Publications by Year: 2019

B. Curtis, B.G. Bergman, A. Brown, J. McDaniel, K. Harper, E. Eisenhart, M. Hufnagel, A. T. Heller, and R. Ashford. 2019. “ Characterizing Participation and Perceived Engagement Benefits in an Integrated Digital Behavioral Health Recovery Community for Women: A Cross-Sectional Survey.” JMIR Mental Health, 6, 8, Pp. e13352. Publisher's VersionAbstract


Research suggests that digital recovery support services (D-RSSs) may help support individual recovery and augment the availability of in-person supports. Previous studies highlight the use of D-RSSs in supporting individuals in recovery from substance use but have yet to examine the use of D-RSSs in supporting a combination of behavioral health disorders, including substance use, mental health, and trauma. Similarly, few studies on D-RSSs have evaluated gender-specific supports or integrated communities, which may be helpful to women and individuals recovering from behavioral health disorders.


The goal of this study was to evaluate the SHE RECOVERS (SR) recovery community, with the following 3 aims: (1) to characterize the women who engage in SR (including demographics and recovery-related characteristics), (2) describe the ways and frequency in which participants engage with SR, and (3) examine the perception of benefit derived from engagement with SR.


This study used a cross-sectional survey to examine the characteristics of SR participants. Analysis of variance and chi-square tests, as well as univariate logistic regressions, were used to explore each aim.


Participants (N=729, mean age 46.83 years; 685/729, 94% Caucasian) reported being in recovery from a variety of conditions, although the most frequent nonexclusive disorder was substance use (86.40%, n=630). Participants had an average length in recovery (LIR) of 6.14 years (SD 7.87), with most having between 1 and 5 years (n=300). The most frequently reported recovery pathway was abstinence-based 12-step mutual aid (38.40%). Participants reported positive perceptions of benefit from SR participation, which did not vary by LIR or recovery pathway. Participants also had high rates of agreement, with SR having a positive impact on their lives, although this too did vary by recovery length and recovery pathway. Participants with 1 to 5 years of recovery used SR to connect with other women in recovery at higher rates, whereas those with less than 1 year used SR to ask for resources at higher rates, and those with 5 or more years used SR to provide support at higher rates. Lifetime engagement with specific supports of SR was also associated with LIR and recovery pathway.


Gender-specific and integrated D-RSSs are feasible and beneficial from the perspective of participants. D-RSSs also appear to provide support to a range of recovery typologies and pathways in an effective manner and may be a vital tool for expanding recovery supports for those lacking in access and availability because of geography, social determinants, or other barriers.

J. F. Kelly, A. W. Abry, N. Fallah-Sohy, and B.G. Bergman. 2019. “ Mutual-help and peer support models for opioid use disorder recovery.” In Treating opioid addiction, edited by J. F. Kelly and S. Wakeman, Pp. 139-168. New York, NY: Humana Press.
B.G. Bergman, N. Fallah-Sohy, L. A. Hoffman, and J. F. Kelly. 2019. “ Psychosocial approaches in the treatment of opioid use disorders.” In Treating Opioid Addiction, edited by J. F. Kelly and S. E. Wakeman, Pp. 109-138. New York, NY: Humana Press.
J. F. Kelly, M. C. Greene, B.G. Bergman, and B. Hoeppner. 2019. “ Smoking cessation in the context of recovery from drug and alcohol problems: Prevalence, predictors, and cohort effects in a national U.S. sample.” Drug and Alcohol Dependence, 195, Pp. 6-12. Publisher's VersionAbstract


Tobacco and alcohol and other drug (AOD) use remain prominent risk factors for morbidity, mortality, and health care utilization. Moreover, these often cluster together within persons, exponentiating health risks. Little is known regarding if and when people resolving AOD problems stop smoking, who stops, and whether recent general population trends toward smoking cessation are evident also among persons more recently entering recovery.


National cross-sectional sample resolving AOD problems (final sample n = 2002).


Weighted smoking/cessation prevalence; logistic regressions; Hazard-models estimated time to smoking cessation overall, and for different cohorts entering recovery during one of three decades: a) 2006-2015; b) 1996-2005; c) 1986-1995.


Approximately 30% of U.S. adults in AOD recovery with a smoking history stopped smoking before entering recovery, 7% quit smoking and AOD use concurrently, 26% stopped after entering recovery; 37% still smoked. Among those quitting after entering recovery, the prevalence of smoking cessation 5- and 10-years later was 27.2% and 55.1% respectively for the 2006-2015 cohort and 14.9% and 34.5% in the 1986-1995 cohort; time to smoking cessation also was 60% shorter (5yrs vs. 8yrs). Time to smoking cessation was associated with education and income, but not 12-step participation or AOD treatment.


Smoking rates among those in AOD recovery are more than double that of the general population but those entering recovery in recent years are stopping and stopping sooner. It is plausible that public health-oriented tobacco policy measures and easier access to smoking cessation aids may be contributing to this salutary trend.

B. B. Hoeppner, S. S. Hoeppner, M. R. Schick, C. M. Milligan, E. Helmuth, B.G. Bergman, L. C. Abroms, and J. F. Kelly. 2019. “ Using the text-messaging program SmokefreeTXT to support smoking cessation for nondaily smokers.” Substance Use & Misuse, 54, 8, Pp. 1260-1271. Publisher's VersionAbstract


Smoking cessation interventions for nondaily smokers are needed. The current study explores the fit of the text-messaging intervention SmokefreeTXT for nondaily smokers.


Adult nondaily smokers (N = 32; mean age = 35 ± 12, 64% female, 53% non-Hispanic White) were enrolled in SmokefreeTXT. SmokefreeTXT usage data were recorded passively, theorized mechanisms of change were assessed at baseline and 2, 6, and 12 weeks after the chosen quit day, and EMA protocols captured real-time cigarette reports at baseline, and during the first two weeks after the quit day.


Most participants completed the SmokefreeTXT program and responded to system-initiated inquiries, but just-in-time interaction with the program was limited. In retrospective recall at treatment end, content of the text-messages was rated as "neutral" to "helpful." Within-person change was observed in theorized mechanisms, with less craving (p < 0.01), increased abstinence self-efficacy (external: p < 0.01; internal: p < 0.01), and poorer perceptions of pros of smoking (psychoactive benefits: p < 0.01, pleasure p < 0.01; and pros: p < 0.01) reported after SmokefreeTXT initiation compared to baseline. Exploratory analyses of real-time reports of smoking (225 cigarette reports in N = 17 who relapsed) indicated that cigarettes smoked in the first two weeks after quitting were more likely to occur to reduce craving (OR = 2.21[1.21-3.72]), and less likely to occur to socialize (OR = 0.06[0.01-0.24]), between 19:00 and 23:00 (OR = 0.34[0.17-0.66]), and on Saturdays (OR = 0.59[0.35-0.99]) than prior to quitting.


While well accepted by nondaily smokers, SmokefreeTXT could potentially be improved by targeting cons of smoking, enhancing engagement with the just-in-time component of SmokefreeTXT, and tweaking the timing of text-messages.

V. A. Earnshaw, B.G. Bergman, and J. F. Kelly. 2019. “ Whether, when, and to whom? An investigation of comfort with disclosing alcohol and other drug histories in a nationally representative sample of recovering persons.” Journal of Substance Abuse Treatment, 101, Pp. 29-37. Publisher's VersionAbstract


Due to shame and fear of discrimination, individuals in, or seeking, recovery from alcohol and other drug (AOD) problems often struggle with whether, when, and to whom to disclose information regarding their AOD histories and recovery status. This can serve as a barrier to obtaining needed recovery support. Consequently, disclosure may have important implications for recovery trajectories, yet is poorly understood.


Cross-sectional, U.S. nationally-representative survey conducted in 2016 among individuals with resolved AOD problems (N = 1987) investigated disclosure comfort and whether disclosure comfort differed by time since problem resolution, disclosure recipient (i.e., with interpersonal intimacy), or primary substance (i.e., alcohol [51%], cannabis [11%], opioids [5%], or "other" [33%]). Predictors of disclosure comfort were also examined. Data were analyzed using LOWESS analyses, analyses of variance, and regression.


Overall, longer time since problem resolution was associated with greater disclosure comfort. In general, participants reported greater comfort with disclosure to family and friends, and less comfort with disclosure to co-workers, to first-time acquaintances, in public settings, and in the media, but these effects varied by primary drug with participants who had problems with alcohol and "other" drugs having significantly more disclosure comfort than those who had problems with opioids.


Dimensions of time since AOD problem resolution, interpersonal intimacy, and primary drug are significantly associated with disclosure comfort. Individuals seeking recovery may benefit from more formal coaching around disclosure, particularly those with primary opioid problems, but further research is needed to determine the desire for and effects of such coaching among those seeking recovery.

J. F. Kelly, M. C. Greene, B.G. Bergman, W. White, and B. B. Hoeppner. 2019. “How many recovery attempts does it take to successfully resolve an alcohol or drug problem? Estimates and correlates from a national study of recovering U.S. adults.” Alcoholism: Clinical and Experimental Research , 43, 7, Pp. 1533-1544. Publisher's VersionAbstract

Background: Alcohol and other drug (AOD) problems are commonly depicted as chronically relapsing, implying multiple recovery attempts are needed prior to remission. Yet, although a robust literature exists on quit attempts in the tobacco field, little is known regarding patterns of cessation attempts related to alcohol, opioid, stimulant, or cannabis problems. Greater knowledge of such estimates and the factors associated with needing fewer or greater attempts may have utility for health policy and clinical communication efforts and approaches.

Methods: Cross-sectional, nationally representative survey of U.S. adults (N = 39,809) who reported resolving a significant AOD problem (n = 2,002) and assessed on number of prior serious recovery attempts, demographic variables, primary substance, clinical histories, and indices of psychological distress and well-being.

Results: The statistical distribution of serious recovery attempts was highly skewed with a mean of 5.35 (SD = 13.41) and median of 2 (interquartile range [IQR] = 1 to 4). Black race, prior use of treatment and mutual-help groups, and history of psychiatric comorbidity were associated with higher number of attempts, and more attempts were associated independently with greater current distress. Number of recovery attempts did not differ by primary substance (e.g., opioids vs. alcohol).

Conclusions: Estimates of recovery attempts differed substantially depending on whether the mean (5.35 recovery attempts) or median (2 recovery attempts) was used as the estimator. Implications of this are that the average may be substantially lower than anticipated because cultural expectations are often based on AOD problems being "chronically relapsing" disorders implicating seemingly endless tries. Depending on which one of these estimates is reported in policy documents or communicated in public health announcements or clinical settings, each may elicit varying degrees of help-seeking, hope, motivation, and the use of more assertive clinical approaches. The more fitting, median estimate of attempts should be used in clinical and policy communications given the distribution.

D. Eddie, L. Hoffman, C. Vilsaint, A. Abry, B.G. Bergman, B. Hoeppner, C. Weinstein, and J. F. Kelly. 2019. “ Lived Experience in new models of care for substance use disorder: A systematic review of peer recovery support services and recovery coaching.” Frontiers in Psychology, 10, Pp. 1052. Publisher's VersionAbstract
Peer recovery support services (PRSS) are increasingly being employed in a range of clinical settings to assist individuals with substance use disorder (SUD) and co-occurring psychological disorders. PRSS are peer-driven mentoring, education, and support ministrations delivered by individuals who, because of their own experience with SUD and SUD recovery, are experientially qualified to support peers currently experiencing SUD and associated problems. This systematic review characterizes the existing experimental, quasi-experimental, single- and multi-group prospective and retrospective, and cross-sectional research on PRSS. Findings to date tentatively speak to the potential of peer supports across a number of SUD treatment settings, as evidenced by positive findings on measures including reduced substance use and SUD relapse rates, improved relationships with treatment providers and social supports, increased treatment retention, and greater treatment satisfaction. These findings, however, should be viewed in light of many null findings to date, as well as significant methodological limitations of the existing literature, including inability to distinguish the effects of peer recovery support from other recovery support activities, heterogeneous populations, inconsistency in the definitions of peer workers and recovery coaches, and lack of any, or appropriate comparison groups. Further, role definitions for PRSS and the complexity of clinical boundaries for peers working in the field represent important implementation challenges presented by this novel class of approaches for SUD management. There remains a need for further rigorous investigation to establish the efficacy, effectiveness, and cost-benefits of PRSS. Ultimately, such research may also help solidify PRSS role definitions, identify optimal training guidelines for peers, and establish for whom and under what conditions PRSS are most effective.
A. M. Yule, N. W. Carrellas, M. DiSalvo, R. M. Lyons, J. W. McKowen, J. E. Nargiso, B.G. Bergman, J. F. Kelly, and T. E. Wilens. 2019. “ Risk factors for overdose in young people who received substance use disorder treatment.” The American Journal on Addictions, 28, 5, Pp. 382-389. Publisher's VersionAbstract


To identify substance and psychiatric predictors of overdose (OD) in young people with substance use disorders (SUDs) who received treatment.


We conducted a retrospective review of consecutive medical records of young people who were evaluated in a SUD program between 2012 and 2013 and received treatment. An independent group of patients from the same program who received treatment and had a fatal OD were also included in the sample. OD was defined as substance use associated with a significant impairment in level of consciousness without intention of self-harm, or an ingestion of a substance that was reported as a suicide attempt. t Tests, Pearson's χ2 , and Fisher's exact tests were performed to identify predictors of OD after receiving treatment.


After initial evaluation, 127 out of 200 patients followed up for treatment and were included in the sample. Ten (8%) of these patients had a nonfatal OD. Nine patients who received treatment and had a fatal OD were also identified. The sample's mean age was 20.2 ± 2.8 years. Compared with those without OD, those with OD were more likely to have a history of intravenous drug use (odds ratio [OR]: 36.5, P < .001) and mood disorder not otherwise specified (OR: 4.51, P = .01).


Intravenous drug use and mood dysregulation increased risk for OD in young people who received SUD treatment.


It is important to identify clinically relevant risk factors for OD specific to young people in SUD treatment due to the risk for death associated with OD. (Am J Addict 2019;28:382-389).