Recovery = Abstinence… Or not

The Substance Abuse and Mental Health Services Administration (SAMHSA) just release a new definition of “recovery” from mental health and addiction:

A process of change through which individuals improve their health and wellness, live a self-directed life, and strive to reach their full potential.

I’ll give you 10 seconds to find a key missing ingredient in this definition of recovery without peeking at our title. Hey! No Looking!!!

The definition calls recovery a process the provides improvements in well-being and that allows people to gain control of their life. It seems that abstinence is simply nowhere to be found in this new SAMHSA definition.

I have no doubt that some people will be upset about the decision not to include abstinence in the definition of recovery, but I won’t be one of them. I’ve been saying that we should be moving to a different definition, one that focuses on improvement in quality of life, as the basis for whether someone is in recovery or not. You see as far as I’m concerned it doesn’t matter whether a person is using any substances – all I care about is the impact of such use on their well being, their “quality of life.”

We’ve already written a few article on All About Addiction making this exact point (see here and here for some examples) and there have been some addiction researchers calling for the same when measuring success in addiction treatment research (see here and here).

Most addiction treatment research simply measures abstinence when individuals finish treatment (especially outpatient treatment) and then maybe 6 or 12 months later. But as the research I linked to earlier shows, there are a whole slew of people who are not abstinent a year after their release from addiction treatment but are without a doubt involved in recovery: Their substance use is either fully under control or is at least producing much less of a problem than it had before. As far as I’m concerned that is a success, and if the use begins being troublesome again, then it is possible that more treatment, and perhaps complete abstinence, is necessary.

This whole thought process can easily lead us right down the harm reduction, substitution therapy, and legalization argument rabbit hole, and I’m all for that discussion. I’m also sure that I will once again get some more hate-mail from readers who think I’m being irresponsible by suggesting that people who have at one point had trouble with substance abuse may be able to use anything (even substances that were not their drug of choice) ever again. They’ll accuse me of being responsible for those who decide to try such methods and fail while taking absolutely no responsibility for the countless who try their approach and relapse. Fortunately for me I’ve learned to ignore those emails.

One response to “Recovery = Abstinence… Or not”

  1. Hey Adi–
    Love your work–
    I’m a (formerly, I hope!) “old school” addiction counselor who, after 30 years of working in the abstinence-only trenches have become aware of alternative approaches to recovery. Approaches based on instilling hope, reducing stigma, empowerment of the person, embracing individual strengths and unique paths.
    I”m making a transition in my practice to include more compassionate, harm reduction approaches with my clients–
    Keep up the great work!


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