Initial Development and Psychometric Properties of a New Measure of Substance Use Disorder “Recovery Progression”: The Recovery Progression Measure (RPM)

There is a growing literature around substance use disorder treatment outcomes measures. Various constructs have been suggested as being appropriate for measuring recovery outcomes, including “recovery capital” and “treatment progression.” However, these previously proposed constructs do not measure changes in psychosocial functioning during the recovery process. Therefore, a new psychometric assessment, the “Recovery Progression Measure” (RPM), has been developed to measure this recovery oriented psychosocial change. Aims: The aims of this study were to evaluate the reliability and factor structure of the RPM via data collected from 2218 service users being treated for their substance dependence. Method: Data were collected from service users accessing the Breaking Free Online (BFO) substance use disorder treatment and recovery program, which has within its baseline assessment a 36-item psychometric measure previously developed by the authors to assess the six areas of functioning described in the RPM. Reliability analyses and exploratory factor analyses (EFA) were conducted to examine the underlying factor structure of the RPM measure. Results: Internal reliability of the RPM measure was found to be excellent (α > .70) with the overall assessment to have reliability α = .89, with item-total correlations revealing moderate–excellent reliability of individual items. EFA revealed the RPM to contain an underlying factor structure of eight components. Discussion: This study provides initial data to support the reliability of the RPM as a recovery measure. Further work is now underway to extend these findings, including convergent and predictive validity analyses.     

Severity of heroin dependence in Taiwan: reliability and validity of the Chinese version of the Severity of Dependence Scale (SDS[Ch])

The development of instruments to assess substance use that are easy to use, valid and reliable across cultures is an important task. The present study investigates the reliability and validity of the Chinese language version of the SDS (SDS^[Ch]) when used to measure severity of dependence among heroin users in Taiwan (n = 522). Data were collected on demographic data, heroin use behaviours, and criminal convictions. Taiwanese heroin users recorded high SDS^[Ch] scores and the results support the validity and reliability of the Chinese version of the SDS. A positive correlation was found between SDS^[Ch] scores and DSM-IV criteria for heroin dependence. SDS^[Ch] scores were positively related to heroin injection, frequency of heroin injection, spending on heroin, earlier age of onset of heroin use and more drug-related criminal convictions. The findings support the suggestion that the concept of dependence as assessed by the SDS has cross-cultural validity.     

Biased labels: An experimental study of language and stigma among individuals in recovery and health professionals

Background: Labels such as “addict” and “substance abuser” have been found to elicit implicit and explicit stigma among the general public previously. The difference in the levels of this bias among individuals in recovery and those employed in the health profession has not yet been identified, however. The current study seeks to answer this question using measures of implicit bias. Methods: A subset sample (n?=?299) from a previously completed study (n?=?1288) was selected for analysis. Mixed-model ANOVA tests were completed to identify variance between d-prime automatic association scores with the terms “addict” and “substance abuser” among individuals in recovery and those identified as working in the health professions. Results: Individuals in recovery did not have lower negative associations with either term, whereas individuals employed as health professionals had greater negative associations with the term “substance abuser” but did not have greater negative associations with the term “addict.” Conclusions: Results provide further evidence that previously identified stigmatizing labels have the potential to influence medical care and medical practitioner perceptions of individuals with substance use disorders and should be avoided. Further exploration into the role negative associations derived from commonly used labels have in the individual recovery process is needed to draw appropriate recommendations.     

Findings from mixed-methods feasibility and effectiveness evaluations of the “Breaking Free Online” treatment and recovery programme for substance misuse in prisons

Reshaping substance misuse treatment in prisons is central to the UK Government’s drive to address substance dependence in the prison population and reduce substance-related offending and recidivism. Therefore, a through-care project to support prisoners released from custody to community, “Gateways”, is taking place across North-West England. Amongst support with housing, education, training and employment, Gateways incorporates the Breaking Free Online (BFO) substance misuse treatment programme. Aims: To explore BFO’s potential to provide support to prisoners’ substance misuse recovery and continuity of care post-release, and examine quantitative outcomes provided by prisoners who have used the programme. Methods: Qualitative interviews with prisoners and analyses of quantitative psychometric data collected pre- and post-intervention. Findings: Themes emerging from qualitative data around prisoners’ experiences of engaging with BFO illustrate its potential for use in prison settings and also upon release to the community. Significant quantitative improvements to quality of life, severity of substance dependence and aspects of recovery progression illustrate initial effectiveness of BFO. Conclusions: The BFO programme demonstrates potential in providing effective treatment for offenders with substance misuse difficulties, and specifically in delivering continuity of care following release to the community.     

Construct Validity for Alcohol Dependence as Indicated by the SUDDS-IV

Objective.?This study considers the diagnostic construct validity of the DSM-IV (Diagnostic and Statistical Manual-IV) for “alcohol dependence”. Previous reports have indicated that “dependence” constitutes a more distinct and pronounced syndrome than “alcohol abuse”. Method.?Data were collected in 2000–2001 on 1340 male and female inmates evaluated for “substance use disorders” using the SUDDS-IV, a detailed structured diagnostic interview, to collect data on all of the DSM-IV diagnostic criteria for “abuse” and “dependence”. Results.?Dependent individuals tended to produce distinct and extensive symptom profiles that distinguished them from individuals without a diagnosis or those meeting abuse criteria. Conclusions.?Alcohol dependence as defined by the DSM-IV appears to be quite distinct from abuse and can be identified unequivocally for the majority of dependent cases.     

Identifying “Hitting Bottom” Among Individuals with Alcohol Problems: Development and Evaluation of the Noteworthy Aspects of Drinking Important to Recovery (NADIR)

Background: Alcohol use disorder (AUD) is a costly public health concern; yet, many individuals with AUD never receive formal treatment. Prior studies have identified that “hitting bottom” may be an important factor in seeking treatment for AUD) and the notion that “hitting bottom” is necessary for recovery is commonly portrayed in the popular media. Yet, “hitting bottom” has never been formally operationalized. Objectives: The present article aimed to operationalize “hitting bottom.” Methods: A multiphase process was used to develop a measure of hitting bottom among individuals experiencing alcohol problems: The Noteworthy Aspects of Drinking Important to Recovery (NADIR). Psychometric evaluation of the measure was conducted using online data collected from individuals who identified as moderate to heavy drinkers (N = 597). Results: The NADIR included five lower-order dimensions and one higher-order dimension (“hitting bottom”), had strong concurrent validity with measures of alcohol use severity and alcohol-related problems, and was found to have excellent internal consistency reliability (α > 0.90). An overall summary score on the NADIR of 50+ (factor scores>0) differentiated individuals who had previously sought treatment for AUD and reported more excessive alcohol use compared to those with no treatment history and lower levels of alcohol use. Thus, the NADIR with a cutoff of 50 may be a good starting point for future researchers to test as a method to identify individuals who have hit bottom. Conclusions/Importance: The NADIR provides a viable operational definition of hitting bottom. Future research should evaluate the predictive validity of the NADIR.     

Psychometric properties of the Recovery Assessment Scale in a sample with substance use disorder

Background: Conceptualisations of recovery from substance use disorder (SUD) and mental illness overlap significantly, and the rate of comorbidity of these problems is high. This study investigated the psychometric properties of the Recovery Assessment Scale (RAS), a measure originally developed for individuals with mental illness. Method: A sample of 1094 people with SUD attending residential treatment services provided by the Australian Salvation Army completed the RAS and other outcome measures at admission. Results: Confirmatory factor analysis (CFA) indicated a poor fit of the data to the five factor solution previously identified in mental illness samples. Exploratory factor analysis, however, produced three of the five factors included in the CFA, and two factors which arranged constructs in a slightly different manner from previous factor analytic studies in samples with mental illness. Correlations of these factors with other symptom distress and recovery measures indicated satisfactory convergent and divergent validity. Conclusions: The study provides modest support for the use of the RAS in groups with SUD.     

A brief Addiction Recovery Questionnaire derived from the views of service users and concerned others

Aims: (i) To quantify support across five stakeholder groups for 20 recovery indicators previously generated from focus groups of service users and concerned others and (ii) To create a brief recovery questionnaire. Methods: Indicators were rated by stakeholders for their overall importance and the three most important ranked. The factor structure was determined by principal component analysis. Findings: The initial 20 recovery indicators covered the spectrum of substance misuse, social and psychological domains. Positive endorsement of each indicator by stakeholder group ranged from 53% to 74% of the maximum support possible with stronger support from service users and concerned others than from practitioners and commissioners. The greatest number of individuals in each stakeholder group, from 86% of combined problem drinkers and drug takers to 36% of specialist practitioners, rated abstinence as the single most important aspect of recovery and well-being was rated second most important. The indicators were refined to create a 12-item Addiction Recovery Questionnaire – the items have good independent evidence of importance to outcome to support their inclusion. Originality: The questionnaire is derived solely from the views of service users and concerned others – it is a brief tool with high face validity and suitable for routine use.     

The Therapeutic Implications of Poetry Writing: A Methodology

Abstract

Within the field of addiction, the majority of work regarding “stages and processes of change” has focused on single drug problems, such as cigarette smoking or alcohol use. However, the majority of the substance abuse treatment population present with more than one substance use disorder. This article reports the results of the internal consistency and test-retest reliability of the University of Rhode Island Change Assessment (URICA) in a sample of 41 methadone-maintained, opioid-dependentmale veterans who had concurrent problems of cigarette and cocaine dependence. These volunteers were given a URICA for each of their three drug problems, followed by a repeated administration three to fivedays later. All the stage-of-change scale scores showed excellent internal consistency and stability across the three- to five-day interval for all three drug problems, thus confirming the reliability of the measure in this population. URICA scores were lowest on the precontemplation stage, with higher and approximately equivalent scores on the other three stage measures. Most surprising was that these profile scores were almost identical across the three drugs tested, suggesting limits to the validity of this measure with this population.     

Exploring the Factor Structure of a Recovery Assessment Measure among Substance-Abusing Youth

Abstract

To date, the measurement of recovery in the field of substance abuse is limited. Youth recovery from substance abuse is an important area to consider, given the complexities of such issues. The Recovery Assessment Scale (RAS) has been validated with mental health patient populations; however, its measurement characteristics have not been examined for individuals in substance abuse treatment. The current study explored the factor structure of the RAS with a sample of 80 substance-abusing youth who participated in a pilot aftercare study (M_age 20.5, SD = 3.5; 71.3% male). Reliability analysis showed an internal consistency of α = .90 for the entire RAS measure among the youth sample. Results of exploratory factor analysis identified the following four factors: personal determination, skills for recovery, self-control in recovery, and social support/moving beyond recovery among the substance-abusing youth sample. The RAS also demonstrated sound convergent and divergent validity in comparison to other validated measures of functioning, sobriety, and well-being. Collectively, results support that the RAS has adequate psychometric properties for measuring recovery among substance-abusing youth.     

Reliability and construct validity of 3 psychometric trust scales for women seeking substance abuse treatment in a community setting

Abstract

Background: Women with a history of substance use disorder (SUD) constitute a unique population with gender-specific needs in treatment. Most notable is high rates of prior trauma and the need for a trauma-informed care framework. Given theoretical links between trauma and interpersonal trust, understanding quantitatively how trust may impact outcomes for women in this population requires confirmation of validity of existing psychometric instruments. Objective: This study sought to confirm reliability and construct validity of the Rotter Interpersonal Trust Scale, Wake Forest Trust in Physician Scale, and the Revised Health Care System Distrust Scale (RHCSDS) for use in women with a history of SUD seeking treatment in a community-based setting. Methods: A total of 301 participants were enrolled between August 2017 and March 2018 at an urban, community-based residential substance abuse treatment program in the mid-South. Participants were given an electronic survey containing questions about demographics/clinical characteristics, the Rotter, Wake Forest, and RHCSDS scales, Socially Desirable Response Five-Item Survey (SDRS-5), and the Adverse Childhood Experiences (ACEs) questionnaire. All participants also completed a modified protocol of the “Trust Game.” Statistical analysis was completed for each trust scale in regard to scale means and distribution, internal consistency, interscale correlation, and scale correlation to the ACE score. Results: Results confirm statistically significant (P?<?.001) differences in global trust and trust of health care providers compared with general population samples in prior studies. Internal consistency of scales is comparable to reliability testing in prior studies (α?>?.70 for all scales). Interscale correlation between individual scales is statistically significant, with the strongest relationship between the 2 health care–specific scales (r?=??.740, P?<?.001). There was a weak, negative correlation between the ACE score and interpersonal trust (r?=??.135, P?=?.019). Individual scales do not have statistically significant correlation with “Trust Game” scores. Discussion: Findings suggest reliability and construct validity of scales for use in this population.     

The Patients in Recovery (PIR) Perspective: Teaching Physicians About Methamphetamine

ABSTRACT

Methamphetamine dependence is an emerging epidemic confronting physicians. In an effort to improve understanding of its impact, the authors presented an educational workshop at a national meeting for general internists featuring small group discussions with patients in recovery (PIR) from methamphetamine dependence. Participants rated the workshop highly, stating it would lead to concrete change in their teaching, research, or patient care practices and they would invite the workshop to their institution for presentation. Direct interaction with PIR was the most valued aspect of the workshop. Lessons learned included patient's fear of being “turned in” limits disclosure of methamphetamine use to physicians; active users have little insight into methamphetamine-related changes in physical appearance; and a sense of productivity reinforces ongoing methamphetamine use. Workshops that include small group discussions between physicians and PIR are an innovative, practical, and acceptable method to teach physicians about their role in helping patients with substance dependence.     

Betel Quid Chewing,Personality and Mood: Betel Quid Chewing Associated with Low Extraversion and Negative Mood

Background: Betel quid (BQ), chewed by about 600 million people worldwide, is one of the most widely used addictive substances. Little is known about psychological factors in BQ chewers. Objectives: The present study was the first attempt to explore the relationships between BQ chewing, personality, and mood. Methods: A survey was conducted with a purposive sample to assess BQ chewing habits in four subgroups: BQ-only users, BQ users who smoke and/or drink, smokers and/or drinkers only, and substance nonusers. A total of 494 participants were recruited from the civilian, non-institutionalized population in Taiwan. Habitual consumption of BQ, smoking and drinking; socio-demographic variables; extraversion; and mood (tension, depression, anger, vigor, fatigue, confusion, and self-esteem). All BQ chewers were evaluated on BQ dependence domains using DSM IV and ICD-10 criteria. Results: The 6-month BQ dependency rate among BQ chewers, defined by either DSM-IV or ICD-10 criteria, ranged from 42.9 to 45.6%. BQ-only users had significantly lower scores on extraversion than substance nonusers. BQ-only users had statistically significant higher scores on confusion and total mood than substance nonusers. BQ-only users had significantly higher scores on fatigue, anger, tension, and depression, than substance nonusers, BQ users who smoke and/or drink, and smokers and/or drinkers only. The number of BQ dependence domains correlated significantly negatively with total mood scores. Conclusions/Importance: The results supported the two hypotheses: (a) BQ chewing is associated with low extraversion; and (b) BQ chewing is related to negative mood.     

Understanding How People with Mental Health Difficulties Experience Substance Use

Background: Quantitative studies dominate research exploring reasons for substance use and experiences of substance use by people with mental health difficulties. This limits the depth of understanding which can be gained about these experiences. Objectives: In the present article, we synthesized current qualitative research in this area to provide enhanced theoretical knowledge of these experiences. Methods: Following a systematic literature search, we identified 12 studies which explored how people with mental health difficulties experienced using substances, and which met additional inclusion criterion. We used Noblit and Hare's metaethnographic approach to qualitatively synthesize these studies. Results: Synthesis led to the development of two themes; “substance use mediates acceptance and social inclusion” and “substance use provides perceived opportunities for control and power.” Conclusions/Importance: The findings suggest that in the studies reviewed people's motivation for substance use was embedded in social and psychological contexts. It indicated that substance use could provide perceived benefits such as mediating the impact of mental health stigma, enabling the development of alternative identities, increasing their sense of power and providing opportunities for social inclusion. Mental health and substance use workers should therefore aim to develop alternative opportunities for people with co-occurring disorders to gain such benefits, and seek to challenge mental health stigma.     

The Concept of Recovery as Experienced by Persons with Dual Diagnosis: A Systematic Review of Qualitative Research From a First-Person Perspective

Objectives: In recent years, the concept of recovery has gained ground in the treatment of persons with dual diagnosis. Recovery refers to living a meaningful life despite limitations caused by mental illness and substance use disorders. It also implies that support for persons with dual diagnosis should be organized according to the personal needs and wishes of its users. Therefore, it is important to gain insight into the aspects that persons with dual diagnosis deem important for their recovery process. This systematic review aims to summarize existing qualitative research on the meaning of recovery from the perspective of persons with dual diagnosis. Methods: A literature search was conducted following the guidelines of the Preferred Reporting Items for Systematic Reviews and Meta-Analyses statement for systematic reviews in the following databases: Cumulative Index to Nursing and Allied Health Literature, PsycINFO, Medline, Embase, and Web of Science. Results: Sixteen studies using a qualitative research design were retained in which four overarching themes could be identified. The first theme focused on feeling supported by family and peers and being able to participate in the community. The second theme focuses on the need for a holistic and individualized treatment approach, seeing the persons “behind the symptoms.” The third theme that emerged was having personal beliefs, such as fostering feelings of hope, building a new sense of identity, gaining ownership over one's life, and finding support in spirituality. The last theme identified was the importance of meaningful activities that structure one's life and give one motivation to carry on. Conclusions: In this review, the participants pleaded for “flexibility” in mental health care, i.e., an approach that allows for both successes and failures. However, in order to come to a more comprehensive theoretical model of recovery in persons with dual diagnosis, future research is necessary to gain insight into the underlying mechanisms of recovery processes.     

Country-wide distance training for delivery of screening and brief intervention for problematic substance use: A pilot evaluation of participant experiences and patient outcomes

ABSTRACT

Background: In this study, the authors evaluated if the 120-hour distance learning (DL) course SUPERA (an acronym in Portuguese meaning “System for detection of excessive use or dependence on psychoactive substances: brief Intervention, social reinsertion and follow-up”) was an effective way to train health professionals and social workers to apply screening and brief intervention (SBI) for patients with substance use disorders. Methods: In the first phase, 2420 health professionals or social workers, who had completed the course, answered an online survey about their use of the SBI. In the second phase, 25 of those professionals applied the ASSIST (Alcohol, Smoking and Substance Involvement Screening Test) followed by a brief intervention (BI) to patients with substance use disorders. Three months after the SBI delivery, independent researchers followed up 79 patients who had received SBI, reapplying the ASSIST and a questionnaire to evaluate the patients'/clients' satisfaction with the intervention they received. Results: In the first phase, it was found that most health professionals and social workers who completed the course applied the SBI in their work and felt very motivated to do it. In the second phase of the study, at a 3-month follow-up, most patients had significantly reduced their ASSIST scores in respect of alcohol and cocaine/crack in relation to their baseline levels. Those patients classified by their ASSIST score as “suggestive of dependence” presented a significant reduction in their scores regarding alcohol, tobacco, and cocaine/crack, whereas those classified as “at risk” presented a reduction in respect of alcohol problems only. Patients associated changes in their substance use with the SBI received. Conclusions: A reduction in substance use–related problems was associated with the SBI applied by the health professionals or social workers trained by the DL course SUPERA. Two significant limitations of this study were the small number of participants (professionals and patients in the follow-up) and the absence of a control group in the second phase of the study.     

Assessing the association between the strength of state policies on school drug prevention and substance use disorders

Background: Adolescent substance use has been linked to numerous adverse health, social, and educational outcomes. While there have been intensive resources placed in school-based prevention programs, the association of these policies on prevention outcomes is still unclear. State variation in policies provides an opportunity to assess the influence of school-based prevention programs. Objectives: To examine the association between the strength of state high school-based prevention programing and the prevalence of substance use disorders among adolescents ages 14–17 in the United States. Methods: National Survey on Drug Use and Health (NSDUH) data with state-level identifiers were merged with National Association of State Boards of Education (NASBE) information on school-based prevention policy strength, categorized into “required,” “recommended,” and “no policy.” Unadjusted comparisons and multilevel random intercept linear regression models were estimated to assess the change in rates of substance abuse or dependence from pre- to post- policy implementation, accounting for the nesting of individuals within states. Results: Rates of alcohol and tobacco abuse/dependence were significantly lower in states that required an alcohol prevention curriculum. After covariate adjustment, rates of alcohol abuse/dependence remained significantly lower in those states. Conclusions: Reinforcing alcohol prevention messaging in school appears to have a modest association with decreased rates of adolescent alcohol use disorders, possibly in part due to a different approach to the curriculum. For other substances, policy requirements appear to be less effective in reducing the prevalence of adolescent substance use disorders, suggesting that more targeted messaging with higher-risk students may be required.     

Validation of Krathom (Mitragyna speciosa Korth.) Dependence Scale (KDS): A Dependence Screen for Internationally Emerging Psychoactive Substance

ABSTRACT. Background: Krathom (Mitragyna speciosa Korth.) is the most commonly used illicit substance in Thailand, and its use has become widespread internationally. Studies on krathom dependence and its health impact are scarce, as there has been no instrument to measure its dependence syndrome and classify krathom users. This study aimed to develop and explore the factor structure, reliability, and validity of a Krathom Dependence Scale (KDS). Methods: This study comprised 2 phases. First, cross-sectional surveys were conducted with 523 (Phase I) and 595 (Phase II) male villagers aged >25 years who were regular, occasional, ex-, or nonusers of krathom. Scale construction was based on the qualitative results from users and previous literature. Exploratory factor analysis (EFA) using maximum likelihood extraction with oblimin rotation was conducted in Phase I and confirmatory factor analysis (CFA) in Phase II to confirm the construct of the scale. Internal consistency of the KDS was assessed using Cronbach's alpha coefficient. Discriminative validity was examined by checking its ability to differentiate between regular and occasional users and patterns of krathom use and its concurrent validity by comparing its levels of score with the Fagerstrom Test for Nicotine Dependence (FTND). The KDS contains 16 items on a 0–3 (never–always) rating scale, making a total score of 0–48. Results: Phase I EFA revealed a single-factor solution for the scale, which was confirmed by the CFA in Phase II, with an alpha coefficient of .98. The KDS discriminates regular from occasional users reasonably well and is highly correlated with the FTND score. Two cutoffs were suggested: 34/35 for distinguishing moderate from high dependence and 13/14 for low from moderate. Conclusions: The KDS appears to capture key theoretical constructs and correlates with indices of drug dependence by standard criteria. It should be useful in early intervention for those with krathom use disorders in community and primary care settings.     

A clinical instrument to guide brief interventions for adolescents with substance use concerns

ABSTRACT

Background: Adolescent substance use is an important public health problem in New Mexico and the United States. The New Mexico Department of Health school-based health centers (SBHCs) universally administer a validated screen, the CRAFFT (Car, Relax, Alone, Forget, Friends, Trouble), for adolescent substance use concerns; however, quality assurance efforts revealed that SBHC providers needed more information at the point of screening to initiate brief interventions for students with positive CRAFFT screens. The CHISPA (Cocaine, Heroin, IV drugs, Synthetic pot, Pot, Alcohol) was developed to gather specific information on recent substance use experience to guide brief interventions. This paper describes the development and initial reliability and validity of data obtained using the CHISPA instrument. Methods: In 2015, 99 high school–aged SBHC users in Albuquerque, New Mexico, completed the CRAFFT and CHISPA twice over 2 weeks using standard test-retest methods. Using the CHISPA, students reported for the prior 3 months substances used, frequency of use, and signs of addiction or acute danger (adverse events). Results: Retest reliability for the CRAFFT score was 0.82. CHISPA retest reliabilities were 0.75 for alcohol use; 0.91 for having used any substances; 0.92 for number of substances used; 0.81 for frequency of substance use; and 0.79 for number of adverse events. CRAFFT scores correlated with CHISPA measures of number of substances used at 0.62; with frequency of substance use at 0.58; and with number of adverse events at 0.64. Conclusions: CHISPA measures show preliminary evidence of reliability and validity. SBHC providers and other providers in primary care settings who use the CRAFFT screen may benefit from using the CHISPA to define recent substance use experience to guide brief interventions for adolescents with substance use concerns. The CHISPA instrument is currently being tested in electronic form in selected SBHCs in the state of New Mexico.     

Emerging consensus on measuring addiction recovery: Findings from a multi-stakeholder consultation exercise

Aim: To identify indicators that diverse stakeholders believe are important when measuring recovery from addiction. Methods: Our previous work with service users had generated 28 indicators of recovery. Using Delphi group methodology (three rounds), we assessed the extent to which stakeholders working in the addictions field agreed that the 28 indicators were important on a scale of 1–10. Participants included 146 individuals with diverse job roles in 124 organisations across the British Isles. Findings: Round 1 scores were high. There was evidence of greater scoring consensus in Round 2, but this trend was less certain in Round 3. Participants scored 27/28 indicators ≥7/10 in Round 3, so confirming their importance. The only Round 3 indicator with a mean score <7 was “experiencing cravings”. There were statistical differences between the Round 3 indicator scores of some sub-groups of participants, but absolute differences were small (never more than 1 point for any indicator). Conclusions: We have identified 27 recovery indicators that stakeholders working within the addiction field in the British Isles consistently ranked as important. Replicating our methods in other countries, and with additional stakeholder groups, will provide greater clarity on the term “recovery”, its relevance and value, and how it can best be measured.