Substance abuse practitioners ask 'what is recovery?'

Nov 2 2007

Abstinence from alcohol and drugs is just the starting point in defining "recovery" for people with substance abuse disorders, according to a paper in the October issue of the Journal of Substance Abuse Treatment (JSAT).

According to an initial definition developed by a panel of experts from the Betty Ford Institute, recovery is "a voluntarily maintained lifestyle characterized by sobriety, personal health, and citizenship." The panel's report appears as part of a special section of JSAT devoted to Defining and Measuring Recovery.

Although "recovery" is widely recognized as the goal of treatment for substance abuse disorders, there has been no widely accepted definition of what the term actually means. "Recovery may be the best word to summarize all the positive benefits to physical, mental, and social health that can happen when alcohol- and other drug-dependent individuals get the help they need," the expert panel writes.

The panel's report outlines some of the thinking behind key components of the definition. Sobriety—meaning complete abstinence from alcohol and all other nonprescribed drugs—is regarded as necessary, but not in itself sufficient for recovery. The panel suggests a classification to define the duration of sobriety: "early" sobriety between one month and one year; "sustained" sobriety, between one and five years; and "stable" sobriety, five years or longer. People in "stable" recovery are thought to be at lower risk of relapse.

Personal health is included as a component of recovery that may be of special importance to substance abusers and their families, as well as to society. In this context, personal health refers not only to physical and mental health, but also to social health—ie, participation in social roles and supports. Citizenship refers to "giving back" to community and society. While acknowledging the need refine this part of the definition, the panel felt is was important to recognize the traditional place of citizenship as a key element of recovery.

The panel members hope their definition will help in overcoming some of the remaining obstacles to substance abuse treatment—including the stigma associated with being in recovery. They liken being "in recovery" to being a "cancer survivor"—a term reflecting research evidence that the risk of relapse is significantly reduced for patients who are cancer-free after five years.

"[P]ublic discussion of survival rates has increased the proportion of individuals willing to get early screening for [cancer] and to take preventive measures," the experts write. They hope that their new definition of recovery "might be the beginning of a similar course of events in the addiction field. If recovery can be effectively captured, distilled, and communicated, it can come to be expectable by those now suffering from addiction." This in turn could promote more realistic perceptions of recovery, and its true worth from social and economic standpoint.