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					    Patterns and Predictors of Sustained Recovery Among Former Poly-substance Drug Users
                                                                                           Alexandre Laudet, PhD1, William White, MA2, and Keith Morgen, PhD1
                                                                                      1National Development and Research Institute, Inc.; 2Chestnut Health Systems
                                                                                                       Funded by Grant # R01DA14409; Correspondence: laudet@ndri.org
                Background-The recovery process                                                             Substance Use: Length, Severity and Baseline Status                                          Descriptive: Mean Baseline Levels of Recovery Capital by
    Addiction conceptualized as a chronic disorder                                         GENERALLY LONG AND SEVERE HISTORY OF POLYSUBSTANCE USE                                                                           Recovery Stage e
    Recovery from a chronic disorder is a process that:                                                                                                                                                                             Total            >6 mos          6 - 18 mos.      18 – 36 mos         3 yrs+
        Unfolds over time; and                                                             Years regular use of alcohol                       Mean = 17.4                     St. Dev = 10.6
                                                                                           Years regular use of drugs                         Mean = 18.7                     St. Dev = 12.0                                       N = 312            N = 87          N = 82           N = 63             N = 80
        May occur in a succession of stages
    Most addiction research has used relatively short-term follow-ups (<2 yrs)                                                                                                                    Lifetime severity        11.7                      11.6              11.6                 11.8            11.8
    As a result, we know more about recovery initiation than about later stages -          Lifetime Dependence Severityc                      Mean = 11.6                     St. Dev =2.4        Commitment to abstinence* 3.1                       3.1               3.2                  3.2             3.1
     recovery maintenance and consolidation                                                                                                                                                       Recovery support**        3.0                       2.9               3.0                  3.1             3.0
    Likelihood of sustained recovery increases as a function of recovery length            Time since last used (median) ….
    However, risk of relapse remains a reality well into ‘stable’ recovery (3+ yrs)                                                                                                               12-step attendance       11.4                       9.3              12.2                 15.2             9.7
    Costs of return to active addiction are many and they are high                         Alcohol (median)                                   14 months (range = .1 to 528)                       12-step involvement*      4.2                       3.2               3.5                  5.0             4.5
    Need to identify factors that promote recovery maintenance over the course             Illicit drugs (median)                             14 months (range = 1 to 231)                        Quality of life***        7.6                       6.7               7.6                  8.2             8.0
    of the process (i.e., at different stages)
                                                                                                                                                                                                  Spirituality**            3.0                       2.8               3.0                  3.1             3.0
    Factors associated with recovery initiation and maintenance may differ
                                                                                                                                                            Sustained Recovery @ F1d              Religiosity               5.1                       4.8               5.1                  5.2             5.5
                                                                                                      Baseline Recovery @ F1d
                                                                                                     Sustained Recovery Stages
                                                                                                                                                                    (N=313)                       Life meaning              3.2                       3.1               3.2                  3.2             3.2
                              Recovery Capital                                                                (N=313)
    RECOVERY CAPITAL = the amount and quality of internal and external
    resources that one can bring to bear to initiate and sustain recoverya
                                                                                                                                                                                                      Bivariate Correlations between Baseline Recovery Capital and
     A number of factors have been identified as predictors of recovery in short-
                                                                                                                                                                                                          Sustained Recovery @ F1 by Baseline Recovery Stage
     term studies and constitute recovery capital. They include:                                                                                                                                                                  Total        > 6 mos          6 - 18 mos.           18 - 36 m           3 yrs+
            Motivation                                                                                   Three Years +           Under 6                                                                                        N = 312           N = 87           N = 82               N = 63           N = 80
            Social support                                                                                   26%                 months                             No                            Length of recovery               .20***             .29**              .29*               .10            .15
            Participation in 12-step fellowships (attendance and involvement)                                                     28%                               34%                           Lifetime severity                .09                .19                .01                .17           -.09
            Faith/spirituality/life meaning
                                                                                                                                                                                                  Commitment to abst.              .22***             .16                .39***           -.01             .19
                                                                                                                                                                                            Yes   Recovery support                 .10               -.12                .21                .07            .07
                              Study Objectives
                                                                                                                                                                      Yes                   66%   12-step attendance               .05                .15                .29**            -.07            -.02
•   This study examines the prospective role of recovery capital on sustained
    recovery (abstinence from drugs at one-year follow-up) among former poly-                             18 to 36                                                    66%                         12-step involvement              .18***             .16                .07                .06            .12
                                                                                                                               Six to
    substance users to determine whether the role of recovery capital domains is                          months                 18                                                               Quality of life                  .21***             .09                .18                .02            .08
    similar or different at different stages of the process.                                               20%                 months                                                             Spirituality                     .21***             .03                .23*               .22            .07
                                                                                                                                26%                                                               Religiosity                      .22***             .18                .32**              .20           -.05
              Overview of Method and Procedures                                                                                                                                                   Life meaning                     .23***             .04               .33**              .21            .24*
•   Pathways is a 5 year NIDA-funded study ongoing in New York City.
•   Longitudinal investigation of predictors of stable recovery over time.
•   Naturalistic prospective design: Data collected 4 times at yearly intervals.                                                                                                                      Baseline Recovery Capital as Predictor of sustained recovery
•   Individuals self-identified as ‘in recovery” from one month to 10+ years                                                                                                                                       @ F1: Multiple regression findings
    recruited through media advertisement
•   Cohort interviewed (BL – N = 354) and re-interviewed one year                                     Sustained Recovery at F1 as a                                        85%                                                   Total         > 6 mos          6 - 18 mos.           18 - 36 m          3 yrs+
                                                                                                                                                  84.1%
    later (F1) - N= 313 (to date) , 89% of those remaining alive (4 deceased)                                                                                                                                                   N = 312          N = 87            N = 82              N = 63            N = 80
•   Voluntary participation based on informed consent
                                                                                                90
                                                                                                      Function of Baseline Recovery
                                                                                                      Staged (N=313)                                                                              Length of recovery       .25***                    .29*               .28*               .09             .18
•   Semi-structured interviews lasting approximatively 2 hours.
•   Participants receive $30 for baseline interview, $40 at 1YR
                                                                                                80                                                                                                Commitment to abstinence .15*                      .19                .27*              -.07             .28*
                                                                                                                                                                                                  12-step attendance      -.08                       .07               -.14               -.15             .19
                                                                                                70                            58.5%
                                                                                                                                                                                                  12-step involvement      .09                      -.04                .17                .13             .02
                 Baseline Study Cohort (N=354)                                                                                                                                                    Quality of life          .08                       .08                .07               -.09             .05
                                                                                                60
Men                                            56%
                                                                                                                                                                                                  Spirituality             .03                      -.09               -.11                .25             .0
Age (median)                                   43 (range: 19 to 65 years old)                          42.4%
                                                                                                50                                                                                                Religiosity              .06                       .30†              -.03                .25            -.30*
Race/ethny
                                                                                                                                                                                                  Life meaning             .08                      -.23                .23               -.05             .30*
  African American                             62%                                              40
  Caucasian                                    16%                                                                                                                                                F                       7.8***                    1.9                3.4**               .93            2.3*
  Mixed/Other                                  22%                                              30
                                                                                                                                                                                                  R2                      17%                      16%                27%                 12%             20%
Education (median years)                       12 (range: 5 to 19)
Employed full/part-time                        40%                                              20                                                                                                                       Summary of Findings and Implications
Primary income                                                                                                                                                                                        Findings suggest that different sets of factors may be associated with sustaining recovery at
  Job on/off the books                         34%                                              10                                                                                                    different stages of the process
  Govt. assistance                             59%                                                                                                                                                    Baseline length of recovery and commitment to abstinence were the most consistent
  Other legitimate income                       7%                                              0                                                                                                     predictors of sustained recovery overall and across recovery stages
                                                                                                       Under 6 months      Six to 18 months       18 to 36 months         Three +   years
                                                                                                                                                                                                      Taken together, the recovery capital domains under study accounted for only 16 to 27% of the
HIV+                                           22%
                                                                                                                                                                                                      explained variance in sustained recovery at F1.
Psychiatric disorder (ever)                    39%
                                                                                                                                                                                                      Therefore, the bulk of the variance in sustained recovery remains unexplained so that
No legal involvement                           82%                                                                                      Analytic plan
                                                                                                                                                                                                      additional work is critically needed that identifies other ingredients of recovery capital and
                                                                                           We used a two-stage process to identify the role of recovery capital domains as predictors of              determinants of sustained recovery over time
                                                                                             sustained recovery at one-year follow-up:                                                                Moreover, future studies must consider recovery outcomes that go beyond substance use and
                   Drug and Alcohol Use History                                                                                                                                                       encompass global health domains such as quality of life and social functioning.
                                            Primary             Other                      1.    Bivariate relationships between sustained recovery @ F1 and each baseline recovery capital
                          Ever              Problem            Problemsb
                          (%)                  (%)                   (%)                         domain were examined for the entire sample and for each of the four baseline recovery stage                                                          Footnotes
                                                                                                                                                                                                  a Granfield, R, & Cloud, W. (2001) Social context and "natural recovery": The role of social capital in the resolution of
Crack                     86                  58.3                   14.2                        groups
                                                                                                                                                                                                    drug-associated problems. Subst. Use & Misuse, 36, 1543-70.
Heroin                    64                  18.6                   12.4
Cocaine                   92                  10.1                   22.7                  2.    Baseline recovery capital domains that emerged as significant in the analyses in Step one were   b Adds to over 100 because of multiple responses
                                                                                                                                                                                                  c Sheehan DV & Lecrubier Y (2002) Mini International Neuropsychiatric Interview. University of South Florida –
Alcohol                   99                    8.1                  28.3                        entered as predictors in multiple regression analysis with sustained F1 recovery as the            Tampa. Possible Score range: 0 to 14. Primary substance only
Marijuana                 97                    2.3                   5.6                        dependent variable. Separate regressions were conducted for the entire sample and for each of
                                                                                                                                                                                                  d No drug or alcohol use since baseline

Hallucinogens             60                    2.1                   3.1                                                                                                                         e ANOVAS

Nothing else              NA                    NA                   36.0                        the four baseline recovery stages                                                                *p<.05 ** p<.01 *** p<.001 †p <.1 [trend]

				
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