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  • David Best, Ph.D.

Cascading contagion: Creating environments where recovery contagion can flourish

One of the most exciting things about my job is coming across incredible innovations and initiatives that promote recovery and create the opportunities for recovery to emerge and flourish.


This latest blog is primarily about a prison programme in Virginia, USA, that I have had the good fortune to visit but will also draw on two other sources – one also here in Virginia, and the other in Middlesbrough in the UK – that illustrate the main conceptual point I want to make about the role of professionals and institutions in promoting recovery.


What is the main theoretical point?

All of my research, and most of the published research would suggest that addiction recovery is primarily (but not exclusively) a process of transmission from peer to peer in both individual and group forms, through processes of social attraction, social learning and social control as outlined in a paper from 2007 by Rudolph Moos. While professionals can, through the power of connection be the catalyst, more often their role is more subtle. The role of professionals, organisations and institutions is to create the conditions that maximise the chances for recovery contagion to flourish – or to extend Don Coyhis’ metaphor of the healing forest, to prepare and fertilise the soil for trees to grow healthy and to flourish (Coyhis, 2002).


Chesterfield HARP: As part of our REC-CAP programme of work building recovery capital measurement we had the honour and privilege of visiting the HARP programme in Chesterfield County Jail. In an inspiring day where programme participants talked of the benefits of a strengths-based approach where they can monitor and chart their own recovery progress, there was a genuine commitment to a Therapeutic Community model.


Our interest in this programme is that there is an initiative to support pathways from the programme directly into recovery residences, and in a future blog we will summarise the incredible results we are seeing in terms of the initial gains in recovery capital for HARP participants, but also crucially how those gains are sustained on transitioning to recovery housing, effectively bridging the high-risk gap from the prison to the community.




The charismatic and inspirational Sheriff, Karl Leonard, spoke of decisions around admission to HARP (Helping Addicts Recover Progressively) and removal from the programme being decisions for the group not for the prison hierarchy or administration.


On the day of our visit, one programme participant was being released to recovery housing, and he spoke incredibly articulately about the challenges of continuing support (and we talked about Putnam’s ideas of bonding and bridging capital, ideas that were not new to him). And what is unique about HARP is that it was a programme alumni who was in the meeting and was to be his driver to the recovery residence, but the person leaving also spoke of his intention of coming back. Not in the usual sense of being returned to prison, but of giving back to his peers still in the programme, but also as part of his own ongoing recovery journey.


In other words, the HARP programme was not a phase in the journey, but an integral and ongoing part of the recovery pathway. This flies in the face of the conventional wisdom that ex-offenders should not frequent with their former peers through a risk reduction model. But using Moos’ concept of social learning and social connection, our argument would be that success creates attraction creates contagion.


So what about the role of the professionals – Sheriff Leonard and his wonderful team of Dr Gay, Bailey, Kerry and April. They form genuine and human Connections, they transmit Hope, they provide opportunities for Meaningful activities and they create the conditions for individual and collective Empowerment and achievement. The men and women of HARP are supported to trust each other and the team, to build personal and collective efficacy and to live in a recovery-oriented system of care that is not delimited by prison walls.


The professionals offer programmes, innovative therapeutic interventions, primary and specialist health care and pathways to the community but the fundamental job of transmitting the mechanics and values of recovery is recognised as a peer process. This requires incredible skill, patience, humility and trust – but that is repaid with a wonderful, vibrant and effective model of recovery contagion based on recovery cascade.



HARP is unique but not alone

The HARP programme is also part of a broader recovery model and system in Virginia, with a network of recovery residences, overseen by the Virginia Association of Recovery Residences, led by Anthony Grimes, and ably supported by Matt Conner and Bob De Triquet. We held a Community of Practice for 18 recovery navigators from our REC-CAP system and were blown away by the commitment to recovery science and practice in the group. This group are leading our work on implementing recovery care planning and helping recovery residents meet their goals and improve their recovery pathways. We were able to run an effective Community of Practice because of the shared trust, values and commitments in this group. The same formula applies here of:


Connection + Meaningful Activities = Individual and collective efficacy

Finally, at Hardwick Hall in Teesside on the 24th of January, Recovery Connections held their annual awards ceremony. The event started with this wonderful rolling clock that finally stopped at 301, which represented the total number of years in recovery for the staff at Recovery Connections – a wonderful achievement. The event was an incredible showcase of individual achievement celebrated with dignity, pride and wonder that is testament to the same model of a professional cascade of recovery values creating the conditions for recovery contagion.


So what is the conclusion of this? Nurturing saplings is the job of healthy trees and their flourishing creates the forests that are communities of recovery based on trust and connection. This alone can be achieved by peer-led recovery communities, but the space for the forest to grow and the quality of the soil requires a coalition of trust and connection where recovery communities are embraced and enriched by professional cascades of recovery values.


Acknowledgements

Many thanks to William White for his helpful and enthusiastic comments on an earlier draft of this blog – and to acknowledge his huge influence on my thinking and my work.


References

Coyhis, D. (2002) The Red Road to Wellbriety. White Bison, Inc: Colorado Springs, CO.


Moos, R. (2007) Theory-based processes that promote the remission of substance use disorders, Clinical Psychology Review, 27(5), 537-551


Putnam, R. (2000) Bowling Alone. Simon and Schuster: London, England.

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