Effects of strength of relationship ties in recovery homes: A conundrum.

Recovery homes are a widespread source of support for those attempting to maintain abstinence. For those who are able to remain in these settings for at least 6 months, outcomes tend to be favorable; however, many leave prematurely. There is a need to better understand the social integration processes that play a major role in giving recovery home residents access to available recovery-related social capital that is associated with better outcomes. The current study involved Oxford House recovery homes in 3 states and examined the strength of relationship ties among house members. We found that those who associated with peers who have higher recovery scores tend to improve their own recovery scores over time. However, we also found that those with higher recovery scores tended to create "strong" ties with similarly high-scoring alters; likewise lower-scoring individuals preferentially formed strong ties with each other. These findings suggest a conundrum: recovery home residents most in need of relational support from more recovered housemates are the least likely to obtain it. We discuss possible pathways to creating more ties between high and low-recovered residents.

Dynamic social network analysis of a brief alcohol intervention trial in heavy-drinking college students shows spillover effects.

BACKGROUND: Heavy-drinking college students tend to have close social networks, and there is theoretical and empirical support for the idea that behavior change can spread through those networks via close ties. The objective of this research was to determine whether intervention-induced behavior change in a subset of heavy drinkers in a sociometric (whole) college class-year social network is transmitted to other heavy drinkers in the network, resulting in reduced behavioral risk and change in network ties. METHODS: We conducted a controlled trial in which most of a first-year college class (N = 1236; 56.9% female) was enrolled, with alcohol use and social network ties measured early in each of three semesters. Following a baseline assessment, the network was divided into two groups, brief motivational intervention (BMI) and natural history control (NHC) according to dormitory residence location. A subset of heavy drinkers in each group was selected, and those in the BMI group received an in-person intervention. RESULTS: Using stochastic actor-oriented modeling, we found a significant tendency for participants in the BMI group to shed ties with individuals with similar drinking behaviors between the first and second semesters, relative to the NHC group. Furthermore, heavy drinkers with reciprocal ties to intervention recipients in the BMI group showed a significant reduction in drinks per week. CONCLUSIONS: Individual alcohol interventions appear to have effects both on behavior and network connections among individuals who did not receive the intervention. Continued research is needed to identify the optimal conditions for the diffusion of behavior change.

A reverse translational study of PPAR-α agonist efficacy in human and rodent models relevant to alcohol use disorder.

Alcohol Use Disorder (AUD) is a chronic relapsing disorder affecting an estimated 283 million individuals worldwide, with substantial health and economic consequences. Peroxisome proliferator-activated receptors (PPARs), particularly PPAR-α and PPAR-γ, have shown promise in preclinical studies as potential therapeutic targets for AUD. In this human laboratory study, we aimed to translate preclinical findings on the PPAR-α agonist fenofibrate to a human population with current AUD. We hypothesized that, relative to placebo, fenofibrate at the highest FDA-approved dose of 145 mg/d would attenuate responsiveness to in vivo alcohol cues in the lab and reduce drinking under natural conditions. However, the results did not show significant differences in craving and alcohol consumption between the fenofibrate and placebo groups. Reverse translational studies in rodent models confirmed the lack of fenofibrate effect at human-equivalent doses. These findings suggest that inadequate translation of drug dose from rodents to humans may account for the lack of fenofibrate effects on alcohol craving and consumption in humans with AUD. The results highlight the need for new brain-penetrant PPAR-α agonists to adequately test the therapeutic potential of PPAR-α agonists for AUD, and the importance of reverse translational approaches and selection of human-equivalent doses in drug development.

Preclinical and clinical evidence for suppression of alcohol intake by apremilast.

Treatment options for alcohol use disorders (AUDs) have minimally advanced since 2004, while the annual deaths and economic toll have increased alarmingly. Phosphodiesterase type 4 (PDE4) is associated with alcohol and nicotine dependence. PDE4 inhibitors were identified as a potential AUD treatment using a bioinformatics approach. We prioritized a newer PDE4 inhibitor, apremilast, as ideal for repurposing (i.e., FDA approved for psoriasis, low incidence of adverse events, excellent safety profile) and tested it using multiple animal strains and models, as well as in a human phase IIa study. We found that apremilast reduced binge-like alcohol intake and behavioral measures of alcohol motivation in mouse models of genetic risk for drinking to intoxication. Apremilast also reduced excessive alcohol drinking in models of stress-facilitated drinking and alcohol dependence. Using site-directed drug infusions and electrophysiology, we uncovered that apremilast may act to lessen drinking in mice by increasing neural activity in the nucleus accumbens, a key brain region in the regulation of alcohol intake. Importantly, apremilast (90 mg/d) reduced excessive drinking in non-treatment-seeking individuals with AUD in a double-blind, placebo-controlled study. These results demonstrate that apremilast suppresses excessive alcohol drinking across the spectrum of AUD severity.

House Level Latent Classes as Predictors of Recovery and Evictions.

The current study explored whether substance abuse recovery houses could be categorized into meaningful classes, which might be associated with house evictions as well as changes in individual-level recovery capital. A total of 602 individuals from 42 recovery homes were followed for up to 6 data collection periods over 2 years. House level latent class analyses were based on house-level data. A 3-class model fit very well (entropy 0.94) and better than a 2-class model. Class profiles examined concurrent (averaged across waves 1 and 2) house and resident-level variables (e.g., gender, race, age, employment, education). Class was then used to prospectively predict outcomes of the hazard of eviction and improvement in a recovery index over waves 3-6. One latent class representing 45% of the recovery houses had the highest density of members willing to loan, able to pay their rent, active involvement in outside chapter activities-this group of houses had the best outcomes including the lowest eviction rate and highest mean recovery factor. The two other classes had higher eviction rates, with one having the lowest density of friendship, selectivity of residents, and ability to pay rent. The other of the higher eviction-rate classes surprisingly had the highest density of friendship and advice seeking, but the lowest density of willingness to loan. These findings suggest that there are meaningful differences in types of recovery homes, and that house characteristics appear to influence recovery changes and eviction outcomes.

Dynamic Interdependence of Advice Seeking, Loaning, and Recovery Characteristics in Recovery Homes.

Recovery homes in the US provide stable housing for over 200,000 individuals with past histories of homelessness, psychiatric co-morbidity and criminal justice involvement. We need to know more about how these settings help those remain in recovery. Our study measured advice seeking and willingness-to-loan relationships and operationalized them as a dynamic multiplex social network-multiple, simultaneous interdependent relationships--that exist within 42 Oxford House recovery homes over time. By pooling relationship dynamics across recovery houses, a Stochastic Actor-Oriented Modeling (SAOM) framework (Snijders et al., 2010) was used to estimate a set of parameters governing the evolution of the network and the recovery attributes of the nodes simultaneously. Findings indicated that advice and loan relationships and recovery-related attitudes were endogenously interdependent, and these results were affected exogenously by gender, ethnicity, and reason for leaving the recovery houses. Prior findings had indicated that higher advice seeking in recovery houses was related to higher levels of stress with more negative outcomes. However, the current study found that recovery is enhanced over time if advice was sought from residents with higher recovery scores. Our study shows that social embedding, i.e. one's position in relationship networks, affects recovery prospects. More specifically, the formation of ties with relatively more recovered residents as an important predictor of better outcomes.

Individual and Contextual Protective and Risk Characteristics for Residents of Recovery Homes.

Some recovery homes have facilitating relationships and organizational characteristics, and there are also social capital differences among residents of these recovery homes. It is important to better understand the impact of protective and risk individual and house factors on recovery issues among residents of these community-based settings. Individuals from 42 recovery homes were followed for up to six data collection periods over two years. House level latent class analyses tapped relationship and organizational domains and individual level latent class analyses were from derived from elements of recovery capital. Houses that manifested protective factors provided most residents positive outcomes, except those with elevated self-esteem. Houses that were less facilitating had more negative exits, except for those residents who were the highest functioning. Both individual and house characteristics are of importance in helping to understand risk factors associated with eviction outcomes for residents in recovery homes.

A Longitudinal Study of E-Cigarette, Cigarette, and Marijuana Use Sequence in Youth.

Objective: There is evidence linking youth use of electronic (e-) cigarettes to subsequent cigarette and marijuana use, raising public health concerns. We examined the sequence of use of e-cigarettes, conventional cigarettes, and marijuana in a longitudinal sample of adolescents, to determine if use of e-cigarettes often preceded use of other substances. Methods: We collected self-reports from 1123 Oregon adolescents (52% female; 37% Hispanic) longitudinally from 8th to 11th grade (8 total surveys) regarding their lifetime (ever use) and current use (last 30 days) of e-cigarettes, cigarettes, and marijuana. If applicable, students also reported the delivery method of their current marijuana use. Results: Almost 10% of adolescents reported using e-cigarettes prior to use of cigarettes or marijuana, and the majority of these youth initiated use of marijuana, cigarettes, or both by 11th grade. More youth transitioned from e-cigarette use to marijuana use then from e-cigarettes to use of conventional cigarettes. Participants who were co-using e-cigarettes and marijuana in 11th grade had an increased likelihood of consuming marijuana via vaping, dabbing, and edibles, compared to those who were only using marijuana. Discussion: E-cigarettes were often the first substance used in this longitudinal sample, and more of these youth subsequently used marijuana compared to cigarettes. While research has focused on the progression from e-cigarettes to cigarettes in youth, these findings indicate that more attention should be focused on the subsequent initiation of marijuana.

Latent profile analysis in recovery homes: A single quantitative dimension captures most but not all of the important details of the recovery process.

Background: Our study explored whether latent classes adequately represented the social capital recovery indicators at the resident level and whether latent class membership predicted subsequent exits from the recovery homes. Method: Our sample included about 600 residents in 42 recovery homes. Over a 2-year period of time, every 4 months, data were collected on eight elements of recovery capital. Results: We found 5 latent classes were optimal for representing 8 elements of recovery capital. Representing 79% of the sample, 3 of the 5 latent class profiles of the means of the 8 recovery indicators were roughly parallel and differed only in level, but the remaining 2 latent class profiles, representing 21% of the sample, were not parallel to the first 3, suggesting that a single quantitative dimension of perceived recovery may capture most but not all of the important details of the recovery process. Next, using longitudinal data from homes, the distal outcomes of resident eviction and voluntary exit were found to be related to latent class membership. Resident level pre-existing predictors (e.g., employment status, educational attainment, gender, Latinx ethnicity) and house level pre-existing predictors (e.g., financial health, poverty level of typical population served, new resident acceptance rate) significantly discriminated the classes. In a model that combined both pre-existing predictors and distal outcomes, latent class membership was still the strongest predictor of evictions controlling for the pre-existing predictors. Conclusions: These classes help to clarify the different aspects of the recovery latent score, and point to classes that have different ethnic and gender characteristics as well as outcomes in the recovery homes. For example, the high levels of self-confidence found in class 3 suggest that Latinx might be at higher risk for having some difficulties within these recovery communities.

Social integration in recovery living environments: A dynamic network approach.

Oxford Houses (OHs) are a large network of self-run community-based settings for individuals with substance use disorders. This present study explored a model based on conceptualizing recovery home social systems as dynamic multirelational (multiplex) social networks. The model is developed from data obtained from 42 OH recovery homes in three parts of the US, addressing whole networks of friendship, close friendship, and willingness to loan money. Findings indicated that close friend and loan relationships mutually reinforced each other over time as they coevolved. These types of insights can help community psychologists to better understand complex network dynamics in community-based settings.

Willingness to Lend Resources is Associated with Increases in Recovery and Participation in Community Activities.

Recovery homes may facilitate individuals with substance use disorders re-integration back into community settings by providing friendship, resources, and advice. Participants of the current study were over 600 residents of 42 Oxford House recovery homes. Findings indicated that willingness to share resources in the form of loans was associated with higher levels of house involvement in recovery home chapters. Active involvement in house and community affairs may influence more recovery within homes or may be an indicator of houses with residents with more capacities and skills for positive long-term health outcomes. Such findings suggest that recovery is a dynamic process with multiple ecological layers embedding individuals, their immediate social networks, and the wider community.

Personal and Environmental Social Capital Predictors of Relapse Following Departure from Recovery Homes.

Substance use recovery homes represent the largest residential, community-based post-treatment option for those with substance use disorders in the United States. It is still unclear what unique factors predict relapse after residents leave such homes. This study presents results of a longitudinal study of 497 residents who departed from 42 Oxford House recovery houses. We hypothesized that the predictors of post-departure relapse would be a multi-item measure of latent recovery, length of stay, and reason for departure from the home (voluntary vs. involuntary). Predictor effects were estimated as part of a two-step model with two outcomes: (a) lack of follow-up data after departure from the house, and (b) the likelihood of relapse. Determinants of missing follow-up data included less education, less time in residence, and involuntary departure. Relapse was more likely for individuals who were younger, had involuntarily left the house, and had lower values on the latent recovery factor. The implications of these important factors related to relapse following departure from residential recovery home settings are discussed.

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.

Exploring possible network properties facilitating recovery for residents of sober living homes.

Background: Recovery homes provide supportive settings for thousands of individuals with substance use disorders each year. However, not all residents of recovery homes improve in these settings, and the reasons for both improvement and lack of improvement are still unclear. It is possible that those low in recovery might benefit when they are in settings with high recovery residents. Methods: We examined social network ties among 19 recovery home settings that had pairings of low and high recovery residents. Results: We found that low recovery factor individuals generally increased their recovery factor scores over time. In the cases where recovery factor scores did not increase, the low recovery factor individuals had few social network ties with the high recovery residents. Conclusions: Both selection and influence can likely be factors that affect recovery behavior in these social settings, as residents may select friends who already exhibit similar behaviors as their own or be influenced by friends to adjust their behavior, so it is more like that of the group. A dynamic systems-based perspective can help investigators better understand how recovery-related behaviors and social relationships co-evolve, and how individual characteristics and house-level social structures can link to changes in individuals' recovery.

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.

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.

Reducing health disparities among black individuals in the post-treatment environment.

An important step in reducing health disparities among racial and ethnic minorities with substance use disorders involves identifying interventions that lead to successful recovery outcomes for this population. The current study evaluated outcomes of a community-based recovery support program for those with substance use disorders. Participants included 632 residents of recovery homes in three states in the US. A multi-item recovery factor was found to increase over time for these residents. However, rates of improvement among Black individuals were higher than for other racial/ethnic groups. Black Americans perhaps place a higher value on communal relationships relative to all other racial/ethnic groups, and by adopting such a communitarian perspective, they might be even more receptive to living in a house that values participation and involvement. The implications of these findings for health disparities research are discussed.

An Empirically-based Theory of the Relationships Among Social Embeddedness, Economic Viability, Learned Recovery Skills and Perceived Quality of Life in Recovery Homes.

Key characteristics of recovery homes include governance style (which can play a central role in structuring recovery mechanisms), social embeddedness (e.g., social relationships within the home), economic viability (e.g., the individual's ability to be self-supporting), and learned recovery skills (such as coping with stress, avoiding putting one's self in risky situations, etc.). These domains can have important associations with perceived quality of life (measured across physical, psychological, social relationships, and environmental domains). The current study investigated relationships among these key "active ingredients" (Moos, 2007) of recovery homes. In addition, we present dynamic model consistent with these observed relationships, to illustrate how relevant mechanisms interact over time to and affect system evolution. Data were collected from recovery home residents in three states. Findings supported our overall hypotheses indicating that social embeddedness, stress, and self-efficacy were related to quality of life, and policy and treatment-design implications are further examined by simulating system dynamics.

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).

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.