Living in Recovery: What Works?

Recovery from addiction is an ongoing process of finding a path to a healthy lifestyle. Although it is different for every individual, the end goal is the same: adopting positive changes and values that people choose on their own to stay healthy. The 25 million Americans currently in recovery demonstrate that individuals are not alone in successfully achieving this goal.

In the past few decades, science has brought us effective behavioral and medication addiction treatments as well as lifesaving treatments that revive people from overdose and give them a chance to seek lasting recovery. Lived experience suggests that individuals may need tools to manage their health long-term, as well as friendship and support from those with similar lived experiences. Research also suggests that support from families can be key to recovery, but that few families become engaged in the process. Both are areas where research can help.

Studying Recovery Support Services

Helping people stay healthy and free from addiction deserves scientific solutions, and the Helping to End Addiction Long-term^® Initiative, or NIH HEAL Initiative^® is expanding current research supported by the National Institute on Drug Abuse (NIDA) to learn more. Key questions center on which types of recovery support are effective, for whom – and for how long – as well as how to integrate supports with other health services, including medications for opioid use disorder

The goal of recovery support services – which were originally developed by people in recovery and have grown largely outside of the health care system – is to help people either in or seeking recovery from addiction build and sustain positive social networks. They address multiple factors including education, job training and employment, positive family and social relationships, and housing opportunities, and they work to meet many other personal and professional needs. These factors, known collectively as “recovery capital,” enhance an individual’s ability to function in his or her surroundings, reduce the risk of problematic substance use, and maximize quality of life.

Although it may seem obvious that having basic life needs met and being around people who are also in recovery is helpful to recovery success, relatively little research has rigorously assessed the effects of recovery support services for individuals and communities, or looked at whether they are cost-effective. That is becoming a key metric for making these supports widely available through expanded public or private funding, or for linking the services to healthcare systems.

Various HEAL-funded research projects, such as the HEALing Communities Study, partner with recovery organizations to help communities choose the most effective strategies to meet local needs and conditions. The NIH HEAL Initiative also partners with NIDA to fund research within the Consortium on Addiction Recovery Science, a nationwide effort that focuses on research network-building initiatives. Put simply, these projects will benefit communities grappling with opioid misuse and overdose and other substance use disorders by rapidly advancing research aimed at providing effective recovery support services to people who need them.

An important objective of this research is to plant seeds for recovery organizations to continually evaluate progress toward keeping their participants safe and healthy. The ability to generate and analyze evolving data is also important for responding to changing circumstances, such as the pernicious rise of fentanyl-related overdoses or uneven access to recovery services among communities of color: a stark reality borne out by recent data showing significant racial/ethnic disparities in overdose rates.

Planting Seeds for Future Research

As part of the Consortium on Addiction Recovery Science, two HEAL-funded research teams are laying the groundwork for current and future science-based community participation in recovery research.

Jay Unick, Ph.D., and Michelle Tuten, Ph.D., of the University of Maryland School of Social Work in Baltimore, set up the Innovations in Recovery through Infrastructure Support research program, which aims to build and share infrastructure to help communities become research-ready – toward developing, sharing, and testing their strategies to provide recovery support services that meet the needs of distinct communities. That includes offering interactive, online seminars; pilot grant funding; research mentoring programs; help with designing and testing new measures; as well as collecting and sharing existing measurement resources.

The work is far from academic: Unick refers to the approach as “practice to research.” It collects knowledge generated by real people in real situations to know and do what works, and importantly, to measure success. Real-life settings where individuals access treatment and recovery support vary a lot. It could be a van that offers buprenorphine prescriptions outside a jail. It could be volunteers delivering food, clothing, and naloxone to homeless individuals struggling with addiction. Or possibly an emergency department where individuals with opioid use disorder (or those who have overdosed) often seek medical care.

And although there are a multitude of factors that influence whether people can succeed in long-term recovery, many of the outcomes are largely the same, and they can be measured: time on medications or number visits to providers, or finding stable employment, supportive relationships, and affordable, safe housing.

Some of the recovery organizations Unick and Tuten are working with are operations that are using sophisticated methods for data collection and using that evidence to influence practice, citing as one example Mosaic Community Services. This organization, for example, collects has a patient-centered program called Partners in Recovery that offers recovery supports such as both medication for substance use disorders and behavioral therapy in the same location, helps people find transportation and housing, and connects them with peer support specialists.

Many organizations, however, are small and not as familiar with how to collect and analyze data. Building relationships with some of these groups takes persistence and patience, toward improving their impact on people’s lives, he says.

“We ask them, for example, how can you collect information to make meaningful comparisons to know whether your organization is doing comparing to similar organizations, or how your people are doing compared to others with similar characteristics?

The goal of this research is to engage people where they are at every possible opportunity.

“What’s working, what’s not working, and when do we need to turn around and try something different? What predicts future success; what tells us that the engagement is working?”

Family Matters

The NIH HEAL Initiative recognizes the complexity of recovery and the need to zero in on especially vulnerable populations. Adolescents and young adults between the ages of 15 and 25 are one such group, with the lowest rates of engagement for medication for their opioid use problems.

“There are a lot of reasons for this,” explains HEAL-funded clinical psychologist Aaron Hogue, Ph.D., of the New York City-based Partnership to End Addiction.

He states that research shows that family-based support for addiction recovery is critical but often not obtained. Yet sustained, personalized recovery services are essential because treatment is just the first step toward growth and finding a high quality of life without substances.

Various barriers have made family involvement in services for substance use disorders the exception rather than the rule. In many cases, providers don’t have training or tools to know what to do. Hogue sees this as a huge, missed opportunity.

“A young person’s close family is almost always a key part of the solution,” Hogue says, adding that family isn’t just parents and siblings. For young adults, family also includes significant others and close friends who spend most time with that individual and are the source of both positive and negative influences.

Hogue’s HEAL-funded research aims to create tools for providers, youth, and their families to find lasting recovery by targeting three concrete principles. First is developing family-involvement protocols for providers to learn how to bring families into the picture; second is defining metrics to measure success; and third is creating user-friendly remote services for use by individuals and family members.

“We need providers to know how to support youth in making decisions,” Hogue explains, “and we want them to be thoughtful, skilled, and confident in talking to families.”

Meeting People Where They Are

Recovery support resources can be found within recovery organizations at the local, state, and national levels. Today, there are hundreds of such organizations throughout the United States. The groups vary widely in size, membership, and activities – but all provide various types of support to people living with the disease of addiction, including a human touch that connects people with lived experiences who have walked a familiar path.

Sometimes, the word “recovery” isn’t a familiar term. People may not know what paths exist, or even that a path exists at all, says Philip Rutherford, Chief Operating Officer at Faces and Voices of Recovery, who has been in recovery for 20 years and is also a member of the HEAL Community Partner Committee. This group of people with lived experience advises the NIH HEAL Initiative on research directions and ensures that research takes into consideration input from people and communities the initiative aims to benefit.

In 2016, Rutherford created the cloud-based Recovery Data Platform that houses “recovery vital signs” from 70 recovery organizations nationwide. This information can be used by any organization to provide tailored recovery services to program participants. The vital signs include various evidence-based assessments that measure engagement (health outcomes and ratings related to relationships and cravings) and the many sources of recovery capital. The goal, Rutherford explains, is to construct a “recovery story” built from both qualitative and quantitative data for each individual seeking support.

Recovery stories are important because people need choices that work for them, he urges. A faith-based approach in conjunction with medication may resonate with one person, whereas someone else may prefer behavioral therapy and a different type of medication for opioid use disorder (at least three are available and effective).

What’s more, many individuals who cycle in and out of recovery have various health problems, such as chronic pain or mental illness, that can affect recovery progress. These factors need to be considered.

“You can’t always expect people to find what they need on their own,” he says, “they’re not always seeking clinical help, and sometimes it takes real ‘belly to belly’ work to reach them, wherever they may be.”

The HEAL Community stands behind these scientists – and thousands more – who are working every day to harness the power of data and the strength of community to make sure people seeking a secure future in recovery have the best tools and support to arrive at that future and stay there.