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新兴事物:对美国康复社区中心的物理、运营、人员及服务特征的调查。

New kid on the block: An investigation of the physical, operational, personnel, and service characteristics of recovery community centers in the United States.

作者信息

Kelly John F, Fallah-Sohy Nilofar, Vilsaint Corrie, Hoffman Lauren A, Jason Leonard A, Stout Robert L, Cristello Julie V, Hoeppner Bettina B

机构信息

Recovery Research Institute, Massachusetts General Hospital and Harvard Medical School, Harvard Medical School, 151 Merrimac Street, Boston, MA 02114, United States of America.

Recovery Research Institute, Massachusetts General Hospital and Harvard Medical School, Harvard Medical School, 151 Merrimac Street, Boston, MA 02114, United States of America.

出版信息

J Subst Abuse Treat. 2020 Apr;111:1-10. doi: 10.1016/j.jsat.2019.12.009. Epub 2019 Dec 19.

Abstract

BACKGROUND

Professional treatment and non-professional mutual-help organizations (MHOs) play important roles in mitigating addiction relapse risk. More recently, a third tier of recovery support services has emerged that are neither treatment nor MHO that encompass an all-inclusive flexible approach combining professionals and volunteers. The most prominent of these is Recovery Community Centers (RCCs). RCC's goal is to provide an attractive central recovery hub facilitating the accrual of recovery capital by providing a variety of services (e.g., recovery coaching; medication assisted treatment [MAT] support, employment/educational linkages). Despite their growth, little is known formally about their structure and function. Greater knowledge would inform the field about their potential clinical and public health utility.

METHOD

On-site visits (2015-2016) to RCCs across the northeastern U.S. (K = 32) with semi-structured interviews conducted with RCC directors and online surveys with staff assessing RCCs': physicality and locality; operations and budgets; leadership and staffing; membership; and services.

RESULTS

Physicality and locality: RCCs were mostly in urban/suburban locations (90%) with very good to excellent Walk Scores reflecting easy accessibility. Ratings of environmental quality indicated neighborhood/grounds/buildings were moderate-good attractiveness and quality. Operations: RCCs had been operating for an average of 8.5 years (SD = 6.2; range 1-33 years) with budgets (mostly state-funded) ranging from $17,000-$760,000/year, serving anywhere from a dozen to more than two thousand visitors/month. Leadership and staffing: Center directors were mostly female (55%) with primary drug histories of alcohol (62%), cocaine (19%), or opioids (19%). Most, but not all, directors (90%) and staff (84%) were in recovery. Membership: A large proportion of RCC visitors were male (61%), White (72%), unemployed (50%), criminal-justice system-involved (43%) and reported opioids (35%) or alcohol (33%) as their primary substance. Roughly half were in their first year of recovery (49%), but about 20% had five or more years. Services: RCCs reported a range of services including social/recreational (100%), mutual-help (91%), recovery coaching (77%), and employment (83%) and education (63%) assistance. Medication-assisted treatment (MAT) support (43%) and overdose reversal training (57%) were less frequently offered, despite being rated as highly important by staff.

CONCLUSIONS

RCCs are easily accessible, attractive, mostly state-funded, recovery support hubs providing an array of services to individuals in various recovery stages. They appear to play a valued role in facilitating the accrual of social, employment, housing, and other recovery capital. Research is needed to understand the relative lack of opioid-specific support and to determine their broader impact in initiating and sustaining remission and cost-effectiveness.

摘要

背景

专业治疗和非专业互助组织在降低成瘾复发风险方面发挥着重要作用。最近,出现了第三层康复支持服务,既不是治疗也不是互助组织,而是一种将专业人员和志愿者结合起来的全方位灵活方法。其中最突出的是康复社区中心(RCCs)。RCC的目标是提供一个有吸引力的中央康复中心,通过提供各种服务(如康复指导;药物辅助治疗[MAT]支持、就业/教育联系)来促进康复资本的积累。尽管它们在不断发展,但对其结构和功能的正式了解却很少。更多的了解将使该领域了解它们潜在的临床和公共卫生效用。

方法

2015年至2016年对美国东北部的RCCs进行实地考察(K = 32),与RCC主任进行半结构化访谈,并对工作人员进行在线调查,以评估RCCs的:地理位置;运营和预算;领导和人员配备;会员情况;以及服务。

结果

地理位置:RCC大多位于城市/郊区(90%),步行分数非常好到优秀,表明交通便利。环境质量评级表明社区/场地/建筑具有中等至良好的吸引力和质量。运营:RCC平均运营了8.5年(标准差 = 6.2;范围1 - 33年),预算(大多由州政府资助)从每年17,000美元到760,000美元不等,每月服务的访客人数从十几人到两千多人不等。领导和人员配备:中心主任大多为女性(55%),主要药物成瘾史为酒精(62%)、可卡因(19%)或阿片类药物(19%)。大多数但并非所有的主任(90%)和工作人员(84%)都处于康复状态。会员情况:RCC访客中很大一部分是男性(61%)、白人(72%)、失业者(50%)、涉及刑事司法系统(43%),并报告阿片类药物(35%)或酒精(33%)为其主要成瘾物质。大约一半处于康复的第一年(49%),但约20%有五年或更长时间的康复期。服务:RCC报告了一系列服务,包括社交/娱乐(100%)、互助(91%)、康复指导(77%)以及就业(83%)和教育(63%)援助。药物辅助治疗(MAT)支持(43%)和过量用药逆转培训(57%)提供得较少,尽管工作人员认为这些非常重要。

结论

RCC交通便利、颇具吸引力,大多由州政府资助,是为处于不同康复阶段的个人提供一系列服务的康复支持中心。它们似乎在促进社会、就业、住房和其他康复资本的积累方面发挥着重要作用。需要进行研究以了解阿片类药物特定支持相对缺乏的情况,并确定它们在启动和维持缓解以及成本效益方面的更广泛影响。

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