Enhancing Role Integrity for Peer Workers.

Although informal peer support has been a central feature of recovery for people with substance use disorder (SUD), more recently there has been a stark increase in formal models of peer support. In the infancy of formalized peer support, researchers warned of potential threats to the integrity of the peer support role. Now, almost two decades into the rapid expansion of peer support, research has yet to evaluate the extent to which peer support is being implemented with fidelity and role integrity. The present study aimed to assess peer workers' perceptions of peer role integrity. Qualitative interviews were conducted with 21 peer workers in Central Kentucky. Results suggest that the role of peers is not well understood by onboarding organizations, and thus, the integrity of peer support is diluted. Findings from this study suggest room for improvement in the training, supervision, and implementation of peer support.

Partnering with recovery community centers to build recovery capital by improving access to reproductive health.

BACKGROUND: People with substance use disorders (SUD), especially opioid use disorder (OUD) have the highest rates of unintended pregnancies (80-95%) and report unmet reproductive health needs. Women of childbearing age have some of the highest death rates from opioids and are notably rising the most rapidly, and when pregnancy does occur overdose is one of the leading causes of maternal mortality. There are numerous gender-based health disparities and social determinants of health shaped by the distribution of power and privilege that influence the risk trajectories of people who can get pregnant or are pregnant with a substance use disorder (SUD). PURPOSE: The purpose of this paper is to describe how reproductive health is essential to recovery and building recovery capital for people who can get pregnant, (1) introduce a pilot implementation science study working with trained peer support coaches to promote reproductive autonomy in the community, and (2) make policy and advocacy recommendations relevant to the new reproductive health landscape in the United States. We will also describe the adaptation and feasibility of the initial pilot study where we partnered with a recovery community center to train peer recovery coaches to provide low barrier resources (contraception, pregnancy tests and prenatal vitamins) and referrals to health care. METHODS: This initiative is the merging of best practices in recovery and community-based global reproductive health, to empower people with SUD who can get pregnant in an implementation science framework. The pilot study will last 3 months in each city and aims to (1) assess and describe the effectiveness of the training of local peer recovery coaches on the link between recovery capital and reproductive health, and (2) assess the feasibility, acceptability, appropriateness, scalability, sustainability, and uptake and reach of low barrier reproductive health resources (pregnancy tests, prenatal vitamins, and emergency contraception). In this paper we are only reporting the initial findings regarding adaptation and feasibility. FINDINGS: Informed by qualitative interviews with stakeholders and participants, the method of contraception was adapted from injectable to emergency to meet the needs and context of the community with SUD. Early outcomes such as uptake and acceptability indicate that this is a feasible model with peer recovery coaches and recovery community centers, with the greatest uptake of emergency contraception and pregnancy tests. CONCLUSION: Considering recent policies limiting access to reproductive health, innovative community-based solutions are needed to engage and empower people who can get pregnant or are pregnant while in active drug use and in recovery. Providing low barrier reproductive health items by people with lived experience with SUD can serve as a valuable harm reduction model and improve recovery capital. CLINICAL RELEVANCE: This is the first study to propose a methodology and context to implement a community-based study merging best practices in recovery with those in reproductive health with the potential to improve recovery capital and maternal/child health trajectories for people with SUD.

Voices of hope: A feasibility study of telephone recovery support.

BACKGROUND: Substance use disorders (SUDs) are chronic disorders frequently managed with crisis stabilization or short-term treatment. To improve rates of sustained remission from SUD, there is a need to shift the existing treatment paradigm away from an acute care model and toward a model of ongoing recovery management. Telephone recovery support (TRS) is a promising recovery management tool, consisting of weekly calls from volunteers, including peer workers, to people in recovery to offer support and connect participants with resources. The aim of this study was to evaluate feasibility and acceptability of a TRS program in Central Kentucky, United States. METHODS: Participants (n = 506) were recruited for the program from a variety of settings, such as sober living/halfway houses, drug court, residential treatment transitional living, and outpatient and intensive outpatient treatment. For each call, participant status (e.g., experiencing psychosocial stressors, concerned about relapse) was recorded. To assess acceptability, we performed semi-structured interviews with participants (n = 7), which were subsequently transcribed and analyzed via content analysis. RESULTS: Volunteers completed 35.7% of calls (a completed call was defined as either answered or returned) with 88% of participants reporting being okay, 9% reporting psychosocial stressors, and 3% reporting relapse or concerns about relapse. Participants reported that TRS provided a felt sense of support and consistent recovery engagement, and appreciated that volunteers took the initiative to reach out to them. Multiple participants reported a desire to increase the frequency of TRS contact. CONCLUSION: TRS holds promise as a resource to promote long-term recovery support. More research is needed to determine the efficacy and adequate dosing of TRS calls.

Peer support specialists and perinatal opioid use disorder: Someone that's been there, lived it, seen it.

Perinatal opioid use disorder (OUD) has increased drastically since 2000 and is associated with myriad adverse outcomes. The Substance Abuse and Mental Health Services Administration (SAMHSA) recommends using peer support services to promote sustained remission from substance use disorders (SUDs). Integrating peer support specialists into perinatal OUD treatment has the potential to improve maternal and child health. However, there is limited published research on the experiences of pregnant and parenting women with peer support specialists during SUD treatment. The purpose of this study was to: (1) describe experiences of perinatal women undergoing OUD treatment with peer support specialists; (2) describe recommendations for improving or enhancing peer support services. For this qualitative descriptive study, we conducted two focus groups in a private location in a clinic that serves postpartum women with OUD (N = 9) who were parenting a child under the age of 5. The focus groups were voice recorded, professionally transcribed, and analyzed in MAXQDA using content analysis. Four themes emerged from the data: Feeling Supported by Peer Support Specialists, Qualities of an 'Ideal' Peer Support Specialist, Strategies to Improve Interactions with Peer Support Specialists, and Importance of Communication Across the Perinatal Period. Participants reported that PSSs had a strong, positive impact on their recovery. Postpartum women report overall positive experiences receiving peer support services during their pregnancy and postpartum period. However, participants offered suggestions to improve their interactions with PSSs, such as clarifying the boundaries between peer supporters and clients. Pregnant and postpartum women in OUD treatment have the potential to benefit from access to PSS throughout their perinatal period. Future research is needed to determine the impact of PSS on sustained recovery for perinatal women with OUD.

Mental health disparities and high-risk alcohol use among non-heterosexual high school students.

PURPOSE: To examine disparities in mental health and high-risk alcohol use among high school students by sexual orientation, and the impact of having access to an adult with whom to talk. DESIGN AND METHODS: Cross-sectional survey, from the 2015 Kentucky Youth Risk Behavior Survey. Logistic regression estimated the relationship between being "non-heterosexual" on mental health (e.g, suicidal ideation/attempt) and alcohol behaviors (e.g, binge drinking), controlling for demographics and "having an adult to talk to." FINDINGS: Non-heterosexual students were more likely to report all adverse outcomes and risk was lower among students who report "having an adult to talk to." PRACTICE IMPLICATIONS: Psychiatric nurses need to assess sexual minority youth for access to positive adult relationships.

Perinatal Navigator Approach to Smoking Cessation for Women With Prevalent Opioid Dependence.

Women who smoke during pregnancy face psychosocial barriers to cessation, and women with opioid use disorder (OUD) face amplified barriers. We pilot tested a Perinatal Wellness Navigator (PWN) program for a group of high-risk perinatal women (N = 50; n = 42 with OUD) that consisted of (a) one-on-one tobacco treatment, (b) comprehensive assessment of cessation barriers, and (c) linkage to clinical/social services. Outcome measures were assessed at baseline and postintervention. Participants smoked 10 fewer cigarettes per day (p = .05) at postintervention and were less dependent on nicotine (p < .01). Mean postnatal depression scores (p = .03) and perceived stress (p = .03) decreased postintervention. Participants received at least one referral at baseline (n = 106 total), and 10 participants received an additional 18 referrals at postintervention to address cessation barriers. The PWN program was minimally effective in promoting total tobacco abstinence in a high-risk group of perinatal women, but participants experienced reductions in cigarettes smoked per day, nicotine dependence, stress, and depression.

Emerging Adults and Recovery Capital: Barriers and Facilitators to Recovery.

INTRODUCTION: Substance use disorders (SUDs) are chronic, relapsing brain disorders associated with morbidity, mortality, and high healthcare costs. Emerging adults are particularly vulnerable, with twice the risk of developing an SUD relative to their adult or adolescent counterparts. Emerging adults in addiction and recovery are understudied. Accordingly, the concept of recovery capital has been developed to account for the internal and external resources that an individual can mobilize to recover from an SUD. To better understand the barriers that contribute to relapse, we explored recovery capital among emerging adults. The aims of this phenomenological study were to explore and describe the experience of emerging adults in recovery and to identify the barriers and facilitators to their recovery. METHODS: The informants (n = 8) were 18-25 years old in recovery from SUDs. Data were collected in 2016 using semistructured interviews and subsequently analyzed in 2017 for emerging themes. RESULTS: Informants in this study reported challenges that may be unique to their age and stage of development. Informants reported residential and financial instability as barriers to recovery. Alternatively, informants reported spirituality and visible role models in recovery as facilitators of recovery. Finally, informants reported that the role of their families changed temporally throughout the course of their addiction to facilitate their recovery. CONCLUSION: The results from this study suggest that the developmental tasks facing emerging adults are exacerbated in addiction and recovery, which increases the likelihood of SUD relapse.