Research Publications

  • Brown, AM, McDaniel, JM, Johnson, VH, & Ashford, RD. (2019). Dynamic Labeling Discernment: Contextual Importance of Self-Identifiers for Individuals in Recovery.

    ABSTRACT

    Recent studies associate identifiers, such as “alcoholic/addict”, with stigma, discrimination, and service deficits. Yet, little is known about why and how self-identifiers are chosen. This study analyzed qualitative responses from individuals (N = 42) in recovery from substance use disorders (SUDs) concerning their use of “alcoholic/addict” or “person with a SUD”. Evaluative structure and generative theories were developed via latent content analysis and grounded theory. Secondary analysis evidenced four thematic constructs: contextual significance, flexibility/rigidity, leveraging identity to counteract stigma, and indications of identity integration/disintegration. Some individuals indicated the contextual utility of certain identifiers, regardless of associated stigma and bias.

  • Ashford, RD, Brown, AM, Ryding, R, & Curtis, B. (2019). Building Recovery Ready Communities: The Recovery Ready Ecosystem Model and Community Framework.

    ABSTRACT

    Public and private systems in the United States and around the World are impacted by substance use disorders (SUD). Despite recent attempts at bringing top down solutions, SUDs continue to be a leading cause of death, a leading correlate in violent crime, and a leading cause of lost productivity in the workplace. Community-based resources have been shown to positively affect SUD impact and SUD recovery, by orienting stakeholders towards the problem and creating continuity among support services. Community-based innovations, such as recovery community organizations and other recovery support services, have provided evidence of successfully scaling recovery efforts and improving the chance of sustained recovery for individuals that live within the community.

  • Ashford, RD, Brown, AM, Ashford, A, & Curtis, B. (2019). Recovery Dialects: A Pilot Study of Stigmatizing and Nonstigmatizing Label Use by Individuals in Recovery from Substance Use Disorders.

    ABSTRACT

    Previous research has found language used to describe individuals with a substance use disorder (SUD; e.g., “addict,” “substance abuser”) contributes to and elicits negative bias among the general public and health care professionals. However, the prevalence in which recovering individuals use these labels to self-identify and the impact of such labels are unknown. The current pilot study, a cross-sectional design, examined the usage of two labels (“addict,” “person with a SUD”) as well as the differences in recovery outcomes among individuals in recovery. Participants (n = 54) used both labels at high rates (“addict”: 66.67%; “person with a SUD”: 38.89%), though mutually exclusive use was lower (“addict” only: 35.19%, “person with a SUD” only: 7.5%). Common label use settings included mutual-aid recovery meetings, with friends and family, and on social media. Analysis of variance tests found no statistically significant differences between label groups for recovery capital, self-esteem, internalized stigma and shame, flourishing, or length in recovery. Descriptively, participants using only “person with a SUD” had more positive outcomes, although these individuals also had higher levels of internalized shame. Results suggest that language may have only a marginal impact on individuals in recovery, although professionals and the general public should continue to avoid using stigmatizing labels. Additionally, many individuals in recovery have the ability to discern context and setting, switching between positive and negative labels as appropriate. Future research is warranted given these pilot findings and should focus on long-term impacts of self-labeling and internalized stereotypes among individuals in recovery. 

  • Ashford, RD, Brown, AM, & Curtis, B. (2019). Expanding Language Choices to Reduce Stigma: A Delphi Study of Positive and Negative Terms in Substance Use and Recovery.

    ABSTRACT

    Purpose
    Public perception has been found to be influenced by the words used to describe those with behavioral health disorders, such that using terms like “substance abuser” can lead to higher levels of stigma. The purpose of this paper is to identify additional stigmatizing and empowering terms that are commonly used by different stakeholders.
     
    Using digital Delphi groups, the paper identifies positive and negative terms related to substance use disorder (SUD) from three distinct stakeholder groups: individuals in recovery, impacted family members and loved ones, and professionals in the treatment field.

    Findings
    Participants identified 60 different terms that are considered stigmatizing or positive. Previously identified stigmatizing terms (abuser, addict) were present for all stakeholder groups, as was the positive term person with a SUD. Additional stigmatizing terms for all groups included junkie and alcoholic. Additional positive terms for all groups included long-term recovery.


    Social implications
    The results suggest that the continued use of terms like addict, alcoholic, abuser and junkie can induce stigma in multiple stakeholders. The use of more positive terms such as person with a SUD or person in recovery is suggested to reduce stigma.

  • Ashford, RD, Brown, AM, Brown, T, Callis, J, Cleveland, HH, Eisenhart, E, Groover, H, Hayes, N, Johnston, T, Kimball, T, Manteuffeul, B, McDaniel, JM, Montgomery, L, Phillips, S, Polacek, M, Statman, M, & Whitney, J. (2019). Defining and Operationalizing the Phenomena of Recovery: A Working Definition from the Recovery Science Research Collaborative.

    ABSTRACT

    A number of definitions exist for the concept of “recovery” in both the substance use disorder (SUD) and mental health (MH) fields. Previous attempts to define recovery have not reached consensus among experts within the field. Thus, the definition has remained diffuse at the expense of attempts to measure and evaluate treatment and recovery outcomes. The notion of recovery as an organizing principle between SUD and MH, collectively identified as behavioral health (BH), can be better served by a collaborative endeavor to define the word and concept of “recovery”. The Recovery Science Research Collaborative (RSRC), an interdisciplinary bi-annual collaboration among recovery researchers and professionals from across the country, sought to address the definition of recovery at the inaugural meeting in December 2017 at Kennesaw State University. The RSRC undertook this task with the primary goal of defining “recovery” for use in research – aiming to create a consensus definition that allows recovery to be clearly operationalized and effectively investigated.

  • Brown, AM & Ashford, RD. (2019). Recovery-Informed Theory: Situating the Subjective in the Science of Substance Use Disorder Recovery.

    ABSTRACT

    As recovery from substance use disorder becomes more than a mere quantifiable outcome, there exists a need to discuss and propose the underlying theoretical constructs that ultimately describe and identify the science of recovery. In this abstract undertaking, we propose an initial formulation of a grand theory of recovery science, built upon the seminal theories of recovery capital, recovery-oriented systems of care, and socioecological theory. This grand theory - labeled recovery-informed theory (RIT) - states that successful long-term recovery is self-evident and is a fundamentally emancipatory set of processes. This paper will discuss, analyze, and explore this theory as it is situated within the larger substance use, misuse, and disorder contexts. The uses, implications, and benefits of RIT as an organizing point of inquiry for recovery science are also discussed. By promoting the role of subjective recovery experience in the formulation of the study of recovery, it may be possible to summon new ideas, metrics, and strategies that can directly address substance use disorders in society. Adopting a recovery-informed understanding as follows from this grand theory may allow individual recovery and wellness trajectories to be explored, adapted, and modified to exemplify person-centered and individualized recovery strategies.

     

  • Ashford, RD, Meeks, M, Curtis, B, & Brown, AM. (2019). Utilization of Peer-Based Substance Use Disorder and Recovery Interventions in Rural Emergency Departments: Patient Characteristics and Exploratory Analysis.

    ABSTRACT

    The current opioid crisis has necessitated timely, grassroots social entrepreneurship from stakeholders involved in the substance-use disorder and recovery fields. One such innovation involves the use of peer-recovery-support services in acute settings in which points of contact are made with high-risk substance-using populations. These programs have emerged organically in emergency departments (EDs) across the country. The Georgia Council on Substance Abuse, Northeast Georgia Community Connections Program is a peer-recovery-support service (PRSS) that uses certified addiction-recovery empowerment specialists (CARES) in rural EDs in Georgia, a Medicaid nonexpansion state. In this study, we reviewed initial data from the Community Connections Program captured at rural EDs. Patients (N = 205) met the American Psychiatric Association’s (2013) Diagnostic and Statistical Manual of Mental Disorders (5th ed.; DSM–5) criteria for substance-use disorder. This study demonstrated that peer interventions can be beneficial for all types of drug use, not just for individuals who experience accidental opioid drug poisoning (i.e., overdose). In addition, results suggest that both clinical and community-based supports can be used for referrals to appropriate levels of care. These findings also highlight the utility of innovative and adaptive peer-recovery-support programs in rural EDs across the United States. 

  • Ashford, RD, Curtis, B, & Brown, AM. (2018). Peer-Delivered Harm Reduction and Recovery Support Services: Initial Evaluation from a Hybrid Recovery Community Drop-in Center and Syringe Exchange Program.

    ABSTRACT

    Background

    Recovery from substance use disorder (SUD) is often considered at odds with harm reduction strategies. More recently, harm reduction has been categorized as both a pathway to recovery and a series of services to reduce the harmful consequences of substance use. Peer recovery support services (PRSS) are effective in improving SUD outcomes, as well as improving the engagement and effectiveness of harm reduction programs.

    Methods

    This study provides an initial evaluation of a hybrid recovery community organization providing PRSS as well as peer-based harm reduction services via a syringe exchange program. Administrative data collected during normal operations of the Missouri Network for Opiate Reform and Recovery were analyzed using Pearson chi-square tests and Monte Carlo chi-square tests.

    Results

    Intravenous substance-using participants (N = 417) had an average of 2.14 engagements (SD = 2.59) with the program. Over the evaluation period, a range of 5345–8995 sterile syringes were provided, with a range of 600–1530 used syringes collected. Participant housing status, criminal justice status, and previous health diagnosis were all significantly related to whether they had multiple engagements.

    Conclusions

    Results suggest that recovery community organizations are well situated and staffed to also provide harm reduction services, such as syringe exchange programs. Given the relationship between engagement and participant housing, criminal justice status, and previous health diagnosis, recommendations for service delivery include additional education and outreach for homeless, justice-involved, LatinX, and LGBTQ+ identifying individuals.

  • Brown, AM, Ashford, RD, Heller, AT, Whitney, J, & Kimball, T. (2018). Collegiate Recovery Students and Programs: Literature Review from 1988-2017.

    ABSTRACT

    Objectives

    To present a review of the existing research on college students living in recovery, including the research on students in recovery participating in collegiate recovery programs.  

    Methods

    Studies were included if they: a) were peer-reviewed or archived dissertations, b) were published between 1988 and 2017, c) directly involved students in recovery on campus, either with or without involvement in a collegiate recovery program.

    Results

    From 1988 to 2017, 25 studies met the inclusion criteria. These included 7 studies on students living in recovery within the general framework of higher education and 18 studies involving students in collegiate recovery programs. Qualitative reports and quantitative descriptive studies were both included. 

    Conclusions

    Findings identify the gaps in currently available research, and support rationale for increasing longitudinal and quantitative studies of collegiate recovery programs and the students they serve.

  • Ashford, RD, Brown, AM, & Curtis, B. (2018). Substance Use, Recovery, and Linguistics: The Impact of Word Choice on Explicit and Implicit Bias.

    ABSTRACT

    Background

    The general public, treatment professionals, and healthcare professionals have been found to exhibit an explicit negative bias towards substance use and individuals with a substance use disorder (SUD). Terms such as “substance abuser” and “opioid addict” have shown to elicit greater negative explicit bias. However, other common terms have yet to be empirically studied.

    Methods

    1,288 participants were recruited from ResearchMatch. Participants were assigned into one of seven groups with different hypothesized stigmatizing and non-stigmatizing terms. Participants completed a Go/No Association Task (GNAT) and vignette-based social distance scale. Repeated-measures ANOVAs were used to analyze the GNAT results, and one-way ANOVAs were used to analyze vignette results.

    Results

    The terms “substance abuser”, “addict”, “alcoholic”, and “opioid addict”, were strongly associated with the negative and significantly different from the positive counterterms. “Relapse” and “Recurrence of Use” were strongly associated with the negative; however, the strength of the “recurrence of use” positive association was higher and significantly different from the “relapse” positive association. “Pharmacotherapy” was strongly associated with the positive and significantly different than “medication-assisted treatment”. Both “medication-assisted recovery” and “long-term recovery” were strongly associated with the positive, and significantly different from the negative association.

    Conclusions

    Results support calls to cease use of the terms “addict”, “alcoholic”, “opioid addict”, and “substance abuser”. Additionally, it is suggested that “recurrence of use” and “pharmacotherapy” be used for their overall positive benefits. Both “medication-assisted recovery” and “long-term recovery” are positive terms and can be used when applicable without promoting stigma.

  • Ashford, RD, Brown, AM, & Curtis, B. (2018). Collegiate Recovery Programs: The Integrated Behavioral Health Model.

    ABSTRACT

    Campus-based recovery programs have been shown to support students in recovery from substance use disorders, as well as mental health disorders. However, this support has been historically delivered in isolation. This study highlights preliminary outcomes from a novel collegiate recovery program, one that uses a model of recovery with integrated support services for students in recovery from substance use or mental health disorders, or co-occurring behavioral health disorders. Similar to traditional collegiate recovery programs, beneficial services of the integrated program were most often related to peer-based services. Outcomes were also similar, with students in recovery having higher than average Grade Point Average (M = 3.68, SD = .34) and lengths of recovery time (M = 3.69, SD = 2.87 [years]).

     

  • Ashford, RD & Brown, AM. (2017). Bridging the Gaps: Intergenerational Findings from the Substance Use Disorder and Recovery Field.

    ABSTRACT

    The substance use disorder and recovery field has undergone rapid transformation over the last 40 years. It currently has a workforce that includes three generations—Baby Boomers, Generation X, and Millennials. The current study sought to identify generational differences among those involved in the substance-use disorder and recovery profession using an embedded design and grounded theory approach. Findings suggest that generational differences do exist across the three generations in regard to ideologies, value of formal and informal knowledge, training, and education. Results from the current study provide a further understanding of how we may bridge perceived contentious ideologies and knowledge gaps between generations to better develop current and future professionals within the field.

     

  • Ashford, RD, Brown, AM, Eisenhart, E, Heller, AT, & Curts, B. (2018). What We Know About Students in Recovery: A Meta-Synthesis of Collegiate Recovery Programs, 2000-2017.

    ABSTRACT

    As a relatively new field of practice, collegiate recovery programs (CRP), have used a practice-informed approach as a means of establishing best practices and pedagogy. While research on collegiate recovery programs and populations of students in recovery is growing, much of the qualitative studies have yet to be synthesized into a useful organizing matrix. This study utilizes meta-synthesis design to explore the leading qualitative research on student experiences in collegiate recovery. From this synthesis, researchers identified six metaphors from ten included studies from 2000–2017. The six metaphors of social connectivity, recovery supports, drop-in recovery centers, internalized feelings, coping mechanisms, and conflict of recovery/student status, support much of the preexisting practices and provide a critical framework for future program design, service delivery, and research.

     

  • Brown, AM & Bohler, R. (2018). Achieving a 15% Relapse Rate: A Review of Collegiate Recovery and Physician Health Programs.

    ABSTRACT

    Evidence from physician health programs (PHPs) suggest that long-term continuums of step-down care are effective at achieving at or near a 15% relapse rate. Parallel to the PHP model, evidence from collegiate recovery programs (CRPs) cite a relapse rate from year to year of 8%. The CRP and PHP models involve long-term, comprehensive components of care and ancillary services oriented toward highly transformative abstinence-based recovery. This article identifies factors between the two models that facilitate recovery and discusses the implications for future research.

  • Brown, AM, Ashford, RD, Figley, N, Courson, K, Curtis, B, & Kimball, T. (2018). Alumni Characteristics of Collegiate Recovery Programs: A National Survey.

    ABSTRACT

    Collegiate recovery programs (CRPs) support students in or seeking recovery from substance use disorders or mental health disorders while enrolled in college. Collegiate recovery has been established as a field of study since the 1970s. To date, a number of qualitative studies have been completed on the programs and students served, along with a single national descriptive survey. This pilot study is the first undertaken exploring the status (recovery, professional, and quality of life) of student alumni that engaged in undergraduate collegiate recovery programs (CRP). Results contain alumni recovery status, primary recovery supports utilized, relapse rates since graduation, and recovery capital/quality of life scores. Similar to previously published works, CRP alumni remain actively in recovery, with relapse rates only slightly higher than the national average of students currently engaged in CRPs (10.2% vs. 6.8%). Findings are preliminary evidence that collegiate recovery programs adequately prepare engaged students for future recovery and professional life.

  • Ashford, RD, Wheeler, B, & Brown, AM. (2018). Collegiate Recovery Programs and Disordered Eating: Exploring Sub-Clinical Behaviors Among Students in Recovery.

    ABSTRACT

    The co-occurring prevalence of disordered eating (DE) with substance use disorders is estimated to be high among college students. Collegiate recovery programs (CRPs), primarily used for the support of students with mental health disorders and substance use disorders, are well positioned to potentially provide support for students with DE behaviors. The current study identifies the prevalence of subclinical DE behaviors among college students currently participating in a collegiate recovery program at a U.S. institution. 61 recovering students (Age: M = 29 years, SD = 8.35, 59% male) completed a digital survey inquiring about subclinical DE behaviors using 9 Likert-type scaled questions. Composite subclinical DE scores were significantly different between student genders, as well as full-time and part-time students. Female and full-time students were more likely to experience subclinical DE behaviors than male and part-time students. As subclinical DE behaviors are present among students engaged in CRPs at a high rate, and though behaviors are most pronounced among female students, they are also are present in males. A majority of students engaged in the CRP feel that the CRP can support mental health and DE recovery in addition to serving those in recovery from substance use disorders.

  • Ashford, RD, Brown, AM, & Curtis, B. (2018). The Language of Substance Use and Recovery: Novel Use of the Go/No–Go Association Task to Measure Implicit Bias.

    ABSTRACT

    Previous research has found initial evidence that word choice impacts the perception and treatment of those with behavioral health disorders through explicit bias (i.e., stigma). A more robust picture of behavioral health disorder stigma should incorporate both explicit and implicit bias, rather than relying on only one form.

    The current study uses the Go/No–Go Association Task to calculate a d′ (sensitivity) indexed score of automatic attitudes (i.e., implicit associations) to two terms, “addict” and “person with substance use disorder.”

    Participants have significantly more negative automatic attitudes (i.e., implicit bias) toward the term “addict” in isolation as well as when compared to “person with a substance use disorder.”

    Consistent with previous research on explicit bias, implicit bias does exist for terms commonly used in the behavioral health field. “Addict” should not be used in professional or lay settings. Additionally, these results constitute the second pilot study employed the Go/No–Go Association Task in this manner, suggesting it is a viable option for continued linguistic stigma related research.

  • Ashford, RD, Brown, AM, & Curtis, B. (2018). Systemic Barriers in Substance Use Disorder Treatment: A Prospective Qualitative Study of Professionals in the Field.

    ABSTRACT

    Background

    The US is in the midst of one of the largest public health crises in recent history with over 63,000 drug poisoning deaths in 2016 and a projected annual economic cost of over $420 billion. With the rise of deaths and economic burden related to substance use, it is paramount that systemic barriers within the treatment industry be identified and resolved.

    Methods

    Data were collected from US substance use treatment professionals (N = 182) in the fall of 2016. Thematic analysis with axial coding was used on anonymized responses to an online open-ended survey. Additional ad hoc testing for variance (education, generation, regional location, and employment) was completed using Monte Carlo chi-square analyses.

    Results

    7 major themes emerged: 1) additional training, education, and use of evidence-based practices, 2) expansion of treatment services, 3) increased resources, 4) stigma reduction, 5) increased collaboration and leadership, 6) reductions in regulations, requirements, and incentives, and 7) expansion of recovery support services. Participant response yielded a significant relationship between employment type (p = 0.002) and regional location (p = 0.046).

    Conclusions

    Systemic barriers in the treatment field are prevalent from the perspective of professionals engaged in the field. While previously identified barriers are still present, newly reported barriers include: 1) lack of treatment services (e.g., capacity), 2) lack of technological resources (e.g., technological support tools), 3) lack of recovery support services (e.g., recovery housing), 4) lack of collaboration and leadership (e.g., communication and partnership), and 5) increasing unethical practices in the field (e.g., incentive-based patient brokering).

  • Ashford, RD, Brown, AM, & Curtis, B. (2018). “Abusing Addiction”: Our Language Still Isn’t Good Enough.

    ABSTRACT

    Previous research has found initial evidence that word choice affects the perception and treatment of those with behavioral health disorders. These previous studies have relied on vignette-based methodologies, however, and a more quantifiable index of the stigma words can produce is needed. The current study uses the Go/No-Go Association Task to calculate a d-prime (sensitivity) indexed score of automatic attitudes to two terms, substance abuser and a person with substance use disorder. Participants have significantly more negative automatic attitudes toward the term substance abuser, as compared to a person with a substance use disorder. Consistent with previous research, implicit bias does exist for terms commonly used in the behavioral health field. Substance abuser and its derivatives should not be used in professional or lay settings.

  • Ashford, RD, Brown, AM, McDaniel, JM, & Curtis, B. (2019). Biased Labels: An Experimental Study of Language and Stigma Among Individuals in Recovery and Health Professionals.

    ABSTRACT

    Background
    Labels such as “addict” and “substance abuser” have been found to elicit implicit and explicit stigma among the general public previously. The difference in the levels of this bias among individuals in recovery and those employed in the health profession has not yet been identified, however. The current study seeks to answer this question using measures of implicit bias. Methods: A subset sample (n = 299) from a previously completed study (n = 1288) was selected for analysis. Mixed-model ANOVA tests were completed to identify variance between d-prime automatic association scores with the terms “addict” and “substance abuser” among individuals in recovery and those identified as working in the health professions. 

    Results

    Individuals in recovery did not have lower negative associations with either term, whereas individuals employed as health professionals had greater negative associations with the term “substance abuser” but did not have greater negative associations with the term “addict.” Conclusions: Results provide further evidence that previously identified stigmatizing labels have the potential to influence medical care and medical practitioner perceptions of individuals with substance use disorders and should be avoided. Further exploration into the role negative associations derived from commonly used labels have in the individual recovery process is needed to draw appropriate recommendations.

  • Ashford, RD, Brown, AM, Canode, B, McDaniel, JM, & Curtis, B. (2019). A Mixed-Methods Exploration of the Role and Impact of Stigma and Advocacy on Substance Use Disorder Recovery.

    ABSTRACT

    Obstacles to intrapersonal and interpersonal growth, due to stigma and discrimination, may constitute a significant challenge to those in recovery. Engaging in recovery-related advocacy may serve as a buffer to the experience of stigma and discrimination. The purpose of this pilot study is to examine whether the perception of stigmatization is associated with common recovery measures such as recovery capital, self-esteem, and self-efficacy, as well as to explore the role of advocacy for individuals in recovery through thematic analysis. Statistically significant results suggest that individuals who believe they are stigmatized have less recovery capital and self-esteem than those who do not hold this belief. Several major themes related to the overall impact, perceived benefits, and perceived harms of engaging in advocacy emerged from the thematic analysis such as reduction in stigma, improving soft skills, service to others, and reduced ability to engage in self-care. Findings suggest that individuals who believe they are stigmatized have lower functional outcomes (recovery capital and self-esteem) and mitigating these effects may be important for future recovery success. Additionally, thematic results suggest that engaging in recovery related advocacy offers a multitude of potential benefits and positive impacts, but also may have important potential harms to consider.

  • Curtis, B, Bergman, B, Brown, AM, McDaniel, JM, Harper, K, Eisenhart, E, Hufnagel, M, Heller, AT, & Ashford, RD. (2019). Characterizing Participation and Perceived Engagement Benefits in an Integrated Digital Behavioral Health Recovery Community for Women: A Cross-Sectional Survey.

    ABSTRACT

    Background

    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.

    Objective

    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.

    Methods

    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.

    Results

    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.

    Conclusions

    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.

  • Ashford, RD, Brown, AM, McDaniel, JM, Neasbitt, J, Sobora, C, Riley, R, Weintstein, L, Laxton, A, Kunzelman, J, Kampman, K, & Curtis, B. (2019). Responding to the Opioid and Overdose Crisis with Innovative Services: The Recovery Community Center Office-Based Opioid Treatment (RCC-OBOT) Model.

    ABSTRACT

    Opioid use disorder (OUD) and opioid-related overdose mortality are major public health concerns in the United States. Recently, several community-based and professional innovations - including hybrid recovery community organizations, peer-based emergency department warm handoff programs, emergency department buprenorphine induction, and low-threshold OUD treatment programs - have emerged or expanded in an effort to address significant obstacles to providing patients the care needed for OUD and to reduce the risk of overdose. Additional innovations are needed to address the crisis. Building upon the foundational frameworks of each of these recent innovations, a new model of OUD pharmacotherapy is proposed and discussed: the Recovery Community Center Office-Based Opioid Treatment model. Additionally, two potential implementation scenarios, the overdose and non-overdose event protocols, are detailed for communities, peers, and practitioners interested in implementing the model. Potential barriers to implementation of the model include service reimbursement, licensing regulations, and organizational concerns. Future research should seek to validate the model and to identify actual implementation and sustainability barriers and best practices.

  • Ashford, RD, Brown, AM, Dorney, G, McConnell, N, Kunzelman, J, McDaniel, JM, & Curtis, B. (2019). Reducing Harm and Promoting Recovery Through Community-Based Mutual Aid: Characterizing Those Who Engage in a Hybrid Peer Recovery Community Organization.

    ABSTRACT

    Background

    Peer-based support services are often used within harm reduction organizations, and more recently within recovery community organizations (RCO). Identifying the characteristics of individuals who engage with these novel RCOs is needed. Additionally, conducting collaborative research with communities of people who use drugs (PWUD) or are in recovery is an effective and rewarding approach that allows individuals to take ownership and play a critical role in the study.

    Methods

    This exploratory study employs a community-based participatory research (CBPR) framework in partnership with a peer-led hybrid recovery community organization, Rebel Recovery, in Florida. Peer staff participated in all phases of the study, helping to inform the study protocol, data collection, analysis, interpretation, and results write-up. A cross-sectional survey instrument was used to collect consumer intake data. Pearson Chi-square tests and multivariate binomial logistic regressions were used to examine relationships between consumer characteristics and service utilization.

    Results

    Consumers (n = 396) of Rebel Recovery peer support services had a mean age of 35.60 years (SD = 9.74). Many were experiencing homelessness (35.4%), unemployed (69.7%), high school graduates or GED holders (68.2%) and had a last year income of less than $10,000 (58.3%). The majority were users of heroin primarily (70.7%), with intravenous use being the preferred route of administration (63.9%). Exploratory analysis found that gender, marital status, and involvement in the child welfare system were significantly related to primary substance of use. Past 30-day engagement in recovery meetings had several statistically significant predictors including primary substance of use, age, housing status, annual income level, past-30-day arrests, tobacco use, and alcohol harm perception. Process findings from the CBPR methods used reconfirm the value of including peers in research involving PWUD and individuals in recovery.

    Conclusions

    Results suggest that peer-based support services at a hybrid recovery community organization can successfully engage populations that are often underserved (i.e., experiencing homelessness, involved in drug court, intravenous users, etc.). Significant relationships identified in the exploratory analysis suggest that additional education concerning overdose and the potential benefits of recovery meetings may be useful for specific consumers. Additionally, several recommendations and benefits of engaging in community-based participatory research with peer-led organizations are made for future research.

  • Brown, AM, McDaniel, JM, Austin, K, Ashford, RD. (2019). Developing the Spirituality in Recovery Framework: The Function of Spirituality in 12-Step Substance Use Disorder Recovery.

    ABSTRACT

    A large portion of substance use disorder recovery research has incorporated the study of mutual-aid 12-Step programs and faith-based programs. However, spirituality as a centerpiece of substance use disorder recovery, as an actionable or operationalized means of transformative change, is not well studied. As many individuals in recovery point to spirituality as the chief means by which they have overcome their substance use disorder, this represents a significant gap in the current literature. Though spirituality is difficult to operationalize and measure, several previous studies have examined aspects of the role of spirituality in the recovery process. This current article puts forth a theoretical framework in which leading articles involving spirituality in recovery are synthesized in order to inform a functional, theoretical model of change that can be utilized in future research design.

 

 

 

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