What is "recovery" from drug addiction?
Recovery from addiction has long meant total abstinence. Such a narrow definition can be harmful and even deadly.
On a cloudy Sunday afternoon before going to see The Northman, a 2 hour and 17 minute blood-curdling epic about Vikings, I ate part of an edible. In total, it was probably two milligrams of THC.
I’m an adult and weed is legal where I live so I use it on ocassion. I prefer small doses because lately that thing that happens to adults who use weed has definitely started happening to me. I get anxious and feel like I’m trapped in a doom spiral where all the silly mistakes and doubts in my life start playing on a neverending loop. So I keep my consumption to a minimum.
Sometimes, I also drink alcohol. But I don’t really like how alcohol makes me feel. I’ll babysit one gin and tonic at a bar when I’m out with friends, or sip on the same beer for the duration of a party. Having more than two drinks garuntees a headache. It’s not even a hangover because it happens almost instantly.
It’s pretty easy for me to avoid a drug that causes headaches, or another drug that produces Dark Knight levels of terror upon inhaling it.
So why am I talking about my boring ass consumption patterns? Because if anybody asks—and they rarely do—I consider myself to be in recovery from an opioid use disorder. And for me, recovery doesn’t require “sobriety” or “abstinence.” But I didn’t always think this way. I had to come to that conclusion for myself, and it took a few years for me to figure it out.
For much of my twenties I was completely, continuously abstinent from not just opioids, but from everything! (except caffiene, of course)
That’s because when I went to treatment for addiction, I didn’t really have any notion of what “recovery” was. The concept of recovery, the goals of treatment, all came pre-packaged and defined for me. Sure, I had some pop-culture references: Someone’s life is in shambles, they go away to a spa-like rehab, they find God, and voila! they’ve become a clean-cut, spiritually awakened, fully actualized person. Come in a strung out caterpillar and fly away as a bright beautiful butterfly.
The idea of recovery presented to me was primarily focused on “maintaining sobriety.” And sobriety clearly meant abstinence from alcohol and other drugs. That was the bedrock first principle, the foundation for everything and perquisite for “recovery.” Only if I’m completely sober could I achieve this state called recovery.
But as I started researching, writing, reporting, and interviewing people across the addiction field, I began to question these principles. Rather than subscribe to a set of beliefs somebody else came up with, I wanted to chart my own path.
The Substance Abuse and Mental Health Services Adminstration (SAMHSA) defines “recovery” from substance use disorder 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.”
Sounds pretty nice. A definition thats’s inclusive and focuses broadly on the journey of life rather than the much narrower idea of “sobriety.” But it’s also a definition that your average person probably hasn’t heard before. Or if they have heard it, they certainly haven’t memorized it, so that doesn’t make for a great universal definition.
The American Society of Addiction Medicine’s (ASAM) definition of recovery is similar to SAMHSA’s but even more ornate. “Recovery from addiction is an active process of continual growth that addresses the biological, psychological, social and spiritual disturbances inherent in addiction.” Six criteria follow that sentence, like “improvement of an individual’s own behavioral control” and “improvement in an individual’s emotional self-regulation.” Those two things sounds similar to me: Mastery of thy self.
Both of these definitions sound like they were focused grouped. Not that that’s necessarily a bad thing. Some smart people consulted a wide range of experts and stakeholders to cook up a definition of recovery that felt universal and un-offensive to the many different pathways of recovery that are out there. Rather than emphasizing words like “abstinence” they use words like “health” and “growth.” ASAM’s second criteria, to be sure, does mention abstinence:
“An individual’s consistent pursuit of abstinence from the substances or behaviors towards which pathological pursuit had been previously directed or which could pose a risk for pathological pursuit in the future.”
This seems to suggest that complete and total abstinence from all substances isn’t necessary for ASAM’s definition of recovery. The only abstinence that seems to matter is from certain substances or behaviors that caused distress in a person’s life. That’s close to how I conceive of recovery for myself. I draw a line at using opioids because that’s the drug that caused problems in my life. But like SAMHSA’s, its unlikely your average person is aware of this definition.
Moving down the row of definitions, here is what pops up when I type “recovery definition” into Google: “A return to a normal state of health, mind, or strength.” The ordinary dictionary definition of recovery doesn’t quite capture recovery from addiction, which is all about growth and transformation rather than returning to an old self. But for some people, maybe that’s all they want. Life was going fairly well but for this problematic substance use or behavior. They want to get control of it and return to their normal life. This applies to more people than maybe you’d think. For instance, more than half of people who once had an addiction do not identify as being in recovery. They’ve just moved on with their life.
Finally, there’s a simple definition of recovery that’s quite popular among those in the harm reduction movement. Because it is just three words, it’s a definition I’ve heard repeated back to me many times during my years of reporting: “Any positive change.” Within those three words is the idea that even people who are still using substances can engage in a recovery process regardless of their level of abstinence.
Dan Bigg and the Chicago Recovery Alliance came up with the phrase any positive change. I feel lucky that I got to interview Bigg many times before he died. I live in Chicago, and he was always accessible. I’d just buy him a latte and he’d talk and talk for hours, never pulling punches. He was a fountain of killer quotes. About “any positive change,” Bigg told me that the Chicago Recovery Alliance specifically used the word “recovery” in order to take it back from the abstinence crowd who he viewed as hijacking the word.
“Recovery in the name has been deliciously ironic for people,” Bigg told me. He said the Chicago Recovery Alliance name really threw people off because they were operating off a narrow definition that emphasized abstinence and “being clean.” Still, I’ve heard some valid criticisms of this definition, at least in the world of research and such, that it could be difficult to concretely study and measure something as broad as “any positive change.” But the fact that there isn’t hard limits and borders to the phrase is precisely why Bigg and so many others liked it.
Any positive change, at least how I read it, means that just because somebody is still using a substance doesn’t mean they cannot be helped. If someone is using, they can still make positive changes in their life, and these changes ought to be acknowledged and celebrated. Bigg’s idea of recovery wasn’t concerned about what chemicals pop up in your urine. And that makes sense for the guy who helped bring naloxone, the opioid overdose antidote, out of hospitals and ambulances and to the streets. Everyone deserved helped, he thought, especially those who are still actively using.
Here’s how Maia Szalavitz talked about “any positive change” in a recent interview with Tracie Gardner in Guernica:
“The thing about ‘any positive change’ is that you can be making slow positive changes and still be in a really chaotic state that most people would not label recovery. And I get why people want to count their days so that they can put some distance between that chaos and where they’re at (sorry!) now.
But I think what’s good about “any positive change” and why it remains valuable, despite those caveats, is that if you are engaging in a process of change, the work you’re doing before you get out of the chaos still counts. Also, let’s say you have ten years of abstinence and you slip for one day. In traditional recovery, you go back to square one and those ten years don’t count anymore, and it’s very shameful and discouraging. My answer to that would be: get 90 days again, and you get your ten years back.
So that can kind of be a bridge. If your recovery involves abstinence, it recognizes the value of continuous abstinence but it’s not so punitive. It doesn’t pretend that your earlier successful abstinence didn’t count.
Szalavitz and Gardner hit that topic in the context of discussing longstanding rifts between those in abstinence-based recovery and those in harm reduction. These two movements have always co-mingled, but lately they’ve collided as the overdose crisis came to be a massive issue impacting so many people. More people in “recovery” are talking to more people in harm reduction, heightening these old tensions. What I’ve noticed is that people from the abstinence world get a little bit squeamish or, maybe feel threatened by, people who maybe once had addictions but still use substances.
It’s fair enough to think all this talk of recovery is a semantic debate. More than 100,000 people are dying from drug overdoses out there, and you’re busy thinking about what words mean! Of course I’m busy thinking about what words mean—I’m a writer. But the definition of words like “recovery” actually have material impact on all kinds of important things, from what treatments are considered “effective” to whether people can participate in self-help groups, to what community they feel apart of. So it’s not a closed-loop semantic debate, or an internecine conflict between movements.
How we think of this word “recovery” has real-world consequences.
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