Recovery Capital Research Articles

Emotion regulation predicts recovery capital beyond mindfulness and demographic variation in Recovery Dharma

Recovery Dharma is a Buddhist-inspired mutual-aid recovery program for those with substance use disorders and behavioral addictions. The program combines meditation, emotion regulation techniques, literature, and Buddhist practices during meetings to help people achieve emotional balance and improve their well-being. Despite the growing popularity of Recovery Dharma, how the practices in this program predict recovery resources remain largely unknown. We conducted a study investigating whether mindfulness and difficulty regulating emotions can predict individuals’ recovery capital - a construct strongly correlated with positive recovery outcomes. Recovery Dharma members (n = 122; 88% White; 45% women) completed two online surveys six months apart. We conducted hierarchical linear regressions and found that mindfulness predicted unique variability in recovery capital. However, our final model that included difficulty regulating emotions explained a significantly larger portion of variability above and beyond demographic variation and mindfulness. In an exploratory analysis, we found that difficulty regulating emotions predicted recovery capital as a unidimensional construct, not any particular subconstruct. The results suggested that Recovery Dharma members’ emotion regulation skills were the strongest predictor of positive recovery outcomes, surpassing demographic characteristics and mindfulness. As such, the intentional cultivation and improvements in emotion regulation skills inherent in Buddhist practices within the Recovery Dharma framework may indicate positive long-term recovery outcomes.

Cross-cultural adaptation and psychometric validation of the brief assessment of recovery capital (BARC-10) scale into Bangla.

Recovery capital is a construct central to the substance use disorder treatment and recovery field. Lack of structured instrument for its assessment in the local context necessitated the translation of the English self-assessment version of the "Brief Assessment of Recovery Capital" (BARC-10) scale to Bangla and the study of its psychometric properties. The objective was to develop a culturally adapted and validated Bangla version of the BARC-10 scale for substance use disorders patients. This study conducted in the period of January 2021 to March 2022 in the department of Psychiatry of a tertiary hospital and central drug addiction treatment center. Initially BARC-10 questionnaire was translated into Bangla (T1 and T2) by 2 separate translators and then synthesis of a single version (T12) was done based on the previous translations. After that 2 back translations (BT1 and BT2) were done by 2 more translators based on the synthesized version (T12). By reviewing all these forward and backward translations, an expert committee made the pre-final version after making some linguistic modification. Then data collection was done among 100 subjects who were selected purposively. Reliability was assessed by Cronbach alpha. Content validity, face validity and Construct validity by factor analysis were measured. Internal consistency measured by Cronbach alpha found was 0.846. No significant change in Cronbach alpha was observed following deleting any item. Confirmatory factor analysis revealed a good fit to data by a chi-square/df value1.33, RMSEA value 0.058. Kaiser-Meyer-Olkin value (.840) showed sampling adequacy. Exploratory factor analysis of the principal component identified 2 factors which had eigenvalues of more than 1. Scree plot also revealed similar factors. These 2 factors together explained 53.1% of the variance. All items were loaded under 2 factors after varimax rotation. The validated Bangla version of the BARC-10 demonstrated high internal reliability and validity. It can potentially be applied in "recovery-oriented" deaddiction service.

Recovery from Addictions in Europe: Theory, Models and Methods

Abstract Recovery is a therapeutic intervention in addictive behaviors (and other kind of disorders), based in the improvement of personal, social and collective skins and capacities, in order to improve the health and social balance and to decrease the impact of substance use and other addictions. In the book Recovery from Addictions in Europe: Theory, models and Methods, the author makes an analysis of the history of the concept (including the Recovery Capital concept and the development of the Science of Recovery), the evolution of the interventions, an evaluation of good practices and a critical reflection about what it works and what it needs improvement in Recovery Oriented programs. Main conclusions are the increasing of the Science of Recovery, the necessary adaptation of Recovery oriented programs and other interventions to actual addictive behaviors and the development of a Recovery oriented model (the HERMESS model). Keywords: Recovery capital, HERMESS model, evaluation of programs, mixed methodology, Science of Recovery.

Assessing a pilot scheme of intensive support and assertive linkage in levels of engagement, retention, and recovery capital for people in recovery housing using quasi-experimental methods

IntroductionStrong and ever-growing evidence highlights the effectiveness of recovery housing in supporting and sustaining substance use disorder (SUD) recovery, especially when augmented by intensive support that includes assertive linkages to community services. This study aims to evaluate a pilot intensive recovery support (IRS) intervention for individuals (n = 175) entering certified Level II and III recovery residences. These individuals met at least three out of five conditions (no health insurance; no driving license; substance use in the last 14 days; current unemployment; possession of less than $75 capital). The study assesses the impact of the IRS on engagement, retention, and changes in recovery capital, compared to the business-as-usual Standard Recovery Support (SRS) approach (n = 1758). MethodsThe study employed quasi-experimental techniques to create weighted and balanced counterfactual groups. These groups, derived from the Recovery Capital assessment tool (REC-CAP), enabled comparison of outcomes between people receiving IRS and those undergoing SRS. ResultsAfter reweighting for resident demographics, service needs, and barriers to recovery, those receiving IRS exhibited improved retention rates, reduced likelihood of disengagement, and growth in recovery capital after living in the residence for 6–9 months. ConclusionThe results from this pilot intervention indicate that intensive recovery support, which integrates assertive community linkages and enhanced recovery coaching, outperforms a balanced counterfactual group in engagement, length of stay, and recovery capital growth. We suggest that this model may be particularly beneficial to those entering Level II and Level III recovery housing with lower levels of recovery capital at admission.

‘Ageing with an alcohol problem is not what I envision’: reclaiming agency in shaping personal ageing trajectory and recovery from alcohol problems

BackgroundEliciting and understanding older persons’ descriptions of their resources for healthy ageing and the interaction of these resources with alcohol use and alcohol problems can facilitate health promotion. It can also inform clinicians when identifying areas of recovery capital that present risks and strength for older people seeking alcohol treatment. The objective of this study was to illuminate the experiences and perspectives of older persons on ageing, alcohol use, treatment, and recovery from alcohol problems, as well as their understanding of healthy ageing.MethodsEight men and two women, aged 61 to 73 years, with moderate drinking as a treatment goal and treated at an outpatient alcohol clinic in Sweden, participated in semi-structured audio-recorded virtual interviews. A qualitative content analysis examined the transcribed interviews.ResultsThree themes were identified: “Tipping the balance”, “Staying behind a veil” and “Lifting the vail”. First, participants understood healthy ageing as a personal and multidimensional process that involved actively expanding, maintaining or adjusting to the resources needed to lead an active and meaningful life while preserving autonomy, dignity and independence for as long as possible. Second, most participants viewed moderate alcohol use as a contributor to healthy ageing. They sought treatment when their drinking became unsustainable and an immediate threat to their healthy ageing resources. Stigma, ambivalence and a lack of treatment options, however, contributed to delayed treatment. Third, the participants responded to treatment approaches that elicited their concern, incorporated their expertise and treatment and life goals, appreciated their autonomy and agency, and considered them partners in goal setting and decision making. Reduced drinking helped participants regain their agency and improved their healthy ageing capital which in turn catalyzed continuing recovery.ConclusionsOlder persons in non-abstinent recovery perceive healthy ageing and alcohol recovery as personal and interacting multidimensional processes involving their agency to improve biopsychosocial functioning. Treatment approaches that recognize older persons’ desire for healthy ageing, incorporate their treatment goals and respect their autonomy are likely to be acceptable and effective.

The co-creation and evaluation of a recovery community center bundled model to build recovery capital through the promotion of reproductive health and justice

People who can get pregnant who use drugs face disproportionate harms such as violence, exploitation and trauma and have unmet reproductive health needs as they have the greatest burden of unintended pregnancy (>75%). Recovery community centers (RCCs) provide recovery support services and are primarily staffed with people with lived experience using drugs. RCCs employ recovery coaches who are entrusted with helping participants improve their recovery capital, health, and wellbeing through person-centered strengths-based approaches. Although reproductive health and the prevention of unintended pregnancy can greatly impact all domains of recovery capital, recovery coaches generally do not have training to address this complex issue. We aimed to fill this gap by co-creating and evaluating a bundled model as an intervention tailored for RCCs (training & low-barrier resources including pregnancy tests, prenatal vitamins, and emergency contraception) to promote more equitable outcomes in reproductive health. We described the training and used mixed methods to assess pre-post knowledge, belief, and comfort with the bundled model (n = 20) and further explored perceptions of the model qualitatively to inform future iterations (n = 58). Results included significant gains in all three domains following the training, as well as favorable perceptions that the model will enhance recovery capital. Most were empowered to champion the model, asking for more information about the three resources, perinatal health, and referral information. We seek to begin to expand the theoretical construct of recovery capital by pilot testing an intervention to promote recovery through enhancing reproductive health and justice for people who use drugs (PWUD) who can get pregnant.

Bridging the gap: building and sustaining recovery capital in the transition from prison to recovery residences

The transition from jail to community is a high-risk time for individuals experiencing substance use disorders (SUD), with elevated risks of overdose and other substance-related harms, as well as high recidivism rates and re-incarceration. Gains made from successful treatment in prison are often lost in this transition. The current paper evaluates this process for one justice programme, Chesterfield HARP, a Therapeutic Community based in the Chesterfield County jail that continues supporting former inmates through their release by examining engagement and retention rates and changes in recovery capital among incarcerated individuals before incarceration and after transition to recovery housing in the community. Adult prisoners (both male and female) who engaged in the Chesterfield HARP programme completed an assessment of recovery capital (REC-CAP instrument) while in prison and following their transitions to one of a number of local recovery residences with strong links to the prison programme (ensuring continuity of care and support). The results suggest successful bridging with positive growth across multiple recovery capital domains. The study provides further evidence for the importance of continuity of care and integrated models of strength-building and recovery-focused interventions in successfully bridging the transition from prison to the community for offenders with a SUD history.

Health-related quality of life and recovery capital among recovery residents taking medication for opioid use disorder in Texas.

Recovery from opioid use disorder (OUD) includes improvements in health-related quality of life (HRQOL) and is supported by recovery capital (RC). Little is known about RC and HRQOL among recovery residents taking medication for OUD. We described HRQOL and RC and identified predictors of HRQOL. Project HOMES is an ongoing longitudinal study implemented in 14 recovery homes in Texas. This is a cross-sectional analysis of data from 358 participants' on HRQOL (five EQ-5D-5L dimensions-mobility, self-care, usual activities, pain/discomfort, and anxiety/depression) and RC (Assessment of Recovery Capital scores) collected from April 2021 to June 2023. Statistical analyses were conducted using T-, Chi-squared, and Fisher's exact tests. Most participants were 35 years/older (50.7%), male (58.9%), non-Hispanic White (68.4%), heterosexual (82.8%), and reported HRQOL problems, mainly anxiety/depression (78.4%) and pain/discomfort (55.7%). Participants who were 35 years/older [mean (SD) = 42.6 (7.3)] were more likely to report mobility and pain/discomfort problems than younger participants. Female participants were more likely to report pain/discomfort problems than male participants. Sexual minorities were more likely to report anxiety/depression problems than heterosexual participants. Married participants and those in committed relationships were more likely to report problems conducting self-care than single/never-married participants. Comorbid conditions were associated with mobility, pain/discomfort, and usual activities problems. Most participants reported high social (65.4%), personal (69.0%), and total (65.6%) RC. Low personal RC was associated with mobility (aOR = 0.43, CI = 0.24-0.76), self-care (aOR = 0.13, CI = 0.04-0.41), usual activities (aOR = 0.25, CI = 0.11-0.57), pain/discomfort (aOR = 0.37, CI = 0.20-0.68), and anxiety/depression (aOR = 0.33, CI = 0.15-0.73) problems. Low total RC was associated with problems conducting self-care (aOR = 0.20, CI = 0.07-0.60), usual activities (aOR = 0.43, CI = 0.22-0.83), pain/discomfort problems (aOR = 0.55, CI = 0.34-0.90), and anxiety/depression (aOR = 0.20, CI = 0.10-0.41) problems. Social RC was not associated with HRQOL. Personal and total RC and comorbid conditions predict HRQOL. Although the opioid crisis and the increasing prevalence of comorbidities have been described as epidemics, they are currently being addressed as separate public health issues. Our findings underscore the importance of ensuring residents are provided with interprofessional care to reduce the burden of comorbidities, which can negatively impact their OUD recovery. Their RC should be routinely assessed and enhanced to support their recovery and improve HRQOL.

“Now I Have My Own Key”: The Impact of Housing Stability on Recovery and Recidivism Reduction Using a Recovery Capital Framework

The National Institute on Drug Abuse (2020) reported 85% of the U.S. prison population had a substance use disorder (SUD) or was incarcerated for drug-use crimes. Applying Comprehensive Opioid, Stimulant, Substance Use Program funds, the Palm Beach County Office of Behavioral Health, and SUDs developed a comprehensive person-centered, recovery-oriented approach. This mixed-methods study (N= 36) examined how social capital, housing stability, and recovery-oriented care impacted personal capital, rearrest, and housing stability in criminal-justice-involved individuals with SUDs. Of the 36 participants, 86% (n= 31) did not have a rearrest, and 70% of participants were then employed shortly after their Comprehensive Opioid Stimulant Substance Use Program enrollment. Three major themes emerged from the interviews (n= 8): beginning recovery, peer navigation, and housing stability. This study demonstrates that housing stability, peer-support specialists, and care coordination are vital to increase recovery capital, aiding recovery, and reducing recidivism.

Positive addiction recovery therapy: a replication and follow-up study

PurposeThe purpose of this study is to see if the affirmative results seen in the pilot study of the positive addiction recovery therapy (PART) programme are replicable and durable given a new cohort of participants. PART is a programme of work designed to improve the recovery and well-being of people in early addiction recovery. Its foundation is in the G-CHIME (growth, connectedness, hope, identity, meaning in life and empowerment) model of addiction recovery. It also uses the values in action character strengths and includes a set of recovery protection techniques.Design/methodology/approachThis study uses a mixed method experimental design, incorporating direct replication and a follow-up study. Measures for recovery capital, well-being and level of flourishing are used to collect pre-, post- and one-month follow-up data from participants. The replication data analysis uses the non-parametric Wilcoxon test, and the follow-up analysis uses the Friedman test with pairwise comparison post hoc analysis. The eligibility criteria ensure participants (n = 35) are all in early addiction recovery, classified as having been abstinent for between three and six months.FindingsThis study found a statistically significant improvement in well-being, recovery capital and flourishing on completion of the PART programme. These findings upheld the hypotheses in the pilot study and the successful results reported. It also found these gains to be sustained at a one-month follow-up.Practical implicationsThis study endorses the efficacy of the PART programme and its continued use in a clinical setting. It also adds further credibility to adopting a holistic approach when delivering interventions which consider important components of addiction recovery such as those outlined in the G-CHIME model.Originality/valueThis study adds to the existing evidence base endorsing the PART programme and the applied use of the G-CHIME model.

Recovery Capital Gains May Precede Craving Reduction in Opioid Use Disorder.

Cravings for drugs and alcohol have been significantly associated with worse treatment outcomes. We investigated if improvements in recovery capital (RC) (eg, a measure of social capital/network, financial resources, education, and cultural factors) over time were associated with decreased reported cravings. The original cohort consisted of 133 participants (63 females) with opioid use disorder seeking outpatient treatment, who completed the Assessment of Recovery Capital (ARC) (range 0 to 50) and the Brief Addiction Monitor (BAM) thrice over the 6-month study. Intervention was medication and case management. Analysis included one-way mixed models testing change over time for ARC total scores and single question craving rating (5-point Likert scale). Cross-lagged panel estimates used structural equation models with variables z-scored, allowing for path coefficient evaluation as standard deviations (sd). Total ARC significantly increased over the study (χ2 = 33.77, df = 2, p < 0.0001), with baseline of 36.6 (n = 114, sd = 11.1) and 6-month of 41.2 (n = 107, sd = 9.5). Craving also changed significantly (χ2 = 8.51, df = 2, p < 0.015), with baseline of 1.1 (n = 101, sd = 1.2) and 6-month of 0.9 (n = 107, sd = 1.1). The cross-lag from baseline RC to 3-month craving was significant (β = -0.28, SE = 0.11, z = -2.53, p < 0.011). The converse was not true; baseline craving did not affect later RC. Results were similarly significant when comparing 3-month to 6-month. The majority of sample was on buprenorphine. As RC improves, the reported cravings at both 3- and 6-month study time points are significantly reduced. When evaluated inversely, there was not a significant association with baseline cravings and follow-up RC. Significant path coefficients provide an estimation of a directional effect from increased RC towards craving reduction.

Relationship-Oriented Recovery System for Youth (RORSY): Clinical Protocol for Transition-Age Youth with Opioid Use Disorders.

This article introduces the Relationship-Oriented Recovery System for Youth (RORSY) protocol, which is designed to increase uptake of Medications for Opioid Use Disorder (MOUD) and related services among adolescents and young adults. Youth exhibit alarmingly poor rates of MOUD initiation and adherence, OUD services involvement and long-term recovery success. RORSY attends to three developmentally unique recovery needs of this age group: assess and bolster youth recovery capital, prioritize involvement of concerned significant others, and use digital direct-to-consumer recovery supports. RORSY contains five evidence-informed intervention modules that can be flexibly tailored to meet the individual and relationship needs of a given youth: Relational Orientation, Youth Recovery Management Planning, Relational Recovery Management Planning, Relationship Skills Building, and Digital Recovery Support Planning. The article concludes with practice and policy recommendations for making relationship-building a top clinical priority for addressing youth OUD.

Implementing a Recovery Capital Model Into Therapeutic Courts: Case Study and Lessons Learned.

Recovery capital is a strengths-based and multi-level model for examining the process and outputs of recovery and desistance. Recovery capital posits that the more positive resources one accrues, the better the chances of recovery. Oftentimes growth of one's recovery capital must be initiated through identifying programs in the community to create supportive scaffolding: this may be especially true for individuals involved in the justice system who may experience additional barriers to accessing programming. This manuscript presents the results of a pilot evaluation of the REC-CAP, a recovery-capital oriented system of measurement, planning, and engagement in two drug treatment courts. We include a description of the implementation process and results from surveys and focus groups with the court staff. Results suggests that the trainings were useful and that court staff meaningfully engaged with the REC-CAP system. Court staff felt the REC-CAP provided important information about court clients' strengths and barriers and suggested next steps for staff to take to guide their clients. Future work should explore how the REC-CAP score profile may change with client progress through the court phases as well as how to incorporate more system level supports for a REC-CAP orientation among probation officers and other court staff.

Using the Recovery Capital Model to Explore Barriers to and Facilitators of Recovery in Individuals with Substance Use Disorder, Psychiatric Comorbidity and Mild-to-Borderline Intellectual Disability: A Case Series.

Recovery capital (RC) encompasses the wide range of resources individuals can employ to recover from Substance Use Disorder (SUD). It consists of five subdomains: human, social, cultural, financial, and community RC. Negative recovery capital (NRC) represents the obstacles to recovery. Research on (N)RC in complex multimorbid populations is scarce. This study offers an initial exploration of the viability of (N)RC in three individuals with SUD, psychiatric comorbidities, and an intellectual disability (a triple diagnosis) in inpatient addiction treatment. We collected case file data, ranked recovery goals, and conducted follow-up interviews. The data were subjected to template analysis, using (N)RC domains as codes. All domains were prevalent and relevant, showing dynamic and reciprocal effects, influenced by critical life events acting as catalysts. Notably, during treatment, patients prioritized individual skill development despite challenges in other domains. RC emerges as a valuable concept for mapping recovery barriers and facilitators in individuals with a triple diagnosis, serving as an alternative to the medical model and complementing the biopsychosocial model. It provides a systematic framework to assess critical factors for recovery in complex cases and accordingly align interventions. Future studies should explore the intersections of NRC domains and the dynamic nature of (N)RC to enhance the understanding of the challenges faced by individuals with a triple diagnosis.

Sex Differences in Recovery Capital Gains Post-Incarceration

Background People with substance use disorders are highly prevalent in the carceral system. Recovery capital (RC) is the resources available to an individual to initiate or maintain substance use cessation. Sex differences have been identified in RC during both active substance use and recovery in the general population, however, less is known about these sex differences in the post-incarceration population. Methods Participants (n = 136) were those with an opioid or stimulant use disorder with past year involvement with the Iowa criminal justice system (USA), who completed the Assessment of Recovery Capital (ARC) twice over a six-month cohort study. Participants were involved in an addiction clinic that utilized active case management. Analysis of covariance evaluated changes in ARC during the study. Separate models compared total ARC and individual ARC domains, with sex as the independent variable of interest. Model means were generated for interpretation based on sex, comparing baseline and study endpoint ARC scores. Results There were no baseline sex differences in total ARC. ARC increased significantly for the group, however, males showed disproportionate growth. Females ended the study with a mean ARC of 37.8 (SD= 9.3) and males finished at 41.6 (SD= 9.3), which was a significant difference (p = 0.044); this significant difference was driven by ARC subdomains of ‘Psychological Health’ and ‘Physical Health.’ Conclusions People post-incarceration are at high risk for return to substance use. Treatment that is informed by sex-based differences may have the potential to decrease the differing rates of growth in RC between sexes.

Situational Confidence and Recovery Capital Among Recovery Residents Taking Medications for Opioid Use Disorder in Texas.

Situational confidence, that is, confidence to resist substance use in high-risk situations, and recovery capital (RC) are resources that individuals can draw upon to initiate and sustain their recovery from opioid use disorder. We assessed the associations between total, social, and personal RC and situational confidence among recovery residents taking medications for opioid use disorder. Cross-sectional associations between the Brief Situational Confidence Questionnaire and Assessment of Recovery Capital scores were assessed among participants (N = 267) enrolled in a longitudinal study in 13 recovery homes for persons taking medications for opioid use disorder in Texas using χ 2 tests and multivariable logistic regression. Most participants were 35 years or older (51.7%), male (59.4%), non-Hispanic White (71.5%), and unemployed (66.0%); used more than one substance (77.9%); and had higher educational levels (53.8%). The majority had high situational confidence (66.7%), social (63.7%), physical (67.0%), and total (64.8%) RC. Education (model 1: adjusted odds ratio [aOR], 1.96; confidence interval [CI], 1.13-3.40; model 2: aOR, 2.03; CI, 1.17-3.51) and social (aOR, 2.08; CI, 1.11-3.92), personal (aOR, 2.06; CI, 1.08-3.93), and total (aOR, 2.98; CI, 1.71-5.20) RC were associated with situational confidence. Our findings highlight the need for recovery housing operators to be trained on the relevance of RC and situational confidence to practice to improve recovery outcomes among residents with opioid use disorder. Health planners, recovery housing administrators, and policymakers should strengthen recovery residence-based services and systems to improve individual RC and situational confidence.

A qualitative study of a recovery capital assessment tool in alcohol and drug treatment facilities: Perspectives from social work professionals.

The ambition to translate the concept of recovery capital (RC) from research to practice has entailed operationalisations of RC to measure progress and outcomes of alcohol and other drug (AOD) treatments.At the same time, the role played by standardisation in social work organisations is known to be a complex matter, and research suggests that the implementation of standardisation should be carried out with caution. By examining the need for a RC assessment tool in a Swedish AOD treatment context, this paper contributes to the discussion on the use of assessment tools for measuring treatment progress and outcome in AOD treatments, as well as interrelations between standardisation aims and social work professionals. Four group interviews with employees at AOD treatment facilities were conducted in Stockholm, Sweden. The interviewees were presented with an example of an RC-based assessment tool and asked to review the applicability of the tool in their daily work. The findings provide insights on the applicability of specific assessment list items, as well as general observations on the complex relationship between standardisation and discretion in social work. The findings suggest that professionals will ultimately rely on their knowledge and experience, and act accordingly to support the service user, regardless of any manual or standardisation that regulates their work.

Composition of social networks to build recovery capital differ across early and stable stages of recovery

Background Recovery capital describes the sum of resources – personal, social, or community – that can be drawn upon to sustain recovery from addiction. Recovery capital increases with progression through the stages of recovery; early (< 1 year), sustained (1 to 5 years), stable (> 5 years). The proportion of people in recovery within one’s social network, as well as the number of supports, have been associated with greater recovery capital, although recovery capital has been found to be lower if one’s entire network is in recovery. It remains unclear which social network characteristics are more important at early compared to stable recovery stages. Method The study assesses recovery strengths and barriers using the Strengths and Barriers Recovery Scale (SABRS) from the Australian Life in Recovery survey (n = 478). SABRS scores were compared between periods of active addiction and recovery, and across the stages of recovery. The impact of social network characteristics on SABRS score across early and stable recovery stages were also explored. Results Recovery social network diversity (some network members in recovery but not all or none) was associated with more recovery strengths in early but not stable recovery. However, for those in stable recovery, having a greater number of close people in a network was more important. Conclusion The study provides evidence that the elements (e.g. diversity and number of supports) of a social network that facilitate recovery capital change as individuals progress through recovery stages, and highlights the importance of peer support in early recovery.

Recovery Capital Correlates With Less Methamphetamine Use and Crime in the Community.

Reentry postcorrectional involvement is a high-risk time for patients with a history of addiction. We investigated whether participation in an addiction medicine clinic with active case management led to improvements in patients' recovery capital and whether there were associated changes in criminal activity and co-occurring methamphetamine or alcohol use. Participants (n = 136) were patients with an opioid or stimulant use disorder who had Department of Corrections involvement in the preceding year, who completed the Assessment of Recovery Capital (ARC) and reported criminal activity and days of methamphetamine or alcohol use twice over a 6-month study. Three logistic regression models were used to assess changes in total ARC with criminal activity, alcohol use, and methamphetamine use over the previous 30 days. Baseline mean (SD) ARC scores were 34.1 (11.1) and increased to a mean (SD) score of 40.3 (9.4) at study end. A 1-SD shift in ARC was significantly protective across outcomes, with adjusted odds ratios of 0.32, 0.18, and 0.34 for any past 30-day criminal activity, alcohol use, or methamphetamine use. There was no significant difference in baseline ARC, crimes committed, days of alcohol use, or days of methamphetamine use for study completers versus noncompleters; however, unmeasured confounders may have had a differential impact on retention. Recovery capital provides an additional framework to help address patients' substance use and criminal activity in a multifaceted way, which is especially important in the postincarceration community. Recovery capital is dynamic and has multiple areas to target psychosocial interventions.

Caregivers’ Attitudes Toward Treatment Length for Persons in Swedish Opioid Agonist Treatment. A Qualitative Interview Study

ABSTRACT Although opioid agonist treatment (OAT) has several beneficial effects, the issue of optimal treatment length remains unresolved. It is plausible that caregivers’ attitudes toward treatment length are of importance to whether, how and when tapering off will take place. In this study, we investigated caregivers’ attitudes toward treatment length by interviewing 15 caregivers from a variety of professions working in seven OAT treatment programs in Sweden. Data were analyzed using applied thematic analysis. The participants were generally hesitant concerning the idea of tapering off. Few of them had experiences of patients tapering off successfully. Many of them never brought up the subject unless the patient did so her-/himself. Only younger, socially stable patients were perceived to be suitable for tapering off. Participants also expressed a need among staff for education and ethical discussions on treatment length. A person-centered focus may be promoted by recurrently discussing treatment goals and by co-operating with patients to map the recovery capital of those interested in tapering. To further support caregivers in developing person-centered care, more knowledge of opioid use disorder and professional and interprofessional discussions of caregivers’ own attitudes and beliefs are paramount.