BACKGROUND AND OBJECTIVE: The European Pain Federation EFIC, the International Association for Hospice and Palliative Care, International Doctors for Healthier Drug Policies, the Swiss Romandy College for Addiction Medicine, the Swiss Society of Addiction Medicine, and the World Federation for the Treatment of Opioid Dependence called on medical journals to ensure that authors always use terminology that is neutral, precise, and respectful in relation to the use of psychoactive substances. It has been shown that language can propagate stigma; and that stigma can prevent people from seeking help and influence the effectiveness of social and public health policies. The focus of using appropriate terminology should extend to all patients who need controlled medicines, avoiding negative wording.
DESIGN AND METHODS: A narrow focus on a few terms and medical communication only should be avoided. The appropriateness of terms is not absolute, and indeed varies between cultures and regions, and over time. For this reason, it is important that communities establish their own consensus of what is “neutral”, “precise”, and “respectful”.
RESULTS: We identified twenty-three problematic terms – most of them we suggest avoiding – and their possible alternatives.
CONCLUSION: The use of appropriate language improves scientific quality of manuscripts, and increases chances that patients will receive the best treatment and that government policies on psychoactive substance policies will be rational.
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. (PsycINFO Database Record.)
BACKGROUND: A growing literature on adults with substance use disorders (SUD) suggests that religious and spiritual processes can support recovery, such that higher levels of religiosity and/or spirituality predict better substance use outcomes. However, studies of the role of religion and spirituality in adolescent SUD treatment response have produced mixed findings, and religiosity and spirituality have rarely been examined separately.
METHODS: The present study examined religiosity and spirituality as predictors of outcomes in an outpatient treatment adolescent sample (N = 101) in which cannabis was the predominant drug of choice. Qualitative data were used to contextualize the quantitative findings.
RESULTS: Results showed that higher levels of spirituality at post-treatment predicted increased cannabis use at 6-month follow-up (β = .237, p = .043), whereas higher levels of baseline spirituality predicted a lower likelihood of heavy drinking at post-treatment (OR = .316, p = .040). Religiosity did not predict substance use outcomes at later timepoints. When asked to describe the relation between their religious/spiritual views and their substance use, adolescents described believing that they had a choice about their substance use and were in control of it, feeling more spiritual when under the influence of cannabis, and being helped by substance use.
CONCLUSIONS: Together, findings suggest that for adolescents with SUD, religion and spirituality may not counteract the use of cannabis, which may be explained by adolescents' views of their substance use as being consistent with their spirituality and under their control.
BACKGROUND: 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.
METHOD: 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.
RESULTS: 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.
CONCLUSION: 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.
BACKGROUND: Alcohol and other drug (AOD) treatment and recovery research typically have focused narrowly on changes in alcohol/druguse (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 recoverymilestones and points of vulnerability and growth.
METHODS: 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.
RESULTS: 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.
CONCLUSIONS: 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.
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, recoverysupport 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.
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.
This is a protocol for a Cochrane Review (Intervention). The objectives are as follows:
The primary objective of this review is to evaluate the efficacy of Alcoholics Anonymous mutual help groups, operated by peers, and TSF interventions, operated by professionals. Both will be evaluated relative to other interventions for AUD by examining their effects on abstinence, drinking intensity, and drinking‐related consequences. The secondary objective is to examine the healthcare utilization cost impact of Alcoholics Anonymous attendance and of TSF.
In this review, Alcoholics Anonymous attendance and TSFs will be compared with the following interventions.
The European Pain Federation EFIC, the International Association for Hospice and Palliative Care, International Doctors for Healthier DrugPolicies, the Swiss Romandy College for Addiction Medicine, the Swiss Society of Addiction Medicine, and the World Federation for the Treatment of Opioid Dependence called on medical journals to ensure that authors always use terminology that is neutral, precise, and respectful in relation to the use of psychoactive substances. It has been shown that language can propagate stigma, and that stigma can prevent people from seeking help and influence the effectiveness of social and public-health policies. The focus of using appropriate terminology should extend to all patients who need controlled medicines, avoiding negative wording. A narrow focus on a few terms and medical communication only should be avoided. The appropriateness of terms is not absolute and indeed varies between cultures and regions and over time. For this reason, it is important that communities establish their own consensus of what is 'neutral', 'precise', and 'respectful'. We identified twenty-three problematic terms (most of them we suggest avoiding) and their possible alternatives. The use of appropriate language improves scientific quality of articles and increases chances that patients will receive the best treatment and that government policies on psychoactive substance policies will be rational.
BACKGROUND: It has been long established that achieving recovery from an alcohol or other drug use disorder is associated with increased biobehavioral stress. To enhance the chances of recovery, a variety of psychological, physical, social, and environmental resources, known as "recovery capital", are deemed important as they can help mitigate this high stress burden. A 50-item measure of recovery capital was developed (Assessment of Recovery Capital [ARC]), with 10 subscales; however, a briefer version could enhance further deployment in research and busy clinical/recovery support service settings. To help increase utility of the measure, the goal of the current study was to create a shorter version using Item Response Theory models.
METHOD: Items were pooled from the original treatment samples from Scotland and Australia (N=450) for scale reduction. A reduced version was tested in an independent sample (N=123), and a Receiver Operating Characteristic Curve was constructed to determine optimal cut-off for sustained remission (>12months abstinence).
RESULTS: An abbreviated 10-item measure of recovery capital captured item representation from all 10 original subscales, was invariant across participant's locality and gender, had high internal consistency (α=.90), concurrent validity with the original measure (rpb=.90), and predictive validity with sustained remission using a cut-off score of 47.
CONCLUSION: The brief assessment of recovery capital 10-item version (BARC-10) concisely measures a single unified dimension of recovery capital that may have utility for researchers, clinicians, and recovery support services.
BACKGROUND AND AIMS: The integration of 12-Step philosophy and practices is common in adolescent substance use disorder (SUD) treatment programs, particularly in North America. However, although numerous experimental studies have tested 12-Step facilitation (TSF) treatments among adults, no studies have tested TSF-specific treatments for adolescents. We tested the efficacy of a novel integrated TSF.
DESIGN: Explanatory, parallel-group, randomized clinical trial comparing 10 sessions of either motivational enhancement therapy/cognitive-behavioral therapy (MET/CBT; n = 30) or a novel integrated TSF (iTSF; n = 29), with follow-up assessments at 3, 6 and 9 months following treatment entry.
SETTING: Out-patient addiction clinic in the United States.
PARTICIPANTS: Adolescents [n = 59; mean age = 16.8 (1.7) years; range = 14-21; 27% female; 78% white].
INTERVENTION AND COMPARATOR: The iTSF integrated 12-Step with motivational and cognitive-behavioral strategies, and was compared with state-of-the-art MET/CBT for SUD.
MEASUREMENTS: Primary outcome: percentage days abstinent (PDA); secondary outcomes: 12-Step attendance, substance-related consequences, longest period of abstinence, proportion abstinent/mostly abstinent, psychiatric symptoms.
FINDINGS: Primary outcome: PDA was not significantly different across treatments [b = 0.08, 95% confidence interval (CI) = -0.08 to 0.24, P = 0.33; Bayes' factor = 0.28).
SECONDARY OUTCOMES: During treatment, iTSF patients had substantially greater 12-Step attendance, but this advantage declined thereafter (b = -0.87; 95% CI = -1.67 to 0.07, P = 0.03). iTSF did show a significant advantage at all follow-up points for substance-related consequences (b = -0.42; 95% CI = -0.80 to -0.04, P < 0.05; effect size range d = 0.26-0.71). Other secondary outcomes did not differ significantly between treatments, but effect sizes tended to favor iTSF. Throughout the entire sample, greater 12-Step meeting attendance was associated significantly with longer abstinence during (r = 0.39, P = 0.008), and early following (r = 0.30, P = 0.049), treatment.
CONCLUSION: Compared with motivational enhancement therapy/cognitive-behavioral therapy (MET/CBT), in terms of abstinence, a novel integrated 12-Step facilitation treatment for adolescent substance use disorder (iTSF) showed no greater benefits, but showed benefits in terms of 12-Step attendance and consequences. Given widespread use of combinations of 12-Step, MET and CBT in adolescent community out-patient settings in North America, iTSF may provide an integrated evidence-based option that is compatible with existing practices.
BACKGROUND: Opioid overdose deaths have become a major public health crisis. While efforts have focused mostly on helping opioid-addicted individuals directly, family members suffer also from the grave and enduring unpredictability associated with opioid addiction and often play a vital role in helping addicted loved ones access care. Little is known, however, about resources to help affected family members. Here we describe results from the first quantitative and qualitative investigation of a free and growing support organization for family members of addicted individuals ("Learn to Cope" [LTC]; www.learn2cope.org), organized around three key questions: 1. Who participates, how often, and in what ways? 2. What are the demographic and clinical histories of their addicted loved-ones? 3. How do participants benefit?
METHOD: Survey with LTC members at meetings and online (N=509; 95% participation rate).
RESULTS: 1. Participants were primarily middle-aged mothers (77%) of opioid-addicted adult male children, attending LTC meetings several times per month, using LTC online resources several times a week, and meeting with LTC members between meetings. 2. Their addicted loved-ones were mostly male (73%), addicted to opioids (88%), with a criminal history (70%), with just under half (41%) having suffered at least one prior overdose. Almost three-quarters (71%), however, reported their loved one was "in recovery", with 30% having a year or more. 3. Benefits since beginning participation included gains in understanding and coping with addiction, feeling better able to help and communicate with their loved-one, and reductions in self-blame and stress. Of members trained in Narcan administration (66%), 86% had received training at LTC meetings; LTC members reported having deployed Narcan for over 44 overdose reversals.
CONCLUSION: The growing availability of LTC may provide a needed source of support and information for family members of opioid-addicted loved-ones and may help reduce overdose deaths through Narcan training and distribution.
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<0.03).
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.
INTRODUCTION: Smartphone apps are emerging as a promising tool to support recovery from and prevention of problematic alcohol use, yet it is unclear what type of apps are currently available in the public domain, and to what degree these apps use interactive tailoring or other dynamic features to meet users' specific needs.
METHODS: We conducted a content analysis of Android apps for managing drinking available on Google Play (n = 266), downloaded between November 21, 2014 and June 25, 2015. We recorded app popularity (> 10,000 downloads) and user-rated quality (number of stars) from Google Play, and coded the apps on three domains (basic descriptors, functionality, use of dynamic features).
RESULTS: In total, the reviewed 266 apps were downloaded at least 2,793,567 times altogether. The most common types of app were BAC calculators (37%), information provision apps (37%), tracking calendars (24%), and motivational tools (21%). Most apps were free (65%) or low in cost (mean = $3.76; SD = $5.80). Many apps provided at least some level of tailored feedback (60%), but the extent of tailoring was limited. Use of other dynamic features (i.e., push notifications, passive data collection) was largely absent. Univariate models predicting app popularity (i.e., > 10,000 downloads vs. not) and user-rated quality (i.e., star rating) indicated that tailoring was positively related to popularity (OR = 2.41 [1.30–4.46]), and the existence of time-based tailoring (e.g., tracking) was related to quality (b = 0.48 [0.19–0.77]).
CONCLUSIONS: These apps have a wide public health reach with > 2.7 million total combined downloads to date. A wide variety of apps exist, allowing persons interested in using apps to help them manage their drinking to choose from numerous types of supports. Tailoring, while related favorably to an app's popularity and user-rated quality, is limited in publicly available apps.