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Knowledge in practice: The feasibility of recovery capital in Swedish alcohol and other drug treatment
Stockholm University, Faculty of Social Sciences, Department of Social Work.ORCID iD: 0000-0002-4984-9879
2024 (English)Doctoral thesis, comprehensive summary (Other academic)
Abstract [en]

The recovery model, endorsed by various governmental bodies, emphasises the integration of a recovery perspective into alcohol and drug policy, with a focus on post-treatment interventions such as housing, employment and education needs. In an effort to enhance the utility of the recovery perspective in treatment, the concept of recovery capital (RC) has been used as a foundation for operationalisations used to measure treatment needs and progress. While other countries have embraced the recovery model and RC in alcohol and other drug (AOD)-related policy and treatment, the treatment setting in Sweden has not undergone a comparable transformation. This dissertation aims to explore the feasibility of implementing RC in Swedish AOD treatment. It examines the transferability and applicability of assessment tools and considers the challenges of translating research into practice. This involves delving into the complexities of knowledge transfers, production and use in order to bridge the gap between research findings and practical implementation. 

The feasibility study involved qualitative interviews with AOD treatment professionals to gather their perspectives on the applicability of an RC-based assessment tool (Papers II and III). Insights into feasibility were also obtained from a quantitative study assessing treatment progress in individuals residing in a recovery residence in Florida, USA, using an established RC-based assessment tool (Paper I). To further evaluate the target setting for the feasibility study, the use of a locally developed assessment tool was explored through a deviant case analysis (Paper IV). The dissertation’s theoretical framework is built upon conceptualisations of standardisations and professions that emphasise their interconnected nature and thereby underscore the significance of their relationship in the analysis of knowledge production and use, thus situating the study within a broader theoretical discourse on the interplay between standardisation and professionalism.

The findings confirm the applicability of the RC concept in Swedish AOD treatment by highlighting its unique benefits in exploring diverse recovery pathways to address individual challenges and strengths. However, it is evident that certain elements of its conceptual framework are already implemented in the treatment facilities visited in the study. Furthermore, whether or not to use standardised assessment tools to implement RC in Swedish AOD treatment remains unclear. The dissertation also emphasises the importance of collaborating with professionals during the development of assessment tools as a way of ensuring that these tools align with the cultures and structures of the social work profession, presenting this collaboration as an approach to bridging the gap between research and practice. It also identifies a significant knowledge gap in locally produced knowledge, urging further research to map its extent and evaluate its impact on current and future knowledge production and use in social work. Lastly, the absence of client participation is acknowledged. The need for future research to explore the client perspective is emphasised, given the potential adverse effects of recovery-oriented interventions on clients.

Place, publisher, year, edition, pages
Stockholm: Department of Social Work, Stockholm university , 2024. , p. 77
Series
Stockholm studies in social work, ISSN 0281-2851 ; 45
Keywords [en]
the recovery model, recovery capital, alcohol and other drug treatment, assessment tools, feasibility study, transferability, applicability, jurisdiction, social work practice
National Category
Social Work
Research subject
Social Work
Identifiers
URN: urn:nbn:se:su:diva-224565ISBN: 978-91-8014-631-9 (print)ISBN: 978-91-8014-632-6 (electronic)OAI: oai:DiVA.org:su-224565DiVA, id: diva2:1820559
Public defence
2024-02-16, Hörsal 5, Hus 2, Campus Albano, Albanovägen 18, Stockholm, 10:00 (Swedish)
Opponent
Supervisors
Available from: 2024-01-24 Created: 2023-12-18 Last updated: 2024-01-16Bibliographically approved
List of papers
1. The growth of recovery capital in clients of recovery residences in Florida, USA: a quantitative pilot study of changes in REC-CAP profile scores
Open this publication in new window or tab >>The growth of recovery capital in clients of recovery residences in Florida, USA: a quantitative pilot study of changes in REC-CAP profile scores
Show others...
2022 (English)In: Substance Abuse Treatment, Prevention, and Policy, E-ISSN 1747-597X, Vol. 17, no 1, article id 58Article in journal (Refereed) Published
Abstract [en]

Background: There is a growing evidence base around predictors of retention and completion in a range of recovery residence models, particularly Oxford Houses and Sober Living Houses, and recovery housing is recognized as a clearly evidenced area of recovery intervention. The aim of the study was to quantitatively assess recovery capital in a sample of recovery residence clients.

Method: The study used a repeated measures self-completion of a standardized recovery capital instrument (REC-CAP) for clients retained across various houses within one Level 2 recovery residence provider whose program was based on a 12-step approach. While 823 clients participated in the baseline assessment, a sample of 267 clients was achieved for six-month follow-up interview, based on those retained in the residence. A logistic regression model examined factors associated with retention and a repeated measures marginal mixed model evaluated the factors associated with changes in recovery capital between the baseline and the follow-up assessment.

Results: Members of the group that remained in recovery residences were more likely to be older with a record of high participation in recovery groups, with greater drop-out among younger residents, female residents and those with an identified housing need. For those retained to follow-up, greater recovery capital growth was associated with employment, higher levels of social support and more recovery group involvement, as well as age and a higher quality of life. The need for family support was shown to reduce levels of recovery capital. However, those younger people who were retained reported better recovery capital growth during the initial six months of residence.

Conclusion: The key conclusion is that while recovery capital generally increases during a stay in a recovery residence, it does not do so consistently across the sample population. This has implications for how pathways to recovery group engagement are supported for women and young people and how social support (encompassing housing, employment and family issues) is provided to those populations during periods of residence. This suggests the potential need for training and guidance for house managers working with these groups.

Keywords
REC-CAP, Recovery residence, Recovery capital, Retention
National Category
Sociology
Identifiers
urn:nbn:se:su:diva-208271 (URN)10.1186/s13011-022-00488-w (DOI)000836780600001 ()35933398 (PubMedID)2-s2.0-85135460308 (Scopus ID)
Available from: 2022-08-30 Created: 2022-08-30 Last updated: 2024-01-17Bibliographically approved
2. Balancing standards and flexibility – Preconditions for a recovery-based tool in a Swedish alcohol and drug treatment context
Open this publication in new window or tab >>Balancing standards and flexibility – Preconditions for a recovery-based tool in a Swedish alcohol and drug treatment context
2022 (English)In: Nordic Social Work Research, ISSN 2156-857X, E-ISSN 2156-8588, Vol. 12, no 4, p. 564-577Article in journal (Refereed) Published
Abstract [en]

This article presents the outcome of the first phase in the development of a recovery capital-based assessment tool in a Swedish alcohol and drug treatment context. In the process of studying the potential usefulness of such a tool, other aspects besides psychometric properties and validity have been examined. The experience and knowledge of professionals in the Swedish alcohol and drug treatment context represent the empirical data. Five group interviews have been conducted with staff from different alcohol and drug treatment facilities in Sweden. The respondents were asked to discuss an outlined idea of a recovery capital-based assessment tool. The transcribed interviews were thematically analysed and divided into three themes: the impact and need for assessment and evaluation, the need for flexibility and simplicity, and the role of the professional. The findings indicate that there is a demand for a strength-based tool in the Swedish alcohol and drug treatment context. There was a divergence between the professionalism of the social work practitioners and the use of assessment tools. To meet this divergence, the professionals emphasized aspects such as simplicity and flexibility. The findings indicate that the conditions are favourable for the implementation of a recovery capital tool in a Swedish alcohol and drug treatment context, but certain questions remain unanswered. This requires further cooperation with professionals, and in particular provides them with the possibility to reflect on its usefulness and applicability, while applying it to their daily work and procedures. 

Keywords
AOD treatment, recovery capital, standardization, social work practitioners, assessment tool
National Category
Social Work
Identifiers
urn:nbn:se:su:diva-205083 (URN)10.1080/2156857x.2020.1823873 (DOI)2-s2.0-85141095398 (Scopus ID)
Available from: 2022-05-30 Created: 2022-05-30 Last updated: 2023-12-18Bibliographically approved
3. A qualitative study of a recovery capital assessment tool in alcohol and drug treatment facilities: Perspectives from social work professionals
Open this publication in new window or tab >>A qualitative study of a recovery capital assessment tool in alcohol and drug treatment facilities: Perspectives from social work professionals
2023 (English)In: Nordic Studies on Alcohol and Drugs, ISSN 1455-0725, E-ISSN 1458-6126Article in journal (Refereed) Epub ahead of print
Abstract [en]

The ambition to translate the concept of recovery capital (RC) from research to practice has entailed operationalisations of RC to measure progress and outcomes of alcohol and other drug (AOD) treatments.At the same time, the role played by standardisation in social work organisations is known to be a complex matter, and research suggests that the implementation of standardisation should be carried out with caution. By examining the need for a RC assessment tool in a Swedish AOD treatment context, this paper contributes to the discussion on the use of assessment tools for measuring treatment progress and outcome in AOD treatments, as well as interrelations between standardisation aims and social work professionals. Four group interviews with employees at AOD treatment facilities were conducted in Stockholm, Sweden. The interviewees were presented with an example of an RC-based assessment tool and asked to review the applicability of the tool in their daily work. The findings provide insights on the applicability of specific assessment list items, as well as general observations on the complex relationship between standardisation and discretion in social work. The findings suggest that professionals will ultimately rely on their knowledge and experience, and act accordingly to support the service user, regardless of any manual or standardisation that regulates their work. 

Keywords
alcohol- and drug-related treatment, assessment tool, social work professionals, standardisation in social work
National Category
Social Work
Identifiers
urn:nbn:se:su:diva-220976 (URN)10.1177/14550725231175354 (DOI)001044119100001 ()2-s2.0-85167344062 (Scopus ID)
Available from: 2023-09-13 Created: 2023-09-13 Last updated: 2023-12-18
4. Methodological lucidity or relevance?: A deviant case analysis of a locally developed assessment tool used in a psychiatric and addiction clinic in Stockholm, Sweden
Open this publication in new window or tab >>Methodological lucidity or relevance?: A deviant case analysis of a locally developed assessment tool used in a psychiatric and addiction clinic in Stockholm, Sweden
(English)Manuscript (preprint) (Other academic)
Abstract [en]

This paper analyses the use of a locally developed assessment tool designed to generate aggregated data to evaluate the work of a psychiatric and addiction clinic. The use of tools, methods and interventions in the Swedish social services is usually based on recommendations in national guidelines established by the National Board of Health and Welfare (NBHW). Thus, a locally produced and systematically used assessment tool provides an interesting deviant case for discussing knowledge production and use from the perspective of evidence-based practice. The assessment tool was characterised by the specific psychiatric and addiction clinic context, where local needs and prerequisites were prioritised over the recommendations found in NBHW guidelines. The empirics comprise interviews with 12 professionals who used the tool, where experience of using the tool was analysed using a thematic analysis. The findings can be summarised in three main conclusions. First, tinkering of tools and methods is not necessarily associated with limited practice applicability or relevance. Second, professionals are more likely to appreciate a tool if that tool is designed with a treatment and conversation rationality in mind. Third, rather than perceived as more valid than other types of knowledge, NBHW-recommended tools are associated with a certain shape or style – but a shape or style that is permeated by legitimacy. 

Keywords
locally produced knowledge, social work, evidence-based practice, assessment tools, social work professionals
National Category
Social Work
Research subject
Social Work
Identifiers
urn:nbn:se:su:diva-224566 (URN)
Available from: 2023-12-18 Created: 2023-12-18 Last updated: 2023-12-18

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