America's perceptions of opioid related impairment: A national randomized study examining how different individuals may stigmatize addiction in response to different terminology.

INTRODUCTION: Prior research has found that different ways of describing opioid-related impairment influences the types and degrees of stigmatizing beliefs held by the American public. In this study we examined the extent to which different characteristics of the American public (i.e., age, gender, race/ethnicity, religiosity, sexual orientation, political affiliation, personal history of addiction/mental health problem) are associated with holding different types and degrees of stigmatizing beliefs when asked to consider someone treated for opioid-related impairment. We also assessed whether any observed differences in stigmatizing beliefs related to participant characteristics are dependent on how an opioid-impaired patient is described in terms of both the nature of the impairment (e.g., as a "chronically relapsing brain disease", "brain disease", "disease", "illness", "disorder", or "problem") as well as the gender of the depicted opioid-impaired person. METHODS: A nationally representative sample of the U.S. population (N = 3643) was randomized to one of six vignettes describing a patient being treated for opioid-related impairment that differed only in the way the impairment was described (as a "chronically relapsing brain disease", "brain disease", "disease", "illness", "disorder", or "problem"). Participants subsequently were asked to rate statements assessing five stigma dimensions (blame, prognostic pessimism, continuing care, dangerousness, and social distance). RESULTS: Several characteristics were associated with different types and higher levels of stigmatizing beliefs: older age, male gender, White race, heterosexual orientation, being religious, Republican political affiliation, and having no prior alcohol/drug or mental health problem history (ps < 0.001). With very few exceptions, the way the opioid-impairment was described or whether the depicted patient was a man or a woman did not influence the strength of these associations. CONCLUSIONS: Certain characteristics of members of the US population were associated with holding different types and degrees of stigmatizing attitudes when asked to consider someone receiving treatment for opioid-related impairment and these were largely unaffected by how the impairment was labeled or the opioid-impaired person's gender. Depending on the specific target of clinical and public health anti-stigma campaigns, both addiction terminology and the beliefs held by certain population sub-groups will need to be considered when creating opioid use disorder related anti-stigma campaigns.

Recovery among sexual minorities in the united states population: Prevalence, characteristics, quality of life and functioning compared with heterosexual majority.

BACKGROUND: Lesbian, gay, and bisexual individuals ("sexual minorities" [SMs]) are overrepresented among individuals suffering from alcohol and other drug (AOD) problems. However, little is known regarding differences, particularly in functioning and well-being, between SMs and heterosexuals in recovery from AOD problems. METHOD: Cross-sectional, nationally representative sample of US adults who resolved an AOD problem (N = 2002; National Recovery Study [Kelly et al., 2017]). Univariate analyses tested for differences between SMs and heterosexuals on socio-demographic, AOD use/treatment and clinical/legal factors. Unadjusted regressions tested for group differences on indices of current functioning and well-being. Multivariable regressions investigated factors that differentiated groups to understand which might explain any observed group disparities in functioning and well-being. LOWESS analyses explored differences across time in recovery on functioning/well-being. RESULTS: Prevalence of SMs in the US recovery population was 11.7% (n = 220). Compared with heterosexuals (88.3%, n = 1666), SMs had shorter time in recovery (OR=0.97; 95% CI: 0.96, 0.99); were less likely to be employed (OR=0.64; 95% CI: 0.43, 0.96); and more likely to have a co-occurring psychiatric disorder (OR=2.24; 95% CI: 1.49, 3.37), an arrest history (OR=1.61; 95% CI: 1.08, 2.39), and report opioids as primary substance (OR=2.50; 95% CI: 1.18, 5.28). Unadjusted models showed, compared to heterosexuals, SMs had significantly worse levels on all functioning and well-being outcomes. Adjusted models explained most differences, except for psychological distress. CONCLUSION: SMs evince more problematic clinical/legal histories and face greater psychosocial challenges in recovery. Research is needed to understand the unique experiences of recovering SMs in order to better address observed functioning and well-being disparities.

Independent effects of entering recovery as a young versus older adult on long-term functioning and quality of life: Results from a U.S. national study of recovering persons.

BACKGROUND: For physical health conditions, earlier intervention typically results in better prognoses and improved quality of life (QoL). Despite some evidence that early intervention yields better subsequent functioning too for behavioral health conditions like alcohol and other drug (AOD) disorders, less is known. This study examined the relationship between the life-stage at which individuals entered AOD recovery, demographic and clinical correlates, and its relationship to a variety of indices of current functioning, QoL and well-being. METHOD: Nationally representative sample of U.S. adults who resolved an AOD problem (Weighted N = 1844). Structured regression analyses tested whether life-stage at which individuals entered recovery (i.e., as a young [18-30yrs,n = 746] vs. older [>30yrs,n = 1098] adult), was associated with current QoL, happiness, self-esteem, distress, and recovery capital, independent of confounders. Sensitivity analyses investigated effects during the first 5-years of recovery. RESULTS: Young adult recovery entry was independently associated with current employment, younger age of onset for primary substance, primary substance other than alcohol, and less lifetime psychiatric comorbidity. In fully-adjusted models examining indices of functioning, no association was found between life-stage at recovery entry and current self-esteem, happiness, or distress, but an association was found between young adult recovery entry and better current functioning and QoL. This effect was even more pronounced during the first 5-years of recovery. CONCLUSION: Irrespective of current age, duration of recovery, and clinical markers of impairment, entering recovery as a young, versus older, adult, is associated with better subsequent QoL - an advantage that appears even more discernable early in recovery.

Preparing for the Quit Day: Comparing Beliefs of Nondaily Versus Daily Young Adult Smokers as They Prepare for a Quit Attempt.

INTRODUCTION: Most smoking cessation approaches are modeled on heavy daily smoking. With increasing prevalence of nondaily smoking, it may be necessary to modify these approaches for nondaily smokers. AIMS: To provide information about beliefs and attitudes relevant to smoking cessation for nondaily smokers. METHODS: Secondary analysis of two prospective studies on young adult smokers (18-24 years of age) provided brief advice to quit smoking. Measures include baseline levels of constructs relevant to smoking cessation counseling and perceived benefits of and barriers to smoking cessation. RESULTS: Participants (n = 40 nondaily, 122 daily smokers) were predominantly White (70% and 84%, respectively), gender-balanced (50% and 43% female), full-time college students (89% and 95%). At baseline, nondaily smokers reported lower levels of nicotine dependence (p < .001; nondaily: Fagerström Test for Nicotine Dependence (FTND) = 0.8 ± 1.5, daily: FTND = 3.1 ± 1.9), lower urge to smoke (p < .001), greater self-efficacy when facing external smoking stimuli (p = .03), expecting to experience fewer positive effects (reduced negative affect, p = <.001, stimulation, p = .02), and valuing the importance of smoking effects less (ps < .01) than daily smokers. During counseling, nondaily smokers generated both fewer benefits of cessation (Wald X2(df = 1) = 4.91, p = .027) and fewer barriers (Wald X2(df = 1) = 5.99, p =.014) than daily smokers. Withdrawal was not listed by nondaily smokers as a barrier (p < .01). CONCLUSIONS: Constructs relevant to smoking cessation for daily smokers were less salient to young nondaily smokers, compared with moderately addicted young daily smokers, as indicated by responses to standardized scales and by the generation of fewer benefits and barriers in counseling. Interventions may need to find novel ways to engage nondaily smokers, particularly young adult, in smoking cessation efforts. IMPLICATIONS: This study is unique in eliciting benefits and barriers from nondaily smokers as they are about to make a quit attempt. This is a critically important point in time, as this is the point in time in which an action plan is formed and can be informed and enhanced by smoking cessation support. Our study further allowed direct comparison to daily smokers undergoing the same procedures, which allowed the identification of unique factors that may impact nondaily smokers in their quit attempt, which may guide intervention efforts. Use of a mixed method design further strengthen the rigor of this study.

A US national randomized study to guide how best to reduce stigma when describing drug-related impairment in practice and policy.

BACKGROUND AND AIMS: Drug-related impairment is persistently stigmatized delaying and preventing treatment engagement. To reduce stigma, various medical terms (e.g. 'chronically relapsing brain disease', 'disorder') have been promoted in diagnostic systems and among national health agencies, yet some argue that over-medicalization of drug-related impairment lowers prognostic optimism and reduces personal agency. While intensely debated, rigorous empirical study is lacking. This study investigated whether random exposure to one of six common ways of describing drug-related impairment induces systematically different judgments. DESIGN, SETTING AND PARTICIPANTS: Cross-sectional survey, US general population, among a nationally representative non-institutionalized sample (n = 3635; 61% response rate; December 2019-January 2020). INTERVENTION: Twelve vignettes (six terms × gender) describing someone treated for opioid-related impairment depicted in one of six ways as a(n): 'chronically relapsing brain disease', 'brain disease', 'disease', 'illness', 'disorder' or 'problem'. MEASUREMENTS: Multi-dimensional stigma scale assessing: blame; social exclusion; prognostic optimism, continuing care, and danger (a = 0.70-0.83). FINDINGS: US adults [mean age = 47.81, confidence interval (CI) = 47.18-48.44; 52.4% female; 63.14% white] rated the same opioid-impaired person differently across four of five stigma dimensions depending on which of six terms they were exposed to. 'Chronically relapsing brain disease' induced the lowest stigmatizing blame attributions (P < 0.05); at the same time, this term decreased prognostic optimism [mean difference (MD) = 0.18, 95% CI = 0.05, 0.30] and increased perceived need for continuing care (MD = -0.26, 95% CI = -0.43, -0.09) and danger (MD = -0.13, 95% CI = -0.25, -0.02) when compared with 'problem'. Compared with a man, a woman was blamed more for opioid-related impairment (MD = -0.08, 95% CI = -0.15, -0.01); men were viewed as more dangerous (MD = 0.13, 95% CI = 0.06, 0.19) and to be socially excluded (MD = 0.16, 95% CI = 0.09, 0.23). CONCLUSIONS: There does not appear to be one single medical term for opioid-related impairment that can meet all desirable clinical and public health goals. To reduce stigmatizing blame, biomedical 'chronically relapsing brain disease' terminology may be optimal; to increase prognostic optimism and decrease perceived danger/social exclusion use of non-medical terminology (e.g. 'opioid problem') may be optimal.

Alcoholics Anonymous and 12-Step Facilitation Treatments for Alcohol Use Disorder: A Distillation of a 2020 Cochrane Review for Clinicians and Policy Makers.

AIMS: A recently completed Cochrane review assessed the effectiveness and cost-benefits of Alcoholics Anonymous (AA) and clinically delivered 12-Step Facilitation (TSF) interventions for alcohol use disorder (AUD). This paper summarizes key findings and discusses implications for practice and policy. METHODS: Cochrane review methods were followed. Searches were conducted across all major databases (e.g. Cochrane Drugs and Alcohol Group Specialized Register, PubMed, Embase, PsycINFO and ClinicalTrials.gov) from inception to 2 August 2019 and included non-English language studies. Randomized controlled trials (RCTs) and quasi-experiments that compared AA/TSF with other interventions, such as motivational enhancement therapy (MET) or cognitive behavioral therapy (CBT), TSF treatment variants or no treatment, were included. Healthcare cost offset studies were also included. Studies were categorized by design (RCT/quasi-experimental; nonrandomized; economic), degree of manualization (all interventions manualized versus some/none) and comparison intervention type (i.e. whether AA/TSF was compared to an intervention with a different theoretical orientation or an AA/TSF intervention that varied in style or intensity). Random-effects meta-analyses were used to pool effects where possible using standard mean differences (SMD) for continuous outcomes (e.g. percent days abstinent (PDA)) and the relative risk ratios (RRs) for dichotomous. RESULTS: A total of 27 studies (21 RCTs/quasi-experiments, 5 nonrandomized and 1 purely economic study) containing 10,565 participants were included. AA/TSF interventions performed at least as well as established active comparison treatments (e.g. CBT) on all outcomes except for abstinence where it often outperformed other treatments. AA/TSF also demonstrated higher health care cost savings than other AUD treatments. CONCLUSIONS: AA/TSF interventions produce similar benefits to other treatments on all drinking-related outcomes except for continuous abstinence and remission, where AA/TSF is superior. AA/TSF also reduces healthcare costs. Clinically implementing one of these proven manualized AA/TSF interventions is likely to enhance outcomes for individuals with AUD while producing health economic benefits.

Lived Experience in New Models of Care for Substance Use Disorder: A Systematic Review of Peer Recovery Support Services and Recovery Coaching.

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

On being "in recovery": A national study of prevalence and correlates of adopting or not adopting a recovery identity among individuals resolving drug and alcohol problems.

The concept of recovery has become an organizing paradigm in the addiction field globally. Although a convenient label to describe the broad phenomena of change when individuals resolve significant alcohol or other drug (AOD) problems, little is known regarding the prevalence and correlates of adopting such an identity. Greater knowledge would inform clinical, public health, and policy communication efforts. We conducted a cross-sectional nationally representative survey (N = 39,809) of individuals resolving a significant AOD problem (n = 1,995). Weighted analyses estimated prevalence and tested correlates of label adoption. Qualitative analyses summarized reasons for prior recovery identity adoption/nonadoption. The proportion of individuals currently identifying as being in recovery was 45.1%, never in recovery 39.5%, and no longer in recovery 15.4%. Predictors of identifying as being in recovery included formal treatment and mutual-help participation, and history of being diagnosed with AOD or other psychiatric disorders. Qualitative analyses regarding reasons for no/prior recovery identity found themes related to low AOD problem severity, viewing the problem as resolved, or having little difficulty of stopping. Despite increasing use of the recovery label and concept, many resolving AOD problems do not identify in this manner. These appear to be individuals who have not engaged with the formal or informal treatment systems. To attract, engage, and accommodate this large number of individuals who add considerably to the AOD-related global burden of disease, AOD public health communication efforts may need to consider additional concepts and terminology beyond recovery (e.g., "problem resolution") to meet a broader range of preferences, perspectives and experiences. (PsycINFO Database Record

The clinical basis of orthorexia nervosa: emerging perspectives.

Orthorexia nervosa describes a pathological obsession with proper nutrition that is characterized by a restrictive diet, ritualized patterns of eating, and rigid avoidance of foods believed to be unhealthy or impure. Although prompted by a desire to achieve optimum health, orthorexia may lead to nutritional deficiencies, medical complications, and poor quality of life. Despite its being a distinct behavioral pattern that is frequently observed by clinicians, orthorexia has received very little empirical attention and is not yet formally recognized as a psychiatric disorder. In this review, we synthesize existing research to identify what is known about the symptoms, prevalence, neuropsychological profile, and treatment of orthorexia. An examination of diagnostic boundaries reveals important points of symptom overlap between orthorexia and anorexia nervosa, obsessive-compulsive disorder (OCD), obsessive-compulsive personality disorder (OCPD), somatic symptom disorder, illness anxiety disorder, and psychotic spectrum disorders. Neuropsychological data suggest that orthorexic symptoms are independently associated with key facets of executive dysfunction for which some of these conditions already overlap. Discussion of cognitive weaknesses in set-shifting, external attention, and working memory highlights the value of continued research to identify intermediate, transdiagnostic endophenotypes for insight into the neuropathogenesis of orthorexia. An evaluation of current orthorexia measures indicates a need for further psychometric development to ensure that subsequent research has access to reliable and valid assessment tools. Optimized assessment will not only permit a clearer understanding of prevalence rates, psychosocial risk factors, and comorbid psychopathology but will also be needed to index intervention effectiveness. Though the field lacks data on therapeutic outcomes, current best practices suggest that orthorexia can successfully be treated with a combination of cognitive-behavioral therapy, psychoeducation, and medication.