Table 1 - uploaded by Douglas Polcin
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Focus group questions
Source publication
Background:
The study of motivation in the substance abuse field has typically examined the extent to which substance users want to quit or reduce substance use. Less frequently examined is the desire to maintain sobriety after achieving abstinence. The current study examined motivation to maintain sobriety among residents of sober living houses (...
Context in source publication
Citations
... Challenges associated with co-occurring mental health concerns may impede the effectiveness of recovery housing. People with higher mental health symptom severity, for example, may struggle to integrate into the social structure of the home (Edwards et al., 2018;Polcin & Korcha, 2015). Poor mental health is also associated with shorter stays in the home and an increased risk of a resident being expelled after breaking a house rule or returning to substance use (Aase et al., 2013;Harvey et al., 2016;Krentzman et al., 2022). ...
... Residents with more severe mental health concerns or histories of interpersonal trauma may benefit from additional support to cope with this stress. This is consistent with Polcin and Korcha's (2015) assertion that people with mental health conditions may struggle to participate in the dynamic social structure of a recovery residence. However, our findings suggest that these concerns are particularly concentrated in periods of growth or turnover in the home and can be ameliorated with community building and professional and peer support. ...
... Residents report seeking out advice from housemates with similar mental health issues, adding support for social network analyses that show residents with similar diagnoses often form reciprocal bonds (Bobak et al., 2022). Polcin and Korcha (2015) report that the social structure of recovery housing allows residents to recognize subtle changes in one another. While Polcin and Korcha (2015) primarily focus on how this peer monitoring prevents recurrence of substance use, our findings demonstrate that this type of peer support also improves residents' mental health. ...
Co-occurring mental health concerns are prevalent among substance use recovery housing residents. We sought to explore how residents with co-occurring mental health and substance use needs experience recovery housing. We conducted semi-structured interviews with residents (N = 92) in recovery homes across Texas and developed themes through thematic analysis. Residents note that living in a group home can exacerbate anxiety and paranoia, especially during periods of high turnover. Overwhelmingly, however, residents believe recovery housing improves their mental health. Residents use their shared lived experiences to support one another. Residents also express appreciation for the transition period offered by recovery housing, allowing them to solidify their recoveries before fully re-entering society. Participants describe recovery homes as a critical support for their co-occurring mental health and substance use concerns. These results provide key insights on how to better support mental health in recovery housing.
... Nevertheless, the possible loss of family trust and support due to the highintensity use of illicit drugs leads to seeking or accepting treatment at a drug rehabilitation center (Pope et al., 2010;Sharma et al., 2019). Battling addiction alone without familial support triggers a sense of hopelessness regarding treatment (Broome et al., 1997;Polcin & Korcha, 2015). ...
Objective
Inpatients with substance use disorders often go unheard. Through qualitative interviews, this study lends voice to their views and beliefs about the factors that affect their recovery.
Methods
In-depth interviews were conducted from February 10 to 11, 2020 with 15 in- patients with methamphetamine use disorder residing at the Marikina Rehabilitation Center in the Philippines. Semi-structured qualitative interviews were thematically analyzed to determine the factors that promote and hinder methamphetamine use disorder treatment and recovery.
Results
We identified six barriers to recovery: homesickness, lack of family visitation and support, fear of treatment, financial stress, social stigma and criticism, and boredom. Four motivating factors that influenced treatment and recovery included the therapeutic community treatment program, familial relationships, and visitations, belief in God, and hope.
Conclusions
A treatment integration program that combines psychotherapy and cognitive behavioral therapy, as well as strong familial support, is imperative for patients’ recovery from methamphetamine use disorder.
... Heightened motivation to change attitudes and behaviours is a factor in predicting programme completion [65], which in turn reduces likelihood of reoffending [65,100]. This can allow for higher levels of supervision and compliance [65], lifestyle and outlook changes [118], programme and treatment adherence [135,212,[218][219][220], and establishing a positive therapeutic alliance between the participant and diversion team [221,222]. Motivational and behaviour change elements such as motivational interviewing and cognitive behavioural or social learning strategies can be embedded [102, 155, 210-212, 218, 219]. ...
Purpose
Women in prisons are known to suffer with more mental health difficulties and many experience challenges prior to incarceration. Diversion programmes are initiatives designed to divert people with pre-existing mental illness from the criminal justice system into mental health services. The variability of effectiveness of interventions makes realist approaches particularly appropriate for diversion programmes, and this paper presents the first realist review to be undertaken across the breadth of this topic. This realist review aimed to explain the successes, failures and partial successes of these programmes as an intervention to improve the outcomes of women offenders with mental health issues.
Methods
We conducted a realist review of published literature explaining the impact of diversion programmes on participants with mental health issues. Consultations with six specialists in the field were conducted to validate the principles and hypotheses about key dynamics for effective programmes.
Results
The review included 69 articles. We identified four essential principles, developed through thematic groupings of context-mechanism-outcome configurations, to articulate key drivers of the effectiveness of diversion programmes: coordination between services; development and maintenance of relationships; addressing major risk factors; and stabilisation through diversion programmes.
Conclusions
The behaviour of women offenders is driven by need, and the complex needs of this group require individualised plans that incorporate relationships as vehicles for support and change. Although there is a role for gender-specific interventions, it is not fully understood and further research is required. Implications for future interventions are discussed.
... The relationships built, as part of the recovery home support system, kept the residents accountable to one another. This finding aligns with the results of Polcin and Korcha's (2015) study, which identified camaraderie and responsibility as strong driving forces leading to recovery. In the current study, the residents highlighted how genuine and inspiring their new-formed relationships were and the need to be accountable to those who have shown so much care for their well-being. ...
... Optimism, or hope for a better future, is an important factor in the pursuit of long-term recovery. It motivates commitment to the program and the work that is necessary to perform in order to reach the desired goal by focusing on the benefits of long-term success (Korcha et al. 2011;Polcin and Korcha 2015). Timpson et al. (2016) found that as a result of recovery, participants experienced a sense of belonging, improved self-worth, and overall confidence. ...
... Maintenance of SUD recovery after discharge from inpatient SUD treatment often requires profound transformation (Manuel et al., 2017;Robertson & Nesvåg, 2018). Several factors have been highlighted as facilitating in the transformation process, such as social support (see, e.g., Bahl, Nafstad, Blakar, Landheim, & Brodahl, 2019;Brooks, Magaña Lòpez, Ranucci, Krumlauf, & Wallen, 2017;Levälahti, 2007;Pettersen et al., 2019;Soyez & Broekaert, 2003), motivation, self-efficacy, self-awareness (Eslami, Norozi, Hajihosseini, Ramazani, & Miri, 2018;Polcin & Korcha, 2015;Turpin & Shier, 2017) and predictability in basic elements such as employment, housing and personal finances (Andersson, Otterholt, & Gråwe, 2017;Kruk & Sandberg, 2013;Soyez & Broekaert, 2003;Sumnall & Brotherhood, 2012). ...
... In our findings, participants reported that having a role model strengthened their motivation. These findings are slightly different from recent research on inpatients' expectations previous to their transition from SUD treatment, which found that people who were seen as role models perceived increased motivation (Manuel et al., 2017;Polcin & Korcha, 2015). ...
... Previous research on experiences of SUD recovery and the relation between treatment motivation and abstinence after discharge, found that motivation may prevent stressful situations in everyday life, and protect against relapse to substance use (Eslami et al., 2018). Motivation has also been reported to be positively associated with an improved sense of belonging, including factors such as social recovery capital and social connectedness (Polcin & Korcha, 2015). These previous findings underpin the value of incorporating services and interventions that enable participants to remain motivated during the transition and post-discharge period. ...
Aim
There is limited knowledge about how inpatients anticipate factors that facilitate the transition between specialised inpatient treatment for substance use disorder (SUD) and the post-discharge period. This study explores factors that inpatients anticipated would facilitate such a transition period.
Method
A focus group study, consisting of four group interviews with individuals in inpatient SUD treatment, was conducted to explore their expectations for the transition and post-discharge period ahead of them. The transcribed interview material was analysed using thematic analysis.
Findings
The analytical process led to three themes: “Belonging”, “Intrapersonal processes” and “Predictability”. Correspondence between inpatients’ expectations and the services they are offered in the transition and post-discharge period may serve as proper support for inpatients ahead of a vulnerable phase, such as the transition and post-discharge period.
Conclusions
Findings from the current study highlight overarching elements that inpatients envisioned to be facilitating, such as social support, motivation, self-efficacy, self-awareness and predictability in basic elements such as employment, housing and personal finances. Findings from this study and previous ones imply that certain factors appear to facilitate in vulnerable phases, such as service level transitions. These facilitating factors should be taken into consideration and used as steppingstones through the transition and post-discharge period after inpatient SUD treatment.
... Heslin et al (2013) conducted focus groups with SLH residents and found peers residing in the homes helped each other avoid substance use triggers in the community as well as cope with triggers that are unavoidable. Polcin and Korcha (2015) conducted focus groups with house managers to identify factors that motivate residents to maintain abstinence. Managers felt that residents were motivated to maintain abstinence in part because of perceived benefits as well as the de Guzman et al. ...
... Participants with the most positive experiences described it in relational terms, such as the benefits they personally received from peers and staff and the support they extended to others. In previous research (Polcin & Korcha, 2015), this type of mutual support was viewed as a primary motivating force for maintenance of sobriety. ...
Purpose
Persons in the USA who are incarcerated for drug offenses are increasingly being released into the community as a way to decrease prison and jail overcrowding. One challenge is finding housing that supports compliance with probation and parole requirements, which often includes abstinence from drugs and alcohol. Sober living houses (SLHs) are alcohol- and drug-free living environments that are increasingly being used as housing options for probationers and parolees. Although a few studies have reported favorable outcomes for residents of SLHs, little is known about resident experiences or the factors that are experienced as helpful or counterproductive. The paper aims to discuss this issue.
Design/methodology/approach
This study conducted qualitative interviews with 28 SLH residents on probation or parole to understand their experiences living in the houses, aspects of the houses that facilitated recovery, ways residence in an SLH affected compliance with probation and parole, and ways the houses addressed HIV risk, a widespread problem among this population. Interviews were audiotaped and coded for dominant themes.
Findings
Study participants identified housing as a critically important need after incarceration. For residents nearing the end of their stay in the SLHs, there was significant concern about where they might live after they left. Residents emphasized that shared experiences and goals, consistent enforcement of rules (especially the requirement of abstinence) and encouragement from probation and parole officers as particularly helpful. There was very little focus in HIV issues, even though risk behaviors were fairly common. For some residents, inconsistent enforcement of house rules was experienced as highly problematic. Research is needed to identify the organizational and operational procedures that enhance factors experienced as helpful.
Research limitations/implications
Data for this study are self-reported views and experiences. Therefore, the study may not tap into a variety of reasons for resident experiences. In addition, the data set was small ( n =28) and limited to one city in the USA (Los Angeles), so generalization of results might be limited. However, SLHs represent an important housing option for criminal justice involved persons and knowledge about resident experiences can help guide organization and operation of houses and identify areas for further research.
Originality/value
This paper is the first to document the views and experiences of persons on probation or parole who reside in sober living recovery houses. These data can be used by SLH operators to develop houses that are responsive to factors experienced as helpful and counterproductive. The significance of this paper is evident in the trend toward decreasing incarceration in the USA of persons convicted of drug offenses and the need for alcohol- and drug-free alternative living environments.
... Previous interviews with managers of SLHs suggest that the interpersonal connections among residents within the SLHs and extent to which those relationships are valued provide strong motivation to maintain recovery. 38 Previous research on SLHs has shown that psychiatric problems improve over time and that higher psychiatric distress is associated with worse substance abuse outcome. 26 Because psychiatric problems are associated with homelessness and unstable housing we wanted to assess its relative influence on substance abuse outcomes by including housing status in our models. ...
... Previous focus groups with SLH managers suggests significant modifications of standard SLHs need to be made to effectively address the needs of persons with co-occurring severe mental illness and substance abuse. 38 However, it should be noted that persons with severe mental illness constitute a minority of persons who are homeless. 1 One of the biggest criticisms of the continuum of care model for addressing substance abuse problems among homeless persons is the failure of clients to access and maintain long-term housing. ...
Studies show individuals entering sober living recovery houses (SLHs) make significant, sustained improvement on measures of substance abuse problems, employment, and arrests. The current study assessed changes in housing status among SLH residents over 18 months and the relative influences of housing status and psychiatric distress on substance abuse outcomes. Two hundred forty one men and 58 women, all age 18 and older, were interviewed within their first week of entering 20 SLHs and again at 6-, 12-, and 18-month follow-up. Between entry into the SLHs and 18-month follow-up homelessness declined from 16% to 4%, marginal housing declined from 66% to 46%, and stable housing increased from 13% to 27%. Psychiatric severity was generally mild to moderate in severity, but nevertheless showed improvement over the 18-month study period. Multivariate models showed worse substance abuse outcomes for residents with higher psychiatric distress and unstable housing. Relative to persons with stable housing, those who were homeless or marginally housed had worse outcomes and those in SLHs had better outcomes. Overall, we conclude that individuals entering SLHs show improvement in housing status and psychiatric distress, both of which are associated with better substance abuse outcomes.
... A review of studies examining the relation between homelessness and mortality found that 30-70% of deaths in homeless individuals were related to alcohol intoxication or chronic alcohol use, with average age at death ranging from 42 to 52 years (O'Connell, 2005). Treatment of alcohol use disorder in the homeless is complicated by the range of problems they face (Fischer and Breakey, 1991;Toro et al., 1995) including extreme poverty, unemployment, co-occurring drug use and mental health problems, frequent contact with correctional agencies, and poor general health (Larimer et al., 2009;Polcin and Korcha, 2015). The Institute of Medicine identified the homeless as a group in need of specialized interventions that are tailored to their specific characteristics and needs (IOM, 1990), including housing, income, and employment (Zerger, 2002). ...
Background
Recovery homes for persons with alcohol and drug problems provide an abstinent living environment and social support for recovery. Research shows residents in these homes make significant, sustained improvements. However, descriptions of recovery environments within the homes have been limited.
Purpose
The current study assessed psychometric properties for the Recovery Home Environment Scale (RHES), which assessed social environments within one type of recovery home, sober living houses (SLHs).
Methods
373 residents were interviewed at entry into the house, 1-month follow-up, and 6-month follow-up. Measures included the RHES, other measures of the social environment, days of substance use, and length of stay.
Results
Principal components analysis suggested the RHES was largely unidimensional. Exploratory factor analysis suggested items could be grouped into recovery support (3 items) and recovery skills (5 items). Cronbach’s alphas for the full scale and the recovery support and recovery skills subscales were 0.91, 0.89, and 0.87, respectively. As hypothesized, construct validity of the RHES was supported by correlations with other measures of the social environment and predictive validity was supported by associations with length of stay and substance use.
Conclusions
SLHs have been described as “the setting is the service.” However, the field has lacked a way to capture characteristics of the social environment. The RHES represents a new way to measure the recovery environment by focusing on social interactions among residents within SLHs and shared activities in the community.
