Commentary on Day et al.: From concept to practice—Challenges in building a continuum of recovery support services in Belgium

Abstract

The monograph ‘Recovery support services as part of the continuum for care for alcohol and drug use disorders’ [1] provides an excellent scoping review of North American and United Kingdom literature on recovery support services (RSS). It provides invaluable information to policy makers, commissioners and support providers and substantiates their efforts to establish recovery-oriented systems of care (ROSC). In line with recent conceptualizations of addiction recovery as a lengthy, idiosyncratic and multidimensional process [2, 3], Day and colleagues [1] distinguish between six forms of support services beyond traditional treatment approaches to build recovery capital: (1) peer-based recovery support services; (2) employment support; (3) recovery housing; (4) continuing care and recovery check-ups; (5) recovery community centres; and (6) RSS in educational settings.

Although the importance of a broad range of interconnected RSS is increasingly underscored [4, 5], integrating these into cohesive systems of care remains a significant challenge internationally and demonstrates the gap between shared conceptual or rhetorical definitions of addiction recovery and its practical implementation. This disconnect often results in fragmented, inconsistent and even incompatible applications of recovery-oriented principles in daily practice [6]. In Belgium, for example, a recent comprehensive evaluation of de-institutionalizsation and integration of mental health and addiction services revealed substantial gaps in the continuum of care for persons with substance use disorders (SUD) [7]. Service users experienced insufficient specific expertise in fostering individuals' recovery capital and lack of trauma-informed support. Institutionalized stigma alongside inflexible intake criteria that explicitly exclude individuals with SUD were reported as significant barriers in general mental health services. Such persistent dynamics undermine efforts to integrate RSS, hamper continuity of care and leave service users feeling inadequately supported. Moreover, collaboration between addiction treatment services and peer-based RSS is limited in Belgium [8]. Applying Day and colleagues' framework [1], recovery support mainly consists of forms 1 and 4, whereas tailored employment support, recovery housing, community centres and training/education—despite the evidence provided in this review—are often missing or not specifically targeted at persons with SUD. This lack of (integration of) services results in missed opportunities for providing person-centred support and exploiting available recovery capital [9]. Unfortunately, critical barriers and facilitators to implementing ROSCs remain under-explored in the monograph by Day and colleagues.

Although this scoping review examines an impressive number of publications on RSS (>250), it lacks the methodological rigor of a systematic review to evaluate the effectiveness of various types of support within ROSCs. It also overlooks valuable practices and research conducted in non-Anglo-Saxon countries, which are often not published in English peer-reviewed journals. Yet, this review holds potential to inspire more focused reviews on specific (sub)types of recovery support and could serve as a precursor to a comprehensive umbrella review synthesizing evidence from reviews and meta-analyses [10]. Such evidence is highly needed, given the absence of comprehensive networks of RSS in many countries worldwide and the lack of guidance on phased approaches to building a continuum of care. This is particularly critical in countries that have only recently adopted a recovery perspective to SUD (like most European Union countries) and in low- and middle-income countries, where scarce resources demand informed prioritization of decision-making and efficient resource allocation [11]. Incorporating service users' self-reported experiences and outcomes in evaluations of RSS is crucial for designing ROSCs that address the evolving needs of individuals with SUD [4, 12]. Finally, although formal treatment and RSS often play a key role in building recovery capital, several persons recover from SUD without engaging in treatment or support [13, 14]. Building recovery capital should not be viewed as a process that begins with treatment, but rather as an ongoing endeavour, including and extending beyond the six forms of recovery support services.

ROSCs can only thrive if they actively address social and structural issues underlying SUD and recovery processes [4, 15, 16]. These factors, which significantly shape access to recovery capital, should be central to the design and implementation of ROSCs. We unequivocally agree with Day and colleagues, RSS are not merely a complement, but a cornerstone of addiction recovery that should be prioritized as the foundation of any robust and comprehensive system of care [1].

Wouter Vanderplasschen: Conceptualization (lead); writing—original draft (lead). Florian De Meyer: Writing—original draft (supporting). Clara De Ruysscher: Conceptualization (supporting); writing—original draft (supporting).

W.V. receives public funding for studying recovery support and is a member of the board of governors of a recovery support organisation, De Kiem (Belgium). F.D.M. and C.D.R. have no financial or other relevant links to companies or organisations with an interest in the topic of this article.