Recovery: The Many Paths to Wellness

Because the brain can take a long time to return to health following a long period of heavy substance use, risk of relapse is high at first. It can take a year of abstinence before an individual can be said to be in remission;43 for people recovering from an alcohol use disorder it can take 4 to 5 years of abstinence for the risk of relapse to drop below 15 percent42—the level of risk of individuals in the general population developing a substance use disorder during their lifetime. In addition, successful recovery often involves making significant changes to one’s life to create a supportive environment that avoids substance use or misuse cues or triggers. This can involve changing jobs or housing, finding new friends who are supportive of one’s recovery, and engaging in activities that do not involve substance use. This is why ongoing RSS in the community after completing treatment can be invaluable for helping individuals resist relapse and rebuild lives that may have been devastated by years of substance misuse.

Recovery has become an increasingly important concept for researchers and practitioners in the substance use disorder field, as well as in the community. It is central to a movement to bring greater awareness to the struggles and the successes of people fighting addiction and increase solidarity in overcoming the discrimination, shame, and misconceptions historically associated with substance use disorders. In general, the term sends a positive, hopeful message that recovery is possible, that there is life after even the most devastating struggles with addiction, and that people suffering with or recovering from an alcohol or drug use disorder have essential worth and dignity. It also provides a positive focus and construct for scientific, program, and policy-level thinking about substance use disorders.

Recovery support services are not the same as treatment and have only recently been included as part of the health care system. Many of these services began long before the modern era of evidence-supported interventions; some have been studied and found to be effective at maintaining abstinence and promoting other positive long-term outcomes in those who take advantage of them. The most well-known approach, mutual aid groups, link people in recovery and encourage mutual support while providing a new social setting in which former alcohol or drug users can engage with others in the absence of substance-related cues from their former life.

The best-known mutual aid groups are 12-step programs like Alcoholics Anonymous (AA) and Narcotics Anonymous (NA). Narcotics Anonymous has not been extensively studied, but AA has been shown in many studies to have a positive effect in reducing a person’s likelihood of relapse to drinking.42-46 Mutual aid groups are facilitated by peers, who share their lived experience in recovery. However, health care professionals have a key role in linking patients to these groups, and encouraging participation can have great benefit.49 Recovery coaches, who offer individualized guidance, support, and sometimes case management, and recovery housing—substance-free living situations in which residents informally support each other as they navigate the challenges of drug- and alcohol-free living—have led to improved outcomes for participants.48-52 Several other common RSS, recovery community centers, and recovery high schools, have not yet been rigorously evaluated.

In summary: People can and do recover. The recovery movement offers a valuable opportunity for people with substance use disorders and their loved ones to get the support they need to gradually return to a healthy and productive life away from the destructive impact of substance use. The movement also provides an opportunity for people to advocate for improvements in prevention and treatment services. Equally, this movement can contribute to efforts to reduce negative public attitudes as well as discrimination embedded in public policies and the health care system.


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References: 

42. White, W. L. (2012). Recovery/remission from substance use disorders: An analysis of reported outcomes in 415 scientific reports, 1868-2011. Philadelphia, PA: Philadelphia Department of Behavioral Health and Intellectual Disability Services.

43. American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders (DSM-5) (5th ed.). Arlington, VA: American Psychiatric Publishing.

44. Emrick, C. D., Tonigan, J. S., Montgomery, H., & Little, L. (1993). Alcoholics Anonymous: What is currently known? In B. McCrady & W. Miller (Eds.), Research on Alcoholics Anonymous: Opportunities and alternatives. (pp. 41-77). New Brunswick, NJ: Rutgers Center of Alcohol Studies.

45. Kelly, J. F., & Yeterian, J. D. (2008). Mutual-help groups. In W. O'Donohue & J. R. Cunningham (Eds.), Evidence-based adjunctive treatments. (pp. 61-106). New York, NY: Elsevier.

46. Humphreys, K., Blodgett, J. C., & Wagner, T. H. (2014). Estimating the efficacy of Alcoholics Anonymous without self-selection bias: An instrumental variables re‐analysis of randomized clinical trials. Alcoholism: Clinical and Experimental Research, 38(11), 2688-2694.

48. Kaskutas, L. A. (2009). Alcoholics Anonymous effectiveness: Faith meets science. Journal of Addictive Diseases, 28(2), 145-157.

49. Walitzer, K. S., Dermen, K. H., & Barrick, C. (2009). Facilitating involvement in Alcoholics Anonymous during out-patient treatment: A randomized clinical trial. Addiction, 104(3), 391-401.

50. LePage, J. P., & Garcia-Rea, E. A. (2012). Lifestyle coaching's effect on 6-month follow-up in recently homeless substance dependent veterans: A randomized study. Psychiatric Rehabilitation Journal, 35(5), 396-402.

51. Douglas-Siegel, J. A., & Ryan, J. P. (2013). The effect of recovery coaches for substance-involved mothers in child welfare: Impact on juvenile delinquency. Journal of Substance Abuse Treatment, 45(4), 381-387.

52. Groh, D. R., Jason, L. A., Ferrari, J. R., & Davis, M. I. (2009). Oxford House and Alcoholics Anonymous: The impact of two mutual-help models on abstinence. Journal of Groups in Addiction and Recovery, 4(1-2), 23-31.