Addiction professionals across America are witnessing the field’s paradigmatic shift from a pathology and intervention focus to a recovery focus (White, 2004; 2005). Attention on the lived solution to alcohol and other drug (AOD) problems is reflected in the growing interest in defining recovery; conducting recovery prevalence surveys; illuminating the varieties of recovery experiences; and mapping the patterns, processes, and stages of long-term recovery (Betty Ford Institute Consensus Panel, 2007; White & Kurtz, 2006). 

One of the key ideas at the core of this shift is that of recovery capital (RC). This article defines RC and explores how attention to RC can be integrated into the service practices of front-line addiction professionals.  

Recovery capital defined

Recovery capital (RC) is the breadth and depth of internal and external resources that can be drawn upon to initiate and sustain recovery from severe AOD problems (Granfield & Cloud, 1999; Cloud & Granfield, 2004a). RC is conceptually linked to natural recovery, solution-focused therapy, strengths-based case management, recovery management, resilience and protective factors, and the ideas of hardiness, wellness and global health. There are three types of RC that can be influenced by addictions professionals. 

Personal RC can be divided into physical and human capital. A client’s physical RC includes: physical health; financial assets; health insurance; safe and recovery-conducive shelter; clothing; food; and access to transportation. Human RC includes a client’s values, knowledge, educational/vocational skills and credentials; problem solving capacities; self-awareness; self-esteem; self-efficacy (self-confidence in managing high risk situations); hopefulness/optimism; perception of one’s past/present/future; sense of meaning and purpose in life; and interpersonal skills. 

Family/social RC encompasses intimate relationships; family and kinship relationships (defined here non-
traditionally, i.e., family of choice); and social relationships that are supportive of recovery efforts. Family/social RC is indicated by the willingness of intimate partners and family members to participate in treatment; the presence of others in recovery within the family and social network; access to sober outlets for sobriety-based fellowship/leisure; and relational connections to conventional institutions (school, workplace, church and other mainstream community organizations). 
Community RC encompasses community attitudes/policies/resources related to addiction and recovery that promote the resolution of AOD problems. Community RC includes:

• active efforts to reduce addiction/recovery-related stigma
• visible and diverse local recovery role models
• a full continuum of addiction treatment resources
• recovery mutual aid resources that are accessible and diverse
• local recovery community support institutions (recovery centers / clubhouses, treatment alumni associations, recovery homes, recovery schools, recovery industries, recovery ministries/churches)
• sources of sustained recovery support and early re-intervention (e.g., recovery checkups through treatment programs, employee assistance programs, professional assistance programs, drug courts or recovery community organizations)

Cultural capital is a form of community capital. It constitutes the local availability of culturally-prescribed pathways of recovery that resonate with particular individuals and families. Examples of such potential resonance include: Native Americans recovering through the “Indianization of AA” or the “Red Road”; or African Americans recovering within a faith-based recovery ministry or within an Afrocentric therapeutic orientation (Coyhis & White, 2006; White & Sanders, in press).

In total, RC constitutes the potential antidote for the problems that have long plagued recovery efforts: insufficient motivation to change AOD use; emotional distress; pressure to use within
intimate and social relationships; interpersonal conflict; and other situations that pose risks for relapse. 

Early scientific findings

Modern addiction science has illuminated critical factors that contribute to the onset and complicate the course of substance use disorders, (e.g., a family history of AOD problems; childhood victimization; early age of unsupervised AOD use; multiple drug use; injection drug use; long delay from onset of AOD problems to first treatment; high emotional distress (co-occurring psychiatric illness); and enmeshment in an AOD-saturated social milieu (See White, in press/a for a review). The protective factors that can offset such risk factors or increase one’s odds of successful long-term addiction recovery have yet to be fully charted. The following key findings from recent scientific studies and reviews underscore the potential importance of RC.  

• RC, both its quantity and quality, plays a major role in determining the success or failure of natural and assisted recovery (e.g., recovery from AOD problems without or with participation in professional treatment or a recovery mutual aid society) (Granfield & Cloud, 1996, 1999; Moos & Moos, 2007; Kaskutas, Bond, & Humphreys, 2002).
• Increases in RC can spark turning points that end addiction careers; trigger recovery initiation; elevate coping abilities; and enhance quality of life in long-term recovery (Cloud & Granfield, 2004b; Laudet, Morgan, & White, 2006).
• Such turning points, both as climactic transformations and incremental change processes, may require the accumulation of RC across several years and multiple episodes of professional treatments (Dennis, Foss, & Scott, 2007).
• Elements of RC vary in importance within particular stages of long-term recovery (Laudet & White, in press).
• RC is not equally distributed across individuals and social groups.  Members of historically disempowered groups often seek recovery from addiction lacking assets that are taken for granted by those seeking recovery from a position of privilege (Cloud & Granfield, 2001).
• Post-treatment recovery check-ups, and, when needed, early re-
intervention can help preserve the RC developed through addiction treatment (Dennis, Scott, & Funk, 2003).
• Most clients with severely depleted family and community RC gain little from individually-focused addiction treatment that fails to mobilize family and community resources (Moos & Moos, 2007).
• Long-term recovery outcomes for those with the most severe AOD problems may have more to do with family and community RC than the attributes of individuals or a particular treatment protocol (Bromet & Moos, 1977; Humphreys, Moos, & Cohen, 1997; Mankowski, Humphreys, & Moos, 2001).

Science is confirming what front-line addiction professionals have long known:   “environmental factors can augment or nullify the short-term influence of an intervention” (Moos, 2003). This suggests that therapeutic processes in addiction treatment must encompass more than a strictly clinical intervention (Simpson, 2004). Strategies that target family and community RC can elevate long-term recovery outcomes as well as elevate the quality of life of individuals and families in long-term recovery (White, in press/b).

Recovery capital and clinical practice

Heightened attention to RC can significantly influence one’s service delivery practices. The following prescriptions reflect such attention.

1. Support screening and brief intervention (SBI) programs that reach people before their RC is depleted and substance use disorders have become severe, complex and chronic (Cloud & Granfield, 1994a). SBI programs are sometimes viewed as tools of case finding and induction for addiction treatment, but their greatest value is in helping people resolve AOD problems using personal, family and community resources before specialty-sector professional treatment is needed. To achieve such a goal, we must all become students of the processes through which AOD problems in the larger community are resolved. 
2. Engage people with low RC through aggressive programs of community outreach. “Hitting bottom” only has meaning when there is still personally meaningful RC to be lost. When RC is exhausted, people will die before such a mythical bottom is reached. The obstacle to recovery under such conditions is not insufficient pain, but the absence of hope, connectedness and potential for fulfillment. People with severely depleted RC have unfathomable capacities for physical and psychological pain. We must go get people with high problem severity and extremely low RC rather than wait for their pain or coercive institutions to bring them to us. The catalytic turning point for those with depleted RC is more likely to be one of seeing an achievable top than hitting bottom. 
3. Assess RC on an ongoing basis.
Traditional assessment technologies in addiction treatment are
distinctly pathology-focused. Addiction professionals have been trained to employ assessment instruments and interview protocols to generate a problems list that forms the basis of treatment planning activities. Growing evidence on the role of RC in AOD problem resolution calls for a more strengths-based approach to the assessment process. The fact that RC ebbs and flows through both addiction and recovery careers also calls for a continual assessment process that can identify subtle but crucial shifts in recovery assets. The AOD cessation capacity of each individual at a particular point in time might well be thought of as the interaction between problem severity and RC.  
4. Use RC levels to help determine level of care placement decisions. Traditional placement models link problem severity and intensity of care. Those with high problem severity and complexity are placed in the most restrictive levels of care; (e.g. inpatient and residential programs) and are provided the longest course of professional care. This formula misses the crucial influence on RC.

• A client with moderate problem severity but high RC arriving at a treatment agency in response to a positive drug test might be quite appropriate for screening and brief intervention. Such individuals often terminate addictions on their first attempt without professional or peer assistance and without embracing an addiction/recovery-based personal identity (Granfield & Cloud, 1996; Cloud & Granfield, 1994b). They can also often be helped through non-specialty helping institutions, culturally indigenous support institutions (e.g., cultural revitalization movements) or from peer-based recovery support groups without facing the cost, life disruption or stigma associated with addiction treatment (Cloud & Granfield, 1994a,b). This same individual with multiple risk factors (e.g., family history, early onset of use, etc.) might be appropriate for SBI followed by periodic recovery check-ups as a means of lowering the risks for future problem escalation.
• A client with high problem severity and complexity but exceptionally high RC might be appropriate for outpatient detoxification and outpatient treatment despite a level of problem severity that, viewed in isolation, would justify inpatient care. Assertive linkage to recovery mutual aid groups, in tandem with motivational interviewing and ongoing recovery check-ups, might well serve as an alternative to inpatient or residential treatment.
• A client with low problem severity but high risk factors and extremely low RC might be in greater need of residential treatment and step down care than the above profiled clients, even though he or she is likely to end up with SBI or outpatient treatment within current assessment and placement systems.
• A client with high problem severity/complexity and extremely low RC requires services of high intensity, broad scope (e.g., outreach, assertive case management and sustained recovery coaching) and long duration (Cloud & Granfield, 2001, 2004; White, in press,a). Providing such clients brief treatment isolated from their natural environment and then “graduating” them into that same environment without substantial community-based supports is a set-up for failure. Clients from historically disempowered communities are often punished (e.g., lost custody of children, incarceration) following such “failures” on the grounds that they “had their chance” (White & Sanders, in press). 

5. Target all three spheres of RC within professionally-directed treatment plans and client-directed recovery plans. The question is: What resources need to be mobilized within the individual, the family/social milieu, and the community to support the long-term recovery of each client? The Native American Wellbriety movement uses the metaphor of the “healing forest” to underscore the inextricable link between personal, family and community health. Treatment and recovery plans that reflect this understanding include interventions to elevate family and community RC, and assertively link clients and families to other individuals, families and community institutions rich in RC.  
6. Support recovery-linked cultural revitalization and community development move- ments. One of the ways addiction professionals can increase the RC of the individuals and families they serve is to actively support local movements aimed at increasing recovery support services, and creating a community milieu within which recovery can flourish. Such support could include serving on the board of a recovery community organization; volunteering at a recovery support center; encouraging those seeking to start a new recovery support group; participating in recovery education or recovery celebration events; and providing financial contributions to help promote and conduct such events. 
7. Use changes in levels of RC to evaluate your program and your own professional performance. The most effective addiction treatment programs help build community RC beyond their own service programs. This can be done by regularly assessing aggregate community RC; issuing a periodic report card on community recovery resources; and by allocating organizational resources to support recovery community development activities. If non-treatment community RC decreases in tandem with the growth of treatment services, the community is being inadvertently wounded by treatment expansion.

One of the best ways to assess the impact of treatment resources is to evaluate whether they generate long-term increases or decreases in community RC. 

At a personal level, we tend to evaluate our effectiveness based on what is subtracted from the lives of our clients (e.g., AOD use, criminal activity, threats to public safety, financial problems, high health care consumption and emotional distress); but the short-term elimination or reduction of these ingredients may or may not have any linkage to the prospects of long-term recovery. A better predictor of long-term recovery may be what has been added to the lives of the individuals and families with whom we work (e.g., radically altered perceptions of alcohol and other drugs; physical and emotional health; increased coping and communication skills; improved family relationships; new family rules and rituals; safe/stable housing and employment; clean and sober friends; membership in a community of recovering people; and life meaning and purpose). 

Summary

The concept of RC reflects a shift in focus from the pathology of addiction to a focus on the internal and external assets required to initiate and sustain long-term recovery from AOD problems. As this concept permeates the field, addiction treatment programs will increase their involvement with families and communities, and addiction professionals will become more involved in recovery community building activities. RC has a contagious quality. It is time we all became its carriers.

William L. White, M.A. ( This e-mail address is being protected from spambots. You need JavaScript enabled to view it ) is Senior Research Consultant at Chestnut Health Systems and author of Slaying the Dragon:  The History of Addiction Treatment and Recovery in America.

William Cloud, PhD is Professor at the Graduate School of Social Work, University of Denver.  Much of his teaching,
research, and writing has been in the areas of substance abuse cessation and substance abuse policy.

References

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