In a previous blog, 8 Dimensions of Recovery Capital, we introduced the concept of Recovery Capital. And as a recovery community, we know the importance of engagement. When it comes to both Recovery Capital and Engagement, how do they relate to each other? How does one influence the other?
“Recovery Capital is the depth and breadth of internal and external resources that can be used by someone to begin and sustain wellness from addiction.”
— Granfield & Cloud, 1999
In the context of addiction recovery, we describe sobriety (defined as abstinence from all mood altering and non-prescribed drugs) as the gold standard of outcomes. The person who maintains “abstinence” is said to have attained the desired outcome for the recovery effort. In the mental health world, we talk about reducing the symptoms of mental illness. Is he less depressed? Are her manic symptoms managed? Have the person’s hallucinations abated? As we know, abstinence from drugs or alcohol is the precondition for reducing many other harms associated with SUDs. It is true that abstinence/sobriety will reduce drunk driving, overdose deaths, child neglect, domestic violence, chronic liver disease, HIV or other addiction related problems. Better managed mental health symptoms reduce the likelihood of homelessness, help a person function better in relationships, and improve their ability to maintain employment.
We propose that sobriety and measurement of symptom reduction are important, even necessary, but insufficient measures of outcome. But, what does that mean?
Measurement of symptom reduction is Important and maybe necessary because it is vital to know in real time that the intervention, services or activities are having the intended and positive effect on the target problem. Is the treatment working, and if not, what can we do to adjust the plan so that people improve?
But symptom reduction is a lagging indicator. Lagging indicators reflect something we often have no direct control over. It is a condition that we can only indirectly influence. A lagging indicator gives you hindsight, not insight. A lagging indicator is influenced by engagement, but not directly reflective of engagement.
- Measuring Recovery Capital Monthly
- Tracking Engagement Metrics
- Completion of Treatment Plan
- Completion of Individual or Group Session
- Number of Calls Daily
- Quarterly Reviews
- Capturing Recovery Status at 6 Months
- Number of Calls Monthly
- Number of Admissions at End of Month
In terms of metrics, leading and lagging indicators, work well together, and optimally, you’ll use a combination of both.
Sobriety is indeed an outcome but there are many pathways to that lagging outcome. Lagging indicators show an outcome, but it can be unclear what variables impacted that outcome. In contrast, Recovery Capital is a leading indicator. What do we as Champions of recovery and the improvement of lives, have direct ability to influence and that is quantifiable? Measuring Recovery Capital helps me understand the indicators that influence a person’s wellbeing and recovery success or risk. When a person is understood relative to the state of their internal and external resources, we can make better matched and informed decisions about what will help them advance their recovery. At some point, the insights gained from measuring and analyzing the results of these leading indicators can become predictive. In this scenario we are looking through the windshield at the road ahead rather than the rearview mirror looking at the road we have already traveled. Engagement is optimized for people who can see where they are headed and not just avoid the consequences of the past visible in the rear view mirror..
“There’s an urgent need to focus on the social, economic, and environmental determinants of health. Conditions like addiction are rooted in these determinants, yet our care strategies position sobriety as the goal or a key indicator of success.”
- David Whitesock, Commonly Well
Implicit in this idea of social determinants of wellbeing is the notion that people are not isolated personalities that are solely responsible for determining their destiny. There is a dynamic interplay between the individual and her environment. Between his sense of self and his sense of self in the world and in relationship with others. There are three domains of recovery capital that influence a person’s ability to flourish and improve their wellbeing: Personal, Social and Cultural Capital. Measuring and framing one's recovery in the context of these domains enables one to more directly influence a person’s engagement with their recovery care plan.
As a comprehensive and meaningful measure of subjective experience, recovery capital can improve and directly impact Engagement. This is an important issue. Engagement, as we have highlighted already, is the key ingredient to any effective pathway of recovery. Without engagement, recovery gains will likely never take root, be insufficient or be unsustainable. The recovery journey is a personal one and the extent to which people feel life is getting better impacts the likelihood that a particular course of action will endure. People often engage more when they feel empowered, are nudged gently in the right direction and are supported. And, if a person’s recovery slides back, recovery capital can make the difference between someone being lost to addiction or returning to recovery.
Take social capital. Often it is the encouragement of a mentor or sponsor that moves someone to get to a support meeting on a regular basis or to read the assigned recovery literature. Personal capital might allow someone to feel confidence needed to apply for a job or to ask for help. There are many aspects of a person’s wellbeing that are mediated through the level of personal, social and cultural capital that they have attained. There are few effective measures for recovery from drug and alcohol addiction, most of which narrowly focus only on sobriety.
Measures of recovery capital are holistic, person-centered, track the wellness of the whole person, and positively influence engagement. Recovery capital and engagement in behavioral change pathways are positively correlated. As capital increases, so does the capacity and likelihood of engagement and a person’s capacity for flourishing.
“Recovery is better predicted on someone’s strengths, rather than their weaknesses, and so much of the focus of interventions is on helping individuals to build recovery strengths, more often referred to as ‘recovery capital’.”
- Dr. David Best, What is Recovery