Investigating the role of interpersonal relationships on low-income SUD patients' recovery: a qualitative analysis of various stakeholders in New York State.

Background: While positive impacts of recovery capital and social capital in facilitating substance use disorder (SUD) recovery is increasingly documented, research has shown that low-income and marginalized individuals have lower social capital and may rely on different networks. A more comprehensive approach is needed to understand the social capital of low-income individuals with SUD and how these relationships impact their treatment and recovery. Methods: Qualitative data were gathered through semi-structured interviews and analyzed employing thematic analysis. Participants included individuals with SUD (n=10), clinicians (n=12), and policy leaders (n=13). Results: Three themes emerged: 1) Patients' positive and negative interpersonal relationships with friends and family influenced decisions to seek treatment; 2) strong patient-provider relationships, often defined by the quality of SUD providers and treatment settings, were perceived as crucial for staying in treatment; and 3) justice involvement facilitated treatment access yet deteriorated treatment engagement. Themes emphasized social and structural factors that inhibit patients from fostering support and treatment engagement. Conclusions: Our study underscores the importance of interpersonal relationships in SUD treatment-seeking and recovery and the need for positive interactions across the care continuum within broader social networks. Opportunities for positive interpersonal relationships include increasing access to language-concordant treatment; provider training to enhance cultural humility and patient-provider relationships; and mechanisms that improve interpersonal relationships between patients, parole officers, and other justice system members. Accentuating the role of interpersonal relationships and expanding social support interventions can pave the way for structural changes that improve recovery by harnessing different types of social capital.

Changes in Recovery Capital Among Patients Receiving Buprenorphine Treatment for Opioid Use Disorder in a Telehealth Setting.

BACKGROUND: Medications for the treatment of opioid use disorder (MOUD) such as buprenorphine are the most effective treatment available for OUD; yet, beyond drug testing results and retention in care, systematically measured clinical outcomes have proven elusive. There is growing interest in integrating systematic monitoring of patient-reported outcomes and measurement-based care as strategies to improve patients' success in treatment. METHODS: We analyzed changes in recovery capital assessed via the Brief Assessment of Recovery Capital (BARC-10) from baseline to 30-120 days post-intake among patients initiating buprenorphine treatment from May to October 2023 at Ophelia, a telehealth MOUD provider, who were retained for ≥90 days. Differences in baseline characteristics were assessed between patients with and without high "remission-predictive" baseline scores (≥47) using chi-squared and t-tests. Changes in scores from baseline to follow-up were assessed using paired t-tests. RESULTS: In all, 791 patients initiated treatment during the study period, 742 (93.8%) of whom had a baseline BARC-10 score, 542 (73.0%) of whom were retained in treatment for ≥90 days, and 477 of whom (88.0%) had a follow-up BARC-10 score and represent the analysis sample. Older patients, those not requiring buprenorphine induction, and those not using heroin or fentanyl at intake were more likely to have remission-predictive baseline BARC-10 scores (P < .05). Patients with remission-predictive baseline scores (n = 257) had a mean increase of 1.4 (SD = 5.9) from 52.7 (SD = 4.1) (P < .001), and 234 (91%) sustained remission-predictive scores throughout the assessment period. Patients without remission-predictive baseline scores (n = 220) had a mean increase of 9.2 (SD = 8.2) from 38.4 (SD = 6.6) (P < .001), and 129 (59.0%) achieved a remission-predictive score at follow-up. CONCLUSIONS: Most patients had increased or sustained already high levels of recovery capital, an established predictor of sustained remission. Further research is required to better understand variability across patients and how it may relate to long-term outcomes.

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.

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.

Self-Forgiveness and Gratitude in Recovery from Substance Use Disorders.

Substance use is a multifaceted disorder of the whole person that is manifested on three levels: intrapersonal, interpersonal, and spiritual. Previous research has demonstrated that self-forgiveness and gratitude help build personal and social resources and reinforce the process of recovery from substance use disorders. The aims of the present narrative review article were to (a) explore self-forgiveness and gratitude as psychological mechanisms of behavioral change in recovery through the lens of positive criminology and recovery capital approach, (b) review the practice of self-forgiveness and gratitude in the Narcotics Anonymous (NA) and Alcoholics Anonymous (AA) programs, and (c) present a conceptual model of self-forgiveness and gratitude in long-term recovery. Self-forgiveness and gratitude have been described as positive emotions and prosocial, empathy-based moral virtues that enhance well-being and health by reinforcing the establishment and maintenance of long-lasting positive relationships with self, others, and spirituality. This effect may occur through different levels and psychological mechanisms. This article contributes to the field by presenting the intrapersonal, interpersonal, and spiritual benefits associated with self-forgiveness and gratitude interventions that can initiate and sustain long-term recovery.

Longitudinal trajectories in recovery capital and associations with substance use among adult drug treatment court clients.

BACKGROUND: Recovery capital (RC) refers to the resources individuals use to support substance use disorder (SUD) recovery. Individuals with SUD who are involved with the criminal justice system often have limited RC. Drug treatment courts (DTCs), including traditional drug treatment courts (tDTCs) and opioid intervention courts (OICs), can link clients to important sources of RC in the short-term, but few studies have assessed RC longitudinally. METHODS: The current study analyzed five waves of data from a one-year longitudinal study on substance use and RC collected from clients of tDTCs and OICs (n=165, 52% male, 75% non-Hispanic White, Age=21-67 years). Mixed-effects models examined (1) within-person trends over time in RC, (2) individual characteristics associated with differences and changes in RC, and (3) patterns of relationships between RC and substance use over time. We also tested differences by court type. RESULTS: First, OIC participants had lower RC at baseline relative to tDTC participants, and there was considerable within-person variability in RC over time. Second, the effect of a high school diploma/GED at baseline on RC change over time was greater for OIC relative to tDTC participants. Third, there was a negative concurrent within-person association between drug use and RC that became stronger over time for OIC relative to tDTC participants. CONCLUSIONS: This study is among the first to examine longitudinal, within-person trajectories in RC. Results revealed important within-person variability over time in RC that was linked to education and drug use, particularly among OIC clients. Findings could help inform DTC treatment approaches.

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.

Lift Yourself Up: The Short-Term Associations Between Strength Training and Mood States and the Longer Term Development of Physical Capital and "Grit" Among People Recovering From Substance Use Disorders.

Mind Body Connect is a charity that delivers community-based physical exercise (PE) classes to people in recovery from substance use disorders. This study aimed to identify the contribution that strength training played in the development of positive short- and long-term psychological attributes for people recovering from substance use disorders by assessing (a) the short-term associations between participation in group exercise classes (N = 43, t = 2,940) and (b) the prospective long-term association between strength development and individuals' self-assessed level of "grit" among participants for whom strength training became a habitual activity (N = 13, median 8 weeks supported training). Participants completed demographic, Profile of Mood States-Adapted Short Form, and Short Grit Scale questionnaires before and after each strength training session over a period of 45 noncompulsory training sessions between February 2020 and March 2021. Weekly training logs recording the weight lifted were normalized into a measure of physical capital development. Short-term associations were tested using multilevel regression models predicting change in mean Grit score with interactions for gender; long-term associations were assessed through the use of latent growth models. We found that training sessions were associated with weak to moderate reductions (ß = -0.112 to -0.533) in many negative mood states but elevated fatigue (ßMEN = 1.071, ßWOMEN = 0.397). Latent growth in recorded strength was strongly associated with latent growth in self-assessed grit (ß = 0.674). The findings suggest that PE classes and supported long-term strength training may assist with the development of recovery capital.

"I was already there once": Cumulative attempt capital of marginalized women exiting substance use and street prostitution contributes to their recovery capital.

Despite a move to view substance use as a disease of the brain, relapse into drugs is still often viewed as a personal failure. Low recovery capital has been used to explain relapse among certain marginalized populations. Recovery capital is a recent framework that refers to the individual's sum of all internal and external assets that may assist in their recovery process. It includes four categories: physical, human, social, and cultural capital. However, this framework does not relate to the role of actual relapses in the recovery process, despite their common occurrence. To bridge this gap, in-depth interviews with 29 women formerly engaged in substance use and street prostitution in a large urban area were used to probe women about their relapse and recovery experiences. The current study demonstrates the value in repeat recovery setbacks, what I term "cumulative attempt capital": lessons learned from previous recovery attempts. I argue that previous attempts improve women's social and professional networks, help them learn from past mistakes, improve and maintain their health, and provide them with a sense of self-efficacy. This research expands our understanding of the positive role failed attempts play in one's recovery. Such reframing by service providers can alleviate a sense of shame and low self-worth for women in street prostitution and substance use and has implications for policy and program development.

Exploring indicators of natural recovery from alcohol and drug use problems: findings from the life in recovery survey in Flanders.

INTRODUCTION: Research has established natural recovery (NR) as an important pathway to substance use recovery. Studies investigating correlates of NR have mainly focused on demographic and substance use variables rather than life circumstances. This study seeks to better understand the phenomenon of natural recovery by (i) validating the international scientific literature concerning demographic and substance use indicators of NR in Flanders and (ii) assessing the additional explanatory power of recovery strengths and barriers during active addiction, controlling for demographic and substance use covariates. METHODS: A total of 343 persons in recovery from alcohol or drug use problems (≥ 3 months) completed an online cross-sectional survey in Flanders. Participants in NR and in recovery after following treatment were compared using multivariate linear regression models. Reasons for not following treatment were analyzed using inductive thematic analysis. RESULTS: Higher education level, lower severity of dependence, and cannabis use as the main problem substance (vs. alcohol) were statistically significant (p < 0.05) correlates of NR. When scores for the number of barriers and strengths associated with active addiction were added, barriers (but not strengths) were significantly associated with NR. When barrier items were individually tested, having untreated emotional or mental health problems, having a driver's license revoked and damaging property were statistically significant correlates. The most reported reason for not entering treatment was not experiencing any need to do so. CONCLUSION: The results highlight the importance of a holistic approach to recovery support across multiple life domains. Limitations and opportunities for further research are discussed.

Identifying components of recovery capital that support substance use disorder treatment completion.

Purpose: Individuals who do not complete substance use disorder treatment (SUDT) have similar outcomes to the untreated. Recovery capital (RC) is the collection of one's resources that contribute to the initiation and maintenance of sobriety. The aim of this paper was to identify individual measures of RC that are associated with SUDT completion. Methods: RC data for 69 residents from a men's recovery center was obtained from questionnaires administered to residents at intake and after SUDT graduation or dismissal. Participant data was divided into two groups, Graduates (n = 39, age 35.87±10.83) and Non-Graduates (n = 30, age 34.35±14.44), and retrospectively analyzed to compare RC between groups at various points during SUDT and which RC measures are associated with SUDT completion. Results: At baseline all participants reported limited RC and there was no significant difference in RC between groups. At graduation, Graduates reported significantly more RC in all measures when compared to baseline and Non-Graduates at dismissal. Non-Graduates reported a significant increase in Checking and Savings at dismissal but no other measure. Conclusion: Baseline levels of RC in both groups were limited and not significantly different which limited the capacity of the study to identify measures of RC associated with SUDT completion. A lack of RC at onset of SUDT did not preclude SUDT completion and obtaining RC during SUDT was associated with completion as only Graduates reported increases in RC. Future study designs should include participants with variable amounts of RC when entering SUDT.

Self-change from problems with alcohol and drugs: A scoping review of the literature since 2010.

ISSUES: Self-change from alcohol and drug use problems is increasingly acknowledged in research. Despite the growing number of published studies, the most recent broad review of this dispersed field dates back to 2010. The present review narratively synthesises key findings from empirical studies and critically identifies research gaps and directions for further research. APPROACH: Following the PRISMA guidelines for scoping reviews, a systematic search was conducted in multiple scientific databases, resulting in the identification of 56 relevant articles with explicit empirical results on self-change. KEY FINDINGS: The scoping review presents findings related to: (i) methods and definitions used; (ii) the prevalence of self-change; (iii) indicators of self-change; (iv) the process of self-change; and (v) population views on self-change. CONCLUSION: The review highlights the significant growth in research on self-change considering key themes as well as the need for a relational and time-bound approach to self-change in research and practice.

Learning with conviction: Exploring the relationship between criminal legal system involvement and substance use and recovery outcomes for students in collegiate recovery programs.

This study examines the association of criminal legal system involvement and age with substance use and academic related outcomes among students involved in collegiate recovery programs in the US. We examined 435 students in collegiate recovery using a national survey of college students. We computed differences between non-system-involved, system-involved with no incarceration history, and formerly incarcerated participants on relevant substance use and recovery-related outcomes. The results provide evidence that there are significant differences between those system-involved and those who are not. Specifically, we found significant differences across the outcomes of recovery capital, quality of life, hours worked per week, and substance use disorder symptoms, but after controlling for relevant covariates, only the differences between hours worked (non-system involved and system involved < formerly incarcerated) and substance use disorder symptoms (non-system involved < system involved and formerly incarcerated) remained significant. The study contributes to the literature by demonstrating that nearly half of the collegiate students in recovery in this sample have legal system-involvement and a third have been incarcerated. Further, interventions for collegiate recovery programs may need to be adjusted to account for legal system involvement among their members.

Exploring social connectedness, isolation, support, and recovery factors among women seeking substance use treatment.

This cross-sectional study examined the relationship between social variables, recovery orientation, and recovery capital among a sample of n = 30 women actively seeking substance use disorder treatment at a community-based facility in the Midwest United States. Results indicated a positive association between social connectedness, abstinence recovery orientation (p = .048) and social isolation (p = .010). Social isolation was positively associated with abstinence recovery orientation (p = .004) and negatively related to recovery capital (p = .003). Social support was positively correlated with positive expectancy (p = .030) and recovery capital (p = .033). Further, moderate/high alcohol use was related to lower normal living scores (t(28) = 3.10, p = .004), lower recovery capital scores (t(28) = 4.15, p < .000), and higher social isolation scores (t(28) = -2.53, p = .017). Screening at moderate/high risk for cannabis use was related to lower normal living scores (t(28) = 3.01, p = .005), and lower positive expectancy scores (t(28) = 3.03, p = .005). Finally, screening for moderate/high risk for polysubstance use was related to lower normal living orientation (t(28) = 2.52, p = .018) and recovery capital scores (t(28) = 2.79, p = .009). Current findings may inform strategies for examining social connectedness and social isolation variables in future clinical practice, policy, and scholarship.

Recovery Barrier Characterizations by Hospitalized Patients with Substance Use Disorders: Results from a Randomized Clinical Study on Inpatient Peer Recovery Coaching.

Patients hospitalized with medical complications from substance use disorder (SUD) encounter unique health problems that may complicate their recovery. Recovery barriers are not well understood in this population. The study objective is to characterize recovery barriers in this patient population. Participants (n = 96) in this six-month longitudinal study were randomized to a peer recovery coaching intervention or standard of care. The primary outcome measures were qualitative, open-ended questions addressing factors interfering with participants' recovery. Data were analyzed using content analysis. Themes were identified a priori using past research on recovery capital domains; these seven barriers were (1) psychological health difficulties, (2) physical health challenges, (3) lack of social support, (4) insufficient treatment or recovery support to maintain sobriety, (5) environmental and housing concerns, (6) deficits in coping skills, and (7) lack of meaningful activities. At baseline, the most common recovery barriers were in the environment and housing (28.1%), psychological health (27.1%), and social support (22.9%) domains. At six-month follow-up, participants were asked to describe barriers they felt they had made improvement in over the last six months. The primary themes that participants reported improvements in were treatment and recovery support to maintain sobriety (52.1%), coping skills (35.4%), and social support (27.1%). Hospitalization and participation in a randomized controlled trial may be a turning point in which to address recovery barriers for patients hospitalized with complications from SUD.

The impact of spiritual well-being and social support on substance use treatment outcomes within a sample of predominantly Black/African American adults.

INTRO: Substance use and associated problems often return following treatment for substance use disorder (SUD), which disproportionally impact Black/African American (AA) individuals. Social support and spiritual well-being are sources of recovery capital identified as particularly important among Black/AA adults. Social support and spiritual well-being are also posited mechanisms in 12-step; thus, this study tested the effects of social support and spiritual well-being on substance use outcomes over time, distinct from 12-step involvement, among Black/AA adults post-SUD treatment. The study hypothesized that social support and spiritual well-being would demonstrate significant interactions with time, respectively, on substance use frequency and substance use consequences, above the effect of 12-step involvement. METHOD: The study drew data from a study of 262 adults (95.4 % Black/AA) entering residential SUD treatment (NCT#01189552). Assessments were completed at pretreatment and at 3-, 6-, and 12-months posttreatment. Two generalized linear mixed models (GLMM) tested the effects of social support and spiritual well-being, above the effect of 12-step involvement, on substance use frequency and substance use consequences over the course of 12-months posttreatment. RESULTS: Higher spiritual well-being predicted significantly less frequent substance use during recovery (ß = 0.00, p = .03). Greater 12-step involvement predicted significantly fewer substance use consequences during recovery (ß = 0.00, p = .02). In post hoc analyses the effect of spiritual well-being and 12-step involvement dissipated by 3.5- and 6.6-months posttreatment, respectively. The study found no significant effects of social support over time. DISCUSSION: Spiritual well-being and 12-step involvement are associated with lower substance use and substance use consequences, respectively, in the early months of posttreatment recovery among Black/AA adults. These findings contribute to the growing recovery capital literature informing paths to recovery and sources of support outside of 12-step affiliation. However, these effects diminish over time.

Assessing a pilot scheme of intensive support and assertive linkage in levels of engagement, retention, and recovery capital for people in recovery housing using quasi-experimental methods.

INTRODUCTION: Strong and ever-growing evidence highlights the effectiveness of recovery housing in supporting and sustaining substance use disorder (SUD) recovery, especially when augmented by intensive support that includes assertive linkages to community services. This study aims to evaluate a pilot intensive recovery support (IRS) intervention for individuals (n = 175) entering certified Level II and III recovery residences. These individuals met at least three out of five conditions (no health insurance; no driving license; substance use in the last 14 days; current unemployment; possession of less than $75 capital). The study assesses the impact of the IRS on engagement, retention, and changes in recovery capital, compared to the business-as-usual Standard Recovery Support (SRS) approach (n = 1758). METHODS: The study employed quasi-experimental techniques to create weighted and balanced counterfactual groups. These groups, derived from the Recovery Capital assessment tool (REC-CAP), enabled comparison of outcomes between people receiving IRS and those undergoing SRS. RESULTS: After reweighting for resident demographics, service needs, and barriers to recovery, those receiving IRS exhibited improved retention rates, reduced likelihood of disengagement, and growth in recovery capital after living in the residence for 6-9 months. CONCLUSION: The results from this pilot intervention indicate that intensive recovery support, which integrates assertive community linkages and enhanced recovery coaching, outperforms a balanced counterfactual group in engagement, length of stay, and recovery capital growth. We suggest that this model may be particularly beneficial to those entering Level II and Level III recovery housing with lower levels of recovery capital at admission.

Health-related quality of life and recovery capital among recovery residents taking medication for opioid use disorder in Texas.

Background: Recovery from opioid use disorder (OUD) includes improvements in health-related quality of life (HRQOL) and is supported by recovery capital (RC). Little is known about RC and HRQOL among recovery residents taking medication for OUD. We described HRQOL and RC and identified predictors of HRQOL. Methods: Project HOMES is an ongoing longitudinal study implemented in 14 recovery homes in Texas. This is a cross-sectional analysis of data from 358 participants' on HRQOL (five EQ-5D-5L dimensions-mobility, self-care, usual activities, pain/discomfort, and anxiety/depression) and RC (Assessment of Recovery Capital scores) collected from April 2021 to June 2023. Statistical analyses were conducted using T-, Chi-squared, and Fisher's exact tests. Results: Most participants were 35 years/older (50.7%), male (58.9%), non-Hispanic White (68.4%), heterosexual (82.8%), and reported HRQOL problems, mainly anxiety/depression (78.4%) and pain/discomfort (55.7%). Participants who were 35 years/older [mean (SD) = 42.6 (7.3)] were more likely to report mobility and pain/discomfort problems than younger participants. Female participants were more likely to report pain/discomfort problems than male participants. Sexual minorities were more likely to report anxiety/depression problems than heterosexual participants. Married participants and those in committed relationships were more likely to report problems conducting self-care than single/never-married participants. Comorbid conditions were associated with mobility, pain/discomfort, and usual activities problems. Most participants reported high social (65.4%), personal (69.0%), and total (65.6%) RC. Low personal RC was associated with mobility (aOR = 0.43, CI = 0.24-0.76), self-care (aOR = 0.13, CI = 0.04-0.41), usual activities (aOR = 0.25, CI = 0.11-0.57), pain/discomfort (aOR = 0.37, CI = 0.20-0.68), and anxiety/depression (aOR = 0.33, CI = 0.15-0.73) problems. Low total RC was associated with problems conducting self-care (aOR = 0.20, CI = 0.07-0.60), usual activities (aOR = 0.43, CI = 0.22-0.83), pain/discomfort problems (aOR = 0.55, CI = 0.34-0.90), and anxiety/depression (aOR = 0.20, CI = 0.10-0.41) problems. Social RC was not associated with HRQOL. Conclusion: Personal and total RC and comorbid conditions predict HRQOL. Although the opioid crisis and the increasing prevalence of comorbidities have been described as epidemics, they are currently being addressed as separate public health issues. Our findings underscore the importance of ensuring residents are provided with interprofessional care to reduce the burden of comorbidities, which can negatively impact their OUD recovery. Their RC should be routinely assessed and enhanced to support their recovery and improve HRQOL.

Giving and Receiving Help among Persons Entering Sober Living Houses.

Giving and receiving help are integral to creating the social environments necessary to support recovery. However, studies assessing the effects of helping behaviors have focused primarily on the benefits derived from giving help to others in 12-step programs and treatment. The current study examined the frequency of giving and receiving help among 188 persons entering sober living houses (SLHs), a type of recovery home that is common in California. Helping was assessed in three contexts: the SLH, 12-step meetings they attended, and interactions with their family and friends. Residents who gave help to others in one of these contexts tended to also receive help in that context. Residents who reported giving or receiving help in one context tended to report giving and receiving help in other contexts. Study findings suggest helping in recovery occurs in a broader, more reciprocal manner than currently conceptualized. Studies should address how giving and receiving help in different contexts affects recovery outcomes. Research is also needed to describe the determinants of giving and receiving help. Considerations for facilitating help among SLH residents are described.

Six-month length of stay associated with better recovery outcomes among residents of sober living houses.

Background: Sober living houses are designed for individuals in recovery to live with others in recovery, yet no guidelines exist for the time needed in a sober living house to significantly impact outcomes.Objectives: To examine how the length of stay in sober living houses is related to substance use and related outcomes, focusing on early discontinuation (length of stay less than six months) and stable residence (length of stay six months or longer).Methods: Baseline and 12-month data were collected from 455 sober living house residents (36% female). Longitudinal mixed models tested associations between early discontinuation vs. stable residence and abstinence, recovery capital, psychiatric, and legal outcomes. Final models were adjusted for resident demographics, treatment, 12-step attendance, use in social network, and psychiatric symptoms, with a random effect for house.Results: Both early discontinuers (n = 284) and stable residents (n = 171) improved significantly (Ps ≤ .05) between baseline and 12 months on all outcomes. Compared to early discontinuation, stable residence was related to 7.76% points more percent days abstinent (95% CI: 4.21, 11.31); 0.88 times fewer psychiatric symptoms (95% CI: 0.81, 0.94); 0.84 times fewer depression symptoms (95% CI: 0.76, 0.92); and lower odds of any DSM-SUD (OR = 0.65, 95% CI: 0.47, 0.89) and any legal problems (OR = 0.58, 95% CI: 0.40, 0.86).Conclusion: In this study of sober living houses in California, staying in a sober living house for at least six months was related to better outcomes than leaving before six months. Residents and providers should consider this in long-term recovery planning.