SAMHSA’s Working Definition of Recovery Updated
Written By: Paolo del Vecchio, Acting Lead, Recovery Support Strategic Initiative, Acting Director CMHS
In December 2011, SAMHSA released a working definition of recovery and a set of guiding principles. The December release of this definition represented the culmination of a lengthy process that began with an August 2010 Dialogue Meeting and ended with a formal public engagement process (via the SAMHSA Feedback Forum) in August 2011. At the time SAMHSA released the working definition, we indicated that we would continue dialogue with the field to refine the definition and principles. Based on additional stakeholder input, SAMHSA is now issuing a slightly revised working definition and principles.
The revised working definition and principles give more emphasis to the role of abstinence in recovery from addictions, and indicate that an individual may be in recovery from a mental disorder, a substance use disorder, or both. The revised definition is below.
SAMHSA appreciates the many thoughtful comments and suggestions received throughout the period of developing and vetting the definition and principles. SAMHSA will disseminate the working definition and principles as a resource to policy-makers, systems administrators, providers, practitioners, consumers, peers, family members, advocates, and others. The definition and principles are intended to help with the design, measurement, and reimbursement of services and supports to meet the individualized needs of those with mental disorders and substance use disorders.
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SAMHSA’s Working Definition of Recovery from
Mental Disorders and/or Substance Use Disorders
The Substance Abuse and Mental Health Services (SAMHSA) recognizes there are many different pathways to recovery and each individual determines his or her own way. SAMHSA engaged in a dialogue with consumers, persons in recovery, family members, advocates, policy-makers, administrators, providers, and others to develop the following definition and guiding principles for recovery. The urgency of health reform compels SAMHSA to define recovery and to promote the availability, quality, and financing of vital services and supports that facilitate recovery for individuals. In addition, the integration mandate in title II of the Americans with Disabilities Act and the Supreme Court’s decision in Olmstead v. L.C., 527 U.S. 581 (1999) provide legal requirements that are consistent with SAMHSA’s mission to promote a high-quality and satisfying life in the community for all Americans.
Recovery from Mental Disorders and/or Substance Use Disorders: A process of change through which individuals improve their health and wellness, live a self-directed life, and strive to reach their full potential.
Through the Recovery Support Strategic Initiative, SAMHSA has delineated four major dimensions that support a life in recovery:
- Health: overcoming or managing one’s disease(s) or symptoms—for example, abstaining from use of alcohol, illicit drugs, and non-prescribed medications if one has an addiction problem—and for everyone in recovery, making informed, healthy choices that support physical and emotional wellbeing.
- Home: a stable and safe place to live;
- Purpose: meaningful daily activities, such as a job, school, volunteerism, family caretaking, or creative endeavors, and the independence, income and resources to participate in society; and
- Community: relationships and social networks that provide support, friendship, love, and hope.
Guiding Principles of Recovery
Recovery emerges from hope: The belief that recovery is real provides the essential and motivating message of a better future – that people can and do overcome the internal and external challenges, barriers, and obstacles that confront them. Hope is internalized and can be fostered by peers, families, providers, allies, and others. Hope is the catalyst of the recovery process.
Recovery is person-driven: Self-determination and self-direction are the foundations for recovery as individuals define their own life goals and design their unique path(s) towards those goals. Individuals optimize their autonomy and independence to the greatest extent possible by leading, controlling, and exercising choice over the services and supports that assist their recovery and resilience. In so doing, they are empowered and provided the resources to make informed decisions, initiate recovery, build on their strengths, and gain or regain control over their lives.
Recovery occurs via many pathways: Individuals are unique with distinct needs, strengths, preferences, goals, culture, and backgrounds including trauma experiences that affect and determine their pathway(s) to recovery. Recovery is built on the multiple capacities, strengths, talents, coping abilities, resources, and inherent value of each individual. Recovery pathways are highly personalized. They may include professional clinical treatment; use of medications; support from families and in schools; faith-based approaches; peer support; and other approaches. Recovery is non-linear, characterized by continual growth and improved functioning that may involve setbacks. Because setbacks are a natural, though not inevitable, part of the recovery process, it is essential to foster resilience for all individuals and families. Abstinence from the use of alcohol, illicit drugs, and non-prescribed medications is the goal for those with addictions. Use of tobacco and non-prescribed or illicit drugs is not safe for anyone. In some cases, recovery pathways can be enabled by creating a supportive environment. This is especially true for children, who may not have the legal or developmental capacity to set their own course.
Recovery is holistic: Recovery encompasses an individual’s whole life, including mind, body, spirit, and community. This includes addressing: self-care practices, family, housing, employment, education, clinical treatment for mental disorders and substance use disorders, services and supports, primary healthcare, dental care, complementary and alternative services, faith, spirituality, creativity, social networks, transportation, and community participation. The array of services and supports available should be integrated and coordinated.
Recovery is supported by peers and allies: Mutual support and mutual aid groups, including the sharing of experiential knowledge and skills, as well as social learning, play an invaluable role in recovery. Peers encourage and engage other peers and provide each other with a vital sense of belonging, supportive relationships, valued roles, and community. Through helping others and giving back to the community, one helps one’s self. Peer-operated supports and services provide important resources to assist people along their journeys of recovery and wellness. Professionals can also play an important role in the recovery process by providing clinical treatment and other services that support individuals in their chosen recovery paths. While peers and allies play an important role for many in recovery, their role for children and youth may be slightly different. Peer supports for families are very important for children with behavioral health problems and can also play a supportive role for youth in recovery.
Recovery is supported through relationship and social networks: An important factor in the recovery process is the presence and involvement of people who believe in the person’s ability to recover; who offer hope, support, and encouragement; and who also suggest strategies and resources for change. Family members, peers, providers, faith groups, community members, and other allies form vital support networks. Through these relationships, people leave unhealthy and/or unfulfilling life roles behind and engage in new roles (e.g., partner, caregiver, friend, student, employee) that lead to a greater sense of belonging, personhood, empowerment, autonomy, social inclusion, and community participation.
Recovery is culturally-based and influenced: Culture and cultural background in all of its diverse representations including values, traditions, and beliefs are keys in determining a person’s journey and unique pathway to recovery. Services should be culturally grounded, attuned, sensitive, congruent, and competent, as well as personalized to meet each individual’s unique needs.
Recovery is supported by addressing trauma: The experience of trauma (such as physical or sexual abuse, domestic violence, war, disaster, and others) is often a precursor to or associated with alcohol and drug use, mental health problems, and related issues. Services and supports should be trauma-informed to foster safety (physical and emotional) and trust, as well as promote choice, empowerment, and collaboration.
Recovery involves individual, family, and community strengths and responsibility: Individuals, families, and communities have strengths and resources that serve as a foundation for recovery. In addition, individuals have a personal responsibility for their own self-care and journeys of recovery. Individuals should be supported in speaking for themselves. Families and significant others have responsibilities to support their loved ones, especially for children and youth in recovery. Communities have responsibilities to provide opportunities and resources to address discrimination and to foster social inclusion and recovery. Individuals in recovery also have a social responsibility and should have the ability to join with peers to speak collectively about their strengths, needs, wants, desires, and aspirations.
Recovery is based on respect: Community, systems, and societal acceptance and appreciation for people affected by mental health and substance use problems – including protecting their rights and eliminating discrimination – are crucial in achieving recovery. There is a need to acknowledge that taking steps towards recovery may require great courage. Self-acceptance, developing a positive and meaningful sense of identity, and regaining belief in one’s self are particularly important.
SAMHSA has developed this working definition of recovery to help policy makers, providers, funders, peers/consumers, and others design, measure, and reimburse for integrated and holistic services and supports to more effectively meet the individualized needs of those served.
Many advances have been made to promote recovery concepts and practices. There are a variety of effective models and practices that States, communities, providers, and others can use to promote recovery. However, much work remains to ensure that recovery-oriented behavioral health services and systems are adopted and implemented in every state and community. Drawing on research, practice, and personal experience of recovering individuals, within the context of health reform, SAMHSA will lead efforts to advance the understanding of recovery and ensure that vital recovery supports and services are available and accessible to all who need and want them.
[...] According to their blog, SAMHSA has received enough public input that they have decided to release a new version of the definition. The slightly revised working definition of recovery and principles now place more emphasis on abstinence and note that an individual may be in recovery from a substance use disorder, mental disorder, or both. [...]
This definition is exceptional primarily I believe because it is all inclusive of those people who are actively seeking and participating in the recovery process no matter where they find themselves on the continuum of treatment. Other definitions have often left one group or more out of the equation. To have a definition that not only should be acceptable to providers and insurance reimbursers but also to those afflicted with MH/SA disorders is commendable.
This all sounds real good, but come one. The last decade has been nothing but running programs off the face of the earth and people who care and want to continue to see programs made better not worse, have had to lobby alone many tims and be taken in as the “Troublemaker etc” So if you are realy serious about all this, lets first figure out how we can get communities back to believing in t his being a Top Priority because if we dont people will continue to use and the programs will continue to die….What can we do??? otherwise I do love what you have done here and in spite of myself it makes me feel hopeful.
SAMHSA! This definition, with all it’s complexities & nuances, brings tears to my eyes. I feel/think YOU ARE GETTING IT, which few do.
The message of Hope cannot be underestimated. Having even just one person on your side, who believes in you, understands the harshness of this disease, is in fact, life saving.
Thank you for all you do & are doing !
From One Who Really Knows ,
Donna
Any chance of getting this in a brochure format? Thanks!
The definition, like the journey of Recovery itself, is an evolution and I am so proud and honored to see the work, voices and commitment of so many of my fellow recovering human beings culminating in such a powerful, moving definition. Kudos to you, SAMHSA, for all you do every day to help us help ourselves on our personalized journeys.
Okay… sure. “Recovery.”
From what?
Because the way this “definition” maunders on, apparently we’re talking about “recovery from anything that involves dysfunction.”
Which is nice.
But not terribly useful when you’re talking about someone at risk of dying from liver failure because the KEEP DRINKING.
Or someone who keeps swinging from the depths of depression to extremes of mania because they WON’T TAKE MEDS.
By trying to make a definition that “fits everything,” you have effectively rendered the word “recovery” in this context meaningless.
It takes longer to say, or type, “recovery from addiction” or “recovery from bipolar disorder,” but I guess we’re going to have to go back to providing the specificity from our end, since SAMHSA is now in the One Big Happy Eat Well Think Good Thoughts Have Supportive Relationships Do Good Stuff Sleep and Exercise And All That Neat Stuff category.
The economy is weakened or strengthened through the actions, and in-actions of its people. What SAMSHA offers is an avenue of identified needs that apply to all people which, when effectively addressed, can help in assuring that we all are able to work, and/or be able to give helpful support to those who do work. I know that a chain is only as strong as its weakest link and our economy is only as strong as its people.
Review Maslow’s Hierarchy of Needs to determine where you presently are.
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[...] is a journey and often involves several components. One essential component is support from others. Support from family and friends and can play an [...]
my views on the importance of voice in the journey from remission to recovery
from an elder- nancy pizzo boucher
I spent my professional life being a teacher in special education. The big surprise for me was that someone was paying me to do this work that I loved from the core of my being. I was a student first at heart and a teacher next with my heart and my mind always on the job.
So along the way of my profession and my life , my own boy got sick with a serious mental illness and I became a student again with an investment of greatest magnitude in understanding what might help in easing the suffering that all of us in our family were experiencing .
Here is what I have distilled out so far :
***Any treatment for mental illness that wants to improve and empower the future for those who are ill, needs first off to attend to and to address healing of the person who got sick .****
Let me digress with a recent experience that holds all of what I believe is essential as part of recovery from a mental illness.
I am a family speaker as part of Voices Of Recovery from Portland, Maine. At a recent engagement where I spoke along with a brave consumer, we met a most amazing woman who is a practitioner in the field -working to alleviate the suffering of those with mental illness. She told me this story that has emblazoned itself on my heart and my will to continue to do my part towards understanding and healing.
This woman worked in the woods with homeless folks with mental illness. She had this one client whom she described initially as whiney and demanding – until one day someone else told her to ask this women to show “her pictures” ;so, she asked her. What came out of that was the history of this person, absent and preceding her illness.
This client had owned fitness centers with her husband, had national magazine coverage – where she looked fabulous-and at some point this highlighted coverage compared her to Farrah Fawcett. Once this practitioner asked this woman about her pictures, the journey together towards trust began. This unusual gifted worker then began to ask her client’s opinion about what other folks there needed for physical health and exercise. This practitioner told me that her dream for this woman’s recovery plan was to get her into a gym, as a volunteer and to work from there.
In our country, all industries including those dedicated to work, to care, and to treat mental illness, seem to be beholden at some point to a funding source. Change in that dynamic will require breaking away..breaking away from a reliance on medications and pharmaceutical industries …breaking away from any rigidness or close mindedness about best practices .
Change in the current mainstream dynamic about treatment and care of those suffering from mental illness will require foremost an emphasis on hearing what happened to those who got sick and to their families….will require an acknowledgement and a welcome of what is known by those who have walked the walk…a knowing that the experts who need to be included around the table of those working to shine a light on the wilderness of mental illness should be smart enough to choose families and consumers as their guides.
My pragmatic ideas are these:
1)create a movement that works to require that primary sources are included in the curriculum of those preparing to work in the field of mental health
2)create momentum for those in the field to generate qualitative research proposals from the content analysis etc. of these primary sources
3) conduct quantitative research that stem from these proposals with the goal of developing best practices in healing and recovery from mental illness
Take care and goodwill. Nancy Pizzo Boucher
amazon.com/author/nancyboucher
While SAMHSA went to great lengths to polish this their journey also exposed a serious flaw in the way we deal with drugs, and other issues, in the US and around the world. The definition, for all its thoughtfulness and consideration becomes internally inconsistent when it prescribes — contrary to the respectful and individual journey it also describes — what goal all people should have regarding drug use (abstinence-only). Ignoring natural history studies and human realities from thousands of years is hardly a way to make an accurate definition of recovery.
On the positive side it does distill the needed work down to its essence: Is there a role for intoxication within a healthy and fulfilled life?
Here’s to hoping we can focus on this issue and thus continue to evolve…
As per the United States Constitution, “We the People of the United States, in Order to form a more perfect Union, establish Justice, insure domestic Tranquility, provide for the common defence, promote the general Welfare, and secure the Blessings of Liberty to ourselves and our Posterity, do ordain and establish this Constitution for the United States of America”, guidelines have already been established for the continuance of a strong nation. Are we really having these many issues with promoting the general Welfare of our people?
Or, is the problem related to who benefits as opposed to whether benefits are obtained?
[...] SAMHSA releases revised working definition of recovery [...]
Have publication been made with this?
Nancy » A brochure was developed with the most recent working definition of recovery: http://store.samhsa.gov/product/SAMHSA-s-Working-Definition-of-Recovery/PEP12-RECDEF