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:
- Not drinking too much
- Not using street drugs
- Taking care of mental health
- Coping with problems without drug/alcohol
- Feeling emotionally stable and secure
- Feeling like a worthwhile person
- Taking care of physical health
- Managing pains/ill-health without drugs/alcohol
- Taking care of appearance
- Eating a good diet
- Sleeping well
- Getting on well with people
- Feeling supported by people
- Having stable housing
- Having a regular income
- Managing money well
- Having a good daily routine
- Going to appointments
- Spending time on holidays without drugs/alcohol
- Participation in education, training or work
- Feeling happy with overall quality of life
- Feeling positive
- Having realistic hopes and goals for oneself
- Being treated with respect/consideration by people
- Treating others with respect/consideration
- Being honest and law-abiding
- Trying to help and support other people
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.