http://informahealthcare.com/dep ISSN: 0968-7637 (print), 1465-3370 (electronic) Drugs Educ Prev Pol, 2015; 22(1): 26–34 ! 2015 Informa UK Ltd. DOI: 10.3109/09687637.2014.947564 ‘‘You’re all going to hate the word ‘recovery’ by the end of this’’: Service users’ views of measuring addiction recovery Joanne Neale 1,2 , Charlotte Tompkins 3 , Carly Wheeler 4 , Emily Finch 1,5 , John Marsden 1 , Luke Mitcheson 1,6 , Diana Rose 7 , Til Wykes 8 , and John Strang 1 1 Addictions Department, King’s College London, Institute of Psychiatry, London, UK, 2 Centre for Social Research in Health, University of New South Wales, Sydney, NSW, Australia, 3 Leeds Community Healthcare NHS Trust, Leeds, UK, 4 Department of Psychology, Social Work and Public Health, Oxford Brookes University, Oxford, UK, 5 Blackfriars Road Community Drug and Alcohol Team, South London and Maudsley NHS Foundation Trust, London, UK, 6 Lambeth Drug and Alcohol Service, South London and Maudsley NHS Foundation Trust, London, UK, 7 Service User Research Enterprise (SURE), Department of Health Services and Population Research, King’s College London, Institute of Psychiatry, London, UK, and 8 Department of Psychology, King’s College London, Institute of Psychiatry, London, UK Abstract Aims: To explore how service users’ views of measuring addiction recovery differ from those of service providers. Methods: Five focus groups conducted in two English cities with (i) people currently using Class A drugs (n ¼ 6); (ii) people currently using alcohol (n ¼ 12); (iii) individuals in residential detoxification (n ¼ 12); (iv) individuals in residential rehabilitation (n ¼ 7); and (v) people who defined themselves as ex drug or alcohol users (n ¼ 7). Each focus group reviewed 76 measures of recovery previously identified by senior service providers. Findings: Service users identified multiple problems with the 76 measures. Difficulties could be categorized as expecting the impossible of service users; the dangers of progress; the hidden benefits of negative outcomes; outcomes that negate the agency in recovery; contradictory measures; failure to recognise individual differences; entrenched vulnerabilities; the misattribution of feelings and behaviours; and inappropriate language. Conclusions: Service users experience recovery as a process and personal journey that is often more about ‘coping’ than ‘cure’. Involving service users in designing measures of recovery can lessen the likelihood that researchers develop assessment tools that use inappropriate, contradictory or objectionable outcomes, and ambiguous and unclear language. People who have experienced drug or alcohol problems can highlight important weaknesses in dominant recovery discourses. Keywords Focus groups, measurement, outcomes, recovery, service users, substance misuse History Received 23 May 2014 Revised 3 July 2014 Accepted 18 July 2014 Published online 4 August 2014 Background Reasons for researching the views of people who use addiction services are legion. Very obviously, service users have detailed knowledge and understanding of their own health status, psychosocial problems, personal resources, support needs and aspirations. Such information can be crucial to researchers, service providers, service commis- sioners and policy-makers who may not have first-hand experience of the addiction and related problems they are seeking to address. In this paper, we analyse data collected in focus groups (n ¼ 5) with current and former drug and alcohol service users (n ¼ 44) to explore how their views on measuring addiction recovery differ from those of service providers. This work forms part of a broader study in which we are seeking to develop a novel recovery outcome measure that will prioritise the goals of people who are, or who have been, addicted to alcohol or drugs and used treatment services (cf. Neale, Finch, et al., 2014). In recent years, ‘recovery’ has become a core principle within the drug and alcohol sector, resulting in a significant move towards ‘recovery-oriented’ drug treatment nationally and internationally (Duke, Herring, Thickett, & Thom, 2013). Recovery is, however, a contested concept that lacks clear meaning (Neale, Finch, et al., 2014; Neale, Nettleton, & Pickering, 2014; Paylor, Measham, & Asher, 2012). Indeed, definitions range from the vague and nebulous (‘recovery is what each individual wants it to mean’) to the highly prescriptive (‘recovery means abstinence from all substance use’). Latterly, there has been emergent stakeholder agreement that recovery can be achieved with appropriately prescribed medications (Recovery Orientated Drug Treatment Expert Group, 2012) and is more than just a reduction in substance use (ACMD, 2013; HM Government, 2010; Scottish Government, 2008). Instead, it involves individuals achieving benefits in a wide range of life areas, including their relationships, housing, health, employment, self-care, use of time, community participation and well-being (ACMD, 2013; Burns & MacKeith, 2012; Neale, Pickering, & Nettleton, 2012). Correspondence: Joanne Neale, Addictions Department, 4 Windsor Walk, Institute of Psychiatry, Denmark Hill, London SE5 8AF, UK. Tel: +44 20 7848 0835. E-mail: joanne.neale@kcl.ac.uk