Mechanisms and mediators of addiction recovery

Vanderplasschen, Wouter; Best, David

doi:10.1080/09687637.2021.1982521

Cited by 8 publications

(5 citation statements)

References 30 publications

(46 reference statements)

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“…Our results resonate with empirical findings stating that recovery is a cumbersome and non-linear process (26,(45)(46)(47)(48). We found positive and negative fluctuations from one measurement occasion to the next across follow-ups over five years.…”

Section: Recovery Is Cumbersome and Non-linearsupporting

confidence: 91%

The interdependence of substance use, satisfaction with life, and psychological distress: a dynamic structural equation model analysis

Moe,

Erga,

Bjornestad

et al. 2024

Front. Psychiatry

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IntroductionLongitudinal studies with annual follow-up including psychological and social variables in substance use disorder recovery are scarce. We investigated whether levels of substance use, satisfaction with life, and psychological distress fluctuate across five years in relation to having drug-free friends.MethodsA prospective naturalistic cohort study of change trajectories in a cohort of people diagnosed with substance use disorder and using multiple substances with quarterly and annual follow-up over five years. Two-hundred-and-eight patients were recruited from substance use disorder treatment in Rogaland, Norway. Out of these, 164 participants fulfilled the inclusion criteria. We used Bayesian two-level dynamic structural equation modelling. The variable ‘drug-free friends’ was assessed by a self-reporting questionnaire, while psychological distress was assessed using the Symptoms Checklist 90 Revised. Satisfaction with life was assessed using the Satisfaction With Life Scale while drug use was assessed using the Drug Use Disorders Identification Test.ResultsThe main findings are that higher-than-average psychological distress at a three-month lag credibly predicts higher-than-normal substance use at the concurrent time point t. Substance use and satisfaction with life seem to have synchronous trajectories over time, i.e. as the first decreases the latter increases and vice versa. During the five years after treatment, the participants mainly experienced a decrease in substance use and increase in satisfaction with life.ConclusionSince the participants experienced positive and negative fluctuations for several years after treatment, it seems crucial to establish a dialogue with treatment professionals in order to create functional solutions for maintaining motivation and aiding recovery.

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Section: Recovery Is Cumbersome and Non-linearsupporting

confidence: 91%

The interdependence of substance use, satisfaction with life, and psychological distress: a dynamic structural equation model analysis

Moe,

Erga,

Bjornestad

et al. 2024

Front. Psychiatry

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“…Reported motivations included improved health, wellbeing and social functioning, a desire for a ‘normal’ life, as well as illicit drug consumption reduction. Such motivations sit within broad definition recovery as a multi-faceted, dynamic process of change across multiple life domains including improved physiological, psychological and social functioning, where abstinence is not a prerequisite for recovery [ 44 , 58 , 67 – 70 ]. Thus, HAT appeals to individuals who are motivated by a broad range of recovery-related goals, including but not limited to reduced substance use.…”

Section: Discussionmentioning

confidence: 99%

“…Thus, participants were motivated by the harm-reducing potential of MHAT, with medical diamorphine perceived as a safer and healthier choice than continued use of potentially contaminated and harmful street heroin. Alongside harm-avoidance, participants also expressed goals that aligned with broad definitions of ‘recovery’ [ 58 , 59 ] such as improved social functioning and better quality of life [ 58 , 59 ]. I was so desperate to get on this course because I wanted to stop, I wanted to get off the merry-go-round……I want to be off everything….I want a clean, healthy life.…”

Section: Methodsmentioning

confidence: 99%

‘This is hardcore’: a qualitative study exploring service users’ experiences of Heroin-Assisted Treatment (HAT) in Middlesbrough, England

et al. 2023

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Background Heroin-Assisted Treatment (HAT) is well evidenced internationally to improve health and social outcomes for people dependent on opioids who have not been helped by traditional treatment options. Despite this evidence base, England has been slow to implement HAT. The first service outside of a trial setting opened in 2019, providing twice-daily supervised injections of medical-grade heroin (diamorphine) to a select sample of high-risk heroin users in Middlesbrough. This paper explores their experiences, including the negotiation of the strict regularly controls required of a novel intervention in the UK context. Methods We conducted in-depth interviews with service providers and users of the Middlesbrough HAT service between September and November 2021. Data from each group were thematically analysed and reported separately. This paper details the experiences of the twelve heroin dependent men and women accessing HAT. Results Participants’ accounts of HAT treatment evidenced a tension between the regulatory constraints and uncertainty of treatment provision, and the positive outcomes experienced through supportive service provision and an injectable treatment option. Limited confidence was held in treatment efficacy, longevity of funding, and personal capacity for treatment success. This was counteracted by a strong motivation to cease engagement with the illicit drug market. While attendance requirements placed restrictions on daily activities, participants also experienced benefits from strong, supportive bonds built with the service providers through their continued engagement. Conclusions The Middlesbrough HAT programme provided benefits to a high-risk population of opioid dependent people who were unable or disinclined to participate in conventional opioid substitution treatments. The findings in this paper highlight the potential for service modifications to further enhance engagement. The closure of this programme in 2022 prohibits this opportunity for the Middlesbrough community, but holds potential to inform advocacy and innovation for future HAT interventions in England.

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“…Service providers' contention that vigilance is necessary for recovery is consistent with leaders in the recovery arena that highlight the high risk of relapse, as well as substitute addictions in early recovery (Sussman & Black, 2008;Vanderplasschen & Best, 2021). Substitute behaviours may be an antecedent to relapse by lowering inhibitions and/or detracting from engagement with recovery support.…”

Section: Discussionmentioning

confidence: 78%

Service Providers’ Perceptions of Substitute Addictions in the Western Cape, South Africa

Sinclair

Sussman

Vantomme

et al. 2023

Journal of Drug Issues

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Globally little is known regarding substance use service providers’ perceptions of substitute behaviours and this significant gap could hinder service provision and recovery outcomes. Semi-structured focus group discussions (including 22 service providers across five sites) were conducted in residential treatment facilities in the Western Cape, South Africa. Service providers recognised substances (e.g. cigarettes and caffeine) and behaviours (e.g. gambling, eating, love, sex, shopping, exercise, and gaming) as potential substitutes. Identified substitute motives included managing cravings; self-medication; filling the experiential void of the primary substance, and time-spending. Concurrent behaviours and addictions were believed to be a key mechanism underlying substitution however, service providers did not uniformly screen for co-occurring behavioural addictions. Substitute behaviours were primarily considered a pathway to relapse and service providers emphasised prevention, detection and family education. To suitably intervene, screening for co-occurring behaviours should be an integral part of the assessment of those presenting for substance use treatment.

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Mechanisms and mediators of addiction recovery

Cited by 8 publications

References 30 publications

The interdependence of substance use, satisfaction with life, and psychological distress: a dynamic structural equation model analysis

The interdependence of substance use, satisfaction with life, and psychological distress: a dynamic structural equation model analysis

‘This is hardcore’: a qualitative study exploring service users’ experiences of Heroin-Assisted Treatment (HAT) in Middlesbrough, England

Service Providers’ Perceptions of Substitute Addictions in the Western Cape, South Africa

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