1. Patterns and Predictors of Sustained Recovery Among Former Poly-substance Drug Users Alexandre Laudet, PhD 1, William White, MA 2, and Keith Morgen, PhD 1 1 National Development and Research Institute, Inc.; 2 Chestnut Health Systems Funded by Grant # R01DA14409; Correspondence: laudet@ndri.orglaudet@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 Recovery Capital RECOVERY CAPITAL = the amount and quality of internal and external resources that one can bring to bear to initiate and sustain recovery a 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 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. Overview of Method and 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 Study Cohort (N=354) Men 56% Age (median)43 (range: 19 to 65 years old) Race/ethny African American62% Caucasian 16% Mixed/Other 22% Education (median years) 12 (range: 5 to 19) Employed full/part-time40% Primary income Job on/off the books 34% Govt. assistance59% Other legitimate income7% HIV+22% Psychiatric disorder (ever)39% No legal involvement82% Drug and Alcohol Use History Primary Other EverProblemProblems b (%) (%) (%) Crack8658.314.2 Heroin6418.612.4 Cocaine9210.122.7 Alcohol998.128.3 Marijuana972.35.6 Hallucinogens602.13.1 Nothing elseNA NA36.0 Substance Use: Length, Severity and Baseline Status GENERALLY LONG AND SEVERE HISTORY OF POLYSUBSTANCE USE Years regular use of alcoholMean = 17.4St. Dev = 10.6 Years regular use of drugsMean = 18.7 St. Dev = 12.0 Lifetime Dependence Severity c 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) 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] 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. Bivariate Correlations between Baseline Recovery Capital and Sustained Recovery @ F1 by Baseline Recovery Stage Total> 6 mos6 - 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* 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 severity11.711.611.611.811.8 Commitment to abstinence * 3.13.13.23.23.1 Recovery support ** 3.02.93.03.13.0 12-step attendance11.49.312.215.29.7 12-step involvement * 4.23.23.55.04.5 Quality of life *** 7.66.77.68.28.0 Spirituality ** 3.02.83.03.13.0 Religiosity5.14.85.15.25.5 Life meaning 3.23.13.23.23.2 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: 1. 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 2. 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 Sustained Recovery @ F1 d Baseline Recovery Stages (N=313) Yes 66% Three Years + 26% 18 to 36 months 20% Under 6 months 28% Six to 18 months 26% Baseline Recovery Capital as Predictor of sustained recovery @ F1: Multiple regression findings Total> 6 mos6 - 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***1.93.4**.932.3* R 2 17% 16% 27% 12% 20% Sustained Recovery at F1 as a Function of Baseline Recovery Stage d (N=313) Sustained Recovery @ F1 d (N=313) Yes 66% No 34%