The aim of this article is to report lessons learned from feasibility challenges faced in a mixed-methods study designed to test the feasibility of measuring recovery in participants of an Alternative Peer Group (APG). The APG integrates pro-recovery peers and social activities into clinical practice to engage adolescents in recovery. Though well established, APGs have never been tested. This study was one phase in a line of research that aims to develop an APG evidence base. The study used a mixed-methods design and naturalistic sampling of participants of one APG program. Repeated measures analysis with linear mixed models was planned to test the hypothesis that spending time in the APG builds recovery capital, resulting in progress in the processes of recovery, and improved symptoms. Semistructured interviews were conducted and framework analysis was used to explore feasibility challenges. Recruitment and retention challenges precluded meaningful measurement of change over time in recovery. Lessons learned from qualitative findings informed multiple strategies for revisions to strengthen future study protocols. Recruitment and retention of adolescents are common challenges that can threaten a study’s validity. Researchers seeking to recruit and retain adolescents with SUD in longitudinal studies may benefit from strategies derived from this study.
Agency for Healthcare Research and Quality. (2003). The role of community-based participatory research: Creating partnerships, improving health (No. AHRQ Publication No. 03-0037). Rockville, MD. Retrieved from https://archive.ahrq.gov/research/cbprrole.htm
2.
AkersR. L.KrohnM. D.Lanza-KaduceL.RadosevichM. (1979). Social learning and deviant behavior: A specific test of a general theory. American Sociological Review, 44, 636-655.
3.
American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders (5th ed.). Arlington, VA: American Psychiatric Publishing.
BanduraA. (1969). Social-learning theory of identificatory processes. In D. A. Goslin (Ed.), Handbook of socialization theory and research (pp. 213-262).
6.
BestD.LaudetA. (2010). The potential of recovery capital. London, England: Royal Society for the encouragement of Arts, Manufactures and Commerce.
7.
BickmanL.AthayM.RiemerM.LambertE.KelleyS.BredaC.AndradeA. (2010). Manual of the Peabody treatment progress battery. Nashville, TN: Vanderbilt University.
BlackJ. J.ChungT. (2014). Mechanisms of change in adolescent substance use treatment: How does treatment work?Substance Abuse, 35, 344-351. doi:10.1080/08897077.2014.925029
10.
BrodeyB. B.McMullinD.KaminerY.WintersK.MosshartE.RosenC. S.BrodeyI. S. (2008). Psychometric characteristics of the teen addiction severity index 2. Substance Abuse, 29(2), 19-32. doi:10.1080/08897070802092942
11.
BronfenbrennerU.EvansG. (2000). Developmental science in the 21st century: Emerging questions, theoretical models, research designs and empirical findings. Social Development, 9, 115-125.
12.
BuckheitK. A.MoskalD.SpinolaS.MaistoS. A. (2018). Clinical course and relapse among adolescents presenting for treatment of substance use disorders: Recent findings. Current Addiction Reports, 5(2), 1-18.
13.
ChungT. (2014). Personal network characteristics of youth in substance use treatment: Motivation for and perceived difficulty of positive network change. Substance Abuse, 1, 1-9.
14.
ChungT.MaistoS. A. (2006). Relapse to alcohol and other drug use in treated adolescents: Review and reconsideration of relapse as a change point in clinical course. Clinical Psychology Review, 26, 149-161. doi:10.1016/j.cpr.2005.11.004
15.
CieslaJ. R.YaoP. (2011). Validation of a targeted peer relations scale for adolescents treated for substance use disorder: An application of Rasch modeling. Substance Abuse, 5, 35-44. doi:10.4137/SART.S7367
16.
ClarkeD. E.KuhlE. A. (2014). DSM-5 cross-cutting symptom measures: A step towards the future of psychiatric care?World Psychiatry, 13, 314-316.
17.
CollierC.HillikerR.OnwuegbuzieA. (2014). Alternative peer group: A model for youth recovery. Journal of Groups in Addiction & Recovery, 9, 40-53. doi:10.1080/1556035X.2013.836899
CreswellJ. W.Plano-ClarkC. V. L. (2007). Designing and conducting mixed methods research. Thousand Oaks, CA: SAGE.
20.
DennisM. L.ScottC. K.LaudetA. (2014). Beyond bricks and mortar: Recent research on substance use disorder recovery management. Current Psychiatry Reports, 16(4), 442. doi:10.1007/s11920-014-0442-3
21.
FinchA. J.MobergD. P.KruppA. L. (2014). Continuing care in high schools: A descriptive study of recovery high school programs. Journal of Child & Adolescent Substance Abuse, 23, 116-129. doi:10.1080/1067828X.2012.751269
22.
FisherJ. (2010). Development and application of a spiritual well-being questionnaire called SHALOM. Religions, 1, 105-121.
23.
Global Appraisal of Individual Needs (GAIN) Coordinating Center. (2013). Briefing book slides on all grantees in the 2012 SAMHSA/CSAT summary analytic file. Normal, IL: Chestnut.
24.
GaleN. K.HeathG.CameronE.RashidS.RedwoodS. (2013). Using the framework method for the analysis of qualitative data in multi-disciplinary health research. BMC Medical Research Methodology, 13, Article 117. doi:10.1186/1471-2288-13-117
25.
GarnerB. R.PassettiL. L.OrndorffM. G.GodleyS. H. (2007). Reasons for and attitudes toward follow-up research participation among adolescents enrolled in an outpatient substance abuse treatment program. Journal of Child & Adolescent Substance Abuse, 16(4), 45-57. doi:10.1300/J029v16n04_03
26.
GodleyS. H.SmithJ. E.PassettiL. L.SubramaniamG. (2014). The adolescent community reinforcement approach (A-CRA) as a model paradigm for the management of adolescents with substance use disorders and co-occurring psychiatric disorders. Substance Abuse, 35, 352-363. doi:10.1080/08897077.2014.936993
27.
GomezR.FisherJ. W. (2005). Item response theory analysis of the spiritual well-being questionnaire. Personality and Individual Differences, 38, 1107-1121.
28.
Gonzales-CastanedaR.KaminerY. (2016). Youth recovery from substance use disorders and co-occurring disorders: Implications of developmental perspectives on practice, assessment, definitions, and measurement (Commissioned paper by the National Academies of Sciences). Retrieved from https://sites.nationalacademies.org/cs/groups/dbassesite/documents/webpage/dbasse_173832.pdf
29.
GreenJ.ThorogoodN. (2013). Qualitative methods for health research (3rd ed.). Los Angeles, CA: SAGE.
30.
HennessyE. A. (2015). A meta-analysis exploring the relationship between 12-step attendance and adolescent substance use relapse. Journal of Groups in Addiction & Recovery, 10, 79-96.
31.
HennessyE. A. (2017). Recovery capital: A systematic review of the literature. Addiction Research & Theory, 25, 349-360. doi:10.1080/16066359.2017.1297990
32.
HennessyE. A.GlaudeM. W.FinchA. J. (2017). “Pickle or a cucumber?” Administrator and practitioner views of successful adolescent recovery. Addiction Research & Theory, 25, 208-215.
33.
HoeppnerB. B.KellyJ. F.UrbanoskiK. A.SlaymakerV. (2011). Comparative utility of a single-item versus multiple-item measure of self-efficacy in predicting relapse among young adults. Journal of Substance Abuse Treatment, 41, 305-312. doi:10.1016/j.jsat.2011.04.005
34.
HogueA.HendersonC. E.OzechowskiT. J.RobbinsM. S. (2014). Evidence base on outpatient behavioral treatments for adolescent substance use: Updates and recommendations 2007-2013. Journal of Clinical Child and Adolescent Psychology, 43, 695-720. doi:10.1080/15374416.2014.915550
35.
HolkupP. A.Tripp-ReimerT.SaloisE. M.WeinertC. (2004). Community-based participatory research: An approach to intervention research with a native American community. ANS Advances in Nursing Science, 27, 162-175. Retrieved from http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2774214/
36.
JonesK. D. (2012). Dimensional and cross-cutting assessment in the DSM-5. Journal of Counseling & Development, 90, 481-487.
37.
KaminerY.WagnerE.PlummerB.SeiferR. (1993). Validation of the Teen Addiction Severity Index (T-ASI). The American Journal on Addictions, 2, 250-254. doi:10.1111/j.1521-0391.1993.tb00427.x
38.
KaskutasL. A.WitbrodtJ.GrellaC. E. (2015). Recovery definitions: Do they change?Drug and Alcohol Dependence, 154, 85-92. doi:10.1016/j.drugalcdep.2015.06.021
39.
KellyJ. F.DowS. J.YeterianJ. D.KahlerC. W. (2010). Can 12-step group participation strengthen and extend the benefits of adolescent addiction treatment? A prospective analysis. Drug and Alcohol Dependence, 110, 117-125. doi:10.1016/j.drugalcdep.2010.02.019
40.
KellyJ. F.HoeppnerB. (2015). A biaxial formulation of the recovery construct. Addiction Research & Theory, 23, 5-9. doi:10.3109/16066359.2014.930132
41.
KellyJ. F.MyersM. G.BrownS. A. (2000). A multivariate process model of adolescent 12-step attendance and substance use outcome following inpatient treatment. Psychology of Addictive Behaviors, 14, 376-389. Retrieved from http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1945122/
42.
KellyJ. F.StoutR. L.SlaymakerV. (2013). Emerging adults’ treatment outcomes in relation to 12-step mutual-help attendance and active involvement. Drug and Alcohol Dependence, 129, 151-157. doi:10.1016/j.drugalcdep.2012.10.005
43.
KellyJ. F.UrbanoskiK. A.HoeppnerB. B.SlaymakerV. J. (2011). Facilitating comprehensive assessment of 12-step experiences: A multidimensional measure of mutual-help activity. Alcoholism Treatment Quarterly, 29, 181-203. doi:10.1080/07347324.2011.586280
44.
KvaleS.BrinkmanS. (2009). Interviews: Learning the craft of qualitative research interviewing (2nd ed.). Thousand Oaks, CA: SAGE.
45.
LanhamC. C.TiradoJ. A. (2011). Lessons in sobriety: An exploratory study of graduate outcomes at a recovery high school. Journal of Groups in Addiction & Recovery, 6, 245-263.
46.
LaudetA. B.WhiteW. L. (2008). Recovery capital as prospective predictor of sustained recovery, life satisfaction, and stress among former poly-substance users. Substance Use & Misuse, 43, 27-54. doi:10.1080/10826080701681473
47.
McKayJ. R. (2017). Making the hard work of recovery more attractive for those with substance use disorders. Addiction, 112, 751-757. doi:10.1111/add.13502
48.
MeyersK.WebbA.FrantzJ.RandallM. (2003). What does it take to retain substance-abusing adolescents in research protocols? Delineation of effort required, strategies undertaken, costs incurred, and 6-month post-treatment differences by retention difficulty. Drug & Alcohol Dependence, 69, 73-85. doi:10.1016/S0376-8716(02)00252-1
49.
MiechR. A., et al. (2017). Monitoring the Future National Survey Results on Drug use (pp. 1975-2016). Secondary School Students. Ann Arbor, MI: Institute for Social Research, The University of Michigan.
50.
NarrowW. E.ClarkeD. E.KuramotoS. J.KraemerH. C.KupferD. J.GreinerL.RegierD. A. (2013). DSM-5 field trials in the United States and Canada, Part III: Development and reliability testing of a cross-cutting symptom assessment for DSM-5. American Journal of Psychiatry, 170, 71-82.
51.
NashA. J.CollierC. (2016a). The alternative peer group: A developmentally appropriate recovery support model for adolescents. Journal of Addictions Nursing, 27, 109-119. doi:10.1097/JAN.0000000000000122
52.
NashA. J.CollierC. (2016b). Operationalizing youth recovery. In GordonA. (Ed.), The 40th Annual Meeting of AMERSA: Highlights, abstracts and awards. Substance Abuse, Podium Presentation. Association for Medical Education and Research (AMERSA) 40th Annual Conference (In Substance Abuse Vol. 38, No. 1; abstract Supp. 1, p. 37).
53.
NashA. J.MarcusM. T.EngebretsonJ. C.BuksteinO. G. (2015). Recovery from adolescent substance use disorder: Young people in recovery describe the process and keys to success in an alternative peer group. Journal of Groups in Addiction & Recovery, 10, 290-312. doi:10.1080/1556035X.2015.1089805
54.
National Center on Addiction and Substance Abuse. (2011). Adolescent Substance Abuse: America’s # 1 Public Health Problem. New York, NY: National Center on Addiction and Substance Abuse at Columbia University.
55.
NorcrossJ. C.KrebsP. M.ProchaskaJ. O. (2011). Stages of change. Journal of Clinical Psychology, 67, 143-154. doi:10.1002/jclp.20758
56.
PassettiL. L.GodleyM. D.KaminerY. (2016). Continuing care for adolescents in treatment for substance use disorders. Retrieved from doi:10.1016/j.chc.2016.06.003
57.
PerryJ. L., et al. (2011). “Prefrontal Cortex and Drug Abuse Vulnerability: Translation to Prevention and Treatment Interventions.”Brain research reviews65, 124-149.
SheedyC. K.WhitterM.ChinB. (2013). SAMHSA national leadership summit on youth recovery meeting report (No. HHSS280201100002C). Bringing Recovery Supports to Scale Technical Assistance Center Strategy. Retrieved from http://brsstacs.center4si.com/SAMHSA_National_Summit_508.pdf
61.
SlavetJ. D.SteinL.ColbyS. M.BarnettN. P.MontiP. M.GolembeskeC.Lebeau-CravenR. (2006). The marijuana ladder: Measuring motivation to change marijuana use in incarcerated adolescents. Drug and Alcohol Dependence, 83, 42-48.
62.
SquegliaL. M.GrayK. M. (2016). Alcohol and drug use and the developing brain. Current Psychiatry Reports, 18(5), 1-10.
63.
StorrC. L.PacekL. R.MartinsS. S. (2013). Substance use disorders and adolescent psychopathology. Public Health Reviews, 34(2), 1-42.
64.
Substance Abuse and Mental Health Services Administration. (2009). Designing a recovery-oriented care model for adolescents and transition age youth with substance use or co-occurring mental health disorders. Rockville, MD: U.S. Department of Health and Human Services. Retrieved from https://gucchdtacenter.georgetown.edu/publications/AdolescentRecoveryReport.pdf
65.
Substance Abuse and Mental Health Services Administration. (2017). Recovery and recovery support. Retrieved from http://www.samhsa.gov/recovery
66.
WhiteW. L. (2012). Recovery/remission from substance use disorders: An analysis of reported outcomes in 415 scientific reports, 1868–2011. Rockville, MD: Substance Abuse and Mental Health Services Administration.
67.
WhiteW. L.RothJ. (2012). New addiction recovery support institutions: Mobilizing support beyond professional addiction treatment and recovery mutual aid. Journal of Groups in Addiction & Recovery, 7, 297-317.
68.
WintersK. C.KaminerY. (2008). Screening and assessing adolescent substance use disorders in clinical populations. Journal of the American Academy of Child & Adolescent Psychiatry, 47, 740-744. doi:10.1097/CHI.0b013e31817395cf
69.
WintersK. C.KaminerY. (2011). Adolescent behavioral change: Process and outcomes. In Clinical manual of adolescent substance abuse treatment (pp. 143-162). Washington, DC: American Psychiatric Publishing.
70.
YaoP.CieslaJ. R.MazurekK. D.SpearS. F. (2012). Peer relations scale for adolescents treated for substance use disorder: A factor analytic presentation. Substance Abuse: Treatment, Prevention, and Policy, 7, 1-6.
71.
YeterianJ. D.DowS. J.KellyJ. F. (2011). Ensuring retention in longitudinal studies: A practical evaluation of an intensive follow-up protocol and suggested adaptations. International Journal of Social Research Methodology, 15(5), 369-383. doi:10.1080/13645579.2011.623958
72.
YeterianJ. D.DowS. J.KellyJ. F. (2012). Ensuring retention in longitudinal studies: A practical evaluation of an intensive follow-up protocol and suggested adaptations. International Journal of Social Research Methodology, 15, 369-383. doi:10.1080/13645579.2011.623958
73.
SheedyC. K.WhitterM.ChinB. (2013). SAMHSA National Leadership Summit on Youth Recovery Meeting Report. HHSS280201100002C Vol. Bringing Recovery Supports to Scale Technical Assistance Center Strategy (BRSS TACS).
