On the origins of recovery capital

Recovery capital respects the entire experience and presence of a person 

This is the first in a series of essays on the concept of recovery capital.

— The TLDR —

Despite popular depictions and tropes of people struggling with addiction, most people overcome alcohol and drug dependencies without the aid of formal treatment.

How is this possible?

How does someone suffering a “disease” get well without clinical care?

That was the question Robert Granfield and William Cloud explored and set out to answer in the late 90s. Their goal was not to discredit formal treatment. Instead, they wanted to broaden the understanding of the wider externalities that contribute to the experience of overcoming addiction without the aid of formal treatment. This understanding could focus social, political, and clinical solutions across the spectrum of addiction and dependency experiences.

Recovery capital was the term they coined to encapsulate the physical, social, and human resources that individuals draw upon to naturally recover.

Why is this important?

There is a very real and ever increasing demand for addiction, recovery, and mental health care. But the gap between the supply of care and demand is enormous.

Approx. 22 million Americans are likely diagnosable with addiction. Only 3.7 million engaged in treatment in 2020 across 14,000 providers. There is a massive bottleneck for services. The demand is creating burnout and providers are struggling to keep up with the full spectrum of need and risk levels.

If we truly understood what Cloud and Granfield were getting at, we could use recovery capital as a strategic opportunity that maximizes the potential for natural recovery for the low risk / low need segment of the population.

Recovery capital has evolved since “Coming Clean”

This series on recovery capital sets out to do three things: 1) Summarize the origin of recovery capital as a concept; 2) Highlight the work that has advanced the concept; and 3) List the assessments that have emerged to help measure recovery capital.

This guide will start with the origin of recovery capital. It is not an exhaustive writing. Think of it as a starter’s resource that connects the dots from 1999 to today. Future writing will get more specific and pull back the layers of recovery capital in concept and in practice.

Granfield and Cloud published “Coming Clean: Overcoming addiction without treatment” in 1999. Their objective was to lift “the veil of secrecy surrounding the fact that most people overcome their addictions without ever entering formal treatment or participating in 12-step groups.” (“Coming Clean”, p. xiii)

Most people affected by alcohol and drug addiction and/or dependency naturally recover. Despite Coming Clean being published in 1999, the research supporting that statement is well documented and has been replicated since.

Granfield and Cloud heard repeatedly in in-depth interviews about the various structural and personal resources individuals would directly (and indirectly) utilize to overcome their consuming and negative relationship with alcohol and/or drugs.

As hardened social scientists, this made sense. But nothing in the field had specifically explored the variety of resources, that when accessed, could “increase the likelihood of successful outcomes with or without treatment.” (“Coming Clean”, p. 163).

Of course, personal, familial, and community resources are never dispersed or available in equal amounts to all people. Thus, the need for some people to engage in clinical care or rely on social services.

At the time “Coming Clean” was written, the disease model of addiction was taking hold and the “contextuality of use and recovery [were] overlooked in favor of the use itself.” (“Coming Clean”, p. 179).

Isolating the emerging care model from the “social embeddedness” of addiction and recovery was what led Cloud and Granfield to define the concept of recovery capital. They recognized that individuals all have assets that can be drawn upon to facilitate recovery.

Granfield and Cloud were expressly making an argument for natural recovery. They conclude that by understanding recovery capital in an asset-like framework, it could be possible to engage and intervene earlier in a person’s addiction or dependency experience – thus, reducing personal, social, and economic costs.In the meantime,

Meeting a need at a critical time

Their argument also sought to focus the necessity of formal treatment for the right people at the right time. Twenty years after “Coming Clean”, we have an increased rates of substance use, dependency, and mental health issues. This is creating tension on a system that cannot handle more demand. In order to allow formal treatment to rise to the occasion and be successful, we must look to Granfield and Cloud’s original definition and positioning of recovery capital.

We must get strategic and not myopic in our application of recovery capital as a mechanism for change.

Granfield and Cloud were quite clear that recovery capital was not exclusive to traditional notions of “recovery” as assets for overcoming addiction and sustaining recovery.

However, notions of recovery capital as it emerges in the “recovery community” tend to over emphasize recovery relationships, peer support, recovery community organizations, and other recovery support services.

While important to some and to the fabric of community-based support, most people that overcome alcohol and/or drug dependency will never engage in recovery supports. They instead, will draw upon the broader social, personal, and cultural assets available to all people in the development of a person’s quality of life.

This is vital for us in the field to understand. By working in our community to improve the general social, personal, and cultural assets, we’ll impact the lives of everyone. We will undoubtedly prevent the onset of addiction for some, but also make it easier for others to recover and thrive.

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The next piece in this series will look at the work that followed Granfield and Cloud’s “Coming Clean”. Who are the leading researchers today, what are they learning, and how has it advanced or drifted from the original concept of recovery capital?

In the meantime, consider this supplement on the definition and origin of recovery capital.

Have you seen how the Recovery Capital Index data comes together? Check this out!