Based on the peer-reviewed journal article: Citation
“Best, D., Sondhi, A., Best, J., Lehman, J., Grimes, A., Conner, M. & DeTriquet, B. (2023) Using recovery capital to predict retention and change in recovery residences in Virginia, USA, Alcoholism Treatment Quarterly, doi.org/10.1080/07347324.2023.2182246”
One of the reasons that we developed the REC-CAP was to address the criticism directed against our previous measures that they were no benefits to either recovery organisations or to the people in recovery who completed the forms.
So the REC-CAP was designed with two key features:
1. That the moment the navigator or person in recovery pressed the submit button, a visually attractive and engaging summary of their scores would appear immediately
2. This then provided direction and suggestions for what to do next, both in the form of a recovery care plan and support to engage positive community assets and resources
But there was also a third objective – which was to create a recovery tool that was evidence-based and that contributed to building recovery research and a new evidence base. This article is about is the first product from one innovative and highly productive partnership, with the Virginia Association of Recovery Residences (VARR), where the REC-CAP has become routine practice across a range of recovery residences, as well as a pilot prison, and this will soon be extended to Recovery Community Organisations (RCOs) across the state.
What the paper does and what it finds
This paper is based on a cohort of residents entering VARR-certified recovery residences with a baseline REC-CAP measure completed within 72 hours of arrival at the recovery residence which allowed two questions to be asked:
1. What was different about the people who dropped out of the residence (whatever the reason) before they were able to complete a follow-up at 45 days?
2. For those who did stay long enough in the residence to have at least two completions, what predicted growth in recovery capital?
Participants were recruited from around 50 NARR (National Association of Recovery Residences) certified recovery residences in Virginia. The data consisted of 3,681 records from 2,182 individuals of whom 1,469 (67%) have been assessed only once (“Not Retained”) and 713 (33%) providing provided more than one assessment (“Retained”). In this initial analysis, we were not able to follow what happened to people not followed up and so we cannot assume that all of them had left or been discharged for negative reasons.
Retention and early drop-out: However, this split allowed us to look at what was associated with early departure. People who did not stay long enough to complete a second REC-CAP were:
- More likely to have reported recent substance use at baseline
- Have better physical health at baseline and less perceived need for primary healthcare
- Be female
- Be African American
- Have lower citizenship and community capital
- Reported greater need for housing services at baseline and less satisfaction with housing and safety
What this suggests is that there are challenges for recovery residences in retaining two groups of residents – women and African Americans. However, there are also risks related to REC-CAP scores – those with higher levels of substance use and those less actively involved in their communities as well as those who have had greater housing problems in the past. Each of these groups may need special supports to address their elevated risks of early departure. More surprisingly people who reported better physical health and less need for health support were also more likely to drop out early. This may be a group who have greater faith in the extent of their early recovery. We will pick up on some of these themes in the next steps section of the paper.
Recovery capital growth: The second question was restricted to the 713 people who had completed at least two REC-CAP assessments allowing us to look at what predicted recovery capital growth. What Figure 1 below shows is that, across multiple completions, not only does time in recovery residences lead to very clear improvements in the first three months, and
that these gains are sustained over time.
Figure 1. Changes in ORC (Overall Recovery Captial) over assessments.
So overall there are clear improvements. But this does not show the variability within the group and the remaining analysis looks at what is associated with doing better over time. The key factors associated with growth in personal and social recovery capital were:
- Cessation of substance use
- No risk-taking behaviour around injecting
- Not being at risk of eviction or homelessness
- No unmet needs around mental health or family support
- Better quality of life
- Better social support
- Higher levels of commitment to sobriety
- Higher involvement in recovery groups
It is perhaps not surprising that recovery capital growth is associated with lack of negative risks around substance use, injecting and homelessness and no urgent needs around mental health and family support. These are the foundations for recovery – overcoming barriers and reducing unmet needs. But it is also significant that recovery capital growth is associated with greater involvement in peer-based mutual aid, with better social support for recovery, with higher levels of motivation and with better general overall quality of life.
The full link for the paper is available here- https://doi.org/10.1080/07347324.2023.2182246
What are we currently working on?
So what we have shown here is that there are different things that predict successful retention in recovery residences in Virginia (which includes demographic factors gender and ethnicity) and what predicts growth in recovery capital (which includes overcoming barriers and unmet needs and building active engagement in the recovery community and social supports). These findings will be tested further as more data is collected in Virginia and in other states and as we continue to build our evidence base.
Using a slightly larger sample from Virginia, we are also looking what the differences are for people from justice compared to non-justice backgrounds, what the experiences are for people who come through one incredibly innovative criminal justice programme (Chesterfield HARP) and what happens when people with low recovery capital on arrival are provided with additional supports and resources. We are also going to start looking at what happens to people inside the residences (in terms of their goals and activities) and will assess how that improves recovery capital.
What are the next steps?
We have shared our findings with our partners in Virginia and we will continue to build a team of research scientists and practitioners to further test and develop our model. This in turn will inform any changes we may make to the REC-CAP model or our underlying algorithms and weightings. We will continue to meet with residents and with recovery navigators and residence owners to improve both what the REC-CAP has to offer and how to intervene to improve outcomes based on local profiles of scores. We will also look to see how we can build our portfolio of measures and interventions to support this approach and ultimately to improve recovery outcomes hand in hand with improving recovery science.