Higher education institutions are paying increasing attention to the health needs and well-being of students as part of a high-quality educational experience, and the impact of the COVID-19 pandemic may mean that this process needs to be accelerated. In 2020, Universities UK launched ‘Stepchange: mentally healthy universities’, a strategic framework for a whole university approach to mental health and wellbeing at universities. Although this mentions drugs and alcohol as part of health promotion, students in recovery from addiction are often inadvertently excluded from support by the stigma of addiction.
Addiction is understood as compulsive reward-seeking behaviour that occurs despite significant negative consequences across multiple life domains. It is thought to be underpinned by a chronic neurobiological process that is linked to a deficiency in the individual’s brain reward system. It is caused by a complex interplay between genetic and neurobiological mechanisms on the one hand and developmental, social and environmental factor on the other. Research has demonstrated a strong association between adverse childhood experiences and the development of addiction in later life.
Medical diagnostic systems require not only physiological elements such as tolerance (the need for increased use to obtain the same effect) and withdrawal (unpleasant symptoms when the substance is stopped or reduced abruptly), but also loss of control over use despite considerable problems and a gradual replacement of meaningful activities by the addiction. Other rewarding behaviours such as gambling, gaming, sex, shopping and exercise can also produce similar effects. Such is the similarity in activation of brain circuitry, aetiology, symptom expression and treatment, these behavioural addictions are now starting to be classified in the same manner as substance use disorders.
Nearly 300,000 men and women are treated annually for alcohol or drug use disorders in the UK, but it is estimated that this represents only 10% of people who would benefit from treatment. Likewise only 3% of the nearly 300,000 problem gamblers access treatment. Serious addiction is a chronic condition that can involve cycles of abstinence and relapse, possibly over several years. Those with lesser degrees of severity may manage to stop and never experience further problems. In more severe cases, remission requires broader change in behaviour, outlook and identity – a move from being immersed in the culture of addiction to the culture of recovery. This change occurs over a period of time, and alters how the individual thinks about themselves and their life. Such people describe themselves as being ‘in recovery’. Recovery is a process, not a single event, and takes time to achieve and effort to maintain. It must be voluntarily-sustained in order to be lasting.
Recent evidence has suggested that the number of young people using drugs is increasing, although the number entering professional treatment is decreasing. Educational difficulties associated with early addiction (or living in a family with addiction) may limit access to higher education for this already marginalised population. As treatment alone may not provide these young adults with the support they need to maintain abstinence and build strong recovery while simultaneously growing into mature young adults, Universities in the USA began to create Collegiate Recovery Programs (CRPs). The first University-based recovery support services began at Brown University in 1977, with the aim of enabling recovering students to fully participate in a continuing care program without having to give up their educational goals. In 2005 Texas Tech University documented and exported a model for recovery support services on campus, and this led to a rapid increase in the number of CRPs in the USA. The Association for Recovery in Higher Education (ARHE) estimates there are more than 150 established or in development.
A student in recovery may be defined as someone who “has a history of addiction that resulted in significant consequences in at least one life domain… [who] has made a voluntary commitment to an abstinent lifestyle and is actively engaging in activities that promote abstinence and overall wellness”. The primary goal of a CRP is to provide a safe haven for young adults who are struggling to maintain their hard-won abstinence from their addiction(s) while surrounded by the frequent temptations offered by the social context of a University campus. There may be an overwhelming lack of peer support for abstinence in these environments, and young adults struggle to either find or develop a social niche that is addiction-free. Non-disclosure leads students to experience considerable pressure, but even normative self-disclosure with non-addicted peers can create social distance.
CRPs aim to promote hope and purpose, positive identity development, a sense of achievement and accomplishment, capacity for stable interpersonal relationships, and healthy coping skills by:
- support with completing the university admissions process, early orientation, developing individual plans of study, and general academic advice
- establishing a safe, anonymous space for students to express their struggles with addiction(s) and to receive peer support for behaviour change
- a weekly open meeting in ‘celebration’ of recovery that provides continued support to CRP members whilst also educating the wider community about the reality of addiction and recovery
- training student peer mentors to address both recovery and educational issues
- developing a student organisation responsible for facilitating recovery-orientated recreational and community volunteering activities
- providing safe, sober accommodation
Preliminary data suggest that CRPs effectively promote recovery, prevent relapse, and improve educational outcomes for the individuals participating in them. Research is beginning to highlight the needs of CRP students in terms of social, academic, and recovery support. Over a third of CRP members report that they would not be at University without the CRP and 20% would not have attended their present University.
The first CRP in the UK started at Teesside University, and the University of Birmingham will launch its own CRP in September 2021. A philanthropic grant from the CrEdo Foundation will support a national network of UK CRPs.