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Every day Americans are educated over and over again about the meaning of recovery: celebrities tour the country describing their miraculous redemption due to 12-step rehab; columnists instruct readers with alcohol problems to attend AA post haste; schools lecture about the AA recovery message.
I, on the other hand, alert Americans to the idea that our recovery-treatment system does more harm than good, and that we need a new approach to addiction. I make this claim because I say the traditional 12-step approach pollutes the experience of young people who ordinarily outgrow substance abuse on their own; that it misdirects attention away from treatments that are far more effective; and -- since it belies the reality that few people go from addiction or problem use to abstinence -- that it is a moralistic fantasy rather than a realistic approach.
So it is a remarkable development that SAMHSA (Substance Abuse and Mental Health Services Administration), the government agency charged with formulating drug and alcohol abuse treatment policy, after surveying the leading specialists in the mainstream of the field, has created "Recovery Defined -- A Unified Working Definition and Set of Principles." Where SAMHSA ends up is at my view of recovery -- not AA's -- as "A process of change through which individuals improve their health and wellness, live a self-directed life, and strive to reach their full potential."
SAMSHA issued a Dec. 22 press release, entitled, "New Working Definition of 'Recovery' from Mental Disorders and Substance Use Disorders." The first thing to notice is the unification of mental and substance disorders. Such symmetry has been anathema to recovery advocates, who view alcoholism and addiction as having their own domain. (Consider, for instance, that mental health services are not led by recovering mentally ill people, but generally by trained professionals.)
The release describes this process:
The definition is the product of a year-long effort by SAMHSA and a wide range of partners in the behavioral health care community and other fields to develop a working definition of recovery that captures the essential, common experiences of those recovering from mental disorders and substance use disorders, along with major guiding principles that support the recovery definition.
Here is the resulting formulation:
Working Definition of Recovery
Recovery is a process of change whereby individuals work to improve their own health and wellness and to live a meaningful life in a community of their choice while striving to achieve their full potential.
Principles of Recovery
Person-driven;
Occurs via many pathways;
Is holistic;
Is supported by peers;
Is supported through relationships;
Is culturally-based and influenced;
Is supported by addressing trauma;
Involves individual, family, and community strengths and responsibility;
Is based on respect; and
Emerges from hope.
Furthermore SAMHSA's Recovery Support Initiative identifies four major domains that support recovery:
Health: overcoming or managing one's disease(s) as well as living in a physically and emotionally healthy way;
Home: a stable and safe place to live that supports recovery;
Purpose: meaningful daily activities, such as a job, school, volunteerism, family caretaking, or creative endeavors, and the independence, income and resources to participate in society; and
Community: relationships and social networks that provide support, friendship, love, and hope.
What to say about this definition? First, it emphasizes functionality above all -- how well the person deals with his or her environment and life -- rather than focusing on substance use and demanding abstinence. Secondly, it indicates that there is not one true path to recovery: "Recovery occurs via many pathways. Individuals are unique with distinct needs, strengths, preferences, goals, culture, and backgrounds -- including trauma experiences -- that affect and determine their pathway(s) to recovery." Note, especially, the recognition of culture and personal values: "Recovery is culturally-based and influenced. Culture and cultural background in all of its diverse representations -- including values, traditions, and beliefs -- are keys in determining a person's journey and unique pathway to recovery."
The definition never mentions "powerlessness." In fact, it points in quite the opposite direction: "Recovery is person-driven. Self-determination and self-direction are the foundations for recovery as individuals define their own life goals and design their unique path(s) towards those goals." Also, "Recovery is built on the multiple capacities, strengths, talents, coping abilities, resources, and inherent value of each individual. Recovery pathways are highly personalized."
Meanwhile, the definition pinpoints purpose as a pillar of recovery.
The new definition-approach, along with building on the capacity of the individual and identifying purpose as crucial, speaks of integrating the recovering person within the family and community -- as opposed to creating separate "recovery" groups and communities:
Recovery involves individual, family, and community strengths and responsibility: Individuals, families, and communities have strengths and resources that serve as a foundation for recovery. In addition, individuals have a personal responsibility for their own self-care and journeys of recovery.
In place of powerlessness, this new approach highlights a belief in the individual. This vision underlies the two culminating principles among the ten listed in the new definition: "is based on respect;" and "emerges from hope."
I imagine that 12-steps groups will rush to claim that they subscribe to exactly these principles. But, just take two of the 12-steps -- the first two:
Step 1 -- We admitted we were powerless over our addiction -- that our lives had become unmanageable
Step 2 -- Came to believe that a Power greater than ourselves could restore us to sanity
A difference in emphasis, to say the least, wouldn't you agree?
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P.S. British public health has reached the same conclusion -- only AA and American rehab haven't gotten the message:
The British Liver Trust is launching a new report, which argues that people with alcohol problems must be offered effective support and treatment to meet their individual needs, an "individual person-centred journey" as the government's drug strategy would describe it. There has been much talk about recovery and abstinence-based approaches for those with alcohol dependence.
Our report suggests that it is vital that people who misuse alcohol are not treated by a one-size fits all abstinence approach; but, to be as successful as possible, healthcare professionals must work with patients to understand their preferences in setting goals to reduce their alcohol harm. Problem drinkers are after all a mixed bag of people with a range of mild, moderate and severe alcohol dependence.
