A personal and social model of recovery
We now have the tools to measure not only personal recovery from addiction, but also recovery readiness in communities – David Best writes from the cutting-edge of research underpinning practice.
Download Intervene 3 – 149 – Personal & social model of recovery
There has been a subtle change to the role of recovery in UK addictions research, policy and practice in recent years, with a transition from the periphery to centre stage. But it can be argued that, for all the bluster, we still have a limited evidence base and we have not come far in developing an integrated or testable theoretical model.
Humphreys and Lembke (2013) have done a good job in summarising the ‘what works’ of recovery – focusing on three areas: peer-inclusive interventions, recovery housing and mutual-aid groups – so this article will not revisit that evidence. What I will do is overview three key component parts of a theoretical model of recovery, then draw them together to derive conclusions about what we should do next to make policy and practice stronger in this area.
1. Recovery capital – personal and social resources – the journey of growth
2. Social identity and social contagion in recovery – the role of friends and connections
3. Therapeutic landscapes of recovery – the role of location.
Recovery capital. Since the original idea of Granfield and Cloud (2001), recovery capital has come to refer to the sum of resources that a person has at their disposal to overcome their addiction.
One way of characterising recovery capital is in terms of skills, resources and strengths (such as resilience, coping skills and self-esteem), social supports and commitment to the social network (in other words, it is not just the number of people who help you to recover that matters, it is also your commitment to them) and finally the influence of the community that you live in (which is dealt with here in the section on therapeutic landscapes).
My work with William White and Teodora Groshkova has resulted in a simple measure of recovery capital called the ARC, the Assessment of Recovery Capital. It has been shown to be a scientifically sound measure which is increasingly used to measure how far along the recovery pathway somebody is. But measuring recovery capital also has a clinical use – measuring strengths and resources tells the clinician and the client not only what is missing (the traditional approach to care planning and assessment) but also what strengths you have that should form the basis of a recovery care planning model.
My more recent work with ACT Recovery in this area has been round the creation of an online recovery mapping tool called the REC-CAP, a new instrument that provides staff with an easy-to-complete assessment of a client’s recovery functioning, and will contribute significantly to recovery-oriented care planning. The REC-CAP scores clients on their recovery strengths and can be used both to measure recovery outcomes and to create strengths-based recovery plans, for people who are in and out of formal treatment. Because this is an online tool, it requires no data entry.
The REC-CAP interactive recovery outcomes tool – the Recovery Star (see pdf above) summarises the kind of information that REC-CAP yields. The remainder of the image shows the five points of the star and the three categories they fall into. It is designed to chart the recovering person’s growth and ongoing needs in their recovery journey.
Recovery capital is the currency of recovery, based on strengths and support rather than illness and pathology. What the ARC and the REC-CAP do is to offer a scientific way of mapping growth and change which do not stop on the day of abstinence but track the ongoing recovery pathway.
Social identity and social contagion. At the heart of recovery capital is the idea of social capital and the importance of a strong sense of belonging and a supportive social network of people who encourage and support the recovery journey.
We know this from a wide range of studies including Project Match and my own Glasgow Recovery Study. We also know that being connected is beneficial to all our healths – as long as the groups we are connected to are not socially excluded or stigmatised. That is why engaging in recovery groups is so important. They provide practical support and guidance. And they provide a forum for learning how to live sober and happy, whether this is in the form of a treatment community, a 12-step group or a recovery football team.
Belonging to these groups has another effect: it changes how people see themselves and what is possible in their world. This is social identity – that we define ourselves in part by the groups we belong to (and by those we don’t) and that process provides us with a lens for seeing the world through. That is part of the reason why belonging to recovery groups is so important in helping people to build the skills and confidence (personal capital) that they will need. Belonging matters. It also provides a safe space for making changes and growing recovery strengths.
We do not need to worry too much about people who already have supportive families and friendship networks that they can go back to. But the situation is very different for people who have severed ties or never had supportive and positive social and family networks. For them, the visibility and accessibility of recovery resources is crucial.
Recovery is desirable to almost all who have lasting addiction problems but seems unrealistic to many. That is where the power of the group and the recovery role model or champion is so important. Individuals and groups that model successful recovery are crucial, but not always visible – and recovery can only be contagious if those in active addiction can see and believe in the possibility of recovery and the viability of a social identity of recovery for themselves.
Therapeutic landscapes of recovery. This is where we turn to the field of human geography. In 2006, Wilton and DeVertueil published a paper in the journal Social Science and Medicine outlining the configuration of treatment and recovery services in a US city and used the term ‘therapeutic landscape’ to describe not only the services but also the underlying networks of people in recovery who were visible and prominent in the city.
The concept of a therapeutic landscape can be applied to the lived environment of recovery – the quality of traditional ‘treatment’ services and their links to and engagement with recovery groups and communities. Much more importantly, the concept of a therapeutic landscape can be applied to the size, diversity, attractiveness and visibility of recovery groups and communities: 12-step, peer-based, religious, vocational, sporting and so on. This is the geography of hope, the field in which the individual addict must plot their personal recovery journey.
There is another key aspect to the therapeutic landscape. It can be more or less visible and more or less engaged in the community. In an ideal world, there is a diverse recovery community that is effectively engaged with many community groups and activities – and through doing so, generates links and opportunities for people in recovery to access ‘community capital’.
Where recovery is invisible, and where it is not effectively linked, there is a much greater likelihood of community ignorance of the possibility of recovery, and so greater risk of discrimination and social exclusion. These are the communities where the recovery journey is much harder.
We now have the tools to measure not only personal recovery, but also recovery readiness in communities.
So what does this mean? We now know that personal recovery is a complex journey that might take years and involve false starts – but it is one that we know will probably end in success. We also know some of the things about personal skills and social supports which will dramatically swing the odds in favour of recovery. We must link this to a commitment to measuring and mapping recovery pathways.
We can also now start to map out what it is in communities that promotes or blocks recovery pathways. If we can reduce community barriers and increase recovery visibility, we will make that personal journey just that much more manageable. But we need less rhetoric and more systematic and coherent thinking about recovery.
David Best is director of ACT Recovery, associate professor of Eastern Health Clinical School at Monash University and head of research and workforce development at Turning Point, Melbourne.