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Recovery capital: A primer for addictions professionals

White, W. & Cloud, W. (2008). Recovery capital: A primer for addictions
professionals. Counselor, 9(5), 22-27.
Recovery Capital:
A Primer for Addictions Professionals
William L. White, MA and William Cloud, PhD
From Pathology to Resiliency and Recovery
The history of addiction treatment in America contains within it a
history of key ideas that have transformed service philosophies and
practices. In the early history of modern treatment, for example, chemical
dependency emerged as a core idea that helped integrate what were then two
separate fields: one focused on alcoholism, the other on drug addiction.
Other concepts, such as codependency, dual diagnosis, gender-specific,
developmental appropriateness, cultural competence, trauma-informed,
evidence-based, stages of change, motivational enhancement, recovery
management, and recovery coaching helped, or are now helping, transform
addiction treatment into a more person-centered, holistic, family-centered,
and recovery-focused system of care.
Addiction professionals across America are witnessing the field’s
paradigmatic shift from a pathology and intervention focus to a recovery
focus (White, 2004, 2005). Attention on the lived solution to alcohol and
other drug (AOD) problems is reflected in the growing interest in defining
recovery, conducting recovery prevalence surveys, illuminating the varieties
of recovery experiences, and mapping the patterns, processes, and stages of
long-term recovery (Betty Ford Institute Consensus Panel, 2007; White &
Kurtz, 2006).
One of the key ideas at the core of this shift is that of recovery capital.
This article defines recovery capital and explores how attention to recovery
capital can be integrated into the service practices of front-line addiction
Recovery Capital Defined
Recovery capital (RC) is the breadth and depth of internal and
external resources that can be drawn upon to initiate and sustain recovery
from severe AOD problems (Granfield & Cloud, 1999; Cloud & Granfield,
2004). Recovery capital is conceptually linked to natural recovery, solution-
focused therapy, strengths-based case management, recovery management,
resilience and protective factors, and the ideas of hardiness, wellness, and
global health. There are three types of recovery capital that can be
influenced by addictions professionals.
Personal recovery capital can be divided into physical and human
capital. A client’s physical recovery capital includes physical health,
financial assets, health insurance, safe and recovery-conducive shelter,
clothing, food, and access to transportation. Human recovery capital
includes a client’s values, knowledge, educational/vocational skills and
credentials, problem solving capacities, self-awareness, self-esteem, self-
efficacy (self-confidence in managing high risk situations),
hopefulness/optimism, perception of one’s past/present/future, sense of
meaning and purpose in life, and interpersonal skills.
Family/social recovery capital encompasses intimate relationships,
family and kinship relationships (defined here non-traditionally, i.e., family
of choice), and social relationships that are supportive of recovery efforts.
Family/social recovery capital is indicated by the willingness of intimate
partners and family members to participate in treatment, the presence of
others in recovery within the family and social network, access to sober
outlets for sobriety-based fellowship/leisure, and relational connections to
conventional institutions (school, workplace, church, and other mainstream
community organizations).
Community recovery capital encompasses community
attitudes/policies/resources related to addiction and recovery that promote
the resolution of alcohol and other drug problems. Community recovery
capital includes:
active efforts to reduce addiction/recovery-related stigma,
visible and diverse local recovery role models,
a full continuum of addiction treatment resources,
recovery mutual aid resources that are accessible and diverse,
local recovery community support institutions (recovery centers /
clubhouses, treatment alumni associations, recovery homes, recovery
schools, recovery industries, recovery ministries/churches), and
sources of sustained recovery support and early re-intervention (e.g.,
recovery checkups through treatment programs, employee assistance
programs, professional assistance programs, drug courts, or recovery
community organizations).
Cultural capital is a form of community capital. It constitutes the
local availability of culturally-prescribed pathways of recovery that resonate
with particular individuals and families. Examples of such potential
resonance include Native Americans recovering through the “Indianization
of AA” or the “Red Road,” or African Americans recovering within a faith-
based recovery ministry or within an Afrocentric therapeutic orientation
(Coyhis & White, 2006; White & Sanders, in press).
In total, recovery capital constitutes the potential antidote for the
problems that have long plagued recovery efforts: insufficient motivation to
change AOD use, emotional distress, pressure to use within intimate and
social relationships, interpersonal conflict, and other situations that pose
risks for relapse.
Early Scientific Findings
Modern addiction science has illuminated critical factors that
contribute to the onset and complicate the course of substance use disorders,
e.g., a family history of AOD problems, childhood victimization, early age
of unsupervised AOD use, multiple drug use, injection drug use, long delay
from onset of AOD problems to first treatment, high emotional distress (co-
occurring psychiatric illness), and enmeshment in an AOD-saturated social
milieu (See White, in press/a for a review). But the protective factors that
can offset such risk factors or increase one’s odds of successful long-term
addiction recovery have yet to be fully charted. The following key findings
from recent scientific studies and reviews underscore the potential
importance of recovery capital.
Recovery capital—both its quantity and quality—plays a major role in
determining the success or failure of natural and assisted recovery
(e.g., recovery from AOD problems without or with participation in
professional treatment or a recovery mutual aid society) (Granfield &
Cloud, 1996, 1999; Moos & Moos, 2007; Kaskutas, Bond, &
Humphreys, 2002).
Increases in recovery capital can spark turning points that end
addiction careers, trigger recovery initiation, elevate coping abilities,
and enhance quality of life in long-term recovery (Cloud & Granfield,
in press; Laudet, Morgan, & White, 2006).
Such turning points, both as climactic transformations and
incremental change processes, may require the accumulation of
recovery capital across several years and multiple episodes of
professional treatments (Dennis, Foss, & Scott, 2007).
Elements of recovery capital vary in importance within particular
stages of long-term recovery (Laudet & White, in press).
Recovery capital is not equally distributed across individuals and
social groups. Members of historically disempowered groups often
seek recovery from addiction lacking assets that are taken for granted
by those seeking recovery from a position of privilege (Cloud &
Granfield, 2001).
Post-treatment recovery check-ups, and, when needed, early re-
intervention can help preserve the recovery capital developed through
addiction treatment (Dennis, Scott, & Funk, 2003).
Most clients with severely depleted family and community recovery
capital gain little from individually-focused addiction treatment that
fails to mobilize family and community resources (Moos & Moos,
Long-term recovery outcomes for those with the most severe AOD
problems may have more to do with family and community recovery
capital than the attributes of individuals or a particular treatment
protocol (Bromet & Moos, 1977; Humphreys, Moos, & Cohen, 1997;
Mankowski, Humphreys, & Moos, 2001).
Science is confirming what front-line addiction professionals have
long known: “environmental factors can augment or nullify the short-term
influence of an intervention” (Moos, 2003, p. 3). This suggests that
therapeutic processes in addiction treatment must encompass more than a
strictly clinical intervention (Simpson, 2004). Strategies that target family
and community recovery capital can elevate long-term recovery outcomes as
well as elevate the quality of life of individuals and families in long-term
recovery (White, in press/b).
Recovery Capital and Clinical Practice
Heightened attention to recovery capital can significantly influence
one’s service delivery practices. The following prescriptions reflect such
1. Support screening and brief intervention (SBI) programs that reach
people before their recovery capital is depleted and substance use disorders
have become severe, complex, and chronic (Cloud & Granfield, 1994a).
SBI programs are sometimes viewed as tools of case finding and induction
for addiction treatment, but their greatest value is in helping people resolve
AOD problems using personal, family, and community resources before
specialty-sector professional treatment is needed. To achieve such a goal,
we must all become students of the processes through which AOD problems
in the larger community are resolved.
2. Engage people with low recovery capital through aggressive
programs of community outreach. “Hitting bottom” only has meaning when
there is still personally meaningful recovery capital to be lost. When
recovery capital is exhausted, people will die before such a mythical bottom
is reached. The obstacle to recovery under such conditions is not
insufficient pain, but the absence of hope, connectedness, and potential for
fulfillment. People with severely depleted RC have unfathomable
capacities for physical and psychological pain. We must go get people with
high problem severity and extremely low recovery capital rather than wait
for their pain or coercive institutions to bring them to us. The catalytic
turning point for those with depleted recovery capital is more likely to be
one of seeing an achievable top than hitting bottom.
3. Assess recovery capital on an ongoing basis. Traditional
assessment technologies in addiction treatment are distinctly pathology-
focused. Addiction professionals have been trained to employ assessment
instruments and interview protocols to generate a problems list that forms
the basis of treatment planning activities. Growing evidence on the role of
recovery capital in AOD problem resolution calls for a more strengths-based
approach to the assessment process. The fact that recovery capital ebbs and
flows through both addiction and recovery careers also calls for a continual
assessment process that can identify subtle but crucial shifts in recovery
assets. The AOD cessation capacity of each individual at a particular point
in time might well be thought of as the interaction between problem severity
and recovery capital.
4. Use recovery capital levels to help determine level of care
placement decisions.
Traditional placement models link problem severity and intensity of care.
Those with high problem severity and complexity are placed in the most
restrictive levels of care, e.g. inpatient and residential programs, and are
provided the longest course of professional care. This formula misses the
crucial influence on recovery capital. The figure below illustrates four
potential interactions between problem severity/complexity and recovery
capital (Figure and discussion abstracted from White, in press/a).
Figure 1: Recovery Capital / Problem Severity Matrix
High Recovery Capital
High Problem Severity
/ Complexity
Problem Severity /
Low Recovery Capital
Factoring in the unique combination of a client’s problem severity can
alter placement decisions.
A client with moderate problem severity but high recovery capital
arriving at a treatment agency in response to a positive drug test might
be quite appropriate for screening and brief intervention. Such
individuals often terminate addictions on their first attempt without
professional or peer assistance and without embracing an
addiction/recovery-based personal identity (Granfield & Cloud, 1996;
Cloud & Granfield, 1994b). They can also often be helped through
non-specialty helping institutions, culturally indigenous support
institutions (e.g., cultural revitalization movements), or from peer-
based recovery support groups without facing the cost, life disruption
or stigma associated with addiction treatment (Cloud & Granfield,
1994a,b). This same individual with multiple risk factors (e.g., family
history, early onset of use, etc.) might be appropriate for SBI followed
by periodic recovery check-ups as a means of lowering the risks for
future problem escalation.
A client with high problem severity and complexity but exceptionally
high recovery capital might be appropriate for outpatient
detoxification and outpatient treatment despite a level of problem
severity that, viewed in isolation, would justify inpatient care.
Assertive linkage to recovery mutual aid groups in tandem with
motivational interviewing and ongoing recovery check-ups might well
serve as an alternative to inpatient or residential treatment.
A client with low problem severity but high risk factors and extremely
low recovery capital might be in greater need of residential treatment
and step down care than the above profiled clients, even though he or
she is likely to end up with SBI or outpatient treatment within current
assessment and placement systems.
A client with high problem severity/complexity and extremely low
recovery capital requires services of high intensity, broad scope (e.g.,
outreach, assertive case management, and sustained recovery
coaching), and long duration (Cloud & Granfield, 2001, 2004; White,
in press,a). Providing such clients brief treatment isolated from their
natural environment and then “graduating” them into that same
environment without substantial community-based supports is a set-up
for failure. Clients from historically disempowered communities are
often punished (e.g., lost custody of children, incarceration) following
such “failures” on the grounds that they “had their chance” (White &
Sanders, in press).
5. Target all three spheres of recovery capital within professionally-
directed treatment plans and client-directed recovery plans. The question is:
What resources need to be mobilized within the individual, the family/social
milieu, and the community to support the long-term recovery of each client?
The Native American Wellbriety movement uses the metaphor of the
“healing forest” to underscore the inextricable link between personal, family,
and community health. Treatment and recovery plans that reflect this
understanding include interventions to elevate family and community
recovery capital and assertively link clients and families to other individuals,
families, and community institutions rich in recovery capital.
6. Support recovery-linked cultural revitalization and community
development movements. One of the ways addiction professionals can
increase the recovery capital of the individuals and families they serve is to
actively support local movements aimed at increasing recovery support
services and creating a community milieu within which recovery can
flourish. Such support could include serving on the board of a recovery
community organization, volunteering at a recovery support center,
encouraging those seeking to start a new recovery support group,
participating in recovery education or recovery celebration events, and
providing financial contributions to help promote and conduct such events.
7. Use changes in levels of recovery capital to evaluate your program
and your own professional performance. The most effective addiction
treatment programs help build community recovery capital beyond their own
service programs. This can be done by regularly assessing aggregate
community recovery capital, issuing a periodic report card on community
recovery resources, and by allocating organizational resources to support
recovery community development activities. If non-treatment community
recovery capital decreases in tandem with the growth of treatment services,
the community is being inadvertently wounded by treatment expansion. One
of the best ways to assess the impact of treatment resources is to evaluate
whether they generate long-term increases or decreases in community
recovery capital.
At a personal level, we tend to evaluate our effectiveness based on
what is subtracted from the lives of our clients (e.g., AOD use, criminal
activity, threats to public safety, financial problems, high health care
consumption, and emotional distress). But the short-term elimination or
reduction of these ingredients may or may not have any linkage to the
prospects of long-term recovery. A better predictor of long-term recovery
may be what has been added to the lives of the individuals and families with
whom we work, e.g., radically altered perceptions of alcohol and other
drugs, physical and emotional health, increased coping and communication
skills, improved family relationships, new family rules and rituals,
safe/stable housing and employment; clean and sober friends, membership in
a community of recovering people, and life meaning and purpose.
The concept of recovery capital reflects a shift in focus from the
pathology of addiction to a focus on the internal and external assets required
to initiate and sustain long-term recovery from alcohol and other drug
problems. As this concept permeates the field, addiction treatment programs
will increase their involvement with families and communities, and
addiction professionals will become more involved in recovery community
building activities. Recovery capital has a contagious quality. It is time we
all became its carriers.
About the Authors: William White ( is Senior
Research Consultant at Chestnut Health Systems and author of Slaying the
Dragon: The History of Addiction Treatment and Recovery in America.
William Cloud is Professor at the Graduate School of Social Work,
University of Denver. Much of his teaching, research, and writing has been
in the areas of substance abuse cessation and substance abuse policy.
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... Their use can take something that works well, for example, a life in recovery, and further strengthen it using an individual's own resources. This is similar to the more established concept of recovery capital, where a person develops their internal and external resources to successfully navigate life in recovery (O'Sullivan et al., 2017;White, 2008). In this case, however, when a person uses their character strengths, they improve their capacity to function more effectively, for example, in being better equipped to constructively reframe negative situations (Niemiec, 2019;Rashid and Seligman, 2018). ...
... In March 2022, the time of authoring this work, a search of the scholarly databases Google Scholar and ProQuest using the search term "Character Strengths" AND "Addiction Recovery" did not return any results looking at character strengths as a broad-spectrum strategy for strengthening addiction recovery. The results returned from this search showed existing work was limited, having focused on the specific application of a strength, for example, the use of gratitude as a means to build reserves of recovery capital to safeguard long-term recovery (White, 2008;Chen, 2017) or in how character strengths relate to a particular area of interest such as spirituality (Selvam, 2015). The present study looks at how the VIA model of character strengths can be applied as a general resource to support those in addiction recovery, with the aim of suggesting a way to appreciate the positive outcomes seen in other areas of research (Niemiec, 2019;Schutte and Malouff, 2019) to addiction recovery. ...
Purpose The purpose of this study is to demonstrate how the values in action (VIA) character strengths model can be applied as a resource to support people in addiction recovery. The purpose of this is to appreciate the positive outcomes seen in other areas of research, applied to addiction recovery. To achieve this, a character strengths intervention has been designed and delivered as a case study. The objective of the intervention is to identify some of the strengths described by an individual in their account of recovery, ascertain their signature strengths through validated assessment and, based on the exploration of this information, support the individual in a reflective exercise to consider how their character strengths have positively affected their recovery to date and the effect this new knowledge could have on their ongoing recovery. Design/methodology/approach The VIA character strengths model has identified 24 positive qualities that are present in the human condition. In this case study, the VIA model is used to identify strengths from a first-hand account of the recovery process; the VIA character strengths survey is used to ascertain the signature strengths of the participant who is also the author of the account. Information from the strengths identification and VIA survey is explored, and a follow-up e-interview is conducted using questions designed to encourage the participant to reflect on the use of strengths in their present and ongoing recovery. Findings This case study shows that the VIA model of character strengths can be applied in addiction recovery to help people appreciate how they have used their character strengths in the recovery process, what their signature strengths are and how they can be used with good effect to improve their well-being and future recovery. Originality/value In this work, a new broad-spectrum approach using the VIA model of character strengths has been proposed to help people in addiction recovery use their own resources to improve their function, well-being and thus recovery.
... Social capital, meant as resources in one's own social network (57), is a component of the set of "internal or external resources that can be drawn upon to initiate and sustain recovery" (58). The construct of individual's "recovery capital" encompasses economic, social, identity, personal and relationship capital, the significant gaps of which suggest a proactive capacity-building approach while working with the person and their social environment (59). ...
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Covid-19 is referred to as a “syndemic,” i.e., the consequences of the disease are exacerbated by social and economic disparity. Poor housing, unstable work conditions, caste, class, race and gender based inequities and low incomes have a profound effect on mental health and wellbeing. Such disparities are increasing between, among and within countries and are exacerbated by human rights violations, in institution and in society, stigma and discrimination. Social capital can mediate health outcomes, through trust and reciprocity, political participation, and by mental health service systems, which can be coercive or more open to demand of emancipation and freedom. Societal inequalities affect especially vulnerable groups, and Covid itself had a wider impact on the most socially vulnerable and marginalized populations, suffering for structural discrimination and violence. There are complex relations among these social processes and domains, and mental health inequalities and disparity. Participation and engagement of citizens and community organizations is now required in order to achieve a radical transformation in mental health. A Local and Global Action Plan has been launched recently, by a coalition of organizations representing people with lived experience of mental health care; who use services; family members, mental health professionals, policy makers and researchers, such as the International Mental Health Collaborating Network, the World Federation for Mental Health, the World Association for Psychosocial Rehabilitation, the Global Alliance of Mental Illness Advocacy Networks (GAMIAN), The Mental Health Resource Hub in Chennai, India, The Movement for Global Mental Health (MGMH) and others. The Action Plan addresses the need for fundamental change by focusing on social determinants and achieving equity in mental health care. Equally the need for the politics of wellbeing has to be embedded in a system that places mental health within development and social justice paradigm, enhancing core human capabilities and contrasting discriminatory practices. These targets are for people and organizations to adopt locally within their communities and services, and also to indicate possible innovative solutions to Politics. This global endeavor may represent an alternative to the global mental discourse inspired by the traditional biomedical model.
... For instance, Godley et al. (2005) found that environmental factors were both directly and indirectly related to ongoing substance use and related problems among adolescents. The family environment, including parental involvement, is an important source of recovery capital (i.e., individual, social, and structural resources to initiate and sustain recovery) for adolescents with histories of SUDs (Hennessy, 2017;White & Cloud, 2008). Thus, understanding how to best assess key parenting practices among this particular clinical population is paramount to prompting adolescents' recovery processes. ...
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Psychometrically sound parenting instruments are a critical aid in guiding clinical assessments of adolescent behavioral outcomes, particularly among clinical samples of adolescents. However, there is a paucity of research on these parenting instruments among adolescents with histories of substance use disorders (SUDs) who represent a high-risk clinical population for whom parents are critical in their recovery process. This study investigated the psychometric properties of an abridged 17-item Alabama Parenting Questionnaire (APQ) in a sample of 294 adolescents (45% female, mean age = 16 years) and their parents (84% female) recruited from substance use treatment facilities as part of a longitudinal parent study. Confirmatory factor analyses established the factor fit of the abridged APQ, and path analyses assessed the predictive validity of the APQ constructs in relation to adolescent externalizing behaviour symptoms 6 months later. Results suggested the hypothesized three-factor model consisting of Positive Parenting, Poor Monitoring, and Inconsistent Discipline parenting constructs represented a satisfactory fit to the data, with minor modifications in scale content for both adolescent and parent versions. All three latent factors were moderately correlated in the adolescent-reported version, but there was no evidence that Inconsistent Discipline and Poor Monitoring were significantly correlated in the parent-reported version. Additionally, results supported the predictive validity of these constructs related to adolescent externalizing behavioral outcomes. Overall, results of the present study support the utility of a multi-informant abridged parenting assessment. However, some items of the Parental Monitoring and Inconsistent Discipline constructs may not be strong indicators of parenting practices among youth in recovery from SUDs. We conclude with suggestions for future research efforts as well as clinical implications of parenting measures among adolescents with SUD histories.
... values, tastes, and traditions) and community (e.g. community-level resources) capital (White and Cloud 2008;Hennessy 2017). Study team members then wrote at least one item per element. ...
... Recovery-oriented systems of care aim to facilitate recovery by addressing the needs of the individual beyond just symptom reduction or abstinence (DiClemente et al., 2016). This involves fostering recovery capital, or internal and external resources that can initiate and sustain recovery (White & Cloud, 2008). Such resources can include housing, social, and employment support (Humphreys & Lembke, 2014), as well as spirituality, life meaning, and group affiliation (Laudet & White, 2008). ...
Objective: Rates of hazardous alcohol consumption and co-occurring posttraumatic stress disorder (PTSD) are high among returning combat veterans and may adversely affect satisfaction with life (SWL). Improving life satisfaction represents a potential secondary outcome of web-based interventions for alcohol use and PTSD. Understanding the relationship between intervention targets and SWL may help inform future interventions and provide clarity regarding how improvements are manifesting. We examined returning veterans enrolled in VetChange, an evidence-based web intervention for co-occurring alcohol use and PTSD, to determine changes in SWL over time and as a function of changes in alcohol consumption and PTSD symptoms. Method: Participants included 222 returning veterans who reported hazardous drinking. Veterans engaged in a nationwide implementation of VetChange and completed measures of average weekly drinks (AWD), PTSD symptoms, and SWL at baseline, 1, 3, and 6 months. We investigated the effects of changes in PTSD and AWD between baseline and 1 month on SWL over 6 months using linear mixed-effects modeling. Results: Across all veterans, SWL increased by 19% over 6 months. AWD and PTSD decreased between baseline and 1 month, but only change in PTSD predicted changes in SWL over the 6-month interval. Conclusions: Reductions in PTSD symptoms within the first month of intervention use, and not reductions in drinking, predicted increased SWL over 6 months. SWL is an important marker for recovery and related quality of life, and an important assessment and intervention target of web-based interventions. Interventions may also target SWL, as improvements in SWL promote future recovery and sustained improvement. (PsycInfo Database Record (c) 2022 APA, all rights reserved).
A cohort of clients was recognised attending an addiction medicine clinic with similar presentations of opioid dependence from use of a rarely known Ayurvedic medication in a specific ethnic community. This retrospective case series was completed to promote wider recognition and further understanding of dependence on Kamini Vidrawan Ras (Kamini). A retrospective file audit of the electronic medical record for clients of an addiction medicine outpatient clinic with a history of dependent use of Kamini identified 12 clients meeting inclusion criteria. All 12 clients were male, aged 27–41 years, all but one of north Indian origin, predominantly employed and predominantly (but not exclusively) without significant other substance use history. All 12 clients were treated with opioid substitution therapy. This case series highlights an opioid dependence syndrome resulting from use of an Ayurvedic medicine by men from a specific area of India, highlighting a potential adverse effect of traditional medicines in ongoing use by migrant and ethnic populations that have emigrated to Australia.
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Background People who inject drugs (PWID) are at high risk for HIV infection, yet in rural areas PWID are understudied with respect to prevention strategies. Kentucky is notable for heavy rural HIV burden and increasing rates of new HIV diagnoses attributable to injection drug use. Despite high need and the strong evidence for Pre-Exposure Prophylaxis (PrEP) as a gold-standard biomedical HIV prevention tool, scale up has been limited among PWID in Kentucky and elsewhere. This paper explores individual, environmental, and structural barriers and facilitators of PrEP care from the perspective of PWID in rural Kentucky. Methods Data are drawn from an ongoing NIH-funded study designed to adapt and integrate a PrEP initiation intervention for high-risk PWID at point of care in two rural syringe service programs (SSPs) in southeastern Kentucky. As part of this initiative, a qualitative study guided by PRISM (Practical, Robust, Implementation, and Sustainability Model) was undertaken to gather SSP client perspectives on intervention needs related to PrEP, competing needs related to substance use disorder, as well as tangible supports for and barriers to PrEP uptake. Recruitment and interviews were conducted during September-November 2021 with 26 SSP clients, 13 from each of the two SSP sites. A semi-structured guide explored injection behaviors, SSP use, knowledge of PrEP, perceived barriers to PrEP, as well as aspects of the risk environment (e.g., housing instability, community stigma) that may impact PrEP uptake. Interviews were digitally recorded, transcribed verbatim and verified by project staff. A detailed coding scheme was developed and applied by independent coders using NVivo. Coded transcripts were synthesized to identify salient themes in the data using the principles of thematic analysis All study procedures were approved by the University IRB. Results Participants were 96% white, 42% female, with a median age of 41 years (range 21–62); all reported injection use within the past month. Overall, we found low PrEP awareness among this sample, yet interest in PrEP was high, with several indicating PrEP is urgently needed. Clients reported overwhelmingly positive experiences at the SSPs, considering them trusted and safe locations to receive health services, and were enthusiastic about the integration of co-located PrEP services. Lack of basic HIV and PrEP knowledge and health literacy were in evidence, which contributed to common misperceptions about personal risk for HIV. Situational risks related to substance use disorder, particularly in the context of withdrawal symptoms and craving, often lead to heightened HIV injection and sexual risk behaviors. Stigma related to substance use and HIV arose as a concern for PrEP uptake, with several participants reflecting that privacy issues would impact their preferences for education, prescribing and monitoring of PrEP. Noted tangible barriers included inconsistent access to phone service and transportation. Primary supports included high levels of insurance coverage, consistent pharmacy access, and histories with successful medication management for other health conditions. Conclusions Drawing on the critical perspectives of people with substance use disorder, our findings provide important and actionable information on individual and environmental barriers and facilitators of PrEP uptake among rural PWID at high risk for HIV infection. These data will drive the adaptation and implementation of a client-centered approach to integrated PrEP care within rurally located SSP settings to address unmet needs for PrEP care.
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a) Introducción: los programas basados en recuperación de conductas adictivas han evolucionado desde las comunidades terapéuticas tradicionales hasta las intervenciones actuales, integradas en las redes sanitarias y sociales, desarrolladas por equipos multidisciplinares profesionales. Esa evolución no ha sido sistemática hasta el siglo XXI, con la aparición de la "Ciencia de la Recuperación". b) Objetivos: analizar el desarrollo de los programas de recuperación, especialmente los modelos teóricos y las buenas prácticas que se desarrollan actualmente en los programas europeos. c) Desarrollo del tema: se analizan cuatro modelos teóricos, relacionados con la recuperación desde una perspectiva científica y previamente documentados, relacionados con buenas prácticas. d) Conclusiones: la "Ciencia de la Recuperación" está avanzando hacia modelos y programas validados, replicables y medibles. Sigue siendo necesario adecuar los programas basados en recuperación a las necesidades y particularidades de personas y grupos específicos. Palabras clave: Buenas prácticas, Recuperación, "Ciencia de la Recuperación", Modelos teóricos, Programas europeos.
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a) Introduction: addictive behaviours recovery-oriented programmes have advanced from traditional therapeutic communities to actual interventions integrated in social and health networks and developed by multidisciplinary professional staff. This evolution has not been systematic until XXIst century, with the beginning of “Science of Recovery”. b) Aims: to analyse the development of recovery programmes, especially the theoretical models and good practices actually in development into European programmes. c) Development of the topic: they have been analysed four theoretical models and two good practices about recovery, from a scientific perspective and experiences previously documented. d) Conclusions: the “Science of Recovery” is advancing to validated, replicable and measurable models and programmes. It´s still necessary to adapt recoveryoriented programmes to needs and particularities of people under treatment and specific groups.
Despite growing availability of several evidence-based approaches in the treatment of substance use disorders, existing pharmacotherapy and psychosocial interventions continue to have significant limitations, such as low treatment retention rates and high rates of relapse. There is a need to develop new strategies and models to address these limitations and target underlying psychosocial drivers of addiction, such as motivation to change – a crucial factor in achieving positive addiction treatment outcomes. Re-emerging clinical evidence and literature signal the promise of psychedelic-assisted psychotherapies as being novel, adjunctive treatments for a range of mental health and substance use disorders, encouraging further research. However, there remains a lack of formally validated metrics to evaluate recovery capital and motivation, limiting interpretation of the growing psychedelic literature. This commentary describes the current state of this line of investigation and potential impact of psychedelic-assisted psychotherapy on enhancing motivation to change in addiction treatment, and the need for validated metrics to evaluate recovery motivation and capital to assess the potential for psychedelic-assisted psychotherapies to elicit positive, lasting changes in substance use behaviors among those seeking treatment.
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Despite the widely accepted view that formal treatment and twelve-step groups are essential for overcoming dependencies on alcohol and drugs, each year large numbers of former addicts quietly recover on their own, without any formal treatment or participation in self-help groups at all. Coming Clean explores the untold stories of untreated addicts who have recovered from a lifestyle of excessive and compulsive substance use without professional assistance. Based on 46 in-depth interviews with formerly addicted individuals, this controversial volume examines their reasons for avoiding treatment, the strategies they employed to break away from their dependencies, the circumstances that facilitated untreated recovery, and the implications of recovery without treatment for treatment professionals as well as for prevention and drug policy. Because of the pervasive belief that addiction is a disease requiring formal intervention, few training programs for physicians, social workers, psychologists, and other health professionals explore the phenomenon of natural recovery from addiction. Coming Clean offers insights for treatment professionals of how recovery without treatment can work and how candidates for this approach can be identified. A detailed appendix outlines specific strategies which will be of interest to addicted individuals themselves who wish to attempt the process of recovery without treatment.
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Communities of color have been ill-served by acute care models of treating severe alcohol and other drug (AOD) problems that define the source of these problems in idiopathic (biopsychological) terms and promote their resolution via crisis-elicited episodes of brief, individual interventions. This article explores how approaches that shift the model of intervention from acute care (AC) of individuals to a sustained recovery management (RM) partnership with individuals, families, and communities may be particularly viable for historically disempowered peoples. The advantages of the RM model for communities of color include: a broadened perspective on the etiological roots of AOD problems (including historical/cultural trauma); a focus on building vibrant cultures of recovery within which individual recoveries can be anchored and nourished; a proactive, hope-based approach to recovery engagement; the inclusion of indigenous healers and institutions with the RM team; an expanded menu of recovery support services; culturally grounded catalytic metaphors and rituals; and a culturally-nuanced approach to research and evaluation.
There is an unknown but very large number of individuals who have experienced and successfully resolved dependence on alcohol or other drugs. These individuals refer to their new sober and productive lifestyle as “recovery.” Although widely used, the lack of a standard definition for this term has hindered public understanding and research on the topic that might foster more and better recovery-oriented interventions. To this end, a group of interested researchers, treatment providers, recovery advocates, and policymakers was convened by the Betty Ford Institute to develop an initial definition of recovery as a starting point for better communication, research, and public understanding. Recovery is defined in this article as a voluntarily maintained lifestyle composed characterized by sobriety, personal health, and citizenship. This article presents the operational definitions, rationales, and research implications for each of the three elements of this definition.
The literature on cessation of drug and alcohol dependency without benefit of treatment or participation in self-help groups spans nearly forty years. While this literature is substantial and analyses of the processes of natural recovery well-developed, discussions directed at treatment providers around the value of these analyses for practice has been sparse. Drawing on our study as well as the research of others, this paper explores two dimensions of natural recovery that hold important implications for treatment providers who work with substance dependent clients. These include the common strategies used by remitters and the concept of recovery capital as a way to capture the embeddedness of these natural recovery strategies within a unique structural context of personal attributes and social environments.
Examined the characteristics of middle-class alcoholics and drug addicts who terminated their addictions without the benefit of treatment. Using what is commonly referred to as natural recovery processes, respondents terminated their addictions without formal treatment or self-help group assistance. Data for this study were based on in-depth interviews with 46 alcoholics and drug addicts. The postaddict identities of the Ss were examined to see how they viewed themselves in relation to their addictive past. Their reasons for avoiding treatment and self-help groups were also explored, as were factors in the Ss' lives that promoted natural recovery. Relevance for clinical treatment and social policy are examined. (PsycINFO Database Record (c) 2012 APA, all rights reserved)
The majority of people presenting for publicly-funded substance abuse treatment relapse and receive multiple episodes of care before achieving long-term recovery. This Early Re-Intervention experiment evaluates the impact of a Recovery Management Checkup (RMC) protocol that includes quarterly recovery management checkups (assessments, motivational interviewing, and linkage to treatment re-entry). Data are from 448 adults who were randomly assigned to either RMC or an attention (assessment only) control group. Participants were 59% female, 85% African American, and 75% aged 30–49. Participants assigned to RMC were significantly more likely than those in the control group to return to treatment, to return to treatment sooner, and to spend more subsequent days in treatment; they were significantly less likely to be in need of additional treatment at 24 months. This demonstrates the importance of post-discharge recovery management checkups as a means to improve the long-term outcomes of people with chronic substance use disorders.