I had always assumed that well before now someone would have compiled and consolidated some of the later-arriving recovery-oriented academic research findings into a framework suitable for clinical implementation. If such work has been completed, I have not seen it. Now, having waited longer than I had hoped, I ventured out on my own to help distill and consolidate such work in writing. This document is my writing in that direction.
As you proceed through this document, you will find it describes a 5-year model of care, identifies common assumptions that underlie our field and provides revisions of them, and outlines critical time frames within the five-year model. Those initial areas of content are probably more conventional and expected. But the document also outlines newer methods. These include 3rd wave CBT/ACT, structural models for long-term services, and material from outside our field related to the management of chronic illness and later-stage long-term group therapy methods we can apply to the formation of enduring recovery. The portion of the monograph addressing these newer methods is somewhat more instructive by nature, given those sections address areas of the field that are largely absent or significantly under-developed.
After the references and suggested readings, you will find an Appendix with two sections of content. First you encounter some supplementary information pertaining to the delivery of a kind of group therapy specifically included for later-stage patients. Lastly you will find summary tables that consolidate the material found in this document. My idea for the summary tables is that these could be adapted or adopted for staff education, training, clinical team meetings, or clinical supervision to help us clarify our targets and methods with an eye toward fidelity and sustainability. I also have the idea they could be adapted or adopted for clinical direct service with patients and their family members to help inform, educate, inspire, empower, encourage, and support change more effectively in our mutual collaboration with them as a team.
The basics of this monograph are simple. Clinical service delivery for this sub-population should sit in a 5-year container. The first 2 years is largely disease management and years 3-5 are largely recovery management. Within the 5-year journey the patient develops efficacy in managing their disease, recovery, and wellbeing. There are four necessary ingredients of service provision: group counseling, individual counseling, coaching, and check-ups. These four services happen across all five years, but they are individualized in frequency, duration, and content across the 5 years. And during that time, the clinician’s attention to normed content is preserved as a constant, and the patient’s responses over time are rolled back in for individualization of care.
My disclaimer is as follows:
- This document is neither comprehensive nor exhaustive. To make it so would be beyond my personal scope to complete.
- This document is out of date by its nature even before it is completed; as research findings continue to become available, they can inform and improve our understanding and our methods.
- This document should not replace continuing education, clinical training, instruction, or clinical supervision.
- My use of the word “recovery” in this document is in its most simple sense, synonymous with “getting better”. Its meaning is not linked to any particular mutual aid fellowship, academic, or government body’s definition of recovery. At times my choice of that word reflects its use by an author whose work is being incorporated in the document.
- When I come across a more competent synthesis of research related to clinical care promoting long-term disease management and recovery management for persons with high severity, complexity, and chronicity SUD’s, I’ll gladly abandon use of this document.
- The basic frameworks and targets in this document are approximations; continuous evaluation of this model and inputs from outside research reports should be recursive to this model and refine it over time. This is a starting point, not a final document.
Thanks and acknowledgments:
I would like to thank the following people for their encouragement and comments on earlier versions of this document: Chris Budnick, Jimmy Cioe, Jennifer Grimes, and Jocelyn King-Delay.
And I offer a special note of thanks to Dr. Bob Lynn, Joe Najdzion, and William White for their suggestions while this document was being developed.
Lastly, I would like to thank Bill White for posting the monograph in the RM/ROSC Library portion of the William White archive on the Chestnut website. Click that link, and if you scroll down a bit you’ll find it. And I also thank Bill for giving me permission to cross-post the monograph and archive link here.
10/20/2025 update. Back on 05/17/2025 I posted a very brief summary of the 5 year model monograph. That included a one-pager summary.
That one-pager is below in a PDF format. Today I made a few changes in both the summary and the one-pager to improve their clarity.
Recovery Review 