What Does ‘Recovery’ Mean to People in Recovery? (Part II)
To mark Recovery Month, we are examining what ‘recovery’ means.
Previously (see Part I) I wrote about the public perception of ‘recovery’. Here, the meaning of ‘recovery’ to the only true experts, people in recovery, is summarized.
The Meaning of Recovery
Note that attempts at defining ‘recovery’ from substance problems are relatively recent. Specifically, in 2005, SAMHSA (the Substance Abuse and Mental Health Administration that allocates block grants to states for publicly funded treatment), brought together representatives from various stakeholder groups to the first National Recovery Summit; we were tasked with developing a definition and principles of recovery. The resulting definition was:
“Recovery from alcohol and drug problems is a process of change through which an individual achieves abstinence and improved health, wellness and quality of life.”
This may seem obvious to most today but ten years ago, this signaled several momentous shifts: Recovery as a process – not an end stage – and critically, recovery as a goal that goes well beyond abstinence. Recovery was now to be conceptualized (and it was hoped, promoted by services) as a journey toward overall wellness. Incidentally and contrary to the perception of a large minority of the general public (described in previous piece), this also signaled that ‘recovery’ was not only attainable, but pretty darn desirable…
As often occurs with paradigmatic shifts, several other events happened shortly after the Recovery Summit that contributed to solidify the turning of the tide from ‘recovery as abstinence’ to ‘recovery as something more’. One such event, organized by the Betty Ford Institute in 2006, brought addiction scientists and policymakers together to draft a recovery definition that could be measured rigorously for scientific purposes – e.g., does treatment A promote ‘recovery’? We came up with:
“Recovery from substance dependence is a voluntarily maintained lifestyle characterized by sobriety, personal health, and citizenship.”
That definition, elaborated in a peer-reviewed paper, went on to guide the UK and Scotland’s drug policies, among others.
“But what about the true experts’ definition?” you ask…
I am coming to that.
The True Experts
In preparation for that meeting, I’d conducted a study using data from one of the NIH funded projects my team and I had at the time. Simple study, really.
Our sample was 354 formerly drug dependent people recruited through newspapers in New York City. The sample ranged from one month to over ten years in recovery. We asked: “How would you define recovery from drug and alcohol use?” (You can read the paper here.) Asked first specifically in terms of substance use, most defined ‘recovery’ as total abstinence (vs. for instance, moderation). But when describing recovery in their own words, few mentioned substance use. Instead, people described recovery with words such as a “new life, a second chance.” In another study with the same people, we asked “what is (or would be) good about being in recovery?” As summarized in this presentation, a third spoke of getting a second chance at life, other answers include having ‘a clear head’ (23%), improving themselves (23%), having goals, a better attitude, better living conditions, physical and mental health, and family life.
Could that just be rose colored glasses or wanting to please researchers who were studying ‘recovery’? Not likely. Among the many items asked in a 90-minute questionnaire, we asked participants to rate how satisfied they were with their life (from 1-10) and how stressed they had been in the past year. We analyzed the data as a function of how long they had been in recovery. To this day, ten years later, I still think of this as ‘my pride and joy slide’ (slide 13 here) – okay, I am a nerd… judge for yourself:
The longer people are in recovery, the better quality of life satisfaction (QOL) becomes, and stress goes down dramatically as recovery progresses. Remember that stress/negative emotions are the number one predictor of relapse. And as if this weren’t interesting enough, here is the coolest of all: quality of life satisfaction predicts subsequent commitment to abstinence, a documented predictor of sustained recovery.
This is all very good news because, when we ask people why they are seeking/sought recovery, over 90% say that they didn’t like where their life was going and they wanted a better life. When we dig into the specifics of people’s goals and priorities in recovery, whether they are just entering treatment or further along in the process, we find pretty much the same ‘stuff’ we would expect from anyone (with the exception of ‘working on my recovery/staying sober’ which is always number one, regardless of recovery stage): Work, family and social relationships, education, leading a productive life, emotional health and physical health among the top priority areas.
So as the next step of this puzzle, we examined how these life areas look as a function of being in recovery. Faces and Voices of Recovery and I conducted the Life in Recovery Survey to start documenting individual recovery experiences and benefits to society – much is known of the costs of addiction to the nation but we know very little of the benefits of recovery to the country’s health and economy. The survey consisted of items tapping into positive and negative experiences in the life domains people in recovery cite as priorities (see earlier) and those society focuses on (e.g., criminal justice involvement). People were asked to report whether each of these 44 experiences had happened to them while they were in active addiction, then, since they had been in recovery; 3,228 people nationwide completed the online survey between November and December 2012.
Our results not only confirm the high costs of addiction, but more importantly, they are the first to document the dramatic improvements people experience in all areas once in recovery.-Alexandre LaudetOur results not only confirm the high costs of addiction, but more importantly, they are the first to document the dramatic improvements people experience in all areas once in recovery. For example, relative to in active addiction, the rate of family activities participation, steady employment and paying taxes increases by 50% or more in recovery; the rate of paying bills on time and paying back personal debt doubles, community volunteering increases nearly threefold and reports of untreated emotional/mental health problems decrease over fourfold. The costs to the individual and to society also decrease compared to active addiction: e.g., we see a dramatic reduction in involvement in domestic violence (as victim or perpetrator), a tenfold decrease in costly Emergency Room visits, and tenfold decreases in involvement in illegal acts and with the criminal justice system (e.g., arrests, incarceration, DWIs). What is more, improvements continue steadily over time as recovery is maintained. Thus life keeps getting better as recovery progresses.
Reports of negative life experiences, a proxy for the costs of addiction, generally decline as recovery gets longer, and conversely, reports of behaviors/circumstances reflecting healthy functioning (i.e., the benefits of recovery) increases with longer recovery time. Note that these findings contradict many of the social stereotypes of recovery (e.g., the belief that recovery means trying to get sober discussed in the last piece) and show that recovery is attainable for many and means a full, healthy and productive life.
What Does This All Mean?
The meaning of ‘recovery’ continues to vary depending on who you ask. Among people who experience it first hand, recovery is a second chance at a new life, a process toward overall wellness where quality of life satisfaction increases as stress decreases. These data afford us some confidence that the hope of a better life is indeed fulfilled in recovery. Moreover, research data underline the fact that recovery is not only good for the individual, but also for the nation’s health and economy.
Services need to guide clients towards strategies and resources to improve areas of life that have been devastated by addiction, not just produce clean urines.-Alexandre LaudetFar from being a lifelong sentence to a bleak existence of abstinence and meetings, recovery is sought and experienced as attractive and productive. This is clearly paramount and ought to be the goal of services and policies: Services need to guide clients towards strategies and resources to improve areas of life that have been devastated by addiction, not just produce clean urines. In fact, failure to do so often leads people to leave treatment early, as they do not feel that services are helping them rebuild their lives.
If all that happens is cessation of substance use in the absence of quality of life improvement (e.g., because of no resources or services to improve life’s conditions), then abstinence will be in serious jeopardy. If on the other hand, reducing/stopping drinking or getting high begins to be associated with feeling better, healthier, rebuilding one’s life and making progress, as the saying goes in the Big Book of AA (and yes, it applies whether or not you’re a 12-stepper) “you will be amazed before you’re half way through.”
In the final installment of this essay marking Recovery Month, I shall reflect on what I, a normie, have learned so far from the recovery experience. Because indeed, we all can learn from that very humbling human experience.
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