2. The Science of Recovery and Recovery Capital

2. The Science of Recovery and Recovery Capital

Introduction

Before the work of Bruce Alexander, it was generally assumed that addiction was an inevitable consequence of exposure, based on numerous animal experiments showing that rats (among other species) if offered water or illicit drugs (generally opiates) would use to the point of exhaustion and death. However, Alexander, as one of the scientists working on these studies, noticed how impoverished the environments were for the rats and decided to do something slightly different. He invented Rat Park, where instead of a bare and empty cage occupied only by the bottles of water or drugs, there was a rich and fulfilling environment.

What Alexander found was that, when rats had playmates and a rich and interesting environment, instead of just an empty cage, there response was entirely different. Use of the drugs were now much less frequent and the rats much preferred fulfilling activities. Addiction was not inevitable. This led Alexander to publish “The Globalization of Addiction” in 2010 where he expounds his basic theory that addiction is not an inevitable biological response to addictive substances but rather it is a response to an impoverished set of social and environmental conditions that can be addressed at a societal level. His experiments would also suggest that addicted rats can recover when they are exposed to a sufficiently enriched social environment. 

JOHANN HARI RAT PARK


RAT PARK


CHIME


RECOVERY CAPITAL AND THE ARC



The Science of Recovery and Recovery Capital

The work of Alexander is one building block in the development of a model of recovery that is based on social factors and a sense of meaning and purpose. This in turn has fed into the optimistic belief that there are things we can do to increase the likelihood that a person will achieve recovery. This concept is referred to as Recovery Capital and is outlined next. 

In 2001, Robert Granfield and William Cloud published a research paper entitled “Social context and "natural recovery": the role of social capital in the resolution of drug-associated problems” (see key readings) which introduced the concept of Recovery Capital to refer to what they classed as the breadth and depth of resources available to an individual to support their recovery journey. This idea was seized upon as a way of explaining why, for example, addicted doctors, generally had much higher rates of recovery than people from marginalized and deprived communities. 

However, Cloud and Granfield published a second paper in 2008 where they argued that recovery capital was not universally positive and that there were negative components to it as well – things that acted as barriers to recovery. This is a contentious idea as the aim of recovery (and particularly recovery capital) has been about building strengths but the four areas they identified as potential barriers were:
  1. Significant mental health problems 
  2. A history of imprisonment 
  3. Being older (and thus having lost any resources that may have once existed)
  4. Being female (because of the greater stigma that accompanies women, and in particular mothers, who have addiction problems.

We will argue that there are other barriers that are more practical and that can be addressed – ongoing substance use, risky behaviors, justice involvement, homelessness and unstable housing and lack of engagement in meaningful activities) but the key thing at this stage is to be aware that we think of many factors in recovery capital as being on a continuum from strength to barrier. 

The idea of recovery capital is crucial to developing our understanding of how recovery happens as it provides the opportunity to map and measure where a person is on their recovery journey and what resources they both have and need. It is also a big shift away from traditional clinical approaches to assessing and risk assessing people in that it:
  • Switches from a deficits to a strengths model
  • It places the individual and their needs at the heart of the process 
  • The key location for building recovery capital is the community not the clinic or hospital
  • There are no bounds to how much recovery capital a person can grow (in other words it is about living a fulfilling life, and not just one that is free of alcohol and drugs)
  • It places responsibility for change both on the individual and on the social networks and communities in which they live 

However, it has also allowed us to do something different – it has given us a way of counting and measuring (in a systematic and scientific way) where someone is on their recovery journey. In 2010, one of the writers of this training program, worked with an American academic called Alexandre Laudet to come up with a way of measuring and quantifying recovery capital, and they came up with three broad categories of recovery capital (this is our second key reading, Best and Laudet, 2010):

Personal recovery capital refers to those internal qualities that need to grow over the period of the recovery journey (which is generally estimated to be around five years on average). These include self-esteem and self-efficacy (which is the ability and belief that you will achieve the goals you set out to achieve), resilience and coping skills and positive communication skills

Social recovery capital refers to the networks you belong to and the commitment you have to them. Often people in active addiction will have networks of people who support their use and the related lifestyle or they will be isolated. What positive social recovery capital means is having strong social networks (that you are committed to and care about) who are not only supportive of your recovery but provide you with a sense of meaning, belonging and identity. 

Community recovery capital refers to access to the resources in the community that are needed to support recovery. In the early stages of recovery that is likely to be a safe place to live and the opportunity to work as well as access to community recovery groups (like 12-step groups and Recovery Community Organizations) and recovery-oriented treatment services. However, it will also include access to generic community resources like social clubs, libraries and college courses that are matched to individuals’ aspirations and needs. 

Our work then went further with the publication of two research scales that attempted to map and measure these things. The Assessment of Recovery Capital scale was published in 2012 (the authors were Teodora Groshkova, David Best and William White, the last of whom is the founding father of recovery science). It is a measure that consists of 50 questions – 25 of them measuring personal recovery capital and 25 of them measuring social recovery capital. 

The second of the measures was called the Recovery Group Participation Scale (RGPS) and was published by the same three authors one year earlier in 2011. This was a shorter measure (there were only 14 questions) and it was designed to assess the extent to which individuals engaged with recovery community organizations. 

However, both of these were designed for research purposes and in the next section we will discuss how this was then adapted and translated into a combined measure that could be used much more practically in recovery groups and organizations to support recovery practice. 

This provides a brief and introductory overview of what we are aiming to chart out – the translation of recovery science into a practical approach to support people building recovery capital over time. What this course will do is to take you through that process and to understand how we think about recovery capital, why and how we measure it and how that knowledge can be applied to support someone’s recovery journey.


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