Spoiler alert: They involve abstinence goals, recovery capital and mutual aid
This post is reprinted with permission from one of TreatmentMagazine.com’s go-to blogs about addiction, treatment and recovery: Recovery Review.
By David McCartney
A few things related to recovery have caught my eye recently, things that I think are worth knowing and that ought to shape our practice.
Set Clear Abstinence Goals
In a study from Swiss researchers involving more than 200 patients going through residential treatment, those who set clear goals for abstinence were much less likely to relapse than those who set conditional goals (like being abstinent for a while and then reviewing that decision). About twice as many of those setting abstinent goals (58%) were sober at the six-month follow-up period as those with ambivalent drinking goals. Demographically the groups were the same, though those with conditional goals tended to have more mental health problems.
[O]f those setting clear goals for abstinence, nearly 60% had achieved that six months later—a very impressive remission rate.
I thought it striking that of those setting clear goals for abstinence, nearly 60% had achieved that six months later—a very impressive remission rate. This is in keeping with a study done on patients I work with and confirms positive outcomes associated with residential rehabilitation.
Participation in Groups Builds Recovery Capital
Recovery capital describes the resources (internal and external) than can be drawn upon to initiate and maintain recovery. International evidence is growing around the value of recovery residences in supporting individuals in reaching their goals. We have at least one such residence in Edinburgh, Scotland. In a study of U.S. recovery house residents (823), a recovery capital measurement tool was used to capture changes in recovery capital over time.
Older men who participated in recovery groups did best, with women and younger residents doing more poorly.
The study showed that, generally, recovery capital increased over time, but it didn’t do so consistently. Older men who participated in recovery groups did best, with women and younger residents doing more poorly, leading the researchers to recommend that more focus on those groups in terms of housing, employment and family issues may help. While bonding within the recovery house is thought to be important, the biggest impact seems to come from participating in mutual aid groups.
Mutual Aid Membership Improves Well-being
I find myself increasingly frustrated about the lack of academic interest in Scotland around recovery communities. We have large numbers of mutual aid groups and increasing numbers of lived-experience recovery organizations, recovery walks, recovery concerts and a variety of other activities organized by people who have resolved their problems with substances. The impact on drug and alcohol deaths for this population (saved lives) must be significant, as must the impact on quality of life. But there is almost no attention being paid—perhaps because it’s just much easier to study medical interventions. It’s such a blind spot.
It’s discouraging to see how little research has been done in the U.K. on how effectively we connect individuals to mutual aid.
So, it was good to read this Polish study involving 70 members of Alcoholics Anonymous. The researcher, Marcin Wnuk, wanted to understand what was going on in the relationship between being involved with AA and how people experience and evaluate different aspects of their lives, particularly regarding mental health, life satisfaction and happiness (subjective well-being). Wnuk found that this was indirectly affected by the impact on finding hope and meaning in life (existential well-being). The study recommends that: “Practitioners, therapists, and counsellors should engage patients with an alcohol addiction diagnosis to participate in AA meetings as an effective way to cope with dependence.”
It’s discouraging to see how little research has been done in the U.K. on how effectively we connect individuals to mutual aid. Mutual aid participation has a significant impact on outcomes. The fact that there is almost no interest in measuring connection rates to mutual aid and of assessing the impact of such interventions is regrettable. In Scotland, the recent publication of the evidence behind the Drug Deaths Task Force recommendations kind of makes the point.
In an otherwise impressive 223-page document evidencing the things that may make an impact on Scotland’s high drug deaths, I was initially encouraged to see that “Recovery” got its own chapter. Well, I say “chapter,” but further exploration revealed that this was in fact a page. Well, I say, “page,” but I mean two paragraphs at the top of an otherwise empty page. This will be seen by some as a slight to the Scotland’s communities of recovery and their potential to make a difference. This is, from my perspective, a wasted opportunity.
As has been pointed out to me recently, there is more awareness south of the border, and a toolkit is available to help services connect people into mutual aid in a way that, as the Polish research shows, will improve hope, meaning and well-being.
This Recovery Review post is by David McCartney, who is an addiction medicine specialist and Clinical Lead at LEAP, a quasi-residential therapeutic community addiction treatment program in Scotland. He trained as a family medicine practitioner and spent much of his career in practice in inner-city Glasgow. Having retrained in addictions, he now works exclusively in the field and until recently was an advisor to the Scottish government on drugs policy. He is a member of the Royal College of General Practitioners. His opinions expressed here don’t necessarily represent the views of his employer. Find more of his writing, as well as a thought-provoking range of articles, insights and expert opinions on treatment and addiction, at RecoveryReview.com.blog.
Photo: Florencia Viadana