Introduction
The aim of the HTA Programme is to ensure that high quality research information on the clinical effectiveness, cost-effectiveness and broader impact of healthcare treatments and tests are produced in the most efficient way for those who plan, provide or receive care from NHS and social care services. The commissioned workstream invites applications in response to calls for research on specific questions which have been identified and prioritised for their importance to the NHS, patients and social care.
Research Question:
What is the clinical and cost-effectiveness of recovery check-ups for adults who have completed an episode of structured treatment for problem alcohol and drug use, as part of drug and alcohol services in England?
- Intervention: Amanualised recovery check-up, to be adapted from an existing intervention (for example, the Recovery Management Check-up). Applicants to define and justify the exact content, delivery method and duration.
- For content, the recovery check-up should comprise a series of planned motivational sessions, which will include; checking in with people and find out how they are; offering support, encouragement, information and advice to help people to address any needs; focusing on building recovery capital; using techniques to support the person to re-engage in treatment where appropriate; and identifying and addressing barriers to accessing support, including treatment.
- For those delivering the recovery check-up, one or a combination of the following should be considered: workers without lived experience, workers with lived experience where that lived experience is not an explicit part of their role, and workers with lived experience in roles where that lived experience is an explicit part of the role (such as peer support workers). This intervention is generally not intended to be delivered face-to-face.
- Target group: Adults who have completed an episode of structured treatment in drug and alcohol services for problem alcohol and/or drug use and have now exited structured treatment. Participants should be representative of all people exiting structured treatment across drug and alcohol services and not just alcohol alone or drugs alone. Applications are encouraged that include recruitment from geographic populations with high prevalence of problem alcohol and drug use including dependence, which have been historically underserved by research activity in this field.
- Setting: Local Authority community drug and alcohol services and/or independent (including in some cases Local Authority-commissioned) Lived Experience Recovery Organisations (LERO).
- Comparator: Standard care. Applicants to define and justify.
- Study design: a) A development phase to adapt an intervention for delivery in drug and alcohol services in England. Applicants should clearly define and justify appropriate success criteria for judging adaptation of the intervention, to warrant a full evaluation, and assess acceptability (to all parties) and uptake and adherence by people receiving the intervention. b) A randomised controlled trial with an internal pilot phase, to test key trial processes (such as recruitment and adherence). Applicants should give consideration to including a process evaluation as part of the study design. Clear stop/go criteria should be provided to inform progression between the development stage, the internal pilot stage, and the full trial. Findings to be subgrouped by type of substance (for example opiates, non-opiates and alcohol, alcohol only and non-opiates only).
- Important outcomes: Continued remission of problem alcohol and/or drug use; measures of recovery capital (for example physical and mental health, employment, education, training, housing status); social (such as accessing and giving peer support, supportive family and friends); community (such as being part of recovery communities); economic evaluation that will take into account trade-offs of all relevant outcomes.
- Other outcomes: Any treatment re-engagement; number of times re-engaged with treatment; total days of treatment; use of other support services (days/number of times); acceptability of the intervention to recipients; self-reported improvement in health and wellbeing; improved coping skills and reduced cravings and urges; adverse events; adherence to intervention. Existing Core Outcomes should be included amongst the list of outcomes unless a good rationale is provided to do otherwise.
Applicants are encouraged to report recruitment and findings disaggregated by sex (and other demographic factors where relevant). - Minimum duration of follow-up: 1 year.
- Longer-term follow-up: If appropriate, researchers should consider obtaining consent to allow potential future follow-up through efficient means (such as routine data) as part of a separately funded study.
Rationale:
In England between April 2021 and March 2022 there were 289,215 adults in contact with drug and alcohol services. During the same period, approximately 67,000 people left services after completing treatment. However, of these people, a significant number are likely to require more treatment in drug and alcohol services in the future.
It is widely acknowledged that alcohol and drug dependence are chronic health conditions, and like diabetes or hypertension, they typically require sustained support beyond the acute treatment episode. The UK government’s 10-year drugs plan acknowledges this by emphasising that ‘recovery is a process that often takes time to achieve and effort to maintain’.
The importance of sustained support after completing a treatment episode is recognised in the UK guidelines on clinical management of drug misuse and dependence, which states that aftercare support with recovery is essential in the period after leaving treatment. As part of this aftercare, the guideline recommends that pre-scheduled recovery check-ups are put in place to monitor recovery, adjust recovery supports and to plan access back into treatment at early signs of relapse risk, if appropriate. Early re-engagement in structured treatment may prevent a more serious relapse, and reduce the duration and intensity of treatment that is required. The guidelines also emphasise the importance of helping a person to build their recovery capital, which is the range of resources that help them to maintain recovery – for example, safe and secure accommodation, social support and being part of recovery communities. New guidance on recovery support services and lived experience initiatives outlines the evidence for, and current provision of, recovery check-ups in England.
There have been trials of recovery check-ups, which have demonstrated some effectiveness, however, most of these have been conducted in the United States, where treatment services differ significantly from those in England. Currently there is not a manualised recovery check-up intervention available that has been robustly evaluated in English services. Therefore, the HTA Programme is interested in commissioning research to adapt and evaluate a recovery check-up intervention.
To support the ambitions of NIHR’s Best Research for Best Health: the next chapter, we strongly encourage the inclusion of nurses, midwives and allied health professionals within well-developed research teams responding to this call, to increase the building of research activity, capacity and capability across these professions.
Depending on the level of experience, this could be through the role of lead applicant, as joint co-applicant (supported by detailed mentoring plans submitted with the application), or as a co-applicant member of the research team. Through this activity, NIHR aims to support nurses, midwives and allied health professionals to become future research leaders and release the potential to lead, use, deliver and participate in research as a part of their job.
Additional commissioning brief background information
A background document is available that provides further information to support applicants for this call. It is intended to summarise what prompted the call and the existing evidence base, including relevant work from the HTA and wider NIHR research portfolio. It was researched and written on the basis of information from a search of relevant sources and databases, and in consultation with a number of experts in the field. If you would like a copy please email htaresearchers@nihr.ac.uk.
Making an application
If you would like to apply for this funding opportunity, you can begin your application via the funding opportunity page.
Your application must be submitted online no later than 1pm on 22 May 2024. Applications will be considered by the HTA Funding Committee at its meeting in July 2024.
Guidance notes and supporting information for HTA Programme applications are available.
Shortlisted Stage 1 applicants will be given 8 weeks to submit a Stage 2 application. The Stage 2 application will be considered at the Funding Committee in November 2024.
For commissioned topics, the Programme strongly discourages the practice of the same co-applicant joining more than one competing team, other than in unusual circumstances (for example, a lead from a named charity or a unique national expert in a condition).
For such exceptions, each application needs to state the case as to why the same person is included. The shared co-applicant should not divulge application details between teams, and both teams should acknowledge in their application that they are aware of the situation, and that study details have not been shared.
Should you have any queries please contact htagb@nihr.ac.uk