Visualizing the Influence of Social Networks on Recovery: A Mixed-Methods Social Identity Mapping Study with Recovering Adolescents.

Background: Social recovery capital (SRC) refers to resources and supports gained through relationships and is vital to adolescent addiction recovery. Much is known about how substance use relates to social networks, but little is known about how other dimensions of social networks influence recovery (e.g., network size/exposure, degree of conflict). Methods: This mixed-methods study sampled 28 adolescents who received treatment for alcohol and other drug (AOD) use disorder (14-19 yrs.: 71% male; M = 17.32 yrs., SD = 1.33; White 82%): 20 were recovery high school (RHS) students. Adolescents completed a social identity map for addiction recovery (SIM-AR), survey, and interview. Qualitative data were content analyzed and the data from the SIM-AR were quantified. Results: On average, participants reported belonging to five distinct groups within their network (Range, 2-9; SD = 1.63; M = 27.89 people, SD = 20.09). Of their social network connections, 51% drank alcohol and 46% used other substances, on average. Larger networks involved more conflict (r = 0.57). Participants were more likely to spend more time with groups that had greater proportions of non-substance-using members. These linkages were stronger for RHS than for non-RHS students. Qualitative analyses revealed that youth reported their recovery-oriented groups as supportive, but some reported that their substance-using friends also supported their recovery. Discussion: SIM-AR was a useful measurement tool, and, through qualitative interviews, we identified unique aspects of youths' social networks important for further examination. Research with recovering youth should examine SRC-related elements within their networks including relationship quality, belonging, and conflict, alongside the substance use behaviors of network members.

Measuring recovery capital for people recovering from alcohol and drug addiction: A systematic review.

Background: Recovery capital theory provides a biopsychosocial framework for identifying and measuring strengths and barriers that can be targeted to support recovery from alcohol and drug addiction. This systematic review analyzed and synthesized all quantitative approaches that have measured recovery capital since 2016. Method: Three databases were searched to identify studies published from 2016 to 2023. Eligible studies explicitly stated they measured recovery capital in participants recovering from alcohol and/or drug addiction. Studies focusing on other forms of addiction were excluded. Results: Sixty-nine studies met the inclusion criteria. Forty-six studies used one of the ten identified recovery capital questionnaires, and twenty-five studies used a measurement approach other than one of the ten recovery capital questionnaires. The ten recovery capital questionnaires are primarily developed for adult populations across clinical and community recovery settings, and between them measure 41 separate recovery capital constructs. They are generally considered valid and reliable measures of recovery capital. Nevertheless, a strong evidence base on the psychometric properties across diverse populations and settings still needs to be established for these questionnaires. Conclusion: The development of recovery capital questionnaires has been a significant advance in the field of addiction recovery, in alignment with the emerging recovery-oriented approach to addiction recovery care. Additionally, the non-recovery capital questionnaire-based approaches to recovery capital measurement have an important place in the field. They could be used alongside recovery capital questionnaires to test theory, and in contexts where the application of the questionnaires is not feasible, such as analyses of data from online recovery forums.

Improving Social Recovery Capital Research To Enhance Clinical Utility: A Proposed Agenda.

Social recovery capital (SRC) is the combination of social resources that can be used to initiate and sustain addiction recovery through friends, family, and peers. Broadly, understanding one's SRC allows us to get a sense of where one has social support for recovery and where there may be social barriers to their recovery process. SRC is often a vital component of many people's recovery journey, yet our understanding of how best to use this concept in research and practice remains underdeveloped. To improve understanding of the role of social recovery capital and strategies to measure and increase it, we present a roadmap involving a five-pronged research agenda to: (1) Refine the measurement of social recovery capital; (2) Model the complexity of social recovery capital empirically; (3) Integrate personality science with social recovery capital research; (4) Optimize evidence-based behavior change techniques of social recovery capital; and (5) Incorporate an intersectional framework when examining or applying social recovery capital. Overall, this five-pronged research agenda seeks to enhance the clinical utility of SRC research to maximize the impact of SRC on one's recovery.

"A lot better than it used to be": A qualitative study of adolescents' dynamic social recovery capital.

Background: Substance use recovery is a dynamic process for youth, and social networks are tied to the recovery process. The Recovery Capital for Adolescents Model (RCAM) situates the resources accessible through social networks - social recovery capital (SRC) - in a larger framework of developmentally-informed recovery resources. This study aims to investigate the social network experiences among recovering youth enrolled in a recovery high school to understand how social influences help to build, or act as barriers to building, recovery capital. Methods: To gain insight into these networks, Social Identity Maps and semi-structured interviews were conducted with ten youth ages 17-19 years (80% male; 50% non-Hispanic White). Study visits were conducted virtually, recorded, transcribed, and thematically analyzed using the RCAM as an organizing framework. Results: Results supported that adolescent social networks play a unique and multifaceted role in the recovery journey. Three key nuances emerged: change permeates adolescent networks throughout the treatment and recovery process; shared substance use history and non-stigmatizing attitudes play a key role in connecting with others; and SRC is interconnected with human, financial, and community recovery capital. Conclusions: With adolescent recovery receiving increased attention from policy makers, practitioners, and researchers, the RCAM may be a useful way to contextualize available resources. Findings suggest SRC as a crucial, yet complex component intertwined with all other forms of recovery capital.

A Socio-Ecological Model for Collegiate Recovery Programs.

Given the major public health issue of substance use in the college environment and among college students, we must improve our understanding of students attempting to resolve substance related issues. Though much of research and policy attention has focused on individual progress according to personal characteristics and experiences, a much broader, theoretically informed understanding based on interpersonal relationships and contextual conditions of the school and society is warranted. Collegiate recovery programs (CRPs) are a system-level intervention that acknowledges the individual in context and seeks to support them and capitalize on their own skills within a safe environment to practice recovery. To ground CRPs as an environmental support targeting emerging adults that can improve student health and well-being, we developed a social-ecological framework that conceptualizes the multifaceted factors that influence them. Specifically, we aimed to understand factors influencing individuals in CRPs through direct and indirect effects. This conceptualization will better inform the development, implementation, and evaluation of these programs. Our theory-driven framework elucidates the multi-level complexity of CRPs and the importance of individual interventions as well as intervention from multiple stakeholder groups.

Ensuring Prevention Science Research is Synthesis-Ready for Immediate and Lasting Scientific Impact.

When seeking to inform and improve prevention efforts and policy, it is important to be able to robustly synthesize all available evidence. But evidence sources are often large and heterogeneous, so understanding what works, for whom, and in what contexts can only be achieved through a systematic and comprehensive synthesis of evidence. Many barriers impede comprehensive evidence synthesis, which leads to uncertainty about the generalizability of intervention effectiveness, including inaccurate titles/abstracts/keywords terminology (hampering literature search efforts), ambiguous reporting of study methods (resulting in inaccurate assessments of study rigor), and poorly reported participant characteristics, outcomes, and key variables (obstructing the calculation of an overall effect or the examination of effect modifiers). To address these issues and improve the reach of primary studies through their inclusion in evidence syntheses, we provide a set of practical guidelines to help prevention scientists prepare synthesis-ready research. We use a recent mindfulness trial as an empirical example to ground the discussion and demonstrate ways to ensure the following: (1) primary studies are discoverable; (2) the types of data needed for synthesis are present; and (3) these data are readily synthesizable. We highlight several tools and practices that can aid authors in these efforts, such as using a data-driven approach for crafting titles, abstracts, and keywords or by creating a repository for each project to host all study-related data files. We also provide step-by-step guidance and software suggestions for standardizing data design and public archiving to facilitate synthesis-ready research.

Parenting to provide social recovery capital: A qualitative study.

Background: Although research demonstrates the necessity of social recovery capital (SRC) for youth in recovery, through having family that do not use substances and who support their recovery, the ways in which parents actually enact SRC have not been empirically examined. This qualitative study applied the Recovery Capital Model for Adolescents to group interview data from parent(s) of youth who resolved a substance use disorder (SUD) to explore the ways parents enacted SRC. Method: The interviews were conducted in a prior ethnographic study in which parents of alternative peer group (APG) alumni volunteered to participate in a group interview; five mothers and five fathers of APG alumni participated in the interviews (n=10). Three investigators analyzed the interview transcripts using the constant comparative method to identify family SRC and the specific components parents supported their child's recovery. Results: The primary themes of parent support of SRC included locus of control, parent growth, and sober/supportive home. Locus of control included parent strategies to leverage youth's participation in treatment/recovery. Parent growth focused on the process of change parents described: from denial to developing insight and learning how to parent a child in addiction. Supportive and structured family included time spent with youth in recovery-related activities and improved communication and relationships. Conclusions: Together, these themes suggest a process of parent change that supports an adolescent's recovery trajectory and increases parenting skills and coping. These themes also highlight how the APG structure enabled this process, generating potential hypotheses for future recovery-oriented research to address.

Comparative Effectiveness of Brief Alcohol Interventions for College Students: Results from a Network Meta-Analysis.

Late adolescence is a time of increased drinking, and alcohol plays a predominant role in college social experiences. Colleges seeking to prevent students' hazardous drinking may elect to implement brief alcohol interventions (BAIs). However, numerous manualized BAIs exist, so an important question remains regarding the comparative effectiveness of these different types of BAIs for college students. This study uses network meta-analyses (NMA) to compare seven manualized BAIs for reducing problematic alcohol use among college students. We systematically searched multiple sources for literature, and we screened studies and extracted data in duplicate. For the quantitative synthesis, we employed a random-effects frequentist NMA to determine the effectiveness of different BAIs compared to controls and estimated the relative effectiveness ranking of each BAI. A systematic literature search resulted in 52 included studies: On average, 58% of participants were male, 75% were binge drinkers, and 20% were fraternity/sorority-affiliated students. Consistency models demonstrated that BASICS was consistently effective in reducing students' problematic alcohol use (ES range: g = - 0.23, 95%CI [- 0.36, - 0.16] to g = - 0.36, 95% CI [- 0.55, - 0.18]), but AlcoholEDU (g = - 0.13, 95%CI [- 0.22, - 0.04]), e-CHUG (g = - 0.35, 95%CI [- 0.45, - 0.05]), and THRIVE (g = - 0.47, 95%CI [- 0.60, - 0.33]) were also effective for some outcomes. Intervention rankings indicated that BASICS, THRIVE, and AlcoholEDU hold the most promise for future trials. Several BAIs appear effective for college students. BASICS was the most effective but is resource intensive and may be better suited for higher risk students; THRIVE and e-CHUG are less resource intensive and show promise for universal prevention efforts.

Recovery high schools: Effect of schools supporting recovery from substance use disorders.

BACKGROUND: Recovery high schools (RHSs) provide post-treatment education and recovery support for young people with substance use disorders (SUDs). This is the first quasi-experimental outcome study to determine RHS effectiveness relative to students in non-RHSs. OBJECTIVES: To examine effects of RHS attendance on academic and substance use outcomes among adolescents treated for SUDs 6 months after recruitment to the study. METHODS: A quasi-experimental design comparing outcomes for adolescents with treated SUDs who attended RHSs for at least 28 days versus a propensity-score balanced sample of students with treated SUDs who did not attend RHSs. The sample included 194 adolescents (134 in RHSs, 60 in non-RHSs) enrolled in Minnesota, Wisconsin, or Texas schools (M age = 16; 86% White; 49% female). Multilevel linear regression models were used to examine the effect of RHS attendance on students' outcomes, after adjusting for a range of potential confounders. RESULTS: Adolescents attending RHSs were significantly more likely than non-RHS students to report complete abstinence from alcohol, marijuana, and other drugs at the 6-month follow-up (OR = 4.36, p = .026), significantly lower levels of marijuana use (d = -0.51, p = .034) and less absenteeism from school (d = -0.56, p = .028). CONCLUSION: These results indicate that RHSs have significantly beneficial effects on substance use and school absenteeism after 6 months for adolescents treated for SUDs.

'Pickle or a cucumber?' administrator and practitioner views of successful adolescent recovery.

INTRODUCTION: Adolescent substance use disorders often involve a recurring cycle of treatment and relapse. The academic and practical definition of addition recovery for adults has been debated; yet, elements determining a successful adolescent recovery aside from abstinence have not been delineated. Thus, we sought to explore how practitioners and administrators define "success" in recovery and how they foster youth progress towards success. METHODS: Using a qualitative design, we purposively selected and visited treatment and recovery services sites and interviewed practitioners and administrators (N = 13). Sites included recovery high schools (N = 2), alternative peer groups (N = 4), and one treatment center. Two authors analyzed the data using the constant comparative method. RESULTS: Success emerged from the interviews in three primary themes (1) factors demonstrating success, (2) progress that highlights success, and (3) factors enabling success and two sub-themes (1) use of metaphors and (2) use of specific examples. A variety of factors and processes were discussed as indicators of success. Multiple practitioners stated that sobriety and length of abstinence were not the best success measures; yet, sobriety and education were mentioned most often. CONCLUSIONS: A key finding of this study, which has not been addressed in existing qualitative studies of youth recovery, is that the understanding of recovery was so diverse and multi-dimensional and provided a view of success beyond sobriety, highlighting the various facets from which practitioners must operate and address recovery. This demonstrates the need for researchers to carefully conceptualize how they operationalize adolescent recovery.

Do brief alcohol interventions reduce tobacco use among adolescents and young adults? A systematic review and meta-analysis.

This meta-analysis synthesizes studies of brief interventions (BIs) that targeted alcohol consumption and reported both alcohol and tobacco outcomes. It examines whether BIs reduce alcohol and tobacco use for adolescents and young adults among interventions that (1) directly targeted tobacco and alcohol use, or (2) did not target tobacco use but measured it as a secondary outcome. Multiple databases and grey literature sources were searched (1980-2012) resulting in the identification of 18 randomized or controlled quasi-experimental studies (5949 participants). Analyses were conducted using random effects inverse-variance weighted three-level models. BIs were associated with a significant reduction in alcohol consumption relative to control groups [g = 0.11, 95 % CI (0.04, 0.17)] but not with a significant decrease in tobacco use [g = 0.07, 95 % CI (-0.01, 0.16)]. Directly addressing tobacco was not a significant moderator affecting tobacco use outcomes. Post-hoc exploratory analysis revealed potential questions to address with future research.

Effectiveness of brief school-based interventions for adolescents: a meta-analysis of alcohol use prevention programs.

To conduct a meta-analysis summarizing the effectiveness of school-based brief alcohol interventions (BAIs) among adolescents and to examine possible iatrogenic effects due to deviancy training in group-delivered interventions, a systematic search for eligible studies was undertaken, current through December 31, 2012. Studies were eligible for inclusion if they used an experimental/quasi-experimental design; focused on school-based BAIs; enrolled adolescent participants; and reported an alcohol-related outcome measure. Studies were coded for key variables, and outcome effect sizes were analyzed as standardized mean differences adjusted for small samples (Hedges' g). Analyses were conducted using inverse-variance weighted mixed-effects meta-regression models. Sensitivity analyses were also conducted. Across all 17 studies eligible for inclusion, school-based BAIs were associated with significant improvements among adolescents, whereby adolescents in the BAI groups reduced their alcohol consumption relative to the control groups (= 0.34, 95 % CI [0.11, 0.56]). Subgroup analyses indicated that whereas individually-delivered BAIs were effective (= 0.58, 95 % CI [0.23, 0.92]), there was no evidence that group-delivered BAIs were associated with reductions in alcohol use (= -0.02, 95 % CI [-0.17, 0.14]). Delivery format was confounded with program modality, however, such that motivational enhancement therapy was the most effective modality, but was rarely implemented in group-delivered interventions. Some school-based BAIs are effective in reducing adolescent alcohol consumption, but may be ineffective if delivered in group settings. Future research should explore whether group-delivered BAIs that use motivational enhancement therapy components may yield beneficial outcomes like those observed in individually-delivered programs.

Can brief alcohol interventions for youth also address concurrent illicit drug use? results from a meta-analysis.

Brief interventions aimed at reducing alcohol use among youth may interrupt a possible developmental progression to more serious substance use if they can also affect the use of other illicit drugs. This meta-analysis examined the findings of recent research on the effects of brief alcohol interventions for adolescents and young adults on both alcohol and illicit drug use. Eligible studies were those using randomized or controlled quasi-experimental designs to examine the effects of brief alcohol interventions on illicit drug use outcomes among youth. A comprehensive literature search identified 30 eligible study samples that, on average, included participants age 17, with 57 % male participants and 56 % White youth. Three-level random-effects meta-analyses were used to estimate mean effect sizes and explore variability in effects. Overall, brief interventions targeting both alcohol and other drugs were effective in reducing both of these substances. However, the brief interventions that targeted only alcohol had no significant secondary effects on untargeted illicit drug use. The evidence from current research, therefore, shows modest beneficial effects on outcomes that are targeted by brief interventions for youth, but does not show that those effects generalize to untargeted illicit drug use outcomes.

Modeling Recovery Housing Retention and Program Outcomes by Justice Involvement among Residents in Virginia, USA: An Observational Study.

Living in recovery housing can improve addiction recovery and desistance outcomes. This study examined whether retention in recovery housing and types of discharge outcomes (completed, "neutral," and "negative" outcomes) differed for clients with recent criminal legal system (CLS) involvement. Using data from 101 recovery residences certified by the Virginia Association of Recovery Residences based on 1,978 individuals completing the REC-CAP assessment, competing risk analyses (cumulative incidence function, restricted mean survival time, and restricted mean time lost) followed by the marginalization of effects were implemented to examine program outcomes at final discharge. Residents with recent CLS involvement were more likely to be discharged for positive reasons (successful completion of their goals) and premature/negative reasons (e.g., disciplinary releases) than for neutral reasons. Findings indicate that retention for 6-18 months is essential to establish and maintain positive discharge outcomes, and interventions should be developed to enhance retention in recovery residents with recent justice involvement.

Implementing a Recovery Capital Model Into Therapeutic Courts: Case Study and Lessons Learned.

Recovery capital is a strengths-based and multi-level model for examining the process and outputs of recovery and desistance. Recovery capital posits that the more positive resources one accrues, the better the chances of recovery. Oftentimes growth of one's recovery capital must be initiated through identifying programs in the community to create supportive scaffolding: this may be especially true for individuals involved in the justice system who may experience additional barriers to accessing programming. This manuscript presents the results of a pilot evaluation of the REC-CAP, a recovery-capital oriented system of measurement, planning, and engagement in two drug treatment courts. We include a description of the implementation process and results from surveys and focus groups with the court staff. Results suggests that the trainings were useful and that court staff meaningfully engaged with the REC-CAP system. Court staff felt the REC-CAP provided important information about court clients' strengths and barriers and suggested next steps for staff to take to guide their clients. Future work should explore how the REC-CAP score profile may change with client progress through the court phases as well as how to incorporate more system level supports for a REC-CAP orientation among probation officers and other court staff.

A qualitative examination of social identity and stigma among adolescents recovering from alcohol or drug use.

Introduction: Alcohol and other drug (AOD) use disorders are stigmatized conditions, but little is known about youth's experience of this stigma, which may threaten their developing social identity and recovery process. This study investigates youth's perceptions of AOD use-related stigma in the context of their social identity. Methods: This study uses data from 12 youth (ages 17-19) who were in recovery from problematic AOD use. Participants completed a Social Identity Mapping in Addiction Recovery (SIM-AR) exercise, in which they created a visual map of their social groups, and semi-structured interview, in which participants were asked about their experience creating their SIM-AR and reflections on their social network. SIM-AR data were descriptively analyzed, and interviews were thematically analyzed for instances of stigma. Results: Using stigmatizing terminology, participants expressed some stigmatizing attitudes towards themselves and others in their network who used substances and perceived both positive and negative reactions from those who knew about their disorder. Findings suggest that youth may experience some internalized stigma and perceive stigma from others in their social networks, which may be a barrier to the development of a healthy social identity and engagement in recovery supports. Conclusions: These findings should be considered when seeking to engage youth in treatment and recovery programming. Despite the small sample, the findings suggest the importance of considering how stigma may influence adolescents' treatment and recovery experience in the context of their social environment.

Daily drinking and social network interactions in network support treatment.

OBJECTIVE: Social networks can be powerful determinants of drinking. Network Support (NS) treatment was designed to help persons with alcohol use disorder alter their social network to be more supportive of abstinence and less supportive of drinking. The present study was intended to determine how NS treatment altered behavior on a daily basis. It was expected that, relative to those treated in a packaged cognitive-behavioral treatment (PCBT), NS patients would report fewer daily contacts with drinking persons and increased contacts with nondrinking persons. METHOD: Patients (N = 193) treated in our second NS trial provided daily recordings of drinks consumed, urge to drink, and self-efficacy for not drinking, as well as reports of associations with drinking and nondrinking friends, via an interactive voice response system. Daily recordings (N = 146) were collected during the first 6 months of the 27-month study. Multilevel modeling was used to analyze daily network variables over time by treatment. Time-varying effect model (TVEM) analyses were also conducted to assess the influence of daily-varying social contacts on daily drinking, drinking urges, and self-efficacy. RESULTS: Consistent with hypotheses, NS patients reported significantly less daily drinking associated with contacts with drinkers than did PCBT patients. Patients in both treatments reported increases in self-efficacy and decreases in urges to drink over days as a function of contact with nondrinkers. CONCLUSIONS: NS treatment was successful in helping patients change their social networks, as well as their responses to social influences, and those changes had effects on day-to-day drinking levels. (PsycInfo Database Record (c) 2023 APA, all rights reserved).

The science of recovery capital: where do we go from here?

BACKGROUND: The concept of recovery capital (RC) has emerged in studies and discussions of the addiction recovery process and as a potential metric and marker for recovery gains. Although conceptual and applied development of the concept in the 20 years since the term was coined has increased, there remains insufficient clarity of key domains, factors and best practice research and applications for populations experiencing addiction. We aimed to review progress around the conceptualisation and operationalisation of RC and to consider future directions for a science of recovery capital. METHOD: We provided a brief overview of theoretical foundations and advances, empirical measurement and application in treatment and continuing care settings. We next introduced four primary areas for addiction science to address, namely: (i) conceptual development (e.g. how RC domains are unique, but interrelated entities, valence of RC), (ii) empirical testing, adequacy of measurement and analysis, (iii) directions for novel application in treatment and recovery settings and (iv) dissemination and communication to policy, practice and lived experience groups. In this review, we also focussed on some of the challenges that must be addressed for a science of RC, which could produce long-term impact in treatment and policy. RESULTS: Despite burgeoning empirical work on RC, its application and translation has been unsystematic. The field currently relies on self-report questionnaires for the development of the theory and quantification of RC. Therefore, there is an urgent need for rigorous and systematic conceptual and empirical development of RC. CONCLUSIONS: A formal collaboration between scholars, practitioners and experts by experience worldwide would move recovery capital forward in an empirically driven and culturally appropriate manner, as would testing its applicability at individual, organisational and societal levels.

Advancing the science of evaluating Collegiate Recovery Program processes and outcomes: A recovery capital perspective.

Collegiate recovery programs (CRPs) offer resources and programming for postsecondary students in addiction recovery to ensure they can initiate or maintain their recovery and complete college. To achieve these goals, CRPs offer a variety of activities that research and theory suggests should produce positive outcomes among their students; yet the lack of systematic evaluation research in this area means it is unknown which programming components may drive outcomes. Recovery capital theory posits a variety of factors at multiple ecological levels that might influence students' recovery experience and their engagement and success in community programs like CRPs. To address this complexity in research and evaluation work on CRPs, we provide a recovery capital-oriented theory of change and logic model for CRP evaluations, and demonstrate how this model could be used with an exemplar case. This is followed by a recovery capital-oriented data collection toolkit for future research and evaluation. These efforts should help to inform program planners and evaluators interested in understanding the influence of the ecosystem of recovery-oriented systems of care in CRPs for emerging adults.

The evidence synthesis and meta-analysis in R conference (ESMARConf): levelling the playing field of conference accessibility and equitability.

Rigorous evidence is vital in all disciplines to ensure efficient, appropriate, and fit-for-purpose decision-making with minimised risk of unintended harm. To date, however, disciplines have been slow to share evidence synthesis frameworks, best practices, and tools amongst one another. Recent progress in collaborative digital and programmatic frameworks, such as the free and Open Source software R, have significantly expanded the opportunities for development of free-to-use, incrementally improvable, community driven tools to support evidence synthesis (e.g. EviAtlas, robvis, PRISMA2020 flow diagrams and metadat). Despite this, evidence synthesis (and meta-analysis) practitioners and methodologists who make use of R remain relatively disconnected from one another. Here, we report on a new virtual conference for evidence synthesis and meta-analysis in the R programming environment (ESMARConf) that aims to connect these communities. By designing an entirely free and online conference from scratch, we have been able to focus efforts on maximising accessibility and equity-making these core missions for our new community of practice. As a community of practice, ESMARConf builds on the success and groundwork of the broader R community and systematic review coordinating bodies (e.g. Cochrane), but fills an important niche. ESMARConf aims to maximise accessibility and equity of participants across regions, contexts, and social backgrounds, forging a level playing field in a digital, connected, and online future of evidence synthesis. We believe that everyone should have the same access to participation and involvement, and we believe ESMARConf provides a vital opportunity to push for equitability across disciplines, regions, and personal situations.