Determinants of recovery: a cross-sectional analysis 99 The third limitation is our inability to find significant pathways between addiction, medication adherence or insight and the degree of clinical, personal and functional recovery. This may have lain in the fact that a majority of the participants in our study had few problems in these domains and therefore showed only limited variance on the scores. Fourth, as our analysis was cross-sectional and not longitudinal, we were unable to determine temporal causality. And as our analysis was led by the directions of the associations suggested in the conceptual framework of IMR, we did not explore reverse directions of the associations between the various concepts. Potential future directions We have chosen to use total scores of most measures. More specific results could be obtained, if analyses were repeated using subscales of the illness management constituents and of the MHRM, but also using other components of personal recovery, such as self-esteem or self-stigma. Secondly: the generalizability of this type of research on recovery could increase if there would be more uniformity in definitions and operationalization’s of the different types of recovery—see introduction. Thirdly: to gain more insight into the impact of addiction, medication adherence and insight on the different types of recovery a research population could be chosen having more variance on the scores on these domains. Fourth: to be able to determine temporal causality this study could be repeated with a longitudinal analysis. Conclusions Our results suggest that coping is a determinant of all three types of recovery, and that social support is a determinant of functional recovery. Clinical recovery appears not to be a prerequisite for functional and personal recovery. Our results also suggest the relevance of improving coping skills for clinical, functional, and personal recovery, and of fostering social support for functional recovery. The conceptual framework of IMR could be only partially supported.
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