Brown, AM, McDaniel, JM, Johnson, VH, & Ashford, RD. (2019). Dynamic Labeling Discernment:
Contextual Importance of Self-Identifiers for Individuals in Recovery.
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.
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.
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.
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
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.
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
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.
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.
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.
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.
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.
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.
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
Brown, AM, Ashford, RD, Heller, AT, Whitney, J, & Kimball, T. (2018). Collegiate Recovery
Students and Programs: Literature Review from 1988-2017.
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
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.
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.
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.
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.
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.
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.
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.
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.
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.
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.
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.
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.
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.
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.
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
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
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).
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.
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.
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.
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
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.
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.
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.
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.
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.
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.
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.
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
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.