The Importance of Recovery Management

Butler Center for Research - April 2016
ID 318, Doctor and Patient at appointment

Download the Importance of Recovery Management Research Update.

How to Maximize the Effectiveness of Your Recovery Management Program

The chronic nature of addiction requires ongoing treatment efforts to ensure that people are supported throughout the duration of their recovery, especially during the critical period immediately following discharge from an intensive treatment program. Follow-up services (called "recovery management") have been shown to have a significant positive impact on abstinence rates and quality of life after acute drug and alcohol treatment.

Drug and Alcohol Recovery Management Programs

The modern understanding of addiction as a chronic disease has led to significant changes in treatment models over recent years (for more information on the disease model of addiction, see the Research Update entitled "The Brain Disease Model of Addiction"). Clinicians have begun to treat addiction in a three-phase model of care that echoes other chronic disease models: (1) symptom stabilization and/or initial detoxification; (2) acute intensive treatment; and (3) recovery management, which focuses on long-term recovery maintenance.1, 2 Recovery management covers an extremely broad array of services that can include individual or group counseling, mutual aid groups (such as Alcoholics Anonymous), and/or brief telephone or online interventions.2

The Effectiveness of Recovery Management

Drug and alcohol recovery management plans that reinforce acute treatment episodes have been widely accepted as a best practice by many national organizations (including the American Psychiatric Association),3 however, researchers have struggled to measure their effectiveness because the breadth of services can make recovery management difficult to define. Overall, studies support that recovery management, in some form, significantly reduces relapse rates among those in recovery.3, 4 Significant benefits of recovery management have been demonstrated in research among adults,3 adolescents,5 and "emerging adults" (defined as adults between the ages of 18 and 25).1 Support for the effectiveness of recovery management has also been shown across various substance addictions, including alcohol and opioids.6, 7 A number of researchers have also discovered patterns that suggest that recovery management engagement correlates significantly with other beneficial patient outcomes that have been strongly tied to long-term recovery, including increased affiliation with sober peer groups and social networks, improved economic status and housing stability, and decreased legal activity.4, 5

Institutional research has also demonstrated significant patient benefits related to drug and alcohol recovery management programs provided by the Hazelden Betty Ford Foundation. A 2015 study of the Lodge, a recovery management program offered by Hazelden Betty Ford Foundation's Dan Anderson Renewal Center, which offers retreats and other recovery services, found that patients who attended Lodge programming within 1 week (7 days) of their discharge from residential treatment demonstrated a number of positive outcomes not found among patients who did not attend Lodge programming after an acute treatment episode.8

This early recovery management engagement significantly correlated with increased participation in other recovery management activities and improved patient-reported outcomes related to recovery during follow-up periods. Six months after discharge from an acute residential treatment episode, Lodge participation significantly increased patient-reported quality of recovery ratings and levels of motivation to maintain a recovery program; at a 12-month follow-up, Lodge participants reported significantly higher ratings of satisfaction with their social support network and were nearly twice as likely to report being active in a mutual aid group.8 These findings lend further support to the value of recovery management immediately following an acute treatment episode for increasing long-term patient recovery outcomes.

Maximizing the Effectiveness of Drug and Alcohol Recovery Management

As stated previously, the heterogeneity of recovery management options (and the endless possible combinations of multiple services) can make the assessment of recovery management's overall effectiveness difficult. While the beneficial effects of recovery management are generally accepted by clinicians and other treatment providers, the specific elements that can make a recovery management program more (or less) effective are debated.

Several studies have attempted to discover what aspects of recovery management are most effective, with mixed results. A 2009 literature review on recovery management outcomes suggested that greater duration and intensity/frequency, more active treatment delivery methods, and the use of interventions with recent empirical support would elicit more successful patient recovery outcomes;2 however, a follow-up meta-analysis conducted in 2014 found that of these three elements, only the use of a recent evidence-based practice during interventions (in this case, cognitive-behavioral therapy) was found to have a significant effect on patient outcomes.3 Several other studies demonstrate the importance of ongoing patient progress monitoring in maximizing outcomes during recovery management treatment, regardless of the specific services or activities that may be included as part of the treatment plan.9 In a recent meta-analysis of recovery management clinical trials, researchers determined that the most-effective strategy for recovery management was taking an integrative approach that incorporated several evidence-supported services and activities that could be easily tailored to meet the needs and preferences of patients on a more individual basis.10 Studies have also demonstrated support for recovery management programs that increase consistent contact with patients through telephone or computerized methods, including brief check-up calls and follow-up interviews and web-based disease management software modules.11, 12

Summary

Drawing conclusions from such a divided body of research can be difficult; however, a number of concurrent themes persist among the findings. Generally, there is strong support for the overall effectiveness of recovery management following an acute treatment episode.3, 10 Most researchers have established preliminary support for recovery management programs that are flexible and customizable and that rely upon evidence-based or empirically supported modalities and techniques.1, 3, 10 Consistent ongoing contact with patients appears to be very effective, although the specific duration of care and frequency of contacts are less important, and the use of technology to facilitate consistent contacts has emerging support.3, 4, 5, 11, 12 Regardless of the care program, patient contacts should include a standard method for treatment professionals to assess patient progress through questions and observations related to common symptoms or co-occurring conditions of alcohol and other drug dependence.9

Studies support that recovery management, in some form, significantly reduces relapse rates among those in recovery

The Hazelden Betty Ford Foundation strongly encourages patients to engage actively in recovery management services following acute treatment and offers a number of programs that have been developed to help maintain long term recovery.

MORE is an exciting development in the use of online tools that provide flexible, personalized support for those who are embarking on a recovery management plan following acute treatment. MORE features educational online modules and workbook activities, progress checks and virtual achievements, online support communities, and access to a live recovery coach electronically or by phone, MORE offers those in recovery the opportunity to create a flexible and comprehensive supplement to support in-person recovery services such as attending Twelve Step meetings and working with a sponsor. Preliminary research has provided support for the effectiveness of the MORE program, demonstrating that increased MORE participation is significantly correlated with abstinence at 6- and 12-month follow-ups.12

Connection is designed for people who need additional support and accountability in their early recovery. This intensive program is ideal for people facing legal issues, custody matters, or loss of professional license; students returning to college; people who have been in treatment multiple times; and anyone who needs additional support and accountability in their early recovery. The Connection team works with patients to develop an individualized Recovery Care Plan. Plans use patients’ existing professional and support networks to help encourage active participation and to monitor accountability. Throughout the program there is coaching on life skills and recovery needs, random drug testing, and monitoring and reporting of adherence to the Recovery Care Plan.

Available as a stand-alone recovery experience or as a supplement to more structured recovery treatment programs, the Lodge Program at the Dan Anderson Renewal Center offers immersive Twelve Step support for participants at various stages of recovery. Lodge participants are able to set a customized schedule of lectures, meetings, wellness activities, and personal reflection. A recent analysis of Lodge participants showed that patients who attended the Lodge immediately following an acute treatment episode had several significant recovery benefits.8

Patients: Research has shown that it is important to continue regular participation in recovery-focused activities following a treatment episode for alcohol or other drug dependence. Regardless of what programs or activities you engage in to maintain sobriety, your chances for long-term recovery increase significantly with regular, consistent participation in recovery management.

Providers: While there are no definitive studies that outline which recovery management services are most effective, researchers agree that flexible, customizable programs and regular patient progress monitoring are key. Studies have also provided support for the use of telephone and online interventions, so consider using technology to help regularly engage your patients in recovery.

1. Bergman, B. G., Hoeppner, B. B., Nelson, L. M., Slaymaker, V., & Kelly, J. F. (2015). The effects of recovery management on emerging adult outcomes following residential addiction treatment. Drug and Alcohol Dependence. Advance online publication. doi: 10.1016/j. drugalcdep.2015.05.017

2. McKay, J. R. (2009). Recovery management research: What we've learned and where we're going. Journal of Substance Abuse Treatment, 36(2), 131–145.

3. Blodgett, J. C., Maisel, N. C., Fuh, I. L., Wilbourne, P. L., & Finney, J. W. (2014). How effective is recovery management for substance use disorders? A meta-analytic review. Journal of Substance Abuse Treatment, 46(2). Advance online publication. doi: 10.1016/j. jsat.2013.08.022

4. Dennis, M. L., Foss, M. A., & Scott, C. K. (2007). An eight-year perspective on the relationship between the duration of abstinence and other aspects of recovery. Evaluation Review, 31(6), 585–612.

5. Garner, B. R., Godley, M. D., Funk, R. R., Dennis, M. L., & Godley, S. H. (2007). The impact of recovery management adherence on environmental risks, substance use, and substance-related problems following adolescent residential treatment. Psychology of Addictive Behaviors, 21(4), 488–497.

6. Weisner, C., Matzger, H., & Kaskutas, L. A. (2003). How important is treatment? One-year outcomes of treated and untreated alcohol dependent individuals. Addiction, 98, 901–911.

7. Flynn, P. M., Joe, G. W., Broome, K. M., Simpson, D. D., & Brown, B. S. (2003). Recovery from opioid addiction in DATOS. Journal of Substance Abuse Treatment, 25, 177–186.

8. Hazelden Betty Ford Foundation. (2015). Benefits of post residential Lodge participation. Center City, MN: Bethany Ranes.

9. Goodman, J. D., McKay, J. R., & DePhilippis, D. (2013). Progress monitoring in mental health and addiction treatment: A means of improving care. Professional Psychology, Research and Practice, 44(4), 231–246.

10. Lenaerts, E., Mathei, C., Matthys, F., Zeeuws, D., Pas, L., Anderson, P., & Aertgeerts, B. (2014). Recovery management for patients with alcohol use disorders: A systematic review. Drug and Alcohol Dependence, 135, 9–21.

11. McKay, J. R., Lynch, K. G., Shepard, D. S., Ratichek, S., Morrison, R., Koppenhaver, J., & Pettinati, H. M. (2004). The effectiveness of telephone-based recovery management in the clinical management of alcohol and cocaine use disorders: 12-month outcomes. Journal of Consulting Clinical Psychology, 72, 967–979.

12. Klein, A. A., Slaymaker, V. J., Dugosh, K. L., & McKay, J. R. (2011). Computerized recovery management support for alcohol and drug dependence: A preliminary analysis of usage and outcomes. Journal of Substance Abuse Treatment. Advance online publication. doi: 10-1016/j.jsat.2011.07.002

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