Recovery Capital: A Holistic Approach to Substance Abuse Care

What is recovery capital?

Recovery capital is a treatment model that describes the all the internal and external resources an individual has at their disposal to achieve (and maintain) recovery from a substance use disorder. It also measures circumstances that could hinder a person’s recovery.

When determining how to best treat a person’s addiction, professionals – in both sobriety-based programs and those focused on harm reduction – should consider recovery capital in conjunction with the level of severity of their substance use disorder.   

For example, a person with a severe substance use disorder but high recovery capital might be able to maintain recovery with fewer resources than a person with an equally-severe disorder but minimal recovery capital.

So, intake assessments should include a comprehensive assessment of the client’s recovery capital, so it can be used to determine the appropriate level of care.   

The 6 dimensions of recovery capital

There are 6 primary dimensions of recovery capital:

1. Personal
2. Family/social connections
3. Barriers
4. Unmet needs
5. Community
6. Culture

However, it’s important to note that the concept of recovery capital is fluid, because all the factors which go into determining it can change. For instance: A person may have low recovery capital early in their recovery journey, but their recovery capital might increase later on.

Likewise, a relapse or change in life circumstances can reduce a person’s recovery capital. 

1. Personal recovery capital

Personal recovery capital includes what is sometimes called the social determinants of health. These are basic human needs such as:

• Shelter
• Food
• Clothes
• Transportation
• Healthcare
• Financial means
• Access to opportunities for physical activity/exercise

A person’s strengths and abilities are additionally considered personal recovery capital. This includes their:

• Problem-solving abilities
• Communication skills
• Knowledge
• Level of education
• Social skills
• Sense of purpose
• Determination to achieve goals
• Resilience
• Confidence

Furthermore, the personal recovery capital dimension considers co-occurring psychiatric conditions and physical disabilities and their potential impact on recovery. 

2. Family and social recovery capital

Family and social recovery capital includes a person’s:

• Supportive family members
• Friends
• Spouse/partner
• Sober support network and access to sober social events and opportunities  

This dimension also considers whether client has meaningful relationships with and actively reaches out to their support system. As a person progresses in recovery, their recovery capital in this dimension might increase as they get involved in programs like AA, NA or SMART recovery and as relationships with family and friends improve.  

3. Community recovery capital

Community recovery capital pertains to a person’s ability to access in their community:

• Substance use treatment resources
• Mutual self-help support groups
• Sober/recovery housing
• Trained counselors and therapists, as well as early intervention and treatment programs
• Drug court programs and recovery organizations in the person’s community
• Educational and work training programs

Community recovery capital also looks at how any pervasive addiction stigma in the community might impact a person. 

4. Barriers to recovery

Barriers that significantly reduce someone’s recovery capital include:

• Unemployment
• Being unhoused
• Socializing or living with people in active addiction
• Being unable to access prescribed medication
• Being in an unsafe (i.e. abusive) relationship 

5. Unmet needs

Unmet needs include:

• Being an active user/drinker
• Lack of housing
• Lack of food
• Little or no access to transportation
• Few financial resources. 

6. Culture

A sixth dimension may also be considered: A person’s cultural beliefs and faith traditions that might support – or hinder – the person’s recovery. 

Measuring recovery capital

In order to optimize a client’s ability to maintain recovery, efforts need to be made to increase their level of recovery capital, along with addressing their substance use disorder.   

A number of screening tools have been developed to measure recovery capital, such as this 50-question screener.¹ Each question is worth one point; the higher the score, the higher the recovery capital.   

Another screening tool asks the user to rank their recovery capital in the dimensions of physical, human, family/social and community on a scale from 1 to 10, with 10 representing the highest recovery capital.²

A matrix can additionally be used to apply the concept of recovery capital.³  

The top left box is labeled high recovery capital and the top right-hand box is labeled high problem severity/complexity. The lower left-hand box is labeled low problem severity/complexity and the lower right-hand box is labeled low recovery capital.   

The client described by the top two boxes has high recovery capital and high problem severity/complexity, meaning a more severe substance use disorder. This client might not need as high a level of care or as many treatment resources as a client with similar severity and complexity, but lower recovery capital. On the other hand, a client with low problem severity and complexity and low recovery capital may need greater resources to maintain recovery.

What’s helpful about this model is that it takes the reality of a client’s situation into account. A person struggling with homelessness, for example, may have trouble being consistent with substance use treatment and self help support meeting, even if their substance use disorder is relatively mild.   

In contrast, a healthy and well-educated person with a supportive family, stable housing, steady employment, financial resources may be able to maintain recovery in a lower level of care and with fewer interventions and resources, even if their disorder is more severe. 

The concept of recovery capital also makes clear that substance use treatment programs are most successful when they involve themselves in the community and with the families of their clients. A program that’s plugged into resources for food, housing, medical care, mental health care, educational and training programs, recreation and arts programs, and spiritual and cultural program is better equipped to serve the needs of its clients than one that stays in its silo and only focuses on substance use.   

Likewise, including families in treatment is also important for improved outcomes. As well as connecting with peer-supported recovery programs.

Key Takeaways

Arguably, recovery capital is a fancy name for a holistic approach to care.   

This model is about treating the whole person and doing a comprehensive assessment to determine strengths and areas for growth. It is also about helping a client access resources to build recovery capital. Some other takeaways:

• An effective treatment program works to address unmet needs and barriers as well as working on issues related to drugs and alcohol.   
• Opportunities for clients to develop new interests and talents should also be offered. Think chess tournaments, volunteering, cooking lessons, yoga classes and art projects.
• All treatment programs and clinicians have an obligation to help reduce the stigma surrounding substance use disorders so that clients feel more comfortable accessing services.

Sources

1. Groshkova, T., Best, D., & White, W. (2013). The Assessment of Recovery Capital: Properties
   and psychometrics of a measure of addiction recovery strengths. Drug and Alcohol
   Review, 32, 187-194. ↩︎
2. https://ccar.us/wp-content/uploads/Recovery-Capital-Self-Assessment.pdf ↩︎
3. White, W. & Cloud, W. (2008). Recovery capital: A primer for addiction professionals. Counselor, 9(5), 22-27. ↩︎