An upsurge in a recovery-oriented focus on addressing alcohol and drug problems in the United States and around the world is resulting in national destigmatization campaigns and fresh attempts to conceptualize, organize and structure services to support long-term remission and recovery that goes far beyond the more traditional provision of acute stabilization care. In the United States, these efforts have included the establishment of Faces and Voices of Recovery and the designation of September as “Recovery Month,” as well as the growth of state-based Recovery Community Organizations, Recovery Community Centers, Collegiate Recovery Communities and Recovery High Schools. Yet, while the prevalence of recovery support services is increasing rapidly, the evidence base documenting the effectiveness of such services remains scarce. Between the dramatic changes to health care delivery that are occurring under new health care reforms and the philosophical shift in the addiction field, new opinions and information are being circulated rapidly, yet for many, the reliability, validity, and credibility of this information remains difficult to decipher. To help create a credible scientific foundation for these new recovery initiatives, the Recovery Research Institute, a new initiative at the Massachusetts General Hospital Center for Addiction Medicine and Harvard Medical School, seeks to disentangle the myths from the facts, conduct needed research and serve as a resource to locate the evidence-based truths about recovery
What do we know? What do we need to know?
We do know that substance misuse is the nation’s number one public health problem and results in enormous economic costs to society. Furthermore, addiction is not a rare disorder. Beyond the 15 percent of adults in the United States with a substance use disorder, there are 25-40 million people in recovery. We know that there is a high risk of relapse for those entering recovery, however this risk declines substantially over time. Many people in recovery have increasingly utilized community-based recovery support services or clinical recovery management services, if available, and anecdotally report that these are beneficial to their recovery and protective against relapse. A four-year randomized, controlled trial evaluating the efficacy of “recovery management checkups” – a model akin to managing chronic illnesses, such as diabetes – has shown that continued monitoring and pro-active linkage to services is associated with reducing time to treatment re-entry and greater abstinence. Conducting controlled investigations of other recovery support services, particularly freely-available community-based services, can prove challenging due to ethical and study design limitations. Thus, there is a lack of empirical evidence providing clear causal relationships between community-based recovery services and remission and recovery. However, the wealth of data repeatedly showing an association between these variables, and the potential for good, encourages further investigation and investment.
How will the Recovery Research Institute (RRI) reduce the gap between what we know and what we need to know?
The recent recovery movement is a manifestation of a societal recognition for the need of a new approach to address endemic substance-related problems. Currently, the evidence base for recovery research is limited, but growing. As interest in the recovery movements develops, an increasing number of websites, social media posts and other platforms with information about recovery are appearing, many of which report conflicting information lacking credible sources. Under the auspices of Harvard Medical School and the Massachusetts General Hospital Center for Addiction Medicine, the Recovery Research Institute (RRI) is being established, which is purposed to serve as a valid and reliable source of information and resources related to addiction recovery. The aim is to provide information that can be used by a variety of stakeholders: people in, and seeking, recovery; family members; friends; clinicians; administrators; and policymakers. The hope is to increase access to empirically-based addiction recovery information by objectively summarizing, synthesizing and disseminating recovery research in a digestible format that can be easily understood. To enhance understanding of the significance and impact of the research, the context of the scientific results and their implications will be described. In the near future the aim is to disseminate information through a regular newsletter, generate blog posts which can serve as discussion boards and build up our linkages to existing resources that will be directly useful to our audience. The RRI hopes to further recovery research by not only identifying what is known, but also by highlighting what new information needs to be gathered, and by conducting further recovery research of its own. In so doing, the broader goal is to encourage recovery-oriented evaluation research and identify “best practices” that can be used to further the field and promote recovery.
John F. Kelly, PhD & M. Claire Greene, MPH
Massachusetts General Hospital & Harvard Medical School