Examining Recovery Program Participants by Gender: Program Completion, Relapse, and Multidimensional Status 12 Months After Program Entry

• Date: 01 October 2020
• Published date: 01 October 2020
• Author: Robert Walker,TK Logan,Jennifer Cole
• DOI: 10.1177/0022042620923985
• Subject Matter: Articles

https://doi.org/10.1177/0022042620923985

Journal of Drug Issues

2020, Vol. 50(4) 436 –454

© The Author(s) 2020

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DOI: 10.1177/0022042620923985

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Article

Examining Recovery Program

Participants by Gender:

Program Completion, Relapse,

and Multidimensional Status

12 Months After Program Entry

TK Logan1, Jennifer Cole1,

and Robert Walker1

Abstract

This study examined individual-level characteristics and factors associated with program

completion, relapse, and multidimensional status at follow-up for 213 men and 248 women who

entered one of 17 peer-led recovery programs and who completed a follow-up interview 12

months later. Study results found that although there were some significant gender differences

at program entry among participants entering Recovery Kentucky, there were few gender

differences at follow-up. In addition, although participants had significant psychosocial problems,

polysubstance use patterns, and severe substance use disorder (SUD), the majority of both

men and women reported completing the program (80.3%), a small minority reported relapse

(9.5%), and about one third had worse multidimensional status about 12 months after program

entry. Lower quality of life rating at program entry was associated with program completion and

with better multidimensional status at follow-up. Study results suggest the recovery program

provides an important option for some of the most vulnerable individuals with SUD.

Keywords

resources, program outcomes, supportive housing

Access to substance use disorder (SUD) treatment has increased over the past decade due, in part,

to Medicaid expansion (Guerrero et al., 2017; McKenna, 2017; Su, 2017). Nonetheless, there are

still vulnerable individuals with SUDs who have difficulty initiating and maintaining SUD treat-

ment (Creedon & Le Cook, 2016; Jones et al., 2015; Manuel et al., 2017; McKenna, 2017; Su,

2017; Tsai & Gu, 2019). For example, individuals who are homeless or who are transitioning out

of jail or prison may have multiple and complex needs which can make participation in tradi-

tional SUD treatment programs difficult (Chen, 2018; Kahn et al., 2019; Padgett et al., 2016; Tsai

& Gu, 2019). In addition to not having stable housing, they are often not employed, have limited

financial means, have limited transportation options, have lack of social support, and have

1University of Kentucky, Lexington, USA

Corresponding Author:

TK Logan, Department of Behavioral Science, University of Kentucky, 333 Waller Ave., Suite 480, Lexington,

KY 40504, USA.

Email: tklogan@uky.edu

923985JODXXX10.1177/0022042620923985Journal of Drug IssuesLogan et al.

research-article2020

Logan et al. 437

co-occurring severe mental health problems including depression, anxiety, and suicidality

(Compton et al., 2014; Coohey et al., 2015; Kahn et al., 2019; Lee et al., 2017). Acute SUD mod-

els are not as effective for those with complex needs as is evident in the lower rates of treatment

initiation, high dropout rates, low participation in aftercare, and high readmission and/or relapse

rates (Creedon & Le Cook, 2016; Davidson et al., 2010; Jones et al., 2015). Even so, individuals

with multiple and complex needs can, and do, achieve recovery when provided with sustained

and appropriate support (Polcin & Korcha, 2017; White et al., 2003, 2004).

Safe and stable housing should be one of the highest priorities for individuals with SUDs who

are homeless or at risk of becoming homeless (Reif, George, et al., 2014; Rog et al., 2014). The

lack of safe and stable housing increases the risk of substance use as well as incarceration,

whereas incarceration increases the risk of homelessness upon release from jail/prison (Chavira

& Jason, 2017; Cusack & Montgomery, 2017; Polcin, 2016). Regardless of the pathway into

unstable housing, maintaining program participation and recovery is more difficult without safe

and stable housing (Jason et al., 2006; Milby et al., 2005; Polcin et al., 2010a, 2010b; Reif,

George, et al., 2014; Shaham et al., 2003). There are several models of SUD treatment that pro-

vide housing including therapeutic communities (TCs) and sober living houses (Malivert et al.,

2012; Vanderplasschen et al., 2013, 2014; Wittman et al., 2017). Characteristics of both TCs and

sober living houses include the following: (a) drug- and alcohol-free living environments; (b)

strongly encouraged or mandated attendance at 12-step mutual-help groups; (c) peer support for

recovery; and (d) compliance with program rules that include engaging in nonviolent prosocial

behavior, doing communal chores, and participating in community meetings (Polcin et al., 2010b;

Polcin & Henderson, 2008).

Although sober living housing is a residential option that has shown some success (Chavira &

Jason, 2017; Polcin et al., 2010a; Polcin & Korcha, 2017; Reif, George, et al., 2014), many of

these programs require financial resources from the residents making this less of an option for

individuals with SUDs with limited resources such as those who are homeless or at risk of being

homeless (Winn & Paquette, 2016). Furthermore, there is limited availability of sober living

homes, particularly in rural areas (Browne et al., 2016; National Association of Recovery

Residences, 2012). To address these access limitations, Kentucky implemented a supportive

housing program called Recovery Kentucky which is similar to a modified TC or sober living

home (Vanderplasschen et al., 2013, 2014). The Recovery Kentucky programs were designed to

serve adults who are homeless or who are at risk of homelessness including those with recent

incarceration (Townsend, 2012). Recovery Kentucky provides supportive housing that promotes

education, personal and community accountability, vocational support, and an emphasis on

12-step mutual-help participation in 17 programs throughout the state, including nonmetropoli-

tan communities (Townsend, 2012).

Recovery Kentucky, like many sober living homes and TCs, uses peer mentors and empha-

sizes 12-step mutual help participation. Some studies suggest peer support is associated with

lower relapse rates, higher program retention, and higher satisfaction with the overall treatment

experience (Polcin et al., 2010b; Reif, Braude, et al., 2014). Peers help individuals initiate and

maintain engagement in programs (Tracy et al., 2011; White, 2010), help them with practical and

emotional needs, and can serve as role models (Bassuk et al., 2016; Pantridge et al., 2016; White,

2010). Peer support networks are a central component of the program and emphasize the impor-

tance of having, and giving, peer support, both of which can be empowering (Davidson et al.,

2010; Kaskutas et al., 2014; Polcin et al., 2010b). The other similarity of the Recovery Kentucky

program with sober living homes and TCs is the use of 12-step mutual-help groups, which have

been associated with reduced substance use in participants involved in sober living houses, indi-

viduals who recover without any formal treatment, and among individuals in a variety of formal

treatment settings (Kelly, 2017; Polcin & Henderson, 2008; Zemore et al., 2017). Although

12-step mutual-help groups have received a variety of criticisms, the positive aspects of 12-step