Recovery, Rehabilitation, and Social Reintegration

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6. Drug Dependence Treatment and Sustained Recovery Management

"Drug dependence treatment—within an acute care, symptoms-focused paradigm—has fallen short of properly addressing the complex, multifactorial nature of drug dependence that often follows the course of a relapsing and remitting chronic disease. There is disillusionment with the 'admit, treat, and discharge', revolving door cycles of high dropout rates, post-treatment relapse, and readmission rates. As a response to this situation there is a shift towards a more long term perspective of sustained recovery management (White 2007; White and Davidson, 2006) that is much broader and holistic in scope (Bradstreet, 2004) than linear recovery models."

TreatNet. Drug Dependence Treatment: Sustained Recovery Management. Vienna, Austria: United Nations Office on Drugs and Crime, 2008, p. 14.

7. Importance of Social Reintegration for Recovery

"Research shows that drug treatment contact impacts positively on clients’ physical and psychological health, reduces drug use and criminal activity, reduces injection and lowers the risk of non-fatal overdose (e.g. Gossop et al., 2000a,b; Prendergast et al., 2002; Stewart et al., 2002; WHO, 2009). Thus, accessing and adhering to drug treatment is a significant step towards recovery from drug dependence, but additional social support is often required. Indeed, drug use affects many spheres of life, including family and relationships, housing, education and employment, and it is also associated with social and economic exclusion. This can undermine the gains people have made while in treatment. It is therefore increasingly recognised that, in order to improve treatment outcomes, prevent relapse and ensure successful integration into society, drug dependence must not be treated in isolation; instead, the wider context in which drug use and recovery take place must also be considered and addressed (UNODC, 2008; Neale and Kemp, 2010). The United Nations Office on Drugs and Crime (2008a, p. 18) describes this approach as ‘sustained recovery management’, as a positive alternative to the current common approach of ‘admit, treat, and discharge’, often resulting in revolving-door cycles of high dropout rates, post-treatment relapse and readmission rates.

"Consequently, the aim of social reintegration measures is to prevent or reverse the social exclusion of current and former drug users (including those who are already socially excluded and those who are at risk of social exclusion), but also to facilitate the recovery process and help sustain the outcomes achieved during treatment."

European Monitoring Centre for Drugs and Drug Addiction. EMCDDA Insights Series No 13: Social reintegration and employment: evidence and interventions for drug users in treatment. Luxembourg: Publications Office of the European Union, 2012, p. 22.

8. A Sustained Recovery Management Approach to Substance Dependence Treatment

"The recognition of drug dependence as a multi-factorial health disorder, which often follows the course of a relapsing and remitting chronic disease, has spurred calls to shift the focus of drug dependence treatment from acute care to an approach of sustained recovery management in the community. Sustained recovery management applies many of the central components of recovery capital and the Sustainable Livelihoods framework. Service wise, a sustained recovery management approach offers the following:

"• Uses a strengths-based approach, considering the resources available in the clients life;
"• Takes into account the main areas of life/the eight domains of recovery capital (and their potentially compounding interrelationships) that can support rehabilitation and social reintegration for drug dependent persons;
"• Integrates a broader range of drug dependence rehabilitation and social reintegration support services, to strengthen human, vocational, and social capital necessary for a healthy, stable and meaningful life.
"• Uses broad, family- and community-focused, strengths-based, continual assessment processes;
"• Implements early and assertive engagement by service professionals;
"• Develops client- and family-generated recovery plans;
"• Includes assertive management of co-occurring disorders and challenges to recovery;
"• Uses peer-based models of recovery support and community resource development and mobilization;
"• Shifts the centre of service activity from the institutional environment to the client/family’s natural environment in the community;
"• Puts emphasis on sustained monitoring, recovery coaching, assertive development and linkages to the community services for recovery support and, as needed, early re-intervention;
"• Focuses on long-term evaluation of the effects of service combinations and sequences.
"• Establishes a sustainable health care partnership between service providers and clients;
"• Aims at easy access to services by shifting their location from remote institutions to the client/family’s natural environment in the community;
"• Emphasizes the importance of policy change and advocacy to reduce social stigma attached to drug dependence, and to promote recovery supportive policies and programmes (White, Boyle, and Loveland, 2002);

"Building social capital is a visible, central element of sustained recovery management. It encompasses four of the eight domains of recovery capital in Figure III above, namely, family and social supports; peer-based support; community integration and cultural renewal; and healthy environments."

TreatNet. Drug Dependence Treatment: Sustained Recovery Management. Vienna, Austria: United Nations Office on Drugs and Crime, 2008, p. 18-19.

9. Recovery Capital

"In this context, “recovery capital“ is the sum of personal and social resources at one’s disposal for addressing drug dependence and, chiefly, bolstering one’s capacity and opportunities for recovery” (Cloud and Granfield, 2001).

"Recovery capital can be used as a tool for drug dependence treatment professionals practitioners, to identify the strengths of their clients, support them in building up and maintaining a sustainable livelihood, while looking holistically at all domains of life. This approach meets individuals 'where they are' and supports them along the continuum of treatment, rehabilitation and social reintegration.

"Building recovery capital is a strengths-based approach. It involves identifying and building upon the client’s major personal and social assets, which may have been developed earlier in life or are newly acquired. These assets can support treatment engagement and enhance motivation for treatment, the treatment process and ongoing recovery from drug dependence problems.

"The eight domains of recovery capital identified by the Treatnet working group (shown in Figure III) are:
"1) Physical and mental health;
"2) Family, social supports, and leisure activities;
"3) Safe housing and healthy environments;
"4) Peer-based support;
"5) Employment and resolution of legal issues;
"6) Vocational skills and educational development;
"7) Community integration and cultural support; and
"8) (Re)discovering meaning and purpose in life.

"A lack of such assets could hamper the recovery process and desired outcomes."

TreatNet. Drug Dependence Treatment: Sustained Recovery Management. Vienna, Austria: United Nations Office on Drugs and Crime, 2008, p. 17.

10. Four Dimensions of Recovery Capital

"Cloud and Granfield delineate four dimensions to recovery capital: social, physical, human and cultural.
"Social capital: The sum of resources that each person has as a result of their relationships, support from and obligations to groups to which they belong
"Physical capital: Tangible assets such as property and money that may increase recovery options
"Human capital: Personal skills and education, positive health, aspirations and hopes
"Cultural capital: Values, beliefs and attitudes that link the individual to social attachment and the ability to fit into mainstream social behaviour
"Source: Cloud and Granfield 2008"

Munton AG, Wedlock E and Gomersall A (2014) The role of social and human capital in recovery from drug and alcohol addiction. HRB Drug and Alcohol Evidence Review 1. Dublin: Health Research Board. Citing Cloud W and Granfield R (2009) Conceptualizing recovery capital: expansion of a theoretical construct. Substance Use and Misuse, 43: 1971–1986.