A Shared Understanding - A consensus definition of recovery
Recovery in the context of substance use is generally recognised as a process of change through which individuals improve their health and wellness, live self-directed lives, and strive to reach their full potential. This definition, established by the Substance Abuse and Mental Health Services Administration (SAMHSA), emphasises that recovery extends beyond abstinence and encompasses physical and mental health, social connections, and community involvement.
The Betty Ford Institute and the American Society of Addiction Medicine (ASAM) both additionally include the deliberate intentionality of sustained effort to manage substance use with the goal of abstinence in their definition of recovery. Betty Ford further emphasises the importance of pro-social communal involvement, which they call "citizenship". Here, citizenship refers to meaningful social participation, contribution, belonging, and valued roles within community life.
The Global Recovery Network (GRN) synthesises the various components of the definitions and subscribes to the following:
“Recovery from alcohol and other substance use disorders is an active, voluntary process and a health outcome. Recovery is an individual's continual growth that most often involves support networks and that builds recovery capital to address the biological, psychological, social, and spiritual disturbances that characterise substance use disorders. Recovery is an ongoing process of growth to achieve the outcome of a substance-free life, which allows an individual to reach their full potential.”
The GRN stresses that recovery includes the following seven factors:
- Marked improvements in quality of life and wellness that include freedom from substance and behavioural addictions, compulsions and dependencies
- The ongoing pursuit of abstinence from problematic substances or behaviours
- Relief from addiction symptoms, including cravings
- Better emotional, behavioural and self-regulation
- Healthy interpersonal, social and communal experiences that include purpose, meaning and citizenship
- Availability of culturally appropriate resources that promote recovery
- Recognising the dynamic, multiple approaches to attaining recovery by treating substance use and other co-occurring mental health disorders.
Link to GRN Charter.
Management, Abstinence and Recovery
How is recovery different from abstinence? Does spending 2 weeks in a detox centre where someone feels better without the use of substances mean the same thing as recovery? What about controlled use and moderation? How do these three different concepts differ? And are these all the same as recovery… or are they different? We take a closer look at understanding moderation, abstinence and recovery.
The earliest definitions and concepts of recovery were solely equated with abstinence and remission of symptoms. Newer work found that to be a narrow definition that failed to capture the nuances of recovery. While the process of recovery most often includes regaining control over alcohol and substance use and abstinence, it also includes broader life improvements.
Below are the differences between moderation, abstinence and recovery.
Moderation often refers to the controlled use of alcohol or substance use to reduce problematic patterns of consumption. The focus is solely on the strategies to control alcohol and substances by reducing the frequency, intensity and quantity of use. It is best suited to individuals with mild or moderate substance use disorders who have not yet developed dependency or who use substances as a primary coping mechanism. Most individuals who have experienced addiction and substance use disorders find that managing and controlling their use of alcohol or substances is challenging. This is because continued use of substances causes long-term changes in brain regions that regulate reward and pleasure-seeking.
Abstinence and sobriety are states where the individual is no longer using alcohol or substances. Many treatment centres and traditional support groups consider abstinence as the central goal for people who have substance use disorders. Research on recovery shows that abstinence alone is not sufficient for recovery. One may be abstinent but remain unwell, isolated and lacking purpose.
Recovery is a deliberate, ongoing process in which individuals make effortful, self-defined changes and modifications that have positive impacts on all aspects of their lives. These changes are predominantly, but not limited to, improvements in their physical and mental health and quality of life, as well as in interpersonal, social, and community life. Recovery is commonly described as a spiritual experience or shift in how a person views himself, others, and the world, reflected in the embrace of new values. The liberation from substance use and mental health challenges gives space for the individual to work towards living the life they desire and are capable of achieving.
The Holistic Facets of Recovery
Based on the definitions of recovery, the common themes and core components of recovery include:
- Recovery is both dynamic and fluid
- Recovery is a process, not an event
- Recovery is characterised by a series of changes
- Improved Health
- A state of physical, mental, and overall wellness that is fulfilling
- Self-directed and self-defined goals and life directions
- Having the freedom and ability to live to one’s full potential
- Intentional and deliberate effort
- Pursuit of abstinence
- Becomes a thriving member of society through citizenship
Additional Reading: Recovery Centred Research Requires Accepted Definitions of Recovery, Recovery Review
