Full length articleSocial networking online to recover from opioid use disorder: A study of community interactions
Introduction
The current opioid epidemic in the U.S. is being described as the “worst drug crisis in American history” (Nolan and Amico, 2016). From 1999–2015, the rate of opioid overdose deaths tripled from 16,849 to 52,404 annually, and the prevalence of opioid use disorder (OUD) likewise is continuing on an ascending path with an estimate of 35 million people abusing opioids worldwide (Rudd et al., 2016, United Nations Office on Drugs and Crime, 2017). Substance use disorders are extremely maladaptive and difficult to overcome. Many individuals struggle with overcoming opioid abuse due to the intense withdrawal symptoms that occur when opioid use is discontinued that may include dysphoric mood, nausea or vomiting, fever, insomnia and/or muscle aches among others (American Psychiatric Association, 2013). Accordingly, relapse from opioid abstinence is common and makes the necessity for accessibility to OUD treatment vital for many to experience success in their recovery (Gustin et al., 2015, Martin et al., 2007).
Effective treatment of OUD has been identified as a national priority to reduce the rates and societal costs of individual disability associated with OUD, the infectious disease burden associated with intravenous opioid use (especially hepatitis C [HCV] and HIV transmission), escalating rates of accidental opioid overdose deaths, and pediatric opioid ingestions (Office of National Drug Control Policy and US Executive Office of the President, 2011). There are many different forms of treatment for OUD, with the most common forms being pharmacologic therapy (e.g., Methadone Maintenance Therapy (MMT), Buprenorphine, Clonidine, Lofexidine), evidence based psychosocial interventions, cognitive behavior therapy, dynamic psychotherapy, aversion therapy, psychosocial therapy, group therapy, and Narcotic Anonymous (NA) groups (Bart, 2012; Dixon, 2017). However, only a minority individuals with OUD seek out or receive treatment (Jones et al., 2015), and further lowering the likelihood of recovery is that the treatment that is available often lacks structural support (i.e., social connectedness, or embeddedness in a social network) which is necessary for success (Havassy et al., 1991, Saloner and Karthikeyan, 2015, Wasserman et al., 2001).
In the setting of low engagement in traditional treatment options, some opiate users turn to social media for health-related information and peer support (Day et al., 2013). Online social platforms, including web forums, allow individuals to freely share their experiences, post questions, comments, and opinions; it can also provide a very rich source of unsolicited self-disclosures of drug use behaviors (Holt-Lunstad et al., 2010). Studies have shown that for individuals struggling with addictive behaviors, online peer support groups provide an open forum for discussion while minimizing perceived barriers and stigma (De Choudhury and De, 2014). Indeed, Morahan-Martin and Schumacher (2003) found that isolated individuals were more likely to be disinhibited and engaged online as opposed to when they were in face to face communication. Social media has the resources to provide an interactive platform between individuals who desire cessation from their opioid use or are currently recovering from their opioid use. However, social media has never been studied as a platform for individuals to express symptoms of OUD, risk of relapse, issues with cessation, and therapeutic factors among other social media members.
The current study investigates the online content of one relatively large online community (+5000 subscribers) that describes itself as a forum to help individuals who are recovering from OUD. To protect the anonymity of this “Opiates-Focused Forum”, we hereafter reference this online community as “OFFopiates”. OFFopiates was organically developed (i.e., without hierarchical or overarching control) and exists on Reddit, a free, anonymous, and popular social networking site that is used all around the world but primarily in the US. In consideration of emerging evidence about social media as an online and accessible tool to potentially support individuals during recovery, we performed a content analysis of OFFopiates. Specifically, we aimed to understand the social networking occurring on OFFopiates by qualitatively coding the online questions/comments posted by its subscribers as well as the follow-up, subsequent responses that those subscribers received from other individuals within this community. To further validate OFFopiates as a community for individuals who are recovering from OUD, in particular, we focused a segment of our content analysis on delineating the extent to which the questions/comments posed by its subscribers aligns with the expression of OUD as categorized by the Diagnostic and Statistical Manual of Mental Disorders (5th ed.; DSM–5; American Psychiatric Association, 2013).
Section snippets
Methods
In this study, publically available Reddit posts were analyzed from OFFopiates. The posts are reported without usernames and the wording of the posts are changed for ethical concerns. This study is classified as non-human subjects determination by Washington University’s Human Research Protection Office.
Author characteristics
The 100 analyzed posts were written by 73 unique usernames. Of these 73 individuals, 22% (16/73) were classified as mild severity OUD (i.e., 2–3 symptoms), 10% (7/73) as moderate severity OUD (i.e., 4–5 symptoms), and 1% (1/73) as high severity OUD (i.e., 6 or more symptoms). Twenty-six percent (19/73) of the post authors only mentioned one DSM-5 criteria in their posts, and were therefore not assigned an OUD severity level. Additionally, 41% (30/73) did not describe any symptoms that were
Discussion
This study provides an exploratory analysis of user-generated content from OFFopiates which is an organically formed opiate-related self-help group on Reddit. Our in-depth analysis of content posted on this forum reveals discussions of self-reported struggles with OUD among group members. The majority of unique posters in our sample met at least one criteria of OUD, of whom 1/5 identified as currently using opioids. Only a small number of OFFopiates members appeared to be engaged in treatment,
Conclusions
Our findings from OFFopiates provide validation for non-curated online peer support communities. Data from our sample described specific OUD DSM-5 criteria, and unfettered comments were found to incorporate validated therapeutic principals. Additionally, our data suggests a potential need for treatment among those networking on this forum given that few posts mentioned involvement in formal treatment. The relatively common discussions about withdrawal symptoms and relapse risks indicate the
Conflict of interest
None.
Role of funding source
Nothing declared.
Contributors
Ms. D’Agostino participated in data analysis, interpretation of results, and drafted the first draft of the manuscript. Dr. Optican assisted in drafting the manuscript and performed critical revisions to the manuscript. Ms. Sowles and Ms. Krauss participated in data analysis, interpretation of results, and critically revised the manuscript. Dr. Escobar Lee participated in the acquisition of the data, data analysis, interpretation of results, and drafting the manuscript. Dr. Cavazos-Rehg
Acknowledgement
This work was supported by the National Institutes of Health [grant numbers R01 DA039455, R01 DA032843].
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