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What do we mean by recovery and recovery capital?

 

Researchers and clinicians have devised the construct of ‘recovery capital’ to refer to the sum of resources necessary to initiate and sustain recovery from substance misuse. Before discussing this construct in more detail, it is first necessary to explain what we mean by recovery. In the US, the Betty Ford Institute Consensus Panel (2007, p. 222) defined recovery as “a voluntarily maintained lifestyle characterised by sobriety, personal health and citizenship”. Subsequently, the UK Drug Policy Commission (2008, p.6) followed up this statement with a definition of recovery as “voluntarily sustained control over substance use which maximises health and wellbeing and participation in the rights, roles and responsibilities of society”. Both of these definitions involve three primary component parts – wellbeing and quality of life, some measure of community engagement or citizenship, and some measure of sobriety.

In contrast, the definition from mental health recovery is typically more focused on the quality of life component regardless of the others. Deegan (1988) has argued that “recovery refers to the lived experience of people as they accept and overcome the challenge of disability… they experience themselves as recovering a new sense of self and of purpose within and beyond the limits of the disability”.

What is clear, however, is that the essence of recovery is a lived experience of improved life quality and a sense of empowerment; that the principles of recovery focus on the central ideas of hope, choice, freedom and aspiration that are experienced rather than diagnosed and occur in real life settings rather than in the rarefied atmosphere of clinical settings. Recovery is a process rather than an end state, with the goal being an ongoing quest for a better life.

With recovery conceptualised as a process in this way, recovery capital refers to the sum of resources that may facilitate the process. The notion of social capital initially developed in the field of sociology, where Pierre Bourdieu (1980) described it as one of three resource forms along with economic and cultural capital as the basic resources for power. When this concept was applied to the addictions field, Granfield and Cloud (2001) suggested that “Those who possess larger amounts of social capital, perhaps even independently of the intensity of use, will be likely candidates for less intrusive forms of treatment”.

However, social capital in this sense does not mean only the social resources that an individual can draw upon – their parents and families, partners, friends and neighbours when times are tough. It also implies the person’s engagement and commitment to the community and their willingness to participate in its values.

Further, Granfield and Cloud (1999) defined recovery capital as “…. the breadth and depth of internal and external resources that can be drawn upon to initiate and sustain recovery from AOD [alcohol and other drug] problems”. In the same paper, they summarise early evidence among naturally recovering individuals (people who did not seek professional treatment or participate in mutual aid support groups) suggesting that both the quality and the quantity of recovery capital play a major role in predicting recovery success both in and out of treatment, and crucially that the growth of recovery capital can signal a ‘turning point’ in addiction careers.

White and Cloud (2008) assert that the type of interventions that will be appropriate will depend in part on the balance of recovery capital and problem severity/complexity. They represent this in a ‘quadrant model’ as shown in Table 1 below, where people can be allocated to one of four cells (although this is a shorthand for people’s overall ratings of recovery capital and problem profile). Thus, people with high recovery capital and low problem severity may be appropriate for brief interventions of various types. People with high recovery capital but also high problem severity may be appropriate for out-patient detoxification with intense community support. White and Cloud argue that people with low problem severity and low recovery capital may be appropriate for residential rehabilitation with appropriate follow-up and people with low recovery capital and high problem severity may need a combination of intensive interventions.

 

Table 1: Recovery Capital / Problem Severity Matrix

Consistent with Deegan’s definition of recovery in the mental health field, this model makes no assumption that those high in addiction severity/ complexity will be low in recovery capital. However, the influence of change in recovery capital (increases or decreases) on subsequent patterns of substance use and related problems remains an unanswered question.

 

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