Measuring Recovery from Substance Use or Mental Disorders Workshop Summary (2016) / Chapter Skim
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2 Policy Context and Key Concepts
2 Policy Context and Key Concepts
Pages 7-18
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From page 7... ...
POLICY CONTEXT OF MEASURING RECOVERY FROM SUBSTANCE USE Keith Humphreys began by noting that recovery is embraced as a policy goal in the United States. Similarly, Scotland, England, and Wales consider recovery a guiding goal of drug policy, and other countries, such as Australia, have discussed incorporating this concept into their policies.
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From page 8... ...
High-quality ethnographic and qualitative studies have been conducted by Ramona Asher, Carole Cain, Alain Cerclé, Norman Denzin, and David Rudy, and these contain rich information on lived experiences of recovery. A small number of quantitative surveys have asked recovering people how they define recovery, and these are discussed in detail by Christine Grella and Alexandre Laudet (see Chapter 4)
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From page 9... ...
Another definition comes from the UK Drug Policy Commission, which described recovery as a process, characterized by voluntarily maintained control over substance use, leading toward health and well-being.2 This definition was in a sense a response to the Betty Ford definition, and it is very similar. However, the "voluntarily maintained control over substance use" in the UK definition allows for the possibility of moderate drinking while in recovery.
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From page 10... ...
As Humphreys indicated, one of the challenges associated with measuring recovery is that there is no agreement about whether the recovery experience can be standardized or whether it is entirely subjective. He argued that the solution to this problem is to embrace it, in other words, to always include a simple question that asks whether the person considers themselves to be in recovery from addiction.
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From page 11... ...
noted that this discussion seems to suggest that a study to measure recovery should include multiple approaches to asking the questions, one of which would be to simply ask about whether the person identifies herself or himself as being in recovery. The challenge for SAMHSA will be to decide how much time can be allocated to measuring recovery as part of any overall questionnaire.
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From page 12... ...
POLICY CONTEXT OF MEASURING RECOVERY FROM MENTAL DISORDERS Kenneth Wells (University of California, Los Angeles) discussed the policy issues surrounding recovery from mental disorders, which he argued is important, because it may ultimately determine what needs to be measured and how measured outcomes are used.
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From page 13... ...
The clinical definition of recovery emphasizes symptom remission, return to functioning, and not using maintenance medication.7 An example of a definition from a research context focuses on sustained symptom remission that lasts more than 2 years, engagement in role activities, such as work and school, living independently, and age-appropriate relations.8 The consumer or survivor definitions focus on the process (rather than the outcome) and on a model of patient-centered approach to treatment.9 Consumer definitions also tend to emphasize strength-based qualities: hope, respect, and empowerment.
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From page 14... ...
Wells highlighted a number of additional developments and issues relevant to the health and social policy contexts and the interface of the two, some of which may promote recovery or potentially have an adverse effect, if they direct attention elsewhere: • Medicare Accountable Care Organizations demonstration programs • Medicaid health homes • "co-location" grants • funds to improve the mental health and substance use capacity of federally qualified health care centers • dual eligible financial integration demonstration • Medicaid expansion and waivers (including, integrated care, "whole person")
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From page 15... ...
In addition to national and state initiatives, Wells also discussed several local programs with implications for recovery. The Los Angeles County Health Neighborhood initiative reflects the understanding that if improved functioning is the goal, then sometimes social policy changes are needed in addition to health policy changes.
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From page 16... ...
Wells noted that both the Los Angeles and New York City initiatives were to some extent based on the Community Partners in Care community-based demonstration in Los Angeles, for which he was the principal investigator.15 That project focused on quality-improvement programs for depression and involved a randomized demonstration of multisector coalitions for community engagement and planning in comparison with expert assistance. The study found that the community coalition model resulted in improved 6-month mental health quality of life, physical health, and mental wellness.
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From page 17... ...
He also argued that the methodological implications of differences between people who label themselves as in recovery and those who do not are important to examine. Wells said that an additional complicating factor in mental health recovery, and to some extent in addiction recovery, is the issue of stigma.
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