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Voicing Student Recovery: Embracing Diversity in Collegiate Recovery Programs

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Title: Voicing Student Recovery: Embracing Diversity in Collegiate Recovery Programs
Language: English
Authors: Evelyn Vázquez (ORCID 0000-0002-3781-7466), Tanya Nieri, Frances Fernandes, Danielle Cravalho, Fiona Ryan-Shirey, Lisa Molina, Sarah Marie Pemberton, Ann M. Cheney
Source: Journal of American College Health. 2024 72(8):2546-2555.
Availability: Taylor & Francis. Available from: Taylor & Francis, Ltd. 530 Walnut Street Suite 850, Philadelphia, PA 19106. Tel: 800-354-1420; Tel: 215-625-8900; Fax: 215-207-0050; Web site: http://www.tandf.co.uk/journals
Peer Reviewed: Y
Page Count: 10
Publication Date: 2024
Document Type: Journal Articles
Reports - Research
Education Level: Higher Education
Postsecondary Education
Descriptors: Diversity, Minority Groups, Barriers, Drug Addiction, Drug Rehabilitation, Alcohol Abuse, College Students, Intervention, Access to Health Care, Prevention, School Health Services, Student Needs, Cooperative Planning
DOI: 10.1080/07448481.2022.2119400
ISSN: 0744-8481
1940-3208
Abstract: Objective: To discuss the engagement of patients and stakeholders (i.e., faculty, staff, healthcare providers, and university administrators) in capacity building activities to prepare for future patient-centered research on collegiate recovery. Participants: 502 attended capacity building activities and provided input on priorities for future research in collegiate recovery and 77 participated in the deliberative democracy forum process. Methods: We used surveys and the deliberative democracy forum method, which includes framing sessions and forums for data collection. This method enables individuals with diverse backgrounds to share and learn about differing viewpoints to build consensus for decision making. Results: Forum participants prioritized barriers to recovery for future research and discussed the need to address diversity in collegiate recovery programs, including racial/ethnic diversity in the student recovery population and diversity in pathways to recovery, to decrease barriers to recovery. Conclusions: Institutional support for research on collegiate recovery is critical to move the field forward.
Abstractor: As Provided
Entry Date: 2024
Accession Number: EJ1448356
Database: ERIC
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  Value: <anid>AN0180828327;acl01nov.24;2024Nov14.03:52;v2.2.500</anid> <title id="AN0180828327-1">Voicing student recovery: Embracing diversity in collegiate recovery programs </title> <p>Objective: To discuss the engagement of patients and stakeholders (ie, faculty, staff, healthcare providers, and university administrators) in capacity building activities to prepare for future patient-centered research on collegiate recovery. Participants: 502 attended capacity building activities and provided input on priorities for future research in collegiate recovery and 77 participated in the deliberative democracy forum process. Methods: We used surveys and the deliberative democracy forum method, which includes framing sessions and forums for data collection. This method enables individuals with diverse backgrounds to share and learn about differing viewpoints to build consensus for decision making. Results: Forum participants prioritized barriers to recovery for future research and discussed the need to address diversity in collegiate recovery programs, including racial/ethnic diversity in the student recovery population and diversity in pathways to recovery, to decrease barriers to recovery. Conclusions: Institutional support for research on collegiate recovery is critical to move the field forward.</p> <p>Keywords: Barriers to recovery; college health; collegiate recovery; critical theory; deliberative methods; diversity in recovery</p> <hd id="AN0180828327-2">Introduction</hd> <p>We know relatively little about the experiences of the ∼9% (22.35 million persons) of the United States (US) adult population in recovery from substance use, including how they resolve alcohol and other drug (AOD) problems and maintain recovery.[<reflink idref="bib1" id="ref1">1</reflink>] We know even less about recovery from AOD among students in higher education. College students have high rates of AOD use.[<reflink idref="bib2" id="ref2">2</reflink>],[<reflink idref="bib3" id="ref3">3</reflink>] Population-based studies indicate that approximately 9% of college students ages 18–22 meet the criteria for past-year alcohol use disorder.[<reflink idref="bib4" id="ref4">4</reflink>]</p> <p>A significant body of work exists on policy, practice, and AOD treatment and recovery, but little attention has been given to college students in recovery from AODs.[<reflink idref="bib5" id="ref5">5</reflink>] An estimated 600,000 of college students are in recovery from AOD problems (ACHA-NCHA, 2021). While we know this population of adults faces challenges in maintaining sobriety in the recovery-hostile environment of a college campus,[<reflink idref="bib6" id="ref6">6</reflink>] we know little about the lived experiences of students in recovery, including who they are (eg, race/ethnicity, LGBTQ+, undergraduate, graduate, professional student), how they resolve AOD problems, how they maintain recovery, and what they need in terms of collegiate recovery support and management.</p> <p>Nationwide empirical evidence shows poly-drug use, including alcohol, marijuana, and other drugs (heroin, crack or cocaine, pain medication) is common among this recovery population.[<reflink idref="bib7" id="ref7">7</reflink>] Students in recovery are often younger (mean age of 26) than most other adults in recovery (age 25–49), and their substance use histories are more severe. These students often feel isolated and alienated from their campus community, mainly because the mainstream college culture celebrates excessive drinking and drug use.[<reflink idref="bib8" id="ref8">8</reflink>]</p> <p>Recovery plays a significant role in college students' well-being and psychological development. Ninety-five percent of students in college recovery programs (CRPs) or collegiate recovery communities (CRCs) maintain sobriety while attending college.[<reflink idref="bib9" id="ref9">9</reflink>] In general, collegiate recovery programs have been found to reduce relapse and alcohol and drug-related cravings, offer supportive environments, and facilitate educational goals.[<reflink idref="bib10" id="ref10">10</reflink>] Despite their potential for positive impacts, higher education institutions are often hesitant to provide financial support and services to CRPs or CRCs because of the stigma around substance use, addiction, and recovery from AODs.[<reflink idref="bib11" id="ref11">11</reflink>] This lack of institutional investment thwarts growth in the field and contributes to a lack of diversity among students accessing CRPs/CRCs as well as the limited ability of these programs to support racial-ethnic and gender minority students in recovery.</p> <hd id="AN0180828327-3">Diversity in substance use disorder type and pathways to recovery</hd> <p>The Substance Abuse and Mental Health Services Administration (SAMHSA) defines recovery as "a process of change through which people improve their health and wellness, live self-directed lives, and strive to reach their full potential."[<reflink idref="bib12" id="ref12">12</reflink>] This lifelong process of change is shaped by the social interactions of individuals in their recovery environment.[<reflink idref="bib13" id="ref13">13</reflink>] These environments provide supportive and meaningful community networks, which can create safer spaces promoting hope and motivation while students pursue a transformative and restorative pathway of recovery.</p> <p>However, students of color and members of the LGBTQ + community may have more difficulty establishing community when there is a lack of student, staff, and/or faculty diversity on campus. Or, the recovery resources and services available to them fail to account for their cultural, racial/ethnic, and gender identities and experiences. Many recovery methods (eg, harm reduction, abstinence, and 12-step programs) were designed by white men for white men[<reflink idref="bib6" id="ref14">6</reflink>]; despite being presented as colorblind and universally applicable, they often are not. Studies show that people of color and LGBTQ + people benefit from culturally specific, tailored recovery programs.[<reflink idref="bib14" id="ref15">14</reflink>],[<reflink idref="bib15" id="ref16">15</reflink>]</p> <p>Finally, campus recovery communities and programs may not provide diverse pathways to recovery nor address the systemic oppression experienced by students of color and LGBTQ + students that shape recovery pathways. US higher education institutions typically have a colonial, white/European, cisgender culture.[<reflink idref="bib16" id="ref17">16</reflink>] Students of color and LGBTQ + students experience multiple forms of exclusion and discrimination during their college experience,[<reflink idref="bib17" id="ref18">17</reflink>] and may also experience cultural misorientation—that is, overidentification with the dominant European American culture—which, in turn, may be a factor in their AOD problems.[<reflink idref="bib18" id="ref19">18</reflink>],[<reflink idref="bib19" id="ref20">19</reflink>] Students of color may not pursue or access student health services or campus recovery resources because that do not address the oppression embedded in the social structure, which assumes there are limited pathways to achieving sobriety (eg, residential or out-patient treatment services).</p> <p>This study, an engagement award funded by the Patient Centered Outcomes Research Institute (PCORI), aimed to build the capacity of patients (ie, students in recovery from AOD problems) and diverse stakeholders, including faculty, staff, student allies, university administrators, and healthcare providers to partner in patient-centered outcomes and comparative effectiveness research (PCOR/CER). PCOR/CER engages patients and stakeholders in the development of research questions, patient outcomes, and study designs on health topics meaningful to patients and include stakeholder input and is intended to establish the best possible evidence for patients and providers to make healthcare decisions.[<reflink idref="bib20" id="ref21">20</reflink>],[<reflink idref="bib21" id="ref22">21</reflink>]</p> <p>In this article, we present both our engagement and capacity building activities as well as data collected throughout the engagement process that will inform next steps for PCOR/CER. We also frame our analysis of collected data within critical approaches to identify gaps and needs in the field based on the perspectives of individuals not typically represented in recovery scholarship, which include, but are not limited to, racially/ethnically diverse students, non-gender conforming students, first-generation students, and university staff providing recovery-related services.</p> <hd id="AN0180828327-4">Methods</hd> <p>We used a community-based participatory research approach (CBPR), which focuses on shared decision making, co-creation of knowledge, and resource sharing,[<reflink idref="bib22" id="ref23">22</reflink>] to engage stakeholders (eg, students, faculty, staff, healthcare providers, and university administrators) in capacity building activities and identifying priorities for future PCOR/CER on collegiate recovery. As part of our engagement activities, we collaborated with students in recovery, academic researchers, and campus and community practitioners to organize a webinar and podcast series presented by practitioners and students in recovery. A 10-person steering council with representation from all stakeholder groups met quarterly throughout the project to guide activity. The study was approved by the Institutional Review Board (IRB) at a large US Western University.</p> <hd id="AN0180828327-5">Study setting</hd> <p>Our study was conducted within a US Western University public research university system. In terms of diversity, more than half of the campuses in the university system are recognized as Hispanic-serving Institutions, defined as schools whose student population is at least 25% Hispanic (cite).[<reflink idref="bib23" id="ref24">23</reflink>] Forty percent of undergraduate students in this large public university system are first-generation, more than 25% self-identify as members of underrepresented minorities, and 35% are Pell Grant recipients.</p> <p>Students are automatically enrolled in the university's student health plan, which offers medical, pharmacy, dental, vision, mental health, as well as substance use disorder benefits. Students can access primary healthcare services at outpatient student health centers staffed by physicians, mid-level practitioners (eg, nurse practitioners), nurses, and pharmacists. They can also access free-to-students behavioral health services at student counseling and psychological services. For specialized services, the student health centers coordinate off-campus inpatient and outpatient care. Only a few campuses dedicate a full-time staff member to oversee their collegiate recovery program, though most of those without established programs offer on-campus resources (eg, student-led meetings) and/or referrals to off-campus services.</p> <hd id="AN0180828327-6">Data collection</hd> <p>In fall 2019 to spring 2020, we held several capacities building activities, including 3-part training series and a 4-part webinar series on collegiate recovery led by professionals in the field and accompanied by student-centered podcasts that aligned with the webinar topics. During capacity building activities, we collected input from on future topics for collegiate recovery research. After each engagement activity, we asked participants, "If you were to suggest a topic for future research on collegiate recovery, what would it be?" We compiled the text responses and used them to inform subsequent data collection using the deliberative democracy forum method. This approach is commonly used to reach consensus on policy change or civic action[<reflink idref="bib21" id="ref25">21</reflink>]; and is increasingly used to create spaces where private or stigmatized concerns are transformed into public health issues for deliberation.[<reflink idref="bib24" id="ref26">24</reflink>],[<reflink idref="bib25" id="ref27">25</reflink>] A workgroup of student patients and stakeholders (academics, healthcare providers) then discussed the prioritized topic and potential research questions and study designs for next steps for PCOR/CER. Figure 1 provides an overview of the engagement process, capacity building activities, deliberative forum methods, and next step research workgroup.</p> <p>Graph: Figure 1. Deliberative democracy forum method.</p> <p>The deliberative democracy forum method is informed by deliberative democracy theory which holds that informed, well-reasoned input from people of diverse backgrounds is critical to decision making.[<reflink idref="bib26" id="ref28">26</reflink>] Deliberation engages diverse stakeholders in collectively weighing issues, or possible solutions intended to reach consensus on collective action.[<reflink idref="bib27" id="ref29">27</reflink>] It creates a neutral space to diminish power imbalances and enables individuals of diverse backgrounds (eg, race/ethnicity, sexuality, status, occupation) to share and learn about differing viewpoints, find a common sense of purpose, and build consensus for decision making.[<reflink idref="bib28" id="ref30">28</reflink>],[<reflink idref="bib29" id="ref31">29</reflink>] The purpose is to produce informed, well-reasoned, and fair public decisions to inform collective action.</p> <p>We used deliberative democracy forums (DDF), an approach previously employed to identify patient-centered health priorities and initiate community mobilization around collectively defined solutions.[<reflink idref="bib25" id="ref32">25</reflink>],[<reflink idref="bib30" id="ref33">30</reflink>] This method's structured process involves framing the issue via group framing sessions, developing an issue book, and conducting forums to put diverse stakeholders in the same space to deliberate the pros and cons of alternate choices.</p> <p>In Spring 2020, the academic-community team implemented the DDF process. We collected data virtually using the Zoom conference platform because of COVID-19. To build students' capacity to partner in future research on collegiate recovery, we trained 12 students (undergraduate and graduate) to assist with data collection and analysis. All students attended a two-part training series on deliberative methodology and group facilitation. Students involved in data analysis took additional training on data quantification (ie, cultural domain analysis) and template and matrix analysis of narrative text (see methods described below for additional information).</p> <hd id="AN0180828327-7">Framing the issue</hd> <p>Two of our four framing sessions involved students in recovery and student allies (<emph>n</emph> = 9) and two with healthcare providers, faculty, staff, parents, and other perspectives (<emph>n</emph> = 11). During this phase of data collection potential solutions to the issue were generated and reduced to three or four topics to be deliberated during forums. As Table 1 indicates, 39 unique ideas were identified for future research on collegiate recovery.</p> <p>Table 1. Ideas for future research on collegiate recovery.</p> <p> <ephtml> <table><tbody valign="top"><tr><td>1</td><td>Abstinence</td></tr><tr><td>2</td><td>Academic performance</td></tr><tr><td>3</td><td>Addiction awareness</td></tr><tr><td>4</td><td>Addiction beliefs</td></tr><tr><td>5</td><td>Allies</td></tr><tr><td>6</td><td>Barriers to healthcare</td></tr><tr><td>7</td><td>Brain chemistry</td></tr><tr><td>8</td><td>Campus culture</td></tr><tr><td>9</td><td>Cannabis concentrates</td></tr><tr><td>10</td><td>CBD</td></tr><tr><td>11</td><td>Connecting students</td></tr><tr><td>12</td><td>CRP impacts</td></tr><tr><td>13</td><td>Diverse drug use experiences</td></tr><tr><td>14</td><td>Engaging students in care</td></tr><tr><td>15</td><td>Faith-based programs</td></tr><tr><td>16</td><td>Harm reduction</td></tr><tr><td>17</td><td>Help seeking</td></tr><tr><td>18</td><td>Inclusive communities</td></tr><tr><td>19</td><td>Integrated care</td></tr><tr><td>20</td><td>Linkage to care</td></tr><tr><td>21</td><td>Marijuana legalization</td></tr><tr><td>22</td><td>Mental health</td></tr><tr><td>23</td><td>Mindfulness approaches</td></tr><tr><td>24</td><td>Peer-based programs</td></tr><tr><td>25</td><td>Pleasure in SU</td></tr><tr><td>26</td><td>Policies</td></tr><tr><td>27</td><td>Pre-teen & teen AOD use</td></tr><tr><td>28</td><td>Recovery pathways</td></tr><tr><td>29</td><td>Recruitment</td></tr><tr><td>30</td><td>Retention</td></tr><tr><td>31</td><td>Sober housing</td></tr><tr><td>32</td><td>Stigma</td></tr><tr><td>33</td><td>Student recovery needs</td></tr><tr><td>34</td><td>Substance use patterns</td></tr><tr><td>35</td><td>SUD pathways</td></tr><tr><td>36</td><td>Support networks</td></tr><tr><td>37</td><td>Vaping</td></tr><tr><td>38</td><td>Violence exposure</td></tr><tr><td>39</td><td>Web-based services</td></tr></tbody></table> </ephtml> </p> <p>Framing sessions began with pile sorting. Facilitators instructed each participant to place the 39 items into piles based on similarity using the remote mouse function. Participants then labeled each pile and explained why items belonged together. After, we conducted a group pile sort in which participants collectively placed the items into four piles, named the piles, and explained why they belonged together. We recorded and transcribed the collective pile sorting discussions.</p> <p>We analyzed the pile sort data using cultural domain analysis (CDA), which examines how members of a cultural group express parts of that culture through cognitive domains (ie, defined by a set of words, phrases, or concepts that symbolize an idea[<reflink idref="bib30" id="ref34">30</reflink>]).</p> <p>We assigned a unique number to each of the 39 items and recoded pile sort data (replaced the text with a number replaced the text) and entered it into Anthropac, an analytic program designed to collect and analyze cultural domain data by identifying underlying relationships between items and sorting them into meaningful group clusters.[<reflink idref="bib31" id="ref35">31</reflink>] As indicated in Figure 2, four clusters were identified: pathways to recovery (Group 1); barriers to recovery (Group 2); campus contributions to recovery (Group 3); and polarized ideas about substances (Group 4). These clusters informed the development of the issue book and were deliberated during the forums.</p> <p>PHOTO (COLOR): Figure 2. Grouping of items.</p> <hd id="AN0180828327-8">Writing the issue book</hd> <p>Issue books contain background information on the topic of deliberation and outline the issues for deliberation. The information is intended to be neutral, nonpartisan, and non-prescriptive, sufficient for forum participants to engage in meaningful deliberation.[<reflink idref="bib32" id="ref36">32</reflink>] Student facilitators (including students in recovery and student allies) and community-academic team members with expertise in deliberative methods developed the issue book. The content was informed by key stakeholder input during engagement activities, discussions during the framing sessions, and national and local data on collegiate recovery.</p> <p>Consistent with standard issue book guidelines, we included a descriptive title, background information on students in recovery, and descriptions of the four issues to be deliberated during forums. Each issue included three questions aimed to elicit the rationale, strengths and resources, and barriers to conducting future work on the issue. The following questions prompted deliberation of each issue: 1) Why should we focus on [name of issue]? 2) What are existing strengths and resources in our community that can be used to conduct future work on [name of issue]? and 3) What are some of the barriers to conducting future work on [name of issue]?</p> <hd id="AN0180828327-9">Conducting the deliberative democracy forums</hd> <p>We conducted four 90-minute virtual forums using the Zoom video conferencing platform with 77 participants between May and June 2020. We used snowball sampling (a version of chain referral) and purposive sampling (nonrandomized selection) to recruit participants across four settings. Fifty-four participants responded to a brief socio-demographic survey that also asked participants to select their prioritized topic. Forum attendees were predominantly students (35%) who self-identified as cis women (65%) and were nonwhite (50%). As shown in Table 2, participants represented diverse backgrounds and perspectives, including students in recovery, student-allies of people in recovery, staff, faculty, university administrators, healthcare providers, police, and community-based organizations.</p> <p>Table 2. Forum participant sociodemographic information.</p> <p> <ephtml> <table><thead><tr><td><italic>N =</italic> 54</td><td><italic>N</italic></td><td>%</td></tr></thead><tbody valign="top"><tr><td>Affiliation</td><td /><td /></tr><tr><td> Students</td><td char=".">19</td><td char=".">34.04%</td></tr><tr><td> Faculty</td><td char=".">9</td><td char=".">19.15%</td></tr><tr><td> Staff members</td><td char=".">15</td><td char=".">31.91%</td></tr><tr><td> Healthcare provider</td><td char=".">3</td><td char=".">6.38%</td></tr><tr><td> Employees by a community-based organization</td><td char=".">2</td><td char=".">4.26%</td></tr><tr><td> Other perspective</td><td char=".">2</td><td char=".">4.26%</td></tr><tr><td>Identify as</td><td /><td /></tr><tr><td> Hispanic or Latino</td><td char=".">11</td><td char=".">23.40%</td></tr><tr><td> Asian</td><td char=".">3</td><td char=".">6.38%</td></tr><tr><td> Black or African American</td><td char=".">2</td><td char=".">4.26%</td></tr><tr><td> Native Hawai'ian or Other Pacific Islander</td><td char=".">1</td><td char=".">2.13%</td></tr><tr><td> White</td><td char=".">24</td><td char=".">51.06%</td></tr><tr><td> Other</td><td char=".">6</td><td char=".">12.77%</td></tr><tr><td>Gender</td><td /><td /></tr><tr><td> Cis woman</td><td char=".">31</td><td char=".">65.96%</td></tr><tr><td> Cis man</td><td char=".">16</td><td char=".">34.04%</td></tr></tbody></table> </ephtml> </p> <p>Participants received an electronic copy of the issue book and were asked to review it prior to the forum. Community-academic team members made PowerPoint presentations on the information in the issue book, including a review of the four issues, the purpose of deliberation, and the forum structure. We used Zoom's breakout room function to hold 30-minute, small-group deliberation, followed by 60-second reports from each group and five-minutes of full-group deliberation per issue. Finally, participants identified common ground or shared ideas represented across the small- and large-group deliberations. Facilitators asked participants, "If we have to choose only one of the four issues, which one would it be?" Using the Zoom polling function, participants selected one option and the results were presented in real time. Participants then shared their ideas for action to advance research on the identified topic. At the end of each forum, participants provided their sociodemographic information and were asked via brief survey to select one of the issues for future research on collegiate recovery.</p> <p>Small-group and large-group deliberations were audio recorded, transcribed, and analyzed using a two-step analytic process: summary template and cross-case matrix analysis.[<reflink idref="bib33" id="ref37">33</reflink>] Team members read the transcripts line by line and inserted data into summary templates; these included exemplar quotes from the small- and large-group deliberations. A matrix structured with small- and large-group deliberations as rows and the issues as columns was further broken down by rationale, strengths and resources, and barriers, and used to synthesize information in the summary templates. The matrix condensed the data and facilitated identification of themes and patterns across deliberation groups.[<reflink idref="bib33" id="ref38">33</reflink>] This approach allowed for an iterative analysis that generated a collective prioritization and understanding of future research on collegiate recovery.</p> <hd id="AN0180828327-10">Results</hd> <p>The general themes that emerged from small group deliberations are shown in Table 3 and include the rationale or reason, strengths and resources, and barriers to conducting research on each of the four issues. Below, we highlight the key points per issue and qualitative evidence for each of those issues that arose across forums.</p> <p>Table 3. Deliberation of issues.</p> <p> <ephtml> <table><thead><tr><td>Issue</td><td>Rational/reasons</td><td>Strengths and resources</td><td>Barriers</td></tr></thead><tbody valign="top"><tr><td>Barriers to recovery</td><td>Equal access to recovery resources and support; further investigation of recovery programs for underrepresented students, as well as peer-support, non-religious, and mental health focused programs; education for faculty and administration</td><td>Previous research in related fields (psychology, psychiatry); knowledge and resources held by healthcare professionals working in recovery communities or treatment facilities</td><td>Stigmatizing attitudes around recovery in campus contexts; lack of campus administrative support; limited funding opportunities; limited access to students in recovery; lack of diversity among researchers</td></tr><tr><td>Campus contributions to recovery</td><td>Infrastructure and resources for student recovery; need to raise awareness about students in recovery; educate administrators on addition and recovery</td><td>Existing infrastructure and student health services; identify students in recovery through existing on-campus networks; sober living spaces; designated spaces for students in recovery</td><td>Stigma; internal competition for campus resources; focus on harm reduction</td></tr><tr><td>Pathways to recovery</td><td>Early intervention and relapse prevention; allocation of campus resources; increased awareness about students in recovery; diversity in pathways for infrastructure development; stigma reduction</td><td>Peer-based groups; counseling program; recreational activities and resources; administrative support for student health; existing networks, programs, and organizations</td><td>Stigma and shame; lack of funding; student hesitancy to participate in research; campus culture of drinking</td></tr><tr><td>Polarized ideas about substances</td><td>Identify harm reduction strategies; raise awareness about polarizing views on substances; create safe spaces for conversations; public health education on substances</td><td>Existing alcohol and tobacco use education and public health programming</td><td>Complex topic due to policies, normalization of use, and minimization of harmful health effects</td></tr></tbody></table> </ephtml> </p> <hd id="AN0180828327-11">Common ground and collegiate recovery research priorities</hd> <p>Nearly a third of all participants (64%) prioritized "barriers to recovery" as the topic for future collegiate recovery research. Not only did participants prioritize this via their individual responses, but it was also collectively prioritized during the forum discussion. "Barriers to Recovery" was top priority in three of the four forums; 65% of participants voted for this topic in forum 1, 57% in forum 2, and 50% in forum 3. Only in forum 4 did participants differ: 75% selected campus contributions to recovery as the preferred focus of future research. In post-forum responses, 56% of all participants surveyed selected "Barriers to Recovery" as the future research priority (Figure 3).</p> <p>PHOTO (COLOR): Figure 3. Prioritized topics.</p> <hd id="AN0180828327-12">Barriers to recovery</hd> <p>Forum participants indicated the need to provide equal access to recovery resources and support. As the below quote illustrates, students in recovery are diverse and social factors may contribute to disparities in health or treatment seeking:</p> <p>Something to mention about barriers to recover is to recognize that students come from a diverse amount (sic) of communities, some from underserved populations. Adhering and making sure that we are aware of these students needs and how culture or environment might influence students' decisions to seek recovery. They may feel more comfortable engaging with peers from similar backgrounds or staff as well. Health disparities carry on to this field and is something to keep in mind when deciding on which issue to focus on.</p> <p>A sentiment that this participant and others shared was attending to diversity in recovery models and services:</p> <p>Would be good to look in to culturally and linguistically relevant recovery models/services and to partner/collaborate with community-based recovery programs especially in Asian American and Pacific Island communities.</p> <p>Many institutional strengths within university settings and community resources can be employed to carry out research on barriers to recovery. As participants shared, future research can build on previous research on barriers to substance use treatment services and related research in the fields of psychology and psychiatry. Additionally, research on this topic can synthesize the wealth of knowledge and resources held by healthcare providers (eg, on- and off-campus substance use counselors) treating patients in treatment facilities or recovery programs.</p> <p>However, as participants shared, stigmatizing attitudes about substance use addiction can create significant barriers to engaging members of the campus community, including administrators, in research on this topic. Campus environments are known for their culture of drinking and drug use, which has shaped administrators' responses and on-campus public health programming, which traditionally focuses on harm reduction. Participants stated this has resulted in a lack of support for sober spaces and attention to students in recovery, which could translate into support for research on students in recovery. Framing the topic in a way that speaks to diverse audiences is critical:</p> <p>It [the research] depends on who, what, what the purpose of the study is for. If really trying to change the minds of the administration and the people in charge of allocating money, then ... it might be more important to study, GPA, graduation rates, that kind of stuff, that they kinda, the language that they [administrators] speak. But for the individual who's going through it [trying to get into recovery], this [barriers to recovery] might be more important to them. So, it just kind of, you kind of have to play that, play that game of, well, what's the point of the study? Who are we doing it for? Why are we doing it?</p> <hd id="AN0180828327-13">Campus contributions to recovery</hd> <p>The second priority was campus contributions to recovery. Participants emphasized that most 4-year campuses have the infrastructure and resources to support student health and therefore have resources to also support student recovery from AODs. Yet, as they indicated, stigma may factor into why there is a systemic lack of attention to students in recovery. Participants discussed the need to raise awareness of student addition and recovery among administrators, faculty, and staff, focusing on recovery as critical to overall student body health and wellbeing:</p> <p>We need the campus to contribute because the pathway has to start on the campus ... a very good point was made that transportation is a barrier and that disproportionately affects marginalized students. So, to the extent that the campus fails to contribute to recovery, then we perpetuate the very disparities that we argue we are fighting.</p> <p>The existing infrastructure and resources for student health and wellbeing could be leveraged for collegiate recovery research by identifying students in recovery and other stakeholders (eg, substance use counselors, therapists specializing in addition recovery). Participants also noted that there might be external pressures on campus administration to address student substance use, especially for campuses with well-known reputations as "party schools." Such pressures might be helpful in crafting arguments geared toward administrators on the importance of such research.</p> <p>Several barriers exist to considering research focused on infrastructure and the administration's role in recovery. For instance, participants noted there is often an internal competition for campus resources. Most universities fund student mental health programs, which are perceived to capture all student mental health needs including AOD. This results in lower priority and attention/resources given to severe substance use disorders and recovery among college students. Similarly, a consistent focus on harm reduction (especially around alcohol use) might be perceived as sufficient to address students' unhealthy use of substances. Participants stated researchers will need to have open and honest conversations with administrators about their research goals, which can present its own set of challenges. The following statement captures the extant barriers: "The capacity of faculty, staff, providers to have the time or the budget to conduct the research or (whether) campus administration felt this is an important topic."</p> <hd id="AN0180828327-14">Pathways to recovery</hd> <p>The third priority was pathways to recovery. Participants emphasized conducting research on diversity in students' pathways to recovery to inform the structure of recovery programs. They noted that collegiate recovery programs, which have a strong history on the East Coast and the South (cite),[<reflink idref="bib34" id="ref39">34</reflink>] have served as a template for programs nationwide and may not capture the diversity of California or other areas of the West Coast:</p> <p>There's a lot of different pathways to recovery, but also it is a shifting landscape, especially with legalization of cannabis, especially in California.... So, the research that has been done in the past may not be as relevant to students today because it is such a shifting atmosphere. Now, you have different designer drugs. Things are changing rapidly in this field. I think it's important to update research on different pathways to recovery.</p> <p>Acknowledging the diversity of pathways to recovery can increase engagement and commitment from key diverse stakeholders and administration:</p> <p>It [will] also be important that these pathways be diverse to help address different people with different backgrounds and different perspectives and different preferences.</p> <p>Forum participants also commented on the role of on- and off-campus resources (eg, peer-based groups, student organizations, counseling programs) to facilitate research on pathways to recovery and administrative support and resource allocation for student health services:</p> <p>There are counseling programs that are available [on campus] ... peer groups as well as residential group programs, and then, psychological services... CAPS [counseling and psychological services] that provide counseling for students. So just kind of tapping into those, resources that are already existing.</p> <p>Yet, as participants indicated, this topic may be difficult to study as there are several barriers to future research on this topic, including stigma. Students in recovery often experience social seclusion, isolation, and marginalization and may be hesitant to share their story and their recovery path in the context of research. Furthermore, the campus environment, especially one where the administration neither prioritizes nor values recovery can undermine stakeholder participation in research.</p> <hd id="AN0180828327-15">Polarized ideas about substances</hd> <p>The fourth and least prioritized topic was polarized ideas about substances. Participants generally agreed on the need for public health education on polarized substances for student populations; yet they did not see this topic as a priority area for future research. They indicated the need to raise awareness about polarizing substances (especially legalized substance like cannabis products and vaping) by creating safe spaces for student discussion. This can be accomplished by building on existing alcohol and tobacco use curriculum, which characterizes many college campus harm-reduction campaigns.</p> <p>This topic is complex in college environments as using alcohol, tobacco and other drugs is often normalized and their harmful effects minimized. As participants shared, there are differing opinions on the use of cannabis and tobacco products for individuals with mental health conditions as well as among those in recovery from AODs:</p> <p>This particular issue, area [of research], it could easily have, strong differences of opinion about whether CBD or cannabis would help people truly with anxiety, cancer, depression, or epilepsy, perhaps cancer, as it relates to some of the chemotherapies. However, as it relates to anxiety and depression CBD and cannabis, it does not have evidence-base... but to me, this one's sort of provocative, but shouldn't be our major areas of focus.</p> <hd id="AN0180828327-16">Discussion</hd> <p>Our study highlights the value of using community engagement approaches and deliberative methods to prioritize topics for future PCOR/CER on collegiate recovery (cite).[<reflink idref="bib35" id="ref40">35</reflink>] By engaging student patients and stakeholders in capacity building activities and the DDForum process, we identified barriers to recovery as a key topic for future collegiate recovery research—a topic meaningful to patients and which reflects stakeholder input. Furthermore, our critical analysis of forum discussions, similar Vest et al's scoping review,[<reflink idref="bib10" id="ref41">10</reflink>] highlights the need for research that considers racial/ethnic and gender diversity, low-income and first-generation, as well as diversity in pathways to recovery among college students.</p> <p>As we learned through capacity building activities and the forums, lack of attention to diversity is a barrier to recovery. Students are diverse in terms of their racial/ethnic, gender, economic, and cultural backgrounds, as well as student statuses (eg, undergraduate, graduate, professional, first-generation student) and pathways to recovery.</p> <p>Race/ethnicity and gender shape access to recovery capital and internal (eg, self-worth, self-meaning) and external (eg, peer support, healthcare services) resources needed to begin and maintain recovery.[<reflink idref="bib36" id="ref42">36</reflink>],[<reflink idref="bib37" id="ref43">37</reflink>] For instance, men have been more likely to seek substance use disorder treatment services; therefore, recovery programs were more tailored to address a white, heterosexual male perspective.[<reflink idref="bib37" id="ref44">37</reflink>] Recovery programs for emergent adults, including CRPs, have largely adopted these existing programs.[<reflink idref="bib6" id="ref45">6</reflink>] Students are also diverse in terms of both the types of substance use problems and their paths to recovery. They may seek recovery through on- or off-campus counseling services, support groups, Web-based sources, or other avenues identified outside mainstream recovery resources. They may enter the campus already in recovery or seek out recovery in settings of higher education.</p> <p>The findings have implications for future research on collegiate recovery and collegiate recovery programming, especially in terms of diversity, equity, and inclusion. Future research needs to actively engage Black, Indigenous and People of Color (BIPOC), LGBTQ+, low-income and first-generation students in research on collegiate recovery. Information on CRP use, outcomes, and experiences among historically marginalized students in recovery is needed.[<reflink idref="bib10" id="ref46">10</reflink>] Furthermore, existing CRPs need to consider, especially among LGBTQ + students and students of color, how the lived experience of discrimination and micro-aggressions within institutions of higher education, breeds distrust of the power structures, which include university administrations, academic departments, and healthcare services on campus. In recent decades there has been a shift to include the voices, experiences, and needs of women in recovery programming. For instance, women-focused curricula address disempowerment, co-occurring mental health disorders (eg, depression, anxiety, eating disorders, PTSD), sexual trauma histories, and women's roles as caretakers.[[<reflink idref="bib38" id="ref47">38</reflink>], [<reflink idref="bib40" id="ref48">40</reflink>]] Attention has yet to be paid to LGBTQ + and BIPOC individuals in recovery.[<reflink idref="bib41" id="ref49">41</reflink>]</p> <p>While it is recognized that attention to diversity is critical in the development of treatment programs, the field, including the subfield of collegiate recovery, has failed to recognize the role of institutional racism and other forms of oppression in recovery program development and the historical exclusion of BIPOC students and students with alternative sexualities and gender identities from accessing these resources and services. Staff and counselors are socialized within racialized institutions and employing anti-racist agendas is necessary to engage a greater diversity of students.[<reflink idref="bib19" id="ref50">19</reflink>] Programs may also need to tailor programs to each individual group, especially for historically marginalized students.</p> <p>Our work also evidences that students in recovery often have co-occurring mental health and substance use disorders. Collegiate recovery programs should both consider how to address students' mental health and substance use needs, as well as the diverse ways students may experience their health and wellbeing and recovery. As participants in forums commented, mental health and additive disorders are viewed differently by various groups and stigma may deter many from admitting to having a problem, utilizing services or participating in research. We advocate for more culturally sensitive approaches that consider the fears, belief systems, and barriers that prevent marginalized communities to access substance use treatment and recovery in higher education settings.</p> <hd id="AN0180828327-17">Limitations</hd> <p>There are several limitations to consider in the interpretation of the results. First, while we strategically selected different campuses based on the diversity of their student population (eg, Hispanic-Serving Institutes) this did not necessarily translate into diversity in our sample. The majority of participants in the forums self-identified as White, about a quarter as Latino/Hispanic, less than 5% as Black/African American and 2% Native Hawai'ian or Other Pacific Islander. This speaks to a broader issue: the voices traditionally represented in recovery research, including research focused on collegiate recovery, are often white. Second, we held the forums during the initial months of the COVID-19 pandemic at the height of civil unrest involving Black lives protests across the country. We suspect that this influenced the recruitment of diverse students into the forum spaces as participation necessitated having access to the Internet, a quiet space, and time to dedicate to research participation.</p> <hd id="AN0180828327-18">Conclusions</hd> <p>There has been a historical lack of institutional attention to collegiate recovery. This inattention could be linked to a belief that images or discussion of recovery from AODs suggest a campus drug problem. To successfully carry out research on collegiate recovery, investigative teams need buy-in from university administrators and student health services' leadership. Furthermore, more federal grant dollars to fund research and recovery resources is needed to conduct research on collegiate recovery, especially for diverse campus communities.[<reflink idref="bib10" id="ref51">10</reflink>] Collegiate recovery programs need to eschew a one-size-fits-all approach and provide diverse services and resources to meet the diverse needs of students in recovery.</p> <p>University settings are perceived as a safe space for students and present unique access to diverse student populations and student-centered healthcare services and resources. Institutional support for research on collegiate recovery is critical to move the field forward. Participants in our project advocated for more institutional support and participation from diverse communities when thinking about future research on collegiate recovery. Such research would provide an opportunity to present administrators with the health and academic benefits of providing services and resources to meet the diverse needs of diverse students in recovery and can demonstrate how research informs practice.</p> <hd id="AN0180828327-19">Conflict of interest disclosure</hd> <p>The authors have no conflicts of interest to report. The authors confirm that the research presented in this article met the ethical guidelines, including adherence to the legal requirements, of the United States and received approval from the University of California Riverside Institutional Review Board.</p> <ref id="AN0180828327-20"> <title> References </title> <blist> <bibl id="bib1" idref="ref1" type="bt">1</bibl> <bibtext> Kelly JF, Bergman B, Hoeppner BB, Vilsaint C, White WL. Prevalence and pathways of recovery from drug and alcohol problems in the United States population: implications for practice, research, and policy. 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  Data: Voicing Student Recovery: Embracing Diversity in Collegiate Recovery Programs
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  Data: <searchLink fieldCode="AR" term="%22Evelyn+Vázquez%22">Evelyn Vázquez</searchLink> (ORCID <externalLink term="https://orcid.org/0000-0002-3781-7466">0000-0002-3781-7466</externalLink>)<br /><searchLink fieldCode="AR" term="%22Tanya+Nieri%22">Tanya Nieri</searchLink><br /><searchLink fieldCode="AR" term="%22Frances+Fernandes%22">Frances Fernandes</searchLink><br /><searchLink fieldCode="AR" term="%22Danielle+Cravalho%22">Danielle Cravalho</searchLink><br /><searchLink fieldCode="AR" term="%22Fiona+Ryan-Shirey%22">Fiona Ryan-Shirey</searchLink><br /><searchLink fieldCode="AR" term="%22Lisa+Molina%22">Lisa Molina</searchLink><br /><searchLink fieldCode="AR" term="%22Sarah+Marie+Pemberton%22">Sarah Marie Pemberton</searchLink><br /><searchLink fieldCode="AR" term="%22Ann+M%2E+Cheney%22">Ann M. Cheney</searchLink>
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  Data: 2024
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  Label: Document Type
  Group: TypDoc
  Data: Journal Articles<br />Reports - Research
– Name: Audience
  Label: Education Level
  Group: Audnce
  Data: <searchLink fieldCode="EL" term="%22Higher+Education%22">Higher Education</searchLink><br /><searchLink fieldCode="EL" term="%22Postsecondary+Education%22">Postsecondary Education</searchLink>
– Name: Subject
  Label: Descriptors
  Group: Su
  Data: <searchLink fieldCode="DE" term="%22Diversity%22">Diversity</searchLink><br /><searchLink fieldCode="DE" term="%22Minority+Groups%22">Minority Groups</searchLink><br /><searchLink fieldCode="DE" term="%22Barriers%22">Barriers</searchLink><br /><searchLink fieldCode="DE" term="%22Drug+Addiction%22">Drug Addiction</searchLink><br /><searchLink fieldCode="DE" term="%22Drug+Rehabilitation%22">Drug Rehabilitation</searchLink><br /><searchLink fieldCode="DE" term="%22Alcohol+Abuse%22">Alcohol Abuse</searchLink><br /><searchLink fieldCode="DE" term="%22College+Students%22">College Students</searchLink><br /><searchLink fieldCode="DE" term="%22Intervention%22">Intervention</searchLink><br /><searchLink fieldCode="DE" term="%22Access+to+Health+Care%22">Access to Health Care</searchLink><br /><searchLink fieldCode="DE" term="%22Prevention%22">Prevention</searchLink><br /><searchLink fieldCode="DE" term="%22School+Health+Services%22">School Health Services</searchLink><br /><searchLink fieldCode="DE" term="%22Student+Needs%22">Student Needs</searchLink><br /><searchLink fieldCode="DE" term="%22Cooperative+Planning%22">Cooperative Planning</searchLink>
– Name: DOI
  Label: DOI
  Group: ID
  Data: 10.1080/07448481.2022.2119400
– Name: ISSN
  Label: ISSN
  Group: ISSN
  Data: 0744-8481<br />1940-3208
– Name: Abstract
  Label: Abstract
  Group: Ab
  Data: Objective: To discuss the engagement of patients and stakeholders (i.e., faculty, staff, healthcare providers, and university administrators) in capacity building activities to prepare for future patient-centered research on collegiate recovery. Participants: 502 attended capacity building activities and provided input on priorities for future research in collegiate recovery and 77 participated in the deliberative democracy forum process. Methods: We used surveys and the deliberative democracy forum method, which includes framing sessions and forums for data collection. This method enables individuals with diverse backgrounds to share and learn about differing viewpoints to build consensus for decision making. Results: Forum participants prioritized barriers to recovery for future research and discussed the need to address diversity in collegiate recovery programs, including racial/ethnic diversity in the student recovery population and diversity in pathways to recovery, to decrease barriers to recovery. Conclusions: Institutional support for research on collegiate recovery is critical to move the field forward.
– Name: AbstractInfo
  Label: Abstractor
  Group: Ab
  Data: As Provided
– Name: DateEntry
  Label: Entry Date
  Group: Date
  Data: 2024
– Name: AN
  Label: Accession Number
  Group: ID
  Data: EJ1448356
PLink https://search.ebscohost.com/login.aspx?direct=true&site=eds-live&db=eric&AN=EJ1448356
RecordInfo BibRecord:
  BibEntity:
    Identifiers:
      – Type: doi
        Value: 10.1080/07448481.2022.2119400
    Languages:
      – Text: English
    PhysicalDescription:
      Pagination:
        PageCount: 10
        StartPage: 2546
    Subjects:
      – SubjectFull: Diversity
        Type: general
      – SubjectFull: Minority Groups
        Type: general
      – SubjectFull: Barriers
        Type: general
      – SubjectFull: Drug Addiction
        Type: general
      – SubjectFull: Drug Rehabilitation
        Type: general
      – SubjectFull: Alcohol Abuse
        Type: general
      – SubjectFull: College Students
        Type: general
      – SubjectFull: Intervention
        Type: general
      – SubjectFull: Access to Health Care
        Type: general
      – SubjectFull: Prevention
        Type: general
      – SubjectFull: School Health Services
        Type: general
      – SubjectFull: Student Needs
        Type: general
      – SubjectFull: Cooperative Planning
        Type: general
    Titles:
      – TitleFull: Voicing Student Recovery: Embracing Diversity in Collegiate Recovery Programs
        Type: main
  BibRelationships:
    HasContributorRelationships:
      – PersonEntity:
          Name:
            NameFull: Evelyn Vázquez
      – PersonEntity:
          Name:
            NameFull: Tanya Nieri
      – PersonEntity:
          Name:
            NameFull: Frances Fernandes
      – PersonEntity:
          Name:
            NameFull: Danielle Cravalho
      – PersonEntity:
          Name:
            NameFull: Fiona Ryan-Shirey
      – PersonEntity:
          Name:
            NameFull: Lisa Molina
      – PersonEntity:
          Name:
            NameFull: Sarah Marie Pemberton
      – PersonEntity:
          Name:
            NameFull: Ann M. Cheney
    IsPartOfRelationships:
      – BibEntity:
          Dates:
            – D: 01
              M: 01
              Type: published
              Y: 2024
          Identifiers:
            – Type: issn-print
              Value: 0744-8481
            – Type: issn-electronic
              Value: 1940-3208
          Numbering:
            – Type: volume
              Value: 72
            – Type: issue
              Value: 8
          Titles:
            – TitleFull: Journal of American College Health
              Type: main
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