The role of specialist substance use and addiction treatment in building recovery capital

Introduction. While specialist treatment is often seen as a prerequisite for addiction recovery, an increasing body of evidence shows that a substantial proportion of persons (up to 50%) overcome severe alcohol and/or drugs without treatment or mutual aid support (Kelly et al., 2017). Previous international studies comparing persons in recovery with and without following treatment focused on differences in sociodemographic background and substance use history, such as problem severity.

Methods. To compare various recovery pathways, we administered the ‘Life in Recovery survey’, a 20-minute online questionnaire, to persons in recovery from alcohol and/or drug use problems (N=343) in Flanders (Belgium). The survey covered sociodemographic details, substance use history, treatment pathways, life circumstances during addiction and in recovery (Strengths and Barriers for Recovery Scale, SABRS), and two open-ended questions about recovery facilitators and barriers. Participants reported diverse recovery pathways, which were clustered into four groups: (1) unassisted recovery (15.2%), (2) mutual aid support only (8.5%), (3) specialized in-or outpatient treatment only (31.8%), and (4) combinations of specialized treatment and mutual aid support (44.5%).

Results. Logistic regression analyses comparing unassisted recovery (1) to recovery following specialized treatment and/or mutual aid support (2-4) confirmed previously established indicators for natural recovery, such as higher educational attainment and lower severity of dependence. Additionally, a difference in the number of experienced health, financial, work, legal, and social barriers as measured by SABRS was found (β=-1.33, OR=0.26, p<.001). Linear regression analyses demonstrated that recovery pathway clusters were associated with the number of experienced barriers and strengths during addiction, but not with the number of strengths and barriers and quality of life in recovery. Analysis of open-ended questions resulted in seven central themes about what facilitated and hindered recovery, which were similar across the four pathways and corresponded to personal, social/relational, and community resources.

Discussion. Findings from this study underscore a variety of support pathways to recovery, in which specialist treatment and mutual aid/peer support are often combined rather than being distinct routes to recovery. Commonalities across the four groups in domains facilitating and hindering recovery, coupled with disparities in starting situations between natural recovery and various treatment assisted groups, emphasize the necessity of a continuum of support across various life domains and the integration of formal and informal types of treatment.