Recovery, Rehabilitation, and Social Reintegration

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Page last updated June 9, 2020 by Doug McVay, Editor/Senior Policy Analyst.

1. Meaning of Recovery for the Individual

"Various definitions of individual recovery have been offered nationally and internationally.13-17 Although they differ in some respects, all of these recovery definitions describe personal changes that are well beyond simply stopping substance use. As such, they are conceptually broader than “abstinence” or 'remission.' For example, the Betty Ford Institute Consensus Panel defined recovery as 'a voluntarily maintained lifestyle characterized by sobriety, personal health, and citizenship.'13 Similarly, the Substance Abuse and Mental Health Services Administration (SAMHSA) defines recovery 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.'16

"The specific meaning of recovery can also vary across cultures and communities. Among some American Indians, recovery is inherently understood to involve the entire family18 and to draw upon cultural and community resources (see, for example, the organization White Bison). On the other hand, European Americans tend to define recovery in more individual terms. Blacks or African Americans are more likely than individuals of other racial backgrounds to see recovery as requiring complete abstinence from alcohol and drugs.19 Within some communities, recovery is seen as being aligned with a particular religion, yet in other communities such as the AA fellowship, recovery is explicitly not religious but is instead considered spiritual. Still other communities, such as LifeRing Secular Recovery, SMART Recovery, and Secular Organization for Sobriety, view recovery as an entirely secular process.

"Adding further to the diversity of concepts and definitions associated with recovery, in recent years the term has been increasingly applied to recovery from mental illness. Studies of people with schizophrenia, some of whom have co-occurring substance use disorders, have found that recovery is often characterized by increased hope and optimism, and greater life satisfaction.20 This same research revealed that whether someone experienced such benefits was strongly related to their experience with broader recovery benefits, such as improved health, improved finances, and a better social life.21"

U.S. Department of Health and Human Services (HHS), Office of the Surgeon General, Facing Addiction in America: The Surgeon General’s Report on Alcohol, Drugs, and Health. Washington, DC: HHS, November 2016.
https://addiction.surgeongener...
https://addiction.surgeongener...

2. How Many People In The US Are In Recovery?

"Summarizing data from six large studies, one analysis estimated that the proportion of the United States adult population that is in remission from a substance use disorder of any severity is approximately 10.3 percent (with a range of 5.3 to 15.3 percent).29 This estimate is consistent with findings from a different national survey, which found that approximately 10 percent, or 1 in 10, of United States adults say, 'Yes,' when asked, 'Did you once have a problem with drugs or alcohol but no longer do?' These percentages translate to roughly 25 million United States adults being in remission.29 It is not yet known what proportion of adolescents defines themselves as being in recovery.

"Despite negative stereotypes of “hopeless addicts,” rigorous follow-up studies of treated adult populations, who tend to have the most chronic and severe disorders, show more than 50 percent achieving sustained remission, defined as remission that lasted for at least 1 year.29 Latest estimates from national epidemiological research using the Fifth Edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-5) criteria for substance use disorder show similar rates of remission.30,31 Despite these findings, widely held pessimistic views about the chances of remission or recovery from substance use disorders may continue to affect public opinion in part because sustained recovery lasting a year or longer can take several years and multiple episodes of treatment, recovery support, and/or mutual aid services to achieve. By some estimates, it can take as long as 8 or 9 years after a person first seeks formal help to achieve sustained recovery.32,33

"In studies published since 2000, the rate of sustained remission following substance use disorder treatment among adolescents is roughly 35 percent. This estimate is provisional because most studies used small samples and/or had short follow-up durations.29 Despite the potentially lower remission rate for adolescents, early detection and intervention can help a young person get to remission faster.29"

U.S. Department of Health and Human Services (HHS), Office of the Surgeon General, Facing Addiction in America: The Surgeon General’s Report on Alcohol, Drugs, and Health. Washington, DC: HHS, November 2016.
https://addiction.surgeongener...
https://addiction.surgeongener...

3. What Is Recovery?

"The target of recovery is about quality of life rather than abstinence, although abstinence may be a long-term goal for clients. However, the underlying theoretical model for much recovery work is the developmental or lifecourse model (e.g., Hser, Longshore, & Anglin, 2007), which would suggest a significant lengthening of the time scale for the recovery process and so the focus on change—whether to the point of abstinence—is a long-term journey that may well take up the rest of the person’s life. So abstinence orientation may well be something that either does not ever occur or at least is not a viable goal. It is also this approach to “addiction and recovery careers” that means harm reduction does not have to be characterized as the antithesis of recovery."

David Best, Stephen Bamber, Alison Battersby, Mark Gilman, Teodora Groshkova, Stuart Honor, David McCartney, Rowdy Yates & William White (2010) Recovery and Straw Men: An Analysis of the Objections Raised to the Transition to a Recovery Model in UK Addiction Services, Journal of Groups in Addiction & Recovery, 5:3-4, 264-288, DOI: 10.1080/1556035X.2010.523362
https://doi.org/10.1080/155603...

4. Social Reintegration, Recovery, and Abstinence

"The WHO Lexicon of alcohol and drug terms (1994, p. 55) defines ‘recovery’ as:

"Maintenance of abstinence from alcohol and/or other drug use by any means. The term is particularly associated with mutual-help groups, and in Alcoholics Anonymous (AA) and other twelve-step groups refers to the process of attaining and maintaining sobriety. Since recovery is viewed as a lifelong process, an AA member is always viewed internally as a ‘recovering’ alcoholic, although ‘recovered’ alcoholic may be used as a description to the outside world;

"whereas ‘rehabilitation’ is defined as:

"The process by which an individual with a substance use disorder achieves an optimal state of health, psychological functioning, and social well-being. Rehabilitation follows the initial phase of treatment (which may involve detoxification and medical and psychiatric treatment) […] There is an expectation of social reintegration into the wider community. (emphasis added)"

"According to these definitions there is a clear overlap between social reintegration and rehabilitation, whereby social reintegration forms an aspect of, but is not synonymous with, rehabilitation. Recovery, according to the WHO glossary, appears to be relatively unrelated to the term. However, since the publication of the WHO glossary in 1994, the understanding of the term ‘recovery’ has developed further and today it is much closer to the meaning of the term ‘rehabilitation’ as quoted above. As Best and colleagues (2010, p. 275) note: ‘The target of recovery is about quality of life rather than abstinence, although abstinence may be a long-term goal for clients.’"

European Monitoring Centre for Drugs and Drug Addiction. EMCDDA Insights Series No 13: Social reintegration and employment: evidence and interventions for drug users in treatment. Luxembourg: Publications Office of the European Union, 2012, p. 31.
http://www.emcdda.europa.eu/pu...
http://www.emcdda.europa.eu/sy...

5. Importance of Social Reintegration for Recovery

"Drug use often develops from being occasional to problematic: ties with close family members and non-using friends are gradually severed, while school and professional performance can be seriously affected and may come to a premature end. As a consequence, the normal process of socialisation, the integration of an individual from adolescence to adulthood as an independent, autonomous member of society, is jeopardised and this often leads to a gradual exclusion into the margins of society. However, this is a two-sided process. At the same time, society is marginalising problem drug users, making their access to education, employment and other social support even more difficult. Also, one should not forget that, in many cases, social exclusion already precedes drug use. Drug use often then exacerbates the already difficult life conditions of excluded individuals, making integration efforts a real challenge for the individual and for those providing support. This aspect is particularly relevant during the current period of economic difficulties in Europe, with high levels of unemployment among young European citizens and their gradual impoverishment.

"In order to protect problem drug users or recovering users from further social exclusion and to support them in their integration efforts, it is crucial that we provide individuals with opportunities and tools that are efficient, adequate and acceptable both for them and for their social environment."

European Monitoring Centre for Drugs and Drug Addiction. EMCDDA Insights Series No 13: Social reintegration and employment: evidence and interventions for drug users in treatment. Luxembourg: Publications Office of the European Union, 2012, p. 7.
http://www.emcdda.europa.eu/pu...
http://www.emcdda.europa.eu/sy...

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