What Are the Biggest Predictors of Success in Recovery?Anna Ciulla
A growing body of research has revealed that certain factors correlate with positive recovery outcomes. What are these biggest predictors of success in recovery? This article provides an overview based on recent findings from addiction science and firsthand knowledge of experts in the field. Together, they drive home the point that with the right treatments and interventions, recovery is indeed possible, regardless of the substance use disorder (SUD). That translates to concrete hope for the millions of people who suffer from untreated substance abuse in this country.
A “Full Continuum of Care in One Location”
Research shows that a “full continuum of care”—a defining characteristic of high-quality treatment—is one important predictor of success in recovery. A “full continuum of care” consists of detox followed by drug or alcohol treatment at various “levels of care”.
The American Society of Addiction Medicine (ASAM) has provided a detailed definition of these levels of care. More broadly, they consist of the following:
- Intensive inpatient services (involving 24/7 medical supervision in a residential setting that provides high-intensity interventions)
- Residential/Inpatient Services (clinically managed lower-intensity 24/7 residential services)
- Intensive Outpatient/Partial Hospitalization Services (typically 10 to 20 hours or more of services weekly that do not require overnight stays)
- Outpatient Services (low-intensity day services typically amounting to less than 10 hours per week, also known as “aftercare”)
Glenn Cohen, the founder and CEO of Beach House Center for Recovery, adds that a full continuum of care should ideally be delivered “in one location”— as opposed to “shipping clients off to detox one place and then shipping them to a Partial Hospitalization Program some place else, so clients are never getting residential care.” The second scenario (which, sadly, can be far too common) leaves clients more vulnerable to relapse. By contrast, continuity of care in one setting provides greater stability and accountability, so that clients are far less likely to slip through the cracks.
By way of example, Cohen shared the recent success story of a client who had been to five other treatment centers before coming to Beach House. “She never had the full continuum in one location with investment in the best therapists and medical care. She just blossomed and transformed in front of our eyes.”
Certain evidence-based treatments tend to predict better recovery outcomes as well. These include both pharmacological interventions, also known as “Medication-Assisted Treatment” (MAT), and behavioral therapies.
Evidence-based MATs now exist for alcohol, opiate and tobacco use disorders. These appear in a treatment guide from the National Institute on Drug Abuse. Key examples include naltrexone for alcohol and opiate use disorders and buprenorphine for opiate use disorder. For more information on naltrexone and buprenorphine, see the following articles in our Learning Center:
- “Naltrexone vs. Narcan: What Are They, and How Are They Used for Opiate Overdoses and Treatment?”
- “Why Medication-Assisted Treatment Is Important for Opiate Addicts in Early Treatment”
Similarly, research has revealed that certain behavioral therapies improve recovery outcomes for clients with SUDs. These include the following best practices in psychotherapy:
- Therapeutic Alliance
- Cognitive Behavioral Therapy (CBT)
- Eye Movement Densensitization Processing (EMDR)
- Motivational Interviewing (MI)
- 12-Step Group Therapy
A “Client-Directed, Outcome-Informed Approach” (CDOI)
In addition to a full continuum of care in one location and the application of evidence-based, medical and behavioral treatments, the CDOI approach has been found to predict positive treatment outcomes, according to recent research. A “client-directed” and “outcome-informed” approach is characterized by at least four key components, including evidence-based therapies for addiction (mentioned above):
- An emphasis on “therapeutic alliance” (the strength of rapport between a client and their primary therapist)
- Evidence-based measurement tools for tracking client outcomes
- Weekly clinical supervision of individual therapy sessions
- Regular third-party evaluation of treatment process and outcomes
To learn more about the CDOI approach as it relates to tracking and evaluating client outcomes, visit our “Treatment Outcomes.”
“Treatment retention” refers to how long a client remains in treatment. It, too, is a predictor of success in recovery. Research suggests that clients who prematurely leave treatment are more likely to relapse, whereas clients who remain in treatment for a longer duration do better at successfully staying sober. Consider just the following findings, for example— and there are many others:
- A Drug Abuse Treatment Outcome Study published in the journal, Psychology of Addictive Behaviors, found that clients in long-term residential programs fared “significantly better” than those with shorter stays.
- A 2013 study concluded that staying in residential treatment for a minimum of 90 days correlated with the most favorable recovery outcomes.
- In contrast, early dropout was “a major barrier for successful outcomes typically defined as reduction or cessation of substance use and improved psychosocial functioning and physical health,” according to a 2009 scientific review of how dropout affects client treatment outcomes.
Strong Motivation for Recovery
A client’s level of motivation is yet another very important predictor of long-term success in recovery, according to the research. The greater a client’s commitment to staying clean, the more likely their success at staying clean. Here, too, behavioral therapies like MI can be effective at helping clients identify key motivators in recovery, so that clients can enact positive lifestyle changes that support long-term sobriety.
A High Degree of Family and Social Support
Last but not least, a large body of literature shows that family and other social supports—12-step peer groups being one prime example of the latter—predict better recovery outcomes. Learn more about “How Family Therapy Boosts Long-Term Recovery.”
In summary, there are many predictors of success in recovery. These include:
- A full continuum of care in one location
- Evidence-based medication-assisted treatment and behavioral therapies
- A client-directed, outcome-informed approach
- Strong motivation for recovery
- And, a high degree of family and social support
There is no easy guarantee of a successful recovery, but when these components are in place, clients can maximize their prospects of finding lasting freedom from drugs and alcohol.