In December 2014 the Health Research Board published the first two issues in its drug and alcohol evidence review series. The reviews are on the topics of prevention1 and recovery capital.2 The series is part of the process of knowledge transfer and exchange between the HRB and those engaged in developing and implementing responses to problem drug and alcohol use in Ireland. The reviews are intended to support drug and alcohol taskforces, service providers and policy makers in using research-based knowledge in their decision-making, particularly in regard to assigned actions in the National Drugs Strategy.
Topics for review are selected following consultation with stakeholders to identify information gaps and to establish how the review will contribute to evidence-based selection and implementation of effective responses.
The authors of the first two reviews used a technique known as Rapid Evidence Assessment (REA) which is designed to get to grips with available research evidence on a policy or practice issue, as comprehensively as possible within a limited period. To determine if there was a solid evidence base in the two chosen areas, the researchers looked at (1) the quality of research studies that make up the body of evidence, identifying well-designed and executed studies that used reliable measures to assess if something worked; (2) the quantity of studies, as the strength of the evidence depends on the number of studies that have tested a particular approach; (3) the consistency of the findings produced by those studies, to see the number of studies which report the same or similar findings; and (4) the social context in which the research was done.
Some of the findings from the two reviews are presented here.
Efficacy and effectiveness of drug and alcohol abuse prevention programmes delivered outside of school settings
The researchers focused on studies published since 2008. Following their initial search they filtered the literature by quality and relevance. The review is based on 33 articles, 12 of which are original research studies and 21 are reviews.
The research evidence suggests that while community-based approaches to preventing drug and alcohol abuse by young people are promising, the evidence is not strong enough to say with certainty which specific programmes work best. Some good-quality evaluation studies have measured the impact of community-based drug and alcohol prevention programmes but there are not yet enough studies looking at the same kind of services in a way that would tell us what works best. Several studies are good, using appropriate research designs and reporting their results properly, but many failed to implement the research methods effectively, or did not adequately report data from their outcome measures.
Despite this we can say that the literature does support community-based prevention interventions that address the range of social and personal issues typically faced by young people who experience difficulties arising from substance abuse. There is potential in multi-dimensional or multi-model approaches. There are many published evaluations of standardised prevention programmes supported by clear instructions and manuals, many of which involve working with the families of young people. They typically include work to address family functioning, parental support, monitoring children’s behaviour and normative beliefs, social skills, and self-efficacy. Evidence for impact of family interventions such as Communities That Care (CTC), Strengthening Families Program (SFP) and Focus on Families (FOF) is promising.
Because they each look at different approaches to prevention, and tend to use different ways of measuring outcomes, it is impossible to pull results from good-quality studies together to get a clear picture of what works best. This inconsistency could be overcome if services would agree to use a common set of measures to assess impact. This would help to increase understanding of what works best and for which client groups, facilitate the sharing of good practice and, ultimately, build a solid body of evidence.
Developing shared outcome measurement would involve services working together to identify what is common in the reasoning behind choosing particular programmes and the similarities in their delivery. They could then also work to develop common data collection systems.
Role of social and human capital in recovery from drug and alcohol addiction
This review looked at recent evidence of how social capital can make a difference to people recovering from drug and alcohol addiction. The authors focused on studies published since 2008. Following their initial search they filtered the literature they found by quality and relevance. The review is based on 26 articles, 21 of which are original research studies, and 5 are reviews.
Research has consistently shown how important it is to understand the social lives of recovering addicts. A good social network seems to provide recovering addicts with a sense of their own self-worth, what psychologists call self-efficacy. The extent to which friends and families support abstinence, the ability to be financially independent, a safe and secure place to live and activities, which provide alternatives to substance abuse, all contribute to what researchers call ‘social capital’ or ‘recovery capital’. Having supportive friends or family helps to persuade recovering addicts that they can change their substance-abusing behaviour: friendships can provide a person in recovery with examples of success, knowledge that others care about what they are trying to achieve, and a sense that they are capable of planning their own lives. This kind of support is what may be provided through the social networking aspects of fellowships such as Alcoholics Anonymous (AA) and Narcotics Anonymous (NA).
One of the purposes of the research was to support task forces in identifying useful ways of measuring their work and the review found a number of examples of how the availability of social capital could be monitored. These include:
- The Perceived Sense of Community Scale (PSCS) looks at the extent to which recovering addicts feel a sense of belonging to social groups they consider to be part of their community;
- The Recovery Capital Scale (RCS) is a 35-item self-report questionnaire that can be administered as an interview;
- The Assessment of Recovery Capital (ARC) scale is a brief and easy-to-administer measurement of recovery capital, designed for use as an outcome measure for dependent individuals in and out of treatment; and
- Quality of Life (QoL) measures assess an individual’s satisfaction with life in general and provide a useful means of measuring personalised support.
There is good evidence that social capital contributes to recovery. The reviewers identified a number of areas in which further work needs to be done so that this process can be understood be better. We need to know more about how self-help groups provide a source of social capital; how the need for social support changes for people over the course of the recovery process; what types of social capital suit particular people and why needs in this area differ from person to person; and what are the financial costs and benefits of providing the kinds of support that will lead to recovery.
As in the prevention area, developing shared measurements for the impact services have on recovering drug users would both help to improve services and make achievements in this work more apparent. Service providers would need to identify shared ways of measuring social capital, consider how shared working with housing and other services could be improved and learn to collect information that will help contribute to cost-benefit analyses.
Hard-to-measure qualitative outcomes of community-based programmes, involving extensive collaboration between stakeholders, have been captured and these examples could be applied very usefully to evaluate programmes supporting recovery. It would be a significant achievement if different services were to use a common approach to measuring impact, as it would lead to better outcomes for the people using services and provide evidence that task forces play an integral and valuable part in responding to problem drug use in Ireland.
1 Munton T, Wedlock E and Gomersall A (2014) The role of social and human capital in recovery from drug and alcohol addiction. HRB Drug and Alcohol Evidence Review 1. Dublin: Health Research Board
2 Munton T, Wedlock E and Gomersall A (2014) The efficacy and effectiveness of drug and alcohol abuse prevention programmes delivered outside of school settings. HRB Drug and Alcohol Evidence Review 2. Dublin: Health Research Board
