We`re finally beginning to define recovery

There is little scientific research onrecovery from drugs of abuse and dependence. This is because there has been no agreement on what recovery is, how it should be measured, and what the outcomes of such research should be. In our field, everyone knows someone in “recovery.” But while to some recovery is mostly abstinence, to others, it is much more—perhaps a return to “normalcy” in one's life without the use of drugs.

Because of the need for more research, and because it would be desirable to find ways to measure recovery and understand how more people might be helped into recovery, a consensus conference on this topic was convened in Rancho Mirage, California in September 2006. The conference was sponsored by the new Betty Ford Institute, a nonprofit organization created to support collaborative programs of research, education, and policy development leading to a reduction in the devastating effects of substance use disorders. Fourteen experts invited for their knowledge of research and recovery worked on the definition, which has now been published in the prestigious Journal of Substance Abuse Treatment.

Work in progress

The definition is preliminary and intended as a prototype for further research and discussion, so it is neither a definitive definition nor one that will never be changed. Just like the first edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-I), this is a first attempt at clarifying concepts that have not yet been agreed upon and might have different meanings to different people.

However, the definition was designed to be quantifiable based upon published validated methods. The definition is designed to stimulate research and further discussion that will lead to changes and updates of the definition over time.

Briefly, here is the multidimensional definition. More details can be found in the original journal article, cited below:

“Recovery from substance dependence is a voluntarily maintained lifestyle characterized by sobriety, personal health, and citizenship.

“Sobriety refers to abstinence from alcohol and all other nonprescribed drugs. This criterion is considered to be primary and necessary for a recovery lifestyle. Evidence indicates that for formerly dependent individuals, sobriety is most reliably achieved through the practice of abstinence from alcohol and all other drugs of abuse. Early sobriety = 1-11 months; sustained sobriety = 1-5 years; stable sobriety = 5 years or more.

“Personal health refers to improved quality of personal life as defined and measured by validated instruments such as the physical health, psychological health, independence, and spirituality scales of the World Health Organization QOL (Quality of Life) instrument.

“Citizenship refers to living with regard and respect for those around you as defined and measured by validated instruments such as the social function and environment scales of the WHO-QOL instrument.

“Criteria 2 and 3 extend sobriety into the broader concept of recovery. Personal health and citizenship are often achieved and sustained through peer support groups such as AA and practices consistent with the 12 Steps and 12 Traditions.”1

The consensus panel took great pains to come up with a definition that was as all-inclusive as possible and did not intend to leave out those using other pathways to recovery. Indeed, one of the important purposes of this initial definition was to promote exploration of different ways to achieve recovery.

Unresolved items

Obviously, one definition cannot answer all questions. When discussing the need for sobriety to include abstinence from nicotine products, for example, members of the consensus panel were divided, for to include it would essentially eliminate a large number of individuals who today are in stable recovery from their drug of choice. The panel realizes, however, that tobacco products are one of the leading causes of death in people in recovery, especially those in recovery from alcoholism.

The consensus panel is encouraging federal agencies to provide more money for research on this definition, and is encouraging scientists in all areas to tackle this critical topic.

Reference

1. The Betty Ford Institute Consensus Panel. What is recovery? A working definition from the Betty Ford Institute. J Subst Abuse Treat 2007; 33:221-8.