Patterns and Predictors of Sustained Recovery Among Former Poly-substance Drug Users

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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 • Addiction conceptualized as a chronic disorder • Recovery from a chronic disorder is a process that: • Unfolds over time; and • May occur in a succession of stages • Most addiction research has used relatively short-term follow-ups (<2 yrs) • As a result, we know more about recovery initiation than about later stages - recovery maintenance and consolidation • Likelihood of sustained recovery increases as a function of recovery length • However, risk of relapse remains a reality well into ‘stable’ recovery (3+ yrs) • Costs of return to active addiction are many and they are high • Need to identify factors that promote recovery maintenance over the course of the process (i.e., at different stages) • Factors associated with recovery initiation and maintenance may differ Substance Use: Length, Severity and Baseline Status GENERALLY LONG AND SEVERE HISTORY OF POLYSUBSTANCE USE Years regular use of alcohol Mean = 17.4 St. Dev = 10.6 Years regular use of drugs Mean = 18.7 St. Dev = 12.0 Lifetime Dependence Severityc Mean = 11.6 St. Dev =2.4 Time since last used (median) …. Alcohol (median) 14 months (range = .1 to 528) Illicit drugs (median) 14 months (range = 1 to 231) Descriptive: Mean Baseline Levels of Recovery Capital by Recovery Stage e Total >6 mos 6 - 18 mos. 18 – 36 mos 3 yrs+ N = 312 N = 87 N = 82 N = 63 N = 80 Lifetime severity 11.7 11.6 11.6 11.8 11.8 Commitment to abstinence* 3.1 3.1 3.2 3.2 3.1 Recovery support** 3.0 2.9 3.0 3.1 3.0 12-step attendance 11.4 9.3 12.2 15.2 9.7 12-step involvement* 4.2 3.2 3.5 5.0 4.5 Quality of life*** 7.6 6.7 7.6 8.2 8.0 Spirituality** 3.0 2.8 3.0 3.1 3.0 Religiosity 5.1 4.8 5.1 5.2 5.5 Life meaning 3.2 3.1 3.2 3.2 3.2 Sustained Recovery @ F1d (N=313) Baseline Recovery Stages (N=313) Sustained Recovery @ F1d • Recovery Capital • RECOVERY CAPITAL = the amount and quality of internal and external resources that one can bring to bear to initiate and sustain recoverya • A number of factors have been identified as predictors of recovery in short-term studies and constitute recovery capital. They include: • Motivation • Social support • Participation in 12-step fellowships (attendance and involvement) • Faith/spirituality/life meaning Bivariate Correlations between Baseline Recovery Capital and Sustained Recovery @ F1 by Baseline Recovery Stage Total > 6 mos 6 - 18 mos. 18 - 36 m 3 yrs+ N = 312 N = 87 N = 82 N = 63 N = 80 Length of recovery .20*** .29** .29* .10 .15 Lifetime severity .09 .19 .01 .17 -.09 Commitment to abst. .22*** .16 .39*** -.01 .19 Recovery support .10 -.12 .21 .07 .07 12-step attendance .05 .15 .29** -.07 -.02 12-step involvement .18*** .16 .07 .06 .12 Quality of life .21*** .09.18 .02 .08 Spirituality .21*** .03 .23* .22 .07 Religiosity .22*** .18 .32** .20 -.05 Life meaning .23*** .04 .33** .21 .24* Three Years + 26% Under 6 months 28% No 34% Yes 66% • Study Objectives • This study examines the prospective role of recovery capital on sustained recovery (abstinence from drugs at one-year follow-up) among former poly- substance users to determine whether the role of recovery capital domains is similar or different at different stages of the process. Yes 66% 18 to 36 months 20% Six to 18 months 26% • Overview of Methodand Procedures • 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. • Individuals self-identified as ‘in recovery” from one month to 10+ years recruited through media advertisement • Cohort interviewed (BL – N = 354) and re-interviewed one year later (F1) - N= 313 (to date) , 89% of those remaining alive (4 deceased) • Voluntary participation based on informed consent • Semi-structured interviews lasting approximatively 2 hours. • Participants receive $30 for baseline interview, $40 at 1YR Baseline Recovery Capital as Predictor of sustained recovery @ F1: Multiple regression findings Total > 6 mos 6 - 18 mos. 18 - 36 m 3 yrs+ N = 312 N = 87 N = 82 N = 63 N = 80 Length of recovery .25*** .29* .28* .09 .18 Commitment to abstinence .15* .19 .27* -.07 .28* 12-step attendance -.08 .07 -.14 -.15 .19 12-step involvement .09 -.04 .17 .13 .02 Quality of life .08 .08 .07 -.09 .05 Spirituality .03 -.09 -.11 .25 .0 Religiosity .06 .30†-.03 .25 -.30* Life meaning .08 -.23 .23 -.05 .30* F 7.8*** 1.9 3.4** .93 2.3* R2  17% 16% 27% 12% 20% Sustained Recovery at F1 as a Function of Baseline Recovery Staged(N=313) Baseline Study Cohort (N=354) Men 56% Age (median) 43 (range: 19 to 65 years old) Race/ethny African American 62% Caucasian 16% Mixed/Other 22% Education (median years) 12 (range: 5 to 19) Employed full/part-time 40% Primary income Job on/off the books 34% Govt. assistance 59% Other legitimate income 7% HIV+ 22% Psychiatric disorder (ever) 39% No legal involvement 82% • Summary of Findings and Implications • Findings suggest that different sets of factors may be associated with sustaining recovery at different stages of the process • Baseline length of recovery and commitment to abstinence were the most consistent predictors of sustained recovery overall and across recovery stages • Taken together, the recovery capital domains under study accounted for only 16 to 27% of the explained variance in sustained recovery at F1. • Therefore, the bulk of the variance in sustained recovery remains unexplained so that additional work is critically needed that identifies other ingredients of recovery capital and determinants of sustained recovery over time • Moreover, future studies must consider recovery outcomes that go beyond substance use and encompass global health domains such as quality of life and social functioning. • Analytic plan • We used a two-stage process to identify the role of recovery capital domains as predictors of sustained recovery at one-year follow-up: • Bivariate relationships between sustained recovery @ F1 and each baseline recovery capital domain were examined for the entire sample and for each of the four baseline recovery stage groups • Baseline recovery capital domains that emerged as significant in the analyses in Step one were entered as predictors in multiple regression analysis with sustained F1 recovery as the dependent variable. Separate regressions were conducted for the entire sample and for each of the four baseline recovery stages Drug and Alcohol Use History Primary Other Ever Problem Problemsb (%) (%)(%) Crack 86 58.3 14.2 Heroin 64 18.6 12.4 Cocaine 92 10.1 22.7 Alcohol 99 8.1 28.3 Marijuana 97 2.3 5.6 Hallucinogens 60 2.1 3.1 Nothing else NA NA 36.0 Footnotes a Granfield, R, & Cloud, W. (2001) Social context and "natural recovery": The role of social capital in the resolution of drug-associated problems. Subst. Use & Misuse, 36, 1543-70. b Adds to over 100 because of multiple responses c Sheehan DV & Lecrubier Y (2002) Mini International Neuropsychiatric Interview. University of South Florida – Tampa. Possible Score range: 0 to 14. Primary substance only d No drug or alcohol use since baseline e ANOVAS *p<.05 ** p<.01 *** p<.001  †p <.1 [trend]