Title: Recovery pathways and societal responses in the UK, Netherlands and Belgium- REC-PATH.
Funder: Department of Health and Social Care

Abstract: 1. Background Changing illicit drug using behaviour is a complex process, in which personal (including gender), social and structural factors interact. Growing interest in recovery led to multiple attempts at definitions (Betty Ford Institute, 2007; UK Drug Policy Commission). Mental health definitions of recovery focus more extensively on personal and subjective experiences of recovery (e.g., Slade, 2010; Deegan, 1998). In the US (Betty Ford Institute Consensus Group, 2008) and UK (UK Drug Policy Commission, 2008), recovery from problem substance use has been defined in more behavioural terms and is characterised as involving control over substance use, global health and wellbeing, and active citizenship (or community participation). The emerging literature on addiction recovery reflects a growing body of research on measuring 'recovery capital' (Granfield and Cloud, 1998; Best and Laudet, 2010), which focuses on the assets and strengths including positive social networks, coping and resilience skills, and access to pro-social supports in the community. 2. Aims in relation to the issue to be addressed The central goal of our research is to examine mechanisms of behaviour change for recovery (MOBCR) from substance use, including an assessment of personal, social and structural factors involved in the process of recovery. These will be framed in the context of two socio-environmental factors, across all three countries: a. The role that different mechanisms of behaviour change for recovery (formal and informal help). b. The role of contextual factors (community and policy level) in creating supports and barriers. The UK Life in Recovery survey (LiR) data (n=803) (Best et al., 2015) suggests that women (at least those who sustain recovery) typically have shorter problem drug use careers and earlier onset of recovery; thus, studying gender-specific recovery pathways is a key aim of the project, with previous research (Grella et al, 2008). 3. Research plan and methods of investigation All countries will use LiR to maximise cohort capture, range of recovery groups and run all these concurrently starting on the same date and will be used as both the screen for study participation and as an initial data source. A unique follow-up of a large cohort of individuals (n=450) in different stages of recovery in 3 countries, based on a core set of instruments that will allow comparison across recovery pathways and countries and incorporating contextual factors as mediating variables, particularly around exclusion and the role of stigma in preventing both help-seeking and effective transition from early to sustained recovery. 4. Research team Prof David Best is one of the pioneers of the international addiction recovery movement. Tim Millar is an addiction epidemiologist with statistical and methodological expertise. Netherlands, IVO, headed by Prof Gerda Rodenburg. Belgian co-PI Prof Vanderplasschen has published on recovery-related topics in addiction with project partners Freya Vander Laenen and Charlotte Colman. The second Belgian co-PI, Jessica De Maeyer is an expert in QoL life research and has extensive experience with qualitative research methods. 5. Potential impact/influence on the relevant policy field, users and wider stakeholders Relevant stakeholders (e.g. service user representatives, treatment providers, policy makers, scholars) will be involved in the Project Advisory Group (PAG), which will monitor the project closely. The use of three innovative qualitative methods (Life Charts, Social Identity Mapping and Photovoice) and one quantitative technique (REC-CAP) provides a range of mechanisms for participant expression and participation Each of these is also designed to increase participant empowerment and active engagement in the research project and both the Life Chart and SIM have potential for use in recovery care planning and in therapeutic settings, which will be of use to policy makers and commissioners.

Lay abstract: Recovery models are well established in policy, commissioning and treatment practice in the UK, but have only begun to emerge in policy discourse in the Netherlands and Belgium. The aim of this project is to map pathways to recovery in populations engaging with different mechanisms of behaviour change for recovery - mutual aid (such as 12-step groups like NA), peer-based support, residential and community treatment, specialist treatment: maintenance and abstinence oriented) or through their own 'natural recovery' endeavours, at different stages of their addiction careers. We will recruit populations in early (5 years) in these 3 countries and will track these individuals over the course of one year. The study will use mixed methods to assess recovery capital, social networks and identity, community engagement and societal responses, with a particular focus on gender differences in utilisation of each of our five pathways and trajectories to change. We will also assess the client experience of policy and practice change on stigma, access to support and reintegration. To supplement this basic measure of change across different recovery populations, the study also includes qualitative elements: 1. A review of policy formation and development in each of the three participating countries and how its effectiveness is assessed 2. A sub-sample of 30 people in each country completing an in-depth qualitative interview aligned to the second structured interview assessing their recovery journeys and experiences 3. A smaller qualitative group in Belgium using an innovative method called Photovoice to visually record their experiences of recovery pathways

Research activity codes: 8.1 ORGANISATION AND DELIVERY OF SERVICES;7.1 INDIVIDUAL CARE NEEDS
Health categories: MENTAL HEALTH