Show Summary Details
Page of

(p. 196) Collegiate Recovery Programs for Emerging Adults 

(p. 196) Collegiate Recovery Programs for Emerging Adults
Chapter:
(p. 196) Collegiate Recovery Programs for Emerging Adults
Author(s):

Sierra Castedo

and Lori Holleran Steiker

DOI:
10.1093/med-psych/9780190490782.003.0009
Page of

Subscriber: null; date: 19 October 2018

Introduction

College campuses have long been associated with excessive substance use, often for the first time in a student’s life. For students seeking to maintain recovery from a substance use disorder (SUD), entering a cultural milieu where alcohol and other drug consumption is the norm can force a choice between recovery protection and pursuing a higher education. For students who recognize their own problematic substance use and wish to make a change, there may be no examples of a recovery lifestyle, no recognition that college-aged students can and do find recovery at a young age, and no entry point into a community of recovery readily accessible on or near campus. Enter collegiate recovery programs: refugia of recovery embedded in a college or university campus.

Collegiate recovery programs (CRPs) offer support to college students in recovery from SUD. That support is centered around a community of students in recovery from SUD, recovery-supportive programming, and a space on campus where recovery is actively celebrated and normalized. While there is significant variation in CRP models, all center around a core community of support. The earliest CRPs date back almost 40 years, and the field remained small until just recently. The rapid proliferation of programs across the United States has led to a diversity of CRP models and practices that has not yet been well catalogued (Laudet, Harris, Kimball, Winters, & Moberg, 2014; Laudet, Harris, Winters, Moberg, & Kimball, 2014).

This chapter discusses the history of CRPs across the country and the current state of research on CRPs. The chapter concludes with a description of the program at the University of Texas at Austin’s Center for Students in Recovery.

(p. 197) Collegiate Recovery Program Standards

Four essential ingredients of CRPs were agreed on in a town hall meeting at the national conference of the Association of Recovery in Higher Education (ARHE) in 2015: (1) a community of students in recovery, (2) recovery-supportive programming, (3) a dedicated space, and (4) staff. Three additional criteria, together with the four essential ingredients, form the standards and recommendations set by the ARHE (Association of Recovery in Higher Education, 2016).

Of the four essential ingredients of a CRP, the community of students in recovery from addiction is of primary importance. Communities vary greatly in size, with nascent or emerging programs counting only a handful of students, and more established programs counting well over 50 active participants (Transforming Youth Recovery, 2015). Age composition varies among programs, with a mean age of 26 for CRP students nationally. Augsburg College’s StepUP program caters specifically to individuals ages 17 to 26 (Laudet, Harris, Kimball, Winters, & Moberg, 2015; StepUP Program, 2016). Community composition also varies somewhat by primary addiction, although most students (85.8%) are in recovery from substance use disorder. Other primary addictions include eating disorders (2.9%), sex addiction (1.3%), self-harm (1.2%), and gambling (0.01%) (Jones, Eisenhart, Charles, & Walker, 2016). Some programs welcome students recovering from a primary mental health diagnosis not involving a behavioral or substance addiction; currently, no data are available on the rates at which these students participate in CRPs.

Recovery-supportive programming forms another pillar of CRPs, with significant variation between programs. Most programs host weekly peer support group meetings aligning with existing mutual-aid pathways, including 12-step meetings, SMART, or a style unique to the CRP. Many programs offer a variety of sober social activities, service opportunities, and personal or professional development activities. Some programs incorporate a seminar taught by CRP staff for academic credit available to the CRP students (Casiraghi & Mulsow, 2010). About 40% of CRPs include a clinical, counseling component (Transforming Youth Recovery, 2015).

Space and staff are two CRP ingredients that frequently prove more challenging to secure, especially in the early stages of CRP development. Only about 28% of collegiate recovery programs and efforts (CRP/Es; programs in the earliest stages of development, which may not yet be formally recognized) had a dedicated space, with the remaining CRP/Es using consistently available space shared with other organizations (43%) or inconsistently available space (24%) or having no access to space (5%) (Transforming Youth Recovery, 2015). Residential housing for students in recovery was available at 18% of CRP/Es surveyed (Transforming Youth Recovery, 2015). A more recent survey of CRPs with formal recognition and membership in ARHE indicates that the majority of established programs have a dedicated space (68%), but a significant minority still do not, in spite of (p. 198) formal recognition and national participation (32%) (Jones et al., 2016). While space is an important facet of moving a CRP toward maturity and sustainability, dedicated space is not considered critical to starting a CRP, thus many nascent programs begin before space is secured (Transforming Youth Recovery, 2015). Similarly, dedicated staff are an important component of sustainability for a program, but only 55.6% of the formally recognized, established CRPs employ at least one full-time employee (Jones et al., 2016).

In addition to these core elements of CRPs are three more standards. While one may seem obvious—CRPs are housed within an institution of higher education that confers academic degrees (Association of Recovery in Higher Education, 2016)—the rapid growth of the field in recent years has proven this standard to be a necessary addition. If 16.3% of emerging adults met the criteria for an SUD in 2014 (Substance Abuse and Mental Health Services Administration [SAMHSA], 2015), and an unknown percentage of those young adults entered into recovery, then even the most generous estimate of CRPs,145 collegiate recovery programs or efforts (Transforming Youth Recovery, 2015), likely falls short of the need. Institutions of higher education may move slowly when implementing new programs, thus programs featuring elements of CRPs but unaffiliated with universities and belonging to the private sector have arisen to fill some of that need. If these CRP-like entities operate on a for-profit business model, they are also not in line with the ARHE standard “CRPs are non-profit entities.” While private-sector entities can complement the work of CRPs, the anti-stigma message delivered by CRPs that are fully embedded in and embraced by college campuses cannot be understated.

The final standard calls for an abstinence-based approach as the gold standard of the field (Association of Recovery in Higher Education, 2016). With the rise in secondary prevention programs like BASICS on college campuses, along with services provided at traditional counseling centers and health promotions programs, support for moderate or low-risk substance use is already found on many campuses. In contrast, a relatively tiny proportion of college campuses have CRPs in which abstinence from substances is actively celebrated and supported. The promotion of sobriety as a valid way to enjoy a college experience is an important part of the work that CRPs do. Nonetheless, many CRPs welcome and fully integrate students in recovery from eating disorders and mental health conditions who may not need to abstain from substances. Some CRPs, including the CRP at the University of North Texas in Denton, Texas, are experimenting with the partial integration of students for whom moderation is the goal rather than total abstinence. The University of North Texas’s model involves a tiered system of participation, with harm reduction–oriented students participating at a different tier than that for students practicing abstinence.

Given the rapid growth of CRPs in recent years, there is considerable variation in how CRPs meet these standards; the full scope of that variation is still being explored (Laudet, Harris, Winters, et al., 2014). Table 9.1 presents several key dimensions on which CRPs vary. (p. 199) (p. 200)

Table 9.1 Key Variables and Range of Variation Between Collegiate Recovery Programs (CRPs)

Variable

Explanation

Range of Variation

Admission

Formal application and admissions process may or may not be required. Admissions criteria vary. Admission to the CRP may influence admission to the college or university.

Admissions criteria range from none (“open-door policy” at University of Texas at Austin) to a formal application process requiring 1 year of sobriety, references, interviews, and advocacy for admission to the university (Texas Tech University). Some programs also have suggested age ranges (Augsburg College’s StepUP program serves ages 17–26, though students outside this range may apply).

Housing

College or university housing for students in recovery associated with the CRP

As of 2015, 18% of CRPs offered housing. Housing may be located on campus (residence hall) or off-campus in a university-owned house (Rutgers University) or other building. It may comprise an entire residence hall (Augsburg’s StepUP) or a portion (University of Texas at Austin).

Scholarships

Financial assistance in the form of scholarships

Scholarship amounts vary within and between programs, based on variables including service hours (both within and outside of the CRP), academic performance or improvement, financial need, and dedication to recovery. Range is from no scholarship dollars to several thousand dollars per semester.

Counseling

Some CRPs include access to counseling services within the CRP, case management services, and other clinical components. Others are nonclinical, emphasizing peer support.

CRPs range from entirely nonclinical, peer support–based models (University of Texas at Austin) to programs that require regular meetings with a counselor (StepUP). Many fall in between, with emphasis on peer support, sober socializing, and building community, while including access to counseling or case management (University of North Texas).

Space

The space used by the CRP for its daily operations

Access to space ranges from a dedicated space for CRP use only to no consistently available space (e.g. classrooms reserved week to week). Variation exists within dedicated space types, from regular 9–5 hours to 24/7, keycard access for CRP members (Oregon State University).

History of Collegiate Recovery Programs

The first collegiate recovery program was established in 1977, at Brown University, by Classics professor and Associate Dean Bruce Donovan. CRPs were then developed at Rutgers University, in 1983, and at Texas Tech University, in 1986 (Finch, 2008). What followed was a long period of relatively slow growth; that is, from the late 1980s to the early 2000s, fewer than 10 CRPs were established on college campuses (Laudet, Harris, Kimball, et al., 2014).

Early adopters in the 1990s and early 2000s still in operation today include Augsburg College’s StepUP program (1997), Case Western Reserve University’s program (2004), the program at Loyola College in Maryland (2004), and the Center for Students in Recovery at the University of Texas at Austin (2004) (Association of Recovery in Higher Education, 2015). In 2005, Texas Tech University released a comprehensive curriculum funded by SAMHSA to promote the replication of their model and proliferation of “collegiate recovery communities”—CRPs that follow the Texas Tech model—across the country (Harris, Baker, & Thompson, 2005). This curriculum and mentorship of fledgling programs, along with a growing body of evidence for CRP efficacy and support from federal agencies, including the Office of National Drug Control Policy (2010) and the Department of Education (2011), led to a growth spurt in the number of CRPs, bringing the total number to over 20 programs by 2010.

In 2012, the University of Texas System Board of Regents voted to fund the expansion of collegiate recovery programs to each of its academic institutions, with the Center for Students in Recovery (CSR) acting as a guide and mentor to the new CRPs (University of Texas System Office of Media Relations, 2012). This funding was extended and expanded in 2015 and included initiatives aimed at secondary prevention, primary prevention, and bystander intervention (University of Texas System Office of Media Relations, 2015). Other statewide initiatives soon followed, with the governor of North Carolina funding CRPs across that state in 2014 (Moon, 2014), and the Arizona governor bringing CRPs to three schools in that state, in 2015 (Governor’s Office for Youth, Faith and Family, 2015).

In 2013, the Stacie Mathewson Foundation created the non-profit Transforming Youth Recovery, which undertook an initiative to provide $10,000 seed grants to 100 schools for the establishment of CRPs. These grantees, called collegiate recovery efforts by Transforming Youth Recovery, contributed to the exponential growth in the number of CRP/Es from 2013 to the most recent count in 2015. As of 2015, 145 CRP/Es were in existence, representing a 1,712.5% change since 2004 (Transforming Youth Recovery, 2015). As part of these growth efforts, Transforming Youth Recovery conducts annual surveys of grantees, identifying and refining assets that are critical to starting a new collegiate recovery effort and essential to serving students and sustaining programs, along with additional assets that are helpful to serving students (Transforming Youth Recovery, 2015). The reports generated from these surveys are described in greater detail later in this chapter.

(p. 201) Statewide initiatives in confluence with Transforming Youth Recovery’s seed grant program built upon the solid foundation laid by earlier replication efforts led by Texas Tech and SAMHSA. This catalyzed the exponential growth of CRPs in recent years. With CRP/Es at just over 3% of the 4,706 degree-granting institutions of higher education in the United States, recovery support on college campuses is still a relatively rare resource (National Center for Education Statistics, 2016). Two primary resources exist to locate colleges and universities with CRPs: the Association of Recovery in Higher Education Collegiate Recovery Program Members list, available at http://collegiaterecovery.org/programs, and the Transforming Youth Recovery Collegiate Recovery Asset Map, available at https://collegiaterecovery.capacitype.com/map. A third resource, Recovery Campus magazine’s Directory of Collegiate Recovery Programs, is being published in 2017.

Collegiate Recovery Research

Introduction

Research on a variety of recovery supports is currently receiving greater attention, including the emerging complementary field of peer-delivered recovery support services (Bassuk, Hanson, Greene, Richard, & Laudet, 2016). Greater research on young people accessing recovery supports is also under way (Kelly, Stout, & Slaymaker, 2013). Almost as long as CRPs have existed there has been research on young people participating in CRPs, but few studies have examined the programs themselves or examined data across multiple institutions. This is likely because too few CRPs were in existence, and to make matters worse, existing programs had insufficient data-collection infrastructure.

This section provides an overview of the available research on CRPs and identifies gaps in the literature. Much of the earliest literature published about CRPs was descriptive, usually evaluating a single aspect of a single CRP. There are also descriptions and evaluations of CRP students, although these, too, tend to focus only on a single CRP. Before the rapid growth of CRPs facilitated by the Transforming Youth Recovery grant initiative there were early attempts to look across institutions at multiple CRPs. Since 2014, large-scale, multi-institutional data collection, analysis, and publications have occurred on a scale not previously accomplished.

Previous reviews of collegiate recovery literature identified needed research (Laudet, Harris, Kimball, et al., 2014; Watson, 2014), with multiple efforts now under way to close some of these gaps (Jones et al., 2016; Laudet et al., 2015; Transforming Youth Recovery, 2015). The collegiate recovery field’s rapid growth in recent years provides greater urgency to fill these research gaps, particularly as it relates to establishing best practices, understanding those best practices in light of particular campus cultural variables, and understanding and defining the variety of CRP models.

(p. 202) Early Research: The Descriptive Era

Much of what can be called the descriptive era of CRP research was driven by the desire to disseminate a novel, much-needed concept to professionals across as many fields as possible, including social workers (Grahovac, Holleran Steiker, Sammons, & Millichamp, 2011), substance use disorder clinicians (Cleveland, Harris, Baker, Herbert, & Dean, 2007), student affairs and other higher education professionals (Harris et al., 2005; Perron et al., 2011), and non-academic professionals (Sullivan Moore, 2012). The early goal of this descriptive work was to encourage institutions to adopt CRPs and raise awareness of CRPs.

These descriptions were rarely ever solely descriptions and usually presented some data that would be useful for supporting the creation of a CRP at the reader’s home institution. For example, Botzet, Winters, and Fahnhorst (2008) described Augsburg College’s StepUP program through the results of a modified Global Appraisal for Individual Needs (GAIN) (Dennis, 1998) survey of 83 current and former StepUP program students. The highly favorable results of this study offered strong supporting evidence in favor of establishing a new collegiate recovery program at an institution. Similarly, evaluations and analyses of Texas Tech University’s collegiate recovery community (CRC) provided both a model for replication and evidence of the model’s positive impact on student outcomes. Bell and colleagues (2009) conducted a qualitative feedback survey of 15 first-year Texas Tech University CRC students multiple times throughout their first year, demonstrating that the support provided by the CRC is essential for many students in recovery. Casiraghi and Mulsow (2010) evaluated a single component of the Texas Tech CRC by focusing specifically on their program’s seminars for academic credit. They explored whether an academic component to a CRP was valuable programmatically and to the students (Casiraghi & Mulsow, 2010). Wiebe, Cleveland, and Dean (2010) and Cleveland, Wiebe and Wiersma (2010) focused on how Texas Tech students involved with the CRC were able to avoid relapse and temptation in the college environment. Rutgers University’s model of a CRP built around a campus recovery house provides important evidence in support of recovery-supportive housing efforts on campus as a way to complete the continuum of care (Laitman, Kachur-Karavites, & Stewart, 2014).

Several of these early research initiatives also focused on CRP student demographics and life histories, though only within a single CRP population. Cleveland and Groenendyk (2010) examined the daily lives of students involved in the Texas Tech CRC, including the frequency and type of social interactions that formed the “substrate of abstinence support” (p. 78). Cleveland, Baker, and Dean (2010) surveyed 52 active members of the Texas Tech CRC over 11 months, gathering data on treatment episode history, drugs of choice, substance use history, family dynamics, religiosity, 12-step participation, living situation, and basic demographics. While focusing only on a single CRP population, this study laid important (p. 203) groundwork for the national CRP student snapshot conducted by Laudet and colleagues (2015) several years later.

Early Multi-Institutional Research

Early forays into multi-institutional research on CRPs included multiple efforts to collate the body of research on CRPs into literature reviews. Smock, Baker, Harris, and D’Sauza (2011) offer a review from the perspective of social support in collegiate recovery communities, focusing primarily on reviewing the body of literature from Texas Tech’s CRC researchers but including other resources as well. Importantly, Smock and colleagues called for CRPs to be considered an evidence-based practice, given the existing data, and to be added to the National Registry of Evidence-Based Programs and Practices (NREPP), which at the time did not include recovery supportive programs in its repository (Smock et al., 2011). As discussed later in the Methodological Considerations section, many of these studies do not meet the standards of NREPP inclusion, as they are not randomized or rigorous quasiexperiments. A broader multi-institutional literature review examined the benefits of recovery-supportive housing on three campuses: Rutgers University, Texas Tech University, and Augsburg College (Watson, 2014).

A significant acknowledgment of diversity within CRP models came from Perron and colleagues (2011), who divided program models into a formal, top-down approach to supporting students and a bottom-up, student-driven approach to support students in recovery. Formal program models included those programs that were well established in 2011: Rutgers University, Augsburg College’s StepUP program, and Texas Tech University’s CRC (Perron et al., 2011). The informal model described was the University of Michigan student organization Students for Recovery (SFR) (Perron et al., 2011; Perron, Grahovac, & Parrish, 2010). SFR was the primary actor galvanizing the community of students in recovery, organizing campus-based 12-step meetings and educating the campus and community about addiction and recovery. Today, numerous CRPs combine both approaches, with a formal CRP and student organization branch operating in unison.

A greater acknowledgment of multiple models in the collegiate recovery movement came from the first nationwide survey of CRPs (Laudet, Harris, Winters, et al., 2014). Laudet and colleagues (2014) recommended that, because CRPs begin organically and are embedded within a unique campus culture, variations in programs must be accounted for before any model is evaluated. In a separate paper, Laudet and colleagues (2014) reviewed the current state of knowledge about CRPs nationally and identified key areas where research is needed, including systematic evaluation and documentation of CRPs and CRP models. The authors also identified the collection of demographic information and addiction recovery history from CRP students, as well as documentation of (p. 204) the diversity of CRP programs as research priorities, gaps that the authors filled in an NIH-funded study described in the next section (Laudet, Harris, Kimball, et al., 2014).

Multi-Institutional Research after Rapid Growth of CRP Field

Several of the research gaps identified by Laudet, Harris, Winters, Moberg and Kimball (2014) were subsequently addressed in their large-scale survey of CRP students (Laudet et al., 2015). The survey was administered in 2012 to 600 students participating in 29 collegiate recovery programs in 19 states, with an 81% response rate for 486 respondents (Laudet et al., 2015). The survey included demographic and life history information similar to that collected by Cleveland et al. (2010) within Texas Tech’s CRC. From this national reference data of CRP students, several growth edges have been identified. First, CRP demographics are not reflective of the gender, racial, and ethnic makeup of university campuses nationwide, skewing more heavily white and male than the general campus population. This has led to the formation of an informal work group within the Association of Recovery in Higher Education to improve diversity and inclusion. Laudet and colleagues’ follow-up publication of the survey data revealed students’ motivations for joining CRPs (Laudet, Harris, Kimball, Winters, & Moberg, 2016). The three primary reasons that students joined CRPs were (1) ready access to a recovery-supportive peer network, (2) a desire to “do college sober” and have a genuine college experience free from substance use, and, less prominently, (3) to give back and be of service while in college (Laudet et al., 2016). Two-thirds of CRP students’ enrollment decisions were based on CRP availability and structure, with 72% of that subset stating that they would not have attended college without a CRP present (Laudet et al., 2016).

Transforming Youth Recovery’s annual surveys of grantees have also resulted in two reports compiling data about collegiate recovery programs and efforts across the nation (Transforming Youth Recovery, 2014, 2015). The 2014 report focused primarily on two areas: the 38 assets and a network examination (Transforming Youth Recovery, 2014). Transforming Youth Recovery’s 38 assets are divided into three main categories: (1) assets that are critical to start a program and begin serving students in recovery; (2) assets that are essential to longer-term support of students but are not critical to start a program; and (3) additional assets that are helpful but are neither critical to start a program nor essential to long-term success (Transforming Youth Recovery, 2014). Assets may be individuals, associations, or institutions, and there is much overlap between the assets considered critical to start a CRP and the standards set by the ARHE, including space, staff, a community of students, and mutual-aid support groups. The network examination component of the 2014 report was intended to help CRP/Es expand their reach by better understanding existing communities and to help identify gaps in existing networks (Transforming Youth Recovery, 2014). The survey also (p. 205) examined staffing, program model (clinical, peer-based, or social-based), average number and range of engaged students at each stage of program development, and the ratio of the number of students invited to participate in the CRP to the number of students engaged (Transforming Youth Recovery, 2014). In this latter metric, more established CRPs had higher engagement ratios (one engagement for every two invitations) than those of programs in earlier stages of development (one engagement for every three to five invitations) (Transforming Youth Recovery, 2014). Programs with dedicated space also had the highest engagement ratios, further supporting the importance of a dedicated space as an asset critical to starting a CRP (Transforming Youth Recovery, 2014). The 2015 Transforming Youth Recovery report also examined assets and networks (named “connections” in this report) and added CRP/E compositions and practices (Transforming Youth Recovery, 2015). “Compositions” refer to staffing, use of space, presence/absence of a residential housing component, and model archetype (clinical, peer-based, social-based) (Transforming Youth Recovery, 2015). “Practices” refer to ongoing recovery programming, activities, and support services for students in recovery (Transforming Youth Recovery, 2015).

More efforts to gather national data on CRPs are under way. Results from a survey of the 54 ARHE institutional members in 2015 were presented at the 2016 ARHE national conference, with a publication soon to follow (Jones et al., 2016). The ARHE member survey captures data from the most established programs, including the longest running programs dating from the 1980s and 1990s (Jones et al., 2016). This survey captures important benchmarking data regarding CRP staffing, finances, and students served, which is of great importance to emerging programs seeking to become more established within their home institutions. A major literature review and literature database creation project is currently under way, spearheaded by ARHE’s Research Committee. A national baseline data collection tool is also in development by the ARHE Research Committee.

Methodological Considerations

Measurement Instruments

In order to choose an appropriate instrument to measure the impact of one or more CRPs, one must first determine how recovery is defined. Is relapse a failure? Most of the “wildly successful” CRPs have a mean relapse rate of 8% (Laudet et al., 2015), but is that a reasonable way to measure a student’s success? Or does it encourage hiding relapse? Or does it deny the potentially positive impact of someone “testing the waters” and coming to a more definitive sense of self as a person with an SUD and a person now in recovery? Among national recovery organizations, including Faces and Voices of Recovery, there is a push to shift the language from “relapse” to more neutral language reflective of stage of change, including “resumption of use,” “recurrence,” or “partial remission” (White & Ali, 2010). The “relapse = failure” paradigm has long been called into question, particularly in (p. 206) light of a growing acknowledgment of SUD as a chronic illness requiring long-term care (McLellan, Lewis, O’Brien, & Kleber, 2000).

Presently, there are no standardized measures used at CRPs but, given the focus on methodological issues within ARHE, the development of a standard data collection instrument may ease this problem. CRPs are using the growing national evidence base, which is shifting from simply demographic information and oversimplified measurement of “sobriety” (often without consideration of the role of resumption in use for movement along the stage of change and readiness continuum) to more recovery-centered instruments such as the Assessment of Recovery Capital (ARC) (Groshkova, Best, & White, 2013) and quality of life (QOL) measures (WHOQOL Group, 1998). “Recovery capital” is the sum of the resources an individual can draw on to initiate and sustain recovery from substance use problems, a concept not well measured by usual problem-based assessments of treatment outcomes (Groshkova et al., 2013). The Recovery Capital measurement instrument has been validated for this population; it was found to be a stable measure substantially related to other similar measures and to duration of recovery, suggesting it might aid recovery-oriented assessment of treatment services and of an individual’s progress and needs. However, it will be important to test whether the measure can predict later recovery, and rather than assessing an underlying ability to recover, it seems partly to measure recovery itself (Groshkova et al., 2013). The World Health Organization Quality of Life instrument measures a number of domains relevant to recovery: Overall Quality of Life and General Health, Physical Health (e.g., energy, fatigue, pain, discomfort, sleep, and rest), Psychological (body image, appearance, feelings, self-esteem, thinking, learning, memory, and concentration), Independence (e.g., activities of daily living, substance dependence, work capacity), Social Relationships (e.g., social support, family, friends, sexual activity, financial resources, safety/security, healthcare, quality of home environment, opportunities for acquiring new skills and information, recreation and leisure and physical environment, transportation), and Spiritual/Religious (e.g., personal beliefs).

The next subsection addresses the most challenging part of researching CRPs: the extensive range of services, populations served, settings, environmental aspects, and administrative departments.

Variables Related to Diverse CRP Characteristics

The research of Alexandre Laudet and colleagues (2015) has established that, while there are some common characteristics of CRPs, the models vary drastically from one campus to another. Specific aspects of CRPs, such as residential versus club locale, small versus large, varied definitions of recovery, and voluntary versus obligatory aspects of programs, lead us to warn the reader not to compare “apples and baseballs.” Laudet et al. (2015) note that, “unlike treatment programs that collect patient history upon admission to guide services, CRPs do not.” While five CRPs have operated for 10 years or longer and some serve up to 80 students, two-thirds emerged in the past decade, and over half serve fewer than 10 students (Laudet et al., 2015). Clearly, the students at one CRP are unlikely to represent the (p. 207) breadth of experiences and issues that a cumulative study of all the varied CRPS can yield. It is for this reason that we recommend that unified efforts through the Association of Recovery in Higher Education and invested groups such as the National Development Research Institute (NDRI) continue in order to research the phenomenon rather than having each campus research “collegiate recovery students.” The most critical point is that findings of small campus studies can and ought not be generalized to the larger population of college recovery students nationwide. Missions of varied CRPs may differ. Staffing and administrations vary as well—is the CRP student-run or student-organization based? Is it housed in a mental health center or department or is it freestanding? Is it under the auspices of student affairs, and, if so, how does the administration of the university see the CRP?

Also, multi-tiered systems exist (everything from “open-door” programs without membership requirement to those with some stipulations to entry due to related scholarship or housing). Those with stringent entry requirements may appear to have better outcomes from a ‘length of sobriety” standpoint, but they ought not be compared with those that aim to extend participation to individuals in the earliest stages of recovery or who have not yet entered into recovery.

Samples and Population

In terms of sample size, CRP programs range from a few students to hundreds. Presently, there are only six schools with 50 or more students in their core participation group. Even among established CRPs the mean size is 24, and among all ARHE members, mean student group size is 22 (Jones et al., 2016; Transforming Youth Recovery, 2015). The median is only 15 (Jones et al., 2016).

As implied earlier, inclusion/exclusion criteria vary from CRP to CRP. For example, Texas Tech’s CRP has a requirement of 1 year of recovery for membership, while the University of Texas at Austin has no requirements or even membership lists. Inclusion of women, minorities, and children/youth have unique human subjects protections implications, but the diversity of a CRP may be limited by the diversity of the campus, stigma attached to recognition of substance use disorders, and willingness to associate with other people in need of CRPs.

Human Subjects Issues and Other Limitations

Given the multiple vulnerabilities of emerging adults on college campuses, care must be given to protection of human subjects from the standpoint of their minor status (in some cases), drug use, and potentially incriminating data. Because students come to CRPs in the midst of crisis, researchers must be thoughtful and cautious to consider not only that consent forms and surveys can lead to research fatigue but also that if a young person gets turned off from CRP involvement by the presence of research, this could be life threatening. It cannot be denied that research impacts the culture of CRPs, especially in areas with high stigma and where traditionalist approaches to 12-step programs exist (i.e., conflict with fundamentalist interpretations of anonymity).

(p. 208) The question of who does the research can be complicated. Outside researchers clearly have more objectivity, but the students at the CRP may not trust them as they would their staff or peers. Many CRPs operate with limited staff and budget (Laudet, Harris, Winters, et al., 2014) and lack the resources to collect student information. Research presently is often being conducted by CRP staff who are typically close with the students and also may have power over scholarship money, housing, and hiring. Perhaps the best compromise is to have the research done by a faculty liaison whom the students know and trust, but who does not have regular contact with them. Researchers should give thought to whether it is advantageous or problematic to survey or investigate the students directly or via the directors/staff.

Social behavioral research, as in many vulnerable settings, cannot use a control group, for ethical reasons. In addition, researchers would not be smart to compare individuals with alcohol drug issues who opt out because they may be vastly different from those that choose to affiliate with a CRP. Another limitation of the research is that most CRPs have “rolling admissions” that change the demographics and data readily. Attrition can be a serious limitation: CRPs with open doors allow for sporadic attendance, and people can come and go before feeling comfortable making a strong commitment to the CRP. For example, the CRP at the University of Texas at Austin (Center for Students in Recovery) had a student who engaged briefly their freshman year and then touched base and made a second and third foray into recovery their sophomore and junior years. In the final semester of senior year, the student entered fully into recovery and has been in recovery since April 2014. These issues, combined with staffing changes, graduation of student leaders, and university climate changes (incidences on campus, such as overdose deaths of students or other drug/alcohol-related issues) all have the potential to influence research findings. History has power in these settings. The most recent and potent example is that at Texas A&M, where a student overdose and related arrests have impacted students’ willingness to identify as an addicted person.

Collegiate recovery programs often involve students who may be recovering from a variety of substance disorders, mental health challenges, and process disorders. Eating disorders, Internet addiction, and binge drinking are all issues that are relevant to CRPs but may require unique programming and group open-mindedness, not to mention qualitative or quasiexperimental research mechanisms.

Growth Areas

Research has been identified as a major growth area for the field of collegiate recovery. At present, few faculty have positions exclusively dedicated to the study of recovery. Funding streams are limited. CRP staff typically do not hold faculty positions and are instead dedicated to the daily functioning of the space and providing services to students.

(p. 209) While CRPs are spreading across the country, several underserved areas have been identified as growth areas for the field: community colleges, historically Black colleges and universities (HBCUs), tribal colleges, rural campuses, and underserved populations on campuses with existing CRPs. Alignment with the goals of mental health recovery supports on campus is also a growth area for the collegiate recovery field. In July 2016, SAMHSA convened the National Summit on Recovery Support in Collegiate Environments, bringing together leaders from the collegiate recovery field, HBCUs, community colleges, tribal colleges, collegiate mental health, and student leaders belonging to underserved populations. The intent was to “identify and advance (a) best practices in supporting students in collegiate environments, (b) strategies to align recovery support programs with other campus-based health and social services, and (c) opportunities for new and existing collegiate recovery support programs to build capacity and infrastructure” (SAMHSA, 2016, p. 2). In addition to the support from SAMHSA, the Association of Recovery in Higher Education has an informal working group dedicated to diversity and inclusion in CRPs.

The Center for Students in Recovery at the University of Texas at Austin

The Center for Students in Recovery (CSR) at the University of Texas (UT) at Austin was established in 2004 to serve a handful of students in recovery. In its 12-year history, CSR has undergone significant shifts while maintaining its core mission: to provide a supportive community where students in recovery and in hope of recovery can achieve academic success while enjoying a genuine college experience free from alcohol and other drugs. One major shift was the formalization of CSR as a stand-alone program within the Division of Student Affairs, in 2013. While maintaining close ties and a clear bridge to clinical resources on campus, CSR is strictly nonclinical in nature. This emphasis on peer support provides an entry point for students who view clinical resources with trepidation, in addition to being the appropriate level of care for students in well-established recovery. Throughout its history, it has been CSR’s goal to meet students “where they are” in the stages of change (Holleran Steiker, 2016).

As mentioned earlier, CRP models vary significantly based on the campus culture in which they were formed. CSR’s model differs from many in that it is entirely open door with no formal membership or entry requirements. Participation is completely voluntary. Students with multiple years of long-term recovery are welcome, as are students not yet in recovery. Additionally, students enrolled at other higher education institutions, or people considering pursuing a higher education but not yet enrolled, are also welcome to participate fully. A major contributing factor to this policy of inclusion is the large, vibrant, and young recovery community off-campus, including some who attend the local community college while seeking to transfer to the University of Texas.

(p. 210) A useful way to conceptualize the variation across CRPs is to describe how a program meets the standards and recommendations set by the Association of Recovery in Higher Education described earlier in this chapter, with particular emphasis on community, space, staff, and recovery-supportive programming. These four pillars will be discussed next. The additional three standards are straightforward. CSR’s mission includes helping students “achieve academic success while enjoying a genuine college experience free from alcohol and other drugs,” maintaining abstinence-based recovery as a core principle. As a stand-alone program within the Division of Student Affairs at the University of Texas at Austin, CSR functions as a student service and resource center within a larger non-profit institution.

Community

The community of students in recovery at CSR varies widely in terms of academic status, recovery time and type, age, background, and life experiences. As described earlier, CSR’s open-door policy results in a community whose recovery time ranges from 0 days to 10 or more years. Students can be categorized into three broad categories: nontraditional students in established, long-term recovery pursuing an education after a significant absence from the educational setting; traditional undergraduate and graduate students new to recovery, remaining in school or returning after a brief hiatus for inpatient treatment or other care; and recovery high school students entering college as traditional first-year students. Throughout its history, CSR has had high participation from nontraditional students in established recovery, thanks to the large, vibrant recovery community surrounding the UT Austin campus, and thanks to staff who have actively participated in that community. As CSR grew in visibility as a campus resource, the second group, consisting of traditional students new to recovery, began to make up a significant portion of the students participating in CSR. This provided an excellent opportunity for students in more established recovery to mentor, sponsor, and support those students with less recovery time. Few students from recovery high schools have participated in CSR because UT Austin has lacked targeted recovery-supportive housing options on campus. With the opening of a recovery-friendly living learning community in the fall of 2017, CSR hopes to encourage more recovery high school graduates to attend UT Austin. CSR also has extensive interactions, including a mentorship program, with the UT Charter School University High School (UHS), Austin’s only recovery high school. Thanks to its proximity to CSR, UHS students attend peer support meetings at CSR and interact regularly with CSR students and staff. CSR also held its first annual college informational session in 2016 for high school students enrolled at three recovery high schools (UHS, Archway Academy and Cates Academy), one adolescent treatment center (Phoenix House), and an alternative peer group (Teen and Family Services—Austin) as part of an ongoing effort to build bridges to CRPs for students graduating from recovery high schools.

(p. 211) Recovery Programming

CSR’s recovery supportive programming falls into four categories: peer support group meetings, sober social activities, service opportunities, and educational programming. Peer support group meetings occur on a weekly basis. Currently, seven peer support group meetings are held 5 days per week, although this number fluctuates each semester as students graduate, schedules change, and student preferences shift. Two weekly meetings—the CSR group activity and Campus Open Recovery on Tuesday night—have remained at the same time and day for years in order to provide a backbone of consistency, while other meetings may be more flexible. Three Alcoholics Anonymous meetings—one open, one for men, and one for women—are held in the CSR space each week. Two meetings are 12-step based but welcome those recovering from any condition. One of these 12-step all-addictions meetings is called Yoga for Recovery and features 45 minutes of yoga followed by 45 minutes of a standard 12-step discussion meeting format. Certified yoga instructors who are also in 12-step recovery teach the yoga portion and lead the peer support meeting. There are two non-12-step meetings held in the space: Nourish, an eating disorder recovery support group, and the CSR group activity. Nourish is welcoming to students in recovery from any variety of eating disorder and is inclusive of any kind of recovery pathway. The meeting is peer-led, but the meeting anchor receives guidance and support from the CSR staff and the university’s Mindful Eating program staff. The CSR group activity varies in content and format each week. Examples of past group activities include mural painting, accountability groups, guest expert speakers, meditation workshops, and scavenger hunts.

The educational programming at CSR includes some sessions of the CSR group activity but also includes the Seminar on Addiction and Recovery (SOAR). SOAR is a monthly speaker-series featuring an expert on addiction and/or recovery. Speaker topics range from overdose prevention and naloxone training to immune signaling in alcohol dependence. SOAR lectures are open to the public and intended to educate both CSR students and the campus at large. SOAR lectures also give students who may have qualms about making an initial visit to CSR a low-stakes opportunity to visit the space. CSR staff members provide educational programming for classes, student organizations, and professional groups intended to lower stigma around students in recovery and provide information about CSR and CRPs in general. Presentations geared toward students provide basic information about how to be an ally to other students in recovery or to a peer actively struggling with SUD. This is intended to empower students to help get a peer in need connected to resources that will help the student find recovery.

Sober social activities include organized events planned and implemented by CSR staff as well as peer-organized and led activities. Past events have included sober tailgates, sober dance parties, bowling, and ugly holiday sweater parties. Sober social activities organized by students include game nights, pumpkin carving, and trail running groups. CSR staff also organize camping trips and retreats for students, usually in conjunction with one or more other CRPs’ students. (p. 212) Collaboration with other CRPs, with recovery high schools, and with other facets of the larger recovery community is a recurring theme in CRP sober social activities, as this integration with a larger recovery community provides more opportunities for students to find sober social supports.

Space and Staff

At its founding CSR did not have dedicated space outside of the founding director’s office. Meetings and programming were held in borrowed classrooms throughout campus, which could lead to confusion and students missing meetings because they became lost or did not have the correct room location. Dedicated space for CSR was secured in 2009 and, because it was a former boiler room, required an extensive remodel before move-in. This dedicated location was in the basement of the School of Social Work at the far southern edge of campus. The dedicated location served CSR well, allowing for greater community-building activities, as students could now use the space to study or socialize with fellow students in recovery outside of a scheduled support group meeting. In 2014, CSR moved to a more central and symbolically important campus location: the Darryl K. Royal Texas Memorial Football Stadium. With football as the most visible athletic event and perhaps the most visible campus event overall, CSR’s current location further communicates to the on- and off-campus community that students in recovery are a valued part of campus. The larger space also allows for a separate study room and small library of recovery literature to provide a quiet and recovery-supportive space for students in recovery to work. The larger meeting room enables a greater range of programming, including SOAR and the hybrid yoga/12-step meeting, neither of which would be feasible in CSR’s previous location.

Student assistants—part-time undergraduate or graduate student workers paid hourly—are hired from within the community of students in recovery to help keep the space open for students wishing to use CSR as a safe space during the school day. The staff was further expanded with the hiring of a second full-time position to complement the duties of the director: a program coordinator. The program coordinator oversees the CSR group activity, CSR-led sober social activities, coordinated service opportunities, and educational programming. The program coordinator also works with students who wish to form new peer-led groups or change existing programming. Currently, the program coordinator is responsible for outreach to campus partners, including student organizations, other campus services, professors, and committees, in addition to the programming already described. The director serves as the primary off-campus liaison, including fundraising, and representing CSR at the national, state, and local levels. The director oversees CSR financials, staffing, and other administrative issues. Additionally, the director makes decisions about scholarships, including evaluating applicants, distributing scholarship funds, and raising funds for scholarships. The CSR Council is also coordinated and facilitated by the CSR director. The council is a volunteer body that serves to brainstorm ideas for CSR programming, outreach, (p. 213) and development activities and tackle specific tasks. The Council consists of students, alumni, UT staff and faculty, and off-campus community supporters. CSR also employs a graduate assistant to take on specific projects. Currently, the CSR graduate assistant works with the CSR director and the staff of University High School (UHS) to coordinate the mentorship program matching CSR students to UHS students in recovery. This mentorship program is intended to build a bridge to college for recovery high school juniors and seniors.

Impact at University of Texas at Austin and Beyond

In the 2015–2016 academic year, CSR had personal interactions with 2,694 members of the campus community, primarily students. These personal interactions include the core CSR participants: a fluctuating group of students and prospective students who regularly attend meetings at CSR, participate in CSR programming, and form the foundation of the community of support, which numbered 50 that year. Peripheral participants are a group of students who are engaged with CSR, but to a lesser degree: these students engage with CSR at least once per semester, but that engagement may be via event attendance only, or only participating in service opportunities. Peripheral participants are typically students in established recovery who have transitioned into a stage of school or work that prevents them from interacting more regularly with CSR but who keep active ties at least once per semester. This group numbered 220 in 2015–2106. The number of event or other programming attendees, plus students that reached out for help but did not engage with CSR long term, totaled 1,072. Finally, over 1,300 students were engaged in class and student organization presentations in 2015–2016.

These in-class and student organization presentations are an essential way that CSR helps normalize recovery on campus and empowers students to respond when their peers ask for help. Each presentation includes education about CSR as a resource, CRPs generally, addiction recovery basics, and a brief recovery ally training. The recovery ally training follows the outline in Figure 9.1.


Figure 9.1. Brief recovery ally training outline used by the Center for Students in Recovery at the University of Texas at Austin, during classroom and student organization presentations.

Figure 9.1. Brief recovery ally training outline used by the Center for Students in Recovery at the University of Texas at Austin, during classroom and student organization presentations.

Combatting stigma is an important part of CSR’s work, which is facilitated greatly by in-class presentations. Stigma influences not only how the general population views addiction but also how healthcare professionals treat their patients (Kelly & Westerhoff, 2010). With UT Austin training nurses, social workers, counselors, pharmacists, and physicians, this early exposure to stigma-combatting efforts is essential. The effects of public service announcements and health promotion campaigns are known to be temporary but have greater success when coupled with on-the-ground efforts like those undertaken at CSR (Noar, 2006; Noar, Palmgreen, Chabot, Dobransky, & Zimmerman, 2009; Snyder et al., 2004; Wakefield, Loken, & Hornik, 2010). When these on-the-ground efforts include in-person interactions with the perceived out-group (people in recovery from SUD), accomplished at CSR by having a student in recovery share their story during an in-class presentation, the ameliorative effects are lasting and significant (Broockman & Kalla, 2016). College is a transformative time for many students, (p. 214) and CSR seeks to include shifting attitudes toward people in recovery from SUD among those transformations.

CSR’s efforts have been expanded to each UT System academic institution in an initiative that began in 2012. The 2015–2016 academic year impacts of these programs totaled 8,685 campus community members across the eight UT System academic campuses. While this number does not represent a majority of UT System campus constituents, it represents a tremendous improvement over the total lack of targeted addiction recovery efforts that characterized the landscape before the initiative.

The impact of CSR extends far beyond campus. In November 2014, CSR staff helped form the Recovery Oriented Community Collaborative with recovery community organizations and other recovery resources in Austin, Texas. This model of local collaboration is being replicated across the state by RecoveryPeople, a SAMHSA-funded initiative based in Austin. CSR also actively collaborates with other CRPs in the state, including an effort to bring the national conference for the Association of Recovery in Higher Education to Houston, Texas, in 2018 with the CRP at the University of Houston.

CSR actively participates at the national level as well. Transforming Youth Recovery frequently uses CSR staff expertise to guide and mentor emerging CRPs and develop best practices for the field. CSR actively participates with the Association of Recovery in Higher Education to further the collegiate recovery movement. The Association of Recovery Schools, the national organization for recovery high schools, held its 2016 conference in conjunction with CSR and University High School. Further, CSR has gained national media attention and recognition with features in The Huffington Post and on National Public Radio in 2015, and with an American College Health Association Best Practices in College Health Award, in 2012 (American College Health Association, n.d.; Goodwyn, 2015; Kingkade, 2015).

(p. 215) Conclusion

The interdisciplinary and interinstitutional collaboration that the Center for Students in Recovery at the University of Texas at Austin employs is characteristic of the collegiate recovery movement. CRPs and the national organizations that serve them represent a tremendous opportunity for extensive collaboration with treatment centers, private practice clinicians, and other on- and off-campus resources. As the growth of the collegiate recovery movement across the country continues, those already serving collegiate populations with substance use disorders can play a major role in supporting that growth. Faculty, staff, alumni, and parents of children enrolled at institutions of higher education can advocate for the creation of a CRP at that institution and can lend support, belonging, and an influential voice to the students who wish to access that resource. These advocates—whether they are attached to a university or serve the off-campus community—are critical components of any collegiate recovery effort (Transforming Youth Recovery, 2015). As a recent report suggests, collegiate recovery programs are a “win-win proposition” for college students, institutions of higher education, and the communities in which they are embedded (Bugbee, Caldeira, Soong, Vincent, & Arria, 2016).

References

American College Health Association. (n.d.). Award recipients. Retrieved September 30, 2016, from http://www.acha.org/ACHA/About/Award_Recipients.aspx#bp

Association of Recovery in Higher Education. (2015). The collegiate recovery movement: A history. Retrieved from http://collegiaterecovery.org/the-collegiate-recovery-movement-a-history/

Association of Recovery in Higher Education. (2016). Standards and recommendations. Retrieved from http://collegiaterecovery.org/standards-and-recomendations/

Bassuk, E. L., Hanson, J., Greene, R. N., Richard, M., & Laudet, A. B. (2016). Peer-delivered recovery support services for addictions in the United States: A systematic review. Journal of Substance Abuse Treatment, 63, 1–9. doi: 10.1016/j.jsat.2016.01.003Find this resource:

Bell, N. J., Kanitkar, K., Kerksiek, K. A., Watson, W., Das, A., Kostina-Ritchey, E., . . . Harris, K. (2009). “It has made college possible for me”: Feedback on the impact of a university-based center for students in recovery. Journal of American College Health, 57(6), 650–658. doi: 10.3200/JACH.57.6.650-658Find this resource:

Botzet, A. M., Winters, K., & Fahnhorst, T. (2008). An exploratory assessment of a college substance abuse recovery program: Augsburg College’s StepUP Program. Journal of Groups in Addiction & Recovery, 2(2-4), 257–270. doi: 10.1080/15560350802081173Find this resource:

Broockman, D., & Kalla, J. (2016). Durably reducing transphobia: A field experiment on door-to-door canvassing. Science, 352(6282), 220–224. doi: 10.1126/science.aad9713Find this resource:

Bugbee, B. A., Caldeira, K. M., Soong, A. M., Vincent, K. B., & Arria, A. M. (2016). Collegiate recovery programs: A win-win proposition for students and colleges. College Park, MD: Center on Young Adult Health and Development. Retrieved from http://www.cls.umd.edu/docs/CRP.pdf.

(p. 216) Casiraghi, A. M., & Mulsow, M. (2010). Building support for recovery into an academic curriculum: Student reflections on the value of staff run seminars. In H. H. Cleveland, K. S. Harris, & R. P. Wiebe (Eds.), Substance abuse recovery in college (pp. 113–143). New York: Springer US.Find this resource:

Cleveland, H. H., Baker, A., & Dean, L. R. (2010). Characteristics of collegiate recovery community members. In H. H. Cleveland, K. S. Harris, & R. P. Wiebe (Eds.), Substance abuse recovery in college (pp. 37–56). New York: Springer US.Find this resource:

    Cleveland, H. H., & Groenendyk, A. (2010). Daily lives of young adult members of a collegiate recovery community. In H. H. Cleveland, K. S. Harris, & R. P. Wiebe (Eds.), Substance abuse recovery in college (pp. 77–95). New York: Springer US.Find this resource:

      Cleveland, H. H., Wiebe, R. P., & Wiersma, J. D. (2010). How Membership in the Collegiate Recovery Community Maximizes Social Support for Abstinence and Reduces Risk of Relapse. In H. H. Cleveland, K. S. Harris, & R. P. Wiebe (Eds.), Substance Abuse Recovery in College (pp. 97–111). Springer US.Find this resource:

        Cleveland, H. H., Harris, K. S., Baker, A. K., Herbert, R., & Dean, L. R. (2007). Characteristics of a collegiate recovery community: Maintaining recovery in an abstinence-hostile environment. Journal of Substance Abuse Treatment, 33(1), 13–23. doi: 10.1016/j.jsat.2006.11.005Find this resource:

        Dennis, M. L. (1998). Global Appraisal of Individual Needs (GAIN) manual: Administration, scoring, and interpretation. Bloomington, IL: Lighthouse Publications.Find this resource:

          Finch, A. J. (2008). Rationale for including recovery as part of the educational agenda. Journal of Groups in Addiction & Recovery, 2(2-4), 1–15. doi: 10.1080/15560350802080704Find this resource:

          Goodwyn, W. (2015). Amid rising concern about addiction, universities focus on recovery.Find this resource:

            Governor’s Office for Youth, Faith and Family. (2015). Collegiate recovery. Retrieved September 16, 2016, from http://substanceabuse.az.gov/substance-abuse/collegiate-recovery-0

            Grahovac, I., Holleran Steiker, L., Sammons, K., & Millichamp, K. (2011). University centers for students in recovery. Journal of Social Work Practice in the Addictions, 11(3), 290–294. doi: 10.1080/1533256X.2011.593990Find this resource:

            Groshkova, T., Best, D., & White, W. (2013). The assessment of recovery capital: Properties and psychometrics of a measure of addiction recovery strengths. Drug and Alcohol Review, 32(2), 187–194. doi: 10.1111/j.1465-3362.2012.00489.xFind this resource:

            Harris, K., Baker, A., & Thompson, A. (2005). Making an opportunity on your campus: A comprehensive curriculum for designing collegiate recovery communities. Lubbock: Center for the Study of Addiction and Recovery, Texas Tech University.Find this resource:

              Holleran Steiker, L. (2016). Youth and substance use: Prevention, intervention, and recovery. New York: Oxford University Press.Find this resource:

                Jones, J. A., Eisenhart, E., Charles, B., & Walker, N. (2016, April). Results of the 2015 National Collegiate Recovery Programs Profiles Study. Presented at the Association of Recovery in Higher Education 7th Annual Conference, Atlanta, GA.Find this resource:

                  Kelly, J. F., Stout, R. L., & Slaymaker, V. (2013). Emerging adults’ treatment outcomes in relation to 12-step mutual-help attendance and active involvement. Drug and Alcohol Dependence, 129(1-2), 151–157. doi: 10.1016/j.drugalcdep.2012.10.005Find this resource:

                  Kelly, J. F., & Westerhoff, C. M. (2010). Does it matter how we refer to individuals with substance-related conditions? A randomized study of two commonly (p. 217) used terms. International Journal of Drug Policy, 21(3), 202–207. doi: 10.1016/j.drugpo.2009.10.010Find this resource:

                  Kingkade, T. (2015, May 28). How Texas college students are using yoga and tailgating to stay sober. Retrieved from http://www.huffingtonpost.com/2015/05/27/college-programs-drug-addicts_n_7343310.html

                  Laudet, A. B., Harris, K., Kimball, T., Winters, K. C., & Moberg, D. P. (2014). Collegiate recovery communities programs: What do we know and what do we need to know? Journal of Social Work Practice in the Addictions, 14(1), 84–100. doi: 10.1080/1533256X.2014.872015Find this resource:

                  Laudet, A. B., Harris, K., Kimball, T., Winters, K. C., & Moberg, D. P. (2015). Characteristics of students participating in collegiate recovery programs: A national survey. Journal of Substance Abuse Treatment, 51, 38–46. doi: 10.1016/j.jsat.2014.11.004Find this resource:

                  Laudet, A. B., Harris, K., Kimball, T., Winters, K. C., & Moberg, D. P. (2016). In college and in recovery: Reasons for joining a collegiate recovery program. Journal of American College Health.64(3), 238–246. doi: 10.1080/07448481.2015.1117464Find this resource:

                  Laudet, A. B., Harris, K., Winters, K., Moberg, D., & Kimball, T. (2014). Nationwide survey of collegiate recovery programs: Is there a single model? Drug & Alcohol Dependence, 140, e117. doi: 10.1016/j.drugalcdep.2014.02.335Find this resource:

                  Laitman, L., Kachur-Karavites, B., & Stewart, L. P. (2014). Building, engaging, and sustaining a continuum of care from harm reduction to recovery support: The Rutgers Alcohol and Other Drug Assistance Program. Journal of Social Work Practice in the Addictions, 14(1), 64–83.Find this resource:

                  McLellan, A. T., Lewis, D. C., O’Brien, C. P., & Kleber, H. D. (2000). Drug dependence, a chronic medical illness. Journal of the American Medical Association, 284(13), 1689–1695.Find this resource:

                  Moon, J. (2014). Governor provides funding for programs aimed at student recovery. Inside UNC Charlotte. Retrieved September 16, 2016, from http://inside.uncc.edu/news-features/2014-06-11/governor-provides-funding-programs-aimed-student-recovery

                  Moore, A. S. (2012, January 22). A bridge to recovery on campus. The New York Times, p. ED14.Find this resource:

                    National Center for Education Statistics. (2016). Digest of Education Statistics, 2014. Washington, DC: U.S. Department of Education.Find this resource:

                      Noar, S. M. (2006). A 10-year retrospective of research in health mass media campaigns: Where do we go from here? Journal of Health Communication, 11(1), 21–42. doi: 10.1080/10810730500461059Find this resource:

                      Noar, S. M., Palmgreen, P., Chabot, M., Dobransky, N., & Zimmerman, R. S. (2009). A 10-year systematic review of HIV/AIDS mass communication campaigns: Have we made progress? Journal of Health Communication, 14(1), 15–42. doi: 10.1080/10810730802592239Find this resource:

                      Office of National Drug Control Policy. (2010). National Drug Control Strategy. Washington, DC: Author.Find this resource:

                        Perron, B. E., Grahovac, I. D., Uppal, J. S., Granillo, T. M., Shutter, J., & Porter, C. A. (2011). Supporting students in recovery on college campuses: Opportunities for student affairs professionals. Journal of Student Affairs Research and Practice, 48(1), 47–64. doi: 10.2202/1949-6605.6226Find this resource:

                        Perron, B. E., Grahovac, I. D., & Parrish, D. (2010). Students for recovery: A novel way to support students on campus. Psychiatric Services, 61(6), 633–633. doi: 10.1176/appi.ps.61.6.633Find this resource:

                        (p. 218) Smock, S. A., Baker, A. K., Harris, K. S., & D’Sauza, C. (2011). The role of social support in collegiate recovery communities: A review of the literature. Alcoholism Treatment Quarterly, 29(1), 35–44.Find this resource:

                        Snyder, L. B., Hamilton, M. A., Mitchell, E. W., Kiwanuka-Tondo, J., Fleming-Milici, F., & Proctor, D. (2004). A meta-analysis of the effect of mediated health communication campaigns on behavior change in the United States. Journal of Health Communication, 9(Supp1), 71–96. doi: 10.1080/10810730490271548Find this resource:

                        StepUP Program. (2016). Frequently asked questions. Retrieved from http://www.augsburg.edu/stepup/frequently-asked-questions/

                        Substance Abuse and Mental Health Services Administration (SMAHSA). (2015). Behavioral Health Barometer: United States, 2015 (No. HHS Publication No. SMA-16-Baro-2015). Rockville, MD: Author. Retrieved from http://store.samhsa.gov/product/Behavioral-Health-Barometer-2015/All-New-Products/SMA16-BARO-2015

                        Substance Abuse and Mental Health Services Administration (SAMHSA). (2016). SAMHSA’s National Summit on Recovery Support in the Collegiate Environment: Agenda. Rockville, MD: Author.Find this resource:

                          Transforming Youth Recovery. (2014). 2014 Collegiate Recovery Asset Survey Report (No. 1). Reno, NV: Author. Retrieved from http://www.transformingyouthrecovery.org/sites/default/files/resource/2014%20Collegiate%20Recovery%20Asset%20Survey%20Report_TYR%208-11-14.pdf

                          Transforming Youth Recovery. (2015). Collegiate Recovery Asset Survey: 2015 Monitor. Reno, NV: Author.Find this resource:

                            University of Texas System Office of Media Relations. (2012). Regents expand Collegiate Student Recovery Program to all UT academic institutions. Retrieved September 16, 2016, from http://www.utsystem.edu/news/2012/11/15/regents-expand-collegiate-student-recovery-program-all-ut-academic-institutions

                            University of Texas System Office of Media Relations. (2015). Regents position UT System to serve as national model for alcohol prevention and education programs. Retrieved September 16, 2016, from http://www.utsystem.edu/news/2015/02/12/regents-position-ut-system-serve-national-model-alcohol-prevention-and-education-pro

                            Wakefield, M. A., Loken, B., & Hornik, R. C. (2010). Use of mass media campaigns to change health behaviour. Lancet, 376(9748), 1261–1271. doi: 10.1016/S0140- 6736(10)60809-4Find this resource:

                            Watson, J. (2014). How does a campus recovery house impact its students and its host institution? Journal of Social Work Practice in the Addictions, 14(1), 101–112.Find this resource:

                            White, W., & Ali, S. (2010). Lapse and relapse: Is it time for a new language?Find this resource:

                              WHOQOL Group. (1998). Development of the World Health Organization WHOQOL-BREF quality of life assessment. The WHOQOL Group. Psychological Medicine, 28(3), 551–558.Find this resource:

                              Wiebe, R. P., Cleveland, H. H., & Dean, L. R. (2010). Maintaining abstinence in college: Temptations and tactics. In H. H. Cleveland, K. S. Harris, & R. P. Wiebe (Eds.), Substance abuse recovery in college (pp. 57–75). New York: Springer US.Find this resource: