Has the word ‘Recovery’ actually reached its sell-by date?

For the purpose of this blog post, the term ‘recovery’ relates to recovery from addictions, or addictive behaviours. I also want to make it clear from the outset; I have no desire or intention to undermine, or belittle in any way, the massive struggle endured by anyone who reaches that point where they can proudly announce – “I’m in Recovery” – that is their choice. It’s a rite of passage they have earned, something they are probably and justifiably proud of, it’s a goal they have undoubtedly worked extremely hard to achieve[1].

What is Recovery?

There are many definitions[2] of the word ‘recovery’ however the version arrived at by SAMHSA[3] in 2012 is probably most relevant here; “A process of change through which individuals improve their health and wellness, live a self-directed life, and strive to reach their full potential” – as used in the UK SMART Recovery Handbook. The dictionary definition of the actual word is shown below.

Recovery

noun: recovery; plural noun: recoveries

a return to a normal state of health, mind, or strength. “signs of recovery from unconsciousness

synonyms:    recuperation, convalescence, return to health, process of getting better, rehabilitation, healing, rallying

antonyms:    relapse, deterioration

the action or process of regaining possession or control of something stolen or lost. “a team of salvage experts will ensure the recovery of family possessions”

synonyms:    retrieval, regaining, repossession, getting back, recapture, reclamation, recouping, retaking, redemption

antonyms:    loss

Professor David Best, a prominent academic within the field of addictions recovery points to the fact; many of the definitions do not “fit with the idea that recovery is both a personal quality and a lived experience.” The de facto standard for a ‘recovery’ in addictions definition isn’t an easy conclusion to arrive at but surely, shouldn’t anyone entering the ‘recovery community’ simply see it as a transitional phase in their life? Irrespective of any 5-7years for stable recovery (Stages of Change Model theory[4]), the relevance of which is disputed by some[5], why would anyone want to remain in a place that you can actually graduate from?

Could it be they are more comfortable/content with where they are, rather than how they think they’d be on the other side of their addiction? In ‘normal’ mainstream life, whatever the term normal is construed to mean; do we stay in school because we don’t want to mature or start working to provide for ourselves and/or our family?

The Recovery Journey

Recovery takes a long time – for most people the journey to stable recovery will (in theory) take around five to seven years, after the last use of their substance of choice. That journey on the individual ‘road to recovery’ is often extremely difficult and filled with regular potholes. Ones that vary in-depth, size and difficulty of escape; not only for the person making that transition to a better life but also, for the family and friends of that individual.

“Recovery does not happen in isolation – it is generally learned from other people who have gone down the same road and who ‘mentor’ or model the methods and principles of recovery” – Prof David Best

There is a growing body of evidence which consistently points to the fact; many of these valuable learned life experiences are immensely beneficial, especially if shared in a controlled and applicable mutual-aid process, for the benefit of the wider recovery community.

“Evidence suggests that a peer-supported community programme focused on self-determination can have a significant positive impact on recovery from substance addictions[6]…”

The UK National Drug Strategy 2008 (rightly) promoted “recovery as the bedrock” of all commissioning decisions in substance addiction treatment. This was probably the predominant catalyst for a greater understanding of the term ‘recovery’ at least in the UK. This was further strengthened with a Government update[7] two years later.

“…focusing primarily on reducing the harms caused by drug misuse, our approach will be to go much further and offer every support for people to choose recovery as an achievable way out of dependency.”  (Rt. Hon Theresa May MP – Home Secretary)

The subsequent publication of ‘Medications in Recovery; Re-orientating drug dependence treatment[8] – the so-called ‘Strang Report’ – as well as highlighting the undoubted value of mutual-aid (as offered by SMART Recovery), did much to reinforce the importance of the ‘magic’ recovery word, at least within the treatment arena. This is probably why; it has since become something of a de rigueur buzzword within those services, to the almost total exclusion of any other aspect of the overall recovery process.

“The process of recovery from problematic substance use is characterised by voluntarily sustained control over substance use which maximises health and wellbeing and participation in the rights, roles and responsibilities of society.” (UK Drug Policy Commission – July 2008)

Partly as a consequence of the many strategic policies and reports on substance addiction, often impacted by political and financial considerations; ‘recovery’ is now (unfortunately) seen as a sales pitch and marketing tool for many managers in treatment services. Individuals ‘in recovery’ are metaphorically (but often hastily) placed on pedestals and paraded in front of not just their peers but also, rafts of civic dignitaries, service commissioners, MPs and the like, at every given opportunity. Often this ‘window dressing’ of treatment services can be almost irrespective of any cognitive decision-making process afforded to the individual concerned.

Irrespective of any inherent human tribalism or desire to be part of an exclusive club, there are also other factors at play in the ‘recovery’ promotion. Within treatment services there has been an organic growth of the organisational ethos, along with the thought processes of individual service users involved which says; you have to be ‘in recovery’ to be an expert about the recovery process.

Even by valued lived experiences alone, this is not only presumptuous but also, at the very best only partially correct. Those ‘experts’ are only intensely knowledgeable about their own individual experiences. It is also somewhat condescending to suggest any other, at least within professional working relationships. Yes, there may be some similarities with the circumstances being faced by others however; it is a well-known and understood fact, the direction of every ‘recovery road’ is a different journey taken individually.

The ‘Recovery Agenda’ Moving Forward

Since inception, the so-called ‘Recovery Agenda’ has achieved much to transform UK drug treatment policy. We are now recovery focused which is good however; could this priority of policy in addictions services, from one of crime and punishment to one of recovery[9] and treatment, actually be presenting unexpected consequences?

Partly as a consequence of that change in policy, it could be argued that, we now have an improved understanding about addictions, addictive behaviours and how best to combat the negative impacts of both. This greater understanding can be seen right across treatment services, supporting statutory and voluntary agencies and not least, our society as a whole however; the development of a recovery focus in UK drug treatment policy and practice, although a worthy cause, could also be a confusion between clear rhetoric and blurred reality[10].

I believe the time is right to scale things back a little. If we don’t, all that previous overt and vigorous banging of the recovery drum could run the risk of rupturing the drum’s skin.

I have neither the inclination or space here to enter the heated and ongoing ‘addiction is/is not a disease’ debate. There is however a clinical analogy that can be drawn here, to illustrate my thought process. If someone is unfortunately diagnosed with cancer (a disease), gets treatment, thankfully gains remission and subsequently recovers, are they in recovery for the rest of their life? Or, as is most often the case, do they actually consider themselves as recovered?

Yes, they may expectedly worry that the cancer could return in the future however, my observed experiences tell me; they mostly move on from that chapter in their life to the post ‘all clear’ phase – perhaps those in recovery from addictions should try to adopt a similar train of thought? After all, isn’t it better to live life with a healthy dosage of positivity, if we genuinely wish to galvanise an effective long-term solution?

The owners of a ‘recovery badge’ can sometimes become overtly pretentious and/or overly self-indulgent around the values of their individual transitional life experiences. In addition, if those individuals subsequently secure employment within the ‘recovery’ workplace, these traits can (if unchecked) become ever more pronounced. When an employer shows any tendency towards allowing the use of a ‘recovery badge’ to disguise professional inadequacies, or even as a protective armour against consequences, this can and does create discord amongst non ‘recovery badge’ wearing staff and/or dysfunctional working practices within the organisation.

My past experiences (internal and external to treatment services) have shown me; individuals ‘used’ in this manner by those services, or who are making a personal choice to remain under their ‘comfort blanket’ of ‘recovery’ for too long, can and do experience counterproductive impacts on the long-term prognosis for their continued journey of recovery. Again, because of individuality and individual circumstance another question is raised; exactly how long is too long?

Additionally, those employed professionals within the treatment arena, who make a personal choice to continually bang the recovery drum, are often less well received by not only some service users, but also some of their colleagues. I have personally witnessed this on numerous occasions. People who may also be ‘in recovery’ (or may not), but only choose to announce that fact when it is appropriate and relevant to the circumstances, generally enjoy greater acceptance and are afforded credence in a far more positive manner.

This point is probably the crux of this issue. When a person ‘in recovery’ is employed as a ‘professional’ within the recovery arena, shouldn’t organisations and individuals concerned be continually asking the question; “is my/their ‘recovery’ appropriate and applicable to the working circumstances?” Too often it isn’t, often it is totally irrelevant to the situation or circumstances. When that is the case, problematic situations often arise and should actually be expected. This continued over-reliance upon the overt ‘recovery badge’ often results in perverse and unexpected outcomes, for individuals and employers alike.

Those unexpected outcomes can be even more pronounced and problematic when endured by colleagues with a diverse range of life/work experiences. Within a recovery orientated therapeutic organisation, or indeed any other working environment, employers who fail to apply the same management standards and methods to all employees, irrespective of any ‘recovery’ status, are actually incubating problems for the future.

In SMART Recovery we “discourage the use of labels which can lead to hopelessness” ergo; isn’t constant residence under the ‘recovery blanket’ telling an individual… I will never fully recover? We also teach that “human beings are far too complex to be defined completely by one bit of our personality, or one thing that we have done” – that was then, this is now. Yes, there is undoubted great value for the individual who learns from their recovery process, when they use that experience to help drive their new direction however; perhaps advertising that experience should be a less widely used tool? To constantly allow/promote the waving of the recovery flag is not dissimilar to allowing a meeting participant with a propensity for recovery ‘war’ stories to ramble on… something else that SMART discourages.

We actively promote ‘unconditional self-acceptance’ (USA) – we are not required to live under a label of our past. We actively promote unconditional other acceptance (UOA) – our thoughts/judgement about others impact upon how we judge ourselves ergo; “if he/she is in still in recovery fifteen years down the line, will I ever recover?” In the promotion of unconditional life-acceptance (ULA) we teach that life throws all kinds of things at you which you can’t control but you accept it and get on with your lot… continuing to move forward.

As I’ve already pointed out, recovery is something to be immensely proud of for any individual. The overall therapeutic value of social connectivity within the recovery community is also soundly evidenced. The life experiences involved both before and after choosing to change any addictive behaviour are immense. Being able to use any of those learned experiences to benefit the journey of others is laudable however; it is my belief there needs to be far greater promotion and application of the graduation from addictions and addictive behaviours, as sometimes but not routinely, outlined in the stages of change.

In many ways the ‘addiction recovery badge’ can be likened to the Gay Pride movement. It’s fine to celebrate diversity and the values of individuality however; do we really expect everyone at the party to suddenly ‘come out’ and join the LGBTQ community?

Irrespective of the deserved celebrations around reaching recovery from addiction or addictive behaviours, isn’t the dwelling on that particular process actually sending mixed messages to those we are trying to help? Aren’t those in recovery who chose not to graduate from that process, in some respects, promoting a self-defeating prophecy?

Perhaps it’s time to start wearing the ‘recovery badge’ a little more covertly?

REFERENCES:

[1] Note: The thoughts and views expressed in this article are those of the author alone. They are not directed towards any particular individual and should in no way be attributed to UK SMART Recovery®, the SMART Recovery® Programme, or indeed any of the employees or trustees of those organisations.

[2] White, William L. “Addiction recovery: Its definition and conceptual boundaries.” Journal of substance abuse treatment 33.3 (2007): 229-241.

[3] The American Substance Abuse and Mental Health Services Administration www.samhsa.gov

[4] Prochaska, J. O., DiClemente, C. C., Velicer, W. F., Ginpil, S. & Norcross, J. C. (1985) Predicting change in smoking status for self-changers. Addictive Behaviors, 10, 395–406.

[5] West, Robert. “Time for a change: putting the Transtheoretical (Stages of Change) Model to rest.” Addiction 100.8 (2005): 1036-1039.

[6] White, William L. “The mobilization of community resources to support long-term addiction recovery.” Journal of substance abuse treatment 36.2 (2009): 146-158.

[7] The 2010 drug strategy, ‘Reducing demand, restricting supply, building recovery: supporting people to live a drug-free life’ – released on 8 December 2010.

[8] Strang J. “Medications in recovery: Re-orientating drug dependence treatment” (July 2012). Available for download at http://www.nta.nhs.uk/uploads/medications-in-recovery-main-report3.pdf

[9] Duke, Karen. “From crime to recovery the reframing of British drugs policy?” Journal of Drug Issues 43.1 (2013): 39-55.

[10] McKeganey, Neil. “Clear rhetoric and blurred reality: The development of a recovery focus in UK drug treatment policy and practice.” International Journal of Drug Policy 25.5 (2014): 957-963.