Addiction recovery stories: Jerome Carson in conversation with Lisa Ogilvie

Purpose The purpose of this paper is to explore the accomplishments of those who realise addiction recovery. To the best of the authors’ knowledge, this is the first in a series of recovery stories, where candid accounts of addiction and recovery are examined. In doing so, shared components of recovery are considered, along with the change and growth necessary to facilitate it. Design/methodology/approach The CHIME (Connectedness, Hope, Identity, Meaning and Empowerment) framework comprises five elements important to recovery. It provides a standard to qualitatively study mental health recovery, having also been applied to addiction recovery. In this paper, an additional element for Growth has been introduced to the model (G-CHIME), to consider both recovery and sustained recovery. A first-hand account of addiction recovery is presented, followed by a semi-structured e-interview with the author of the account. This is structured on the G-CHIME model. Findings This paper shows that successful and sustained recovery from alcohol addiction can be effectively explained using the G-CHIME model. Each element was well represented in the described process of reaching recovery. Originality/value Each account of recovery in this series is unique, and as yet, untold.

Randomized Trial of Molnupiravir or Placebo in Patients Hospitalized with Covid-19

Molnupiravir is an oral agent a metabolite of which has activity against SARS-CoV-2. In a controlled trial in adults hospitalized for Covid-19 who had symptoms for 10 days or less prior to randomization, patients received placebo (n=75) or varying doses of molnupiravir (n=218) administered twice-daily for 5 days. There was no impact of treatment on death. Median time to sustained recovery was 9 days in all groups, with day 29 recovery rates ranging from 81.5%-85.2%. There were no dose-limiting side effects or adverse events.

29. Sustained Recovery in Patients Admitted to Hospital With COVID-19

Background Several interventional Coronavirus Disease 2019 (COVID-19) studies assess outcomes at day 28, but this follow-up time can be too short, since COVID-19 often cause protracted disease. Further, data on mortality and readmissions after discharge are scarse. Methods Patients aged 18-100 years and hospitalized with COVID-19 in Eastern Denmark between March 18th, 2020 and January 12th, 2021, were followed for 91 days after admission. Patients were stratified in a first and second wave, by admissions before or after June 15th, 2020, app. when remdesivir and dexamethasone were introduced as standard of care. Sustained recovery was defined as the first date, achieving 14 consecutive days after hospital discharge without an event of readmission or death. Cumulative incidences of sustained recovery were estimated in both waves and in subgroups based on the patient’s maximum level of respiratory support in the first 14 days of admission as a proxy for disease severity. Risk factors for poor outcomes were assessed in a multivariable cox proportional hazards model. Results Overall 3,386 patients were included in the study; 1,137 and 2,249 patients were admitted in the first and second wave, respectively (Table 1). The cumulative incidence of sustained recovery at day 91 was higher in the second (0.79, 95% CI: 0.77,0.81) than in the first wave (0.72, 95% CI: 0.70, 0.75) (Fig. 1A). In both waves, those with more severe disease recovered at a slower rate (Fig. 2B). There were no differences in cumulative incidences of readmissions or deaths at day 91 after discharge between the two waves, cumulative incidence (0.20, 95% CI: 0.19,0.21) and (0.11, 95% CI: 0.09,0.12), respectively (Fig 1C, Fig 1D). Male sex, high age, cardiovascular disease, diabetes, chronic pulmonary disease, renal disease, malignancies and neurological disease were associated with lower rates of sustained recovery (Table 2). Conclusion A follow-up period of 28 days in clinical trials for COVID-19 treatments is too short, especially for patients with severe disease. Rates of adverse outcomes after hospital discharge are non-neglible. In-hospital mortality was reduced with improvements in treatment, but post discharge mortality and readmissions rates did not change significantly. Disclosures Carsten Utoft Niemann, PhD MD, Abbvie (Grant/Research Support, Advisor or Review Panel member)Astra Zeneca (Grant/Research Support, Advisor or Review Panel member, teaching)CSL Behring (Consultant)Genmab (Grant/Research Support)Gilead (Grant/Research Support)Janssen (Grant/Research Support, teaching)Novo Nordisk Foundation (Grant/Research Support)Roche (Grant/Research Support)Sunesis (Grant/Research Support)

Political crisis to hinder Nicaragua economic recovery

Significance However, the prospects of a sustained recovery are clouded by fiscal weakness, a precarious balance-of-payments position, a deteriorating business environment and the threat of international sanctions on the financial sector. The country's most vulnerable communities are yet to recover from the damage wrought by Hurricanes Eta and Iota. Impacts An accommodative monetary policy will be maintained in an effort to support economic recovery. Ortega’s control over the judiciary will heighten legal uncertainty and erode the ability of investors to enforce contracts. The prolonged depreciation of the Cordoba will increase servicing costs of public and private dollar-denominated debts. Refugee outflows will intensify after November’s elections, with knock-on effects for the rest of the region.

The Best-Laid Plans

This chapter opens with a story of how current beliefs and practices can have disastrous outcomes. It discusses the search to understand why front-line therapists and the treatment systems that employ them were not using empirically proven practices, and a new science that was investigating this research-to-practice gap. This chapter discusses the startling things discovered. Even if it could be guaranteed that every therapist would use evidence-based interventions with every patient every time, there would still be no way to measure and monitor the effectiveness of those validated treatments. In addition to evidence-based practice, a vital tool is still missing to make sure services result in sustained recovery. Along with evidence-based practices, performance-based practice is also needed.

Occupational Lives in Sustained Recovery From Alcohol Dependency: An Interpretive Phenomenological Analysis

Alcohol use is a significant risk factor for ill health. Although many people complete treatment, only one third maintain their sobriety. Research has suggested that occupational engagement supports early recovery, but its role in sustained recovery is not known. This study aimed to explore the occupational lives of individuals in sustained recovery from alcohol dependency. An interpretive phenomenological analysis methodology was used, utilizing an occupational perspective. Participants were recruited from a substance use recovery center. Data were collected through interviews and analyzed thematically. This study had three participants. Four themes emerged: (a) shaping occupational lives, (b) shifting coping strategies, (c) finding a gateway to new social connections and a sense of belonging, and (d) establishing a new role in the context of recovery. Findings suggest that in sustained recovery, occupations develop new meanings and purposes that have the potential to support recovery.