Chapter 3 66 for example, to reduce substance use, improve adherence to medication, increase coping and social support, and become involved in meaningful activities. This may improve illness outcomes such as symptoms, relapse, and hospitalisation. By combining better illness management with the pursuit of personal goals, progress may be made towards recovery. In Mueser’s model, the IMR programme may also lead directly to recovery, though it should be noted that Mueser differentiates between subjective recovery (perceived recovery, sense of purpose, and personal agency) and objective recovery (role and social functioning) (2) (see Fig. 1). IMR is seen as an Evidence Based Practice (EBP) by the researchers who designed it and by the Substance Abuse and Mental Health Services Administration (SAMSHA) in the U.S., who reasoned that its components were evidence based (7, 9). However, research on the overall programme was needed. FIGURE 1 Conceptual Framework for Illness Management and Recovery (2) In a review conducted in 2011, it appeared that three randomised controlled trials (RCTs), three quasi-controlled trials and three pre-post trials on the overall programme had been conducted (14). The results of one further RCT have also been published (15). The RCTs differed from each other with regard to setting, participant number and diagnoses, the length and format of IMR, the trainers’ training and their qualifications, the intensity of supervision of the trainers, the number and IMR program Goal setting Education about illness Using medications effectively Coping skills training Social skills training Relapse prevention training Alcohol and Drugs Use Coping Skills Meaningful Activities Social Support Program Proximal Outcomes Distal Outcomes Medications Stress Biological Vulnerability - Symptom control -Relapse Subjective recovery: - Perceived recovery - Sense of purpose - Personal agency - - - - - + + - Objective recovery: - Role funcioning - Social functioning
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