An Examination of Psychiatric Severity and Social Cohesion Outcomes within Oxford Houses.

It is estimated that nearly 20 million adults in the United States have a substance use disorder (SUD), and 8.4 million of those adults have a comorbid mental disorder. Roughly half of those adults with a SUD and a psychiatric comorbidity fail to receive adequate treatment for either the SUD or the mental disorder (combined or separately). However, this sub-population has shown positive treatment outcomes (e.g., improved quality of life and increased length of stay in a recovery home) when allotted the proper resources to treat the overlapping symptomologies associated with their multiple diagnoses. Many individuals with SUD and psychiatric comorbidity receive community-based support from recovery residences, a ubiquitous form of aftercare treatment in the United States. The aim of the present study was to investigate the relationship between psychiatric severity index scores (a proxy for psychiatric comorbidity that measures social functioning, impairment, symptoms, and behavior), length of stay in Oxford Houses (OHs), and quality of life. The present study found a significant negative relationship between length of stay and psychiatric severity scores, and between psychiatric severity scores and quality of life scores. Psychiatric severity was observed to predict decreased quality of life, while length of stay predicted decreased psychiatric severity. Psychiatric severity mediated the relationship between length of stay and quality of life based on house composition.

Understanding recovery Capital in relation to categorical 12-Step involvement and abstinence social support.

Background: Although recovery capital represents various resources for persons recovering from substance use disorders, measures of this construct examine components that might not necessarily reflect the recovery goals of individuals who base their recovery through involvement in 12-step groups such as Alcoholics Anonymous (AA) and Narcotics Anonymous (NA). It is not clear whether 12-step involvement is related to recovery capital, particularly among individuals living in recovery homes who utilize social networks of recovering peers for their recovery. Thus, categorical involvement in a set of 12-step activities was examined in relation to recovery capital and abstinence social support. Methods: Differences in terms of general (recovery capital scores, retention rates) and abstinence-specific (abstinence social support) resources were examined in relation to recovery home residents who were (n = 395) and were not (n = 232) categorically involved in their 12-step recovery. Results: Residents with categorical 12-step involvement reported significantly higher levels of recovery capital and abstinence social support, and there was no significant difference observed in retention rates between residents who were/were not categorically involved in 12-step groups. Conclusions: Findings suggest community resources such as recovery homes and categorical involvement in 12-step groups are important recovery capital components that help individuals who use a 12-step approach to their recovery. Recovery capital among those involved with 12-step fellowships such as AA and NA should be assessed by examining abstinence-specific components such as representative involvement in 12-step groups and social support that is abstinence-specific.

Delivery Outcomes Among Pregnant Women With Comorbid Psychiatric and Substance Use Disorders Receiving Comprehensive Treatment.

BACKGROUND: Pregnant women with substance use disorders (SUDs) are at risk for adverse delivery outcomes, and some of these women have psychiatric comorbidities that increase this risk. AIMS: Although comprehensive care models offering prenatal care services and substance abuse treatment have been found to positively affect delivery outcomes for pregnant women with SUDs, there is a dearth of research to support such models for women who have psychiatric comorbidities. METHODS: A secondary data analysis was conducted to understand the relationship between pretreatment psychiatric comorbidity and delivery outcomes for pregnant clients with SUDs receiving comprehensive treatment. We analyzed two groups of pregnant women with SUDs and hypothesized that women with psychiatric comorbidities would have worse neonatal and maternal outcomes compared with those who did not have any pretreatment psychiatric comorbidity. Regression models were used to examine changes in delivery outcome criteria (birthweight, neonatal abstinence syndrome, maternal urine toxicology screens at delivery, and hospital length of stay) in relation to psychiatric comorbidity among a sample of 74 mother-baby dyads receiving comprehensive care treatment. RESULTS: Results did not support our hypothesis as delivery outcomes were statistically similar for both groups. CONCLUSION: Findings suggest comprehensive care can reduce the risk of negative delivery outcomes among women with SUDs who have psychiatric comorbidities. Treatment and research implications are provided.

Medications for Opioid Use Disorder Utilization Among Oxford House Residents.

Medications for opioid use disorder (MOUD) and recovery homes that have traditionally served those not taking medications for their recovery are important resources for treating opioid use disorder. However, little is known whether such recovery homes are a good fit for persons utilizing MOUD, and whether residents' characteristics such as drug histories and the composition of recovery homes in terms MOUD and non-MOUD residents are related to attitudes toward MOUD. The present investigation examined characteristics of persons utilizing MOUD, and attitudes regarding MOUD utilization among residents living in recovery homes (Oxford Houses, OH) in the U.S. consisting of MOUD and non-MOUD residents. Residents living with others who were utilizing MOUD reported more favorable attitudes than residents who were not living with such residents, but this was observed only among residents whose primary drug of choice involved heroin or opioids. There were no significant differences observed in terms of abstinence rates, involvement in 12-step groups, or previous MOUD treatments between residents utilizing or not utilizing MOUD. Findings suggest that persons utilizing MOUD benefit by recovery homes such as OHs whose residents have favorable attitudes toward MOUD, especially when living with fellow residents who utilize MOUD.

Correction to: Oxford House Residents' Attitudes Toward Medication Assisted Treatment Use in Fellow Residents.

The original version of this article unfortunately contained a mistake in the author group, where co-authors Isabel Dovale, Noah Gelfman and Sarah Callahan were missed to include and Brandon Isler should be removed from the author group.

Oxford House Residents' Attitudes Toward Medication Assisted Treatment Use in Fellow Residents.

Methadone and buprenorphine/naloxone are medication assisted treatment (MAT) options for treating opioid use disorder, yet attitudes regarding their use within abstinence-based recovery homes have not been assessed. The present investigation examined attitudes regarding MAT utilization among residents living in Oxford Houses. This cross-sectional investigation compared residents (n = 87) receiving MAT whose recent drug use involved opioids, and two groups not receiving MATs; those who had used opioids and those who had used substances other than opioids. The vast majority of residents were not receiving MAT, yet 32% reported MAT histories. Negative attitudes regarding MAT were observed among residents who were not receiving MAT. Those presently receiving MAT reported mixed attitudes regarding the use of methadone and buprenorphine/naloxone, and two of these residents reported they had never been prescribed MAT. Findings suggest that abstinence-based recovery homes such as Oxford Houses may not be optimal resources for persons receiving MATs.

Abstinence Social Support Among Ex-Prisoners With Substance Use Disorders.

The relationships between abstinence social support, substance use, and abstinence self-efficacy were examined among a sample of ex-prisoners exiting inpatient treatment for substance use disorders. Ordinary least squares regressions and bootstrapping procedure were used to test whether the relationship between abstinence social support and substance use would be mediated by abstinence self-efficacy. Significant relationships between variables were observed, and abstinence self-efficacy mediated the relationship between abstinence social support and substance use. Findings suggest that abstinence social support is enhanced by abstinence self-efficacy, and that these recovery resources can benefit persons with incarceration histories who have substance use disorders.

Social Influences on Abstinence Self-Efficacy among Justice-Involved Persons.

Social influences (social support for alcohol/drug use and social support for abstinence) were examined in relation to abstinence self-efficacy among a sample of 250 justice involved persons exiting inpatient treatment for substance use disorders. Hierarchical linear regression was used to examine social influences in relation to abstinence self-efficacy. Social influences were significantly related to abstinence self-efficacy when examined independently. However, only social support for alcohol/drug use was significant when both social influences were entered into the model. Findings suggest social support for alcohol/drug use compromises abstinence social support, particularly among justice involved persons who are early in their recovery from substance use disorders.

Psychiatric severity and HIV-risk sexual behaviors among persons with substance use disorders.

OBJECTIVE: The relationship between mental illness and human-immunodeficiency virus (HIV)-risk sexual behavior among persons with substance use disorders is not well-established because of differences in assessing psychiatric factors (types, symptoms, severity), substance use (diagnosis, survey responses, past substance use), and HIV-risk sexual behaviors (individual measures, combination of sex/drug use risk behaviors) across studies. This study utilized a more global and dimensional aspect of psychiatric issues (problem severity) to examine the relationship with HIV-risk sexual behaviors and substance use among persons with substance use disorders. METHODS: Participants included 224 men and 46 women, with a mean age of 40.4 years (SD = 9.5). The most common substances were heroin/opiates, with 41.4% reporting use of these substances (n = 110), while 27.8% reported using cocaine (n = 74) and 12.8% reported using alcohol (n = 34). Of all participants, 39 (14.4%) were identified as having high psychiatric severity (defined using the psychiatric severity score from the Addiction Severity Index), which was used as an indication of probable comorbid psychiatric and substance use disorders. Among these participants likely to have comorbid disorders, hierarchical linear regression was conducted to examine HIV-risk sexual behaviors (number of partners and unprotected sexual behaviors in the past 30 days) in relation to psychiatric severity, substance use, and gender. RESULTS: Gender (women) and psychiatric severity (higher) were significantly related to greater HIV-risk sexual behaviors. After entering gender and substance use into the regression model, psychiatric severity accounted for another 21.9% of the variance in number of partners and 14.1% of the variance in unprotected sexual behaviors. Overall, the models accounted for 55.5% and 15.6% of the variance, respectively. A significant interaction was found for number of partners (but not frequency of unprotected behavior), such that those higher in psychiatric severity and higher in substance use had a greater number of sexual partners. The model including this interaction term accounted for 63.4% of the variance in number of partners. CONCLUSIONS: Findings suggest psychiatric severity is an underlying risk factor for HIV-risk sexual behavior among persons with substance use disorders who have various psychiatric comorbidities.

Recovery resources and psychiatric severity among persons with substance use disorders.

A comparative analysis of recovery resources (abstinence social support, abstinence self-efficacy) was conducted among two groups exiting inpatient treatment for substance use disorders: persons with psychiatric comorbid substance use disorders and persons with substance use disorders. Both groups reported comparable levels of abstinence social support, but this resource was not significantly related to substance use among persons with psychiatric comorbid substance use disorders. Although abstinence self-efficacy was significantly related to substance use, persons with psychiatric comorbid substance use disorders reported significantly lower levels of abstinence self-efficacy than persons with substance use disorders. Findings suggest that persons with psychiatric comorbid substance use disorders exit alcohol/drug treatment with lower levels of abstinence self-efficacy compared to their substance use disorder peers.

Motivation Among Ex-Offenders Exiting Treatment: The Role of Abstinence Self-Efficacy.

The relationships between motivation, treatment readiness, and abstinence self-efficacy were examined among a sample of ex-offenders exiting inpatient treatment for substance use disorders. Hierarchical linear regression was conducted to examine changes in participants' motivation levels in relation to abstinence self-efficacy beyond what would be expected from treatment readiness and substance use. Abstinence self-efficacy predicted significant decreases in motivation whereas treatment readiness and substance use predicted significant increases. However, there was not a significant relationship between abstinence self-efficacy and treatment readiness. Findings suggest that motivation for change among persons with substance use disorders is related to their self-efficacy for ongoing abstinence.

An Examination of the First Oxford House in the UK: A Preliminary Investigation.

An exploratory investigation was conducted to examine the implementation of the first self-run, communal-living setting based on the Oxford House model, in the United Kingdom (UK). A cross-sectional, mixed methods design was used to examine the Oxford House model's total abstinence approach to recovery from substance use disorders among residents (n = 7) living in the first Oxford House established in the UK. Several measures commonly used in addiction research and personal narratives were used to assess residents' response to Oxford House living. Findings suggest that the Oxford House model is a post-treatment intervention that meets the needs of individuals seeking an abstinence-based recovery from alcohol and/or drug dependence in the UK.

Predictors of HIV-risk sexual behavior: examining lifetime sexual and physical abuse histories in relation to substance use and psychiatric problem severity among ex-offenders.

BACKGROUND: Lifetime histories of sexual and physical abuse have been associated with increased HIV-risk sexual behavior, and some studies have identified other variables associated with these relationships. However, there is a dearth of literature that has critically examined abuse histories and HIV-risk sexual behavior in relation to these other variables. OBJECTIVES: Predictors of HIV-risk sexual behavior were analyzed among a sample of ex-offenders who were completing inpatient substance dependence treatment to identify factors related to increases in HIV-risk sexual behavior beyond that of abuse histories. DESIGN: Hierarchical linear regression was conducted to examine sociodemographic characteristics, recent substance use, and current psychiatric problem severity in addition to lifetime histories of sexual/physical abuse in a cross-sectional design. RESULTS: Gender, substance use, and psychiatric problem severity predicted increases in HIV-risk sexual behavior beyond what was predicted by abuse histories. Proportionately more women than men reported abuse histories. In addition, significantly more unprotected sexual than safer sexual practices were observed, but differences in these practices based on lifetime abuse histories and gender were not significant. CONCLUSIONS: Findings suggest recent substance use and current psychiatric problem severity are greater risk factors for HIV-risk sexual behavior than lifetime abuse histories among persons who have substance use disorders.

Complex Contexts within Oxford Houses: Psychiatrically Comorbid Social Networks.

This study aimed to explore whether there are differences between Oxford House recovery home residents with psychiatric comorbidity in their ability to form, maintain, and dissolve loaning ties and seek advice, when compared to Oxford House residents without comorbidity, and if differences do exist, are those ties mono- or bi-directional. Findings indicated unique interdependencies among individuals with psychiatric comorbidity for advice seeking, loaning, and recovery factor scores. The results of this investigation are consistent with the dynamic systems theory conceptions of community-based recovery. Recovery homes provide access to social capital, via the residents' social network, by facilitating recovery-oriented social exchanges, which can lead to changes to the recovery home social dynamics. Upon interpreting the results of this study, components from a dynamic systems theory emerged (e.g., explaining the processes that preserve or undermine the development, maintenance, and dissolution of a network); and provided a framework for interpreting the loaning, advice-seeking, and the latent recovery factor networks and their relationship with psychiatric comorbidity. A deeper understanding of the interplay among these dynamics is described providing an understanding of how Oxford House recovery homes promote long-term recovery in a shared community setting for those with high psychiatric comorbidity.

Recovery homes coping with COVID-19.

Recovery homes are a widespread community resource that might be utilized by some individuals with substance use disorders (SUD) and COVID-19. A growing collection of empirical literature suggests that housing can act as a low-cost recovery support system which could be effective in helping those with SUD sustain their recovery. Such settings could be already housing many residents affected by COVID-19. Many of these residents are at high risk for COVID-19 given their histories of SUD, homelessness, criminal justice involvement, and psychiatric comorbidity. Stable housing after treatment may decrease the risk of relapse to active addiction, and these types of settings may have important implications for those with housing insecurity who are at risk for being infected with COVID-19. Given the extensive network of community-based recovery homes, there is a need to better understand individual- and organizational-level responses to the COVID-19 pandemic among people in recovery homes as well as those managing and making referrals to the houses. At the present time, it is unclear what the effects of COVID-19 are on recovery home membership retention or dropout rates. This article attempts to provide a better understanding of the possible impact of COVID-19 on the infected and on recovery resources in general.

Medication assisted therapy and recovery homes.

There is a need to better understand improved recovery supportive services for those on Medication Assisted Treatment (MAT) for opioid use disorder (OUD) and, at the same time, enhance the available treatment interventions and positive long-term outcomes for this vulnerable population. A growing empirical literature supports the assertion that improved access to housing and recovery support is a low-cost, high-potential opportunity that could help former substance users who are utilizing MAT to sustain their recovery. Recovery home support could serve the populations that need them most, namely servicing a significant number of the enrolled in MAT programs. The two largest networks of recovery homes are staff run Traditional Recovery Homes (TRH) and self-run Oxford House Recovery Homes (OH). There is a need to better understand how substance users on MAT respond to recovery homes, as well as how those in recovery homes feel toward those on MAT and how any barriers to those utilizing MAT may be reduced. Recovery may be an outcome of the transactional process between the recovering individual and his/her social environment. In particular, how recovery houses can help people on MAT attain long-term recovery.

An examination of abstinence social support among recovery home residents with psychiatric comorbidity.

BACKGROUND: Although social support is a resource that helps persons in their recovery from substance use disorders, it is not clear whether specific types buffer the effects of stress and optimize outcomes for those with psychiatric comorbidity. This investigation examined two types of social support in relation to lengths of stay to identify mechanisms related to retention among individuals with psychiatric comorbidity living in community-based settings. METHODS: Baseline rates of social support (abstinence specific and general types) and stress were examined in relation to follow-up lengths of stay (at four-months and beyond) among individuals (N = 368) with psychiatric comorbidity (n = 90) and no psychiatric comorbidity (n = 278) living in community-based settings (Oxford Houses) in the U.S. The psychiatric severity index of the Addiction Severity Index was used as a proxy measure of psychiatric comorbidity. Moderated mediation analyses were conducted to test the potential mediating effects of abstinence social support and general social support on the relationship between stress and lengths of stay, and whether these were influenced by psychiatric comorbidity. RESULTS: A full mediating effect was observed for abstinence social support for residents with psychiatric comorbidity, whereas a partial mediating effect for general social support was observed for all residents. CONCLUSIONS: Findings demonstrate qualities of social support have differential effects, substantiating the notion that specific components of social support optimize outcomes for those with psychiatric comorbidity living in recovery homes.

An examination of main and interactive effects of substance abuse recovery housing on multiple indicators of adjustment.

AIMS: To assess the effectiveness of community-based supports in promoting abstinence from substance use and related problems. DESIGN AND PARTICIPANTS: Individuals (n = 150) discharged from residential substance abuse treatment facilities were assigned randomly to either an Oxford House recovery home or usual after-care condition and then interviewed every 6 months for a 24-month period. INTERVENTION: Oxford Houses are democratic, self-run recovery homes. MEASUREMENTS: Hierarchical linear modeling was used to examine the effect of predictive variables on wave trajectories of substance use, employment, self-regulation and recent criminal charges. Regressions first examined whether predictor variables modeled wave trajectories by condition (Oxford House versus usual after-care), psychiatric comorbidity, age and interactions. FINDINGS: At the 24-month follow-up, there was less substance abuse for residents living in Oxford Houses for 6 or more months (15.6%), compared both to participants with less than 6 months (45.7%) or to participants assigned to the usual after-care condition (64.8%). Results also indicated that older residents and younger members living in a house for 6 or more months experienced better outcomes in terms of substance use, employment and self-regulation. CONCLUSIONS: Oxford Houses, a type of self-governed recovery setting, appear to stabilize many individuals who have substance abuse histories.

Suicide Attempts and Personal Need for Structure Among Ex-Offenders.

Suicide attempts were examined in relation to sociodemographic (age, gender, ethnicity), psychopathological (prior psychiatric hospitalizations, physical and sexual abuse histories), and cognitive (personal need for structure) variables among a sample of ex-offenders with substance use disorders ( N = 270). Hierarchical logistic regression was conducted to determine whether personal need for structure would significantly predict whether participants reported past suicide attempts beyond sociodemographic and psychopathological predictors. Personal need for structure and prior psychiatric hospitalizations were the only significant predictors, with higher values of these predictors increasing the likelihood of suicide attempts. Findings are consistent with a cognitive model for understanding suicide behavior, suggesting that persons with a high need for cognitive structures operate with persistent and rigid thought processes that contribute to their risk of suicide.

An Examination of Women Ex-Offenders With Methadone Histories.

Criminal (drug and prostitution) charges, employment levels (weekly hours), recent substance use in the past 6 months, and primary sources of income were examined among a sample ( n = 106) of women ex-offenders who had opioid use disorders with and without methadone histories. A general linear model was tested to examine differences in relation to methadone use history. Results from a one-way MANCOVA found that those with methadone histories reported significantly higher levels of drug and prostitution charges than those without any methadone history, but no significant differences in terms of weekly hours of employment or recent substance use were observed between groups. Women ex-offenders with methadone histories reported various sources of income beyond employment, and proportionally, more of these women reported prostitution as a primary source of income. Findings suggest that methadone maintenance treatments are not sufficient in meeting the needs of women ex-offenders.