Testing the Feasibility of Measuring Recovery in Adolescent Participants of an Alternative Peer Group: Lessons Learned and Next Steps

Abstract

The aim of this article is to report lessons learned from feasibility challenges faced in a mixed-methods study designed to test the feasibility of measuring recovery in participants of an Alternative Peer Group (APG). The APG integrates pro-recovery peers and social activities into clinical practice to engage adolescents in recovery. Though well established, APGs have never been tested. This study was one phase in a line of research that aims to develop an APG evidence base. The study used a mixed-methods design and naturalistic sampling of participants of one APG program. Repeated measures analysis with linear mixed models was planned to test the hypothesis that spending time in the APG builds recovery capital, resulting in progress in the processes of recovery, and improved symptoms. Semistructured interviews were conducted and framework analysis was used to explore feasibility challenges. Recruitment and retention challenges precluded meaningful measurement of change over time in recovery. Lessons learned from qualitative findings informed multiple strategies for revisions to strengthen future study protocols. Recruitment and retention of adolescents are common challenges that can threaten a study’s validity. Researchers seeking to recruit and retain adolescents with SUD in longitudinal studies may benefit from strategies derived from this study.

The Twelve Steps and Adolescent Recovery: A Concise Review

“…In another study, adolescents who were actively or recently involved in an APG reported mixed perceptions of the 12 steps. 48,59 Consistent with prior qualitative work, 56,57 low problem recognition, poor motivation for treatment, and stereotypes about 12-step groups were common negative initial perceptions. 48 However, as peers advocated for the benefits and the participants tried working the steps, these initial negative impressions became more positive.…”

The Good, the Bad, and Recovery: Adolescents Describe the Advantages and Disadvantages of Alternative Peer Groups

“…26 The findings of this study concur with the Adolescent Recovery Model (Figure 3). 32 This model depicts adolescent recovery as a protracted process consisting of four distinct but iterative stages that may or may not involve relapse. Elements such as sober fun, relationships with recovering role models, and time emerged as critical to the initiation, progression, and maintenance of recovery.…”

“…Elements such as sober fun, relationships with recovering role models, and time emerged as critical to the initiation, progression, and maintenance of recovery. 3,32 A mainstay of SUD treatment across all age ranges involves helping affected individuals resolve their ambivalence and thus, increase their motivation to pursue recovery. 36 It is not surprising that the advantages and disadvantages of APG elements reported by participants of this study seemed to emerge as a continuum that changed over time as their ambivalence resolved.…”

“…A full description of the methods and findings of the original study were described in a previous paper. 32…”

The science of recovery capital: where do we go from here?

“…In addition to some ambiguity about how best to separate the RC domains to understand them as entities in the real world and as things that can be reliably measured, we lack a common understanding of the key factors within a domain that best indicate the presence of RC [20,[32][33][34][35][36] and whether/how these vary by population. For example, although employment is one component of human RC for adults [36,37], it is likely not yet important for youth populations in recovery for whom school engagement would be more relevant.…”