A team of researchers recently conducted a “systematized review” of the scientific literature on addiction recovery in search of what it means to recover. What they uncovered was a shocking lack of agreement about the nature of recovery and when it has been achieved.

The first definition the authors provide for recovery is “a sustained state of abstinence.” This two-dimensional view of recovery as total withdrawal over an unspecified period of time is totally unsatisfactory. Recovery tends not to arrive after a period of abstinence but to come in “waves of recovery” that include cycles of relapse, treatment and withdrawal.

The systematized review covers only substance use disorders (SUDs) and not behavioral addictions such as smartphone addiction, eating addiction, or gambling addiction. In one insightful paragraph, the authors describe the conundrum that everybody wants recovery but no one knows what it is:

[R]esearchers who study and assess addiction treatments and addiction policymakers do not have a vivid mental image of recovery despite the recent increase in the popularity of this concept. For example, the term recovery has been repeatedly used interchangeably with the words abstinence, remission, and resolution; however, there is no consensus on a unified definition for each one of these terms to differentiate between them.

Some of the theories offered about when a person has recovered from substance use disorder include:

• a voluntarily maintained lifestyle characterized by sobriety and personal health
• voluntarily sustained control over substance use
• total abstinence from a problem substance
• sustained struggle to maintain abstinence
• finding better ways to cope with stress
• the ability to manage substance use disorder in an acceptable way

The researchers note a fundamental split in the way recovery is defined between what recovering individuals say and what medical professionals say. Those in recovery are much more likely to have a definition that includes personal outcomes and quality of life, not just sobriety or abstinence.

The Substance Abuse and Mental Health Services Administration (SAMHSA) has a very rich assessment of an individual’s recovery that includes physical health, mental health, family relationships, social relationships, and housing stability. SAMSA focuses on improvements in all of these areas rather than abstinence.

Alcoholics Anonymous also offers a rich definition of recovery that is more from the perspective of those in recovery and their loved ones than a scientific viewpoint. It includes such things as being honest with yourself, handling negative feelings without substance abuse, enjoying life without the need to use, and taking responsibility for those things you can change.

The General Conference-approved, Alcoholics Anonymous pamphlet, This Is A.A., states, “We don’t say that we’ll never drink again.” Instead, the plan focuses on staying sober for 24 hours. “If we feel the urge for a drink, we neither yield nor resist. We merely put off taking that particular drink until tomorrow.”

The ability to rechannel displacement into less harmless activities rather than succumbing to urges is behind the behavior modification app, BrainWeighve, currently ramping up for a trial through the University of California Los Angeles (UCLA). The trial focuses on weight loss for obese teens using a self-directed, physician-supervised program withdrawing from one problem food at a time.

Recovery turns out not to be a destination so much as a path. The path begins with breaking the physical addiction as safely as possible and then working hard to reprogram yourself to sustain it as long as possible. Part of the reprogramming is to not kick yourself when you relapse but to pick yourself up and keep trying. Along the way, it is possible to reach a point where you can control yourself in a way that is acceptable to you personally and to others.

Written by Steve O’Keefe. First published January 24, 2024.

Sources:

“Addiction Recovery: A Systematized Review,” Iranian Journal of Psychiatry, April 2020.

“Waves of Healing in Addiction,” Psychology Today, January 14, 2024.

This Is A.A., Alcoholics Anonymous, 2022.

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