Data Sheet 1_Recovery capital, the recovery ecosystem, and substance use among recovery high school students.pdf

IntroductionAdolescent development and substance use disorder recovery unfold within diverse contexts, where recovery capital is key to planning. This study examined the relationship between social and personal recovery capital, community recovery capital, and cannabis and alcohol use among adolescents.
MethodsIn this cross–sectional study, 416 students from 20 U.S. recovery high schools reported their past 90–day alcohol and cannabis use and completed the Assessment of Recovery Capital (adapted for youth readability). Student data were merged with data from the Recovery Ecosystem Index, which measures county–level recovery ecosystem, using each high school's county as a proxy for residence. Zero–inflated Poisson regression models estimated the odds of abstinence and substance use days, with recovery capital and recovery ecosystem index as predictors, while accounting for age, race, gender, and duration of enrollment (≥90 days).
ResultsThere were 378 (91%) and 360 (87%) students who provided alcohol and cannabis use data and were subsequently included in each model, respectively. Students, 47% female and 60% White person/persons/people, reported alcohol (M = 2.0; SD = 8.1) and cannabis (M = 6.0; SD = 18.0) use days, with most reporting zero days of use (284 and 266). The results indicated that the recovery capital score was positively associated with alcohol abstinence [adjusted odds ratio (aOR) = 1.03; 95% confidence interval (CI) = 1.01–1.06; P = 0.02] and cannabis abstinence (aOR = 1.03; 95% 1.01–1.06; P = 0.01). As recovery capital increased, adolescents reported fewer alcohol use days [incidence rate ratio (IRR) = 0.93, 95% CI = 0.93–0.94; P < 0.001] and fewer cannabis use days (IRR = 0.95; 95% CI = 0.95–0.96, P < 0.001). The recovery ecosystem index was not associated with alcohol or cannabis abstinence, but days of alcohol use (IRR = 1.12; 95% CI = 1.04–1.22, P = 0.01) and cannabis use (IRR = 1.10; 95% CI = 1.05–1.15; P < 0.001) increased as the index increased.
DiscussionFindings suggest that greater recovery capital is linked to greater alcohol and cannabis abstinence among recovery high school students. Unexpected was that a higher recovery ecosystem index score was associated with more substance use days. Youth–focused recovery supports could benefit from examining how changes in individual recovery capital influence service usage and how service usage, in turn, impacts recovery capital. There is also the need for a youth–tailored recovery ecosystem measure which focuses on factors unique to their developmental phase.

引言
青少年的发展与物质使用障碍（substance use disorder）康复进程处于多样的环境语境中，恢复资本（recovery capital）是康复规划的核心要素。本研究探讨了青少年群体中社会与个人恢复资本、社区恢复资本，以及酒精与大麻使用之间的关联。

方法
本项横断面研究共纳入来自美国20所恢复高中（recovery high schools）的416名学生，参与者报告了其过去90天内的酒精与大麻使用情况，并完成了针对青少年可读性适配调整的恢复资本评估量表（Assessment of Recovery Capital）。研究将学生数据与恢复生态系统指数（Recovery Ecosystem Index）的数据进行合并：该指数用于衡量县级层面的恢复生态系统，以各高中所在县作为学生居住地的代理变量。本研究采用零膨胀泊松回归模型（Zero-inflated Poisson regression models），以恢复资本与恢复生态系统指数作为预测变量，同时控制年龄、种族、性别及入学时长（≥90天），估算戒断率与物质使用天数的发生比。

结果
最终分别有378名（91%）与360名（87%）提供了酒精与大麻使用数据的学生被纳入对应模型。样本中47%为女性，60%为白人，学生报告的酒精使用天数均值（M）为2.0，标准差（SD）为8.1；大麻使用天数均值为6.0，标准差为18.0，其中多数报告无使用天数（分别为284人和266人）。
研究结果显示，恢复资本得分与酒精戒断[校正优势比（adjusted odds ratio, aOR）=1.03；95%置信区间（confidence interval, CI）=1.01~1.06；P=0.02]及大麻戒断（aOR=1.03；95%CI=1.01~1.06；P=0.01）均呈显著正相关。随着恢复资本水平提升，青少年报告的酒精使用天数[发生率比（incidence rate ratio, IRR）=0.93，95%CI=0.93~0.94；P<0.001]与大麻使用天数（IRR=0.95；95%CI=0.95~0.96，P<0.001）均显著减少。
恢复生态系统指数与酒精或大麻戒断无显著关联，但随着指数得分升高，酒精使用天数（IRR=1.12；95%CI=1.04~1.22，P=0.01）与大麻使用天数（IRR=1.10；95%CI=1.05~1.15；P<0.001）均显著增加。

讨论
研究结果表明，恢复资本水平更高的恢复高中学生，其酒精与大麻戒断率也更高。出乎意料的是，恢复生态系统指数得分越高，青少年的物质使用天数反而越多。面向青少年的恢复支持服务可通过探究个体恢复资本的变化如何影响服务使用，以及服务使用反过来如何作用于恢复资本而优化实践。此外，还需开发针对青少年群体的定制化恢复生态系统测评工具，聚焦于其发展阶段特有的相关因素。