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Delphic oracle
Russell Webster

Russell Webster

Criminal Justice & substance misuse expert and author of this blog.

What does recovery mean and how do we measure it?

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New research seeks to establish a basket of indicators to define recovery, now updated with SURE self-checklist: Substance Use Recovery Evaluator

Measuring addiction recovery

An interesting article from a bunch of heavyweights in the drug misuse world, including Emily Finch, John Marsden and John Strang, was published in early 2016 in the journal “Drugs: education, prevention and policy” (you can follow them on Twitter: @DEPPJournal).

This post describes their work on exploring the meaning and measurement of recovery and is now updated (see below) with a new self-assessment tool: The Substance Use Recovery Evaluator (SURE).

“Emerging consensus on measuring addiction recovery” which, I am glad to report, is free to access and download, reports on a consultation exercise with 146 individuals from the substance misuse field in the UK including frontline staff, service managers, commissioners, specialist GPs and pharmacists, independent consultants, and people working in government, policy and think tanks. Critically, 38 of the 146 individuals were also in recovery themselves

The purpose of the consultation was to agree a set of “recovery indicators”.

The authors make the case that, although the word “recovery” has been embedded within drug and alcohol policy and practice for many years now, there is still no clear consensus on what the term means. In fact, they go as far to say that there is also no consensus on whether recovery is a good thing, or how it should be measured.

The oracle speaks

The consultation was undertaken using a Delphi group methodology. This approach (named after the Delphic Oracle) is a systematic communication technique which relies on a panel of experts. The experts answer questionnaires in two or more rounds; after each round a facilitator provides an anonymous summary of the experts’ views as well as the reasons they gave their judgement. In the subsequent rounds, experts are encouraged to revise their earlier answers in the light of replies of other panel members. The rationale behind this approach is the expectation that the range of answers will decrease and the group will converge towards a “correct” answer — a bit like electing a new pope.

For this research on recovery indicators, there were three rounds.

Twenty seven indicators

Following a substantial consultation process with professionals and service users prior to the Delphi groups, the researchers had identified 28 recovery indicators. All but one of these were ratified by the Delphi process (the only one which did not survive the cut was “not experiencing cravings” probably because the experts held the view that cravings could persist for many years after someone’s substance misuse had decreased or stopped).

The 27 indicators were:

  1. Not drinking too much
  2. Not using street drugs
  3. Taking care of mental health
  4. Coping with problems without drug/alcohol
  5. Feeling emotionally stable and secure
  6. Feeling like a worthwhile person
  7. Taking care of physical health
  8. Managing pains/ill-health without drugs/alcohol
  9. Taking care of appearance
  10. Eating a good diet
  11. Sleeping well
  12. Getting on well with people
  13. Feeling supported by people
  14. Having stable housing
  15. Having a regular income
  16. Managing money well
  17. Having a good daily routine
  18. Going to appointments
  19. Spending time on holidays without drugs/alcohol
  20. Participation in education, training or work
  21. Feeling happy with overall quality of life
  22. Feeling positive
  23. Having realistic hopes and goals for oneself
  24. Being treated with respect/consideration by people
  25. Treating others with respect/consideration
  26. Being honest and law-abiding
  27. Trying to help and support other people

Analysis

My original viewpoint was that these 27 indicators do seem to form a very coherent picture of recovery and I can see their value in getting recovering drug and alcohol users to self-assess their own progress.

However, in my mind, there were too many indicators for treatment providers to record, nor do I see them being sufficiently robust or easy to validate that they could be used to measure recovery in any “objective” way.

However, the researchers have now gone a step further and released SURE, The Substance Use Recovery Evaluator.

SURE is a psychometrically valid, quick and easy-to-complete outcome measure, developed with unprecedented input from people in recovery. It can be used alongside, or instead of, existing outcome tools.

  • ‘SURE’ measures recovery from drug and alcohol dependence
  • ‘SURE’ is completed by people in recovery (not by clinicians, researchers or others)
  • ‘SURE’ has good face and content validity, acceptability and usability for people in recovery
  • SURE’ comprises 21 items (5 factors) and is psychometrically valid, quick and easy-to-complete
  • ‘SURE’ can be used by individuals in private or in a therapeutic context

You can download SURE here

Update: 15 March 2017

You can now take the self-evaluation test online here.

I would be very interested in the views of people in recovery about this new, potentially extremely valuable, tool.

Please use the comments section below.

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11 Responses

  1. When you brake down the 27 Indicators we can see from the first to that these indicators are from some one who don’t understand what it means to be in recovery rather than to be Recoverd ,eg some people find it impossible not to drink to much ,and number 2 is justerfied by the same person forgetting or not understanding that alchol kills more people than street drugs (street drugs being illegal based on the goverment has no tax on them yet so they don’t won’t the basic man making profit ,yet the system sells legal highs and then profits from that person who finds himself in recovery designed by the system to make more money ,recovery needs to bring people out the system rather than keeping them in a delusional belief that there in recovery

  2. My issue with all of this is that it kind of assumes that people enter treatment services looking for ‘recovery’ (whatever it is) and in my experience many (maybe most) opioid drug users might simply want access to some free pharmacological assistance to ease the daily grind of “grafting” and “scoring” which, for me, is perfectly legitimate in a context of (opiate) prohibition.

    1. Thanks Mark , I guess no definition will ever capture an individual’s own aspirations and experiences. The difficulty seems (to me) to be how to set high expectations without making people who don’t want to “go the full recovery distance” feel like their choices are less valid.

  3. Being in recovery myself for a number of years, I started to recover when I decided that any positive change was good for me, simplistic but achievable most importantly my decision not a service led decision services helped me along the way but they neither gave me recovery or decided my rec

      1. Good point Jason. I completely agree that recovery is something that is individual, though I feel that treatment and support are vital in the process. They don’t nor should they decide what is best, though should have the skills to encourage and motivate to that most important measure of recovery i.e. that we find that we are on a course of positive development, and in the process using substances less.
        Paul, London

  4. I am in recovery for both Alcoholism and Bi Polar. I am 60 yrs old. in my 40’s I was Dry for 10 yrs but no Mental Health Treatment. At age 50 I found CD-MI treatment with a Harm Reduction Model. It took a couple of years but I am now stable for 8 yrs. I Just want to point out for some users Harm Reduction methods might be the way to go.

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