Substance use, misuse, and disorders (SUDs) are estimated to cost the United States over $500 billion annually. While there are effective SUD behavioral interventions and treatments, there is mounting evidence that technology‐based, digital recovery support services (D‐RSS) have the potential to prevent SUD, complement formal treatment, and improve individual recovery‐related outcomes. This preregistered systematic review focuses on D‐RSS that provide SUD recovery support through websites, smartphone applications, recovery social network sites, or any combination thereof. Data sources included studies found in searching CINAHL Plus (EBSCO), EMBASE, MEDLINE (EBSCO), Index Medicus/MEDLINE (NLM), Psychology & Behavioral Sciences Collection (EBSCO), PsycINFO (ProQuest), ProQuest Psychology Journals (ProQuest), and retrieved references. Observational, mixed‐methods, qualitative, or experimental studies, published in English, between January 1985 and January 2019, that characterized users and recovery‐related outcomes of any D‐RSS were included. The initial search yielded 5,278 abstracts. After removing duplicates, as well as reviewing titles and abstracts and removing studies not indicating an examination of recovery (i.e., treatment or prevention focused) and digital supports, 78 abstracts remained. Final included studies (n = 22) characterized international users of multiple D‐RSS types, including websites, digital recovery forums, recovery social networking sites, smartphone applications, and short messaging service texting programs. Experimental evidence was lacking as most studies were observational or qualitative in nature (n = 18). The review suggests that the evidence base for most D‐RSS is still lacking in terms of demonstrating benefit for recovery‐related outcomes. Descriptively, D‐RSS have high usage rates among engaged participants, across a range of SUD and recovery typologies and phenotypes, with 11% of U.S. adults who have resolved a SUD reporting lifetime engaging with at least one D‐RSS. D‐RSS deployment can help ameliorate barriers related to accessibility and availability of more traditional recovery supports, and may well be a valuable tool in addressing SUD and supporting recovery as uptake increases across the United States.
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.
KEYWORDS: Alcohol Use Disorder; Opioid Use Disorder; Quit Attempts; Recovery; Remission
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.
Objectives: The medical sequalae of alcohol and other drug (AOD) problems exact a prodigious personal and societal cost, but little is known about the specific prevalence of such medical problems, and their relationship to quality of life and indices of well-being among those recovering from problematic AOD use. To better characterize the lifetime physical disease burden, this study investigated the prevalence of medical conditions commonly caused or exacerbated by excessive and chronic AOD exposure in a nationally representative sample of US adults in AOD problem recovery. Comparisons were made to the general US population. Demographic and clinical correlates of disease prevalence were also investigated along with the relationship between distinct medical conditions and indices of quality of life/well-being.
Methods: Cross-sectional nationally representative survey of the US adult population who report resolving an AOD problem (n = 2002). Weighted lifetime prevalence of common medical conditions were estimated and compared to the US population. Demographic and clinical correlates of medical conditions, and also overall disease burden, were estimated using logistic regression.
Results: Relative to the general population, prevalence of hepatitis C, chronic obstructive pulmonary disease, heart disease, and diabetes were elevated. Likelihood of having a lifetime diagnosis of a specific disease was related to primary substance used and sex. Quality of life was lower among those with physical disease histories relative to those without.
Conclusions: Findings highlight the increased medical burden associated with AOD problems, and speak to the need for earlier and more sustained intervention for AOD problems, greater integration of addiction treatment and primary health care, and longitudinal research to explore the complex, dynamic relationships between AOD use and physical disease.
Problematic substance use is a challenge worldwide among adolescents. The recovery process requires holistic support addressing multiple and intersecting substance use risk factors; yet, there remains a lack of evidence on how to best understand and support adolescents in recovery. Recovery capital (RC) is a model that can be used to identify areas of assets that could be enhanced and barriers to address in one’s recovery process; however, this construct was generated through a study of adults who achieved natural recovery and it has since been used to frame adult recovery-related literature across the world. The primary aim of this article is to outline the rationale for and present a Recovery Capital for Adolescents Model (RCAM). The article will discuss the original recovery capital model, describe adolescent development, substance use, and recovery, and detail proposed developmental adaptations. Future qualitative and quantitative research should explore the RCAM to assess whether the proposed dimensions are complete as well as to assess its utility in clinical settings for identifying strengths and barriers for adolescents in or seeking recovery.
Kelly, J. F., Whorley, M., & Yeterian, J. (In Press). Twelve-step approaches. In S. A. Brown & R. Zucker (Ed.), The Oxford handbook of adolescent substance abuse . New York: Springer Science Press.