I have been fortunate enough to have been able to work with a number of US recovery residences over the course of the last six years, all through affiliates of the National Alliance of Recovery Residences, an organisation that not only provides certification to a set of standards for recovery residences agreed through an expert consensus and consultation process (which can be found HERE) but also works towards building consensus, innovation and evidence about what is a central plank of US drug (and recovery) policy.
Five years after attending my first NARR annual conference, in 2017 in Chicago, I was delighted to be invited back to speak at the 2022 NARR Best Practices Summit in the beautiful city of Richmond, Virginia. This is particularly pertinent to my work as the recovery residence movement have been core partners in the development and roll-out of the REC-CAP tool.
Filling in parts of the jigsaw
The literature on residential settings is not new – there is a really strong body of work on Oxford Houses led by Dr Leonard Jason at De Paul University and on Sober Living Houses led by Dr Doug Polcin and Dr Amy Mericle, yet the evidence on NARR affiliates remains thin on the ground, which makes our emerging partnership all the more exciting.
This is underpinned by the commitment that several NARR affiliates have shown to the emerging work on recovery capital and its application in the form of the REC-CAP model based on the ARMS system. This is a wonderful match as the residential setting provides a real opportunity for mapping change and tracking the growth of recovery sustainability. The transition to a recovery capital measurement approach allows us to focus on strengths and to track the accrual of resources and strengths over the course of the recovery journey. What our previous work has shown is that we can use the REC-CAP both to predict who will be retained in residences in particular locations (and by extension who the high-risk groups are for early drop-out) and separately what are the characteristics of individuals who will flourish over the course of their residence. Thus, we know that there is typically a retention issue for younger and for female residents, and that those who engage in meaningful activities and who have stronger social support networks are likely to show greater growth in recovery capital.
Consistent findings and building an evidence base
What we were able to present in preliminary form in Richmond were, appropriately, incredibly positive findings about the implementation and roll-out of the REC-CAP in Virginia. Funded through considerable tenacity and creativity from Anthony Grimes and his colleagues at VARR, we have had an exceptionally strong platform for gathering REC-CAP data allowing us to continue to build an understanding of the success of recovery residences in building recovery capital and the process through which this is achieved. In Virginia, 5,532 REC-CAPs had been completed by a total of 2,679 individuals providing a strong foundation for analysis. On average, we have 3.5 REC-CAP completions for residents who remained beyond their initial completion.
The findings are extremely encouraging – there are marked reductions in barriers to recovery and in unmet needs suggesting that accredited Virginia residences can create the conditions for recovery growth and there is a marked growth in recovery capital across the course of the interviews (the typical duration to the most recent follow-up is between 6 and 9 months). While there are consistent improvements in all three areas of recovery capital (personal, social and community), the overall mean score (the Recovery Capital Index) improves from a mean of 26 to a mean of 47 suggesting considerable growth in recovery capital over time.
Innovation and creative partnerships
However, the other major advantage of the REC-CAP model is that it allows for the assessment of the effectiveness of innovative interventions and there are two that I want to highlight in this blog, which we presented at the conference and where we are now working on peer-review research papers.
1. Enhanced support and intervention for clients with additional need: VARR used the REC-CAP to identify a group of participants with higher levels of need for a more intensive package of support and we were able to demonstrate that these clients (within 6-9 months) were able to close the gap on their peers and show high levels of capital growth and gain.
2. Partnership between recovery residences and criminal justice provision: The use of REC-CAP in the Chesterfield HARP jail has also allowed us to look at the benefits of engaging in their intensive Therapeutic Community programme and to study the impact of transitioning from this programme into recovery residences as a form of continuity of care. Thus, we are able to use the REC-CAP to assess whether moving from a custodial setting to a recovery residence permits continued growth of recovery capital.
Both of these innovations have proved to be successful and so the use of the REC-CAP will effectively provide supportive evidence to staff, funders, participants and families to reassure them that this is an evidence-based approach. However, it will also provide evidence that will allow these programmes to be amended, more effectively targeted and where the results can be used to improve delivery and quality of what is offered to people in recovery.
Back to the conference
So much for the more cerebral and academic gains and benefits but that is not what struck me as most important at the NARR conference in Richmond. It was the response of people who were using the REC-CAP in their residences. On at least three occasions, we were thanked for the incredible difference the REC-CAP had made and how excited and pleased owners of recovery residences were about the impact the system had had on their work and on the lives of their residents. This is so important as it not only vindicates the work but proves the REC-CAP is much more than a research or assessment tool, but is something that can create a collaborative alliance and illuminate the path on the road to recovery. For anyone involved in research and science, it is this – its application and implementation in a way that improves lives and generates hope – that justifies the work and the frustrations of the process.
What does this look like from the UK?
I want to conclude with a footnote from a country where there are relatively few recovery residences, and where funding systems and processes are a barrier to their sustainability and to their integration into recovery systems. The evidence from the new VARR data – as with Oxford Houses and Sober Living Homes – provides overwhelming evidence that they are an integral component of a recovery-oriented system of care. To try to create such systems without housing at its core is inherently flawed and ignores a critical part of effective practice. No amount of specialist addiction treatment or residential rehabilitation will make up for that gap. It is essential that UK policymakers can revise funding processes so that the astonishing successes celebrated in Virginia (and that will be demonstrated again with more force in Michigan next year) can be experienced here in the UK.