CHARACTERIZATION AND
EVALUATION OF ADDICTION
RECOVERY COMMUNITY
CENTERS
John F. Kelly
Recovery community centers and continuing care
for addiction recovery
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The majority of people with a SUD achieve full, sustained
remission
The road to long-term recovery is often oscillatory
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Periods of relapse, treatment, incarceration, and short-term
remission
Development and implementation of continuing care models
(e.g. recovery management checkups, recovery support
services)
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Recovery Community Centers (RCCs)
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Social services, employment linkages, relapse prevention, etc.
Why is research and program
evaluation important?
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Answers the basic questions:
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Does it work or help?
What about it “works”?
For whom does it work?
At what stage(s) of recovery?
At what intensity/“dose”? Over what period?
To what degree do people benefit?
At what price or cost?
Compared to what else?
Is there a better, more cost-effective way to support recovery?
To establish a “proof of concept”
To provide objective evaluation (CCC; sampling bias; selection bias;
attrition bias) - leads to clear causal inference
Should we fund it? - Data gets attention; there is a lot of “heart”; but
without measurement/data difficult to get funders to pay attention and
support services that could help
Background/Significance
Conceptual model of RCCs
Principles of RCCs
Rationale for systematic evaluation of RCCs
Conceptual Model of RCCs
Achievement of sustained
recovery from alcohol or other
drug use disorders is not just a
function of medical stabilization
(e.g. detox) or addressing shortterm deficits and
psychopathology, but also by
building and successfully
mobilizing personal, social,
environmental and cultural
resources that can be brought to
bear on recovery.
Recovery Capital
Stress and coping, social identity, social control, behavioral
economics, social learning theories all play a role…
Stress and
coping, social
identity, social
control,
behavioral
economics,
social learning
theories all
play a role…
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RCCs can:
 Instill
hope for a better future
 Enhance self-esteem/self-worth
 Provide recovery social norm
 Motivate/re-motivate for recovery
 Foster shift in social identity from “addict”
to “recovering person”
 Decrease stress/increase ability to cope
with stress
 Boost sobriety confidence
Principles of RCCs
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RCCs serve as a source of recovery capital at the
community level
Provide different services than formal treatment
 Offer more formal and tangible linkages to social services,
employment, training and educational agencies than do
mutual-help organizations
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Based on the principle that there are many pathways to
recovery
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RCCs are not allied with any specific recovery philosophy
or model
Rationale for systematic evaluation of
RCCs
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Effectiveness/Cost-effectiveness?
Recovery Homes (Oxford Houses): net overall saving of
$17,830-29,000 per person/yr compared to usual
outpatient care
 12-Step Treatment Programs: Reduced healthcare costs by
$8,000 per patient over a 2-year period
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Other continuing care services have shown to be
effective at reducing relapse, improving psychological
functioning and increasing the likelihood of long-term
recovery
Rationale for systematic evaluation of
RCCs
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RCCs are rapidly growing, but have yet to be
systematically evaluated
Research Strategy
Research Aims
Study Design
Participants, Settings and Recruitment
Procedures
Measures
Design Considerations…
Design
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Self-selection problem
Randomization
Site differences
Sample size
Cost
Research Aims
1.
2.
3.
To conduct on-site interviews with RCC directors and staff to systematically
characterize RCCs (k=34) in New England states and New York State using
standardized measures to aid in cross-comparison across centers and states.
Measures will capture the nature and degree of staffing, volunteer contributions,
center size, physical quality/attractiveness, and service capacity, types of services
and support provision, and funding sources and budgets.
To conduct a cross-sectional survey to characterize current RCC users
(approximately 15 from each site; N=510); and examine the perceptions of and
experiences with RCCs.
To conduct a proof-of-concept study by assessing and prospectively following a
sample of new RCC clients (N=300) from k=5 of the highest impact/quality RCCs
(determined empirically from aims 1 and 2) over a 3-month period to assess for
RCC utilization/discontinuation, and to test for the effects of RCC utilization on
relapse and remission rates, and the accrual of recovery capital and enhanced
quality of life.
Study Design
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3 Phases
In-depth, on-site interviews with RCC directors & surveys
with RCC staff
Cross-sectional survey with current RCC clients
Prospective (3-month) observational cohort study of new
RCC clients to establish proof-of-concept
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2.
3.
Alternative Design Considerations
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Matched-control design
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Limitations: resources, time, comparison group
Participants, Setting & Recruitment
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Targeted Enrollment
 Key
informant interviews from 34 RCCs (Aim 1)
 510 current RCC clients (15 per RCC; Aim 2)
 300 new RCC clients from 3-5 RCCs (Aim 3)
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Inclusion/Exclusion Criteria
 Must
be 18+ years old and meet IRB-approved criteria
to consent to participation
Procedures
Aim 1: Characterization of RCCs
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Data Collection
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Staff Training
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Study staff will travel to RCCs to conduct program director
interviews and administer staff survey
Study staff will train RCC staff to recruit participants for
Aims 2-3
Recruitment compensation:
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Centers will earn $50/participant recruited for the
prospective study
Procedures
Aim 2: Cross-sectional survey with current RCC clients
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Data Collection
 Online
informed consent
 Online survey
 Data
submitted electronically to Redcap online data capture
system (Project-redcap.org)
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Compensation
 $10
gift card
Procedures
Aim 3: Prospective proof-of-concept study of new RCC clients at the best RCCs
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Data collection
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Online informed consent
Online survey at baseline and 3-months
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Follow-up
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Data submitted electronically to Redcap online data capture system (Projectredcap.org)
Study staff will collect participant contact information to increase
retention by reminding participants of follow-up assessments
Compensation
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$15 baseline baseline assessment
$20 3-month assessment
Procedures
Project Timeline
Project Activities
Year 1
Year 2
Quarters
Quarters
1
2
Conduct key informant interviews with RCC directors (N=34; Aim 1)
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Conduct cross-sectional survey of current RCC users (N= 510; Aim 2)
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Conduct baseline survey of new RCC clients (N=300; Aim 3)
Conduct three month assessment of new clients (N=300; Aim 3)
Analysis and manuscript preparation
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Measures
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Program Inventory
Key Informant Interview Survey
Current and New Client Survey
Substance Use, Mutual Help, Social Network,
Psychiatric Symptoms
Quality of Life and Spirituality
Recovery Capital
Measures
Program Inventory
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Research staff will
collect information on
the physical nature of
the RCC
 Physical
quality/attractiveness
 Functionality
 Cleanliness
Measures
Key Informant Interview Survey
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Research staff will conduct
interviews with center directors
and administer online surveys to
all other staff members
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General program characteristics
Budget
Services provided
Staff and client characteristics
Program resources
Financing and referral sources
Center needs
Other organizational dynamics
Measures
Current and New Client Survey
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Completed online
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Include scales for:
 Motivation
 Psychological/psychosoc
ial functioning
 Social functioning
 Drug use history
 Current drug use
 Demographics
Measures
Substance Use, Mutual Help, Social Network, Psychiatric Symptoms
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Leeds Dependence Questionnaire (LDQ)
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Form 90
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Mutual help attendance and involvement
Social Support Questionnaire
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Past 90-day alcohol/drug use
Quality of life
Treatment
Psychotropic and anti-craving/relapse medication
Compliance with continuing care
Multi-dimensional Mutual-help Activity Scale
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Alcohol/drug dependence severity
Social networks (family & close friends)
Brief Symptom Inventory-18
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Psychiatric Symptoms
Measures
Quality of Life & Spirituality
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WHOQOL-BREF
 Past
30-day quality of
life scale developed
by the WHO
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Spirituality Index of
Well-Being
 Spiritual
well-being
and life meaning
Measures
Recovery Capital Scale
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Inventory of a variety of salutary
benefits that a participant might
accrue
Domains:
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Substance use and sobriety
Global psychological and
physical health
Citizenship and community
involvement
Social support
Meaningful activities
Housing and safety
Risk-taking
Coping
Research Team
John F. Kelly, Principal Investigator
Bettina Hoeppner, Co-Investigator
Robert L. Stout, Consultant
Leonard A. Jason, Consultant
Research Team
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John F. Kelly
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Bettina Hoeppner
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Health psychologist with expertise in statistical and longitudinal
modeling
Experience in evaluating community-based recovery services and
studying treatment
Robert Stout
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Established researcher in the areas of addiction treatment and
recovery, mutual-help participation, and peer support.
Co-editor of Addiction Recovery Management: Theory, Research and
Practice
Mathematical psychologist who has been the principal investigator on
several addiction studies and a senior investigator on multisite
national studies (e.g. Project MATCH)
Conducted studies with a focus on managed care and quantitative
modeling of long-term outcomes
Leonard Jason
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Internationally recognized expert on addiction recovery community
research
Prior research has focused on Oxford House Recovery Homes
Acknowledgements
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Colleagues
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Eden Evins
Bettina Hoeppner
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Brandon Bergman
Allison Labbe
Karen Urbanoski
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Staff
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Julie Cristello
Sarah Dow
Claire Greene
Veselina Hristova
Jessica Kim
Erin Newman
Jonathan Watson
Julie Yeterian
Sources of Funding
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Fellows
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Recovery Research Institute, Private
Donations
National Institute of Alcohol Abuse
and Alcoholism/R01AA01966401A1
National Institute of Alcohol Abuse
and Alcoholism/R01AA01966401A1S1
Canadian Institute of Health
Research/MOP 126095
National Institute of Alcohol Abuse
and Alcoholism/K24AA022136-01
Conflict of Interest
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None declared