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Recovery capital: A primer for addictions professionals

Authors:
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
professionals.
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,
1
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).
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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).
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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,
2007).
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
attention.
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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
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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
Low
Problem Severity /
Complexity
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-
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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.
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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.
Summary
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
8
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 (bwhite@chestnut.org) 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.
References
Betty Ford Institute Consensus Panel (2007). What is recovery? A working
definition from the Betty Ford Institute. Journal of Substance Abuse
Treatment, 33, 221-228.
Bromet, E., & Moos, R (1977). Environmental resources and the
posttreatment functioning of alcoholic patients. Journal of Health &
Social Behavior, 18, 326-338.
Cloud, W., & Granfield, R. (1994a). Natural recovery from addictions:
Treatment implications. Addictions Nursing, 6, 112-116.
Cloud, W., & Granfield, R. (1994b). Terminating addiction naturally: Post-
addict identity and the avoidance of treatment. Clinical Sociology
Review, 12, 159-174.
Cloud, W., & Granfield, R. (2001). Natural recovery from substance
dependency: Lessons for treatment providers. Journal of Social Work
Practice in the Addictions, 1(1), 83-104.
Cloud, W., & Granfield, R. (2004). A life course perspective on exiting
addiction: The relevance of recovery capital in treatment. NAD
Publication (Nordic Council for Alcohol and Drug Research) 44, 185-
202.
Cloud, W., & Granfield, R. (in press) Conceptualizing recovery capital:
Expansion of a theoretical concept. Substance Use and Misuse.
Coyhis, D., & White, W. (2006). Alcohol problems in Native America: The
untold story of resistance and recovery-The truth about the lie.
Colorado Springs, CO: White Bison, Inc.
Dennis, M.L., Foss, M.A., & Scott, C.K. (2007). An eight-year perspective
9
on the relationship between the duration of abstinence and other
aspects of recovery. Evaluation Review, 31(6), 585-612.
Dennis. M. L., Scott, C. K., & Funk, R. (2003). An experimental evaluation
of recovery management checkups (RMC) for people with chronic
substance use disorders. Evaluation and Program Planning, 26(3),
339-352.
Granfield, R., & Cloud, W. (1996). The elephant that no one sees: Natural
recovery among middle-class addicts. Journal of Drug Issues, 26(1),
45-61.
Granfield, R., & Cloud, W. (1999). Coming clean: Overcoming addiction
without treatment. New York: New York University Press.
Humphreys, K., Moos, R. J., & Cohen, C. (1997). Social and community
resources and long-term recovery from treated and untreated
alcoholism. Journal of Studies on Alcohol, 58(3), 231-238.
Kaskutas, L. A., Bond, J., & Humphreys, K. (2002). Social networks as
mediators of the effects of Alcoholics Anonymous. Addiction, 97(7),
891-900.
Laudet, A, Morgen, K., & White, W. (2006). The role of social supports,
spirituality, religiousness, life meaning and affiliation with 12-step
fellowships in quality of life satisfaction among individuals in
recovery from alcohol and drug use. Alcoholism Treatment
Quarterly, 24(102), 33-73.
Laudet, A.B., & White, W.L. (in press). Recovery capital as prospective
predictor of sustained recovery, life satisfaction and stress among
former poly-substance users. Substance Use and Misuse.
Mankowski, E.S., & Humphreys, K., & Moos, R. (2001). Individual and
contextual predictors of involvement in twelve-step self-help groups
following substance abuse treatment. American Journal of Community
Psychology, 29, 537-563.
Moos, R.H. (2003). Addictive disorders in context: Principles and puzzles
of effective treatment and recovery. Psychology of Addictive
Behaviors, 17, 3-12.
Moos, R.H., & Moos, B.S. (2007). Protective resources and long-term
recovery from alcohol use disorders. Drug and Alcohol Dependence,
86, 46-54.
Simpson, D.D. (2004). A conceptual framework for drug treatment process
and outcomes. Journal of Substance Abuse Treatment, 27, 99-121.
White, W. (2004). Recovery: The next frontier. Counselor, 5(1), 18-21.
White, W. (2005). Recovery: Its history and renaissance as an organizing
construct. Alcoholism Treatment Quarterly, 23(1), 3-15.
10
11
White, W. (in press, a). Recovery management and recovery-oriented
systems of care: Scientific rationale and promising practices.
Chicago, IL: Great Lakes Addiction Technology Transfer Center,
Northeast Addiction Technology Transfer Center, and Philadelphia
Department of Behavioral Health & Mental Retardation Services
White, W. (in press,b). “With a Little Help from my Friends”: The
development and mobilization of community resources for the
initiation and maintenance of addiction recovery. Journal of
Substance Abuse Treatment.
White, W., & Kurtz, E. (2006). The varieties of recovery experience.
International Journal of Self Help and Self Care, 3(1-2), 21-61.
White, W., & Sanders, M. (in press). Recovery management and people of
color: Redesigning addiction treatment for historically disempowered
communities. Alcoholism Treatment Quarterly.
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