Multiple pathways to recovery, multiple roads to well-being: an analysis of recovery pathways in the Australian Life in Recovery survey

It is generally acknowledged that there are multiple pathways to recovery from alcohol and other drug (AOD) problems. These may include participation in AOD treatment, mutual aid, or other activities. It is unclear whether particular sociodemographic characteristics shape a person’s recovery journey or whether particular recovery pathways are associated with improved well-being. This article explores these questions using data from the Australian Life in Recovery study (N = 573). Compared to treatment and/or mutual aid pathway groups, the natural recovery group were less likely to have used mental health services and were more socially connected during periods of addiction. Since being in recovery, mutual aid pathway groups more strongly identified as being in recovery and having social networks consisting of a greater proportion of people in recovery compared to the natural recovery group. People in all pathway groups reported high well-being, and there were no significant differences in well-being measures between groups. Findings suggest that people in recovery may experience high well-being irrespective of the pathway they take, but social factors may be influential in which pathways people take. Treatment and recovery systems need to offer multiple recovery pathways so that people can take the pathway that suits them best

Life in recovery in Australia and the United Kingdom : do stages of recovery differ across national boundaries?

The evidence is now clear that more than one half of those who have a lifetime addiction to alcohol or drugs will eventually achieve stable recovery. As documented in the Life in Recovery surveys and elsewhere, recovery often brings about positive changes across a diverse range of life domains. Although this suggests that there are some universal experiences of recovery, there has been a lack of comparative recovery research examining the variations in recovery experiences across different settings and cultures. Using a combined data set of the United Kingdom and Australian Life in Recovery surveys and the three-stage model of recovery, the authors compare life achievements at each stage across the two settings. There are differences in patterns of recovery, with elevated levels of ongoing mental health problems in Australia, and significant involvement with the criminal justice system in the United Kingdom, suggesting a contextual and structural role in understanding recovery pathways. The implications for policy and practice are reviewed around structural barriers and the role of social justice in advancing recovery models and pathways

Social identity mapping in addiction recovery (SIM-AR): extension and application of a visual method

Background: The Social Identity approach offers a unifying framework for understanding recovery from addiction as a process of identity change, associated with change in social network composition. This paper introduces Social Identity Mapping in Addiction Recovery (SIM-AR) — a visual method for capturing social group memberships, extended to integrate the substance use ‘status’ of group members as an indicator of group substance use norms. The aim here is to test theory-derived predictions focused on the relationship between changes in social identity and network composition reflected in substance use norms in early recovery. Method: 155 therapeutic community (TC) residents in Victoria, Australia, completed the SIM-AR plus measures of substance-using and recovery identities and substance use shortly after admission, and 65% (N=101) again 6 months later. Results: As predicted, substance use severity at follow up was associated with changes in both social identity and network composition. Furthermore, reduced strength of substance-using identity was associated with a decrease in the proportion of groups with heavy substance use norms, while increased strength of ‘recovery’ identity was associated with an increased proportion of non-using groups. Conclusion: SIM-AR proved useful in testing predictions about social identity and network changes in a residential treatment context. It captured key social identity constructs in recovery using a visual technique with value to both research and applied contexts. Findings highlight the clinical importance of assessing a person’s group-based relationships in treatment and early recovery, especially the influence of social group norms in relation to substance use

Social group membership before treatment for substance dependence predicts early identification and engagement with treatment communities

Social relationships play a major role in recovery from substance dependence. To date, greater attention has been paid to the role of important individuals in a person’s life and their contribution to recovery following treatment. This study is the first to examine both individual and wider group-based social connections in the lead up to residential treatment for substance misuse in a therapeutic community (TC), and their influence both on a person’s readiness to engage with the treatment community and with a recovery pathway. Participants were 307 adults interviewed early in treatment about their individual- and group-based social relationships prior to treatment entry, their social identification with the TC, as ‘a user’ and a person ‘in recovery’, their current recovery capital and quality of life. Correlational analysis showed that only pre-treatment group-based, and not individual, relationships, were significantly associated with developing social identification with the TC early in treatment. Moreover, results of hierarchical regression analyses indicated that identification with the TC was best predicted by the extent to which people saw themselves as being in recovery. Finally, mediation analysis indicated that TC identification was the mechanism through which social group memberships prior to treatment commencement protected quality of life in the early phases of treatment. These findings highlight the protective role that group memberships play in building early identification with the TC and supporting well-being in a critical period of transitioning to treatment

Cause of Death in Long-Term Substance Use: A Scoping Study and Review of The Implications For End of Life and Palliative Care

Older people who use substances are more likely than general populations to have complex non-cancer pathologies which are under-represented in palliative care services. Our work explores mortality and morbidity relevant to end of life care and reveals discrepancies in provision for people who use substances, identifying possible explanations. We make recommendations for improved governance to inform policy and practice change

Social networks and recovery (SONAR): characteristics of a longitudinal outcome study in five therapeutic communities in Australia

Purpose - The purpose of this paper is to demonstrate how social identity change can support the TC objective of promoting "right living". This is compatible with the literature on addiction recovery which has shown that identity change is central to this process. While much of the earlier literature focussed primarily on an individual analysis of change, there is a growing body of research showing the important contribution that social networks, social group membership and associated social identities make to sustainable change.Design/methodology/approach - The paper describes baseline data for a multi-site prospective cohort study of 308 clients entering therapeutic community (TC) treatment and characterizes the presenting profile of this cohort on a range of social identity and recovery measures at the point of TC entry.Findings - The sample was predominantly male with a mean age of 35 years, with the large majority having been unemployed in the month before admission. The most commonly reported primary substance was methamphetamine, followed by alcohol and heroin. The sample reported low rates of engagement in recovery groups, but access to and moderate degrees of social support was also reported in the period prior to admission.Research limitations/implications - The paper highlights the important role that TCs play in facilitating identity change and in promoting sustainable recovery.Practical implications - The paper discusses opportunities for working with social identities both during residence and in community re-integration, and highlights what TCs can do to support and sustain recovery.Social implications - The paper brings to light the potential contribution of social group membership and social identity change to management of recovery in TC settings.Originality/value - The study described provides an innovative way of assessing TC effectiveness and testing novel questions about the role of social identity and recovery capital as key predictors of change

Tracing the affordances of long-acting injectable depot buprenorphine: a qualitative study of patients' experiences in Australia.

BACKGROUND: Long-acting injectable depot buprenorphine is an important new treatment option for the management of opioid dependence, delivering therapeutic doses in weekly or monthly formulations. Depot buprenorphine aims to overcome challenges associated with traditional opioid agonist therapy (OAT), including: poor patient adherence; inconvenience of regular attendance for dosing; and, risk of non-medical use of takeaway doses. However, little is known about patients' experiences of depot buprenorphine. This qualitative study aimed to explore patients' experiences of the practical and social affordances of depot buprenorphine. METHODS: Participants were recruited from sites in Sydney, regional New South Wales, and Melbourne, Victoria, Australia. Thirty participants (16 men, 14 women; mean age 47.3 years) participated in semi-structured interviews. Participants had histories of both heroin and prescription opioid use, and previous OAT including daily dosing of buprenorphine and methadone. FINDINGS: Depot buprenorphine afforded positive benefits for many participants, including: opportunities to avoid stigma experienced at pharmacies/clinics; time to engage in activities (e.g., travel, work) by releasing participants from previous OAT treatment regimens; and, cost savings by not having to pay pharmacy fees associated with daily dosing. However, for some participants, moving to depot buprenorphine: disrupted engagements with important social/practical supports available at pharmacies/clinics; constrained their control over dosing; and, constrained their ability to generate income via the sale of takeaway doses. CONCLUSIONS: While generally experienced as affording benefits, depot buprenorphine can have differing social and practical impacts. Clinicians should monitor patients receiving depot buprenorphine to reduce the risk of unintended consequences including disruption to clinical supports

Electronic nicotine devices to aid smoking cessation by alcohol- and drug-dependent clients: protocol for a pilot randomised controlled trial

Background: Up to 95% of people entering treatment for use of alcohol or other drugs (AOD) smoke tobacco. Smokers receiving treatment for AOD use are interested in quitting and make quit attempts, but relapse is more common and rapid compared with the general population of smokers. New ways to address smoking in this population are needed. Electronic nicotine devices (ENDs) or electronic cigarettes hold significant potential as both cessation aids and harm reduction support. This study focuses on the potential of ENDs to facilitate smoking cessation and to sustain it in the medium term among people in treatment for AOD use. The aim of this trial is to explore the effectiveness, feasibility and acceptability of ENDs for smoking cessation compared with combination nicotine replacement therapy (NRT) for clients after discharge from a smoke-free AOD residential withdrawal service.Methods/design: The study is a pragmatic randomised controlled trial. In total, 100 participants will be recruited following admission to a smoke-free residential withdrawal service in Melbourne, Australia. Participants will complete a baseline survey and be randomised to either the END group (n = 50) or the NRT group (n = 50) prior to discharge. Both groups will receive telephone counselling support from quitline. Follow-up measures will be assessed at 6 and 12 weeks following discharge. The primary outcome is continuous abstinence from smoking at 12 weeks post discharge. Secondary outcomes include: 7-day point prevalence from smoking, point prevalence abstinence from all nicotine (including NRT and ENDs), cravings and withdrawal, time to relapse, and treatment adherence (use of NRT, ENDs and quitline).Discussion: This is the first randomised controlled trial to assess the effectiveness and acceptability of ENDs within a population dependent on AOD, a priority group with very high levels of smoking. The research will test a model of how to incorporate novel smoking cessation support into a period of high treatment receptiveness