How should we measure addiction recovery? Analysis of service provider perspectives using online Delphi groups

Abstract

Aim s: To explore ways of measuring addiction recovery and the extent of agreement/disagreement between diverse service providers on potential recovery indicators. Methods: Separate online Delphi groups with (i) addiction psychiatrists (n = 10); (ii) senior resi dential rehabilitation staff (n = 9); and (iii) senior inpatient detoxification unit staff (n = 6). Each group was conducted by email and followed the same structured format involving three iterative rounds of data collection. Content analyses were undertaken and the results from each group were compared and contrasted. Findings: Indicators of recovery spanned 15 broad domains: substance use, treatment/support, psycho logical health, physical health, use of time, education/training/employment, income, housing, relationships, social functioning, offending/antisocial behaviour, well-being, identity/self-awareness, goals/aspirations, and spirituality. Identification of domains was very consistent across the three groups, but there was some disparity between, and consid erable disparity within, groups on the relative importance of specific indicators. Conclusions: Whilst there is general consensus that recovery involves making changes in a number of broad life areas and not just substance use, there is substantial disagreement on particular measures of progress. Further studies involving other stakeholder groups, particularly people who have personally experienced drug or alcohol dependence, are needed to assess how transferable the 15 identified domains of recovery are. BACKGROUND

Philosophical ruminations on measurement: methodological orientations of patient reported outcome measures (PROMS)

“…Our recent experiences of developing a PROM for addiction recovery, with significant service user involvement and combining qualitative and quantitative methods, have been illuminating in this respect (Neale et al, 2014(Neale et al, , 2015. First, we found that service users routinely disagreed on many aspects of the PROM content, particularly the questions to be included and terminology to be used.…”

Rethinking recovery

“…'Recovery' is described frequently as a complex and contested concept [6] which eschews definition [3]. Despite the contentious debate, there has been increasing agreement that 'recovery' means more than abstinence or reduction in substance use, and should encompass improvements in other areas of clients' lives, including housing, relationships, employment, participation and wellbeing [6,7].However, as the work of Neale and colleagues [7][8][9] has shown, conceptualizing, defining and measuring the broad set of outcomes that might constitute 'recovery' is not without its challenges. Recognizing that clinicians and clients may differ in their understandings of 'recovery' and in their assessment of the relative importance of specific outcomes would appear to be essential.…”

“…'Recovery' is described frequently as a complex and contested concept [6] which eschews definition [3]. Despite the contentious debate, there has been increasing agreement that 'recovery' means more than abstinence or reduction in substance use, and should encompass improvements in other areas of clients' lives, including housing, relationships, employment, participation and wellbeing [6,7].…”

“…However, as the work of Neale and colleagues [7][8][9] has shown, conceptualizing, defining and measuring the broad set of outcomes that might constitute 'recovery' is not without its challenges. Recognizing that clinicians and clients may differ in their understandings of 'recovery' and in their assessment of the relative importance of specific outcomes would appear to be essential.…”

“…The measures put forward by treatment providers in Neale's study [7] accord with McKay's [1] concerns and other definitions of 'recovery' developed by experts internationally [14,15], by focusing not only upon reduced drug use and improved health, but also upon notions of citizenship, roles and responsibilities. As I have argued elsewhere [3], underpinning this idea is a set of neoliberal assumptions about work, productivity and what it means to live a 'contributing life' which fail to take into account the differences in the normative and social contexts of people's lives.…”