What Is Meant by “Recovery,” Anyway?
By Kevin Doyle, EdD
The term “recovery” seems to be tossed around so much and to mean different things to different people so as to risk having no meaning at all — and in some ways this seems to be for the worse. For those with substance use disorders, and their friends, family members, and concerned others, this may lead to confusion over whether an individual is truly in recovery or not, and significant consequences may hinge on that very question.
Let’s explore a few of the important issues relating to this important question.
For those who have worked in the treatment/recovery field for a long period of time, the answer was often simple: sustained abstinence. While concrete and specific, this has some obvious shortcomings, mostly notably manifested in the questions “abstinence from what?” and “for how long?”
The longstanding adage of “a drug is a drug is a drug” has been largely, and correctly, replaced with a much more nuanced way of looking at this. For example, while in the past individuals taking medications for psychiatric disorders might have been looked at by some as “not in recovery,” more recently — with the rise inf harm reduction and anti-craving medications approaches, some might advocate for a broader definition of recovery that would be inclusive of decreased, less risky use (harm reduction) or the use of medications to support the recovery process (such as suboxone, naltrexone, or methadone).
Compounding this as well are questions relating to substances like tobacco and nicotine which, although generally legal and not as dangerous in the acute stage (as in operating a motor vehicle) are nonetheless addictive and harmful, or even lethal, over time (chronic use). The long-time stereotype of the smoke-filled A.A. meeting, or the steps outside the meeting, has changed somewhat, but still exists to a degree. Does one consider a person addicted to nicotine, but abstinent from alcohol or opioids, not to be in recovery? And with the growing legalization and prevalence of cannabis use in the United States, do we consider an individual who is abstinent from other addictive substances, but uses marijuana, to be in recovery? (Let’s assume that use is not for a medical reason, but for so-called “recreation.”)
Another question relates to who gets to make the decision about someone’s recovery. Leaving it up to the individual, which makes a lot of sense of course, risks allowing recovery to be whatever anyone wants it to be — which does not sound like evidence-based healthcare. On the other hand, allowing someone else, like a family member or significant other, to make this determination does not sound right either.
Noted recovery advocate and prolific writer William White put forward a broad definition over 15 years ago that still has relevance and applicability today:
Recovery is the experience (a process and a sustained status) through which individuals, families, and communities impacted by severe alcohol and other drug (AOD) problems utilize internal and external resources to voluntarily resolve these problems, heal the wounds inflicted by AOD- related problems, actively manage their continued vulnerability to such problems, and develop a healthy, productive, and meaningful life. (White, Journal of Substance Abuse Treatment, 2007).
As we continue to ponder this important question, I would suggest that an intentional move toward making healthier decisions about substance use, combined with tangible progress/actions in that direction, — whether “medication assisted” or not — can be considered a form of recovery. Ideally, individuals engaged in the process of change that we call “recovery” will also be openly and candidly engaged with a healthcare provider, whether a counselor or a primary care provider, who can provide support for the recovery process, identify warning signs of a return to problematic use, and challenge the individual when that is necessary.
Preparing these professionals to provide the services above is crucial, of course, and encouraging those in recovery to be open with their health care providers is another piece of the puzzle.
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Kevin Doyle Ed.D., is the president and CEO of the Hazelden Betty Ford Graduate School of Addiction Studies in Center City, Minn.
