Developing an Experiential Definition of Recovery: Participatory Research With Recovering Substance Abusers From Multiple Pathways.

BACKGROUND: The What is Recovery? (WIR) study identified specific elements of a recovery definition that people in substance abuse recovery from multiple pathways would endorse. OBJECTIVES: To explain how participatory research contributed to the development of a comprehensive pool of items defining recovery; and to identify the commonality between the specific items endorsed by participants as defining recovery and the abstract components of recovery found in four important broad recovery definitions. METHODS: A four-step, mixed-methods, iterative process was used to develop and pretest items (August 2010 to February 2012). Online survey recruitment (n = 238) was done via email lists of individuals in recovery and electronic advertisements; 54 were selected for in-depth telephone interviews. Analyses using experientially-based and survey research criteria resulted in a revised item pool of 47 refined and specific items. The WIR items were matched with the components of four important definitions. RESULTS: Recovering participants (1) proposed and validated new items; (2) developed an alternative response category to the Likert; (3) suggested criteria for eliminating items irrelevant to recovery. The matching of WIR items with the components of important abstract definitions revealed extensive commonality. CONCLUSIONS/IMPORTANCE: The WIR items define recovery as ways of being, as a growth and learning process involving internal values and self-awareness with moral dimensions. This is the first wide-scale research identifying specific items defining recovery, which can be used to guide service provision in Recovery-Oriented Systems of Care.

Mixed methods study of help seekers and self-changers responding to an online recovery survey.

AIMS: To compare self-changers (natural recovery) with help seekers on demographics, pre-recovery problem severity, and recovery beliefs and behaviors; and to augment these quantitative findings with information extracted from the qualitative stories of a subset of self-changers to explore themes in recovery paths as informed by a nascent natural recovery literature. METHODS: Quantitative secondary analyses were conducted with persons who had responded to a US nationwide online survey called 'What Is Recovery' (WIR) and who reported a prior lifetime alcohol problem (n = 5495). Six men and six women (with longer-term recoveries) interviewed later were asked to tell their 'recovery story from the beginning up to now'. These were coded using a narrative approach. RESULTS: Compared with help seekers, self-changers were younger and never married: they did not differ on problem severity, gender, ethnicity or education. Self-changers identified with 'used to have a problem' more than in recovery/recovered, reported fewer years in that status, and reported more current, non-problematic substance use. A new concept of shadow help and shadow obstacles to help-seeking emerged from the qualitative analysis. Though self-changers believed that they had overcome their alcohol problem on their own, change actually occurred within a social context that allowed access to information, normative expectations, relationships, and other opportunities that provided important resources for change. CONCLUSION: Findings imply that the concept of help-seeking needs to be re-conceptualized to include the informal help we found in this study.

Multi-source recruitment strategies for advancing addiction recovery research beyond treated samples.

BACKGROUND: The lack of established sampling frames makes reaching individuals in recovery from substance problems difficult. Although general population studies are most generalizable, the low prevalence of individuals in recovery makes this strategy costly and inefficient. Though more efficient, treatment samples are biased. AIMS: To describe multi-source recruitment for capturing participants from heterogeneous pathways to recovery; assess which sources produced the most respondents within subgroups; and compare treatment and non-treatment samples to address generalizability. RESULTS: Family/friends, Craigslist, social media and non-12-step groups produced the most respondents from hard-to-reach groups, such as racial minorities and treatment-naïve individuals. Recovery organizations yielded twice as many African-Americans and more rural dwellers, while social media yielded twice as many young people than other sources. Treatment samples had proportionally fewer females and older individuals compared to non-treated samples. CONCLUSIONS: Future research on recovery should utilize previously neglected recruiting strategies to maximize the representativeness of samples.

Elements that define recovery: the experiential perspective.

OBJECTIVE: Although recovery increasingly guides substance use disorder services and policy, definitions of recovery continue to lack specificity, thereby hindering measure development and research. The goal of this study was to move the substance use disorders field beyond broad definitions by empirically identifying the domains and specific elements of recovery as experienced by persons in recovery from diverse pathways. METHOD: An Internet-based survey was completed by 9,341 individuals (54% female) who self-identified as being in recovery, recovered, in medication-assisted recovery, or as having had a problem with alcohol or drugs (but no longer do). Respondents were recruited via extensive outreach with treatment and recovery organizations, electronic media, and self-help groups. The survey included 47 recovery elements developed through qualitative work followed by an iterative reduction process. Exploratory and confirmatory factor analyses were conducted using split-half samples, followed by sensitivity analyses for key sample groupings. RESULTS: Four recovery domains with 35 recovery elements emerged: abstinence in recovery, essentials of recovery, enriched recovery, and spirituality of recovery. The four-factor structure was robust regardless of length of recovery, 12-step or treatment exposure, and current substance use status. Four uncommon elements did not load on any factor but are presented to indicate the diversity of definitions. CONCLUSIONS: Our empirical findings offer specific items that can be used in evaluating recovery-oriented systems of care. Researchers studying recovery should include measures that extend beyond substance use and encompass elements such as those examined here--e.g., self-care, concern for others, personal growth, and developing ways of being that sustain change in substance use.