Week Two Discussion & Knowledge Exchange Forum: Measuring Recovery?

Comment IconWelcome to Week Two of the 6th Annual Addiction Day: Advancing Recovery within Addiction & Mental Health Website Discussion & Knowledge Exchange Forum

This week’s discussion and knowledge exchange will revolve around Measuring Recovery. By participating, your opinion will be incorporated into the conference’s plenary panel discussion. There are two ways to participate:

  • The first is through an anonymous survey, located within this post.
  • The second is by adding a reply to the bottom of this post! Let us know your views on the topic and add to the interactive discussion in the comments section!

Click the “Read More” button below to participate! The discussion topic, brief literature scan, anonymous survey, and the comments section are available within.

We would like to give special acknowledgement to the 6th Annual Addiction Day Presenters who have contributed to advancements relevant to this week’s discussion topic:

Jill Kelland

Jonathan Stea

Glenda McQueen

Measuring Recovery?

Many health services are interested in “putting recovery on the ground”, and are actively seeking the instruments they need in order to move recovery from an ideal vision into an everyday reality. Despite the many innovations taking place, and consensus regarding the importance of recovery, it has been suggested that programs/administrator/clinicians remain at a loss when they attempt to measure consumer recovery and/or whether their service promotes or impedes recovery. (Ridgway & Press, 2004).

We would love for you to share your thoughts and opinions!

Brief Literature Scan:

(Please note this is not an exhaustive, nor preferred list of publications. Rather, they are simply introductory literature to generate discussion. Please feel free to reference publications/resources/webprofiles of your choice in the website discussion & knowledge exchange forum).

1.    Measuring the Promise: A compendium of Recovery Measures Volume II.

In November 2004, a total of thirty consumer/survivor and non-consumer researchers were convened to attend the invitational conference: Measuring the Promise: Assessing Recovery and Self Determination Instrument for Evidence Based Practices. The resultant compendium intends to provide a resource of current recovery and recovery related instrument health system stakeholders to use in research and evaluation.

Campbell-Orde, Chamberlin & Carpenter (2005). Measuring the Promise: A compendium of Recovery Measures Volume II.

http://www.power2u.org/downloads/pn-55.pdf

2.    REFOCUS:

The REFOCUS trial currently underway in England (2009-2014) seeks to develop:
i) recovery-focused fidelity measures and outcome measures;
ii) manualised recovery interventions; and
iii) randomised controlled trial evidence

There are 24 primary and secondary outcome measures in use.

Please visit the following link and view attached article for more information.

http://researchintorecovery.com/refocus/

Slade, Bird, Boutillier, Williams, McCRone & Leamy. ( 2011).  REFOCUS Trial: Protocol fro a cluster randomised controlled trial of a pro-recovery intervention within community based mental health teams. http://www.biomedcentral.com/content/pdf/1471-244X-11-185.pdf

3.    Developing Recovery Enhancing Environments Measure (DREEM).

The Recovery Enhancing Environment Measure (REE) is a self-report instrument that gathers information/data about mental health recovery from people who receive mental health services.

Large mental health systems that want to ensure that each element of their service promotes recovery can use the DREEM to gather information/data across the system, establish some performance standards, and plan system transformation.

For more information on the DREEM please visit the following link:

Ridgway & Press (2004). Assessing the Reocvery – Commitment of your Mental Health Service: A users guide for the Developing Recovery Enhancing Environments Measure (DREEM). http://www.recoverydevon.co.uk/download/DREEM%20total%20dft4%20no%20tc.pdf

4.     Wellness Recovery Action Plan (WRAP)

Research studies have validated the fact that significant numbers of people with mental health problems and substance abuse disorders have been able to self- manage their conditions with positive outcomes.

Mary Ellen Copeland initially practiced WRAP® to help with her own struggles with mental health challenges. In 1997, Mary Ellen began to share WRAP® with other people who were struggling with a wide range of emotional, physical, and mental health challenges.

WRAP® is now being utilized in formal and informal recovery programs throughout the U.S and in countries around the world.

http://www.mentalhealthrecovery.com/wrap/

http://copelandcenter.com/wellness-recovery-action-plan-wrap

Higins, Callaghan, DeVRies, Keogh, Morrissey, Nash, Ryan, Biijbel & Carter, 2012.Mental Health Recovery and WRAP Education Programme; Report to the Irish Mental Health & Recovery Education Consortium.  http://www.nursing-midwifery.tcd.ie/assets/research/pdf/TCD-Evaluation-Report.pdf

Anonymous Opinion Survey

To participate in our anonymous survey, please click the following link:

http://www.surveymonkey.com/s/SQDD3PY

Website Discussion & Knowledge Exchange Forum

We would love to hear your thoughts/reflections/suggestions regarding this week’s topic of discussion: Measuring Recovery?

To leave a response, add your comment at the bottom of this page. Please be aware that comments will be manually approved to help filter out spam, and there may be a short delay before they appear on the page.

We ask that all responses posted on the 6th Annual Addiction Day website are respectful of others and adhere to appropriate communication etiquette. We will be doing our outmost to filter out any spam or unwanted posts that arrive to our site

6 comments

  1. Allison Johnson says:

    It’s worthwhile to consider areas outside of addiction and mental health when contemplating what recovery means. In particular there is an emerging focus in health care on post-cancer recovery and survivorship, in which the reclamation of self is a major theme. While some aspects of cancer survivorship have parallels to addiction and mental health recovery (dealing with shame and guilt around one’s own perceived role in “causing” the cancer, potentially passing the risk on to offspring, and having survived cancer when others have not, for example), there are aspects with less obvious relevance (e.g. managing long-term negative effects of cancer treatment, although there may be parallels to learning to live with side effects of long term psychiatric drug use).In the end, we may find that recovery just adds a significant wrinkle to managing the challenges of living that we all face, regardless of what we may be recovering from.

    Magee, S. (2006). Picking Up the Pieces: Moving Forward After Surviving Cancer. Vancouver, BC: Raincoast Books.

  2. edward kemp says:

    i am impressed with the energy and enthusiasm Tux is bringing to this project.
    It is interesting to note the insight Bill W brought to the program of recovery. He recognized that for recovery to be successful the alcoholic had to address other issues in her life in addition to her drinking challenge. That is why the 12 Steps include the alcoholic acknowledging her character defects and short comings.(note character defects should not be confused with the addiction). By asking for the help of a Higher Power recovery is greatly assisted. We have all heard of the dry drunk. This is the person who does not address these other issues.
    In the recovery process there is also the issue of what damage the chronic alcoholic has sustained to her body. The liver can be severely damaged with an elevated enzyme count. Fortunately, this is the one organ that will recover when drinking stops. The brain is another matter and damage from drinking may be permanent.

  3. sorry to be joining this critical discussion late in the week.
    Measuring recovery is essential to the provision of recovery support services for a number of reasons centering around external accountability and internal quality monitoring.
    Thus far we have used ‘abstinence’ as a proxy for recovery; clearly this is inadequate. As others have pointed out in this forum and I have pointed out here http://partnersforrecovery.samhsa.gov/docs/Environmental_Recovery_Scan.pdf , the recovery construct is multidimensional and all dimensions ought to be included in a measure.
    The development of a psychometrically valid measure of recovery is going to be one of THE most important steps in building the science of recovery. Without such a measure, how are we to evaluate recovery promoting support services? Further, a measure would improve out understanding of the developmental process of recovery, namely, what (area of life) changes (improves?) when and which services and supports are instrumental in facilitating/hastening these changes.
    Thank you for hosting this forum, it is really essential that these issues get discussed and considered seriously.

    • Trish Dribnenki says:

      I’ve just recently started working in Harm Reduction, and as such, I am learning that sometimes, having “abstinence” as the ultimate measure for recovery sets some clients up to feel shame or regret when relapsing. In my experience working with individuals who are experiencing addictions (often in conjunction with mental health challenges), relapse is a part of their recovery process. Our clients want to quit using, we want them to quit using, and there is an immense pressure to abstain. One relapse then equals failure, often the client feels like they’ve not only failed in their recovery, they’ve failed as a person, and that leaves them vulnerable to their addiction and their well-developed perceptions that they are bad people and can’t get better. I think as professionals working in addiction, it is so important for us to show our clients understanding and support when they relapse, so that they can understand and support their vulnerable sense of self.

  4. Tuxephoni says:

    I think the greatest learning for me in relation to this week’s discussion topic (Measuring Recovery?) was discovering how many instruments were in existence that addressed Recovery within Mental Health (ie: Measuring the Promise: A compendium of Recovery Measures Volume II ).

    My greatest reflection/wondering was… “What about measuring Recovery within Addiction?… Is there as many proposed instruments?…or can the instruments be used interchangeably?”…

    I was really excited to find the following article this morning: Dodge, Krantz & Kenny (2010). How can we Begin to Measure Recovery? http://www.substanceabusepolicy.com/content/5/1/31

    The article reflects upon the phenomenal publications of Laudet, White, Arndt, Taylor, Galanter, and McLellan (as well as others!); their work in advancing a clinical definition/Model of Recovery, and the foregoing efforts to establish a set of treatment quality, performance and outcome indicators that reflect a biopsychosocialspiritual perspective of recovery within the substance use population.

    With recognition that “the field of addiction treatment lacks a universally accepted and unambiguously defined clinical definition of recovery” (Laudet, 2007, p.221), the article proposes seven domains that represent aspects of/status of recovery and purposes potential operational measures (all indentified instruments have established reliability and validity) for each of these domains:

    Physical Domain: History & Physical exam;
    Urine Chemistry Panel;
    Brain Imaging;
    ASI Medical Subscale

    BioMarker Domain: Neuropeptides: Orexin, Oxytocin,
    Cortisol

    Chemical Dependency Domain: ASI Alcohol/Drug Use Subscales;
    Urine & Breath Screening

    Psychological Domain: MMSE or TONI-3;
    Shipley Institute of Living Scale

    Psychiatric Domain: DSM-IV-TR Axis I;
    ASI Psychiatric Health Subscale

    Family/Social Domain: ASI: Employment/Self-Support Subscale
    ASI: Family Relations Subscale
    ASI: Illegal Activity Subscales
    MMPI-2: Work Interference,Family Problems,
    Antisocial Practices Scales

    Spiritual Domain: Spirituality Self-Rating Scale;
    ASI-JCAHO Spirituality Scale

    It is exciting to think of all the advances that will be made within Addiction & Mental Health!

    Have a great day everyone!

    • Daniel Scott says:

      Hi Tuxephoni

      I agree that there seems to be a huge number of measures (and programs) for mental health recovery even though the general public still seems to assume that recovery only refers to addiction.

      I think the ‘etic’ and ’emic’ from Week One has a role discussing measures. Most of the measures in the literature are from the external expert perspective and very few are qualitative descriptions from the emic perspective of those experiencing recovery.

      I think that the etic addiction measures would generally apply to both addiction or mental health recovery (ie. physical domains, biomarker domains, etc.).

      The interesting differences may be in the emic descriptions of recovering from addiction compared to recovering from mental illness. For example, the experience of ‘reclaiming self’ in AA is likely to be different than ‘reclaiming self’ while living with a psychotic disorder. Of course, the experience of ‘reclaiming self’ while living with a depressive disorder may be equally different.

      It is easy to get distracted by differences without the language tools of emic and etic. Both are necessary. We need etic evaluation, measurement, and assessment. We also need to hear what people in recovery are telling us about their experience without trying to fit their story into etic categories.

      Try to measure the concept of “sandwich”. We could list all the possible ingredients, identify the nutritional values and do a chemical analysis. Ultimately, you don’t understand “sandwich” unless you include the experience of eating it.

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