“You’re all going to hate the word ‘recovery’ by the end of this”: Service users’ views of measuring addiction recovery

Abstract

Aims: To explore how service users’ views of measuring addiction recovery differ from those of service providers. Methods: Five focus groups conducted in two English cities with (i) people currently using Class A drugs (n = 6); (ii) people currently using alcohol (n = 12); (iii) individuals in residential detoxification (n = 12); (iv) individuals in residential rehabilitation (n = 7); and (v) people who defined themselves as ex drug or alcohol users (n = 7). Each focus group reviewed 76 measures of recovery previously identified by senior service providers. Findings: Service users identified multiple problems with the 76 measures. Difficulties could be categorized as expecting the impossible of service users; the dangers of progress; the hidden benefits of negative outcomes; outcomes that negate the agency in recovery; contradictory measures; failure to recognise individual differences; entrenched vulnerabilities; the misattribution of feelings and behaviours; and inappropriate language. Conclusions: Service users experience recovery as a process and personal journey that is often more about ‘coping’ than ‘cure’. Involving service users in designing measures of recovery can lessen the likelihood that researchers develop assessment tools that use inappropriate, contradictory or objectionable outcomes, and ambiguous and unclear language. People who have experienced drug or alcohol problems can highlight important weaknesses in dominant recovery discourses.

• Focus groups
• measurement
• outcomes
• recovery
• service users
• substance misuse

Acknowledgements

The authors would like to thank the participants of all five focus groups, staff at the participating services and members of our service user research group for their support with the research.

Declaration of interest

The authors report that they have no conflicts of interest. The authors alone are responsible for the content and writing of the article. This study presents independent research funded by the National Institute for Health Research (NIHR) Biomedical Research Centre for Mental Health at South London and Maudsley NHS Foundation Trust and King's College London. The views expressed are those of the authors and not necessarily those of the NHS, the NIHR or the Department of Health.

Notes

¹This earlier research sought to identify possible ways of measuring recovery. Separate online Delphi groups were conducted with addiction psychiatrists, senior residential rehabilitation staff and senior inpatient detoxification unit staff. 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 showed that measures of recovery spanned: substance use; treatment/support; psychological health; physical health; use of time; education/training/employment; income; housing; relationships; social functioning; offending/anti-social behaviour; well-being; identity/self-awareness; goals/aspirations; and spirituality. The individual measures identified by the service providers are shown in Table 1.

²Class A drugs are considered to be the most harmful and attract the most serious punishments and fines under UK law. They include heroin, cocaine, ecstasy and LSD.