Improving Our Language About Addictive Problems, Part 2
By Tom Horvath, PhD
In Part 1 I recommended that the term “addictive problems” replace several similar terms. In Part 2 I recommend that the term “recovery” be replaced with several better alternatives, depending on context.
To summarize Part 1, there is a continuum of addictive problems (abstinence, moderation, misuse, mild substance use disorder, moderate substance use disorder, severe substance use disorder). Over time someone can move up or down that continuum. They are not stuck forever at one level. This possibility of movement is the most radical aspect of viewing addictive problems as lying on a continuum (vs. the view that you are an “alcoholic” or “addict” forever, or that you are not). The lower the level of problems, the less likely someone is to address them because they can easily convince themselves that they are not an alcoholic or addict. The higher the level of problems the more effort we might need to do to resolve them, but not necessarily. Sometimes someone just changes suddenly, without any obvious outside support, and we move down the continuum quickly. The term addictive problems is more inclusive, less stigmatizing, and more likely to encourage someone to seek support and services.
Language Of Addictive Problems – What’s wrong with the term recovery?
Recovery tends to be used as an all-or-none term, which means that it contradicts the reality of a continuum of addictive problems. We often hear that someone is “in recovery” or not. However, just like addictive problems, the process of change also lies on a continuum, and we can also move up and down that continuum. The stages of change are often used to describe that continuum: pre-contemplation, contemplation, determination, action, and maintenance.
I also suggest a final stage, which could be called long-term maintenance (or even termination). At this stage living one’s life has become the change plan. Nothing specific is being done to maintain change (such as attending a mutual help group). Someone now has a life they don’t want to lose, and the thought of losing it and going back to addictive problems is unappealing or even repulsive.
The change process can also be viewed as occurring in degrees, even within a stage of change. “In recovery” or not might mean abstaining or not, but the related changes are not all or none. The change process is a process, not a state. One simple comparison would be having a major plumbing leak at home. The leak itself might be solved quickly. However, fixing all the related damage will probably take much longer. There is much to do in each of the stages of change.
The process of change looks different for each person, but the term recovery appears to suggest that there is only one process. There are indeed common aspects of change. The SMART Recovery 4-Point Program is one description of these common aspects: maintain motivation, know how to cope with urges, learn new ways to manage thoughts, feelings and behaviors, and achieve greater lifestyle balance. Nevertheless, the change process, individual to individual, can look dramatically different.
Recovery tends to mean abstinence. However, that usage ignores the reality that many individuals resolve their addictive problems by reducing but not eliminating their involvement. Moderate alcohol consumption, after previously drinking excessively, is just one example. There are moderate users of all substances and activities, and some of them used to be excessive.
If you doubt this idea, consider that there are moderate smokers who used to smoke heavily. If someone can moderate use of this substance (often described as the most difficult one to change), it suggests other substances or activities might also be used moderately, even after a period of problems. Reports of this phenomenon have been in the scientific literature since at least the 1960’s. Of course, you are unlikely to hear about moderate consumption (after excessive use) at a party: “You know, I used to inject a lot of heroin daily, but now I only smoke it, and only a few times a year.” Not commonly hearing about this phenomenon does not mean it does not exist.
What could we say instead?
Unfortunately, the alternatives to saying someone is “in recovery” or “not in recovery” are can be wordy or acronyms. By comparison, we have PWUD (people who use drugs) or “person with a disability.” It may take us awhile to develop new terms. To keep the following examples simple, I will focus on alcohol.
“In recovery” could be replaced by a statement of the individual’s consumption status. “I no longer drink; I don’t drink; I drink less than I used to; I limit myself to x drinks per time,” etc.
“Are you in recovery?” This question could be eliminated. “Do you drink? How much/often? Do you have problems from drinking? How long ago did you resolve your alcohol problems” or similar questions might not be intrusive, depending on context. Someone might want to volunteer that they attend AA, or that they used to have alcohol problems, or that they now (“do not drink, abstain/moderate, have cut back,” etc.).
“I am a person in long term recovery” could become “I used to have significant/substantial addictive problems, but I resolved them [give timeframe].”
“Not in recovery,” implying the person still has uncontrolled use, could be replaced with “this person drinks excessively” or “this person has significant alcohol problems.”
Peer addictive problems coach could replace peer recovery coach.
When it comes to improving the language of addictive problems, we do not need the term recovery when more accurate terms are available. As with the term addictive problems, by focusing on more accurate language we become more inclusive, less stigmatizing, and more supportive of someone considering the various forms of outside “support for change” (as opposed to “support for recovery”) that are available.
Substance use disorders should be diagnosed only by professionals. Even though anyone can read the criteria, it requires extensive training and experience to apply them accurately (as the diagnostic manual states). However, nearly anyone can identify some level of addictive problems, and realize they are worth addressing.
If someone has freely chosen the term “in recovery” and it is useful to them, they should not be argued with. There are many roads out of addictive problems, and all should be respected.
If you or a loved one are in need of care for an addictive problem, and are interested in whole-person, dignified addiction treatment, our outpatient services might be a good fit. Please don’t hesitate to reach out – you don’t have to do this alone.