Understanding What Motivates Recovery Residents
There are many factors that research has shown are important to achieving and sustaining recovery. Among the most important factors is motivation to quit alcohol and other drugs.
Less is known, however, about the desire to maintain abstinence (also alternatively referred to as sobriety).
WHAT PROBLEM DOES THIS STUDY ADDRESS?
Motivation to make an initial change in drinking or drug use, and motivation to maintain this change are related, but different. For example, Kelly and Greene showed that, among young adults who attended residential substance use disorder treatment, commitment to abstinence – implying a stronger and high priority abstinence motivation – was independently and more strongly related to abstinence over time even than a gold standard measure of how ready someone was to quit alcohol and other drugs, called the Stages of Change Readiness and Treatment Eagerness Scale, or SOCRATES (see here).
In prior work, authors of this study Polcin and Korcha, found that among members of recovery residences– described below in more detail – the benefits someone believes he/she will get from being abstinent (e.g., ability to rebuild relationships) are related to positive recovery outcomes, but more weakly than the costs they feel abstinence will have for them (e.g., will be difficult to relax or have fun).
In this study, the authors conducted focus groups with the staff of recovery residences to explore motivation for abstinence in residents in order to offer directions for future research and to help potentially identify ways to enhance motivation for abstinence among individuals in, or seeking, recovery.
HOW WAS THIS STUDY CONDUCTED?
Authors conducted two focus groups with staff from recovery residences in California. Although they vary in their rules and policies as well as the services they provide, recovery residences are group homes where individuals are usually required to remain abstinent, encouraged to attend mutual-help meetings, and supported in their efforts to obtain employment or engage in school.
- The first focus group included the owner of a recovery residence organization in Northern California, an administrative staff person, and four of the house managers.
- The second focus group included an administrative staff person, and five house managers from a recovery residence organization in Southern California.
Although detail on focus group participants was somewhat limited, authors noted that a majority of participants were men who were in recovery themselves. In these particular recovery residences, the residences generally had a “zero-tolerance” policy around alcohol and other drug use. In other words, residents who drank or used drugs would be asked to leave, and linked with treatment, for example. They also required residents to attend 12-step mutual-help meetings.
On average, residents stayed in the recovery residences for about 5 months. Both focus groups were recorded and transcribed to text. See the box below for the content areas covered by the focus groups.
Following transcription, two members of the research team identified dominant themes from the text, resolved any discrepancies between their themes, and created a set of finalized themes from both focus groups.
Content areas covered by the focus groups:
- General factors that influence motivation for abstinence
- How peer and peer support influences motivation for abstinence
- How family/friend support influence motivation for abstinence
- How both costs and benefits of abstinence influence motivation for abstinence
- Interesting results from prior quantitative studies (e.g., perceived costs of abstinence was an especially strong predictor of abstinence for those high in psychiatric severity)
WHAT DID THIS STUDY FIND?
Participants felt that residents’ motivation was positively influenced by drug testing and the recovery residence zero-tolerance substance use policies.
In addition, they felt that various forms of external pressure (from the legal system or family, for example) served as motivators for abstinence among their residents.
One primary theme of note was the key role of families in residents’ motivation: first in making financial support dependent on entering the recovery residence as influencing initial motivation, and then, residents’ desire to repair and rebuild relationships as influencing abstinence motivation over time.
In addition, focus group participants described a general transition from being motivated for abstinence by consequences of using alcohol and other drugs (e.g., “deficit motivation”) to using the benefits of abstinence as a strategy to maintain or enhance motivation (e.g., being able to maintain a job).
Regarding social support, participants identified fellow residents (i.e., peers) as powerful tools in helping keep each other motivated for abstinence:
- by checking in with resident peers they felt may be struggling emotionally
- by being directive if they felt their resident peers were not fully engaging with recovery activities
Although support specifically from family and friends was part of the initial list of questions, responses pertaining to this question were either not reported in the findings or not discussed in focus groups.
Regarding reactions to authors’ previous quantitative studies, participants noted the potential benefits of smaller vs. larger social networks, and felt generally that recovery residences may be a poorer fit for individuals high in psychiatric severity such as those with psychotic disorders like schizophrenia. These individuals, they felt, may need a more flexible living situation, particularly with respect to their generally rigid policies around relapse.
Participants were unable to provide insights as to the added influence of perceived abstinence benefits for those who are less involved with mutual-help groups as the prompt led primarily to a discussion of the benefits of mutual-help involvement more generally among residents.
In treatment and recovery, motivation is a complex concept with many sides including perceived costs and benefits of abstinence as well as perceived costs and benefits of substance use. This understanding is consistent with a “decisional balance”, an exercise that allows individuals to consider the pros and cons of change and the pros and cons of not changing (see here).
WHY IS THIS STUDY IMPORTANT
In order to help maximize ways to enhance recovery (e.g., increasing abstinence motivation), it is critical to fully understand each of these concepts from the perspectives of individuals in recovery and those who help them day-to-day.
Focus groups like those conducted in this study, and the rich qualitative data they provide, may increase knowledge and lead to more effective ways of addressing low motivation for abstinence and recovery.
One unique addition of this study to scientific research is the potential importance of peer relationships in helping recovery residents maintain abstinence motivation to help sustain recovery. Other studies on 12-step mutual-help have shown that the benefits of attendance may be explained by enhanced ability to help increase the number of people in one’s social circle that are supportive of their recovery (see here).
It is possible that the positive influence of this recovery peer support on enhanced abstinence might be explained by its ability to help maintain motivation for abstinence as described by focus group participants (e.g., checking in if a fellow resident is not doing well). This possibility might be leveraged in treatment and recovery support settings.
- This study was conducted with recovery residence personnel, not residents. As the authors of the study note, however, the house managers that participated were almost all former residents.
- Also, virtually all participants were male and were affiliated with recovery residences that had “zero tolerance” policies around the use of alcohol and other drugs and required residents to attend 12-step mutual-help meetings. The study results may not generalize to recovery residences that do not follow that format.
Next steps potentially include testing the primary hypothesis that emerged from the focus groups: Does residing in a recovery residence promote increased likelihood of sustained abstinence by providing greater access to peer support which helps enhance abstinence motivation over time?
To test this question, researchers could compare abstinence rates of recovery residents randomized to receive either a) resident peer support group in addition to the standard recovery residence or b) standard recovery residence services alone, without the additional support group. Then, if residents randomized to engage with the additional peer support group had better abstinence rates, researchers could examine whether those enhanced outcomes were explained by increases in abstinence motivation over time (e.g., do peer support group members report increases in abstinence motivation compared to non-members, and does that increase in motivation predict enhanced likelihood of abstinence).
- For individuals & families seeking recovery: This study suggests peer support specifically for recovery may be one way to increase or maintain motivation for abstinence. This type of support might be available at 12-step mutual-help groups, like AA or NA, as well as non-12-step groups like SMART or Secular Organization for Sobriety (SOS).
- For scientists: This study used qualitative methodology to examine motivation for abstinence among residents of recovery residences. The findings were consistent with prior studies that operationalize motivation as a multifaceted construct. It also generated several hypotheses and mechanisms of behavior change that could be tested in longitudinal comparative research.
- For policy makers: Strongly consider funding research to better understand the role that recovery residences have in enhancing abstinence motivation via greater and more immediate access to peer support.
- For treatment professionals and treatment systems: This study adds to the body of prior studies on recovery residences that shows they help individuals stay abstinent and enhance the chances of remission over time, achieving this beneficial recovery effect by providing enhanced access to peer support which, in turn, can maintain and increase abstinence motivation over time.
Polcin, D. L., & Korcha, R. (2015). Motivation to maintain sobriety among residents of sober living recovery homes. Substance Abuse and Rehabilitation, 6, 103-111. doi:10.2147/SAR.S89361