October JSAT Features Special Section on “Recovery”

Extending the work of a blue ribbon panel of experts convened last year, the October edition of the Journal of Substance Abuse Treatment contains a Special Section of articles discussing the meaning of the commonly-used but never defined term “recovery.”

“Recovery,” according to the starting definition agreed to by panel members, is “a voluntarily maintained lifestyle comprised of sobriety, personal health and citizenship.”

By “voluntary” the panel means a condition that is not forced or coerced, said Schwarzlose and McLellan who co-authored the centerpiece paper. Abstinence during a jail stay or a forced treatment episode are examples of what does not count as “recovery” they say. The other elements of the definition (sobriety, personal health and citizenship) are each defined in the paper with reference to well validated, internationally used measurement instruments such as the WHO Quality of Life scales.

The reason for undertaking the daunting effort was described this way by the lead authors: “There is a very large but unknown number of individuals who refer to their new sober, productive lifestyle as being ‘in recovery.’ Though widely used, the lack of a standard definition has hindered public understanding as well as recovery-oriented public policies and research that might foster more and better recovery-oriented interventions. Everyone – the clients themselves as well as the researchers, the counselors and the policy makers - need a shared understanding - a common metric against which they can set goals and measure progress.”

“By no means is this the end of the discussion,” Schwarzlose and McLellan continued. “In fact, the BFI statement does not necessarily reflect the positions of all stakeholders in the discussion process – only their shared view that a starting point definition was needed and that a respected body needed to get the ball rolling.”

Other papers in the Journal section confirm that Schwarzlose, McLellan and their panel colleagues have made an important start but hardly ended the process of defining recovery, which requires the perspective of multiple stakeholders in the addictions field.

“What does Recovery Mean to You? Lessons from the Recovery Experience for Research and Practice,” by Alexandre Laudet, Ph.D., examines the recovery definition and experiences among inner-city residents with resolved dependence to crack or heroin. Although most subjects defined recovery as total abstinence, Laudet concludes recovery is experienced as an “ongoing process of growth, self-change and a reclaiming of self.”

In “Addiction Recovery: Its Definition and Conceptual Boundaries,” William L. White from Chestnut Health Systems in Bloomington, Indiana advances a working definition that is similar but different to that proposed by the consensus panel. White explores ten key questions, including: who has professional and cultural authority to define recovery, the defining ingredients of recovery, the boundaries (scope and depth) of recovery, and temporal benchmarks of recovery (when recovery begins and ends). The process of defining recovery touches on some of the most controversial issues within the addictions field, he concludes.

Two articles plumb the relevance of spirituality to recovery, both authored by Marc Galanter, M.D. from NYU’s School of Medicine. “Assessment of Spirituality and its Relevance to Addiction Treatment,” by Galanter and colleagues, suggests that the importance of spirituality to some patients may be underestimated in the way treatment is framed in many clinical facilities. In “Spirituality and Recovery in Twelve-Step Programs: an Empirical Model,” Galanter posits the possibility of defining both the diagnosis of addiction and the criteria for recovery in spiritually oriented terms.

Three pieces reacting to the centerpiece article appear in the October edition. Stuart Gitlow, M.D. of the Mt. Sinai School of Medicine speaks from the physician perspective in “Recovery and Research: A Better Paradigm” where he discusses the obstacles created in research, practice and policy when experts agree that “recovery” is the goal but lack a shared understanding or definition of what they are aspiring to.

Commentary by U.S. Congressman James Ramstad, champion of addiction issues in Congress and himself in “recovery,” applauds the effort to achieve consensus around the practical meaning of the term. Ramstad suggests that insurance discrimination and stigma can result from - and confound policy making - when there are misunderstandings and confusion about addiction and the recovery process.

Pat Taylor and Stephen Arndt, Ph.D. advance a different perspective on BFI’s working definition. Representing Faces and Voices of Recovery in their “Commentary on What is Recovery,” the authors question whether the “words” in the working definition, or the process by which they were developed, adequately represent the views of the recovery community or the organizations that serve it.

To read abstracts or order reprints, visit JSAT online at http://www.sciencedirect.com/science/journal/07405472.