovery support services, and drug court participation. Odds of lifetime internet addiction were 4 times greater for those with ROOT (vs. no ROOT). These data build on studies of technology-based interventions, highlighting the reach of ROOT, and therefore, the potential for a large, positive impact on substance-related harms in the US.
B.G. Bergman, T. M. Dumas, M. A. Maxwell-Smith, and J.P. Davis. 2018. “ Instagram participation and substance use among emerging adults: The potential perils of peer belonging.” Cyberpsychology, Behavior, and Social Networking, 21, 12, Pp. 753-760. Publisher's VersionAbstract
Emerging adults (ages 18-29) have the highest rates of both harmful drinking and participation on social network sites (SNSs) compared to adolescents and older adults. In fact, greater SNS participation has been shown to predict greater alcohol use. Little is known, however, about noncollege samples, substances apart from alcohol, and SNSs other than Facebook. Furthermore, few studies have examined what might moderate any observed influence of SNS participation on substance use. In this study, we used hierarchical linear and negative binomial regression analyses to examine the unique associations between Instagram participation and alcohol as well as marijuana use, controlling statistically for demographic characteristics, peer norms, and social status, in a community sample of emerging adults (N = 194). We also tested whether peer belonging or motives for Instagram participation moderated these relationships. Results showed that Instagram participation was positively related to alcohol use only for those with high levels of peer belonging. The initial negative association between Instagram participation and marijuana use disappeared once peer norms and social status were included. Peer norms were positively related to both alcohol and marijuana use, while peer belonging was positively related to marijuana use. Peer belonging appears to be an important variable in the study of SNSs and substance use among emerging adults. Future work might test the somewhat counterintuitive hypotheses raised by these findings that peer belonging sensitizes individuals to SNS influences on drinking and could be a marker of greater marijuana use.
J. F. Kelly, J. V. Cristello, and B.G. Bergman. 2018. “ Integrated 12-Step Facilitation to promote adolescent mutual-help involvement.” In Treating alcohol and substance abuse in adolescents, edited by P. Monti, S. Colby, and T. O’Leary-Tevyaw, 2nd ed., Pp. 380-404. New York, NY: Guilford Press.
J. F. Kelly, B.G. Bergman, and N. Fallah-Sohy. 2018. “ Mechanisms of behavior change in 12-step approaches to recovery in young adults.” Edited by T. Chung. Current Addiction Reports, 5, 2, Pp. 134-145. Publisher's VersionAbstract

Purpose of review

Empirical evidence indicates that, in general, treatments which systematically engage adults with freely available twelve-step mutual-help organizations (TSMHOs), such as Alcoholics Anonymous (AA) and Narcotics Anonymous (NA) often enhance treatment outcomes while reducing health care costs. Also evident is that TSMHOs facilitate recovery through mechanisms similar to those mobilized by professional interventions, such as increased abstinence self-efficacy and motivation, as well changing social networks. Much less is known, however, regarding the utility of these resources specifically for young adults and whether the TSMHO mechanisms are similar or different for young adults. This article provides a narrative review of the clinical and public health utility of TSMHOs for young adults, and summarizes theory and empirical research regarding how young adults benefit from TSMHOs.

Recent findings

Results indicate that, compared to older adults, young adults are less likely to attend TSMHOs and attend less frequently, but derive similar benefit. The mechanisms, however, by which TSMHOs help, differ in nature and magnitude. Also, young adults appear to derive greater benefit initially from meetings attended by similar aged peers, but this benefit diminishes over time.


Findings offer developmentally specific insights into TSMHO dynamics for young adults and inform knowledge of broader recovery needs and challenges.

J. F. Kelly, M. C. Greene, and B.G. Bergman. 2018. “ Is recovery from cannabis use problems different from alcohol and other drugs? Results from a national probability-based sample of the United States adult population.” International Journal of Drug Policy, 53, Pp. 55-64. Publisher's VersionAbstract


The policy landscape regarding the legal status of cannabis (CAN) in the US and globally is changing rapidly. Research on CAN has lagged behind in many areas, none more so than in understanding how individuals suffering from the broad range of cannabis-related problems resolve those problems, and how their characteristics and problem resolution pathways are similar to or different from alcohol [ALC] or other drugs [OTH]. Greater knowledge could inform national policy debates as well as the nature and scope of any additional needed services as CAN population exposure increases.


National, probability-based, cross-sectional sample of the US non-institutionalized adult population was conducted July-August 2016. Sample consisted of those who responded "yes" to the screening question, "Did you used to have a problem with alcohol or drugs but no longer do?" (63.4% response rate from 39,809 screened adults). Final weighted sample (N = 2002) was mostly male (60.0% [1.53%]), aged 25-49 (45.2% [1.63%]), non-Hispanic White (61.4% [1.64%]), employed (47.7% [1.61%]). Analyses compared CAN to ALC and OTH on demographic, clinical, treatment and recovery support services utilization, and quality of life (QOL) indices.


9.1% of the US adult population reported resolving a significant substance problem, and of these, 10.97% were CAN. Compared to ALC (M = 49.79) or OTH (M = 43.80), CAN were significantly younger (M = 39.41, p < 0.01), had the earliest onset of regular use (CAN M = 16.89, ALC M = 19.02, OTH M = 23.29, p < 0.01), and resolved their problem significantly earlier (CAN M = 28.87, ALC M = 37.86, OTH M = 33.06, p < 0.01). Compared to both ALC and OTH, CAN were significantly less likely to report use of inpatient treatment and used substantially less outpatient treatment, overall (p < 0.01), although CAN resolving problems more recently were more likely to have used outpatient treatment (p < 0.01). Lifetime attendance at mutual-help meetings (e.g., AA) was similar, but CAN (M = 1.67) had substantially lower recent attendance compared to ALC (M = 7.70) and OTH (M = 7.65). QOL indices were similar across groups.


Approximately 2.4 million Americans have resolved a significant cannabis problem. Compared to ALC and OTH, the pattern of findings for CAN suggest similarities but also some notable differences in characteristics and problem resolution pathways particularly regarding earlier problem offset and less use of formal and informal services. Within a shifting policy landscape, research is needed to understand how increases in population exposure and potency may affect the nature and magnitude of differences observed in this preliminary study.

A. M. Yule, N. W. Carrellas, M. Fitzgerald, J. W. McKowen, J. E. Nargiso, B.G. Bergman, J. F. Kelly, and T. E. Wilens. 2018. “ Risk factors for overdose in treatment-seeking youth with substance use disorders.” The Journal of Clinical Psychiatry, 79, 3. Publisher's VersionAbstract


Overdoses (ODs) are among the leading causes of death in youth with substance use disorders (SUDs). Our aim was to identify the prevalence of OD and characteristics associated with a history of OD in youth presenting for SUD outpatient care.


A systematic retrospective medical record review was conducted of consecutive psychiatric and SUD evaluations for patients aged 16 to 26 years with DSM-IV-TR criteria SUD at entry into an outpatient SUD treatment program for youth between January 2012 and June 2013. Unintentional OD was defined as substance use without intention of self-harm that was associated with a significant impairment in level of consciousness. Intentional OD was defined as ingestion of a substance that was reported as a suicide attempt. T tests, Pearson χ² tests, and Fisher exact tests were performed to evaluate characteristics associated with a history of OD.


We examined the medical records of 200 patients (157 males and 43 females) with a mean ± SD age of 20.2 ± 2.8 years. At intake, 58 patients (29%) had a history of OD, and 62% of those patients had a history of unintentional OD only (n = 36). Youth with ≥ 2 SUDs were 3 times more likely to have a history of OD compared to youth with 1 SUD (all P < .05). Compared to those without a history of OD, those with an OD were more likely to be female and have lifetime histories of alcohol, cocaine, amphetamine, anxiety, depressive, and/or eating disorders (all P < .05).


High rates of OD exist in treatment-seeking youth with SUD. OD was associated with more SUDs and psychiatric comorbidity.