Many people can define substance abuse and addiction but few can define recovery. Even people who are recovering from an addiction are hard pressed to define it. There is no consensus on what recovery means. The bulk of scientific study focuses on addiction and treatment. As time enfolds we will know more and more about the process and outcome of recovery. William L. White, research a consultant at Chestnut Health Systems, speaks about recovery. I highly recommend you watch his YouTube videos from ROSC – Recovery Oriented System of Care – 2009 Atlanta, GA workshop.
The DSM 5 (Diagnostic and Statistical Manual of Mental Disorders – 5th revision) covers 11 different criteria of Substance Use Disorders that span a wide variety of problems arising from substance use. The DSM 5 allows clinicians to specify how severe the substance use disorder is, depending on how many symptoms are identified. Clinicians can also add “in early remission,” in sustained remission,” “on maintenance therapy,” and “in a controlled environment” to best describe the recovery process. The DSM 5 defines partial and full remission as determined by an absence or presence of symptoms. Early remission is the absence of symptoms for 1-12 months. Sustained full remission is for a period of 12 months or longer.
The World Health Organization defines health as “a state of complete physical, mental and social well-being, not merely the absence of disease. Following this definition, it seems that recovery is not simply the cessation of a substance but there are also improvements in overall health. This includes psychological, medical, economic, emotional, relationship, occupational and spiritual health. It also implies an integration into one’s larger community – contributing toward society.
William White identifies different types of recovery from the DSM. He identifies partial, full and amplified recovery. Partial recovery is better than no recovery but problems with the substance continue. Harm reduction programs are designed to minimize the negative consequences of addiction. One example of harm reduction would be a needle exchange program as a means to reduce the spread of diseases such as hepatitis and HIV.
Full recovery implies prolonged abstinence and sustained positive change in all aspects of life. White adds another dimension – amplified recovery. These are people who get better than well; people who go on to live incredibly rich lives. The addiction was for them a blessing which enhanced their lives. They gained a quality of life greater than what they would have had prior to recovery.
Some people believe that “once an addict, always an addict.” But is there a point at which people can rest assured that the risk of a relapse is minimal? Is there a recovery endpoint? There are three generally accepted phases to recovery. The first stage is focused on staying abstinent, especially in the first year. One that foundation is established, 1-3 years, they can concentrate on living a normal life. Late recovery, 3+ years, is a time of growth toward full potential.
White says those individuals who manage to get to five or more years of abstinence have an 86% chance of long term recovery. The risk of a relapse is greatly reduced.
It is important that we consider one’s recovery progress because of the stigmatization of people who suffer from an addiction. Many people view addicts as “skid row” types and are sometimes treated as such, regardless of their recovery. For example, prospective employers who view recovery as a lifelong process, with no endpoint, may be more likely not to hire a worker in recovery for fear they will relapse or be unreliable. But rehabilitated addicts can make good employees. Employing recovering people may not be overly risky. In fact, they can be highly motivated, loyal and committed employees.