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Recovery Training and Self-Help

Recovery Training and Self-Help (RTSH) is a group aftercare program for individuals recovering from opioid addiction. RTSH is based on the principle that opioid addiction, regardless of a person's original reasons for using substances, stems from conditioning due to the reinforcing effects of repeated opioid use. RTSH is designed to deactivate addiction by teaching and supporting alternative responses to stimuli previously associated with opioid use. Program goals include reducing the occurrence and frequency of relapse and readdiction and helping unemployed participants obtain employment. RTSH features 6 months of twice weekly meetings, regular weekend recreational activities, and a support network for clients. Each RTSH group is co-led by a professional therapist and a group leader in recovery. At one of the weekly meetings, the professional therapist delivers the Recovery Training (RT) curriculum, a preplanned series of didactic sessions that systematically addresses predictable threats to abstinence from illicit opiates. The second weekly meeting, a self-help session conducted by the group leader in recovery, is devoted to sharing experiences, discussing personal issues, addressing group business, and planning for weekend recreational and community service activities.

Descriptive Information

Areas of Interest Substance abuse treatment
Outcomes Review Date: April 2008
1: Relapse
2: Extent of relapse
3: Employment rates
4: Criminality
Outcome Categories Crime/delinquency
Drugs
Employment
Ages 18-25 (Young adult)
26-55 (Adult)
Genders Male
Female
Races/Ethnicities White
Race/ethnicity unspecified
Non-U.S. population
Settings Inpatient
Outpatient
Geographic Locations Urban
Suburban
Implementation History RTSH has been implemented in several locations in the United States as well as in Hong Kong and the Philippines. More than 600 clients have participated in RTSH groups since the program was first implemented in 1983.
NIH Funding/CER Studies Partially/fully funded by National Institutes of Health: Yes
Evaluated in comparative effectiveness research studies: No
Adaptations Adaptations of RTSH have been developed for a number of countries that required program adjustments to accommodate linguistic, cultural, and educational differences. RTSH has been implemented as part of an AIDS prevention study and also has been used with individuals recovering from cocaine addiction.
Adverse Effects No adverse effects, concerns, or unintended consequences were identified by the developer.
IOM Prevention Categories IOM prevention categories are not applicable.

Quality of Research
Review Date: April 2008

Documents Reviewed

The documents below were reviewed for Quality of Research. The research point of contact can provide information regarding the studies reviewed and the availability of additional materials, including those from more recent studies that may have been conducted.

Study 1

McAuliffe, W. E. (1990). A randomized controlled trial of recovery training and self-help for opioid addicts in New England and Hong Kong. Journal of Psychoactive Drugs, 22, 197-209.  Pub Med icon

Outcomes

Outcome 1: Relapse
Description of Measures Relapse was measured by asking participants to report the frequency of their opioid use since the last data collection point (i.e., over the past 6 months). Urine samples were obtained to corroborate self-reports concerning drug use during the prior 24 hours.
Key Findings At four study sites, three in the United States and one in Hong Kong, participants were randomly assigned to RTSH or a usual care control condition. Among the U.S. sample, significantly more intervention than control participants were abstinent or used opioids rarely (defined as less than once per month) at both the 6- and 12-month follow-ups (p < .05). Among the Hong Kong sample, intervention participants also were more likely to be abstinent or use opioids rarely compared with the control group at the 12-month follow-up (p < .05); the results for this sample at the 6-month follow-up were not statistically significant.
Studies Measuring Outcome Study 1
Study Designs Experimental
Quality of Research Rating 1.9 (0.0-4.0 scale)
Outcome 2: Extent of relapse
Description of Measures The extent of relapse and readdiction was measured by asking participants to report the frequency of their opioid use since the last data collection point (i.e., over the past 6 months). Readdiction encompassed intermittent periods of occasional use (once per month or less), temporary readdiction (10 or more days of continuous use), or readdiction for the entire period. Urine samples were obtained to corroborate self-reports concerning drug use during the prior 24 hours.
Key Findings At four study sites, three in the United States and one in Hong Kong, participants were randomly assigned to RTSH or a usual care control condition. Intervention participants in both the U.S. and Hong Kong samples had significantly lower rates of relapse and readdiction relative to the control group at the 6-month follow-up (p < .01 and p < .05, respectively). At the 12-month follow-up, results were significant among the Hong Kong sample (p < .05) but not the U.S. sample.
Studies Measuring Outcome Study 1
Study Designs Experimental
Quality of Research Rating 1.8 (0.0-4.0 scale)
Outcome 3: Employment rates
Description of Measures Information about participants' employment status was gathered during follow-up interviews.
Key Findings At four study sites, three in the United States and one in Hong Kong, participants were randomly assigned to RTSH or a usual care control condition. Intervention participants in the U.S. sample who were unemployed at program entry had significantly better employment outcomes than the control group at both the 6- and 12-month follow-ups (p < .025 at both time points). Similarly, intervention participants in Hong Kong who were unemployed at program entry had significantly better employment outcomes than the control group at the 12-month follow-up (p < .025); the results for this sample at the 6-month follow-up were not statistically significant.
Studies Measuring Outcome Study 1
Study Designs Experimental
Quality of Research Rating 1.8 (0.0-4.0 scale)
Outcome 4: Criminality
Description of Measures Participants were asked to rate their levels of criminality since the last data collection point (i.e., during the past 6 months) on a scale of 1 (very criminal) to 7 (very crime free).
Key Findings At four study sites, three in the United States and one in Hong Kong, participants were randomly assigned to RTSH or a usual care control condition. Among the Hong Kong sample and across both the U.S. and Hong Kong samples combined, intervention participants rated themselves as significantly more crime free than did the control group at both the 6- and 12-month follow-ups (p < .01 and p < .025, respectively). Among the U.S. sample, intervention participants improved on this outcome relative to the control group at the 6-month follow-up (not statistically significant) but had increased levels of criminality at the 12-month follow-up (p < .05).
Studies Measuring Outcome Study 1
Study Designs Experimental
Quality of Research Rating 1.7 (0.0-4.0 scale)

Study Populations

The following populations were identified in the studies reviewed for Quality of Research.

Study Age Gender Race/Ethnicity
Study 1 18-25 (Young adult)
26-55 (Adult) 		82.7% Male
17.3% Female 		48.2% White
47.6% Non-U.S. population
4.2% Race/ethnicity unspecified

Quality of Research Ratings by Criteria (0.0-4.0 scale)

External reviewers independently evaluate the Quality of Research for an intervention's reported results using six criteria:

For more information about these criteria and the meaning of the ratings, see Quality of Research.

Outcome Reliability
of Measures 		Validity
of Measures 		Fidelity Missing
Data/Attrition 		Confounding
Variables 		Data
Analysis 		Overall
Rating
1: Relapse 1.3 2.3 0.8 2.5 2.3 2.3 1.9
2: Extent of relapse 1.3 2.3 0.8 2.5 2.3 2.0 1.8
3: Employment rates 1.3 1.8 0.8 2.5 2.3 2.3 1.8
4: Criminality 1.3 1.8 0.8 2.5 2.0 2.0 1.7

Study Strengths

The study design was strong, follow-up rates were high, and careful attention was paid to attrition-related issues. The author made several efforts to analyze the data to examine specific behaviors of subgroups.

Study Weaknesses

Little information was provided about therapist training, supervision, or fidelity measurement procedures. The outcome measures had limited evidence of reliability and validity. Although interviewing is an acceptable method of data collection, the author did not describe the specific interview procedures used. Little meaningful data were provided regarding corroboration by urine samples, and only one specimen per client was collected and analyzed as verification for a 6-month period. The control condition was not explained.
Readiness for Dissemination
Review Date: April 2008

Materials Reviewed

The materials below were reviewed for Readiness for Dissemination. The implementation point of contact can provide information regarding implementation of the intervention and the availability of additional, updated, or new materials.

Examples of intervention implementation

McAuliffe, W. E. (2008). Recovery Training and Self-Help overview.

Zackon, F., McAuliffe, W. E., & Ch'ien, J. M. N. (1994). Recovery Training and Self-Help: Relapse prevention and aftercare for drug addicts (NIH Publication No. 94-3521). Rockville, MD: National Institute on Drug Abuse. Reprinted from 1993 edition (NIH Publication No. 93-3521).

Readiness for Dissemination Ratings by Criteria (0.0-4.0 scale)

External reviewers independently evaluate the intervention's Readiness for Dissemination using three criteria:

  1. Availability of implementation materials
  2. Availability of training and support resources
  3. Availability of quality assurance procedures

For more information about these criteria and the meaning of the ratings, see Readiness for Dissemination.

Implementation
Materials 		Training and Support
Resources 		Quality Assurance
Procedures 		Overall
Rating
2.3 1.8 1.5 1.8

Dissemination Strengths

The treatment manual provides information on organizational strategies for implementing the program, explains staff roles, and offers tips for effective group intervention. Multiple resources for intervention training are available to potential implementers. The Addiction Severity Index is recommended for assessing intervention outcomes in implementation settings.

Dissemination Weaknesses

While training is available through multiple locations, no centralized source of formal training is available to support consistent implementation of this intervention. Limited resources are available to support implementers following training. No quality assurance tools are available to support implementation fidelity.
Costs

The cost information below was provided by the developer. Although this cost information may have been updated by the developer since the time of review, it may not reflect the current costs or availability of items (including newly developed or discontinued items). The implementation point of contact can provide current information and discuss implementation requirements.

Item Description Cost Required by Developer
Manual (hard copy) $36.50 each Yes
2-day, on-site training for professional and recovering group leaders and clinical supervisors (includes electronic copies of opiate program manual and manual revised for cocaine) $1,000 for up to 30 participants, plus travel expenses Yes
Telephone clinical and implementation consultation $75 per hour No
On-site clinical consultation $500 per day plus travel expenses No
Research/evaluation consultation Varies depending on scope of project No
Client surveys and group observation surveys Free No

Additional Information

The cost of printing handouts and notebooks for clients is estimated at $20 per client. Annual expenses associated with recreational activities are estimated to be $520 per group section.
Replications

Selected citations are presented below. An asterisk indicates that the document was reviewed for Quality of Research.

McAuliffe, W. E. (1989). From theory to practice: The planned treatment of drug users. International Journal of the Addictions, 24, 527-608.

McAuliffe, W. E., Albert, J., Cordill-London, G., & McGarraghy, T. K. (1990-1991). Contributions to a social conditioning model of cocaine recovery. International Journal of the Addictions, 25, 1141-1177.  Pub Med icon
Contact Information

To learn more about implementation, contact:
Hilding Ohrstrom, Jr., M.Ed., LCPC, CCS
(208) 946-1686
hiloh_3@msn.com

William McAuliffe, Ph.D.
(617) 875-9020
william_mcauliffe@comcast.net

To learn more about research, contact:
William McAuliffe, Ph.D.
(617) 875-9020
william_mcauliffe@comcast.net

Consider these Questions to Ask (PDF, 54KB) as you explore the possible use of this intervention.