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  • David Best, Ph.D.

What can you count beyond the REC-CAP?

As a junior academic, I was lucky enough to be exposed to the incredible and innovative work on Organisational Culture and Readiness to Change developed by Professor Dwayne Simpson and Professor Pat Flynn based at the Institute of Behavioral Research at Texas Christian University.

Dating back to the Drug Abuse Reporting Programme work in the 1980s (written up in a book by Simpson and Sells in 1991), they demonstrated, using US national drug treatment outcome data, that drug treatment outcomes were predicted better on the basis of features of the treatment service that was attended rather than variations in client factors like frequency of drug use, motivation or co-occurring mental health problems. This places the responsibility for change at least as much with the provider of services as with the recipient.


This was crucial to our understanding of how important service level factors are in predicting how well a client does and how researchers need to focus on things that go on around the person and not just what happens in their head and body.


Why is this so important for recovery capital?


There is a general agreement that recovery is something that happens between people and is a fundamentally social process driven by connection and meaning. So while it is important that we continue to develop our ability to measure where someone is in their recovery journey – and huge amounts of work have taken place on the development of the REC-CAP as a key measure of recovery capital – that is never going to be sufficient.


Along with my colleagues Dr David Patton and Dr Arun Sondhi, we have been mapping how the country where recovery takes place matters to what kind of recovery journey a person has available to them. And this is also going to be essential to our ability to measure recovery capital, as something that happens not just at the individual level but also at the collective level. There is already some work on this but for some reason this has stalled and the science of Recovery Oriented Systems of Care remains very early but highly important to our next set of goals.


What is a recovery-oriented system of care?


There are two key and seminal works in this area – a book edited by William White and John Kelly called “Addiction Recovery Management” which provides chapters overviewing a number of successful US cities and states providing historical accounts of the conditions and requirements for establishing a recovery-oriented approach. This was followed by a report from the Substance Abuse and Mental Health Services Administration (SAMHSA) written by Sheedy and Whitter (2013) outlining some of the core conditions for a recovery-oriented system including that it is Person-centred; Inclusive of family and other ally involvement; Individualised and comprehensive services across the lifespan; Systems anchored in the community; That it involves continuity of care; That there are partnership–consultant relationships; That it is strength-based: That it is culturally responsive; Responsiveness to personal belief systems; There is a commitment to peer recovery support services; that it is integrated; that it offers system-wide education and training; that there is inclusion of the voices of people in recovery and their families; That there is ongoing monitoring and evaluation; That it is evidence-driven and research-based and that it is adequately and flexibly funded.


However, this summary and the Kelly and White book are now more than a decade old and there has been little research testing or implementing these approaches. Why this is so important for recovery outcomes is the recognition that there are both structural impediments (such as stigma and exclusion effects) and structural opportunities (pathways to jobs and houses, as well as opportunities for study and college) that compound the immediate effects of therapeutic services.


We must therefore create a recovery model that mirrors the individual tripartite distinction made by Best and Laudet (2010) in creating measures and indicators that exist at three levels:

- The individual level (where the REC-CAP fits in)

- The recovery agency or organisation (whether a recovery housing unit or a recovery community organisation)

- At the systems level (by mapping what is going on in the community)


Not only should each of these be dynamically linked, there is likely to be a significant increase in predicting recovery capital trajectories and the preservation of recovery by being able to quantify things at all three levels.


So what do we want to count?


The next step is to follow in the footsteps of the TCU group and start to develop a measure of recovery organisations to assess their ability to support and sustain recovery and to both create the conditions for recovery capital growth and also address the specific needs of that individual. This will require a process of testing concepts and developing an initial survey method and then working in partnership with a diverse range of recovery organisations – community and housing-based – to develop an initial assessment method. However, this is unlikely to be a single measure and will have to draw upon the assessment of clients as well as some indicators that are collected from staff and volunteers. Among the key domains that our work in this area will pursue are:

- Effective engagement with specialist treatment services for drugs, alcohol and mental health

- Effective engagement with a diverse range of recovery communities

- Effective linkage to a number of broader community assets and resources


There will also be assessments of the range of services provided, the diversity of those effectively engaged and the duration and quality of engagements with the provision. However, this is something that will have to be worked on and developed as a co-production with people in recovery and with people who work with those in recovery. I have a great opportunity in the coming months to partner up with some incredible people and organisations first on the work on recovery-capital generating abilities of recovery organisations and then on building system level markers and measures. The science of recovery will continue to evolve and support this incredible process of transformation and growth.


References

Best, D. and Laudet, A. (2010) The Potential of Recovery Capital, London: RSA.

Kelly, J. & White, W. (2011) Addiction Recovery Management: Theory, Research and Practice. Humana Press: New York.

Sheedy, C. and Whitter, M. (2009) ‘Guiding principles and elements of recovery-oriented systems of care: what do we know from the research?’ HHS Publication No (SMA) 09-4439, Rockville, MD: Center for Substance Abuse Treatment, Substance Abuse and Mental Health Services Administration.


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