Models of recovery evaluation

1. Models of recovery evaluation David Best NTA, Leeds 22nd October 2010

2. Recovery views in the US “The journey to recovery requires great fortitude and a supportive network. As we celebrate National Alcohol and Drug Addiction Recovery Month, we also express our appreciation for the family members, mutual aid groups, peer support programs, health professionals, and community leaders that provide compassion, care, and hope. Across America, we must spread the word that substance abuse is preventable, that addiction is treatable, and that recovery is possible”.—Barack Obama, Presidential Proclamation, National Alcohol and Drug Addiction Recovery Month

3. What do we mean by ‘recovery’? • The Road to Recovery: A New Approach to Tackling Scotland's Drug Problem (Scottish Government, 2008) recovery is defined as:  • ‘a process through which an individual is enabled to move from their problem drug use, towards a drug-free lifestyle as an active and contributing member of society.’ • ‘voluntarily sustained control over substance use which maximises health and wellbeing and participation in the rights, roles and responsibilities of society’ (UK Drug Policy Commission, 2008, p6) • Betty Ford Institute Consensus Panel (2007, p. 222) defined recovery as “a voluntarily maintained lifestyle characterised by sobriety, personal health and citizenship.” • “recovery refers to the lived experience of people as they accept and overcome the challenge of disability... they experience themselves as recovering a new sense of self and of purpose within and beyond the limits of the disability” (Deegan, 1998)

4. CSAT (2009) Principles of recovery • There are many pathways to recovery • Recovery is self-directed and empowering • Recovery involves a personal recognition of the need for change and transformation • Recovery is holistic • Recovery has cultural dimensions • Recovery exists on a continuum of improved health and wellbeing • Recovery emerges from hope and gratitude • Recovery involves a process of healing and self-redefinition • Recovery involves addressing discrimination and transcending shame and stigma • Recovery is supported by peers and allies • Recovery involves rejoining and rebuilding a life in the community • Recovery is a reality

5. CSAT (2009) principles of ROSC • Person-centred • Inclusive of family and other ally involvement • Individualised and comprehensive services across the lifespan • Services anchored in the community • Continuity of care • Partnership-consultant relationships • Strengths-based • Culturally responsive • Responsiveness to personal belief systems • Commitment to peer recovery support services • Inclusion of the voices and the experiences of recovering individuals and their families • Integrated services • System-wide education and training • Ongoing monitoring and outreach • Outcomes driven • Research based • Adequately and flexibly financed

6. Recovery precursors – RETHINK (2008) • Safe place to live • Basic management of physical and psychiatric distress • Basic human rights and choices • Recovery time course • Alcohol 4-5 years • Opiates 5-7 years

7. Desistance rates • CSAT (2009): 58% of life-course dependent users of substances will achieve lasting recovery

8. Mapping the recovery journeys of former drinkers in recovery

9. “The Power of Recovery” (Personal communication with Phillip Valentine, Executive Director, CCAR, Connecticut Community for Addiction Recovery) “5 years+ In recovery” “Recovering People” “Long Term Recovery” “Better than well” “A grateful addict/alcoholic” “Model citizens” “Normal People” Potential “Early Recovery” Time

10. Quality of life by recovery group

11. Recovery studies in Birmingham and Glasgow • Ready access to populations • Untapped group of recovery champions • Glasgow: predictors of higher quality of life: • More meaningful activities in the last month • Greater number of non-using peers in the recovery network • Different levels of recovery in abstinent and maintained groups

12. William White: social qualities of recovery • Emotional support – involving empathy, care, consideration, concern and encouragement • Informational support – providing knowledge about recovery and the recovery support services and groups available • Instrumental support – support in linking in to supportive housing and childcare services, development of leisure and sporting activities and to recovery groups • Companionship • Validation – sharing and supporting their recovery experiences

13. Benefits of engaging in recovery groups • Experience of acceptance and belonging • Build esteem through identification with a large organisation • Provide a belief system through which shame and defeat can be transformed into victory • Provide a vehicle for the safe discharge of powerful emotions • Provide a consistent set of rituals that facilitate emotional release and value-focusing • Provide a forum for consultation on daily problem solving • Provide rituals that allow the group to celebrate success

14. Types of recovery group • Therapeutic • Vocational • Interest • They are the basis for collective recovery capital • Based on assertive linkage • Embedded within recovery oriented systems

15. What are recovery outcomes?Best and Gilman (2010) • Improved quality of life and community engagement • Improved family functioning • Diversity and engagement with communities of recovery • Emergent recovery champions • Giving back • Culture change

16. How do we measure them at the individual level? • Engagement in meaningful activities • Quality of life and wellbeing • Effective family involvement • Safe housing • Reduced burden on state, CJS • Giving something back? • Being a recovery champion?

17. RECOVERY GROUP CAPITAL PHASE 3 5 4 3 SOCIAL RECOVERY CAPITAL TREATMENT ENGAGEMENT 2 5 5 1 4 4 3 3 2 2 1 1 1 1 PHASE 1 2 2 3 3 4 4 5 5 PHASE 2 PERSONAL RECOVERY CAPITAL TREATMENT MOTIVATION

18. How do we measure recovery orientation and effectiveness at a worker / service level? • For acute services, numbers who achieve basic RETHINK criteria and who are engaged and motivated in recovery activities • Links to community • Workers active in community • Assertive outreach and activity • Recovery Attitudes • Links to recovery pillars – housing, ETE, PBRSS • Therapeutic, strategic and community champions • WW – ROMM?

19. Building up recovery capital • Keyworker is both the source of strength through the therapeutic alliance • And the provider of supports and techniques to enable empowerment and change • But you also have the power to link and enable access to communities of recovery • Need for register of local activities and groups

20. How do we measure recovery orientation at a systems level? • Level 1: Basic pillars – housing, ETE, PBRSS options • Level 2: Number of champions / recovery groups • Level 3: Levels of diverse recovery options and numbers actively engaged • Level 4: Epidemiological indicators of success • Level 5: Stigma / discrimination scores • Level 6: Impact on lived community – including attributed children at risk, disability living allowance, stuck clients • Level 7: Shifts in use and relapse patterns – prevalence and incidence markers

21. What Y&H has to offer • 8 innovation projects • 3 treatment development projects – Sheffield, North Lincs, Bradford • 3 peer based activity projects – Doncaster, Keighley, Merlin • 2 system projects – Halifax, Barnsley

22. What are the innovations and inspirations? • Peer diversity and champion emergence • Committed professionals • Innovative data collection and methods • Dynamic leadership • Bold vision • Active participation and multi-agency working • Co-production

23. Potential barriers • Finance • Projects tied to individuals • Cultural barriers • Systemic problems • Measurement – a question of attribution? • Starting from different points • Time and the development of recovery thinking

24. Solutions • Shared aims • Transparent process • Action research methods and learning • Use of common instruments and intervention approaches • Effective and assertive linkage • Learning culture