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Abstract
Many recovering persons report quitting their drug use because they are “sick and tired” of the drug life. Recovery is the path to a better life, but that path is often challenging and stressful. There has been little research on the millions of recovering persons in the United States, and most research has focused on substance use outcomes rather than on broader functioning domains. This study builds on our previous cross-sectional findings that recovery capital (social supports, spirituality, religiousness, life meaning, and 12-step affiliation) enhances the ability to cope with stress and enhances life satisfaction. This study (a) tests the hypothesis that higher levels of recovery capital prospectively predict sustained recovery, higher quality of life, and lower stress one year later, and (b) examines the differential effects of recovery capital on outcomes across the stages of recovery. Recovering persons (N = 312), mostly inner-city ethnic minority members whose primary substance had been crack or heroin, were interviewed twice at a one-year interval in New York City between April 2003 and April 2005. Participants were classified into one of four baseline recovery stages: under 6 months, 6–18 months, 18–36 months, and over 3 years. Multiple regression findings generally supported the central hypothesis and suggested that different domains of recovery capital were salient at different recovery stages. The study's limitations are noted and implications of findings for clinical practice and for future research are discussed, including the need for a theoretical framework to elucidate the recovery process.
Notes
Notes
*The journal's style utilizes the category substance abuse as a diagnostic category. Substances are used or misused; living organisms are and can be abused. From this perspective, “drug abuse” or dependence can neither be licit nor illicit. Editor's note.
1. We note that the term recovery is largely steeped in 12-step culture; the term remission is used in biomedical fields to describe a state where the individual is free of symptoms; e.g., in oncology. The terms remission and recovery both connote the idea that the underlying condition may remain, in contrast to the term cure, which suggests that the underlying condition is no longer present.
2. Total abstinence is but one of the possible recovery goals; in the United States where treatment programs are heavily influenced by 12-step tenets, total abstinence from drugs and alcohol is typically the goal, and reports from recovering persons suggest that total abstinence is their goal as well (CitationLaudet et al., 2005). Tobacco, and nicotine, regarded by some as “drugs” as well, are rarely included in remission goals by either treatment programs or remitting individuals themselves.
3. Although social context and environmental factors are regarded as critical to understanding the etiology, maintenance, and remediation of disease and health, individual-level analysis has been more valued than ecological analysis, and most research on factors promoting remission from substance use and misuse has focused on the individual.
4. Sample text of recruiting ad: “Have you successfully overcome a drug problem? NDRI is interested in interviewing anyone in NYC who used to have a serious problem with drugs and is no longer using. Your experiences can provide valuable information to help people with similar problems. Confidentiality is strictly maintained. Participants compensated for time. We do not provide treatment. Call Pathways toll free (800) xxx-xxxx.”
5. This study is a naturalistic investigation of the role of psychosocial factors on long-term recovery in which we wanted to be able to assess the role of baseline community-related factors on subsequent outcome.
6. Participant incentives were increased at F1 in an effort to maximize participant retention into this 5-year study.
7. Alcohol, cannabis, heroin, street or illegal methadone (to get high), other opiates/analgesics (e.g., morphine, codeine), downers or depressants (e.g., sedatives, barbiturates, or tranquilizers), crack, non-crack cocaine, methamphetamine or other amphetamines/stimulants, PCP or other hallucinogens, inhalants/solvents (glue, gasoline), ecstasy, any other drug including over-the-counter.
8. With respect to individual religious activities, 85% of participants reported thinking about God “daily” or “almost daily,” 78% prayed or mediated “daily” or “almost daily,” 33% attended worship services weekly or more often, 37% read or studied scriptures or holy writings at least weekly, and 43% had a direct experience with God “daily” or “almost daily,” whereas 29% never did and 20% rarely did.
9. In the present study, the association between baseline stress and F1 recovery for the earliest recovery group was positive so that higher baseline stress predicted better recovery outcome. While this finding was not expected, it can be explained by the fact that stress levels at baseline were very high in this subgroup (7.4 on a scale from 0 to 10); further, it may be that high stress level precipitates the decision to initiate recovery, an idea often expressed as “being sick and tired of being sick and tired.”
10. We also note that spirituality may not need to rely on a connection to the transcendent. For example, 12-step members are encouraged to find their own conception of a Higher Power, “however limited” (Alcoholics Anonymous World Services, Citation1976). There is anecdotal evidence of some 12-step members defining their Higher Power as the recovery community, their home group, or even a more experienced recovering peer (e.g., their sponsors); while limited in some ways, this secular form of spirituality may confer a sense of connectedness and belonging, a force that is loving, non-judgemental, and supportive, that can be trusted to be there always. More research is needed on this topic.
11. The finding of low support early in recovery is consistent with previous reports that friendships erode with the cessation of substance use—in all likelihood because the individual is moving away from substance-using associates but may not have yet developed a healthier social network (e.g., CitationRibisl, 1997).
12. In preliminary work, we replicated the analyses presented, adding baseline levels of self-efficacy, size of general support network, and size of recovery network (number of individuals in network who are in recovery); results were unchanged from those presented here and since this study is an extension of our earlier cross-sectional study, we elected to operationalize recovery capital in the same way as we did in the first study.