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Addiction recovery: success in the recovery process
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Addiction recovery: success in the recovery process
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i
ADDICTION RECOVERY:
SUCCESS IN THE RECOVERY PROCESS
by
Brandon E. Mitchell
A Dissertation Presented to the
FACULTY OF THE USC ROSSIER SCHOOL OF EDUCATION
UNIVERSITY OF SOUTHERN CALIFORNIA
In Partial Fulfillment of the
Requirements for the Degree
DOCTOR OF EDUCATION
May 2021
Copyright 2021 Brandon E. Mitchell
ii
Dedication
To my family for supporting me throughout this journey. I will always appreciate my
wife, Julie, for helping to keep this goal in front of me. I want my kids to know that no matter
how you start in life, you will always have a choice in how you end up.
To the special men and women who made this possible. Thank you for sharing your
stories and for putting a personal purpose and meaning behind this paper. I pray you all stay
strong in your commitments to overcome your addictions and know you have inspired me.
I dedicate this to you…
iii
Acknowledgements
Thank you to my dissertation committee, Dr. Courtney Malloy and Dr. Marry Andres.
Your patience with me as I worked to complete this work is extremely appreciated. I am grateful
to you for your feedback, support and holding me to the highest standards I could achieve.
A special thank you to Dr. Darline Robles. You have been a true cheerleader and
advocate to me. I value the relationship we made and want you to know I have great respect for
you as a mentor, an educator, and a friend.
iv
Table of Contents
Dedication…………………………………………………………………………………………ii
Acknowledgements…………… …………………………………………………………………iii
List of Tables……………………………………………………………………………………..vii
List of Figures…………………………………………………………………………………...viii
Abstract…………………………………………………………………...…………………..…..ix
CHAPTER ONE: INTRODUCTION ……………………………………………………….….....1
Introduction to the Problem of Practice……………………………………………. ……..1
Organizational Contexts and Mission ………………………………………….........…….2
Organizational Goal……………………………………………………………….........…3
Related Literature………………………………………………………………….........…3
Importance of the Evaluation………………………………………………………...........5
Description of Stakeholders………………………………………………………….........6
Faculty ……………………………………………………………………………..6
Current Students…………………………………………………………………...6
Former Students…………………………………………………………………...7
Stakeholder Groups’ Performance Goals………………………………………………….7
Stakeholder Group of Focus………………………………………………………………8
Purpose of the Project and Questions……………………………………………………..8
Conceptual and Methodological Framework……………………………………………9
Definitions…………………………………………………………………………………9
Organization of the Project………………………………………………………………10
CHAPTER TWO: REVIEW OF THE LITERATURE………………………………………….12
Influences on the Problem of Practice…………………………………………………...13
Major Addictions in the US……………………………………………………...13
Factors in Addiction……………………………………………………………...14
Theories Examining the Factors…………………………………………………15
Current Types of Recovery Programs ……………………………………………16
Program Effectiveness…………………………………………………………...18
Role of Stakeholder Group of Focus…………………………………………………….20
Clark and Estes Gap Analysis Framework………………………………………………20
Stakeholder Knowledge, Motivation and Organizational Influences……………………21
Knowledge Influences…………………………………………………………...21
Motivation Influences……………………………………………………………23
Organizational Influences………………………………………………………..26
Conceptual Framework: The Interaction of Stakeholders’ Knowledge and
Motivation and the Organizational Context……………………………………………...29
v
Conclusion……………………………………………………………………………….31
CHAPTER THREE: METHODS………………………………………………………………..33
Research Design………………………………………………………………………….33
Participating Stakeholders……………………………………………………………….34
Interview Sampling Criteria and Rationale………………………………………34
Interview Sampling Strategy and Rationale……………………………………..35
Data Collection and Instrumentation…………………………………………………….35
Interviews………………………………………………………………………...36
Documents……………………………………………………………………….37
Data Analysis…………………………………………………………………………….38
Credibility and Trustworthiness………………………………………………………….38
Validity and Reliability…………………………………………………………………..39
Ethics……………………………………………………………………………………..40
CHAPTER FOUR: RESULTS AND FINDINGS……………………………………………….42
Participating Stakeholders……………………………………………………………….43
Determination of Assets and Needs……………………………………………………...44
Results and Findings for Knowledge Causes…………………………………………….44
Conceptual Knowledge…………………………………………………………..45
Procedural Knowledge…………………………………………………………...50
Results and Findings for Motivation Causes…………………………………………….52
Self-Efficacy Theory……………………………………………………………..52
Expectancy Value Theory………………………………………………………..53
Results and Findings for Organizational Causes………………………………………...56
Organizational Influence…………………………………………………………56
Cultural Settings………………………………………………………………….59
Cultural Model…………………………………………………………………...62
Summary of Validated Influences……………………………………………………….66
Knowledge……………………………………………………………………….66
Motivation………………………………………………………………………..66
Organization……………………………………………………………………...66
CHAPTER FIVE: RECOMMENDATIONS AND EVALUATION ……………………………68
Purpose of the Project and Questions……………………………………………………68
Recommendations to Address Knowledge, Motivation and
Organization Influences………………………………………………………………….68
Knowledge Recommendations…………………………………………………..69
Motivation Recommendations…………………………………………………...71
Organization Recommendations…………………………………………………73
Summary of Knowledge, Motivation and Organization Recommendations…………….77
Integrated Implementation and Evaluation Plan…………………………………………78
Organizational Purpose, Need and Expectation………………………………….78
Implementation and Evaluation Framework……………………………………..79
vi
Level 4: Results and Leading Indicators…………………………………………80
Level 3: Behavior………………………………………………………………...81
Level 2: Learning………………………………………………………………...85
Level 1: Reaction………………………………………………………………...90
Evaluation Tools…………………………………………………………………91
Data Analysis and Reporting…………………………………………………….93
Summary of the Implementation and Evaluation………………………………..93
Limitations and Delimitations ……………………………………………………………94
Recommendations for Future Research………………………………………………….95
Conclusion……………………………………………………………………………….96
References………………………………………………………………………………………..98
Appendices……………………………………………………………………………………...102
Appendix A: Interview Protocol………………………………………………………..102
Appendix B: Consent Form…………………………………………………………….105
Appendix C: Post Training Survey Questions………………………………………….106
Appendix D: Delayed Feedback Interview Questions………………………………….107
vii
List of Tables
Table 1. Organizational mission, performance goal, and stakeholder goals…………………….17
Table 2. Knowledge Influence, Types, and Assessments for Knowledge Gap Analysis………..22
Table 3. Motivational Influences and Assessments for Motivation Gap Analysis………………25
Table 4. Organizational Influences and Assessments for Motivation Gap Analysis…………….28
Table 5. Type of tools applied…………………………………………………………………..47
Table 6. Confidence levels before and after……………………………………………………..53
Table 7. Level of effort at start and end of program……………………………………………..55
Table 8. Live-in facility benefits…………………………………………………………………61
Table 9. Structure impact and focus areas………………………………………………………65
Table 10. Knowledge Assets or Needs as Determined by the Data……………………………..66
Table 11. Motivation Assets or Needs as Determined by the Data……………………………..66
Table 12. Organizational Assets or Needs as Determined by the Data…………………………67
Table 13. Summary of Knowledge Causes, Priority, Principle and Recommendations…………69
Table 14. Summary of Motivation Causes, Priority, Principle and Recommendations…………71
Table 15. Summary of Organization Causes, Priority, Principle and Recommendations………73
Table 16. Outcomes, Metrics, and Methods for External and Internal Outcomes………………81
Table 17. Critical Behaviors, Metrics, Methods, and Timing for Evaluation…………………..82
Table 18. Required Drivers to Support Critical Behaviors……………………………………...84
Table 19. Evaluation of the Components of Learning for the Program…………………………89
Table 20. Components to Measure Reactions to the Program…………….……………………..91
viii
List of Figures
Figure 1. Conceptual Model……………………………………………………………………..30
Figure 2. Culture responses by percentages……………………………………………………..63
ix
Abstract
ABC Rehab currently reports an 85 percent success rate among program graduates who
successfully overcome their addictions within three years from leaving the program. This study
examines what ABC Rehab is doing to generate such success and what areas they can focus on
to reach their goal of 100 percent of all their graduates becoming addiction free. This is a
promising study of ABC Rehab to ensure their success is continued by looking at which
Knowledge, Motivation, and Organizational influences impacted graduates the most,
contributing to their success. This was done through qualitative research by the use of interviews
with former graduates who have overcome their addictions. The findings suggest that many of
the contributing factors which ABC Rehab have successfully demonstrated are around structure,
program length, and focusing on changes in behavior. Additional findings were also found to
show gaps in how program graduates understood which tools contributed the most to their
recovery, as well as understanding how the program culture and organizational structure also
contributed to their recovery. Although participants understood each of these areas as
contributing factors, there was not enough evidence to suggest the organization emphasized one
element of these areas over another. Based on the findings from this study, recommendations
were given to allow ABC Rehab to ensure they maintain and strengthen their practices in the
program in an effort to reach their goal of 100 percent of all graduates becoming addiction free.
1
CHAPTER ONE: INTRODUCTION
Introduction to the Problem of Practice
Addiction and substance abuse is an alarming issue faced in our country, and in the
world. Over 21 million Americans battle drug abuse each year, many as young as the age of 12
(National Survey on Drug Use and Health, 2014). Over $200 billion is spent dealing with abuse
including healthcare costs and the impact to the criminal justice system (Office on National Drug
Control Policy, 2007). States are feeling the strain of the financial burden in dealing with drug
related issues, as many have taken measures to legalize certain drugs to reduce this burden
(Governing State Marijuana Laws, 2018). Although these actions may decrease the financial
impact to state and local governments, they do little to treat addiction, or give addicts the tools
they need to overcome substance abuse. Without the support of recovery programs, few options
are left for those suffering from addiction to seek help.
Recovery programs are available for addicts who can afford the costs, or have family to
support them, however, with almost 15,000 treatment centers it can be challenging to know
which center is going to provide the necessary tools for recovery (National Institute on Drug
Abuse, 2018). Relapse is also a major issue in the recovery process, with rates as high as 85
percent within the first year of completing treatment (Osbourn, 2014).
The purpose of this promising study is to look at ABC Rehab, a pseudonym for the
addiction recovery program being studied, to determine which elements of their program
contribute to the 85 percent of program graduates becoming addiction free and look for areas for
the organization to achieve further improvements (ABC Rehab, 2018). This study will examine
the current state of the ABC Rehab program as it relates to the organizational goal and identify
the successful elements in the program that help students overcome addiction and prevent
2
relapse. Further, this study will examine the program elements demonstrating excellence and
inform ABC Rehab of the findings.
Organizational Context and Mission
ABC Rehab is a two-year recovery treatment center helping adults with addiction issues
and providing the tools and support needed to obtain lifelong sobriety (ABC Rehab, 2018).
Their mission is to become a world leader in providing, cultivating, teaching, advancing, and
instilling in each student the desire to always strive to be the best they can be for themselves,
their families, and their communities (ABC Rehab, 2018). ABC Rehab refers to each person
participating in the program as a student, rather than an addict or client. The center is designed
to be a place for people to learn how to overcome their addictions and apply teachings in their
lives in order to reach lifelong sobriety. ABC Rehab has three locations, two in the United
States, and one location in Canada. The program commits adults, of all ages, to stay at their on-
site facilities for a 24-month duration where they will live and work as they develop the tools
needed to overcome their addictions. Although ABC Rehab accepts both men and women, the
facilities are not co-ed. This allows ABC Rehab to adjust the program to allow for gender
specific needs of the students (ABC Rehab, 2018). Each facility houses around 60 students at
any given time, and each student is required to pay a one-time five-thousand-dollar tuition for the
entire two years (ABC Rehab, 2018). The program is modeled after the therapeutic community
(TC) approach to addiction recovery. TC centers, like ABC Rehab, focus on overall lifestyle
changes, and not just abstaining from drugs and alcohol. These programs believe in a
community approach and give their students a safe and structured place for recovery (G. De
Leon, 2000).
3
Organizational Goal
ABC Rehab was established in 2002 as a long-term addiction recovery center. Since that
time ABC Rehab has seen an 85 percent success rate of addicts who maintain sobriety within
three years of graduating from the program (ABC Rehab, 2018). As the program matures and
organizational leaders understand which methods have greater impacts, they have determined a
higher standard should be set. Their goal is for 100 percent of those who graduate to not have
relapsed, by the year 2025, allowing for an incremental increases each year over the next four to
five years. This goal will be measured by tracking graduate’s relapses and success over three
years, after the student’s completion of the program.
Related Literature
Addiction recovery programs have been created to assist people with addictions to
various drugs and alcohol. Addiction recovery studies have been documented as early as 1806 in
Germany, and more careful studies began around 1875 (Musto, 1996). Much of this was the
result from medical breakthroughs around the addictiveness of these drugs, which was not fully
understood (Musto, 1996). Today much more is understood about addiction and effective
treatment practices, as thousands of rehab programs have been established to treat substance
abuse (Patterson, 2018). The Genetic Science Learning Center [GSLC] (2018) states that
modern treatment like behavioral therapy, which is tailored to individual addicts, has shown to
be more effective, with recovery rates of 40-70 percent of addicts remaining drug free after
treatment. This is largely due to drug addiction being understood as a brain disease, rather than a
moral flaw (GSLC, 2018).
4
With 85 percent of addicts relapsing in their first year after leaving a program, it becomes
vital to understand what areas of program curriculum is more effective in order to prevent
relapse and how to manage situations once relapse occurs (Osborn, 2014). Before looking at
these elements, an understanding of what causes addiction should be explained. Addiction is
considered a chronic disease (National Institute on Drug Abuse [NIDA], 2019). The NIDA
noted how this condition is developed when a person voluntarily takes drugs or alcohol, then
repeats this decision despite harmful consequences (NIDA, 2019). Although this initial use is
voluntary, addiction can reduce a person’s self-control and create an involuntary need for the
substance (Felman, 2018). At some point the brain begins to change, interfering with the user’s
ability to resist the intense urges to consume again (Felman, 2018). Longer use of drugs and
alcohol can cause additional changes in the brain’s chemical system affecting learning,
judgment, stress, decision-making, and behavior (NIDA, 2019). This change in the brain is the
dysregulation of the brain’s chemistry, allowing the impaired brain to control substance abuse
behavior (Erickson & Wilcox, 2001). The NIDA also states this condition is considered a
relapsing disease, and people who struggle with addiction have an increased risk of returning to
this behavior even after years of non-consumption (NIDA, 2019).
Without the benefit of an addiction recovery program, most people will not be successful
in overcoming addiction (Osborn, 2014). Prolonged drug abuse results in the brain increasing
the person’s need to repeat the addictive behavior, leading to relapse (NIDA, 2019). Shinha
(2011) argues addicts must first learn how to identify and prevent high-risk situations where
relapse can occur, such as depression, stress and drug cravings. These situations are often
triggers for relapse and can often predict the frequencies of relapse events (Shinha, 2011). These
5
triggers come due to the brain's inability to resist intense urges to take drugs (NIDA, 2019).
Relapse prevention becomes a key factor in order to improve success over a longer period of
time (Witkiewitz & Marlatt, 2004).
Part of the ABC Rehab approach is to evaluate the root cause of both the addiction and
the behaviors leading to addiction and relapse (De Leon, 2000). Because relapse is common,
treatment should be an ongoing process based on how students respond to drug urges (NIDA,
2019). As these underlying issues are addressed through a long-term recovery program, addicts
can better understand why they relapse and what they can do to keep moving towards recovery
(Erickson & Wilcox, 2001). ABC Rehab believes behavior is only a symptom of the cause, not
the cause itself, and giving students the tools needed to address the cause, gives them the tools
needed to overcome relapse situations (ABC Rehab, 2018).
Importance of the Evaluation
It is important to identify which areas of the ABC Rehab addiction recovery program
have contributed to their 85 percent success rate and examine ways the organization can improve
in order to meet their goal of 100 percent recovery rate for all graduates once they leave the
program. If their program is not able to meet this goal, two out of ten graduates will continue
their addictive behavior and be added to the 21 million Americans struggling with addiction each
year (NSDUH, 2014), as well as contribute to the $200 million each year in national costs
dealing with substance abuse (ONDCP, 2007). With up to 150 students in the program at one
time, 30 of those students dealing with serious addiction will not be prepared to face relapse
situations once they leave the program. This study will have a direct impact on addicts
participating in this program through identifying key elements, informing ABC Rehab to assist in
6
program modifications in order to meet the organizational goal, and ensuring greater success in
the recovery process.
Description of Stakeholder Groups
The stakeholders identified for this study are the organization’s faculty team, current
students in the program, and former students who have graduated from the program. Each has a
role in ensuring the success of ABC Rehab’s goal by focusing on what they can do in their
respective areas to improve on the tools and techniques for recovery, as well as sustaining
sobriety once students graduate from the program. This section will further define these
stakeholders and the roles they have in achieving the organization’s goal.
Faculty. Faculty oversee the day-to-day instruction of students. They have the
responsibility over program format and to implement policies and procedures. This group has a
direct impact on the success of each student and the organization’s goal as they work with
students throughout the program and continue to support students, post-graduation. Faculty will
be able to implement new changes to the curriculum of the program and track the progress of
each student to monitor the effectiveness of the changes.
Current Students. Students are those persons enrolled in the addiction recovery
program for two years. They attend 2-4 formal classes each day, as well as participate in service
projects and personal study and application of teachings. Students are required to follow the
program format and apply the tools learned through various activities and situations while in the
program. Following this format gives them the greatest chances of success and therefore impacts
the organization’s ability to achieve their goal. Current students will be able to offer insights to
potential gaps in the program, as it relates to knowledge, motivation, and organizational
7
influences. Current students will also be able to provide the program leaders and faculty
feedback on program changes, as they relate to this study.
Former Students. This group consists of the students who have completed the two-year
program and graduated from ABC Rehab. Former students can help determine what factors lead
to successful graduation, early program termination, and compared relapse events. Past students
will have a greater understanding of tools and practices which have prevented relapse events and
provide input into skills gaps needed with facing relapses. This stakeholder group will be able to
provide ABC Rehab with feedback needed to address gaps in program curriculum.
Stakeholder Groups’ Performance Goals
Specific performance goals have been identified within the organization to align each of
the stakeholder goals with the organization’s goal, as well as the organizational mission. Table 1
gives a greater description of these goals and how they relate to ABC Rehab’s mission statement
and organizational goal of reaching 100 percent of their graduates remaining addiction free after
their first three years from graduating the program by 2025.
Table 1. Organizational mission, performance goal, and stakeholder goals
Organizational Mission
To be a worldwide leader in providing, cultivating, teaching, advancing, and instilling
each student with the desire to always strive to be the best they can be for themselves,
their families, and their communities.
Organizational Performance Goal
By end of year, 2025 ABC Rehab will achieve 100 percent recovery rate for program
graduates, for the first three years after graduating from the program.
Stakeholder Goals
8
Former Students
To maintain sobriety
after three years, or
more, after graduating
from the ABC Rehab
addiction recovery
program.
Leadership and Faculty
To implement program
improvements by 2025 in
order for ABC Rehab to
reach the goal of 100
percent of all graduates
becoming addiction free.
Current Students
To graduate from ABC
Rehab with the skills
and tools needed to
successfully overcome
addiction.
Stakeholder Group of Focus
Although a complete analysis would involve all three stakeholder groups, for practical
purposes, former students will be the stakeholder group focused on for this study. This group
has been selected because of the influence they have on the organization and on the success of
ABC Rehab’s organizational goal. Because the members of this stakeholder group have been
through the program, they are able to reflect on which tools and methods most prepared them to
reach full recovery from their addictions. They are the only stakeholder group who will be able
to offer experiences from the methods taught at ABC Rehab and help to determine which
program tools and methods helped them overcome relapse and addiction.
Purpose of the Project and Questions
The purpose of this study is to gather research on the demonstrated areas of excellence in
ABC Rehab’s addiction recovery program to determine which areas are contributing the greatest
success in student addiction recovery once they leave the program. The purpose is to identify
key elements of the methods and skills taught by ABC Rehab in continuing sobriety among
former students in order to help ABC Rehab reach its goal of 100 percent sobriety. The analysis
of this study focused on the assets in the areas of knowledge and skill, motivation, and
9
organizational influences. While a complete study would focus on all stakeholders, for practical
purposes the stakeholder group to be reviewed for this analysis are the former students in the
program. The questions guiding this study were:
1. What are the knowledge, motivation and organizational elements ABC Rehab has
chosen to effectively address this problem of practice?
2. What assets does ABC Rehab have that effectively addresses this problem of
practice?
After the analysis of findings, recommendations for organizational practice in the areas of
knowledge, motivation, and organizational resources will be provided in Chapter 5.
Conceptual and Methodological Framework
This study employed the Clark and Estes (2008) conceptual framework and used a
qualitative method approach, using the grounded theory, to data gathering. ABC Rehab’s
curriculum was assessed for its effectiveness through qualitative methods, using interviews in
order to understand and identify the areas of knowledge, motivation, and organizational
influences in the program, contributing to the program’s success. By using a qualitative
approach, data was categorized and analyzed to determine gaps and relationships in the data
(Merriam & Tisdell, 2016). A mixed method model was considered, however, using the
qualitative method allowed this study to answer the research questions for this evaluation.
Research-based solutions were recommended and evaluated in a comprehensive manner.
Definitions
Addict: A person who has a physical dependency to a harmful substance, such as drugs and/or
alcohol (National Institute of Health).
10
Addiction: A chronic disease characterized by drug seeking and use that is compulsive, or
difficult to control, despite harmful consequences (NIDA, 2019)
Cultural Model: Shared mental normative understandings of how the world works (Rueda,
2011).
Cultural Setting: The who, what, when, where, why, and how of the routines that define
everyday life (Rueda, 2011).
Full Recovery: For the purpose of this study, full recovery is when a student is free from their
addictive actions.
Long-term Recovery Program: Addiction recovery program lasting more than one year.
Recovery Program: An addiction program designed to help addicts overcome their addictions.
Relapse: Defined as both an outcome and a process, encompassing any transgression in the
process of behavior change (Witkiewitz & Marlatt, 2004).
Sobriety: The state an addict enters once they have overcome their addiction(s) (Witkiewitz &
Marlatt, 2004).
Substance Abuse: When a substance such as drugs and alcohol is used for intentions other than
those recommended by medical professionals (American Addiction Center).
Therapeutic Community (TC): A model, or philosophy, for the treating of addicts in a long-term
recovery program, usually community based where students help each other through the
recovery process (Leon, 2000).
Organization of the Project
This study consists of five chapters. Chapter One provided the reader with overall
concepts and terminology used when discussing addiction recovery and rehabilitation centers. It
11
also gave an overview of the organization being studied, their mission, goals, and a stakeholder
group directly impacting the research questions for this study. Chapter Two further reviews
relevant literature supporting the scope of this study. Topics of addiction and relapse will be
further explained, as well as the models and theories used to address these issues, based on the
Clark and Estes (2008) gap analysis and conceptual framework. Chapter Three details the
knowledge, motivation, and organizational influences to be evaluated, as well as methodology
when it comes to the choosing of participants, data collection and analysis. In Chapter Four the
data and results are assessed and analyzed. Finally, Chapter Five provides solutions, based on
data and literature, for closing the perceived gaps as well as recommendations for an
implementation and evaluation plan for the solutions.
12
CHAPTER TWO: REVIEW OF THE LITERATURE
The purpose of this promising study is to examine how ABC Rehab effectively
demonstrates excellence in their long-term addiction recovery program in order to improve the
percentage of graduates reaching a full recovery within three years from graduation. With 21
million American suffering from addiction each year (NSDUH, 2017), and a 200-million-dollar
national impact (ONDCP, 2007), it is critical to further understand current recovery treatments
and how recovery programs are preparing addicts to overcome addiction and achieve life-long
recovery. This study evaluated one organization’s program and how well it prepared students to
continue in the recovery process once they graduated from the program.
Chapter One introduced a problem of practice and identified ABC Rehab as the
organization being evaluated for this study. Chapter One further defined the organization’s
mission and goals, as well as identified former students as the stakeholder group focused on for
this study. Chapter Two is a literature review discussing the challenges related to overcoming
post recovery program relapse events in graduates and looking at the Clark and Estes (2008)
conceptual framework to evaluate the knowledge, motivation and organizational influences of
ABC Rehab. The first section of this chapter will give an overview of how addiction impacts the
U.S., factors that contribute to addiction, and theories explaining those factors. The second
section will look at current recovery programs and which elements of those programs have
shown to be effective. The third section discusses former students as the stakeholder group of
focus for this study. The fourth section will discuss the Clark and Estes (2008) conceptual
framework and review how it relates to knowledge, motivation and organizational influences.
The next section will look at the those influences and how they pertain to the stakeholder group
13
of focus. Finally, Chapter Two will conclude with the conceptual framework for this study and
how the stakeholder group aligns with the organization and to the organizational goal.
Influences on the Problem of Practice
Major Addictions in the US
Alcohol and drug addiction have quickly become an epidemic in America (Hafner, 2016).
The U.S. Surgeon General conducted a study to find that one in seven Americans suffer from
addiction, and only ten percent of those addicted will seek out treatment (Hafner, 2016). The
American Addiction Center reports that 18 million Americans suffer from alcohol addiction,
over four million with marijuana addiction, and two million are addicted to prescription drugs,
making up three of the top five most common addictions in the U.S., the other two being tobacco
and cocaine addiction (American Addiction Center, 2019). Much of this has to do with the
social acceptability each of these drugs have in society. However, studies show these addictions
can lead to an increased risk of becoming addicted to other drugs such as cocaine, heroin, and
opioids (National Institute on Drug Abuse [NIDA], 2019). Over 80 percent of heroin addicts
attribute their addiction to prescription drugs (NIDA, 2019). One study showed how the use of
voluntary, recreational drug use led to compulsive drug seeking habits (Everitt & Robbins,
2013). This study furthers showed how developing the habit of recreational use contributes to
the compulsive behavior of addiction (Everitt & Robbins, 2013). Hafner argues that solving this
problem can’t be done by just passing laws but will require communities coming together to
fight addiction (Hafner, 2016).
14
Factors of Addiction
Many factors can influence struggles with addiction. Addiction risk factors can include
genetic predisposition; psychological factors, such as stress, personality, depression, and certain
disorders; and environmental influences (Center for Addiction, 2018). Although anyone can
become addicted, these factors greatly increase an individual’s odds of abusing substances. The
Center for Addiction (2018) states that genetics can increase the risk of addiction by 50-70
percent. Kreek, Neilsen, Butelmand, and LaForge (2005) show how genetics plays in the risk for
addiction also depends on other factors. Studies have shown how the linkage between genetics
and addiction can result in higher risks of addiction among those who use drugs and alcohol
(Kreek et al., 2005). Erickson and Wilcox (2001) also argue how combining factors like
genetics, learning ability, or brain chemistry can increase a person's addictive behavior.
Additional risk factors, such as environment, an individual’s friends and family, or critical
development stages in their lives, addiction can become almost certain in many individuals
(National Institute on Drug Abuse, 2018).
One other major contributing factor to addiction deals with relapse events. Osborn
(2014) argued how relapse is part of an underlying process keeping addicts from overcoming
their addictions. Kreek et. al. (2005) also agreed relapse is part of the addiction process
stemming from a perpetual process of regular substance use leading to dependency and resulting
in relapse. Osborn (2014) further stated how 85 percent of individuals will relapse within the
first year following treatment, and up to 70 percent will relapse within the first few months of
treatment. Witkiewitz and Marlatt (2004) discussed how relapse causes individuals to revert
back into previous problematic behavior due to the stress of attempting to change that same
15
behavior. Based on these findings it can be concluded that if an addiction recovery program is
able to decrease the amount of relapse events a student goes through; the student will have a
higher probability of reaching full recovery.
Theories Examining the Factors
Theories explaining the factors of genetics, psychological and environmental give some
understanding around how current treatment is being adopted in recovery centers.
Genetic theory. Research around this theory show an individual’s genetics may
contribute to how they deal with addiction. Kreek et al. (2005) explained the need to focus on
how multiple genetic variants, such as impulsivity and stress responsivity, contribute to
addiction, and understanding the factor of genetics is also key to implementing strategies for
overcoming addictive behaviors. This study also showed linkage between impulsivity and stress
responsivity across multiple generations, as a way to validate this theory. Their study concluded
with the need to further modern technologies in order to study genetic influences on addiction
(Kreek et al, 2005). Another study showed how several gene related anatomical, functional and
cellular changes in the brain system contributed to drug abuse (Ouzir & Errami, 2015). These
genetic changes in the brain showed to affect the reward and decision-making process addicts
make when abusing substances (Ouzir & Errami, 2015).
Psychological theory. The greatest factors around this theory have shown to be stress
and depression. In a study on how depression in both men and women contribute to drug use, it
showed how abuse (sexual, physical, or emotional) led to higher levels of depression than those
in the study who did not suffer from drug addiction (O’Conner et al., 1994). In another study
looking at depression and stress as it relates to internet addiction showed how addiction increases
16
these levels, resulted in loss of control, impairment of function, and reduced decision-making
abilities (Ahmet & Murat, 2011). Their study showed how addiction caused increased levels of
depression and stress because addicts displaced valuable time in areas that would have reduced
these factors, such as spending time with family and friends (Ahmet & Murat, 2011).
Environmental theory. It is important to understand the impact an individual’s
environment plays in their addiction, in order to understand the proper prevention and treatment
strategies (National Institute on Drug Abuse, 2018). The NIDA also stated how the home
environment, especially during childhood, is a major factor in addiction. If other family
members abuse drugs and alcohol there is an increased chance the child will also do the same
(NIDA, 2018). One study has shown how an addict’s relationship with family, community, and
society should be taken into account when evaluating treatment for abuse (Covington, 2008).
Although it is not always recommended for addicts to build on existing relationships during
treatment, it is important they are in an environment to develop new relationships with those they
have not hurt in the past (Vaillant, 1988). S. Peele (2004) stated how improved treatment can be
accomplished through forming new relationships or developing new skills. Kreek et al, (2005)
also agreed how environmental factors influence the progression of drug use, its progression to
abuse, and the propensity for repeated relapse.
Current Types of Recovery Programs
The National Institute on Drug Abuse (2018) defined the current types of treatment for
addiction recovery in two main areas, treatment approaches and individual programs. Treatment
approach programs deal with using medications and counseling whereas individual programs
tend to be specifically designed to the person’s needs (NIDA, 2018). These various programs
17
can be further broken down to program types, such as long-term, short-term, outpatient, and
individualized. Although each of these types of programs have obvious differences, they are
really designed to meet the various needs of those looking for programs which will give them the
greatest chance for success (NIDA, 2018).
Long term programs. These programs provide 24-hour care in a non-hospital setting. They
generally last from 6 to 12 months, but some centers can be longer in duration. According to the
NIDA, the best-known treatment model is the Therapeutic Community (TC). This model
focuses on the resocialization of the addict to use the community of the program (De Leon,
2000). These centers also often offer employment trainings and support services onsite.
Short term programs. These programs are usually intense yet brief treatments, and most
follow a modified 12-step program (NIDA, 2018). Short-term programs were originally
designed to treat alcohol addiction but have begun to include other types of substance abuse.
These programs are usually hospital based and last from 3 to 6 weeks, followed by some level of
outpatient therapy, or self-help group such as Alcoholics Anonymous (AA). The National
Survey of Substance Abuse Treatment Services (2017) stated around 70 percent of recovery
programs follow some type of 12-step program.
Outpatient programs. These programs vary in intensity and length. They generally cost
less than other programs and also help those who are unable to commit to lengthy programs. The
NIDA (2018) stated how these programs may not be able to offer more than drug abuse
education. They also focus on group counseling, or other outpatient programs to help with
mental health issues along with drug addiction.
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Individualized programs. These programs focus on reducing or stopping illicit drug and
alcohol use (NIDA, 2018). Individualized programs also offer areas related to employment,
illegal activity, and family and social relations. These types of recovery programs help patients
develop coping strategies and tools to abstain from drug use. Counselors recommend 12-step
programs and also make referrals for other services such as medical, employment, and
psychiatric (NIDA, 2018). The duration of these programs also varies depending on the needs of
the addict.
Program Effectiveness
Looking at the current effectiveness of addiction recovery programs can be challenging
due to the fact that the structure around these programs is lacking in the United States (Dakis &
O’Brien, 2005). Society has historically viewed addiction as a social problem rather than an
actual disease, making treatment methods challenging to address root causes of addiction (Dakis
& O’Brien, 2005). Addiction recovery programs vary in program format, length, and
effectiveness; however, key elements have shown to be more impactful than others.
Effective elements. The NIDA provides current information on elements of effective
treatment, which should include addressing the needs of individuals, adequate period of time,
behavior therapies, continued assessments, and counseling (NIDA, 2018). Further reviews
regarding these elements agreed in key program areas and should have as part of the treatment
process. Felman (2018) also stated effective treatment must include counseling and behavior
therapies. He added cognitive-behavior therapy has helped in effective treatment (Felman,
2018). This therapy helped addicts recognize and change behavior that is associated with
substance abuse.
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The use of medically assisted drugs to address the physical symptoms of withdrawal have
shown to be effective in some situations, although it has done little to change long-term drug use
(NIDA, 2018). One study showed the use of medically prescribed drugs could decrease alcohol
cravings but showed less success with other addictive substances (Dakis & O’Brien, 2005).
Another study showed the use of medically assisted drugs to treat opioid addiction when used
with psychological support. The findings did show a reduced dependency versus those who did
not receive the medically assisted drug (Pierce et al, 2015). This type of treatment, when used,
should be part of a larger recovery strategy as detoxification alone does not lead to full recovery
(NIDA, 2018).
Effectiveness issues. Although specific areas of treatment have been shown to be
positive, some issues in current programs kept addicts from reaching full recovery. One of these
issues delt with how programs don’t address gender needs, especially for women seeking
treatment. One study concluded that recovery programs need to offer gender responsive services
that address the psychosocial needs of women (Covington, 2008). Another study showed how
treatment programs may not be aware of the particular needs of women who suffer from drug
addiction, keeping them from seeking treatment (O’Conner et al., 1994). Other issues with
treatment effectiveness can come from addicts unable to pay for programs, or not have treatment
covered through insurance. Dakis and O’Brien (2005) argued how treatment options can be
severely limited by insurance company policies, even when the addiction is a chronic illness.
These theories and factors were considered throughout this study and used to help answer
the research questions for the evaluation of ABC Rehab. It is important to understand the
elements of effective treatment and how these elements can increase the likelihood of addicts
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reaching full recovery through recovery programs. There is a need to further study positive
methods and factors of addiction to teach effective ways to decrease relapse and overcome
addiction (Witkiewitz and Marlatt, 2004).
Role of Stakeholder Group of Focus
This section will focus on the background of former students, who have graduated from
the program at ABC Rehab and their role in this study. This group was selected because they are
applying the concepts and tools learned while in the program, and they will be able to provide a
greater understanding of the program’s value as it relates to preparing students to deal with
relapse events and reach full recovery. This section will also further discuss the Clark and Estes
Theoretical Framework as the conceptual framework needed to identify critical areas in the
organization’s curriculum and the format used to capture the areas of focus for this study.
Clark and Estes’ (2008) Gap Analysis Framework
A conceptual framework is a type of analytical tool used to identify gaps keeping an
organization from accomplishing their strategic goals and is suited to study stakeholder
performance within an organization (Clark & Estes, 2008). This problem-solving process is
based on 1) understanding of stakeholder goals compared to the organization’s goals, and 2)
identifying assumed performance influences in the area of knowledge, motivation and
organization based on general theory, context-specific literature and existing understanding of
the organization. These areas helped to determine the performance influences where these gaps
need to be addressed; this is often referred to as the KMO (Knowledge, Motivation,
Organization) model. These elements are tools to help an organization identify problems that
cause gaps between strategic goals and performance (Clark & Estes, 2008). Greater explanation
21
of these factors is further explained in the next section and discusses how these KMO
performance influences apply to the stakeholder group.
Stakeholder Knowledge, Motivation, and Organizational Influences
Knowledge Influences
This factor was used to determine if people within the organization had the knowledge, or
skills, needed to achieve the stakeholder performance goals. If not, then a knowledge and skills
gap was addressed (Clark & Estes, 2008). Two factors were considered when addressing
knowledge and skills gap. First, open communication needed to happen in order to establish the
skills being considered. Second, an organization must give an honest assessment of their current
state in order to ensure skills development is happening in the correct areas.
This study examined literature relevant to the stakeholder and stakeholder goals. Clark
and Estes (2008) discussed the need to determine whether or not people know how to achieve
performance goals. They gave four knowledge and skills enhancements in order to address
knowledge types in an organization. These enhancements are Information, Job Aids, Training,
and Education (Clark & Estes, 2008). Information addresses what stakeholders need to know in
order to succeed on their own. Job Aids provide them with self-help tools stakeholders can use
to achieve their performance goals. Training is when stakeholders need to acquire skills and
knowledge specific to their goals. Finally, Education gives conceptual, theoretical, and strategic
knowledge to deal with the challenges and problems with achieving their goals. Once these
knowledge components are applied to an organization, they will help identify the knowledge
areas which need to be solved (Clark & Estes, 2018). These areas are important to understand as
this study applied these knowledge types to the stakeholder goals and assumed influences on
performance to those goals.
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Knowledge influence 1. Former students leave the program with the tools needed to
overcome addiction.
Knowledge influence 2. Former students will understand how relapse plays a part in the
recovery process.
Knowledge influence 3. Former students will understand which tools learned in the
program were most helpful to reaching full recovery.
Table 2 is a narrative of the Knowledge influences and assessments for identifying a knowledge
gap analysis.
Table 2. Knowledge Influence, Types, and Assessments for Knowledge Gap Analysis
Organizational Mission
To be a world leader in providing, cultivating, teaching, advancing, and instilling in
each student the desire to always strive to be the best they can be for themselves, for
their families, and for their communities.
Organizational Global Goal
ABC Rehab’s organizational goal is to achieve 100 percent recovery rate for all
graduates within the first three years after leaving the program, by 2025.
Stakeholder Goal
The stakeholder groups to accomplish this goal is former students. Each former
student has a role in ensuring the success of ABC Rehab reaching their goal by
focusing on what they learned from the program, and tools they applied to
overcome relapse and reach full recovery after graduation.
Knowledge Influence Knowledge Type Knowledge Influence
Assessment
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Former students need to
leave the program with an
understanding of the tools
needed to overcome
addiction
Conceptual Interview:
What steps from the
program are helping you
to overcome addiction?
What areas could be
improved?
Former students need to
understand how relapse
plays a part in the recovery
process.
Conceptual Interview:
How do you understand
addiction? How do you
understand the role
relapse plays in the
recovery process?
Former students need to
understand which tools
learned in the program were
most helpful to reaching full
recovery.
Procedural Interview:
What techniques have you
applied that have helped
overcome addiction?
What do you feel would
have helped better prepare
you for dealing with
relapse events?
Motivation Influences
Motivation is defined as the process in which goal-directed action is instigated and
sustained (R. Rueda, 2011). Other definitions described this as an internal state of mind that
initiates and maintains behavior (R. Mayer, 2011). Motivational gaps can be challenging to
establish; however, this area is critical to the internal and psychological process that gets
stakeholders working towards performance goals (Clark & Estes, 2004). Three main factors
needed to be addressed in order to close motivational gaps. First, stakeholders needed to make
an active choice to pursue performance goals. Active choice takes place when stakeholders
begin to take steps towards their goals. Second, they needed to keep working at them until the
goal is complete or be persistent when they get distracted throughout the process. Third, there
needed to be consideration of the mental effort required by teams to complete the goals. This
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can be challenging for stakeholders when they lack confidence in their ability to accomplish their
goals (Clark & Estes, 2008). The theories used to explain motivation were self-efficacy theory
and expectancy value theory. This section further explained these theories, as well as how they
applied to former students as the stakeholder group of focus for this study.
Self-efficacy theory. Rueda (2011) explained self-efficacy is how people view their
capabilities at executing a course of action towards their goals. It can also be defined as a
person’s belief in their ability to influence things that impact their lives (Bandura, 2010). As
well as a belief in how someone will think, behave, and feel in a particular situation (Cherry,
2018). Those with higher levels of self-efficacy participate more frequently, work harder, and
show a greater interest in learning (Schunk & Pajares, 2009).
Motivational construct 1. As former students graduate from the program, they will
need to be confident in applying the tools and techniques learned in the program independently.
This confidence will allow them to stay motivated as they work towards full recovery. As
motivation increases, so will self-efficacy (Bandura, 2010).
Expectancy value theory. Feather (1992) stated this motivational theory is a
framework for how someone’s actions are related to the expectations they hold towards a given
action.
O’Keefe and Osborn (2014) argued how within the first year of completing a
rehabilitation program, former students began thinking of their addictions, and their internal
struggles led them to relapse. Feather (1992) further explained the link between expectancy-
value theory and the psychological well-being an addict faces when thoughts of past addictions
take hold.
25
Motivational construct 2. Former students who have graduated need to understand the
value of the program and how their efforts in the program helped them to achieve full recovery
from their addictions. If former students had positive experiences while in the program, they are
more likely to continue towards recovery. This theory will help determine the value former
students have once they graduate from the program and how their actions compare to those
values. Table 3 is a narrative of the stakeholder motivational construct and assessment for
developing a motivational gap analysis.
Table 3. Motivational Influences and Assessments for Motivation Gap Analysis
Organizational Mission
To be a world leader in providing, cultivating, teaching, advancing, and instilling in each
student the desire to always strive to be the best they can be for themselves, for their
families, and for their communities.
Organizational Global Goal
ABC Rehab’s organizational goal is to achieve 100 percent recovery rate for all graduates
within the first three years after leaving the program, by 2025.
Stakeholder Goal
The stakeholder groups to accomplish this goal is former students. Each former student has
a role in ensuring the success of ABC Rehab reaching their goal by focusing on what they
learned from the program, and tools they applied to overcome relapse and reach full
recovery after graduation.
Assumed Motivation Influences Motivational Influence Assessment
26
Self-Efficacy Theory
Former students need confidence in utilizing
the tools and techniques to stay motivated as
they work towards sobriety.
Interview:
How confident are you in your abilities
to overcome addiction?
How motivated are you in applying the
tools and techniques learned as you work
towards sobriety?
Expectancy Value Theory
Former students need to understand the value
from the program in order to see how their
efforts can improve their chances of
achieving full recovery.
Interview:
How valuable was your effort in the
program as your worked towards
recovery?
How did your efforts improve your
chances of reaching full recovery?
Organizational Influences
General theory. The final area of the KMO conceptual framework deals with the
organizational influences. Clark and Estes (2008) stated how stakeholders need to have the
knowledge, skills, and motivation needed to achieve their performance goals, but those goals can
be prevented due to poor organizational processes and resources, as well as a negative cultural
setting. This study evaluated former student goals through qualitative methods and considered
the views of those directly engaged with achieving the organization’s goal. Organizational
barriers were then identified and compared to the problems and aspects keeping organizational
performance goals from being achieved (Clark & Estes, 2008). Another factor to an
organization’s influence would be the cultural model and cultural settings that enable ABC
Rehab to influence students in the program. Cultural models (CM) are generally shared ideas of
how things work, or should work, within an organization (Rueda, 2011). Cultural settings (CS)
are the visible ways the ideas in the cultural model are accomplished (Rueda, 2011). The CM
and CS are elements the organizational influences ABC Rehab is responsible for in order to
27
achieve their goal, while the knowledge and motivational influences are the areas in which the
organization impacts former students to also help achieve their goal.
Stakeholder specific factors. Clark and Estes (2008) stated how organizational culture
develops over time. Students spend up to two years in the ABC Rehab recovery program, and
the culture can change multiple times throughout the program, as opposed to other Therapeutic
Community centers which range from 6 to 12 months (Felman, 2018). Culture can also change
among the students in the program depending on how long they have been in. Once students
graduate from the program, they no longer have the structure of the organization, making it hard
to adjust to new norms and routines. Clark and Estes (2008) further explained how this culture
within groups gives the stakeholders an atmosphere of cooperation and shared responsibility.
Once they leave these groups, former students learn their new culture is about individual
initiative and competition, making it a challenge to adjust to their new environment outside the
program.
This perspective led to two organizational influences within ABC Rehab. First, former
students are moving from an environment in the organization’s structured culture to an
unstructured environment with multi-culture surroundings once they graduate the program and
need to understand how those environment shifts impact the former students’ ability to achieve
full recovery. Second, the organization needs to study the effectiveness of the program and how
prepared students should be to deal with relapse events once they graduate the program.
Additional influences can also be identified through the CM and CS of the organization
(Rueda, 2011). The structured, controlled culture of the organization is one of the main
influences evaluated and is also the cultural model within ABC Rehab. It was important to
understand how this model had prepared former students to reach full recovery after graduation.
28
Since ABC Rehab is a full-time, live-in facility, this can be identified as our cultural setting,
meaning this element is the setting in which the CM can be implemented.
Further study of the organization needs to be addressed in order to evaluate how the
organizational influences and the CM and CS influences impact the knowledge and motivations
of former students and impact the organizational goal. Table 4 shows how the assumed
organizational influences, CM and CS, will be evaluated in order to ensure they align with the
organization’s mission and organizational goal.
Table 4. Organizational Influences and Assessments for Motivation Gap Analysis
Organizational Mission
To be a world leader in providing, cultivating, teaching, advancing, and instilling in each
student the desire to always strive to be the best they can be for themselves, for their
families, and for their communities.
Organizational Global Goal
ABC Rehab’s organizational goal is to achieve 100 percent recovery rate for all graduates
within the first three years after leaving the program, by 2025
Stakeholder Goal
The stakeholder groups to accomplish this goal is former students. Each former student has
a role in ensuring the success of ABC Rehab reaching their goal by focusing on what they
learned from the program, and tools they applied to overcome relapse and reach full
recovery after graduation.
Assumed Organizational Influences Organizational Influence through
Interviews
It is important for the organization to prepare
students to move from a structured
What did ABC Rehab do to help you
transition from a structured environment
29
environment to a new environment outside
the program. (Organizational Influence)
in the program, to a new environment
outside the program?
It is important for the organization to
evaluate student preparedness to reach full
recovery once they leave the program.
(Organizational Influence)
How were you evaluated at the end of the
program, by the ABC Rehab, to determine
how prepared you were to reach full
recovery after graduation?
It is important to understand how living full-
time at ABC Rehab has helped in the
recovery of former students. (CS)
How has living at the facility full-time
helped in your recovery?
It is important to understand how the culture
at ABC Rehab contributed to former students
reaching full recovery. (CM)
How do you feel the culture of the
program helped you while you were there?
It is important to understand how the
organizational structure at ABC Rehab
contributed to former students reaching full
recovery. (CM)
How did the structure of the organization
help you as you worked towards recovery?
Conceptual Framework: The Interaction of Stakeholders’ Knowledge and
Motivation and the Organizational Context
The purpose of the conceptual framework is to explain the concepts of this study, as well
as the relationships between the framework elements. Another key element of the conceptual
framework is to use a model to depict the theory of what is being investigated (Maxwell, 2013).
This section used the conceptual framework model to explain the relationship and interactions of
the former student’s knowledge and motivations with the organizational context. Although each
of these elements have been explained in an earlier section, this section will show how each
relates to one another within the framework.
30
Figure 1 shows the conceptual framework for the ABC Rehab organization and the
relationship with former students as the stakeholder of focus. This model shows each of the
organizational elements that influence the organization, cultural settings, as well as the cultural
model for ABC Rehab. Also shown are the knowledge and motivation influences the
organization has on former students in the program. Each of these elements interact within the
cultural model to achieve the stakeholder’s and organization’s goal of reaching 100 percent of all
program graduates achieving full recovery within three years of leaving the program. This
relationship is important because of the knowledge and skills needed among the former students
and ABC Rehab in order to increase the probability of full recovery over time (Witkiewitz &
Marlatt, 2004).
Figure 1. Conceptual Model
31
Figure 1 shows the relationship between ABC Rehab and the former students as they
relate to the organizational goal. As the organization, ABC Rehab has the responsibility to
provide the correct tools and methods to their students in order for them to successfully reach full
recovery from their addictions. They also create a structured environment at a full-time, live-in
facility where the culture is structured around the program elements. This also shows how
former students in the organization are impacted by the organizational influence and the impacts
of the knowledge and motivational influences for reaching the organization’s goal. As
stakeholders to the organization, former students are connected to the goal, yet they are no longer
part of the organization once they have graduated from the program. In the lower box is the
organization’s goal. The figure shows how both the organization and the stakeholder work
toward accomplishing the same strategic goal for the organization.
Conclusion
Chapter Two reviewed literature around the challenges of overcoming addiction. It also
discussed factors that influenced this problem, as well as specific factors of addiction such as
genetics, environment and relapse. Further discussion reviewed the types of recovery programs
available and the effectiveness those program types have on addicts reaching full recovery. This
chapter also presented elements through the KMO conceptual framework model based on the
Clark and Estes methodological framework. This model helped to define the knowledge,
motivation and organizational influences impacting the research questions for this study. Also
included in this chapter was an overview of former students as the stakeholder group of focus for
this study and the knowledge and motivational influences that impact this group. It discussed the
cultural model and cultural setting which enable the organizational influences and outlined them
in conceptual model. Finally, chapter two discussed how the organizational influences impact
32
the knowledge and motivational influences of the stakeholders, and how all of this aligns to the
organizational goal. Chapter Three will present the study’s methodological approach and will be
used to validate the elements discussed in Chapter Two.
33
CHAPTER THREE: METHODS
This study used a qualitative research method. This method was selected because the
research questions were looking for better meaning and understanding around successful areas of
ABC Rehab’s program (Merriam & Tisdell, 2016). Grounded theory questions how something
changes over time, as well as providing guidelines to identify relationships within the research
(Merriam & Tisdell, 2016). The researcher conducted interviews as a form of data collection.
This data collecting method was selected because of its effectiveness in gathering information
that cannot be observed when collecting information on feelings and events that are impossible
to replicate (Merriam & Tisdell, 2016). Interviews allowed for greater depth of data than other
methods, such as observations and surveys. This study was guided by the following questions:
1) What are the knowledge, motivation and organizational elements ABC Rehab has chosen to
effectively address this problem of practice?, and 2) What assets does ABC Rehab have that
effectively address this problem of practice?
This chapter explains the research design, data collection, and analysis strategy.
Additionally, this chapter looks at the participating stakeholder group, inclusion criteria and the
rationale for the sampling strategy. Finally, information is outlined regarding the data collection
and analysis, credibility and trustworthiness of the data, as well as validity and reliability of the
data collection process. This section concludes by discussing the ethical practices of using
human subjects in the data gathering process, and any limitations and delimitations for this study.
Research Design
The researcher performed interviews as part of the qualitative data collecting method.
This method was chosen because it would provide the highest quality of findings needed to
answer the research questions for this study (Merriam & Tisdell, 2016). Further details about
34
this method are explained in following sections within this chapter, and how the findings from
these interviews will be examined and used.
Merriam and Tisdell (2016), talked about the importance of interviews as a way for the
researcher and participants to address questions related to the research topic. As part of the
interview process, specific questions were asked of each participant to address the knowledge,
motivation, and organizational elements of the study. Other types of data collection methods
were considered, such as observations and surveys, however, it was determined those methods
would not produce relevant finding to the research questions, where the use of interviews could
provide the same findings from those other methods.
Participating Stakeholders
The stakeholder group consisted of former students in the program who have graduated
and have been successful in their recovery for at least 12 months. This group was selected
because they have experience applying the principles and tools learned in the program and have
a greater understanding of which tools and principles have proven to be more effective in their
personal situations. They provided examples of how the program has helped them to overcome
relapse events and reach full recovery.
Interview Sampling Criteria and Rationale
There was one criterion used to determine eligibility to participate in the interviews.
Former students must have graduated from the program prior to being interviewed. One
criterion was selected in order to keep the list of qualified former students the greatest possible to
interview. Currently there are 119 former students who fall within the sampling criteria (ABC
Rehab, 2018). Twenty former students, who have graduated, were interviewed for this study.
35
Graduated from program. Each of the twenty interviewees participated in the
interview process have graduated from the ABC Rehab addiction recovery program. This study
focused on identifying knowledge, motivational, and organizational areas within a recovery
program as it prepared former students to deal with relapse events and reach full recovery.
Students who have completed the program may respond with valuable feedback around which
areas of the program helped them achieve their goal of full recovery
Interview Sampling Strategy and Rational
The sampling strategy for this study was a convenience strategy due to the accessibility
of the population. Potential participants were contacted by phone and email through ABC Rehab
and asked to participate on a volunteer basis. With the consent of each former student to be
interviewed, a contact list was provided to the researcher as a way to communicate the purpose
of the interviews, determine eligibility, answer questions about the interview process, and
schedule interviews. Initial estimates for interviews were former students from each of the three
program locations, Seattle, Washington, Mesa, Arizona and Vancouver, Canada, totaling twenty
participants. The interviewer reached out to each of the former graduates on the list provided by
ABC Rehab. The interviewer scheduled interviews with the first twenty to confirm their
participation in the study. Although twenty former students were interviewed, this number could
be adjusted if saturation in the data was achieved or if additional interviews were needed. By
gathering data from separate locations, the interviews were not biased towards one location’s
culture or differences in applying principles from one program to the other.
Data Collection and Instrumentation
Interviews were chosen as the method used by the researcher to gather information from
the former students of ABC Rehab. The researcher selected this method of data collecting as a
36
way to ask former students about their experiences in the program and how the tools learned
have been applied to their lives once they’ve graduated. The purpose of the research was to
gather information in order to answer the research questions of what ABC Rehab has done to
effectively address the problem of practice. Interviews gave each of the former students the
opportunity to express aspects of the program which helped address relapse and addiction
recovery, and areas of the program which best supported their recovery efforts. Additional
observational data, such as body language, tone in responses, and other behaviors were collected
during the interviews and added to the data through the use of notes from the interviews. This
section discusses how interviews were used to collect data, as well as the data and artifacts used
to support the findings from the interviews.
Interviews
The interviews for this study were semi-structured, the interviewer asked standard
questions to each of the participants; however, the questions allowed for further follow-on
questioning as appropriate. Interviews were considered non-formal; however, they followed a
structured series of questions, but allowed interviewees the opportunity to take part in a relaxed,
comfortable environment. Each interview took place at a mutually agreed upon location, to
ensure the participant was comfortable during the interview. Interviews that took place in the
Seattle, WA area allowed for accommodation on days that accommodated the former student.
Interviews which took place in Arizona or Canada were still allowed for mutually agreed upon
locations but were done on the same day as other interviews in those areas. Twelve of the
interviews were conducted at one of the three ABC Rehab locations, two were conducted at the
interviewees home, and six were conducted over the phone. The phone interviews were needed
because those participants no longer lived within proximity of one of the ABC Rehab locations.
37
All interviews were audio recorded by hand-held recording device, with the consent of each
participant, and transcribed to ensure accuracy of the data.
Each interview question was directly linked to one of the two research questions for this
study, outlined in Chapter One. These questions also aligned with the assumed influences
identified in the conceptual framework to address the KMO gaps within the program. Merriam
and Tisdell (2016) explained the importance of assuring interview questions remain aligned to
the research topic. The interview questions helped interviewees focus on areas aligned to the
organization’s goal and the effectiveness the program has had in their recovery process.
At the completion of the interview process, each interview recording was transcribed and
analyzed for common areas between other interviews. Each of the transcribed interviews was
then sent back to the interviewee for confirmation of the correctness of their responses.
Transcriptions were done by a professional company to ensure proper handling of the
participants information. All transcripts were locked in a secure location for the remainder of the
study. Once the study was completed, the transcriptions were shredded, and the recordings
deleted.
Documents
In addition to performing interviews, additional documents were collected from ABC
Rehab. This information consisted of the organization’s mission statement, strategic goals and
values, a copy of the program curriculum, as well as researcher-generated notes from the
interviews. These documents were provided by the program manager, with the approval of the
program founder. The information provided in these documents was used to assess how ABC
Rehab’s program compares to the information gathered from the interviewee responses. All
38
documents collected were only referenced as it pertains to this research and returned to the
organization once they were no longer needed for the study.
Research consisted of separate notes taken during the interviewing process, used in
companion with the transcriptions of the interviews, as a way to examine thoughts,
interpretations, and impressions during the interviews. These notes also contained additional
insights after the interviews had concluded. Merriam and Tisdell (2016) discussed how this type
of data collecting should be used for generating documents in an effort to learn more about the
people being interviewed. Each research-generated document was added to the specific
interview transcript for which it was intended. The researcher wrote analytic memos after each
interview and each observation. The researcher also documented thoughts, concerns, and initial
conclusions about the data in relation to the conceptual framework and research questions.
Data Analysis
Once the researcher had left the field, interviews were transcribed and coded. In the first
phase of analysis, the researcher used open coding, looking for empirical codes, and applied a
prior code from the conceptual framework. Coding was generated based on the narrative, as
opposed to pre-generated codes. A second phase of analysis was conducted where empirical and
prior codes were aggregated into analytic/axial codes. In the third phase of data analysis the
researcher identified pattern codes and themes which emerged in relation to the conceptual
framework and research questions. The researcher also analyzed documents and artifacts for
evidence consistent with the concepts in the conceptual framework.
Credibility and Trustworthiness
Credibility and trustworthiness are an essential part of the data collection process for this
study. Three strategies were used to ensure credibility and trustworthiness: triangulation,
39
respondent validation, and peer review. Merriam and Tisdell (2016) explained the use of these
increases the credibility of the research because they help ensure the research findings match the
reality of the situation being studied. Triangulation was used to compare student responses with
data found in organizational process documents, provided by ABC Rehab. This method
examined all credible data in the findings through multi-source artifacts.
Respondent validation helped to ensure the interview notes represented the interviewees
correct feelings and responses to the interview questions. By soliciting feedback, greater
credibility was given to notes as they were compared to transcriptions when used for evaluating
the results of the interviews. The final strategy was the use of peer review. All of the findings
from the data collecting process were evaluated by a dissertation committee, familiar with this
research study, to review and determine if the process and findings were credible. Feedback and
recommendations were incorporated into the findings as appropriate to the study. Merriam and
Tisdell (2016) also argued how a peer review of the data helps to assess whether the findings
from the research are plausible.
Validity and Reliability
To ensure validity and reliability of this study, it was important to ensure transferability
of the findings, as well as retention rigor in the qualitative process (Morse et. al, 2002). In order
to achieve this, maximum variations strategy was applied. This strategy focused on interviewing
former students from multiple locations in order to limit cultural biases which could have
resulted from sampling groups who may have shared the same perspectives and experiences.
Merriam and Tisdell (2016) stated how this strategy can enhance the transferability of the
findings, because it allows for a greater range of application of the data.
40
Ethics
This study involved human subjects and the researcher’s responsibility was to protect the
participants of the study. As discussed earlier in this chapter, the researcher had the approval of
ABC Rehab to conduct interviews, prior to reaching out to the former students in the program.
Each participant was asked on a volunteer basis to participate, and a consent form was provided
with information on what the study was about and who they should contact for issues. Nothing
was promised to the former students as a gift for their participation in the interviews.
Participants were documented and referred to as a subject, rather than their name. Each subject
was coded to help organize recordings, transcripts, and other notes collected from the interviews.
Any personal identifying information from the recorded interview was omitted from the
transcriptions to ensure anonymity. All transcripts were done through a transcribing service and
these transcripts and recordings were stored in a locked drawer for the duration of the study.
All interviews were scheduled to take place at a mutually agreed upon location. If
participants were unable to attend in person, online and phone options were also available.
Regardless of interview location, each of the interviews were conducted in a private space with
only the researcher and the participant. Recordings were done through a hand-held recorder,
which kept all recordings on one device to keep recordings organized. Participants were asked to
refrain from using personally identifying information, or the information of others in the
program. Any such information found in the recordings was deleted through the transcription
process. Additional information is outlined in Appendix A, the interview protocol.
As a mentor at ABC Rehab, the researcher had no authoritative position over any student
or faculty member within the organization. Because of this, none of the participants felt coerced
or pressured to participate in the data collecting efforts. Prior to conducting any data collecting,
41
the researcher first gave an overview to the participants of the purpose and role as an
investigator; helping them to understand the relationship with the researcher and the participant
throughout the process. All data collected was used only for the purpose of this evaluation and
were not shared with other individuals or organizations. All data collected by the researcher was
deleted, shredded, or returned to ABC Rehab at the conclusion of the study.
42
CHAPTER FOUR: RESULTS AND FINDINGS
This chapter will present the results from the study and the key findings as they relate to
the purpose of the study and the research questions. As stated in Chapter One, the purpose of the
study was to examine which elements of the addiction recovery program at ABC Rehab
contributed to the success rate of 85 percent of program graduates becoming addiction free
within three years from completing the program (ABC Rehab, 2018). The results from this study
will also examine which elements of the program helped former students overcome addiction
and prevent relapse. The research questions which guided this study were:
1. What are the knowledge, motivation and organizational elements ABC Rehab has
chosen to effectively address this problem of practice?
2. What assets does ABC Rehab have that effectively address this problem of
practice?
In order to answer these questions qualitative data was gathered through interviews.
Chapter 3 explained the research design and data collection strategies through the use of
interviews. The participant stakeholders and sampling criteria for the interviews was also
outlined, along with the rational and sampling strategies for the interviews. This chapter will first
review the demographic results from the participant stakeholders. Next, the results from this
study will be used to answer the research questions for this study as well as the stakeholder
influences as it relates to knowledge, motivation and organizational influences. Finally, a
synthesis of the findings is provided to determine which elements of the addiction recovery
program showed to be effective in graduates overcoming addiction. Chapter Five will then
continue to address recommendations to the research questions as well as recommendations for
43
closing gaps in the areas of knowledge, motivation and organizational influences identified from
this study.
Participating Stakeholders
Interviews were conducted among twenty former students who had successfully
graduated from the program. To ensure the sample of students was random, each eligible
graduate was contacted through ABC Rehab in order to compile a list of volunteers to participate
in the study. The first twenty graduates to respond to the request, and able to commit to the
interviews, were selected. The breakdown of the participant responses showed 40 percent of the
participants graduated from the Seattle, Washington location, 35 percent graduated from the
Surrey, Canada location, and 25 percent graduated from the Mesa, Arizona location. Out of all
the locations combined, 90 percent of the participants were male, and ten percent female. The
average age of the participants was 36 years old, the oldest being 55 and the youngest being 27.
The average time from program completion was five years, the longest being 12 years since
graduation and the shortest was two years since graduation.
ABC Rehab provides rehabilitation for any form of addiction (ABC Rehab, 2018). This
study does not focus on any single form of substance abuse or addiction. However, each of the
twenty participants mentioned in their interviews at least one form of substance they had
recovered from. This information was important to the study as it shows the effectiveness of the
program at ABC Rehab regardless of what addiction a student is trying to overcome.
Prior to commencing the interview questions, each participant was informed that some
questions may seem similar, as it relates to tools applied versus knowledge applied. This study
asked for specific examples for each of these areas but found that some participants responded
the same to both areas, while others gave separate responses.
44
Determination of Assets and Needs
In collecting the data for this study, the primary data source was interviews performed by
the researcher. Secondary data for this study included information provided by ABC Rehab
regarding program format and demographic data of students. Data triangulation was used
through conducting interviews at each of the ABC Rehab locations, as well as conducting
interviews from a diverse group of graduates from the program in age, gender, and time after
program completion. Although 20 graduates were selected for interviews, saturation in the data
collecting was reached between interviews ten and 12. This was largely due to an increased
number of similar responses to 70-80 percent of the questions. It was decided by the researcher
to continue interviews with the remaining participants in order to validate saturation and to have
a greater number of data points in the findings.
In determining if an influence was an asset or a need, the researcher looked for findings
that met or exceeded 60 percent of a particular finding. This number was used to show how the
majority of participant responses aligned, keeping in consideration the differences in program
experiences across multiple locations. In some cases where an influence may have supported
findings greater than 60 percent, yet the details of those findings yielded lower scores from lack
of consistency, the influence may have been identified as both an asset and a need. This scoring
method was also agreed to by the participants in the interviews.
Results and Findings for Knowledge Causes
The results and findings for this section are reported using the knowledge categories and the
assumed causes for each category.
45
Conceptual Knowledge
Influence 1. Former students need to leave the program with an understanding of the
tools needed to overcome addiction.
Interview findings. Participants were asked through the interview process what specific
tools or steps they applied after graduation which helped them as they worked towards full
recovery from their addictions. Each of the participants gave unique responses to this question,
and all participants gave multiple answers to their responses. The results of this finding showed
two main areas the participants applied. These were Outward Tools, specific actions former
students made without being directed to do so, and Inward Tools, the emotional state former
students expressed or felt. Under Outward Tools, 12 of the 20 participants stated cleanliness and
structure were their most important tools for dealing with addiction. The participants explained
the program taught how keeping personal space clean would allow them to feel as if they had
accomplished something each day. The structure behind this gave students the ability to focus
on the importance of getting basic life caring things done each day, as a way to distract from
their addictions and cravings. Participant 20 added, “I still do all the stuff I was taught there, you
know, being clean and putting everything in its place.” Nine out of 20 stated actively engaging
in positive relationships, eight of 20 stated respecting others, and four of 20 said that engaging in
hobbies was a key tool for their addiction recovery. Fostering positive relationships included
friendships with other students in the program, and only associating with those outside the
program who enable a sober life. Participant 8 disclosed how she met her best friend while in
the program and both of them continue to talk and support each other years after graduating. She
also shared how this relationship allowed them to share a trust neither had been able to give in
the past. The ability to respect others gave participants the ability to mend past relationships, as
46
well as remind them of the importance of staying humble. Participant 11 stated, “When you use
you lose all respect for yourself and for others, because you live this life of deception. You have
to earn trust back, and that started with me learning how to respect others, even if I knew they
would never trust me again.” Hobbies were listed as outward tools which included things such
as exercise, schooling, or musical instruments. Each of the hobbies discussed in the interviews
appeared to be things each of the graduates were able to start while in the program.
In regard to Inward Tools, 17 out of 20 participants stated honesty was a major tool for
them in overcoming addiction, while 13 of 20 said how humility was key. Many of the
participants shared they felt deception was the best way to get friends and family to support their
addiction. They had lied about seeking treatment or committing to quit in an effort to get money
or food. Participants expressed being honest was critical to recovery. Participant 13 responded
by saying, “No secrets. That’s how I stay sober.” Humility seemed to be important because it
allowed the participants the ability to fight feelings of failure. Participant Three commented on
being humble and said, “You have to know that struggles will pass. You have to have a humble
mindset. Eight of 20 mentioned attitude, and seven of the 20 participants stated some form of
religion or higher power was a factor for their recovery. Although less than 50 percent
specifically mentioned attitude as a factor, many had stated throughout the interviews the need
for an “attitude adjustment.” This was due to the programs focus on behavior change while at
ABC Rehab. Participant 19 stated, “If you think you’re all cocky and a bad ass all the time, the
program will shut you up pretty quick. You need to figure out it’s not all about you.” Table 5
shows which tools applied from the program the participants felt were the most valuable.
47
Table 5. Type of tools applied
Outward
Tools
Respect Others 8
Cleanliness 12
Hobbies 4
Positive Relationships 9
Structure 12
Inward Tools
Honesty 17
Attitude 8
Humble 13
Religion 7
These findings revealed how important it was for the participants to have a clean and
structured lifestyle, where they are honest and humble with themselves and to others. These
findings also showed the need to be engaged in some sort of positive relationship or hobby as
part of their structure. Participant 19 responded, “The most important steps are the little things.
Each day you have to put in the work.” Participant 1 also stated, “I needed to show that I could
be clean and humble and do those things when no one was watching.” Participant Two also
added in regard to engaging in some sort of hobby, “I need to keep myself interested in things
besides my thoughts and my attitude.”
Summary. The assumed influence that students need to leave the program with an
understanding of the tools needed to overcome addiction showed the need for developing
outward and inward tools. For outward tools, cleanliness and structure were found to be the
most important with 65 percent of the participant responses. Inward tools did appear to have a
greater impact on overcoming addiction with 85 percent stating honesty as a key factor, followed
by humility at 65 percent. Because both of these areas exceeded the 60 percent threshold, both
of these areas under this influence were determined to be assets.
48
Influence 2. Former students need to understand how relapse plays a part in the recovery
process.
Interview findings. Each participant was asked to give a response on how they
understood addiction. Although each of the participants felt they had an understanding of the
term and its meaning, they gave various responses, reflecting how they personally defined
addiction. Collectively, the participants shared how addiction was something keeping them from
living happy lives and how they needed real help in order to overcome their addictions and
addictive behavior. Participant 17 described it as, “An attachment to something you don’t want
to let go.” Participant Five defined addiction as, “Through what I’ve experienced, addiction is a
genetic, environmental, or just emotional imbalance that’s like an allergy that once you start you
can’t stop.” Participant One described addiction as simply, “Something you cannot just stop on
your own.”
Once participants expressed their understanding of addiction, the next step was to see
how they understood relapse as part of the addiction recovery process. One of the questions in
the interviews asked if the participants had ever participated in other programs prior to attending
ABC Rehab, in order to overcome their addiction. Out of all the participants in the study, 100
percent of the participants had sought prior help from their addictions through other programs.
Combined, the 20 participants sought help from 115 programs. These programs ranged from two
weeks to six months. The participants expressed a variety of program types and formats,
however, some similarities were identified, such as detox programs, half-way houses, court-
ordered counseling, and group meetings such as Alcoholics Anonymous. Another finding from
this study showed all 20 of the participants relapsed shortly after each of their recovery attempts,
some immediately after those programs completed. In fact, none of the participants went longer
49
than six months before relapsing from these programs, with ten out of 20 participants relapsing
immediately after completing treatment from other programs, six of 20 relapsing within three
months, and four of 20 participants relapsing within three to six months from other program
completions. Although specific questions were not asked about the reasons participants
relapsed, some expressed reasons such as other programs were just detox and didn’t address
addiction. Others shared how they were required by a court order to attend some type of
addiction program and had no desire to actually overcome their addictions. Two participants
stated how being sent to prison allowed them to get sober, however, they couldn’t wait until they
were released so they could start using again.
Each of the participants were then asked how they understood the role relapse played in
the recovery process. Some of the participants had delt with relapse events and were able to
continue making progress in their recovery. These experiences allowed them to express the
reality of relapse in their recovery journey. Participant 20 stated, “I know it’s real. I know it’s
always in the back of my mind.” Participant 6 commented on his experience dealing with
relapse as, “I don’t worry about using, I worry more about the daily things, like did I make my
bed, or am I too lazy to fix a healthy meal, stuff like that. Once those things go, I know I’m in
trouble.” Not everyone in the study felt relapse was going to be a big part of their recovery
process. These participants were able to overcome their addictions without relapsing after
graduation. Participant Six said, “It’s no longer a choice. I’ve moved on from my addictions
and if I tell myself relapse is real then I’ll use it as an excuse to use again.” Participant Seven
also agreed and stated, “I will never go back to that. I have a wife and a baby on the way. I have
more to lose than I did back then.”
50
Summary. The assumed influence that students needed to have an understanding of
relapse in the recovery process showed how this was a personal perspective to each of the
participants. In order to understand this influence, former students needed to show how they
understood addiction, their efforts to overcome addiction and their understanding of how relapse
impacts the recovery process. Although no two responses were the same, the conclusion of all
the responses showed 100 percent of the participants had a sound understanding of the meaning
of addiction. Also, based on all the interview responses 100 percent of the participants seemed
to have a firm understanding of relapse and how it impacts addiction recovery. Although each of
the participants had varying numbers of past attempts to overcome their addiction, this seemed to
be irrelevant to their understanding of addiction and relapse. Therefore, this influence is
determined to be an asset.
Procedural Knowledge
Influence 1. Former students need to understand which tools learned in the program
were most helpful to reaching full recovery.
Interview findings. Participants were asked which specific knowledge areas they had
applied, after graduation, which helped to prevent relapse in their recovery process. Out of all
the responses given, four main areas were found common among many of the participants, some
referencing multiple of these areas. Participants responded with multiple areas they felt were
contributing factors in their ability to overcome relapse. The findings also showed 11 of 20
participants stated honesty as a key factor to helping them overcome relapse. This was also a
finding for a knowledge influence as participants expressed how critical it was for them to be
honest with friends and family in order to have the support needed while overcoming their
addictions. Eight of 20 participants claimed regular structure and cleanliness helped them, which
51
was also a finding for the knowledge influence. Six of 20 participants stated how regular
communication with their support groups helped them, and five of the 20 participants stated how
keeping their interests in other things such as fitness, education, and religion helped them to
overcome relapse. Many of their responses aligned to other influences and validated the
importance of these elements from the program at ABC Rehab. Many of the participants
continued to meet with counselors, sponsors, or religious leaders as part of their ongoing
sobriety. Participant Nine commented on this in his response stating, “Communication is most
important. Talk to people in your support group and be honest.” Participants further discussed
the importance of keeping a structured lifestyle after graduation as a way to measure progress
towards recovery. They often commented about the importance the program focused on making
their beds each morning. This was symbolic of starting the day with accomplishing small things
which lead to accomplishing other small things throughout the day. Participant 17 also
commented in reference to structure, “At ABC Rehab the first thing they teach you is to make
your bed. They say if you can do that every day at least you can say you did one thing right.”
Summary. The assumed influence that participants need to understand which program
tools applied helped them to overcome relapse showed to be a need based on the interview
results. Each of the top identified factors participants responded fell below the 60 percent
threshold for this study. In one area, 40 percent of the participants responded to cleanliness and
structure as applicable tools, however, this was a major factor in a previous influence, but not as
impactful for this one. Although each of the participants identified areas of the program they
were able to apply when dealing with relapse, it was unique to the individual and not a common
finding based on the program. Therefore, this influence is determined to be a need.
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Results and Findings for Motivation Causes
The results and findings for this section are reported using the motivation categories and the
assumed causes for each category.
Self-Efficacy Theory
Influence 1. Former students need confidence in utilizing the tools and techniques
learned to stay motivated as they work towards sobriety.
Interview findings. Participants were asked to rate their confidence level (low, medium,
or high) at the start of their two years in the recovery program at ABC Rehab, on how confident
they were at overcoming their addictions. They were also asked to rate their confidence levels,
by the same scale, once they completed the program at reaching full recovery from their
addictions. Based on the responses, six of 20 participants started with a low rating in confidence,
13 of 20 had a medium rating, and only one of 20 entered the program with a high level of
confidence. Confidence levels were based on a few factors such as the background of the
participant, the nature of how they got to ABC Rehab, and how committed they were to the
program. Many of the participants had experienced homelessness, time in prison, and near-death
experiences. Some chose to enroll in the program, others asked by parents and loved ones, and
some were forced as part of a legal order. Participant Two shared, “I was either going to die in
the streets or die in jail and neither was an option for me.” Participant Five also stated, “I had no
intentions of getting sober. I knew I wanted to die that way. I knew I needed to change to keep
from living on the streets.”
When asked about confidence levels after graduation four of the six participants with a
low level of confidence moved to high after program completion, while two of the six moved to
medium. Of the participants that rated themselves medium at the start of the program, all 13 out
53
of 20 rated their confidence as high after program completion. Confidence levels grew as
participants were able to first detox, then start engaging in the program. As time in the program
continued for them, they saw themselves accomplishing things they had not previously thought
they could do. Participant Three stated, “I thought I was cured.” Participant Nine also
commented, “I realized my addiction was part of a symptom of a greater problem. I was not
going back to that life again.” Participant Five rated themselves as high for both areas. He also
stated, “It’s a daily battle and you have to realize you’re not always going to have happiness.”
Table 6 gives a breakdown of confidence levels based on the start of the program compared to
when participants graduated from the program. Although not all the participants in the study
reported to have high levels of confidence once they completed the program, each of the
participants showed an increase in confidence towards reaching full recovery after program
completion.
Table 6. Confidence levels before and after
Start Complete
Low 6 0
Med 13 2
High 1 18
Summary. The assumed influence that students need to have confidence in utilizing the
tools they learned to stay motivated as they work towards sobriety was determined to be an asset.
Based on interview responses, this finding shows 95 percent of the participants moved up in
confidence levels from the time they entered the program at ABC Rehab compared to their
confidence level at program completion.
Expectancy Value Theory
54
Influence 1. Former students need to understand the value from the program in order to
see how their efforts can improve their chances of achieving full recovery.
Interview findings. Participants were asked questions to determine the level (low,
medium, high) of value they placed on their efforts while in the recovery program at ABC
Rehab. Then they were asked how those levels of value contributed to the effort they put in
while in the program and what results they hoped for as a result of their efforts. An additional
question was asked to help determine the relationship between expressed value in the program
and the effort levels of the participants while in the program. To help with this determination,
each participant was first asked if they had personally initiated seeking help in recovering from
their addiction from ABC Rehab. Based on this question 15 of the 20 participants sought help
from ABC Rehab, while the other five were sent to ABC Rehab by other means, such as
counselors, court order, or family. This was important to understand because the circumstance in
which participants entered the program was a key indicator of what type of effort they would
give while in the program. Participant Seven stated, “I needed something different, something
more drastic.” Participant 16 commented as well, “I didn’t want to go, but there was nowhere
else for me to go.” Of the 15 who had sought help from ABC Rehab, two had low levels of
effort, ten had medium levels of effort, and three reported having high levels of effort at the
beginning of the program. Out of the five of the 20 participants who stated they did not seek
help from ABC Rehab, four of the five claimed to have low levels of effort and one of the five
claimed to have a medium level of effort when starting the program. This initial finding showed
if a participant sought help for their addictions, they were more likely to give more effort than
those forced to seek support. Participant 12 was one of the participants who started with a low
level of effort. He stated, “I felt defeated, didn’t see my life going anywhere. I was sick and
55
tired, no fight left in me.” Next, the participants were asked to give their level of effort at the
end of their time in the program. Out of the 15 of the 20 who sought help, six of the 15 claimed
to have medium levels of effort, and nine of the 15 claimed to have high levels of effort. Out of
the five who stated they did not seek help from ABC Rehab, one of the five claimed to have a
medium level of effort, and four of the five stated they had high levels of effort at the completion
of their time in the program. Although not all the participants claimed to have had high levels of
effort while in the program, 13 of 20 participants did complete the program with high levels of
effort and 16 of 20 showed an increase effort throughout the program. This finding showed the
level of initial participation in the program at ABC Rehab did not matter if participants entered
the program on their own free will or by other means. Participant 20 stated, “It took me a year of
being in the program before I realized I had a problem.” Participant 12 also stated, “I just felt
like I didn’t want to screw it up, you know.” Table 7 gives a breakdown of the level of effort
each participant gave based on if they had sought help through ABC Rehab or not.
Table 7. Level of effort at start and end of program
Start Complete
Low 6 0
Med 11 7
High 3 13
Summary. The assumed influence that students needed to understand the value from the
program in order to see how their efforts can improve their chances of achieving full recovery,
was determined to be an asset based on interview results. Although 75 percent of the
participants sought out help from ABC Rehab, this finding was not relevant to this influence,
however, 85 percent of the participants showed an increase in their level of effort from the time
56
they started the program compared to when they graduated. Therefore, this influence is
determined to be an asset.
Results and Findings for Organizational Causes
The results and findings for this section are reported using the organization categories and the
assumed causes for each category.
Organizational Influence
Influence 1. It is important for the organization to prepare students to make the
adjustment from a structured environment to a new environment outside the program successful.
Interview findings. Participants were asked to discuss what ABC Rehab did to help them
transition from the structured environment in the program, to a non-structured environment after
graduation when they would leave the program. Structure is a key element to the program at
ABC Rehab (ABC Rehab, 2018) and understanding how they prepared students to transition is
important because graduates will need to continue this element once they leave the program. Out
of all the responses, 16 of the 20 participants stated that ABC Rehab allowed them to stay for up
to one year in their transitional housing. Transition housing was similar to an apartment, or
house where multiple graduates lived allowing them close access to the facilities at ABC Rehab
as well as living with other graduates who could act as a support group during the transition.
This also gave participants the opportunity to not move back home where old addiction triggers
might influence them after graduation. Participant One commented on the value of transitional
housing by stating, “Oftentimes moving back home is terrible and puts you right back in the
same spot you were in before you left. You need an option to prove you can do it on your own.”
Participant Ten also stated, “They allowed me to keep a high level of structure. I knew I
couldn’t let everything just go to the wayside.” In addition, 12 of the 16 who utilized transitional
57
housing were also offered paying jobs at the facilities they graduated from. These jobs included
working at one of the facility’s stores they operated or taking some sort of mentor role in the
program. One participant was even asked to be the program leader for one of the facilities after
he graduated. Nine of the 20 participants stated ABC Rehab helped them to enroll in college
level classes, but it should also be noted these participants were taking classes, tuition covered by
the program, while at the latter end of their time in the program and were continuing their
education, rather than starting as new students. ABC Rehab partnered with small colleges,
allowing students to enroll in college classes as a way to develop study skills and prepare
graduates to return full time to school if they wished.
Not all participants felt ABC Rehab provided adequate transitioning once they graduated
the program. Although a small number, ten percent of the participants felt ABC Rehab should
have done more in this area. Based on comments from participants ABC Rehab really only
responded to requests for support, rather than making it an official part of the transition process.
This meant participants needed to find out from others what options they had once they
graduated from the program. Participant Six stated, “After you leave when you graduate, it’s up
to you to stay on your plan. I know it’s got to be like that on some level, but there really was no
procedure for planning and stuff.”
Summary. The assumed influence that it is important for the organization to prepare
students from a structured environment to a new environment outside the program was
determined to be an asset. Based on the interview responses, 80 percent of the students took
advantage of the transitional housing offered by ABC Rehab. Although the other areas for this
influence were below the 60 percent threshold overall, with 45 percent taking advantage of
educational benefits through the program, the number of participants who claim the organization
58
provided some type of transition did exceed the threshold. Therefore, this influence is
determined to be an asset.
Influence 2. It is important for the organization to evaluate student preparedness to reach
full recovery once they leave the program.
Interview findings. Participants were asked if they had been evaluated prior to
graduation, to determine their readiness for leaving the program. Of all the participant responses
to this question, 19 of the 20 participants stated they were evaluated prior to graduation to
determine their readiness. Based on further questioning, participants revealed that ABC Rehab
performed regular evaluations throughout their time in the program as they moved through
required stages towards graduation. Each participant met with a review board that consisted of
the program director, a counselor, and a senior student currently in the program. The review
board would discuss the participants progress, issues, and readiness for graduation. If the review
board felt the participant was ready to leave the program they were allowed to graduate. If the
review board felt the participant was not ready to graduate, they were asked to extend their
program time for an additional month. Participant 12 was in his last month of the program and
ended up being held another four months for stealing a can of chewing tobacco while out making
deliveries for the onsite store. Participants expressed the importance of always being focused on
the goal of recovery because the urge to go back to using drugs and alcohol is always there.
Participant Two was the only graduate to state they were not evaluated. After further
questioning this participant revealed they had been in and out of the program for over five years
and how ABC Rehab granted them the status of graduate, but did not put them through a formal,
final evaluation. While in the program he experiences several health issues which required him
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to leave the program multiple times. Although he was able to stay sober during those times, he
was never interviewed or evaluated to determine if he was okay to graduate.
Summary. The assumed influence on how important it is for the organization to
evaluate student preparedness to reach full recovery once they leave the program was determined
to be an asset based on interview responses. This determination was due to 95 percent of the
participants responding that they had been evaluated for preparedness prior to graduating from
the program at ABC Rehab. The only participant to not be evaluated was a special circumstance
due to the nature of how they spent their time in the program. Therefore, this influence is
determined to be an asset.
Cultural Setting
Influence 1. It is important to understand how living full-time at ABC Rehab has helped
in the recovery of former students.
Interview findings. Participants were asked how staying at ABC Rehab’s live-in facility
helped in their recovery process. The live-in requirement for the program is designed to first let
the student detox, and then give them a safe place to change behaviors which lead to addiction
(ABC Rehab, 2018). The program was not just a place to live, but each location had some form
of business on site students were expected to operate. As their progress in the program
continued, they were given opportunities to have family visits, leave the facilities for needs of
the program, and even engage in external activities such as movies, bowling, and even
participant in marathons. Based on responses from participants, 12 of 20 participants expressed
how the live-in facilities helped protect them from their triggers. Some shared examples of this
were the ability to be separated from family members, friends, jobs and bills. Participants
expressed how poor family relationships and hanging out with the wrong friends created urges to
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abuse drugs. Other participants talked about getting fired from jobs for using while at work and
needed a place to recover in order to even hold a job. Some even expressed how the stress of
paying bills triggered their addictions because money was something an addict always needed if
they wanted to continue using. The live-in facilities gave them a break from those things while
they worked to get and stay sober. Some participants, seven of 20, shared how living at ABC
Rehab forced them to deal with some type of fear or discomfort. While living at the facilities
students are around each other all day, and even share rooms at night. It can be challenging for
those who are not comfortable being around others for so long. Participant Two shared how
being bullied as a child was one factor that led him to abuse drugs. He stated, “When I moved
in, I realized I had to deal with my fear. I was bullied growing up and being there forced me to
deal with that fear. Once I left, I wondered why I ever even had that mentality.” Another seven
of 20 participants also expressed how living there full-time allowed them to deal with their
addictions in a healthy way. Examples shared were around having to work with various
personalities, other people’s habits, and being able to share feelings and experiences openly.
Participant 15 stated, “You have to be able to take criticism and admit to your problems. These
guys all know when you’re shitting them and being there makes you learn quick lying won’t
work.”
One aspect of living full-time at the ABC Rehab facility, which was expressed by 18 of
the 20 participants, had to do with what they referred to as the “self-check”. This meant if a
student was doing something or behaving a certain way that was against the program rules
another student would simply say, “check yourself”. The first student would then have to
immediately stop the behavior. This self-check system could be used by anyone in the program.
Each night all the students would meet in a room to discuss why the self-check was given and the
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offending student would not be allowed to challenge the self-check, instead they had to promise
to the group that the behavior would change. The purpose for waiting until evening to discuss
these self-checks was to allow each of the students time to think about their behavior and
determine how they would respond after some level of time had passed (ABC Rehab, 2018).
Participant 13 said this about his experience with the self-check, “You’re always uncomfortable,
but you’re forced to deal with things in a healthy way.” Participant 17 also stated, “There you’re
not going to get away with anything. Everyone’s eyes are always on you, ready to check you at
any moment.”
Although responses varied by participant on how living at the ABC Rehab facility helped
them in their recovery process, all 20 participants stated that it was a critical factor in helping
them reach full recovery. Participant 4 shared, “There are days I wish I could go back. It was a
pretty easy way to live if I’m being honest.” Table 8 shows a breakdown of the top benefits from
the interview responses.
Table 8. Live-in facility benefits
Self-Check 18
Triggers 12
Fear/Discomfort 7
Healthy Environment 7
Summary. This assumed influence to understand how the full-time live-in facility
prepared the participants to overcome their addictions was determined to be an asset. Based on
the interview responses 100 percent of the participants stated the live-in facility was critical to
their addiction recovery efforts. Two of the four main responses also exceeded the asset
threshold with 60% stating the facilities allowed them to overcome triggers to their addiction,
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and 90 percent crediting the self-check as a major factor in their recovery as well. Therefore,
this influence is determined to be an asset.
Cultural Model
Influence 1. It is important to understand how the culture at ABC Rehab contributed to
former students reaching full recovery.
Interview findings. Each of the participants were asked to discuss their thoughts on how
the culture of the program contributed to their recovery. As it relates to culture, 5 out of 20
participants specifically identified the program, having a culture of accountability. This was due
to the fact that the program allowed students to hold other students responsible for their actions
(ABC Rehab, 2018). Participants expressed how other students were always watching what they
did and ensured they were following the rules of the program. Participant 14 stated,
“Accountability is super high, and everyone is trying to hold others accountable. If you’re doing
something you know you shouldn’t, you can bet the guy next to you is going to say, “wake up
asshole.”” Also identified as part of the culture, 7 of the 20 participants stated how friendships
and comradery were a key aspect of the culture for them. Participants stated it was easier to
trust someone who had similar experiences to their own over counselors and program leaders
who may not have personally suffered from addiction. Participant 20 stated, “I am more apt to
listen to someone who has walked in my shoes than to listen to someone who may have walked
in my shoes a long time ago, or not at all. It’s easier to trust people who are in the realm of what
you can comprehend.” Other responses to culture with only one or two participants commenting
on were fear-based culture, social culture, and a culture of honesty. Some participants expressed
how they felt other students were allowed to yell and confront other students, creating a feeling
of not wanting to screw up or draw attention.
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Another key finding on culture showed that nine out of 20 participants identified a key
issue with the culture was their dependence on the group of people in the program. Culture
changed as the students in the program changed. This meant that the culture of the program was
never constant and might explain the various responses to this question. Participant 14 stated,
“Accountability ebbs and flows and so culture can be good one day, and bad the next.”
Participant 16 felt because the program is operated and led by current students, culture really
depends on who is in the program at any given time. He added, “The culture really starts with
[the founder], he sets the expectations, but it’s really led by the students and if you get the right
group in there, the culture is strong. A lot of times it’s really weak cause you get the wrong core
of bad students in there and they’re working behind the scenes.” Figure 2 gives a breakdown of
the types of cultures identified from the interview responses.
Figure 2. Culture responses by percentages
Summary. The assumed influence that former students need to understand how the
culture at ABC Rehab contributed to their reaching full recovery was determined to be a need.
Based on the interview responses no one type of culture met the 60 percent threshold for this
35
25
10
10
10
Culture Responses by %
Friendship/Comradery Accountablity Fear-Based Social Other
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influence. Although all the participants responded how culture played a role in their recovery
process, while at ABC Rehab, their did not seem to be enough findings to show how ABC Rehab
focused on a specific culture as part of their program format, rather they let the students
determine the culture of the program. Therefore, this influence is determined to be a need.
Influence 2. It is important to understand how the organizational structure at ABC
Rehab contributed to former students reaching full recovery.
Interview findings. Participants were asked to discuss their thoughts on how the
structure of the program assisted them in their recovery process. The program structure started
from the moment students woke up until they returned to bed in the evening. Each day they
followed a strict routine based on what stage they were in the program, which consisted of meals,
exercise, cleaning, class and group work, as well as job duties at the facility stores (ABC Rehab,
2018). Based on participant responses, 16 of the 20 participants felt the structure of the program
had a direct impact to their recovery. Four of the 20 participants felt the structure of the program
contributed; however, they did not feel a change in the structure would have changed the
outcome of their recovery. When asked follow on questions about which elements of the
structure in the program were most helpful, eight of 20 stated how making their bed each
morning was most impactful. Many of the participants commented on the importance of making
their bed was and how it was a metaphor for the choices they were going to make that day.
Another eight of 20 participants claimed having a daily routine was what worked best for them.
Some participants expressed how maintaining a daily routine allows them to monitor how well
they are doing towards recovery. They felt that if they saw disruptions in key areas of their
routines, they were exposing themselves to addictive behaviors. Participant Two stated, “You
get up in the morning and go do your work, then come back and work on yourself, then do it
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again the next day. It’s a pretty easy way to live.” Seven of 20 participants shared how the self-
check sessions each day helped them. They discussed how it was crucial in their recovery to stay
honest with themselves and with others, the check-in sessions were a time each day to ensure
that was happening. Participant 11 stated,
You can become sober, but if you don’t change who you are inside, your values, morals,
and things like that, you’ll always go back to using. I got called out on things I was
doing wrong and then we had groups when we talked about things I did wrong. You
analyze that and change those behaviors. You’re forced to tell the truth and forced to look
at your lie and say, Yes, I lied.
Participants gave multiple responses when identifying which elements of the program structure
they felt helped them the most, however only a few areas were common among multiple
responses. Table 9 shows how structure impacted the participants and which areas were most
common among their responses.
Table 9. Structure impact and focus areas
Structure Impact
Major Factor 80%
Contributing Factor 20%
Structure Areas
Making Bed 40%
Daily Routine 40%
Self-check 35%
Summary. The assumed influence that former students need to understand how the
organizational structure at ABC Rehab contributed to their recovery process was determined to
be both an asset and a need. Based on the interview responses, 80 percent of the participants
stated how the culture at ABC Rehab had a direct impact on their recovery, however, further
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findings through follow up questions showed that none of the specific culture findings met the
60% threshold for this influence. These findings show the importance of culture in the program
but fails to show which culture is effectively contributing to the participants recovery.
Therefore, this influence is determined to be an asset and a need.
Summary of Validated Influences
Table 10, 11, and 12 show the knowledge, motivation and organization influences for this
study and their determination as an asset or a need.
Knowledge
Table 10. Knowledge Assets or Needs as Determined by the Data
Assumed Knowledge Influence Asset or Need
Factual
No Influence Conducted NA
Conceptual
Influence 1 Asset
Influence 2 Asset
Procedural
Influence 1 Need
Metacognitive
No Influence Conducted NA
Motivation
Table 11. Motivation Assets or Needs as Determined by the Data
Assumed Knowledge Influence Asset or Need
Self-Efficacy
Influence 1 Asset
Expectancy Value
Influence 1 Asset
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Organization
Table 12. Organizational Assets or Needs as Determined by the Data
Assumed Knowledge Influence Asset or Need
Organizational
Influence 1 Asset
Influence 2 Asset
Cultural Setting
Influence 1 Asset
Cultural Model
Influence 1 Need
Influence 2 Asset and Need
Chapter 5 will consider the results from the findings and will present recommendations
for solutions for these influences based on empirical evidence.
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CHAPTER FIVE: RECOMMENDATIONS AND EVALUATION
Purpose of the Project and Questions
The purpose of this promising study was to examine the elements contributing to ABC
Rehab’s success rate of 85 percent and to gather research to determine which areas can
contribute the greatest success in student addiction recovery once they leave the program. The
purpose is to identify key elements of the methods and skills taught by ABC Rehab in continuing
sobriety among former students in order to help ABC Rehab reach its goal of 100 percent
sobriety. This analysis will focus on the assets in the areas of knowledge and skill, motivation,
and organizational influences. While a complete study would focus on all stakeholders, for
practical purposes the stakeholder group to be reviewed for this analysis are the former students
in the program. The questions guiding this study were:
1. What are the knowledge, motivation and organizational elements ABC Rehab has
chosen to effectively address this problem of practice?
2. What assets does ABC Rehab have that effectively addresses this problem of
practice?
Recommendations to Address Knowledge, Motivation, and Organization Influences
This section consists of three parts: Knowledge, Motivation, and Organization, or KMO.
Each KMO section will contain an overview to include the rationale for the need, if any, to
prioritize the examined causes, and a table to show the examined causes and their priority for
improving the performance results. Each of the tables presented will include the KMO cause,
their priority, evidence-based principles supporting the recommendations, as well as the
recommendation for each cause based on the principle being applied. Finally, for each table, a
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detailed discussion is provided for each high priority cause, the principle, the solution, and the
support for each solution based on the literature.
Knowledge Recommendations
Introduction. For knowledge, two of the assumed influences were considered to be an asset,
while one influence was determined to be a need, based on the validated results from this study.
The two assumed influences for Conceptual regarding former students’ ability to understand the
tools needed to overcome addiction as well as how relapse plays a part in the recovery process
were determined assets because they met the 60 percent threshold for this study. The influence
for Procedural regarding students needing to understand which tools were the most helpful in
reaching recovery was identified as a need for not meeting the threshold of 60 percent. Table 13
lists the causes, priority, principle and recommendations. Following the table, a detailed
discussion for each high priority cause and recommendation and the literature supporting the
recommendation is provided.
Table 13. Summary of Knowledge Causes, Priority, Principle and Recommendations
Assumed Knowledge
Influence
Asset or
Need
Priority
Yes or
No
Principle and
Citation
Context-Specific
Recommendation
Conceptual
Former students need
to leave the program
with an understanding
of the tools needed to
overcome addiction.
Asset No To develop mastery,
individuals must
acquire competent
skills, practice
integrating them and
know when to apply
what they’ve
learned (Schraw &
McCrudden, 2006).
It is recommended that
ABC Rehab maintain
current program
teachings for tools
needed to overcome
addiction.
Former students need
to understand how
relapse plays a part in
the recovery process.
Asset No When information
isn’t enough, a brief
checklist form is
adequate support for
It is recommended that
ABC Rehab continue
reaching about how
70
achieving
performance goals
(Clark & Estes,
2008).
relapse plays a part in
the recovery process
Procedural
Former students need
to understand which
tools learned in the
program were most
helpful to reaching full
recovery.
Need Yes Leading indicators
provide
personalized targets
in order to establish
connection between
performance and
results (Kirkpatrick
& Kirkpatrick,
2016).
Develop key
performance indicators
(KPIs) for students to
track progress while in
the program that can
be used to track
progress after
graduation.
Procedural knowledge solutions. Procedural was an influence which was determined to
be a need for the organization, how former students need to understand which tools learned in
the program were more helpful than others in reaching full recovery from their addictions. The
recommendation for this influence is for ABC Rehab to develop key performance indicators, or
KPIs, for students to track their progress while in the program which can then be used to track
their progress after graduation. Kirkpatrick and Kirkpatrick (2016) state how these types of
indicators can be used as personalized targets in order to establish a connection between
performance and results. They also show how these indicators help to identify barriers to
success and allow for adjustments to be made in order to intervene before positive results are
jeopardized. Currently ABC Rehab does not have a process in place that provides KPIs to
students as a method to help them identify which tools they are applying are actually helping
them to recover from addiction.
This study found that no one factor met the 60 percent threshold that was used to
determine assets versus needs for this influence. Although each of the participants stated areas
they felt contributed to their individual success, there was no singular response that was common
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among the majority of the participants. Clark and Estes (2008) argue how the organization needs
to be goal-driven in order to be successful and how setting specific performance goals and
measuring those goals will help achieve the desired performance. This would suggest that ABC
Rehab’s goal of 100 percent of their graduates reaching full recovery within five years from
leaving the program should have KPIs established for their students and then measure student
progress based on those indicators.
Motivation Recommendations
Introduction. For motivation, two influences were examined in this study: Self-
Efficacy, and Expectancy Value. Based on the validated results from the interviews these were
both determined to be assets for the organization. For Self-Efficacy former students were
interviewed to understand their level of confidence in utilizing the tools and techniques they
learned in order to stay motivated towards recovery. When evaluating Expectancy Value,
participants were also interviewed to better understand how their efforts contributed to their
chances of reaching full recovery. Based on interview responses both of these areas exceeded
the 60 percent threshold used for this study and found to be low priority for this knowledge type.
Table 14 lists the motivation causes, priority, principle and recommendations. Following the
table, a detailed discussion for each high priority cause and recommendation and the literature
supporting the recommendation is provided.
Table 14. Summary of Motivation Causes, Priority, Principle and Recommendations
Assumed Motivation
Influence
1
Priority
High
Low
Principle and
Citation
Context-Specific
Recommendation
Self-Efficacy
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Former students need
confidence in utilizing
the tools and techniques
to stay motivated as they
work towards sobriety.
Low Higher levels of self-
efficacy participate
more frequently, work
harder, and show a
greater interest in
learning (Schunk &
Pajares, 2009).
It is recommended that
ABC Rehab continue
program teachings on
how to utilize the tools
and techniques to stay
motivated towards
recovery.
Expectancy Value
Former students need to
understand the value
from the program in
order to see how their
efforts can improve their
chances of achieving full
recovery.
Low There needs to be a
framework in place to
allow individuals the
ability to see how
their actions are
related to the
expectations held
toward any given
action (Schunk &
Pajares, 2009).
It is recommended that
ABC Rehab continue
program teachings on
how students efforts can
improve chances of
reaching full recovery.
Self-Efficacy solutions. Self-Efficacy was an influence determined to be a low priority
for the organization and found to be an asset based on 60 percent threshold used for this study.
Based on the findings from the interviews of former students on how confident they felt in
utilizing the tools and techniques to stay motivated as they worked towards full recovery, 19 out
of 20 participants experienced an increase in confidence while in the program, and one out of 20
entered the program with high confidence to begin with. As stated in chapter 2, high levels of
self-efficacy come as a result of more frequent participation and harder work (Schunk & Pajares,
2006). The structure of ABC Rehab’s program appears to be providing students with these
opportunities to develop self-efficacy as they work their way through the program.
Expectancy Value solutions. Expectancy Value influence was also determined to be a
low priority for the organization and found to be an asset based on 60 percent threshold used for
this study. Value was determined by the level of effort from the participants when they started
the program, compared to when they completed the program. Based on the findings, 85 percent
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of the participants showed an increase in level of effort. Schunk and Pajares (2009) stated how
value needs a framework in place to allow individuals the ability to see how their actions are
related to expectations. Based on the findings from the interviews of former students regarding
this influence, it appears the structure of ABC Rehab’s program is helping students understand
the value the program brings to their efforts in achieving full recovery. Schein (2017) also
argued how important it is to have this type of behavior change as the foundation for cognitive
redefinition. Based on the findings from this study, the level of effort from the participants
contributed to the behavior changes needed to overcome their addictions.
Organization Recommendations
Introduction. For organizational influences, five areas were examined and two of them
were found to be validated as a result of the data collected. Both of these areas were part of the
Cultural Model within the organization and determined to be a high priority for determining
recommendations. This section will further discuss each of the organizational influence areas
which were examined and what solutions, if any, should be considered as part of
recommendations to the organization. Table 15 showed each of these five areas and how they
rated for priority and any recommendations to be considered.
Table 15. Summary of Organization Causes, Priority, Principle and Recommendations
Assumed Organization
Influence
Priority
High
Low
Principle and
Citation
Context-Specific
Recommendation
Organizational
It is important for the
organization to prepare
students to move from a
structured environment to
a new environment
outside the program.
Low Effective change
efforts use evidence-
based solutions and
adapt them, where
necessary, to the
organization’s culture
(Clark & Estes, 2008).
It is recommended that
ABC Rehab continue the
program format for
helping graduates
transition from a
structured environment
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to a new environment
outside the program.
It is important for the
organization to evaluate
student preparedness to
reach full recovery once
they leave the program.
Low The goal of the
assessment is to
develop methods for
determining what
changes have been
made after learning
what to do (Mayer,
2011).
It is recommended that
ABC Rehab continue
their evaluations of
student preparedness
before they graduate
from the program.
Cultural Settings
It is important to
understand how living
full-time at ABC Rehab
has helped in the
recovery of former
students.
Low Organizational
structure and control
systems must be made
consistent in order to
establish a new way
of thinking and
working (Schein,
2017)
It is recommended that
ABC Rehab continue the
full-time live-in facilities
for student while they
attend the program.
Cultural Models
It is important to
understand how the
culture at ABC Rehab
contributed to former
students reaching full
recovery.
High Critical behaviors
should be defined in
terms which connect
them to the outcome
and goal trying to be
accomplished
(Kirkpatrick &
Kirkpatrick, 2016)
Encouragement of the
culture through more
frequent mentoring
programs and monitoring
effectiveness through
observations.
It is important to
understand how the
organizational structure
at ABC Rehab
contributed to former
students reaching full
recovery.
Low/
High
Monitoring leading
indicators throughout
the process gives time
to identify barriers to
success and adjust
before outcomes are
jeopardized
(Kirkpatrick &
Kirkpatrick, 2016)
Perform knowledge
evaluations through
interviews to determine
elements about the
organization’s structure
which contributed most
towards student
recovery.
Organizational influence solution 1. The organizational influence regarding the
importance of ABC Rehab preparing students to transition from a structured environment to an
unstructured environment once they graduated from the program was determined to be a low
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priority. Based on the study results, 80 percent of the participants the organization provided a
transition option for them after graduation, including opportunities for other transitional support
such as college tuition. Clark and Estes (2008) discussed the importance of using evidence-
based solutions. The structure ABC Rehab has in place to help graduates transition out of the
program is determined to have a positive impact on graduate’s recovery process.
Organizational influence solution 2. The organizational influence regarding how the
organization evaluates student’s preparedness once they have graduated and leave the program
has been determined to be a low priority. Based on the research findings 95 percent of the
participants reported being evaluated throughout the program, and at graduation, to determine
preparedness to leave. The only participant who claimed had not been evaluated shared that their
experience was unique, which was a factor in this finding. Mayer (2011) stated how assessments
are used to determine that changes have been made after a learning process. ABC Rehab has a
process in place to perform these assessments as reflected from the results of this study.
Cultural model solutions. Based on the study results for cultural setting, the findings
for former students’ understanding of how living at ABC Rehab full-time had helped them in
their recovery process was determined to be a low priority. The results of the interviews showed
that 100 percent of the participants felt this was a contributing factor in their recovery process.
Schein (2017) argued how an organization needs structure and control systems in place in order
to establish a new way of thinking and working. By providing a live-in facility, students are able
to adapt to the structure and controls of the program, giving them greater success in making
needed changes towards recovery.
Cultural settings solutions 1. Based on the study results for cultural models, the
findings for former students’ understanding of how the culture at ABC Rehab contributed to
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recovery was determined to be a high priority. Interview findings showed how the
organizational culture was not defined enough for participants to identify a common culture of
the program. This study did determine that each participant identified certain cultures within the
program, however culture needs to be consistent even when students depart the program (Schein,
2017). Clark and Estes (2008) described culture as a way for an organization to define its values,
goals, beliefs, and learning processes to help people develop over time. One of the factors for
ABC Rehab not having established a consistent culture might be due to the structure of the
“each-one teach-one” methodology (ABC Rehab, 2017). This allows students to set the tone of
the culture, but as students come and go the culture can be in a constant state of change.
The recommendation for this area would be to encourage ABC Rehab to hold more
frequent mentoring programs with the students, as well as monitoring the effectiveness of the
mentoring through observations. Kirkpatrick and Kirkpatrick (2016) stated how critical
behaviors should be connected to the desired outcomes and goals trying to be accomplished.
Mentoring would allow the organization to encourage a common culture among the students.
The organization could then use observations to determine how to make adjustments in the
program to drive towards a common culture within the program.
Cultural settings solution 2. Based on the study results for cultural models, the findings
for former students’ understanding of how the organizational structure at ABC Rehab
contributed to recovery was determined to be a high priority. Interview findings showed that 80
percent of the participants felt the structure of the program was a major factor in their recovery,
the other 20 percent stated it was only a contributing factor. However, none of the responses for
which parts of the program structure identified in the interviews met the 60 percent threshold for
this criterion. Although it was clear the program structure was critical, it was unclear if the
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program at ABC Rehab was intentionally focusing on any specific areas. Schein (2017) states
how structure allows individuals to quickly fall back into what they know, and organizations
need to create routines and behavioral regularities that will become the stability for its members.
The recommendation for this area would be for ABC Rehab perform knowledge
evaluations through the use of interviews to determine which elements about the organization’s
structure which contributes the most toward student recover. Kirkpatrick and Kirkpatrick (2016)
stated how using and monitoring leading indicators throughout a process gives time for
organizations to identify barriers to success and adjust as needed before outcomes are
jeopardized. Clark and Estes (2008) discuss how interviews can be used by an organization to
ask open questions and to find out which areas are leading toward success. ABC Rehab can use
interviews with students to ask questions around which parts of the structure they feel are the
most beneficial to student recovery. This data can then be used as indicators for the organization
to make adjustments in order to focus their structure on elements that influence the students the
most.
Summary of Knowledge, Motivation and Organization Recommendations
This section looked at each of the elements within the KMO influences to determine the
priority of the findings, based on evidence from the study. Each of the high priority areas were
then further analyzed with research-based literature and finally a recommendation on how ABC
Rehab can adjust their project in order to improve in these specific areas. For the area of
Knowledge, it was determined there was a need for the ABC Rehab to improve student
understanding of which tools learned in the program will be the most helpful in reaching
recovery. A recommendation was given for the organization to develop KPIs to track student
progress while in the program which can be used to track progress after graduation. For the area
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of Motivation, none of the findings were identified as high priority and therefore no
recommendations were given. For the area of Organizational Influence, both findings for
Cultural Model were determined to be high priority, based on research findings. One area was
for ABC Rehab to understand how the culture in the program contributes to student success. The
recommendation for this area is for the organization to use mentoring programs as a way to
discuss culture and use observations to monitor the effectiveness of the mentoring. The second
area was for ABC Rehab to understand how the structure of the program contributes to student
success. The recommendation for this area is for the organization to use interviews to determine
which parts of the structure contribute the most towards student recovery.
The following section will further discuss these recommendations and create learning
goals which can be applied to the organization in order to improve in the areas discussed. Goals
will be created around the Knowledge and Motivation recommendations and will be supported
with what the organization needs to provide to achieve the goals based off of these
recommendations.
Integrated Implementation and Evaluation Plan
Organizational Purpose, Need and Expectations
ABC Rehab’s mission is to be a world leader in providing, cultivating, teaching,
advancing, and instilling in each student the desire to always strive to be the best they can be for
themselves, for their families, and for their communities. In order to help accomplish this they
have a goal to achieve 100 percent recovery rate for all graduates within three years from leaving
the program, currently they have an 85 percent success rate. Although this is a respectable
success rate, ABC Rehab is looking to improve their chances of every graduate overcoming their
addiction. As stakeholders, former students have a role in ensuring the success of ABC Rehab
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by focusing on what they have learning while in the program and implementing the tools and
techniques as they work to reach full recovery.
In order to help ABC Rehab reach their goal of 100 percent of their graduates becoming
addiction free, recommendations were given based on the research findings for this study. The
expectations and desired outcomes would be to have the organization implement changes in the
program, based on the recommendations to determine if an increase in program success is
achieved.
Implementation and Evaluation Framework
The model which will be used to evaluate this framework is the New World Kirkpatrick
Model created by Dr. Don Kirkpatrick. The model was originally established in the 1950s and
used to as a tool to evaluate training programs to determine if those programs were making a
difference to their organizations (Kirkpatrick and Kirkpatrick, 2016). This model is based on
four key elements referred to as the Four Levels: Reaction, Learning, Behavior, and Results.
Each level is designed to evaluate program training and to determine the degree at which the
information being taught is received and implemented by the participants (Kirkpatrick and
Kirkpatrick, 2016). The New World Kirkpatrick Model builds on this foundation and looks for
how it can be applied with a more modern approach. To achieve this, the model was adjusted in
order to focus on what was most important to an organization, results (Kirkpatrick and
Kirkpatrick, 2016). This model will be applied in the way it is presented through the New World
Kirkpatrick Model, in reverse order from Level 4 down to Level 1: Results, Behavior, Learning
then Reaction.
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Level 4: Results and Leading Indicators
Level 4 is defined as the degree to which training supports targeted outcomes in support
of the organization’s strategies (Kirkpatrick and Kirkpatrick, 2016). In order to understand if the
provided training is truly effective, leading indicators need to be established as a measuring tool
to track the impact the training is having on the organization. Kirkpatrick and Kirkpatrick (2016)
state how the use of leading indicators, such as short-term observations and measurements is
critical to create positive impacts on the desired results of the training. By establishing leading
indicators, ABC Rehab can monitor progress along the way as they seek to improve the high
priority KMO influence areas identified from this study. Two types of leading indicators will be
used under this model, internal and external. Internal indicators are established as they are
usually the first to appear in the organization (Kirkpatrick and Kirkpatrick, 2016). These would
be used to evaluate students while they are actively engaged in the program. External indicators
are used to measure critical behavior after the training has been provided (Kirkpatrick and
Kirkpatrick, 2016). These leading indicators would be established once students graduate from
the program. Table 16 breaks down the influences from the study which were determined to be a
need for the organization and identifies the metrics and methods for each to be used as part of
Level 4. This table also shows how, even though the organization wants all students to reach
these outcomes, the study measures the outcomes for graduates. Because Level 4 is also used for
decision-making, the metrics and methods described will allow ABC Rehab to make adjustments
in the program based on the results produced by Level 4.
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Table 16. Outcomes, Metrics, and Methods for External and Internal Outcomes
Outcome Metric(s) Method(s)
External Outcomes
For 100% of graduates to
understand which tools
learned in the program
helped them reach full
recovery
Measure former graduate
performance towards recovery
at 3 months, 6 months, 1 year, 2
years, and 3 years from
graduating
Graduates will be contacted by
preferred method of contact to
discuss their progress towards
full recovery
For 100% of graduates to
understand how the
culture at ABC Rehab
helped them in their
reaching full recovery
Establish KPIs to determine how
graduates understood the
benefits of the culture in the
program contributed to their
success
Create interview questions to be
used as part of the regular
contact with the organization,
after graduation, to ask how the
program culture contributed
towards their success
For 100% of graduates to
understand how the
organization’s structure
contributed to their full
recovery
Perform knowledge evaluations
for graduates to determine how
the program structure
contributed to their success in
reaching full recovery
Evaluations to be performed
every other month over three
years
Internal Outcomes
For 100% of graduates to
understand which tools
learned in the program
helped them reach full
recovery
KPIs will be used to track
progress while in the program
which will then be used to track
progress after graduation
ABC Rehab will work meet
with each student on a monthly
basis to track their progress and
determine which tools from the
program are more impactful
towards their recovery
For 100% of graduates to
understand how the
culture at ABC Rehab
helped them in their
reaching full recovery
KPIs will be used to track
student participation in
mentoring programs where
culture is discussed
ABC Rehab will hold mentoring
sessions with each student at a
minimum of once every two
months to discuss program
culture
For 100% of graduates to
understand how the
organization’s structure
contributed to their full
recovery
KPIs will be used to track
student participation in
interviews where organizational
structure is discussed
ABC Rehab will hold interview
sessions with each student,
while in the program, at a
minimum of once every two
months to discuss
organizational structure
Level 3: Behavior
Critical behaviors. Level 3 has been identified as the most important level because it is
described as the degree participants apply the things they have learned from their training
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(Kirkpatrick & Kirkpatrick, 2016). Because Level 3 drives Level 4: Results, it uses two
indicators as a method to drive performance and behavior. These indicators are support and
accountability. Support methods are used to help drive performance to those applying the
training principles, while accountability methods are used to help those who have not applied
training (Kirkpatrick & Kirkpatrick, 2016). These indicators are further broken down in to four
main methods: Monitoring, Reinforcing, Encouraging, and Rewarding. These methods help
frame how the Level 3 methods can be applied within organizations to drive performance from
participants (Kirkpatrick & Kirkpatrick, 2016).
Table 17 will show the critical behaviors established from this study and align them to
the metrics, methods, and timing for each of them. The critical behaviors will focus on what
outcomes ABC Rehab will be working to achieve and the metrics, methods, and timing the
organization will use to achieve these outcomes. These will then be further examined to
determine their required drivers and how they support critical behaviors.
Table 17. Critical Behaviors, Metrics, Methods, and Timing for Evaluation
Critical Behavior Metric(s) Method(s) Timing
1. Graduates will
understand which
tools learned in the
program were most
helpful in reaching
full recovery.
100% of all students
will be evaluated
throughout the
program on their
progress towards
addiction recovery.
Program administrators
will conduct interviews
with each student to
discuss which program
tools are more effective
in contributing towards
their addiction recovery.
Monthly
2. Graduates will
understand how the
program culture
contributed to their
recovery.
100% of all students
will participate in
interviews to
determine how the
program culture
Program administrators
will conduct interviews
with each student to
discuss with elements of
the program culture they
feel contribute the most
Every two months
83
contributes to their
addiction recovery.
to their addiction
recovery.
3. Graduates will
understand which
elements of the
organizational
structure contributed
to their recovery.
100% of all students
will participate in
interviews to
determine how the
organizational
structure contributes
to their addiction
recovery.
Program administrators
will conduct interviews
with each student to
discuss with elements of
the organizational
structure they feel
contribute the most to
their addiction recovery.
Every two months
Required drivers. There are four types of required drivers which aim to boost,
encourage and reward the positive behavior needed for participants to apply what they have
learned (Kirkpatrick & Kirkpatrick, 2016). These drivers are a critical element to the success of
the organization when monitoring behavior and can be challenging to execute. Kirkpatrick and
Kirkpatrick (2016) state how these drivers need to be both practical and feasible within an
organization if they are going to be successful. The required drivers are:
• Monitoring – The organization lets participants know their performance will be reviewed
during a future even such as a meeting, or interview.
• Reinforcing – Stressing the importance of tracking performance by showing participants
examples of when their performance will be reviewed.
• Encouraging – The organization helps to resolve concerns with the participants regarding
their performance.
• Rewarding – As performance improves, participants may be able to receive a reward or
recognition while in the program.
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Table 18 applies the four required drivers to the Knowledge, Motivation and Organizational
recommendations stated earlier in this section and looks at recommendations for ABC Rehab in
support of these drivers, as well as the timing of each recommendation.
Table 18. Required Drivers to Support Critical Behaviors
Method(s) Timing
Critical Behaviors
Supported
1, 2, 3 Etc.
Reinforcing
Job aids will be provided to
students to show how
addiction recovery tools can
be applied.
After training 1
Reminders will be given by
program administrators on the
importance of culture and
structure in the recovery
process.
Monthly 2, 3
Encouraging
Mentoring will be used by
program administrators to
discuss culture and structure
with each of the students in
preparation for interviews.
Two weeks 2, 3
Program leaders will provide
coaching to program
administrators on how to
conduct interviews with
students.
Annual 1, 2, 3
Rewarding
Program leaders will highlight
program graduates who have
Monthly 1, 2, 3
85
successfully reach full
recovery.
Monitoring
Program administrators will
conduct interviews with
students to discuss progress
towards recovery.
Monthly 1, 2, 3
Program administrators will
use KPIs to track progress of
students will in the program
Monthly 1
Program administrators will
use KPIs to track which
culture and structure areas
contribute most toward
student’s addiction recovery.
Monthly 2, 3
Organizational support. In order to support the critical behaviors of the students in the
program, ABC Rehab will need to ensure they are prioritizing the required drivers and showing
support to those students who need to perform them if the organization is going to be effective.
Kirkpatrick and Kirkpatrick (2016) suggest organizations focus on evaluating performance of
critical behaviors after the training has been completed. Each of the four required drivers can be
used after training, however, reinforcement and encouragement should almost always be used
directly following training (Kirkpatrick & Kirkpatrick, 2016). Another way ABC Rehab can
support these areas is understanding how the implementation of Level 3 will have a direct impact
of Level 4 when it comes to seeing the results of monitoring behavior in the program.
Level 2: Learning
Learning is described as the degree participants acquire the knowledge and skills taught
based on their participation in the training (Kirkpatrick & Kirkpatrick, 2016). The objective of
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Level 2 is to understand if participants can demonstrate what they have learned from the content
of the training. Level 2 focuses on the evaluation of five key areas: Knowledge, Skill, Attitude,
Confidence and Commitment. These focus areas can be examined simultaneously but should
have a plan to evaluate each component efficiently as possible (Kirkpatrick & Kirkpatrick). This
section will consider the findings from this study and look how Level 2 can be applied for these
five areas in order to accomplish the learning goals for the organization.
Learning goals. The learning goals for ABC Rehab, as it relates to this study, are based
on the findings showing areas of need. These goals are:
• 100 percent of program graduates know which tools in the program are more effective in
their recovery process.
• 100 percent of program graduates know how the culture in the program helped them in
their recovery process.
• 100 percent of program graduates know which elements of the structure helped them in
their recovery process.
This section will use the summary of the KMO solutions stated in Chapter Four and will list
what the organization needs to do to ensure participants know and can demonstrate the critical
behaviors listed above.
Program. The recommended program to ABC Rehab based on the research findings
from Chapter 4 and designed using the New World Kirkpatrick Model. This program will focus
on the desired outcomes for Level 4 Results, both internal and external, as well as what ABC
Rehab can implement to address the critical behaviors from Level 3 Behaviors. The goal of the
recommended program will ultimately be for ABC Rehab to achieve their organizational goal of
reaching 100 percent of their graduates becoming addiction free within three years after
87
graduating from the recovery program. In order for this goal to be achieved, graduates would
need to demonstrate their ability to apply the tool and techniques learned from the program to
their personal addiction recovery. This would also include how they are able to overcome
relapse events and continue to strive towards becoming addiction free. At the end of the
graduates three years, they will work with ABC Rehab to determine if this goal has been met.
Recommendation 1. In order for ABC Rehab to have 100 percent of their graduates
understand which tools they learned while in the program helped them reach full recovery it is
recommended that ABC Rehab establish a monthly check-in with each graduate for three years
after graduation. The purpose of this monthly check-in is for the program leaders to discuss with
the graduate what tools they have applied which have provided the most success at the point of
the interview. The program leaders will keep a record of each of the graduate responses which
can then be used to measure how recovery tools are taught to current students in the program.
KPIs can then be used for the program to determine which areas of their recovery program have
proven to be more successful, giving them the opportunity to focus on recovery tools that offer
the greatest chances for students reaching a full recovery from their addictions.
Recommendation 2. In order for ABC Rehab to have 100 percent of their graduates
understand which elements of the program culture helped them in their recovery process it is
recommended that ABC Rehab add additional questions to their monthly check-ins with each
graduate about how the program culture helped in their recovery. The program leaders can then
use KPIs to determine which elements of the program culture have the greatest influence on
students and can then use those findings to develop the program culture in support of those areas
which are more impactful. Program leaders would also meet with current students every other
month to find out which elements of the culture are helping them while in the program and use
88
KPIs to determine how culture is affecting students while in the program compared to how the
culture benefitted students after graduation.
Recommendation 3. In order for ABC Rehab to have 100 percent of their graduates
understand which elements of the program structure contributed most to their recovery it is
recommended that the organization perform an evaluation of each graduate every other month
for three years after their graduation date. These evaluations can be integrated with the monthly
check-ins; however, these check-ins should allow for enough time to discuss how the program
structure influenced their addiction recovery. Program leaders would also need to perform
similar check-ins with current students every other month to determine which areas of the
program structure they feel are helping them the most in their recovery. These questions can be
combined with recommendation 2. Program leaders can then use KPIs to determine which areas
of the program structure are more effective than others and make any adjustments to the program
based on the findings.
These are recommendations that can be added to the existing recovery program at ABC
Rehab and should be implemented as a permanent format to allow for continuous improvements
in these areas. If adapted, all training materials, manuals, and program formats should be
adjusted to account for these recommendations.
Evaluation of the components of learning. In order for ABC Rehab to gain a better
understanding of how graduates were able to implement the program trainings in their personal
recovery process once they leave the program, ABC Rehab will need to utilize these methods to
ensure an acceptable threshold for the learning criteria (Kirkpatrick & Kirkpatrick, 2016). Table
19 lists out the recommended methods or activities which will be used by ABC Rehab, based on
Level 2 Learning techniques, to evaluate the learning goals listed above. These
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recommendations will be based on the Level 2 areas of Knowledge, Skills, Attitude, Confidence,
and Commitment. The table will also show the timing recommendations for each area.
Table 19. Evaluation of the Components of Learning for the ABC Rehab.
Method(s) or Activity(ies) Timing
Declarative Knowledge “I know it.”
Understanding which tools contributed most
towards recovery: Knowledge check-in
Monthly
Understanding which elements of the culture
contributed most towards recovery: Knowledge
Check-in
Every other month
Understanding which elements of the structure
contributed most towards recovery: Knowledge
Check-in
Every other month
Procedural Skills “I can do it right now.”
Understanding which tools contributed most
towards recovery: Interview
Monthly
Understanding which elements of the culture
contributed most towards recovery: Interview
Every other month
Understanding which elements of the structure
contributed most towards recovery: Interview
Every other month
Attitude “I believe this is worthwhile.”
Understanding which tools contributed most
towards recovery: Interview
Monthly
Understanding which elements of the culture
contributed most towards recovery: Interview
Every other month
Understanding which elements of the structure
contributed most towards recovery: Interview
Every other month
Confidence “I think I can do it on the job.”
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Understanding which tools contributed most
towards recovery: Discussion
Monthly
Understanding which elements of the culture
contributed most towards recovery: Discussion
Every other month
Understanding which elements of the structure
contributed most towards recovery: Discussion
Every other month
Commitment “I will do it on the job.”
Understanding which tools contributed most
towards recovery: Discussion
Monthly
Understanding which elements of the culture
contributed most towards recovery: Discussion
Every other month
Understanding which elements of the structure
contributed most towards recovery: Discussion
Every other month
Level 1: Reaction
Level 1 is really around the degree participants find the training favorable, engaging, and
relevant (Kirkpatrick & Kirkpatrick, 2016). The objective of Level 1 Reaction is to efficiently
gather the information needed in order to determine if the training is adding value. There are two
methods used to perform these evaluations, formative and summative. Formative methods are
simply a way to evaluate during the training itself. Some of the benefits of this allow for
immediate feedback, dealing with issues regarding the training setting, and engagement from
participants (Kirkpatrick & Kirkpatrick, 2016). The main methods for formative evaluations are
instructor observations, pulse check, and dedicated observer.
When using summative methods, the goal is to determine the satisfaction and
engagement from participants immediately after the training has been completed. Some
examples of summative evaluations would be the use of surveys and interviews. These methods
91
can be used to determine overall satisfaction with the training, relevance to the program, and
general view of program quality (Kirkpatrick & Kirkpatrick, 2016). Whichever method used, the
objective of both is to conduct the evaluations directly following the training and to keep it
simple in order to not overly complicate this step. Kirkpatrick and Kirkpatrick (2016) state how
not simplifying this process can waste time and resources which could be used to benefit other
levels of the process.
Table 20 below lists the methods to be used in order to determine how participants from
this study will be evaluated for their reactions to the training provided. The table gives examples
of the method or tool used as well as the timing of when the method or tool will be used for
evaluating the training.
Table 20. Components to Measure Reactions to the Program.
Method(s) or Tool(s) Timing
Engagement
Program leader to act as dedicated observer During training
Instructor observations to help encourage
participation and engagement
During training
Relevance
Pulse Check throughout training to address any
issues or questions
During training
Customer Satisfaction
Surveys to determine understanding of training
materials
Immediately following training completion
Interviews between program leaders and
students for further understanding on how
training was applied
One month following training completion
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Evaluation Tools
Immediately following the program implementation. Kirkpatrick and Kirkpatrick
(2016) stated how the timing of the evaluations can have various effects on the feedback from
the participants. They discuss how immediate and delayed evaluation tools can be used to get a
more complete picture of training quality and engagement. Immediate tools are those that can be
done during the training, or directly following the training. The purpose of these tools is to
capture any immediate issues during the training, and to also ensure a high level of participant
feedback when the training is complete (Kirkpatrick & Kirkpatrick, 2016). Delayed evaluation
tools are useful when the organization wants to see how the participants apply the training for a
period of time. Also, by allowing some time to pass the participant feedback will offer different
opinions on the training and can elicit more objective feedback (Kirkpatrick & Kirkpatrick,
2016).
To determine the quality of the training at ABC Rehab it is important for the program
leaders to receive quality feedback from the students in order to understand elements of the
training which are being understood and implemented after training is complete. The program
leaders can better understand this through the use of surveys immediately following the training.
The surveys can be collected and added with the observers notes, as well as instructor feedback
to better understand the quality of the training. During the follow-on interviews with students,
survey questions can be discussed in greater detail and responses can be compared to survey
results to understand how the training is viewed once students have a chance to implement the
training in their recovery process. Appendix C illustrates the survey questions asked after each
training and will also be used as talking points during the post training interviews between the
program leaders and the students.
93
Delayed for a period after the program implementation. One month after each
training session has completed program leaders will conduct interviews with each student who
participated in the training to determine the level of understanding and application of the
concepts taught from the learning. The purpose of these interviews is to better understand the
measured satisfaction and quality of the training based on student feedback. Appendix D is the
delayed feedback interview questions program leaders will ask as part of their follow up to the
survey responses which followed the training. These questions illustrate how Levels 1 through 4
are being address as it relates to training satisfaction (Level 1), student ability to understand the
training (Level 2), student ability to apply what they’ve learned (Level 3), and how the students
have performed based on their efforts after training (Level 4).
Data Analysis and Reporting
Data analysis and reporting should capture the current state of each student and track their
progress throughout the addiction recovery program. ABC Rehab’s goal with the data analysis
and reporting is to determine if the training is meeting the expectations of the program and if not,
what adjustments need to be made for better alignment. KPIs from the trainings, surveys and
interviews should be combined with any observer notes, and other feedback to determine how each
student is responding to the training and progressing in their efforts towards recovery. As part of
the program recommendations these trainings and interviews need to focus on the KMO influences
identified in this study to be a need for the organization. ABC Rehab can use this data to determine
if the trainings meet expectations of the program and if there are areas where improvements should
be made to future program trainings, or address any issues or concerns related to individual
students who may be struggling in these areas. Immediate and delayed instruments should be used
to determine gaps in the training in order for ABC Rehab to make adjustments as needed for
94
improved quality and improved student engagement. This process should be considered iterative
and should be adjusted as more data is presented. Any changes to the trainings or to the program
should also show alignment to organizational strategies for students becoming addiction free.
Summary of the Implementation and Evaluation
The New World Kirkpatrick Model was used in order for ABC Rehab to effectively
achieve desired results from their program trainings by first looking at the desired outcomes of
their trainings, the behaviors that drive those outcomes, how students are applying the
knowledge and skills learning in trainings, and the satisfaction and engagement students have
during the trainings. Recommendations were given as part of a program development plan for
ABC Rehab to implement as a way for them to improve their progress towards reaching their
organizational goal of 100 percent of all graduates reaching full recovery within three years after
graduation.
The expectation for ABC Rehab to so apply these recommendations and use interviews,
surveys, and KPIs to evaluate the progress and changes each student makes during the program
and to make adjustments as needed in order to ensure student progress is meeting the
organization’s expectations. By implementing this plan ABC Rehab can better align their
recovery program to address the needs identified from this study and improve these key areas in
order to add value to the program and to increase each student’s ability to overcome their
addictions.
Limitations and Delimitations
Although this study did meet the expectation of number of interview participants, with an
acceptable range of location and demographics, one limitation to this was the number of
responses to the invitation for participation. Although the notice to participate was sent through
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ABC Rehab, many of the participant’s first impression for the request was they were being
scammed and almost did not respond. This may have been a contributing factor in a lower
response rate. This factor most likely would not have altered the findings however, as saturation
was reached quickly in most cases. Another limitation to this study was the inability to meet
with every single participant in person. Some of the interviews were conducted over the phone
which may have created some issues with considering non-verbal responses that may have led to
additional follow-on questions to determine if greater clarification was needed. Also, ABC
Rehab currently has only one site where females are allowed to attend. This limitation presented
itself most in topics around program culture and structure. Because program is led by the
students, having females in the program would have most likely have impacted these areas in
other locations.
Although these limitations were evident, the findings from this study showed enough
commonality in each of the participant responses to determine these limitations would have had
some impact to this study but may not have change the outcome of the results.
Recommendations for Future Research
Based on this study, it would be recommended to evaluate other addiction recovery programs
to determine which elements have proven successful in those programs, as well as look at how
the assets identified in this study are implemented in other recovery programs. This study only
looked at one program which uses a Therapeutic Community Center methodology for addiction
recovery. The study and comparison to other programs may allow for greater insight and which
recovery methods are common among all methods. It would also be recommended to evaluate
any differences between all male versus all female centers to determine if there are any elements
of the culture or program structure which could improve recovery program’s success, as well as
96
among programs that have men and women integrated in the program. Another recommendation
for future studies would be the use of other methods of research such as the use of surveys and
observations. This study conducted interviews for its data collecting method due to the
sensitivity of the information as well as having the ability to hold in person interviews. Other
methods of gathering data may have been able to generate additional data points for further
analysis. This study found about 75 percent of the graduates had transitioned from the program
to working for ABC Rehab at one of their stores. Further study could be performed to determine
how this improved those graduates ability to stay sober. And lastly, it would be recommended to
compare ABC Rehab to other Therapeutic Community Centers to determine how success rates
differ by organization and location.
Conclusion
The goal of this study was to evaluate ABC Rehab’s addiction recovery program to
determine which elements were contributing most to their current success rate of graduates
reaching a full recovery from their addictions. It also looked to identify gaps using the KMO
model as a way to evaluate influences which could later be used to build recommendations for
improvements. This model was used as a way to use research-based data to help ABC Rehab
consider areas where their addiction recovery program could be improved upon in order to meet
their organizational goal of 100 percent of all their graduates reaching full recovery within three
years from leaving the program. The KMO model addresses each influence and determines if
any needs should be considered by the organization. The New World Kirkpatrick Model was
also used as a framework for establishing recommendations for ABC Rehab to follow as a way
to address those needs and increase their chances of success towards their goal. This was done
through the four levels of training and evaluation in order to address critical behaviors among
97
students as well as develop the metrics and methods to be used for data analysis. This
framework also established the time frames needed for performing these evaluations and
provided tools and methods for ABC Rehab to add continued value to their program. This study
concluded by identifying any limitations to the study and offered recommendations for future
studies to better understand addiction recovery.
98
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Appendix A: Interview Protocol
Welcome [Former Student’s Name], I want you to know how much I appreciate your
participation in this study. I am currently a graduate student and this study is part of my
dissertation. This study is looking at what makes ABC Rehab successful and how you have been
able to apply what you’ve learned while in the program to overcome your addictions. For the
purpose of this study, it is important you understand your participation is voluntary and you may
request at any time to stop the interview for any reason. The interview should take around 30-45
min. With your permission this interview will be recorded for accuracy, however, any names of
persons or places will be removed to keep the responses anonymous, as anonymity is strictly
enforced. Your identity will not be used in this study or shared with any other party or
organization. Please let me know if any breaks are needed during the interview, and you may
stop this interview at any time if you feel the need. Once the interview is complete, a
transcription will be provided to you to validate that your responses were accurately captured.
Are you ready to proceed?
1. What are some of your interests?
2. What made you decide to choose ABC Rehab?
3. How long have been out of the program?
4. How old are you?
5. How did you become aware of your addictions?
6. What were the primary reasons for choosing to overcome your addictions?
7. Is this your first time attending an addiction recovery center?
103
8. You’ve heard the term Therapeutic Community Center, or TC Center? How do you
understand the purpose of a Therapeutic Community Center? (K-Conceptual)
9. How do you understand addiction? (K-Conceptual)
10. How do you feel the program at ABC Rehab prepared you to overcome your addictions?
(K – Conceptual)
11. How do you feel the culture of the program helped you while you were there? (CM)
12. How has living at the facility full-time helped in your recovery? (CS)
13. How do you perceive your addictions once you graduated from the program? (M-Self-
Efficacy)
14. How confident were you in your ability to apply what you learned from the program in
order to overcome addiction? (M-Self-Efficacy)
15. What knowledge did you learn in the program in order to prevent relapse events? (K-
Conceptual)
16. What knowledge have you applied which has helped you prevent relapse events? (K-
Procedural)
17. What knowledge areas do you feel gave you the greatest success towards full recovery?
(K – Conceptual)
18. How valuable was your effort in the program as your worked towards recovery? (M-
Expectancy Value)
19. How did your efforts improve your chances of reaching full recovery? (M-Expectancy
Value)
20. How did the structure of the organization help you as you worked towards recovery?
(CM)
104
21. What did ABC Rehab do to help you transition from a structured environment in the
program, to a new environment outside the program? (Organizational Influence)
22. How were you evaluated at the end of the program, by the ABC Rehab, to determine how
prepared you were to reach full recovery after graduation? (Organizational Influence)
23. What skills have you applied from the program as you worked towards overcoming
addiction? (K-Conceptual)
24. Which of the skills you applied gave you the greatest success towards full recovery? (K –
Procedural)
25. What do you hope will be the result of your effort now that you have graduated from the
program? (M-Expectancy Value)
26. Is there anything you would like to add to our discussion you feel this study would
benefit from?
105
Appendix B: Consent Form
INTRODUCTION: You are invited to participate in a research study on your experience in
applying the tools and techniques learned while in ABC Rehab. The purpose of this study is to
look at what makes ABC Rehab successful and how you have been able to apply what you’ve
learned while in the program to overcome your addictions. You will be asked a series of
questions about your experience, which will be audio recorded. After this study is complete,
recordings of this interview will be destroyed.
TIME INVOLVEMENT: Your participation will take approximately 30 to 45 min.
RISKS AND BENEFITS: There are no foreseeable risks in participating in this study. The
benefits which my reasonably be expected to result from this study are greater knowledge on
effective addiction recovery treatment methods. We cannot and do not guarantee or promise that
you will receive any benefits from this study. Your decision whether or not to participate in this
study will not affect anything related to your participation with ABC Rehab.
PAYMENTS: There are no payments for participating in this study.
PARTICIPANT’S RIGHTS: If you read this form and have decided to participate in this
project, please understand your participation is voluntary and you have the right to withdraw
your consent or discontinue participation at any time without penalty or loss of benefits to which
you are otherwise entitled. The alternative is not to participate. You have the right to refuse to
answer particular questions. Your individual privacy will be maintained in all published and
written data resulting from this study.
106
Appendix C: Post Training Survey Questions
The training held my
interest.
Strongly Disagree Disagree Agree Strongly Agree
The training was
relevant to my recovery.
Strongly Disagree Disagree Agree Strongly Agree
I am able to apply the
training to my recovery.
Strongly Disagree Disagree Agree Strongly Agree
I am confident I will
apply the training to my
recovery.
Strongly Disagree Disagree Agree Strongly Agree
I am committed to
applying the training to
my recovery.
Strongly Disagree Disagree Agree Strongly Agree
107
Appendix D: Delayed Feedback Interview Questions
I am satisfied with how
I’ve implemented the
training towards my
recovery.
Strongly Disagree Disagree Agree Strongly Agree
I understand how to apply
the training to my
recovery.
Strongly Disagree Disagree Agree Strongly Agree
I have the ability to apply
what I’ve learned from the
training.
Strongly Disagree Disagree Agree Strongly Agree
My performance towards
my recovery has improved
as a result of the training.
Strongly Disagree Disagree Agree Strongly Agree
Abstract (if available)
Abstract
ABC Rehab currently reports an 85 percent success rate among program graduates who successfully overcome their addictions within three years from leaving the program. This study examines what ABC Rehab is doing to generate such success and what areas they can focus on to reach their goal of 100 percent of all their graduates becoming addiction free. This is a promising study of ABC Rehab to ensure their success is continued by looking at which Knowledge, Motivation, and Organizational influences impacted graduates the most, contributing to their success. This was done through qualitative research by the use of interviews with former graduates who have overcome their addictions. The findings suggest that many of the contributing factors which ABC Rehab have successfully demonstrated are around structure, program length, and focusing on changes in behavior. Additional findings were also found to show gaps in how program graduates understood which tools contributed the most to their recovery, as well as understanding how the program culture and organizational structure also contributed to their recovery. Although participants understood each of these areas as contributing factors, there was not enough evidence to suggest the organization emphasized one element of these areas over another. Based on the findings from this study, recommendations were given to allow ABC Rehab to ensure they maintain and strengthen their practices in the program in an effort to reach their goal of 100 percent of all graduates becoming addiction free.
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Asset Metadata
Creator
Mitchell, Brandon E.
(author)
Core Title
Addiction recovery: success in the recovery process
School
Rossier School of Education
Degree
Doctor of Education
Degree Program
Organizational Change and Leadership (On Line)
Publication Date
04/08/2021
Defense Date
12/17/2020
Publisher
University of Southern California
(original),
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Tag
Addiction,addiction recovery,addicts,Alcohol,Drugs,OAI-PMH Harvest,therapeutic community
Language
English
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Advisor
Robles, Darline (
committee chair
), Andres, Mary (
committee member
), Malloy, Courtney (
committee member
)
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Tags
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