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Measuring an individual's recovery barriers and strengths

November 1, 2016
by By David Best, Michael Edwards, Adam Mama-Rudd, Ivan Cano and John Lehman
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In 2008, Granfield and Cloud defined recovery capital as “the sum total of one's resources that can be brought to bear on the initiation and maintenance of substance use cessation.” These authors discussed the four component parts of recovery capital as social, human, physical and cultural. They also introduced the idea of “negative recovery capital” to indicate that certain circumstances (a significant history of mental health problems, a history of engagement with the criminal justice system, older age and female gender) constitute barriers to recovery.1

The concept of recovery capital has since been cited in a number of locations, including the U.K., Australia and the U.S., and is recognized in official policy documents ranging from the U.K. Drug Strategy2 to the Victorian drug treatment system reform in Australia.3 In the U.S., recovery capital is also included in SAMHSA's white paper on recovery-oriented systems of care.4 However, while widely discussed, recovery capital remains a poorly operationalized term that has offered little to practitioners or policy leaders in developing metrics for recovery progress.

In 2012, Groshkova, Best and White published the psychometrics for the Assessment of Recovery Capital (ARC), showing positive reliability, internal consistency and concurrent validity for a scale developed in partnership with community recovery services in Scotland and England.5 The ARC consists of 50 items: 25 relating to personal recovery capital and 25 relating to social recovery capital. The questions cluster into 10 subscales providing greater detail into the areas of strength and support that an individual in recovery possesses. The measure was designed to sit alongside a previous measure developed by the same team that evaluates recovery group engagement: the Recovery Group Participation Scale (RGPS).6 This 14-item questionnaire assesses involvement not only in Alcoholics Anonymous (AA) and Narcotics Anonymous (NA) but a range of other community recovery groups. These 64 items in total provide the basis for measuring what resources and support a person has at that stage in his/her recovery journey.

While these scales have been used in both research and clinical practice in several countries, they have never previously been embedded into a measure that tracks recovery progress. This approach utilizes a strengths-based perspective that can be implemented before, during and after specialty treatment. We have embedded both recovery strength measures into a single scale that can be administered by clinicians, peer mentors or people in recovery to create a simple visualization of recovery stage and needs. This new method of assessing recovery capital is a measurement tool called the REC-CAP.

We offer here an overview of initial results from the initial phase of the first U.S. pilot project assessing REC-CAP implementation. This project has been undertaken as a partnership between Sheffield Hallam University, the Florida Association of Recovery Residences (FARR) and eight FARR members. William White is the external partner and adviser to the project.

We present the findings from 100 of the first cases successfully completed at three of our participating sites to showcase what the REC-CAP is capable of, and to illustrate the initial profile of resources, barriers and needs of a cohort living in recovery residences.

Overview of study method

Eight recovery residences throughout Florida signed on to pilot the REC-CAP with their residents. The survey took an average of 20 minutes for each resident to complete.

After basic demographic data, the next section of the REC-CAP assesses quality of life and satisfaction using a “ruler” to measure five areas of well-being: psychological health, physical health, quality of life, accommodation and social support. Barriers to recovery are then assessed in five areas: accommodation, substance use, risk taking (injecting), offending and employment. The aim is to see whether there are problem areas that would block progress in the recovery journey. Also, to assess barriers, questions are asked about specialist help needs across a broad spectrum of services, evaluating whether the participant has ongoing or unmet service needs in areas including housing, mental health and family support, as well as alcohol and drug specialty treatment.

The REC-CAP then turns from barriers to strengths. The core of the strengths measure is the ARC. Following the ARC is the Recovery Group Participation Scale (RGPS). Next is a four-scale measure, the Social Support Scale7, which evaluates the second aspect of social support: support satisfaction that is not related to the level of involvement in recovery groups. The battery of quantitative tools concludes with the Commitment to Sobriety Scale (CSS).8 This measures commitment to or motivation for sobriety and is a six-point Likert-like scale consisting of five statements.

Finally, because recovery is a very personal journey, the final section provides a space for residents to fill in their own thoughts about where they are in the process, what needs they have, and what their individual goals are. The basic REC-CAP process is illustrated in Figure 1.

Findings on barriers and strengths

The sample consisted of 100 cases: 31% of residents from Safe Haven, 28% from Trinity by Traditions, and 41% from Good Works Recovery. The mean time in residence was 180.8 days. The sample consisted of 84 men and 16 women, with an average age of 28.5 years (range: 19 to 62).

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