Context Matters: Home-level But Not Individual-Level Recovery Social Capital Predicts Residents' Relapse.

The purpose of this study is to contribute to the literature on the prediction of substance use relapse, using sophisticated systems' approaches to individuals and their contexts. In the current study of 42 recovery homes, we investigated the construct of social capital from the perspective of both recovery home residents and the house level. A confirmatory factor analysis found a latent recovery factor (including elements of recovery capital, comprising resources such as wages, self-efficacy, stress, self-esteem, quality of life, hope, sense of community, and social support) at both the individual and the recovery house level. Next, using longitudinal data from homes, an individual's probability of relapse was found to be related to house rather than individual-level latent recovery scores. In other words, an individual's probability of relapse was primarily related to the average of the "recoveries" of his or her recovery home peers, and not of his or her own personal "recovery" status. The finding that resident relapse is based primarily upon the total recovery capital available in the homes highlights the importance of the social environment for recovery.

Recovery home networks as social capital.

Ensuring recovery home residents' social integration into a home environment is important for preventing early dropout and facilitating sustained recovery. Social capital theory may provide an explanation for how recovery homes may protect residents and improve recovery rates. However, little is known about how social capital in recovery home environments is structured and accessed. Recovery homes may increase social capital by sharing bonds through friendships, lending money, and advice-seeking. The current study describes social network cross sectional data obtained from a study of 42 Oxford House recovery homes, in three locations in the US (North Carolina, Texas, and Oregon). The residents rated each member of their house on the dimensions of friendship, money loaning, and advice seeking to assess how each resident views one another on these dimensions. The research used baseline data from a larger longitudinal study, and although some data were presented for the full sample (APL, isolates, mean reciprocity and density), the results primarily focused on case studies for three of the participating Oxford Houses-with examples of low, median, and high "connected" houses respectively. Standard measures of network structures were calculated for each home. Although all Oxford Houses follow the same house rules, they were found to vary in network structure. Findings indicated a considerable range of interconnectedness among residents in these houses, with friendship being the most common relationship, willingness to lend money less common, and advice-seeking the least common. The findings on friendship, willingness to lend, and advice-seeking provide promising leads about what occurs among the social networks within these complex eco-systems, and may provide ways to better understand and facilitate resident social integration into these settings.

Recovery homes: A social network analysis of Oxford Houses for Native Americans.

Social network data were collected among residents of an Oxford House (OH) recovery home, which was located on Suquamish Tribal territory. Data were collected on the social connections of eight male residents (including four Native Americans and four non-Native Americans) using a social network instrument. A number of social network relationship types were examined, including friendship, trust, and mentorship. Social network data assessed included diameter, reciprocity, the average path length, cohesion, density, transitivity, and centrality. Findings indicated that the OH provided residents a well-integrated network with multiple sources of friendship, trust, and mentors. This is of importance as recovery from substance abuse is facilitated when recovering individuals are provided stable and well-functioning networks that foster social support, access to resources, and mentorship.

A promising recovery housing model for American Indian communities.

In 2016, two Oxford House (OH) recovery homes were established for the Suquamish Tribal reservation. A group of researchers interviewed house members and key individuals responsible for the creation of these two unique OHs. Because American Indians are an at-risk population for substance use disorders, our study explored whether an OH-type recovery home model could be successfully adapted to this population, given the specific nature of tribal cultures. Findings indicated that the residents, composed of both American Indians and non-American Indians, found these OHs to be supportive of recovery in general and with the values of American Indians. The tribal community's positive attitudes toward these recovery homes may have been due to similarities between the Suquamish Tribal Government and OH's democratic structures, with all individuals having a voice in the decision making process. The overall findings suggest that these types of culturally modified recovery settings on American Indian tribal lands could be an important resource for individuals dealing with substance use disorders.

Relationship of hope, sense of community, and quality of life.

This study examined the role of hope and community in achieving and/or maintaining a successful recovery, and their relationships to quality of life for individuals in recovery. The sample included 229 participants in 42 Oxford House sober living homes in 3 locations in the United States. In this cross-sectional investigation, we assessed whether hope and sense of community were predictors of quality of life for individuals living in recovery homes. Findings indicated that both hope and sense of community were predictors supporting contextual as well as individual characteristics as possible influences on recovery trajectories. These findings have implications for both individual and systems-level resource or competency-based interventions, and they suggest one of the important functions of a recovery residence is in the creation of a sense of community.

Collectivism and individualism in Latino recovery homes.

Research indicates that Latinos underutilize substance abuse interventions; cultural variables may contribute to difficulties accessing and completing treatment for this group. As a result, there is a need to understand the role of cultural constructs in treatment outcomes. The purpose of this study was to investigate how levels of collectivism (COL) and individualism (IND) relate to length of stay and relapse outcomes in self-run recovery homes. We compared Latinos in several culturally modified recovery Oxford Houses to Latinos in traditional recovery Oxford Houses. By examining COL and IND in the OH model, we explored whether aspects of COL and IND led to longer lengths of stay and better substance use outcomes. We hypothesized that higher levels of COL would predict longer stays in an Oxford House and less relapse. COL did not have a main effect on length of stay. However, COL had a significant interaction effect with house type such that COL was positively correlated with length of stay in traditional houses and negatively correlated with length of stay in the culturally modified condition; that is, those with higher collectivism tended to stay longer in traditional houses. When we investigated COL, length of stay, and substance use, COL was negatively correlated with relapse in the culturally modified houses and positively correlated with relapse in the traditional houses. In other words, those with higher COL spent less time and had less relapse in the culturally modified compared to the traditional Oxford Houses. The implications of these findings are discussed.

Investigating Social Support and Network Relationships in Substance Use Disorder Recovery.

BACKGROUND: Social support and characteristics of one's social network have been shown to be beneficial for abstinence and substance use disorder recovery. The current study explores how specific sources of social support relate to general feelings of social support and abstinence-specific self-efficacy. METHODS: Data were collected from 31 of 33 individuals residing in 5 recovery houses. Participants were asked to complete social support and social network measures, along with measures assessing abstinence from substance use, abstinence self-efficacy, and involvement in 12-step groups. RESULTS: A significant positive relationship was found between general social support and abstinence-specific self-efficacy. General social support was also significantly associated with the specific social support measures of sense of community and Alcoholics Anonymous (AA) affiliation. Social network size predicted abstinence-related factors such as AA affiliation and perceived stress. CONCLUSIONS: These results provide insight regarding individual feelings of social support and abstinence-specific self-efficacy by showing that one's social network-level characteristics are related to one's perceptions of social support. We also found preliminary evidence that individual Oxford Houses influence one's feelings of social support.

Factors affecting the stability of social networks during early recovery in ex-offenders.

BACKGROUND: Few studies have considered the retention of the individuals (alters) comprising the social networks of people in recovery. OBJECTIVE: The purpose of this study was to describe factors predicting whether alters were retained 6 months after participants completed treatment. METHOD: The Important Person Inventory was given to 270 ex-offenders (224 men, 46 women) transitioning from treatment to Oxford House residences, Safe Haven therapeutic communities, or to usual aftercare. A 6-month follow-up was completed by 176 participants (137 men, 39 women). RESULTS: We found that alters who were related to the participant, did not use drugs, were embedded in smaller networks, and had more frequent contact with the participant were significantly more likely to be retained as important people over 6 months. The alters' drinking and criminal history were not significantly predictive of retention in the network. CONCLUSIONS: Certain characteristics of important people are related to their retention in a social network. Understanding these relationships and the extent to which the network change that occurs is aligned with abstinence-supporting networks is essential for creating effective social interventions for persons in recovery.

Person-environment interactions among residents of Oxford Houses.

The continued struggle of addiction recovery support systems suggest that the paradigm of this field needs to continue its evolution, which has increasingly emphasized environments. Field Theory suggests that the products of individual and environmental characteristics be considered rather than a summation of the two. This study examined such interactions in Oxford Houses, a network of democratic, and self-governed addiction recovery homes. This study examined sobriety in experienced houses (average length of residency > six months) compared to less experienced houses (average length of residency ≤ six months) in relation to individual resident characteristics (age, length of residence in an Oxford House, and referral from the criminal justice system). Using multilevel modeling, findings indicated that older residents living in an experienced Oxford Houses were more likely to remain abstinent over time than those in inexperienced homes. Additionally, for inexperienced houses, residents who had been in the Oxford House for a longer period had a higher the probability of abstinence than those that had been in the house for a shorter period of time. Finally, legal referral was related to a lower probability of one-year abstinence but only for those in experienced homes. These types of person-environment interactions point to the need for more research to better understand how person variables interact with environmental variables in the processes of recovery and adaptation to settings, as well as for treatment professionals' consideration of both person and environment when making recovery home referrals.

The Importance of Social Support in Recovery Populations: Toward a Multilevel Understanding.

Although social support is commonly investigated in the context of substance recovery, researchers have widely neglected its multilevel nature, thus limiting what we know about its measurement across levels of observation. The current study used multilevel confirmatory factor analyses (MCFA) on 229 individuals living in 42 recovery homes to investigate the structure of single factor of social support at the individual and house-levels. Multilevel structural equation model (MSEM) was then conducted to examine whether the social support factor was associated with stress at the individual and house-levels. MCFA results showed that within individuals, all social support measures were significant and positive while at the house-level, there were a few discrepancies (e.g., IP was negative). Stress was significantly negatively related to the social support factor at the individual-level, but this association was positive at the house-level. These findings suggest that on an individual-level, a person's perception and source of social support is particularly important -even if the source of support comes from someone who is not abstinent. On a house-level, social support is more sensitive to outside influences than within individuals. Implications for future research and substance use interventions targeting social support are discussed.

Individuals in sober living: Effects of contact with substance using family members.

This study examines the effects that substance-using family members have on those working to maintain recovery from substance use disorder. Participants (N = 229) were recruited from Oxford Houses (OH) across North Carolina, Texas, and Oregon. A stepwise linear regression with variables including abstinence self-efficacy, gender, substance use, attendance of Alcoholics Anonymous, and conflict with family and non-family was run to examine associations between the amount of substance using family members in the participant's social network. The abstinence self-efficacy mean score, gender, and days of serious conflict with non-family members were significantly associated with total number of substance-using family members in a participant's social network. These results may indicate that OH's serve as a buffer between substance using family members and one's abstinence self-efficacy. It remains unclear if individuals are at an increased risk of relapse from this familial influence when perceived abstinence self-efficacy drops. If so, OH residents could benefit from interventions that help them maintain their perceived abstinence self-efficacy.

Women's Friendships: A Basis for Individual-Level Resources and Their Connection to Power and Optimism.

The study examined how friendships among women in recovery from substance use disorders are related to individual resources (e.g., social support, self-esteem, and hope) and empowerment (e.g., power and optimism). Findings from a path analysis of 244 women in recovery revealed that friendships among women were positively related to individual resources; that is, the stronger the relationships with other women, the higher women perceived their resources to be. Further, individual-level resources mediated the relations between friendships and empowerment, with higher levels of individual resources related to higher levels of empowerment constructs of power and optimism. Results point to the importance of developing and sustaining empowering relationships for women in recovery. Findings have implications for gender-specific treatment practices and recommendations impacting substance use recovery outcomes.

How Type of Treatment and Presence of PTSD affect Employment, Self-regulation, and Abstinence.

The present study examined self-regulation, unemployment, and substance use outcomes for individuals with and without posttraumatic stress disorder (PTSD) who had transitioned from substance use treatment centers to the community. Participants, recruited from substance abuse treatment centers, were randomly assigned to an Oxford House self-help communal living environment (n = 75) or received usual aftercare (n = 75). Among these 150 individuals, 32 participants (27 women, 5 men) were diagnosed with lifetime PTSD. At a two year follow-up, individuals with PTSD in the usual aftercare condition showed significantly lower levels of self-regulation than those in the Oxford House condition with or without PTSD. These findings highlight the importance of abstinence supportive settings following substance use treatment, especially for individuals with PTSD.

Housing, Relationships, and Substance Use among Formerly Incarcerated Females.

The need for housing is an important concern for most women about to be released from prison, especially by those that need substance use treatment. This study explored the association between housing settings, relationships, and substance use. Two hundred adult females that had endorsed previous incarceration within the past two years participated in the initial baseline study. This study used multi-level modeling to analyze if housing settings and/or relationships within a living condition are associated with substance use. Results indicated that participants in homeless, and mutual settings used substances significantly more than participants in their own house or apartment. Participants that were in controlled, residential and transitional settings used significantly less than those living in their own house or apartment. Living with parents, family, or sexual partner significantly increased substance use. Utilizing these results to plan housing arrangements before women are released from correctional facilities may be beneficial for substance use recovery. Currently, there is no literature that directly measures the relationship between distinct housing settings, as well as the relationships that exist within them and substance use.

Advice seeking and loaning of money related to relapse in recovery homes.

Recovery homes help individuals who have completed substance use treatment programs re-integrate back into the community. However, it is unclear what factors determine who will succeed in these settings and how these factors may be reinforced or undermined by the social interactions and social networks between residents living in the Oxford House recovery homes. In an effort to better understand these factors, the current study evaluated (a) the extent to which the density of social networks (i.e., friendship, willingness to loan money, and advice-seeking relationships) is associated with social capital (i.e., sense of community, quality of life, hopefulness, self-efficacy), and (b) whether the density of social networks predicts relapse over time. Among the findings, willingness to loan money was positively associated with all four individual-level social capital variables, suggesting that availability of instrumental resources may be important to ongoing recovery. To test whether these house-level social network factors then support recovery, a survival analysis was conducted, finding associations between relapse risk and the network densities over a 28-month span. In particular, more dense advice-seeking networks were associated with higher rates of relapse, suggesting that the advice-seeking might represent a sign of organisational house problems, with many residents unsure of issues related to their recovery. In contrast, more dense loaning networks were associated with less relapse, so willingness to lend money could be measuring a willingness to help those in need. The implications of these findings are discussed.

Network measures of advice-seeking and resource sharing are related to well-being in recovery homes.

BACKGROUND: There is a need to better understand the extent to which social capital (reflected in social networks tapping friendship, financial support, advice/informational support) can aid recovery for those residents living in abstinence-based recovery homes. METHODS: Social network characteristics of 42 recovery homes (Oxford Houses) were examined, including friendship, willingness to loan money, and advice-seeking to assess the extent to which house network patterns were related to house-level resident measures of proximal recovery outcomes of well-being (e.g. social support, self-esteem, stress) and financial health (e.g. earned wages). RESULTS: We found that the density of the willingness to loan money network within a house was positively associated with house-level earned wages, social support, and self-esteem, and negatively associated with stress. Conversely, the density of house advice-seeking relationships was positively related to house-level stress. CONCLUSIONS: Houses in which residents are willing to share resources with other members who may be in need showed higher rates of well-being at the house-level. Advice-seeking in itself may signal stress, as stress may motivate residents to seek advice from more peers. The implications of these findings are discussed.

The relationship of Oxford Houses across heterogeneous house and setting characteristics.

Oxford Houses (OH) are democratically run, self-funded, substance-use recovery homes that operate across the United States and internationally. Previous research shows the OHs are present in diverse neighborhoods. The current study examined the neighborhoods of 42 OHs located in Oregon, Texas, and North Carolina to better quantify and understand house and neighborhood characteristics that are related to relapse rates. Independent variables were participants' length of stay in OH, wages earned from employment, and income/education neighborhood characteristics. Neighborhood characteristics were related to relapse rates, with higher relapse rates occurring in neighborhoods with lower income and education levels. This finding supports the OH organization's premise that while OHs may work across community settings, they perform better in neighborhoods with higher average income and education levels. (PsycInfo Database Record (c) 2020 APA, all rights reserved).

Tobacco Use among Recovery Home Residents: Vapers Less Confident to Quit.

Objectives: In this study, we provide estimates of the prevalence of tobacco use among residents in Oxford House (OH) recovery homes. We explore predictors for smoking cessation on future intentions to quit tobacco use, such as self-efficacy, motivation to quit, and level of nicotine dependence. We focus on examining smoking-related differences between 2 groups of tobacco users: (1) residents who only vape, and (2) residents who only smoke or who smoke and vape (ie, dual users). Methods: Data come from a research project examining the social networks of residents in OH homes at Wave 5 (N = 270) when questions were asked about tobacco use and cessation. We conducted multiple logistic regression analysis to assess the predictors on intentions to quit tobacco in the next 6 months. Results: Among residents, 60.4% report that they either smoke cigarettes, vape, or use both products. The odds of quitting are 92.5% lower for residents who only use e-cigarettes than for those who only smoke cigarettes or who smoke cigarettes and vape. Motivation to quit was associated with more than double the odds for self-efficacy on intentions to quit with odds ratios of 3.23 (95% CI: 1.81, 5.78; p = .00) and 1.47 (95% CI: 1.05, 2.07; p = .03) respectively. Conclusion: The high prevalence of smoking and vaping in this population makes it an important target for interventions.

The Reliability and Reciprocity of a Social Network Measure.

There have been few efforts to systematically develop reliable and valid measures of social networks, particularly in studies dealing with individuals having substance use disorders. In the current study, individuals living in recovery homes called Oxford Houses completed a 6-item measure of social networks. The Cronbach's alpha was .85 and a confirmatory factor analysis found excellent fit statistics with all items having substantial (> .70) load factors. In addition, the measure was independent of age, sex, and ethnicity and significantly related to length of stay in the recovery homes and quality of life. The authors have found that this instrument works well as an ego network with adequate psychometric properties and empirical relations to other recovery variables.

The Relationship of Sense of Community and Trust to Hope.

Settings that that have ecological variables that instill hope might be particularly effective for treating individuals with substance use disorders. More specifically, trust and sense of community could be of importance in the fostering of hope among individuals in recovery from substance use disorders. Our study included a sample of individuals who were living in or had lived in Oxford House recovery homes. We found both sense of community and trust are ecological aspects of settings that had important influences on hope, as an engaged individual tends to value trust relationships. Perceptions of the house operating effectively was positively related to an individual's assessment of the house as a good setting, but the house was not perceived to be as effective when the residents were not invested in the setting. The sense of community Self factor was the best predictor of hope, suggesting that an individual's personal investment in their house community are related to their hopefulness in terms of goal attainment and opportunities. Associations of hopefulness, personal commitment, and a supportive ecology provide evidence that an individual's perspective on recovery encompasses personal, environmental, and temporal perceptions.