Disorder Recovery Research Articles

“Your struggles are valid, you are worthy of help and you deserve to recover”: narratives of recovery from orthorexia nervosa

PurposeLimited research has examined recovery processes and conceptualisations of recovery within orthorexia nervosa (ON). This study harnessed Instagram data to examine how people who self-identify with ON use the hashtag #OrthorexiaRecovery and how recovery is represented within this online space.Methods500 textual posts containing #OrthorexiaRecovery were extracted from Instagram. Co-occurring hashtags were analysed descriptively to determine whether this online space is specific to ON, and textual data were analysed using reflexive thematic analysis.ResultsThe hashtag analysis indicated that #OrthorexiaRecovery is being used within a wider context of eating disorder recovery and awareness, but also provides deep insights into experiences of recovery from ON. The thematic analysis generated five themes: the invisibility of orthorexia; a turbulent and continuous process; finding food freedom; from compulsive exercise to intuitive movement; a community of support. Our findings suggest that people with self-reported ON experience recovery as a continuous process and the current invisibility of ON within diagnostic criteria and wider society impedes recovery. While working towards recovery, users aimed to be free from diet culture, become more attuned to their bodies, and develop more adaptive relationships with food and fitness. Users noted a general lack of support for people with ON and so used this online space to create a supportive community, though some content was potentially triggering.ConclusionOur findings highlight the importance of increased recognition of ON and the potential value of targeting societal norms and harnessing social identity resources within therapeutic interventions for ON.

"Like putting on an old pair of gloves" or "realising i am actually over it": a qualitative study exploring the impact of the COVID-19 pandemic lockdown restrictions on eating disorder recovery in the UK.

The online version contains supplementary material available at 10.1007/s12144-023-04353-2.

New grants: Residential SUD treatment for pregnant women

Last month the Substance Abuse and Mental Health Services Administration (SAMHSA) announced funding opportunities for grants for substance use disorder (SUD) treatment and recovery among pregnant and postpartum women.

73. Setting Higher Target Weights in Eating Disorder Recovery May Improve Treatment Outcomes

73. Setting Higher Target Weights in Eating Disorder Recovery May Improve Treatment Outcomes

Impact of COVID-19 on alcohol use disorder recovery: A qualitative study.

In March 2020, restrictions on in-person gatherings were introduced due to the coronavirus disease (COVID-19) pandemic, requiring alcohol use disorder (AUD) recovery resources to migrate to virtual platforms. This study investigated how these restrictions impacted recovery attempts and explored participant experiences with virtual resources using a qualitative approach. Participants attempting recovery from AUD (N = 62; Mage = 48.2; F = 53.2%; 71% White) completed virtual semistructured interviews from July 2020 to August 2020 on their experience during the COVID-19 lockdown, impacts on recovery, and experiences with online resources. Interviews were recorded, transcribed, and analyzed using a thematic coding process. Three overarching themes were identified: Effect on Recovery, Virtual Recovery Resources, and Effect on General Life. Within each overarching theme, lower order parent themes and subthemes reflected varied participant experiences. Specifically, one group of participants cited negative impacts due to COVID-19, a second group reported positive impacts, and a third group reported experiencing both positive and negative impacts. Participants reported both positive and negative experiences with virtual resources, identifying suggestions for improvement and other resources. Findings suggest that while individuals in AUD recovery experienced significant hardships, a proportion experienced positive impacts as well, and the positive and negative consequences were not mutually exclusive. Additionally, the results highlight the limitations of existing virtual resources. (PsycInfo Database Record (c) 2023 APA, all rights reserved).

Increasing Peer Support for Opioid Use Disorder Recovery During COVID-19 Through Digital Health: Protocol for a National Randomized Controlled Trial

Background Increasing numbers of opioid overdoses have been observed during the COVID-19 pandemic, likely reflecting the pandemic’s multiple effects on this already vulnerable population. People in recovery from opioid use disorder (OUD) have reported disproportionate psychosocial distress and isolation, as well as significant disruptions in access to treatment, including peer support, during the COVID-19 pandemic. Peer support is a key component of many evidence-based OUD recovery programs; it improves recovery capital, treatment engagement, and perceived social support and reduces psychosocial distress, particularly when used in conjunction with other evidence-based treatments, such as medication for OUD. Objective This study aims to evaluate a novel mobile peer support app platform among a national sample of individuals in recovery from OUD as an adjunct to usual care during the COVID-19 pandemic. Methods Individuals residing in the United States who are aged ≥18 years; own a smartphone; and self-report being in recovery for an OUD, being in treatment for an OUD (ie, in the past 30 days received prescribed methadone, naltrexone, or buprenorphine), or currently receiving some form of assisted recovery support (n=1300) will be recruited through online, targeted social media advertisements. Eligible participants will be randomly assigned (1:1) to a mobile peer recovery support intervention utilizing a novel smartphone-based app or to a control. Participants will complete 1 baseline survey and then a follow-up survey 1, 3, and 6 months after randomization. The primary aim of recovery capital will be determined by the change in recovery capital between study groups over the 6-month study period. We will also examine treatment engagement by using administrative data from a subset of individuals (n=650) residing in Rhode Island and Indiana. Results As of June 2022, we enrolled 43 participants. Conclusions If this mobile app demonstrates efficacy among a large national sample of patients, it has the potential to augment existing treatment programs, improve recovery capital, and reduce the disproportionate impacts of COVID-19 on this vulnerable population. Conflicts of Interest None declared. Trial Registration ClinicalTrials.gov NCT05405712; https://clinicaltrials.gov/ct2/show/NCT05405712

Predictors of health in substance use disorder recovery: economic stability in residential aftercare environments

ABSTRACT The exit from active substance use presents barriers to achieving and maintaining health, especially as individuals lack the economic resources to afford healthcare access. Treatment settings that strengthen resources may support stability in recovery and influence health. Analyzing a sample of recovery home residents over two years (N = 494), the current study assessed individually held resources (e.g., wages, employment) and the average economic conditions of a resident’s house (e.g., house employment rate) to understand their association with self-reported health status. Employment status, but not wages or transportation access, was associated with reported health scores. The average employment rate of a recovery home was also positively correlated with the health of its residents. Results indicate the need to address employment and other economic issues which plague recovering individuals. Community aftercare settings may offer such a pathway through affordable housing, employment opportunities, and supportive relationships.

Factors related to motivation and barriers influencing treatment and recovery process of methamphetamine use disorder through in-depth, semi-structured, qualitative interviews

ABSTRACT Objective Inpatients with substance use disorders often go unheard. Through qualitative interviews, this study lends voice to their views and beliefs about the factors that affect their recovery. Methods In-depth interviews were conducted from February 10 to 11, 2020 with 15 in- patients with methamphetamine use disorder residing at the Marikina Rehabilitation Center in the Philippines. Semi-structured qualitative interviews were thematically analyzed to determine the factors that promote and hinder methamphetamine use disorder treatment and recovery. Results We identified six barriers to recovery: homesickness, lack of family visitation and support, fear of treatment, financial stress, social stigma and criticism, and boredom. Four motivating factors that influenced treatment and recovery included the therapeutic community treatment program, familial relationships, and visitations, belief in God, and hope. Conclusions A treatment integration program that combines psychotherapy and cognitive behavioral therapy, as well as strong familial support, is imperative for patients’ recovery from methamphetamine use disorder.

Nuestra Recuperación [Our Recovery]: using photovoice to understand the factors that influence recovery in Latinx populations

BackgroundPhotovoice is a form of visual ethnography intended to engage impacted communities in research followed by action to ameliorate the injustices under study. Photovoice has increased in use, especially in collaboration with Latinx communities addressing health inequities. The Latinx population comprises nearly 18% of the overall United States population and according to the census is projected to reach just under 30% by 2060. This diverse panethnic community faces significant structural barriers in accessing services. Racism and the resulting marginalization, specifically, contributes to limited access to recovery services and treatment. Making meaningful advances in substance use disorder training, intervention and policy necessitates learning alongside the Latinx community.MethodsWe partnered with a Latinx serving integrated behavioral health and primary care setting in Boston Massachusetts to explore barriers and facilitators to recovery using photovoice. Spanish-speaking Latinx adults with a substance use disorder participated. The group met for three photovoice sessions over a six-week period. Together group members critically analyzed photographs using the SHOWeD method.ResultsFindings indicate a sense of purpose and meaning, security, faith and housing are important elements of recovery. The results illustrated the importance of sources of connection in maintaining sobriety. Through this photovoice project, Latinx Spanish speaking participants highlighted barriers and facilitators to their substance use disorder recovery which spanned individual, community, and structural levels.ConclusionsThe experiences and voices of the Latinx community are crucial to drive discussions that advance policy (e.g., housing stability and access), enhance providers’ understanding of Latinx Spanish-speakers' substance use disorder recovery, and inform culturally and linguistically appropriate services. This study demonstrated that photovoice is highly acceptable and feasible among Latinx clients receiving substance use disorder services. Visual images related to housing, faith, etc. communicate challenges, power structures, as well as hopes to policymakers at multiple levels (e.g., institution/ agency, state).

Mental Health Crisis During Wildfires: Self-help Resolution

The concern toward wildfires has risen to a global level in recent decades. The startling 2020 California wildfire and 2019 Australian bushfire season have proved the duration of wildfire season has grown to seven months or more. Behind this shocking number, another problem alongside health and environmental crisis emerged. Mental health crisis quietly distributes its power among the crowds. Under the growing influence of wildfires, anxiety, difficulty sleeping, worrying, and other symptoms that relate to mental health are distributed among the civilian population. This research paper aims to discover the factors that should be considered in wildfire stress disorder recovery and design a self-help product that could mitigate those symptoms. Scoping reviews, three intensive interviews with victims of California wildfires, and one expert interview with a research health science specialist at Stanford School of Medicine will be in support of this research.

Eating Disorder blogs during Covid-19: A window into recovery progress

During times of crisis, those who are in recovery from pre-existing conditions such as eating disorders can be at increased risk for exacerbation of existing illnesses and other comorbid conditions. 37 blogs focused on eating disorder recovery were identified via internet searches (Google search, National Eating Disorder Association, HealthLine, and Psychology Today) and reviewed by the research team. Nine blogs with posts spanning November 2019 to June 2020 were chosen, using set inclusion/exclusion criteria of posts written prior to and during the Covid-19 pandemic, for thematic analysis. Persons who identified as being in recovery from eating disorders experienced many of the same stressors as the general population, but these were influenced by the nuances of their illness. Food scarcities led to anxiety and a focus on searching grocery stores to obtain provisions. Lockdown impacted the emotional status of bloggers by distancing them from their support networks and their treatment teams. Loss of support systems, including family and virtual communities, left bloggers feeling isolated. Persons struggling with eating disorders, attempting to overcome their illness but less stable in their recovery in the pre-Covid period tended not to improve during the Covid-19 period, and in some cases experienced increasing symptoms or complete relapse, a loss of motivation, and a sense of despair that can impact recovery status.

What are we aiming for? Exploring tensions in healthcare provider perspectives on and communications about eating disorder recovery

Eating disorder recovery is differently understood in multi-disciplinary healthcare contexts. In this study, we sought to better understand how healthcare providers (HCPs) describe recovery and communicating about recovery. We conducted an anonymous, online, qualitative survey with 41 eating disorder HCPs. In their responses, HCPs noted that communicating about recovery was core to their practice of establishing collaboration and communication with clients, as well as enabling “realistic hope” in clinical encounters. Recovery was described as related to the concept of attaining “normalcy” in life. We identified several tensions across HCP accounts, including what “normalcy” might look like, differences in the role of diagnostic and other contextual factors in determining recovery and different perspectives on how symptom remission figures in recovery. Our findings suggest that attending to differences in communication about recovery is an important direction for eating disorders research and treatment.

The Work of Digital Social Re-entry in Substance Use Disorder Recovery

Early recovery after substance use disorder (SUD) treatment is a period of high risk. The majority of people will relapse, often within weeks of completing treatment. In the modern era, re-entry upon completion of treatment includes both digital and non-digital spaces. Digital spaces, including social media, present unique challenges to the recovery journey. However, research has rarely focused on this critical period and the ways in which technology affect it. We conducted in-depth interviews with 29 participants (8 recoverees and 21 support professionals) across two treatment sites to explore this gap. Using an inductive thematic approach, we gained insights into digital social re-entry, a term that we introduce to describe the process of re-engaging with social spaces online. We describe the work of digital social re-entry, which includes 1) remaking social networks, 2) maintaining boundaries, 3) managing triggering content, 4) resisting access to substances, and 5) shifting personal identity. We conclude by characterizing strategies for navigating digital social re-entry and discussing ways to better support recoverees during this aspect of their recovery journey.

Efficacy of a Contextualized Measurement of Life Satisfaction: A Pilot Study on the Assessment of Progress in Eating Disorder Therapy.

Eating disorders strongly affect psychological distress and its perception. However, most of the existing instruments for assessing life satisfaction rely on a point-estimation method that is biased due to the circumstantial conditions around the time of assessment. The main goal of this study was to apply a different kind of instrument-the Life Satisfaction Chart-that situates the current state of life satisfaction in the context of personal history and describes the life stages through a graph. The assessment was applied to a sample of 29 adolescent women (average age of 17.88) who were enrolled in a clinical program to treat their eating disorders. The results showed that their estimation of their current life satisfaction was almost identical to the estimation provided by a therapist for those who were in therapy phases 1, 2, and 3 (of four), while patients' point-estimation satisfaction showed statistically significant differences when compared with the situated estimations. In therapy phase 4, significant discrepancies were observed between the therapist's perception and the patients' perception, because the therapist focused only on eating disorder recovery, whilst the patients evaluated their lives under almost-normal conditions, taking into account further dimensions. The Life Satisfaction Chart is a new approach to life-satisfaction measurement that showed promising measurement and therapeutical properties.

Impacts of the COVID-19 public health restrictions on substance use, mental health, and psychosocial functioning among individuals with alcohol use disorder

ABSTRACT Background: The COVID-19 pandemic has been associated with major psychosocial disruptions and there is particular concern for individuals with substance use disorders. Objectives: This study characterized the psychosocial and experiential impacts of the pandemic on individuals seeking alcohol use disorder (AUD) recovery, including pandemic impacts on self-reported drinking, heavy drinking, tobacco, cannabis, and stimulant use. Methods: Participants were 125 AUD+ individuals (% males: 57.60; Mage = 49.11, SD = 12.13) reporting on substance use from January 1st–24th March, 2020 (pre-pandemic) and since the stay-at-home orders commenced, 24th March–June 28th 2020 (intra-pandemic). Within-subjects changes were examined and a latent profile analysis was performed to identify subgroups differentially impacted by the pandemic. Results: Large proportions reported psychosocial impacts of COVID-19, but drinking and other substance use did not reveal significant changes. Latent profile analyses revealed two subgroups: Profile 1 (n = 41/125), “Moderately Impacted”) and Profile 2 (n = 84/125), “Severely Impacted”). Compared to the pre-pandemic period, the group that was moderately impacted by the pandemic exhibited significantly fewer heavy drinking days (p = .02) during the intra-pandemic period, but no other substance use changes. The group showing severe pandemic impacts did not exhibit changes in alcohol or other drug use but evidenced more severe anxiety and depression (ps < .001). Conclusions: We found heterogeneous subtypes of pandemic-related impacts in AUD recovery patients. There is need to provide psychosocial support to this particular population and further monitoring substance use and mental health.

Evaluating individual- and sample-level response to treatment for inpatients with eating disorders: Is change clinically significant?

Evaluating treatment efficacy solely on whether sample-level change is statistically significant does not indicate whether clinically significant change (CSC) has occurred at the individual-level. We assessed whether change in measures of eating disorder psychopathology was statistically significant at the sample-level and clinically significant at the individual-level for inpatients treated in a hospital-based eating disorder program. Participants (N=143) were consecutive underweight distinct admissions diagnosed with anorexia nervosa or other specified feeding and eating disorder. The Eating Disorder Examination Questionnaire (EDEQ) and Eating Disorder Recovery Self-efficacy Questionnaire (EDRSQ) were assessed at admission and program discharge. CSC was defined as individual score change that was both statistically reliable and shifted from dysfunctional to normative. Mean EDRSQ and EDEQ scores significantly improved with treatment across the sample; effect sizes were moderate to large. Individual-level analyses demonstrated that 85%, 50%, and 20-35% of participants had CSC or statistically reliable change in BMI, eating symptomatology, and body image respectively. One-third of participants showed CSC on BMI and on at least one self-report measure. Individual-level analyses offer more nuanced outcome data that could identify patients at higher risk of relapse who may benefit from adjunctive interventions during or immediately post-discharge. This study examined change in eating pathology for inpatients with eating disorders using sample- and individual-level analyses, including whether change was statistically reliable and clinically significant (scores statistically improved and moved into the healthy range). Only half of patients responded robustly to treatment, which may be related to high relapse rates following discharge. Individual-level analyses provided a detailed view of treatment response and may identify patients at higher relapse risk.

Lived experience perspectives on a definition of eating disorder recovery in a sample of predominantly white women: a mixed method study

BackgroundThere has recently been a push for recovery-focused research in the eating disorder (ED) field, starting with a consensus definition of recovery. One definition, in particular, proposed by Bardone-Cone et al. [21] has received considerable attention given its transdiagnostic nature and validation studies. However, no studies to date have elicited lived experience views of this definition. The goal of the current study was to examine perspectives on this definition of recovery from individuals with a past or present ED and to determine whether participant agreement with the model differed based on diagnostic history or current symptom severity.MethodsSixty-two individuals (95.2% women; 91.9% White/European) participated in a 1–2 h interview aimed at capturing their perspectives on ED recovery. Transcripts were analyzed using qualitative content analysis and codebook thematic analysis to examine agreement with and thoughts on Bardone-Cone’s definition of recovery, respectively. Chi-squared tests of independence and binary logistic regression were computed to determine whether agreement with the definition differed across diagnostic history and self-reported symptoms.ResultsAlthough some participants indicated acceptance of the definition, the majority expressed concerns related to its categorical nature, proposed criteria, feasibility, language, and applications. There were no differences in acceptance based on diagnostic history or current symptom severity.ConclusionA single definition of recovery does not seem to fit individuals’ lived ED experience. Future research may benefit from distinguishing between recovery as an individually-defined phenomenon and related constructs such as remission (i.e., loss of diagnosis or absence of clinical symptoms). A more comprehensive multi-faceted, and person-centered model of recovery may have merit in clinical settings.

Estimating the Effects of a Complex, Multidimensional Moderator: An Example of Latent Class Moderation to Examine Differential Intervention Effects of Substance Use Services.

Improvements in substance use disorder recovery may be achieved by recognizing that effective interventions do not work equally well for all individuals. Heterogeneity of intervention effects is traditionally examined as a function of a single variable, such as gender or baseline severity. However, responsiveness to an intervention is likely a result of multiple, intersecting factors. Latent class moderation enables the examination of heterogeneity in intervention effects across subgroups characterized by profiles of characteristics. This study analyzed data from adolescents (aged 13 to 18years old) who needed treatment for cannabis use (n = 14,854) and participated in the Global Appraisal of Individual Needs to evaluate differential effects of substance use services on cannabis use outcomes. We demonstrate an adjusted three-step approach using weights that account for measurement error; sample codes in Mplus and Latent Gold are provided and data are publicly available. Indicators of the latent class moderator comprised six contextual (e.g., recovery environment risk) and individual (e.g., internal mental distress) risk factors. The latent class moderator comprised four subgroups: low risk (21.1%), social risk (21.1%), environmental risk (12.5%), and mixed risk (45.2%). Limited moderation of associations between level of care and any past 90-day cannabis use were observed. In predicting number of cannabis use-days, compared to individuals with low risk, those with environmental risk showed improved outcomes from intensive outpatient care whereas individuals with social risk and mixed risk showed improved outcomes from residential care (all compared to early intervention/outpatient care). Latent class moderation holds potential to elucidate heterogeneity in intervention effectiveness that otherwise may go undetected.

Successful substance use disorder recovery in transitional housing: Perspectives from African American women.

Through the lens of Black Feminist Thought, the intersectionality of poverty, racism, and sexism in the lives of urban dwelling African American women was explored. Reflections on recovery among women previously enrolled in a transitional housing treatment program were gathered via semistructured interviews, using an instrumental case study design. Four major themes surrounding the context of recovery were identified and analyzed: Knowledge and awareness of addiction, importance of social support and support groups, peace of mind that resulted from a new lifestyle, and women's desire to maintain their recovery status. Many women did not realize that their drug use constituted an addiction prior to their enrollment in the program. Social support and support groups such as AA, NA, and AODA helped the women to maintain their recovery, and this newfound recovery resulted in additional stress relief. Finally, many women felt empowered to maintain their recovery, not only for themselves but also their children. Paradigm shifts in treatment and recovery processes are needed to better serve minority populations, specifically focusing on women and African Americans. Recovery services must shift from previously male centered, hegemonic, pathology-oriented treatment modalities to serve populations more efficiently and equitably. Furthermore, to create effective social change in recovery, programs must address the social determinants of substance misuse, addictive behaviors, and underlying structural inequalities resulting from the intersection of racism, sexism, and classism. Deeper understandings of complex social issues must be disseminated, particularly for women battling substance misuse who are homeless, racially discriminated against and marginalized. (PsycInfo Database Record (c) 2022 APA, all rights reserved).

"That You Just Know You're Not Alone and Other People Have Gone through It Too." Eating Disorder Recovery Accounts on Instagram as a Chance for Self-Help? A Qualitative Interview Study among People Affected and Self-Help Experts.

In addition to the professional treatment of eating disorders, the use of self-help groups has become increasingly important. Social media offers new possibilities for self-help, not only as online groups but also in increased access to recovery stories of people with similar diseases. People with eating disorders use the internet and social media depending on their motivation in different ways. Eating disorder recovery stories on social media have not yet been systematically used in treatment as appropriate guidelines are still lacking. This study provides an initial insight into the possibilities of using social media for self-help for eating disorders. Due to the exploratory nature, a qualitative design was used, combining interviews with people who have a recovery account on Instagram (n = 6) and self-help experts (n = 2). The results show that recovery stories on Instagram could serve as door openers for further treatment, motivation for therapy, a first step towards behaviour change, and support for existing therapies. If affected people can cope with the self-protection strategies, they can use Instagram positively for themselves and their disease. Nevertheless, there is a risk of negative influence as well as a risk of content and time overload. Therapeutic personnel can use these results to improve existing support services.