Best and colleagues [12] have outlined the design and methods for the REC-PATH study, a multi-site longitudinal study of (gender) differences in recovery pathways in the UK, Netherlands and Belgium, with an exclusive focus on illicit drug recovery. The screening instrument that was used to recruit to this study was the Life in Recovery survey (LiR) with only slight adaptations for the study and a Dutch/Flemish translation [Martinelli et al, in press]. When this survey was launched online, a partnership was developed with the international Recovered Users Network (RUN) to translate the survey into a number of other European languages and to run the study in other countries. A version of the instrument adapted only to change the demographic characteristics was circulated through the Recovered Users Network (RUN), following a process of back-translation to ensure both consistency and that it was meaningful to potential participants. Distribution of the survey relied on support and participation of recovery organisations, therapeutic communities, communes and services providing various supports to people affected by drugs and those in recovery across Europe. The sample should be regarded as a network of these organisations. Member organisations of Recovered Users Network (RUN), the coordinators for their respected countries, have played the most significant role in coordinating data collection.
Procedure: The survey has been translated into the local languages of the countries involved, namely Bosnian/Croatian/Serbian/Montenegrin, Swedish, Polish, Portuguese and Spanish, and it ran for four months, from January 18 2018 until June 1 2018. The survey was available online on the REC-PATH project platform: https://www.rec-path.co.uk/, as well as in hard copies and it was promoted regionally via organisations, social media, websites, TV shows and other partner agencies. The survey used the online platform Qualtrics. Participants could choose which language they wanted to complete the form in. Online information and consent preceded initiation of the questionnaire. For participants to complete the form, each item of each section required an endorsement or they would not be able to pass onto the next question. Consequently, only completed questionnaires were available on the online platform. Hard copies of the survey were made available for those who did not have access to or were not comfortable completing the online version. The aim (as with other LiR surveys) was to start from known recovery groups and then snowball out to a more diverse group of potential participants. Online completion was encouraged as often as possible and only completed hard copies were entered into the database. Thus, no missing data had to be managed in the analysis.
Development of the Strengths And Barriers Recovery Scale (SABRS): The aim of the study was to ‘ translate’ as many of the items of the LiR measure into a new scale consisting of positive and negative experiences and events that could be characterised as positive and negative recovery capital.
From the original set of 44 items in the US LIR, two had been removed for the Australian and UK versions as they did not apply (‘did not have health insurance’ and ‘lost right to vote’). For the current scale, items were removed if they could only apply based on something else happening – thus, a professional licence can only be restored if you have had one in the first place. Similarly, the item ‘had your driving license restored’ rests on two prior conditions – first that the person has a driving license and second, that it has been revoked. Similarly, losing or having a professional registration restored is contingent on the person having a professional registration in the first place. This resulted in a total of 32 items included in the final scale (15 strength items and 17 barrier items) and 10 items excluded (as shown in Tables 1 and 2). All items had binary (yes/no) response options.
Table 1: Final set of included items in the Strengths And Barriers Recovery Scale (SABRS) (n=32)
Recovery strength items
|
Recovery Barrier items
|
- Exercise regularly
- Have a GP
- Have regular dental checks
- Have good nutrition
- Take care of your health
- Maintain a driving license
- Maintain a bank account
- Able to pay your bills
- Maintain stable housing
- Remain in steady employment
- Further your education or training
- Start your own business
- Participate in family life
- Plan for the future
- Volunteer
|
- Have untreated emotional or mental health problems
- Make regular visits to the emergency room
- Regular use of health services
- Smoke
- Have your drivers’ license revoked
- Drive under the influence of alcohol or drugs
- Damage property
- Been arrested
- Been charged with a criminal offence
- Been to prison
- Have bad debts
- Were unable to pay the bills
- Regularly missed school or work
- Dropped out of school or college
- Fired or suspended from work
- Lose custody of children
- Experience family violence
|
Table 2: Excluded items from the Life In Recovery Scale
- Get your driver’s license back
- Complete a term of conditional release or parole
- Have credit restored
- Owe back taxes
- Pay back taxes
- Pay your taxes on time
- Receive good job evaluations
- Lose your professional license
- Have your professional license restored
- Regain custody of your children
The next stage was to separate items into strength and barrier items. All five domains of the LiR – work, finances, legal status, family and social relationships, and citizenship – contained a combination of strength and barrier items and the total remaining items were classified as 15 recovery strength and 17 recovery barrier items. All of these individual items were endorsed if they applied and so were coded as 0 or 1. This meant that the strengths scale ranged from 0-15 and the barriers scale from 0-17. There were four totals then calculated:
- Recovery strengths in active addiction (0-15)
- Recovery barriers in active addiction (0-17)
- Recovery strengths in recovery (0-15)
- Recovery barriers in recovery (0-17)
Sample: Table 3 provides a breakdown of the sample (n=480) for each country of residence – this was recorded rather than nationality. Although the number is small from some of the participating countries, for ethical reasons we did not want to exclude any participant who had successfully completed the survey. The mean age of the sample was 37.6 years (SD = 9.3 years); 68.3% of the sample described themselves as male; 31.0% as female and 0.6% as of other gender alignments. In terms of education, 4.4% did not complete primary school, 17.1% achieved only primary school education, 52.2% achieved secondary education and 24.4% achieved a higher education qualification. In terms of relationships, 41.5% were single and never married, 41.7% were married or co-habiting, 12.7% were separated or divorced. 1.7% were widowed and 2.2% described their relationship status as ‘other’. Thirty-nine per cent of the sample reported that they had dependent children. Just over half of the participants (54.7%) were from the Balkan region.
Table 3: Country of residence of participants (n=480)
|
Frequency
|
Percent
|
Gender - % female
|
Age
(mean, SD)
|
Valid
|
Bosnia & Herzegovina
|
72
|
15.0
|
29.2%
|
35.4 (8.1)
|
Serbia
|
123
|
25.6
|
26.0%
|
36.6 (5.9)
|
Croatia
|
53
|
11.0
|
35.8%
|
39.7 (6.2)
|
Montenegro
|
15
|
3.1
|
6.7%
|
40.1 (5.9)
|
Poland
|
79
|
16.5
|
38.0%
|
29.0 (7.5)
|
Portugal
|
6
|
1.3
|
33.3%
|
40.3 (7.4)
|
Spain
|
60
|
12.5
|
18.3%
|
45.9 (8.5)
|
Sweden
|
44
|
9.2
|
61.4%
|
41.9 (12.9)
|
Other (Please specify)
|
28
|
5.8
|
21.4%
|
40.7 (7.9)
|
Total
|
480
|
100.0
|
100.0
|
|
Analysis: The primary aim of the paper is to examine differences in the newly developed measure of recovery strengths and barriers (SABRS) between active addiction and current experiences in recovery, but also to assess if this varies as a function of the stage of recovery that the respondent is in. Therefore, the initial analysis is a repeated measures t-test comparing strengths and deficits in active addiction and recovery. The second stage of the analysis compares recovery strengths and barriers (both in active addiction and recovery) by stage of the recovery journey (1).
The final analysis will attempt to predict the total number of recovery strengths in recovery to address research question 3. This involved undertaking a linear regression with backwards elimination using all key demographic measures (age, gender), addiction career factors (age of first and last use, and length of time in recovery) and both barriers and strengths while in active addiction and ongoing barriers while in recovery. As duration of recovery was used as a continuous variable, recovery stage was excluded. No bivariate correlation exceeded 0.7 and so collinearity was not a reason for item exclusion.