While a significant body of research has shown that the length of time a person stays in a program is positively linked to abstinence, reduced crime, better employment prospects and improved quality of life, much of the work has focused on achieving and maintaining abstinence as the main measure of a program’s success.
And to date no qualitative research in Australia has moved beyond those indicators to understand what successful recovery means from the client’s point of view.
Therapeutic communities are drug-free residential rehabilitation programs where clients live together in a supportive environment over a period of months, with increasing levels of social and personal responsibility supported by counselling, personal change and skills training used to rehabilitate drug and alcohol users.
Low completion rates of residential drug and alcohol treatment programs are a major challenge in establishing effective and sustainable rehabilitation programs.
A study of former residents of the Buttery, a community-based residential rehabilitation program on the NSW north coast, found that successful drug and alcohol treatment takes a wider view to include their feelings of self-worth and their ability to contribute to society through employment, study or volunteering.
Tarran Prangley, a medical student from Graduate Medicine at the University of Wollongong, interviewed a number of ex-residents of the Buttery to understand the reasons people entered rehabilitation programs in the first place, which could shed light on why they might withdraw early.
“Former residents spoke about the need for a ‘circuit breaker’ in their life. They were struggling with childhood trauma and experienced ongoing poor mental health, or they were in trouble with the law.
The study, a collaboration through the University Centre for Rural Health, Lismore, between the University of Wollongong School of Medicine, Western Sydney University School of Medicine, and the Buttery, revealed the residents’ idea of success involved their sense of overall self-worth, from how the program helped improve relationships, their psychological and physical well-being, understanding of addiction and putting them on the track to gaining employment, studying and volunteering.
While many of the study participants withdrew from the program early, Ms Prangley said many of them were still experiencing positive outcomes, which indicated the program was successful, even if it wasn’t completed.
“Some of the reasons residents left early were not surprising. Nine months away from the world can be quite isolating from friends and family and for some people the programs themselves can be intense, but others left because they felt they’d learned enough about how to manage their addictions and could go back to their normal lives.
“And one or two people experience lapses, they said they were able to recognize the signs early and stop themselves relapsing completely.
Dr Sabrina Pit from Western Sydney University said the study’s results could indicate a shift in the way people view recovery, away from being defined solely by abstinence towards a more holistic view.
Trent Rees, Residential Programs Manager at the Buttery, said the research was a validation of the approach and reinforced the need to change how successful recovery is defined.
“One of the great things the study highlighted was that even when people leave early and they say they don’t understand why we took certain approaches or why they felt the program was hard for them, many of those in the research indicated they understand now, they get it, and that takes time.
“When people come to programs like ours they may have also tried other interventions.
With crime, road accidents, lost productivity and healthcare costs from substance abuse disorders costing the economy and healthcare system around $55 billion annually, Mr Rees said the cost of residential rehabilitation paled in comparison.
The research was published recently in the journal BMC Psychiatry.
The study was funded by a generous donation in memory of the Late John Shaw Warnock.