The Importance of Recovery Management

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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