What is “Recovery?”

By Tom Horvath, PhD

image of plants growing through crack in wall to symbolize the question what is recoveryA recent scientific paper analyzed the responses from nearly 10K individuals who identify themselves as “in recovery” from substance problems. In recent years the addiction recovery field has been considering how to define “recovery.” Five major organizations have offered definitions or attempts at definitions. However, there is not much data on this issue. Two previous studies have looked at how individuals in recovery define it. The present study is an advance because it identified 30 sub-groups, based on socio-demographics, substance use problems, and help-seeking history. Each sub-group was analyzed for which components of a recovery definition might be common for that sub-group. The second study had averaged all subjects together, thus losing some of the differences between the subgroups.  Across all 30 subgroups four highly common components were discovered, and four prevalent ones. Some subgroups also had important differences.

If you are addressing substance problems in your own life, I suggest that these findings are important to you as a “consult” from a wide range of sympathetic peers about how your own personal project has been going. You can consider to what extent the following ideas fit with your experience, and whether you need to consider adding one or more of them to your sense of what you are aiming to accomplish.

Data for this study were already collected in the second study mentioned above. In that study 47 components (or aspects) of recovery had been considered. This study considered 36 of them. A component of recovery was considered “core” to a subgroup if at least 80% of the subgroup endorsed it as significant (using a method described in the paper) and considered core in the overall study if all subgroups endorsed it.

The core components of recovery

The core components of recovery, endorsed as significant by at least 80% of all 30 subgroups, were:

  • A process of growth or development
  • Being honest with myself
  • Taking responsibility for the things I can change
  • Reacting to life’s ups and downs in a more balanced way than I used to
  • Additionally, there were four components of recovery endorsed as significant by at least 80% of 26-29 subgroups:
  • Being able to enjoy life without drinking or using drugs like I used to
  • Handling negative feelings without using drugs or drinking like I used to
  • Abstinence (from alcohol, drugs, and/or RX drug abuse) and/or non-problematic alcohol/drug use
  • Living a life that contributes to society, to your family, or to your betterment

It is noteworthy that only three of these components are directly connected with substance use. This finding is consistent with many approaches to recovery, which cover many more issues than just substance use. For instance, SMART Recovery often states, in various ways, that the ultimate goal of participating is to build a life that is more healthy, productive, and connected. In the 12-step approach establishing a better connection with one’s higher power is a preferred outcome, not just abstinence.

A common definition emerges, and has advantages

The final section of this paper considers the perspective offered by some experts that “there is no consensus on the definition [of recovery] even among those in recovery” (the Betty Ford Institute Consensus Panel), and “recovery is a complex and dynamic process and ….[many factors]… combine with an individual’s unique experiences” (SAMHSA; both statements quoted on pg. 12). Nevertheless, the closing two sentences sum up the rationale for the paper: “While these statements may be true, recovery is probably not completely relative. Current results describe a coherent, fundamental definition of recovery that holds for most recovery pathways” (pg. 12).

The advantages of having a fundamental definition are substantial. As already mentioned, these eight ideas are a worthwhile audit for anyone addressing addictive problems. Treatment could orient itself around these components as goals, rather than being overly focused on reducing or eliminating substance use. Focusing on these other components may be an indirect but faster method for achieving non-problematic use or abstinence. When individuals with a history of substance problems talk about their process of change, they may appreciate being able to focus more on these aspects, rather than simply saying “well, I quit drinking.” New measures of recovery (perhaps rating how important an item is at the beginning, and how important and how well achieved it is later) might also emerge, and provide more guidance on the process of change.

Methodological considerations

As to the shortcomings of this fundamental definition, they may not be any more substantial than the shortcomings of the diagnostic manual (DSM5-TR) which requires meeting, in the case of alcohol use disorder, at least 2 of 11 criteria, leading to hundreds of different ways an individual could merit the diagnosis. Nevertheless, we find the diagnostic manual useful. In using this recovery definition, we might rank someone’s “strength of recovery” based on how many of these eight components were present.

One of the challenges for this study, from a statistics perspective, is the sampling problem. How well did the sample obtained represent the population of interest? Individuals who identify as “in recovery” are a smaller group than the full range of individuals who have resolved substance problems because many individuals who have put a substance problem behind them do not use the term “recovery.” It would be more inclusive to ask for individuals “who used to have substance problems” rather than who are “in recovery.” Even more inclusive would be “who used to have addictive problems” to include those who had problems with gambling, pornography, video games, etc. Although this study allowed subjects the option of identifying “non problematic alcohol/drug use” perhaps a number of potential subjects never even volunteered to participate because they assumed that “in recovery” meant abstaining.

The issue of the identity “in recovery” is important because a substantial portion, perhaps the largest portion, of those with successful change do not adopt this identity. Consequently, this study may to a degree be studying too much of the tip of the iceberg and not enough of the iceberg itself. Consequently, rather than the term “recovery,” we could discuss positive change from an addictive problem.

Nevertheless, it appears that a substantial portion of this iceberg was examined, because some of the subjects exhibited what might be called “recovery light:” they had only mild or moderate substance use disorders (as diagnosed by the diagnostic manual), were not abstaining, and had not ever attended treatment or a mutual help group. As the paper notes, this group may have “only weak ties to the mainstream recovery community.”

A common definition, but diversity remains

There was also the finding that for those with an opiate use history the core components are much more medical. “Freedom from feeling physically sick” was the most highly ranked, and “taking care of my physical health more than I did before” was ranked more highly than in any other subgroup.

For those with 12-step alternative experience (such as SMART Recovery), “being able to enjoy life without drinking or using drugs like I used to” was the top-ranked component, and “being honest with myself” was not in the top three items for them. For this sub-group “taking care of my mental health more than I did before” got more than 80% endorsement, which did not happen in any other sub-group. These findings may reflect how these subjects are socialized in the 12-step alternative groups to think about how to resolve substance problems.

As long as these eight components of positive change do not get used as requirements, or prevent us from perceiving other components, then we have made a significant advance. And as any scientist will tell you, further research would be beneficial.

If you or a loved one are interested in exploring recovery from addiction, our personalized drug and alcohol rehab services can help. Please don’t hesitate to reach out – you don’t have to do this alone.