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The attitudes of individuals who receive, provide, or influence opioid use disorder (OUD) medication services, also called stakeholders, may enhance or hinder their dissemination and adoption. Individuals who have resolved a significant alcohol or other drug (AOD) problem are a group of key stakeholders whose OUD medication attitudes are not well understood empirically. This group subsumes, but is not limited to, individuals who identify as being "in recovery." Analyses leveraged the National Recovery Study, a geo-demographically representative survey of U.S. adults who resolved a significant AOD problem (N = 1,946). We examined the prevalence of positive, neutral, and negative attitudes toward agonists, such as buprenorphine/naloxone and methadone, and antagonists, such as oral and extended-release depot injection naltrexone. Single-predictor logistic regression models tested for demographic, clinical, and recovery-related correlates of these attitudes and, for those significant at the .1 level, multivariable-predictor logistic regression models tested unique associations between these correlates and attitudes. Results showed that participants were equally likely to hold positive (21.4 [18.9-24.0]%) and negative agonist (23.8 [21.2-26.7]%) attitudes but significantly more likely to hold negative (30.3 [27.4-33.3]%) than positive antagonist attitudes (18.0 [15.9-20.4]%). Neutral attitudes were most commonly endorsed for both agonists (54.8 [51.6-57.9]%) and antagonists (51.7 [48.5-54.8]%). For agonists, more recent AOD problem resolution was a unique predictor of positive attitude, whereas Black and Hispanic races/ethnicities, compared with White, were unique predictors of negative attitude. For antagonists, older age group (45-59 and 60 + vs. 18-29 years), lifetime opioid antagonist medication prescription, and past 90-day non-12-step mutual-help attendance were unique predictors of positive attitude, whereas greater spirituality was a unique predictor of negative attitude. This population-level study of U.S. adults who resolved an AOD problem showed that agonist attitudes may be more positive than anecdotal evidence suggests. Certain characteristics and experiences, however, highlight a greater likelihood of negative attitudes, suggesting these factors may be potential barriers to OUD medication adoption. (PsycInfo Database Record (c) 2020 APA, all rights reserved).

To understand how persons with substance use disorders (SUDs) achieve and maintain wellness, it is necessary to expand recovery science research. The experiences of individuals in recovery are rare...

BACKGROUND: Many people who report resolving an alcohol or other drug (AOD) problem continue some level of substance use. Little information exists, however, regarding the prevalence of this resolution pathway, or how continued substance use after resolving an AOD problem, relative to abstinence, relates to functioning, quality of life, and happiness (i.e., well-being). Greater knowledge of the prevalence and correlates of non-abstinent AOD problem resolution could inform public health messaging and clinical guidelines, while encouraging substance use goals likely to maximize well-being and reduce risks. METHODS: We analyzed data from a nationally representative sample of individuals who endorsed having resolved an AOD problem (N = 2,002). Analyses examined: (1) The prevalence of various substance use statuses coded from lowest to highest risk: (a) continuous abstinence from all AOD since problem resolution; (b) current abstinence from all AOD with some use since problem resolution; (c) current use of a substance reported as a secondary substance; (d) current use of the individual’s primary substance only; or, (e) current use of a secondary and primary substance; (2) relationships between substance use status and demographic, clinical, and service use history measures; and (3) the relationship between substance use status and well-being. Weighted, controlled, regression analyses examined the influence of independent variables on substance use status. RESULTS: (1) Prevalence: In this sample, 20.3% of participants endorsed continuous abstinence; 33.7% endorsed current abstinence; 21.0% endorsed current use of a secondary substance; 16.2% endorsed current use of a primary substance; and 8.8% endorsed current use of both a secondary and a primary substance. (2) Correlates: Lower-risk substance use status was associated with the initiation of regular substance use at an older age, more years since problem resolution, and fewer lifetime psychiatric diagnoses. (3) Well-Being: Controlling for pertinent confounds, lower-risk substance use status was independently associated with greater self-esteem, happiness, quality of life and functioning, and recovery capital, as well as less psychological distress. CONCLUSIONS: About half of Americans who self-identify as having resolved an AOD problem continue to use AOD in some form. It appears that although abstinence is, for many, not a requisite for overcoming an AOD problem, it is likely to lead to better functioning and greater well-being. Further, people appear to gravitate toward abstinence/lower risk substance use with greater time since problem resolution.

Background There are many effective treatment options for substance use disorder (SUD), yet most individuals with SUD do not seek formal treatment services. Given the rising popularity of TikTok and need to foster innovative means through which to attract and engage individuals with SUD with treatment, we sought to characterize how TikTok users in SUD recovery are using this platform to bolster their recovery support and/or give hope to others who are struggling with substance use. Methods Our sample consisted of 82 of the most liked TikTok videos related to attempts to cut down on or abstain from substances and/or strengthen SUD recovery. We employed an iterative process to codebook development resulting in codes for demographics, user-sentiment, video type, and mechanisms of recovery-related behavior change. Videos were independently double-coded and evaluated for inter-rater reliability. Results Video in this sample were heavily viewed, accounting for over 2 million views per video and 325,000 likes on average. Most common video themes were sharing a journey from active SUD to recovery (40.2%) and sharing/celebrating a recovery milestone (37.8%), followed by recurrence of substance use (12.2%). Commonly exemplified mechanisms of recovery-related behavior change included embracing a strong social identity as a person in recovery (81.7%), social support (45.1%), and participation in rewarding alternative activities (39.0%). Conclusion TikTok SUD recovery-focused videos can potentially reach millions with portrayed themes similar to established therapeutic mobilizers and mechanisms. More research is needed to better understand whether digital recovery narratives can effectively normalize experiences of addiction and help-seeking behaviors.

The concept of "recovery" from alcohol use disorders (AUD) has garnered increasing scientific interest in recent years including attempts to explicate and measure its presumed component parts. In general, there is consensus that "recovery" should not be solely about abstinence or quantity-frequency measures of alcohol consumption and should include measures of functioning. Some researchers have taken an even more radical step, however, to suggest that psychosocial functioning should be the sine qua non defining feature of "recovery," seemingly irrespective of how much one drinks; as such, people can be classified as achieving and maintaining successful "recovery" despite engaging in regular very heavy drinking. This commentary argues against this notion, as it goes beyond existing data and largely ignores the more insidious toxicity-related, as well as acute intoxication-related, health risks, known to occur with heavy alcohol exposure that contradict the salubrious intent of the "recovery" construct. Furthermore, classifying someone as being in successful "recovery" due to high functioning but while engaging in very heavy drinking, ignores the potential collateral damage to close significant others (eg, children, partners), whose well-being can be severely impacted by the enduring unpredictability of heavy use. Finally, it is argued that exclusive championing of "functioning," while paying little if any attention to AUD remission or alcohol exposure status, creates a conceptual conundrum whereby someone with low functioning but who is in long-term AUD remission or completely abstinent could be classified as not achieving "recovery," holding such individuals to a higher standard and may be stigmatizing.

Parents of youth with substance use disorders (SUDs) often play a vital role in successful treatment, yet little is known about interventions designed to help them cope with the stress of this role, especially as delivered in real-world settings. Evaluations of such interventions could potentially inform adaptations to enhance their clinical utility. Parents of youth with SUDs attending a clinician-led group based on the CRAFT model completed measures at intake, 4- and 8-weeks. Parents (n=545) attended an average of 3.7 sessions; 12% completed all 8 weeks. Analysis of demographic predictors of retention indicated that older parents attended more sessions on average. Overall stress did not change across time points (p>0.05). However, parents reported improvement in parent empowerment as measured by the Parent Empowerment Scale, a novel measure of parent empowerment in coping with their child’s SUD (p

Background Due to shame and fear of discrimination, individuals in, or seeking, recovery from alcohol and other drug (AOD) problems often struggle with whether, when, and to whom to disclose information regarding their AOD histories and recovery status. This can serve as a barrier to obtaining needed recovery support. Consequently, disclosure may have important implications for recovery trajectories, yet is poorly understood. Design and sample Cross-sectional, U.S. nationally-representative survey conducted in 2016 among individuals with resolved AOD problems (N = 1987) investigated disclosure comfort and whether disclosure comfort differed by time since problem resolution, disclosure recipient (i.e., with interpersonal intimacy), or primary substance (i.e., alcohol [51%], cannabis [11%], opioids [5%], or “other” [33%]). Predictors of disclosure comfort were also examined. Data were analyzed using LOWESS analyses, analyses of variance, and regression. Results Overall, longer time since problem resolution was associated with greater disclosure comfort. In general, participants reported greater comfort with disclosure to family and friends, and less comfort with disclosure to co-workers, to first-time acquaintances, in public settings, and in the media, but these effects varied by primary drug with participants who had problems with alcohol and “other” drugs having significantly more disclosure comfort than those who had problems with opioids. Conclusion Dimensions of time since AOD problem resolution, interpersonal intimacy, and primary drug are significantly associated with disclosure comfort. Individuals seeking recovery may benefit from more formal coaching around disclosure, particularly those with primary opioid problems, but further research is needed to determine the desire for and effects of such coaching among those seeking recovery.

Smoking cessation interventions for nondaily smokers are needed. The current study explores the fit of the text-messaging intervention SmokefreeTXT for nondaily smokers.Adult nondaily smokers (N = 32; mean age = 35 ± 12, 64% female, 53% non-Hispanic White) were enrolled in SmokefreeTXT. SmokefreeTXT usage data were recorded passively, theorized mechanisms of change were assessed at baseline and 2, 6, and 12 weeks after the chosen quit day, and EMA protocols captured real-time cigarette reports at baseline, and during the first two weeks after the quit day.Most participants completed the SmokefreeTXT program and responded to system-initiated inquiries, but just-in-time interaction with the program was limited. In retrospective recall at treatment end, content of the text-messages was rated as "neutral" to "helpful." Within-person change was observed in theorized mechanisms, with less craving (p 0.01), increased abstinence self-efficacy (external: p 0.01; internal: p 0.01), and poorer perceptions of pros of smoking (psychoactive benefits: p 0.01, pleasure p 0.01; and pros: p 0.01) reported after SmokefreeTXT initiation compared to baseline. Exploratory analyses of real-time reports of smoking (225 cigarette reports in N = 17 who relapsed) indicated that cigarettes smoked in the first two weeks after quitting were more likely to occur to reduce craving (OR = 2.21[1.21-3.72]), and less likely to occur to socialize (OR = 0.06[0.01-0.24]), between 19:00 and 23:00 (OR = 0.34[0.17-0.66]), and on Saturdays (OR = 0.59[0.35-0.99]) than prior to quitting.While well accepted by nondaily smokers, SmokefreeTXT could potentially be improved by targeting cons of smoking, enhancing engagement with the just-in-time component of SmokefreeTXT, and tweaking the timing of text-messages.

Background Tobacco and alcohol and other drug (AOD) use remain prominent risk factors for morbidity, mortality, and health care utilization. Moreover, these often cluster together within persons, exponentiating health risks. Little is known regarding if and when people resolving AOD problems stop smoking, who stops, and whether recent general population trends toward smoking cessation are evident also among persons more recently entering recovery. Design and participants National cross-sectional sample resolving AOD problems (final sample n = 2002). Analyses Weighted smoking/cessation prevalence; logistic regressions; Hazard-models estimated time to smoking cessation overall, and for different cohorts entering recovery during one of three decades: a) 2006–2015; b) 1996–2005; c) 1986–1995. Results Approximately 30% of U.S. adults in AOD recovery with a smoking history stopped smoking before entering recovery, 7% quit smoking and AOD use concurrently, 26% stopped after entering recovery; 37% still smoked. Among those quitting after entering recovery, the prevalence of smoking cessation 5- and 10-years later was 27.2% and 55.1% respectively for the 2006–2015 cohort and 14.9% and 34.5% in the 1986–1995 cohort; time to smoking cessation also was 60% shorter (5yrs vs. 8yrs). Time to smoking cessation was associated with education and income, but not 12-step participation or AOD treatment. Conclusions Smoking rates among those in AOD recovery are more than double that of the general population but those entering recovery in recent years are stopping and stopping sooner. It is plausible that public health-oriented tobacco policy measures and easier access to smoking cessation aids may be contributing to this salutary trend.

Emerging adults (ages 18–29) have the highest rates of both harmful drinking and participation on social network sites (SNSs) compared to adolescents and older adults. In fact, greater SNS participation has been shown to predict greater alcohol use. Little is known, however, about noncollege samples, substances apart from alcohol, and SNSs other than Facebook. Furthermore, few studies have examined what might moderate any observed influence of SNS participation on substance use. In this study, we used hierarchical linear and negative binomial regression analyses to examine the unique associations between Instagram participation and alcohol as well as marijuana use, controlling statistically for demographic characteristics, peer norms, and social status, in a community sample of emerging adults (N = 194). We also tested whether peer belonging or motives for Instagram participation moderated these relationships. Results showed that Instagram participation was positively related to alcohol use only for those with high levels of peer belonging. The initial negative association between Instagram participation and marijuana use disappeared once peer norms and social status were included. Peer norms were positively related to both alcohol and marijuana use, while peer belonging was positively related to marijuana use. Peer belonging appears to be an important variable in the study of SNSs and substance use among emerging adults. Future work might test the somewhat counterintuitive hypotheses raised by these findings that peer belonging sensitizes individuals to SNS influences on drinking and could be a marker of greater marijuana use.

Objective Alcohol and other drug (AOD) use disorders impose a prodigious personal and societal burden. While most remit, little is known about the achievements accrued as people accomplish and sustain addiction recovery. Greater knowledge regarding the nature and prevalence of such achievements, when such achievements occur, what factors influence accrual of achievements, and how such achievements relate to other indices of functioning would support treatment and policy planning, and may instill hope for individuals and families seeking AOD problem resolution. Methods Nationally representative, cross-sectional survey of United States (US) population of persons who have overcome an AOD problem (N = 2,002), assessing individual factors and achievements in 4 domains: self-improvement; family engagement; civic, and economic participation. Logistic and linear regression models tested theorized associations among variables. Results Most (80.1%) achieved at least one achievement associated with the 4 domains. A linear monotonic relationship was observed with greater achievements accruing with greater time in recovery. Accrual of achievements after AOD problem resolution was related to racial minority status, more education, earlier age of substance use initiation, illicit drugs as primary substance used, more years since resolving AOD problem, more psychiatric diagnoses, lower psychological distress, and regular 12-step program attendance. Multiple regression analyses found greater total achievements were independently associated with greater self-esteem, happiness, quality of life, and recovery capital. Conclusions Most individuals achieve an increasing number of achievements with time since AOD problem resolution, and these are associated with gains in measures of well-being that may support ongoing AOD problem remission, and recovery. (PsycInfo Database Record (c) 2021 APA, all rights reserved).

Background While clinical interventions used to support the recovery process of U.S. adults are well understood, community-based solutions such as peer-based recovery support services delivered by a recovery community organization are not. Methods Previously collected administrative data of 3459 participants at 20 recovery community organizations in the U.S. were analyzed using a paired samples t-test to examine intake and current recovery capital differences, and multiple linear regression models to examine the association between peer-based recovery support engagement on changes in recovery capital. Results Participants were mostly male (52.1%), non-Hispanic (80.2%), White (75.5%), with an average age of 39.38 years (SD = 12.57). Participants’ average engagement was 130.68 days (SD = 166.6) with a total of 4290 engagement sessions (M = 4.75, SD = 4.74) and 8913 brief check-ins (M = 5.0, SD = 5.03) facilitated. Reported health events were 0.09 recurrences of substance use (SD = 0.61) and 0.02 emergency room visits (SD = 0.26) on average. Paired sample t-test results showed a statistically significant increase in recovery capital of 1.33 points (95% CI: 0.97–1.69). Multiple linear regression models for predicting improvements in recovery capital (adjusted r2 = 0.61) found number of follow-up engagements and completed recovery plan goals were statistically significant predictors. Conclusions Peer-based recovery support services delivered by recovery community organizations assist in significantly improving individual recovery capital, as well as helping to facilitate involvement with an array of recovery support services that may contribute to other functional social determinant domain improvements and lower negative health events.

For people with current and remitted substance use disorder (SUD), the COVID-19 pandemic increases risk for symptom exacerbation and relapse through added stressors and reduced service access. In response, mutual-help groups and recovery community organizations have increased access to online recovery support meetings. However, rigorous studies examining online recovery support meeting participation to inform best practices have not yet been conducted. In the absence of such studies, a review of relevant literature, considered in context of potential barriers and drawbacks, suggests the risk-to-benefit ratio is favorable. Particularly given limited in-person SUD service access resulting from COVID-19 precautions, online recovery support meetings may help mitigate a key public health problem during an ongoing, public health pandemic.

Background Technology-based computational strategies that leverage social network site (SNS) data to detect substance use are promising screening tools but rely on the presence of sufficient data to detect risk if it is present. A better understanding of the association between substance use and SNS participation may inform the utility of these technology-based screening tools. Objective This paper aims to examine associations between substance use and Instagram posts and to test whether such associations differ as a function of age, gender, and race/ethnicity. Methods Participants with an Instagram account were recruited primarily via Clickworker (N=3117). With participant permission and Instagram’s approval, participants’ Instagram photo posts were downloaded with an application program interface. Participants’ past-year substance use was measured with an adapted version of the National Institute on Drug Abuse Quick Screen. At-risk drinking was defined as at least one past-year instance having “had more than a few alcoholic drinks a day,” drug use was defined as any use of nonprescription drugs, and prescription drug use was defined as any nonmedical use of prescription medications. We used logistic regression to examine the associations between substance use and any Instagram posts and negative binomial regression to examine the associations between substance use and number of Instagram posts. We examined whether age (18-25, 26-38, 39+ years), gender, and race/ethnicity moderated associations in both logistic and negative binomial models. All differences noted were significant at the .05 level. Results Compared with no at-risk drinking, any at-risk drinking was associated with both a higher likelihood of any Instagram posts and a higher number of posts, except among Hispanic/Latino individuals, in whom at-risk drinking was associated with a similar number of posts. Compared with no drug use, any drug use was associated with a higher likelihood of any posts but was associated with a similar number of posts. Compared with no prescription drug use, any prescription drug use was associated with a similar likelihood of any posts and was associated with a lower number of posts only among those aged 39 years and older. Of note, main effects showed that being female compared with being male and being Hispanic/Latino compared with being White were significantly associated with both a greater likelihood of any posts and a greater number of posts. Conclusions Researchers developing computational substance use risk detection models using Instagram or other SNS data may wish to consider our findings showing that at-risk drinking and drug use were positively associated with Instagram participation, while prescription drug use was negatively associated with Instagram participation for middle- and older-aged adults. As more is learned about SNS behaviors among those who use substances, researchers may be better positioned to successfully design and interpret innovative risk detection approaches.

BACKGROUND Technology-based computational strategies that leverage social network site (SNS) data to detect substance use are promising screening tools but rely on the presence of sufficient data to detect risk if it is present. A better understanding of the association between substance use and SNS participation may inform the utility of these technology-based screening tools. OBJECTIVE This paper aims to examine associations between substance use and Instagram posts and to test whether such associations differ as a function of age, gender, and race/ethnicity. METHODS Participants with an Instagram account were recruited primarily via Clickworker (N=3117). With participant permission and Instagram’s approval, participants’ Instagram photo posts were downloaded with an application program interface. Participants’ past-year substance use was measured with an adapted version of the National Institute on Drug Abuse Quick Screen. At-risk drinking was defined as at least one past-year instance having “had more than a few alcoholic drinks a day,” drug use was defined as any use of nonprescription drugs, and prescription drug use was defined as any nonmedical use of prescription medications. We used logistic regression to examine the associations between substance use and any Instagram posts and negative binomial regression to examine the associations between substance use and number of Instagram posts. We examined whether age (18-25, 26-38, 39+ years), gender, and race/ethnicity moderated associations in both logistic and negative binomial models. All differences noted were significant at the .05 level. RESULTS Compared with no at-risk drinking, any at-risk drinking was associated with both a higher likelihood of any Instagram posts and a higher number of posts, except among Hispanic/Latino individuals, in whom at-risk drinking was associated with a similar number of posts. Compared with no drug use, any drug use was associated with a higher likelihood of any posts but was associated with a similar number of posts. Compared with no prescription drug use, any prescription drug use was associated with a similar likelihood of any posts and was associated with a lower number of posts only among those aged 39 years and older. Of note, main effects showed that being female compared with being male and being Hispanic/Latino compared with being White were significantly associated with both a greater likelihood of any posts and a greater number of posts. CONCLUSIONS Researchers developing computational substance use risk detection models using Instagram or other SNS data may wish to consider our findings showing that at-risk drinking and drug use were positively associated with Instagram participation, while prescription drug use was negatively associated with Instagram participation for middle- and older-aged adults. As more is learned about SNS behaviors among those who use substances, researchers may be better positioned to successfully design and interpret innovative risk detection approaches.

Background Nicotine addiction through cigarette use is highly prevalent among individuals suffering from alcohol and other drug (AOD) problems and remains a prominent risk factor for morbidity, mortality, and healthcare utilization. Whereas most people agree that providing smoking cessation services (SCS) to this vulnerable population is vitally important, the timing of such service provision has been hotly debated, including whether such services should be excluded, available (but not offered), offered, or fully integrated into AOD treatment settings. Important stakeholders in this debate are those in recovery from AOD problems who, in addition to having often been AOD treatment patients themselves, frequently hold influential clinical, research or policy positions and thus can influence the likelihood of SCS provision. This study sought to understand the attitudes of this important stakeholder group in providing SCS in AOD treatment settings. Method We assessed a national cross-sectional sample of individuals in recovery from an AOD problem (n = 1973) on whether SCS should be: a. excluded; b. available; c. offered; or d. integrated into AOD services. We estimated associations between participants' demographic, clinical, and recovery support service use history, and SCS attitude variables, using multinomial logistic regression. Results Roughly equal proportions endorsed each attitudinal position (23.5% excluded, 25% available, 24.6% offered; 26.9% integrated). Correlates of holding more positive SCS implementation attitudes were Black race; primary substance other than alcohol, greater intensity of former or recent smoking, and less mutual-help organization participation; older individuals achieving recovery between 30 and 40 years ago also had more positive attitudes toward integrating SCS. Conclusions About half of those sampled were either against SCS inclusion in AOD settings or were in favor of making it “available” only, but not in offering it or integrating it. This oppositional pattern was accentuated particularly among those with primary alcohol problem histories and those participating in mutual-help organizations. Given the universally well-known negative health effects of smoking, understanding more about the exact reasons why certain groups of recovering persons may endorse such positions is an area worthy of further investigation, as it may uncover potential barriers to SCS implementation in AOD treatment settings.

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 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 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.

Background: It has been long established that achieving recovery from an alcohol or other drug use disorder is\ud associated with increased biobehavioral stress. To enhance the chances of recovery, a variety of psychological,\ud physical, social, and environmental resources, known as “recovery capital”, are deemed important as they can\ud help mitigate this high stress burden. A 50-item measure of recovery capital was developed (Assessment of\ud Recovery Capital [ARC]), with 10 subscales; however, a briefer version could enhance further deployment in\ud research and busy clinical/recovery support service settings. To help increase utility of the measure, the goal of\ud the current study was to create a shorter version using Item Response Theory models.\ud Method: Items were pooled from the original treatment samples from Scotland and Australia (N=450) for scale\ud reduction. A reduced version was tested in an independent sample (N =123), and a Receiver Operating\ud Characteristic Curve was constructed to determine optimal cut-off for sustained remission (> 12 months abstinence).\ud Results: An abbreviated 10-item measure of recovery capital captured item representation from all 10 original\ud subscales, was invariant across participant’s locality and gender, had high internal consistency (α= .90),\ud concurrent validity with the original measure (rpb =.90), and predictive validity with sustained remission using\ud a cut-off score of 47.\ud Conclusion: The brief assessment of recovery capital 10-item version (BARC-10) concisely measures a single\ud unified dimension of recovery capital that may have utility for researchers, clinicians, and recovery support\ud services.

Research shows that digital social network sites (SNSs) may be valuable platforms to effect health behavior change. Little is known specifically about their ability to help address alcohol and other drug problems. This gap is noteworthy, given that individuals are already participating in existing, recovery-specific SNSs (hereafter referred to as recovery SNSs): online communities with the functionality of conventional SNSs (e.g., Facebook) that focus on substance use disorder (SUD) recovery. For example, InTheRooms.com (ITR) is a large, well-known recovery SNS that is available for free 24 hr/day via website and mobile smartphone applications. It offers recovery tools within a digital social milieu for over 430,000 registered users. To augment the knowledge base on recovery SNS platforms, we conducted an online survey of 123 ITR participants (M = 50.8 years old; 56.9% female; 93.5% White; M = 7.3 years of abstinence, range of 0-30 years; 65% cited alcohol as their primary substance). Respondents engaged with ITR, on average, for about 30 min/day several times each week. Daily meditation prompts and live online video meetings were the most commonly utilized resources. Participants generally endorsed ITR as a helpful platform, particularly with respect to increased abstinence/recovery motivation and self-efficacy. Compared to individuals abstinent for 1 or more years, those abstinent less than 1 year (including nonabstinent individuals) showed similar rates of engagement with ITR activities and similar levels of perceived benefit. Our findings suggest that longitudinal studies are warranted to examine the clinical utility of ITR and other recovery SNSs as SUD treatment adjuncts and/or recovery self-management tools. (PsycINFO Database Record

Compared with older adults, emerging adults (18-29 years old) entering treatment typically have less severe alcohol use consequences. Also, their unique clinical presentations (e.g., modest initial abstinence motivation) and developmental contexts (e.g., drinking-rich social networks) may make a straightforward implementation of treatments developed for adults less effective. Yet, this has seldom been examined empirically. This study was a secondary analysis of Project MATCH (Matching Alcoholism Treatments to Client Heterogeneity) data examining (a) overall differences between emerging adults and older adults (≥30 years old) on outcomes during treatment and at 1-year follow-up, and (b) whether emerging adults had poorer outcomes on any of the three Project MATCH treatments in particular.Participants were 267 emerging adults and 1,459 older adults randomly assigned to individually delivered cognitive-behavioral therapy (CBT), motivational enhancement therapy (MET), or 12-step facilitation (TSF). Multilevel growth curve models tested differences on percentage of days abstinent (PDA) and drinks per drinking day (DDD) by age group and treatment assignment.During treatment, compared with older adults, emerging adults reported more DDD but similar PDA. Further, emerging adults assigned to TSF had less PDA and more DDD than emerging adults and older adults assigned to CBT or MET during treatment (i.e., emerging adults in TSF has poorer outcomes initially), but this matching effect was not evident at 1-year follow-up.This study is among the first to test age group differences across three psychosocial interventions shown to be efficacious treatments for alcohol use disorder. Although emerging adults generally did as well as their older counterparts, they may require a more developmentally sensitive approach to bolster TSF effects during treatment.

Peer recovery support services (PRSS) are increasingly being employed in a range of clinical settings to assist individuals with substance use disorder (SUD) and co-occurring psychological disorders. PRSS are peer-driven mentoring, education, and support ministrations delivered by individuals who, because of their own experience with SUD and SUD recovery, are experientially qualified to support peers currently experiencing SUD and associated problems. This systematic review characterizes the existing experimental, quasi-experimental, single- and multi-group prospective and retrospective, and cross-sectional research on PRSS. Findings to date tentatively speak to the potential of peer supports across a number of SUD treatment settings, as evidenced by positive findings on measures including reduced substance use and SUD relapse rates, improved relationships with treatment providers and social supports, increased treatment retention, and greater treatment satisfaction. These findings, however, should be viewed in light of many null findings to date, as well as significant methodological limitations of the existing literature, including inability to distinguish the effects of peer recovery support from other recovery support activities, heterogeneous populations, inconsistency in the definitions of peer workers and recovery coaches, and lack of any, or appropriate comparison groups. Further, role definitions for PRSS and the complexity of clinical boundaries for peers working in the field represent important implementation challenges presented by this novel class of approaches for SUD management. There remains a need for further rigorous investigation to establish the efficacy, effectiveness, and cost-benefits of PRSS. Ultimately, such research may also help solidify PRSS role definitions, identify optimal training guidelines for peers, and establish for whom and under what conditions PRSS are most effective.

Background Alcohol and other drug (AOD) problems are commonly depicted as chronically relapsing, implying multiple recovery attempts are needed prior to remission. Yet, although a robust literature exists on quit attempts in the tobacco field, little is known regarding patterns of cessation attempts related to alcohol, opioid, stimulant, or cannabis problems. Greater knowledge of such estimates and the factors associated with needing fewer or greater attempts may have utility for health policy and clinical communication efforts and approaches. Methods Cross-sectional, nationally representative survey of U.S. adults (N = 39,809) who reported resolving a significant AOD problem (n = 2,002) and assessed on number of prior serious recovery attempts, demographic variables, primary substance, clinical histories, and indices of psychological distress and well-being. Results The statistical distribution of serious recovery attempts was highly skewed with a mean of 5.35 (SD = 13.41) and median of 2 (interquartile range [IQR] = 1 to 4). Black race, prior use of treatment and mutual-help groups, and history of psychiatric comorbidity were associated with higher number of attempts, and more attempts were associated independently with greater current distress. Number of recovery attempts did not differ by primary substance (e.g., opioids vs. alcohol). Conclusions Estimates of recovery attempts differed substantially depending on whether the mean (5.35 recovery attempts) or median (2 recovery attempts) was used as the estimator. Implications of this are that the average may be substantially lower than anticipated because cultural expectations are often based on AOD problems being "chronically relapsing" disorders implicating seemingly endless tries. Depending on which one of these estimates is reported in policy documents or communicated in public health announcements or clinical settings, each may elicit varying degrees of help-seeking, hope, motivation, and the use of more assertive clinical approaches. The more fitting, median estimate of attempts should be used in clinical and policy communications given the distribution.

Treatment admissions for opioid use disorder (OUD) have risen dramatically in the United States, as population exposure to potent opioids, both prescribed and illicit, has increased substantially. Psychosocial approaches are empirically supported and cost-effective interventions in the treatment of substance use disorders (SUD), including alcohol, marijuana, and cocaine use disorders. While many practice guidelines recommend psychosocial approaches in comprehensive treatment protocols for individuals with OUD, key questions exist regarding their nature, scope, and impact in addressing OUD specifically. Given the consensus view that medications such as methadone, buprenorphine/naloxone, and extended-release naltrexone are first-line treatments to decrease opioid use and reduce overdose risk, the utility of psychosocial approaches for individuals with OUD has come under scrutiny. This chapter provides an overview of the application of, and evidence for, psychosocial approaches as independent interventions and as adjuncts to pharmacotherapies in the treatment of OUD. This review further outlines a research agenda to address important but unanswered clinical questions and provides clinical recommendations based on the existing evidence. Given that these recommendations are based on limited OUD-specific empirical support, however, there is a critical need to develop, test, and disseminate psychosocial approaches that can (1) help build on the benefits provided by pharmacotherapies and (2) operate as stand-alone interventions for individuals who prefer not to take OUD medication.

Background The COVID-19 pandemic and related social distancing public health recommendations will have indirect consequences for individuals with current and remitted substance use disorder (SUD). Not only will stressors increase risk for symptom exacerbation and/or relapse, but individuals will also have limited service access during this critical time. Individuals with SUD are using free, online digital recovery support services (D-RSS) that leverage social engagement (i.e., social-online D-RSS) and simultaneously help these individuals to access support and adhere to public health guidelines. Barriers to SUD treatment and recovery support service access, however, are not unique to the COVID-19 epoch. The pandemic creates an opportunity to highlight problems that will persist beyond its immediate effects, and offer potential solutions that might help to address these long-standing, systemic issues. To help providers and other key stakeholders effectively support those interested in, or who might benefit from, participation in free, social-online D-RSS, we review the expected therapeutic benefits and potential drawbacks of social-online D-RSS; we provide a typology to describe the array of services that a D-RSS can provide; and we discuss a D-RSS “case study” to illustrate how to apply the theory and typology, what is known empirically, and whether to refer and how to engage individuals with these online resources. Method Narrative review combining research and theory on both in-person and online D-RSS. Results Studies targeting in-person recovery support services, such as AA and other mutual-help groups, combined with theory about how social-online D-RSS might confer benefits, suggest these digital supports may engage individuals with SUD and mobilize salutary change in similar ways. While people may use in-person and digital supports simultaneously, when comparing the two modalities, communication theory and telemedicine group therapy data suggest that D-RSS may not provide the same magnitude of benefit as in-person services. Research has not yet rigorously tested the effectiveness of social-online D-RSS specifically, though existing data suggest that those who use these services generally find their participation to be helpful. Content analyses suggest that these services are likely to facilitate social support and unlikely to expose individuals to harmful situations. Conclusions When in-person treatment and recovery support services are limited, as is the case during the COVID-19 pandemic, expected therapeutic benefits and emerging data, taken together, suggest providers, mentors, and other community leaders may wish to refer individuals to social-online D-RSS. Given the array of available services with little existing data to guide specific recommendations, providers may rely upon the provided D-RSS typology as well as trusted federal, academic, and national practice organization referral lists offered here when working with patients for whom D-RSS may be appropriate., Highlights • Free, existing social-online digital recovery support services (D-RSS) may help address systemic barriers to SUD service access highlighted by the COVID-19 pandemic • To aid providers and other stakeholders in decision-making regarding D-RSS, we review relevant theory and research • D-RSS converge theoretically with empirically-supported, in-person RSS though data suggest individuals may also encounter challenges on D-RSS • Emerging research targeting social-online D-RSS is promising, though rigorous studies of their effectiveness have not yet been conducted • Referral to social-online D-RSS may be warranted particularly during this time of national crisis

Substance use and substance-related disorders are among the most prodigious public health problems in the United States. Emerging adults (ages 18–25) appear to carry a disproportionately large share of this societal burden, as they are more than twice as likely as adolescents and older adults to be diagnosed with substance use disorders (SUDs), and comprise more than 20% of SUD treatment seekers. Described as the "age of feeling in-between," emerging adulthood is associated with a biopsychosocial profile distinct from both adolescence and older adulthood, making members of this age group unique and challenging clinical cases. Data suggest that although emerging adults can benefit from cognitive-behavioral (CB) and other psychosocial treatments for SUD, they are likely to have poorer treatment response than their younger and older counterparts. Therefore, we propose several theoretically and empirically-grounded treatment modifications for this vulnerable group, such as parent counseling (or "coaching") to facilitate better treatment engagement and benefit via contingency management. A case example is used to illustrate challenges typical in SUD treatment for emerging adults and how a CB practitioner might choose to modify his/her approach based on the proposed modifications. We also offer several recommendations for practitioners who wish to address their patients' SUD or harmful substance use when it is not the primary focus of treatment.

Alcohol and other drug (AOD) use disorders exact a prodigious annual economic toll in the United States (U.S.), driven largely by lost productivity due to illness-related absenteeism, underemployment, and unemployment. While recovery from AOD disorders is associated with improved health and functioning, little is known specifically about increases in productivity due to new or resumed employment and who may continue to struggle. Also, because employment can buffer relapse risk by providing structure, meaning, purpose, and income, greater knowledge in this regard would inform relapse prevention efforts as well as employment-related policy. We conducted a cross-sectional, nationally representative survey of the U.S. adult population assessing persons who reported having resolved an AOD problem (n = 2002). Weighted employment, unemployment, retirement, and disability statistics were compared to the general U.S. population. Logistic and linear regression models tested for differences in employment and unemployment among demographic categories and measures of well-being. Compared to the general U.S. population, individuals who had resolved an AOD problem were less likely to be employed or retired, and more likely to be unemployed and disabled. Certain recovering subgroups, including those identifying as black and those with histories of multiple arrests, were further disadvantaged. Conversely, certain factors, such as a higher level of education and less prior criminal justice involvement were associated with lower unemployment risk. Despite being in recovery from an AOD problem, individuals continue to struggle with obtaining employment, particularly black Americans and those with prior criminal histories. Given the importance of employment in addiction recovery and relapse prevention, more research is needed to identify employment barriers so that they can be effectively addressed.

PURPOSE OF REVIEW: Empirical evidence indicates that, in general, treatments which systematically engage adults with freely available twelve-step mutual-help organizations (TSMHOs), such as Alcoholics Anonymous (AA) and Narcotics Anonymous (NA) often enhance treatment outcomes while reducing health care costs. Also evident is that TSMHOs facilitate recovery through mechanisms similar to those mobilized by professional interventions, such as increased abstinence self-efficacy and motivation, as well changing social networks. Much less is known, however, regarding the utility of these resources specifically for young adults and whether the TSMHO mechanisms are similar or different for young adults. This article provides a narrative review of the clinical and public health utility of TSMHOs for young adults, and summarizes theory and empirical research regarding how young adults benefit from TSMHOs. RECENT FINDINGS: Results indicate that, compared to older adults, young adults are less likely to attend TSMHOs and attend less frequently, but derive similar benefit. The mechanisms, however, by which TSMHOs help, differ in nature and magnitude. Also, young adults appear to derive greater benefit initially from meetings attended by similar aged peers, but this benefit diminishes over time. SUMMARY: Findings offer developmentally specific insights into TSMHO dynamics for young adults and inform knowledge of broader recovery needs and challenges.

BACKGROUND AND OBJECTIVES To identify substance and psychiatric predictors of overdose (OD) in young people with substance use disorders (SUDs) who received treatment. METHODS We conducted a retrospective review of consecutive medical records of young people who were evaluated in a SUD program between 2012 and 2013 and received treatment. An independent group of patients from the same program who received treatment and had a fatal OD were also included in the sample. OD was defined as substance use associated with a significant impairment in level of consciousness without intention of self-harm, or an ingestion of a substance that was reported as a suicide attempt. t Tests, Pearson's χ2 , and Fisher's exact tests were performed to identify predictors of OD after receiving treatment. RESULTS After initial evaluation, 127 out of 200 patients followed up for treatment and were included in the sample. Ten (8%) of these patients had a nonfatal OD. Nine patients who received treatment and had a fatal OD were also identified. The sample's mean age was 20.2 ± 2.8 years. Compared with those without OD, those with OD were more likely to have a history of intravenous drug use (odds ratio [OR]: 36.5, P

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, recovery support 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.

Background Alcohol and other drug (AOD) treatment and recovery research typically have focused narrowly on changes in alcohol/drug use (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 recovery milestones 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.

Background Professional continuing care services enhance recovery rates among adults and adolescents, though less is known about emerging adults (18-25 years old). Despite benefit shown from emerging adults' participation in 12-step mutual-help organizations (MHOs), it is unclear whether participation offers benefit independent of professional continuing care services. Greater knowledge in this area would inform clinical referral and linkage efforts. Methods Emerging adults (N=284; 74% male; 95% Caucasian) were assessed during the year after residential treatment on outpatient sessions per week, percent days in residential treatment and residing in a sober living environment, substance use disorder (SUD) medication use, active 12-step MHO involvement (e.g., having a sponsor, completing step work, contact with members outside meetings), and continuous abstinence (dichotomized yes/no). One generalized estimating equation (GEE) model tested the unique effect of each professional service on abstinence, and, in a separate GEE model, the unique effect of 12-step MHO involvement on abstinence over and above professional services, independent of individual covariates. Results Apart from SUD medication, all professional continuing care services were significantly associated with abstinence over and above individual factors. In the more comprehensive model, relative to zero 12-step MHO activities, odds of abstinence were 1.3 times greater if patients were involved in one activity, and 3.2 times greater if involved in five activities (lowest mean number of activities in the sample across all follow-ups). Conclusions Both active involvement in 12-step MHOs and recovery-supportive, professional services that link patients with these community-based resources may enhance outcomes for emerging adults after residential treatment.

Aims Within 12-step mutual-help organizations (MHOs), a sponsor plays a key recovery-specific role analogous to a ‘lay therapist’, serving as a role model, support and mentor. Research shows that attendees who have a sponsor have higher rates of abstinence and remission from substance use disorder (SUD), yet, while myriad formal psychotherapy studies demonstrate the therapeutic significance of the alliance between patients and professional clinicians on treatment outcomes, very little is known about the influence of the ‘therapeutic alliance’ between 12-step members and their sponsor. Greater knowledge about this key 12-step relationship could help explain greater degrees of 12-step effects. To bridge this gap, this study sought to develop and test a measure assessing the 12-step sponsee–sponsor therapeutic alliance—the Sponsor Alliance Inventory (SAI). Method Young adults ( N = 302) enrolled in a prospective effectiveness study who reported having a 12-step sponsor during the study ( N = 157) were assessed at treatment entry, and 3, 6 and 12 months later on the SAI, their 12-step MHO attendance, involvement and percent days abstinent (PDA). Results Principal axis extraction revealed a single, 10-item, internally consistent ( α 's ≥ 0.95) scale that explained the majority of variance and was largely invariant to primary substance, gender and time. Criterion validity was also supported with higher SAI scores predicting greater proximal 12-step attendance, involvement and PDA. Conclusion The SAI may serve as a brief, valid measure to assess the degree of sponsee–sponsor ‘therapeutic alliance’ within 12-step communities and may help augment explanatory models estimating the effects of MHOs on recovery outcomes.

While a growing body of literature supports the role of mutual help organizations in helping members achieve abstinence, fellowships other than Alcoholics Anonymous and outcomes beyond abstinence have been studied far less often. The current study examined recovery-related correlates of psychological well-being in a sample of Narcotics Anonymous (NA) members. Participants (N = 128) were self-identified NA members from across the United States who completed an online survey assessing an array of psychosocial outcomes. Hierarchical regression models assessed whether abstinence duration and other recovery-related variables accounted for significant incremental variance in psychological well-being, over and above several covariates. As a block, abstinence duration and the recovery predictors accounted for significant incremental variance in three of four psychological well-being domains. As a complement to studies on short-term benefits of mutual help organizations, these data suggest ongoing recovery involvement may be positively associated with subjective psychological well-being in NA members.

Narcotics Anonymous (NA) is a community-based, 12-step organization that holds nearly 62,000 meetings weekly in 129 countries. Relatively little is known about NA members’ recovery experiences. This study presents results of focus groups conducted with long-term NA members to identify key ingredients of recovery, recovery-related processes, and quality-of-life outcomes beyond abstinence. Participants identified personal and program characteristics that were critical to recovery (e.g., responsibility), illuminated several recovery-related processes (e.g., using the 12 steps to obtain a deeper self-understanding), and described personal and interpersonal quality-of-life enhancements (e.g., improved relationships). In addition, fellowship was described as a pervasive and essential element of recovery.

A body of literature has shown that free, widely available mutual-help organizations (MHOs), such as Alcoholics Anonymous (AA), offer cost-efficient community-based sources of recovery support for individuals with substance use disorder (SUD). Emerging adults (18–29 years old) are a prevalent group of individuals in the SUD treatment system who present unique challenges and typically have poorer outcomes than those of older adults (e.g., 30+ years). Given the need to identify low-cost strategies that can help destabilize the course of SUD for emerging adults, this chapter reviews the extent to which emerging adults participate in MHOs and the degree to which they benefit from participation in MHOs. The chapter also outlines the mechanisms through which MHO participation promotes better outcomes and the factors that influence emerging adults’ MHO participation and participation-related benefit. The chapter then highlights opportunities for timely but as-of-yet untapped targets for emerging adult recovery-related research, such as the intersection between MHO participation and opioid agonist treatment.

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.

OBJECTIVE 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. METHODS 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. RESULTS 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). CONCLUSIONS High rates of OD exist in treatment-seeking youth with SUD. OD was associated with more SUDs and psychiatric comorbidity.

Aims: Alcoholics Anonymous (AA) is the most prevalent 12-step mutual-help organization (MHO), yet debate has persisted clinically regarding whether patients whose primary substance is not alcohol should be referred to AA. Narcotics Anonymous (NA) was created as a more specific fit to enhance recovery from drug addiction; however, compared with AA, NA meetings are not as ubiquitous. Little is known about the effects of a mismatch between individuals' primary substance and MHOs, and whether any incongruence might result in a lower likelihood of continuation and benefit. More research would inform clinical recommendations. Method: Young adults ( N = 279, M age 20.4, SD 1.6, 27% female; 95% White) in a treatment effectiveness study completed assessments at intake, and 3, 6, and 12 months post-treatment. A matching variable was created for ‘primary drug’ patients (i.e. those reporting cannabis, opiates or stimulants as primary substance; n = 198/279), reflecting the proportion of total 12-step meetings attended that were AA. Hierarchical linear models (HLMs) tested this variable's effects on future 12-step participation and percent days abstinent (PDA). Results: The majority of meetings attended by both alcohol and drug patients was AA. Drug patients attending proportionately more AA than NA meetings (i.e. mismatched) were no different than those who were better matched to NA with respect to future 12-step participation or PDA. Conclusion: Drug patients may be at no greater risk of discontinuation or diminished recovery benefit from participation in AA relative to NA. Findings may boost clinical confidence in making AA referrals for drug patients when NA is less available.

Generalist mental health practitioners are likely to encounter patients with substance use disorders, indicating community-based, 12-Step mutual-help organizations (MHOs) can be a valuable referral source for these clinicians. Little is known, however, about how generalist practitioners and trainees understand these organizations. Results of a survey among 316 clinical trainees showed that knowledge levels were below a competency benchmark. While views were positive overall, empirically-inconsistent beliefs were also common. Beliefs and attitudes accounted for approximately one half of the variance in professional intentions (e.g., appropriate referral). The study highlighted knowledge gaps, though trainees appeared open to learning more about 12-Step MHOs. Thus systematic development and evaluation of clinical training in the area may be warranted.

Background Participation in 12-step mutual help organizations (MHO) is a common continuing care recommendation for adults; however, little is known about the effects of MHO participation among young adults (i.e., ages 18–25 years) for whom the typically older age composition at meetings may serve as a barrier to engagement and benefits. This study examined whether the age composition of 12-step meetings moderated the recovery benefits derived from attending MHOs. Method Young adults ( n = 302; 18–24 years; 26% female; 94% White) enrolled in a naturalistic study of residential treatment effectiveness were assessed at intake, and 3, 6, and 12 months later on 12-step attendance, age composition of attended 12-step groups, and treatment outcome (Percent Days Abstinent [PDA]). Hierarchical linear models (HLM) tested the moderating effect of age composition on PDA concurrently and in lagged models controlling for confounds. Results A significant three-way interaction between attendance, age composition, and time was detected in the concurrent ( p = 0.002), but not lagged, model ( b = 0.38, p = 0.46). Specifically, a similar age composition was helpful early post-treatment among low 12-step attendees, but became detrimental over time. Conclusions Treatment and other referral agencies might enhance the likelihood of successful remission and recovery among young adults by locating and initially linking such individuals to age appropriate groups. Once engaged, however, it may be prudent to encourage gradual integration into the broader mixed-age range of 12-step meetings, wherein it is possible that older members may provide the depth and length of sober experience needed to carry young adults forward into long-term recovery.

Background Evidence indicates that 12-step mutual-help organizations (MHOs), such as Alcoholics Anonymous (AA) and Narcotics Anonymous (NA), can play an important role in extending and potentiating the recovery benefits of professionally delivered addiction treatment among young adults with substance use disorders (SUD). However, concerns have lingered regarding the suitability of 12-step organizations for certain clinical subgroups, such as those with dual diagnosis (DD). This study examined the influence of diagnostic status (DD vs. SUD-only) on both attendance and active involvement (e.g., having a sponsor, verbal participation during meetings) in, and derived benefits from, 12-step MHOs following residential treatment. Methods Young adults (N = 296; 18 to 24 years old; 26% female; 95% Caucasian; 47% DD [based on structured diagnostic interview]), enrolled in a prospective naturalistic study of SUD treatment effectiveness, were assessed at intake and 3, 6, and 12 months posttreatment on 12-step attendance/active involvement and percent days abstinent (PDA). t-Tests and lagged, hierarchical linear models (HLM) examined the extent to which diagnostic status influenced 12-step participation and any derived benefits, respectively. Results For DD and SUD-only patients, posttreatment attendance and active involvement in 12-step organizations were similarly high. Overall, DD patients had significantly lower PDA relative to SUD-only patients. All patients appeared to benefit significantly from attendance and active involvement on a combined 8-item index. Regarding the primary effects of interest, significant differences did not emerge in derived benefit between DD and SUD-only patients for either attendance (p = 0.436) or active involvement (p = 0.062). Subsidiary analyses showed, however, that DD patients experienced significantly greater abstinence-related benefit from having a 12-step sponsor. Conclusions Despite concerns regarding the clinical utility of 12-step MHOs for DD patients, findings indicate that DD young adults participate and benefit as much as SUD-only patients, and may benefit more from high levels of active involvement, particularly having a 12-step sponsor. Future work is needed to clarify how active 12-step involvement might offset the additional recovery burden of a comorbid mental illness on substance use outcomes.

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 The “therapeutic alliance” between clinicians and patients has been associated with treatment response and outcomes in professionally-delivered psychotherapies. Although 12-step mutual help organizations (MHOs), such as Alcoholics Anonymous, are the most commonly sought source of support for individuals with substance use disorder (SUD), little is known about whether a stronger alliance in comparable MHO relationships between 12-step sponsors and those they help (“sponsees”) confers benefits similar to those observed in professional contexts. Greater knowledge could inform clinical recommendations and enhance models that explain how individuals benefit from 12-step MHOs. Method Young adults (N = 302) enrolled in a prospective, clinical effectiveness study of residential SUD treatment were assessed at treatment entry, and 3, 6, and 12 months after discharge on whether they had a sponsor, contact with a sponsor, and degree of sponsor alliance. Hierarchical linear models (HLM) tested their effects on 12-step MHO attendance, involvement, and percent days abstinent (PDA). Results Approximately two-thirds of the sample (n = 208, 68.87%) reported having a sponsor at one or more follow-up time points. Both having sponsor contact and stronger sponsor alliance were significantly associated with greater 12-step participation and abstinence, on average, during follow-up. Interaction results revealed that more sponsor contact was associated with increasingly higher 12-step participation whereas stronger sponsor alliance was associated with increasingly greater abstinence. Conclusions Similar to the professional-clinical realm, the “therapeutic alliance” among sponsees and their sponsors predicts better substance use outcomes and may help augment explanatory models estimating effects of MHOs in SUD recovery.