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Recovery Defined – Give Us Your Feedback

12 August 2011 311 Comments

Over the past year, SAMHSA – as part of its Recovery Support Strategic Initiative – has worked with the behavioral health field to develop a working definition of recovery that captures the essential, common experiences of those recovering from mental and substance use disorders, along with 10 guiding principles that support recovery.

One of the key events that led to the current working definition of recovery was a 2010 meeting of behavioral health leaders, including mental health consumers and people in addiction recovery, who developed a draft definition and principles of recovery to reflect common elements of the recovery experience for those with mental/substance use disorders. Other significant efforts include national consensus meetings that SAMHSA held in 2004 and 2005 to develop separate definitions of recovery from mental health problems and addictions. SAMHSA is developing a working definition of recovery to help policy makers, providers, funders, peers/consumers and others to design, deliver, and measure integrated and holistic services and supports to more effectively meet the needs of individuals served by behavioral health systems.

In recent months, SAMHSA has reviewed drafts of the working recovery definition and principles with stakeholders at meetings, conferences and other venues. Additionally, in May 2011, SAMHSA posted the working definition and principles on the SAMHSA blog and invited comments from the public.  Many of the comments received have been incorporated into the current working definition and principles.

In order to encourage greater public engagement on this important definition, SAMHSA is inviting the public to provide further feedback.

The current working definition and principles are as follows:

Recovery from Mental and Substance Use Disorders:  A process of change through which individuals work to improve their own health and wellbeing, live a self-directed life, and strive to achieve their full potential.

Through the Recovery Support Strategic Initiative, SAMHSA has delineated four major dimensions that are essential to a life in recovery:

  • Health: overcoming or managing one’s disease(s) as well as living in a physically and emotionally healthy way;
  • 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 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. For children and youth, especially those who are younger, families and caregivers play a key and sometimes primary role in shaping their path to recovery.

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 and non-linear in that they are 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 is an important choice for individuals with addictions.  In some cases, these 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, addictions and mental illness treatment, services and supports, primary healthcare, dental care, complementary and alternative services, spirituality, creativity, social networks, recreation, 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 relationships 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. Peers, family members, 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.

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.

To provide comments, please visit the SAMHSA Stakeholder Feedback Forum.  The forum will be open for two weeks, beginning Friday, August 12 and ending midnight Eastern Time on Friday, August 26.  The feedback forum will provide an open and transparent process by which stakeholders can offer their comments about the definition and principles and suggestions on how they can be improved. SAMHSA cannot guarantee that all comments will be incorporated but would like to hear all views. Feedback received on the forum is an important part of the public dialogue on this issue and will be evaluated in conjunction with feedback previously received on this issue.

Once on the Forum, you will find two questions, one about the Definition of Recovery and one about the Guiding Principles. Please provide your comments and also feel free to vote and comment on input offered by others. You will have up to 10 votes and you can revise your votes throughout the feedback period.

Make your voice heard!  Visit the Definition of Recovery Forum and let SAMHSA know your views on recovery.

Update:  The definition of recovery has been revised incorporating additional feedback.

311 Comments »

  • Miles said:

    Recovery is a change of old ideas, working steps in your life daily.

  • Marina Gethers said:

    Recovery is spiritual. Meditation, prayer, yoga are some sources to help one heal his/her mind and find balance. If one has faith or a belief in a Higher Power, it gives people a reason to achieve the goal of remaining drug/alcohol free.

  • Sheri Hathaway RN,BSN,MPH/Executive Director said:

    Upon opening 7/1/2012 Greenehouse will provide halfway house services to a special population of clients in recovery as detailed in the ROSC methodology. We will be dedicated to men (preference given to ages 18-30) who are on Medication Assisted Therapies (MAT). Currently this populatin is underserved. The 10 guidelines for Recovery are excellent and help to dismiss stigma’s associated with MAT. As a member of the Parent Panel Advisory Council with BDAP in Pennsylvania I have advocated for this change in the recovery definition.

  • Tommie Ann Bower said:

    “Because setbacks are a natural, though not inevitable, part of the recovery process, it is essential to foster resilience for all individuals and families.” Comments like this obscure the direct need for continuing resources, by this I mean ACCESS to services. It begins to sound as if given the proper level of resilience people will be able to recover. Many very resilient people with highly developed resilience have failed to gain access to supportive services such as CBT, trauma-informed counseling, brief residential for stabilization.

  • Molly Cisco said:

    Until the term “Behavioral Health” is no longer used, I just don’t see how anyone who works to support me will be taken seriously. I refuse to use providers that use that term as it shows a foundation of disrespect therefor how can I trust anything else they say or do.
    Shame on SAMHSA for not only using that term but for being the role model for others to use it too.
    I do not have behavioral problems and I resent the fact that you say that I do.

    • Donna Espinola-Rooney said:

      I think you may be taking this “behavioral” word too personally. For many folks and their families behavior is applicable and I believe should be included, taken from my own personal experience of course. I think having SAMHSA look at and help define Recovery is a great step toward elimanting the social stigma attached to substance disorders and in my opinion has nothing to be ashamed of. I believe SAMHSA is an all around inclusive organization serving the greater good of all the people, and certainly not planting any lables to offend anyone.

      • TK said:

        I think behavioral is ok as long as conditional is also referenced, or am I missing something?

  • Deborah said:

    I’d like to see mention of recovery being a process with challenges and rewards along the way that build strength, confidence as the individual develops new and effective coping skills. Movement is not always linear nor does it always appear constant and no two experiences are exactly alike. I’d also like to see a reference that would somehow illustrate that the process of recovery takes an approach that works in the lives of all people; including those without addiction and/or mental illness. It is a way of life that works for all and as momentum builds, the internal results manfest in the external and vice versa.

  • Raul Gordillo said:

    I can appreciate the generated definition and guiding principles of recovery from a professional and ideological perspective. It has been my experience that although definitions and principles are of great help for professionals, in many cases consumers have too many barriers to apply and live by these principles and ideas. There is a proportion of consumers that were not able to educate themselves from any angle, they are simply uneducated, their cognitive abilities have not been promoted, their finances are at the poverty level and they have no opportunity to increase their income. They have registered subconsciously their limited upbringing and all they know is self-destructiveness. Many participants of AA meetings are an example, even after treatment, they learned the 12 steps, they memorize them as well as the serenity pray, but they do not understand the actual purpose of the 12 steps, for instance, they never comprehend the spiritual factor of the 12th step. They might be sober but they just go through the motions of the meeting, they have no understanding of striving to achieve their full potential. They smoke, drink coffee, repeat the same stories, they are not emotionally balanced, have not develop the habit of reading or learning and they have no desire to release traumatic experiences. To these unfortunate individuals, add the age barrier, once they become seniors, their understanding and cognitive ability has been deteriorated, not only by mental health or substance abuse issues, but lack of ability, self esteem and worth. Their hope can only be established within a very limited frame of mind, resources and abilities as well as physical conditions. Perhaps society, funding sources and professionals provide their best, but there is a need to acknowledge, if nothing else, that inclusive definitions, principles, and treatment provide the opportunity to strive and achieve their full potential for some individuals but for the uneducated, poor, ill and older.

    • Ben Hammond said:

      Howdy Raul…I am 77, a recovered alki (AA) and I run a shelter for alkis and addicts that are chronic relapsers that have the willingness to go to any length to recover.
      I agree with your comments and would like to have more communications from you. I live in Tulsa Oklahoma and work with groups in Texas and Oklahoma. God Bless You and God Bless America. Old Ben

    • TK said:

      How about develop a better program then the 12 step program. The method has too much history and is not relevant to many demographics in its current form. Consider the baby boomers. 12 Step as a program is defended more for its methods than it is perceived beneficial for its principles.

    • Billie Campbell said:

      You Have Really made a simple commentits really all about working the 12-steps which brings about a personality change
      in order to recover spiritually,mentally, and physically.
      with all the designed modules which only empowers the professionals;the individual who’s trying to recover gets lost because the basic foundation to recovery has been moved
      from helping the individual to how well the professional writes his or her notes:Oh Well Enough Said.This is from a Certified Addiction CounselorII,MentalHealth CounselorII/Certified Twelve Step Counselor.IT’s not about how well we look as professionals,but how well the recovery process impacts those we are serving to regain recovery of there lives.

  • Noah Lipton said:

    There is no mention of “spirituality” in the guiding principles. Although it may be implied by the use of words and terms like “holistic,” “many pathways,” and “culture,” it is such an explicit part of so many people’s recovery it deserves a more prominent mention.

    • Sarah O Neill said:

      So true. Often the mere term of spiritual healing can have bad connotations. I’d like to recommend this book to you, it’s a poetry collection, loosely inspired by the events of 9/11, but from what I have seen, now works more as a general inspiration piece to many, it’s called Beloved Spirit

  • Matthew Lovacheff said:

    I am a Drug Court Counselor in Clay County, Missouri. When I began working here, I realized many new clients weren’t sure what recovery was and often thought it just meant staying clean. I worked through the definition of the word and put the pieces together to form a comprehensive definition of recovery. I will give the definition first and then show the definitions and breakdown.

    Recovery = the series of actions, or operations, marked by gradual changes, directed toward the struggle against an abnormal state of the body or mind, to achieve a special beneficial state of being operative

    Recover: (vb) 1) to get back again: regain, Retrieve. 2) to regain normal health, poise, or status. 3) to make up for: Recoup 4) reclaim (as taking land from the sea) 5) to obtain a legal judgment in one’s favor

    Recovery: 1 : the act, process, or an instance of recovering; especially : an economic upturn (as after a depression) 2 : the process of combating a disorder (as alcoholism) or a real or perceived problem

    Process: (n) Progress, Advance 2) Something going on: Proceeding 3) a natural phenomenon marked by gradual changes that lead toward a particular result (the process of growth) 4) a series of actions, or operations directed toward a particular result (a manufacturing process) 5)legal action 6) a mandate issued by a court, esp Summons 7) a projecting part of an organism or organic structure

    Combat: (vb) fight, contend 2) to struggle against, Oppose

    Disorder (n) lack of order, Confusion 2) breach of the peace or public order, Tumult 3) an abnormal state of the body or mind, Ailment

    Particular (adj) of or relating to a specific person or thing (the laws of a particular state) 2) Distinctive, Special (the particular point I’m trying to make) 3)Separate, Individual (each particular hair) 4) attentive to details, Precise 5)hard to please, Exacting (She’s so particular about what she wears)

    Result (n) 1. something that results, Effect, Consequence 2)beneficial, or discernable effect 3) something obtained by calculation or investigation

    Effect (n) 1) Meaning, Intent 2) Result 3) Appearance 4) Influence 5) pl. Goods, Possessions 6) the quality or sate of being operative syn outcome

    When one participates in recovery, they complete a series of actions and operations designed to help them cope with, and overcome, an abnormal state of physical and psychological addiction, thinking errors, social skills, and spiritual well being. They show gradual changes (sometimes, unnoticeable by the addict) and eventually, if they persevere, they reach a special state (awakened, enlightened, compassionate, etc) of living a full life (being operative.)

  • Madeline Martin said:

    Recovery, as defined by 12 step support groups like AA and NA is the process of living life and overcoming emtional, behavioral and cognitive problems by utilizing the 12 teps, maintaining abstinence form all mood altering substance, building and utilizing a support network of others who have learned to live with out depending on alcohol and other drugs, including maintainece drugs like suboxone and methadone.

    This is a personal definition based on my personal experience and my own perspective of what recovery is.

    • Scott Smith said:

      Be careful to exclude individuals who are on medication assisted therapy. Many people take replacement prescription medications, which Suboxone and Methadone are, and recover as well as those who do not need medication assisted therapy. Recovery is a personal process and in most cases if the person did not disclose one would not know that person was taking Suboxone or Methadone because that persons life looks just like the average life of a person in recovery. I am in recovery but did not need opiate replacement therapy but know plenty of people who live successful lives who have gone the route of opiate replacement therapy.

  • Alexandre Laudet said:

    In addition to the dimensions of recovery outlined above in the initial announcement, studies show that persons in recovery experience/define it as a ‘better life’, a ‘second chance at life’ and ‘a normal life” and cite the following:
    - Recovery is a process that unfolds over time (not an end point); and
    - Recovery requires symptom reductions AS WELL AS improvement in other areas of functioning typically comprising ‘quality of life’: e.g., physical, mental and social health/functioning (relationships, , spirituality for some, living environment
    See more here: http://pfr.samhsa.gov/docs/Environmental_Recovery_Scan.pdf

    • TK said:

      Labels become icons for some and references for others. Being in recovery for an outsider gives the appearance of “forever stuck.” I have heard this again and again.

  • Charlton Hall, MMFT, LMFT said:

    I don’t believe in the concept of ‘recovery’ per se. Addictive behavior is a learned behavior, and can be un-learned. Research continues to demonstrate this to be true.
    For example, if I had the flu, and then the flu went away, I wouldn’t call myself a ‘recovering flu sufferer.’ We don’t speak of ‘recovering depressives’ or ‘recovering anxiety sufferers,’ or ‘recovering borderlines,’ etc. because most behavior, if not all behavior, consists of learned responses to adverse circumstances.

    • Scott Smith said:

      Please do appropriate research. Substances have an interaction within the brain that influences behavior, not that poor choices are excused by this. But, if we don’t understand the full experience of the problem then we focus on a solution that misses the mark. Read “Healing the Addicted Brain” by Harold C. Urschel, III, MD to learn more.

  • Jeffrey L. Price, CDPT said:

    August 15, 2011 at 7:46 am
    I would like to begin with a quote from C.G. Jung. This is referring to a gentleman named Roland H. “His graving for alcohol was the equivalent on a low level of the spiritual thirst of our being for wholeness, expressed in medieval language: the union with God.” I believe that this applies across the board with mild forms of mental illness and addictions. It is the responsibility of all practioners, whether mental health or addiction driven, to ensure that they “GUIDE” the person to a better understanding of self. We are all teachers and we are all students. The very moment we think that we posess all the answers is the moment we lose the ability to help others.

  • Ellen said:

    I appreciate the hard work that went into the creation of this working definition and the guiding principles! I am a person in recovery from “serious mental illness”. I like that we are trying to be inclusive, but some of the language in this definition doesn’t really “fit” me or my experience. I think it’s because I have not had an addiction (other than smoking cigarettes). I am not sure that recovery from mental illness and addiction follows the same process or has the same guiding principles. I know that most people have co-occuring disorders and that it makes sense to address the majority. This just feels a little awkward to me…”disease”(?), and the references to abstinence–I don’t know what I am to abstain from as a person with a mental illness(?). Otherwise, I like the collection of ideas and I think you’ve done a great job describing it!

    • Scott Smith said:

      Umm. I’m sorry but you do have an addiction called nicotine dependence.

  • Mike Logan said:

    Recovery for me is awareness leading to choices. Thought by thought, heart beat by heart beat, prayer by prayer.

  • Gerald Katchmer, MSW said:

    Recovery is discovering me, going beyong the symptoms and causes to the source of my PAIN. The denial of this pain, fuels my thinking and addiction and helps me to create a delusion. Only by addressing my underlying traumas and experiences by going through my feelings, can I hope to discover me and recover and pierce the denial by shattering the delusion.

  • Mary Lloyd said:

    I do agree with the Recovery Defination but believe in order for this to be a defination that can be supported by all populations and disabilities it must be looked at from the perspective of the IDD population as well (maybe that is not the intent of what you mean to do but we must stop separating disabilities and leaving groups out, it is time that we all work together to make the most of funding and services). For the IDD community the word “recovery “has sometimes been a source of disagreement because the challenges facing this community affects the physical appearance, mental development & functioning levels and has lasting medical effects producing a need for life long mendical treatment and supports. We must recognize that for this community recovery is an option when we speak of changing, improving, strengthening their own health. My suggestion include the Intellectual Developmental Disabilities community.

  • Judith Rosenberger said:

    Every step towards broadening recovery beyond symptom relief/sobriety is a step forward. Support for the holistic interventions………jobs, education, peer mentoring, etc., and most importantly a consistent relationship rather than fragmented services…………needs to come into the funding circle. A need is formed communities that guide and support individuals as they undertake recovering their lives as members of full society. this takes money, to provide space, organization, some staff, as well as an orientation in such centers that goes beyond de-stimatization of the problem, and toward active inclusion and means of entry into the larger world.

  • Diane Theriot said:

    I feel that as long as there are people who are unable to promote the hope of recovery for the mentally ill there will be no progress in averting the stigma associated with mental illness. More than once I have come in contact with people who treat us comsumers (how I hate that lable) as less than human. I hear it from the more thinking individual than from the instutionalised thinking person. I know that some people need more guidance than others but there should be a respect shown to the individual. Just as there are teachers who should not come within ten feet of a child , there are people in the mental health system who could not care less about people with mental health issues. They should be fired for the hurtful and disrespectable way that they treat people with mental health issuses. The money saved could be used for peer run places that would house the helful organizations such as Meanful Minds, Bridges, NAMI, etc. I have been greatly blessed in my recovery by a great mental health doctor
    who belived that I was caple of graduating from college. Various organizations, presentations, education on mental illnesses has helped me grow in my recovery. The stigma from the proffessionals has discouraged me from sharing my view-point of how I feel that the more the proffessionals are involved in a

  • Richard J Lillis said:

    I applaud your definition of recovery, but it appears to written by health professionals for healths professionals. If that is the goal you have accomblished your goal. However, for the recovering addict with mental health problems it tends to be too many words.
    Reading the comments listed shows a conflict between professionals and 12-step programs this is unfortunate. My own personal experience shows me that professional counseling and 12-step programs will achieve optimum results. I believe a simpler definition would be more useful.
    Recovery is learning to see, feel, and hear differently. The life events which led to mental health problems and addiction need to be explored with abstinance as one’s constant companion. Changing negative thinking to postive thinking (reframing) is the pathway. Learning from one’s experience is the journey. No one should argue with “one day at a time” because recovery happens one day at a time.

  • Patrick said:

    Recovery is individual and it is a process of cultivate the hope and the dream lost within ourself.

  • Natasha said:

    Recovery is evolutionary. It is a gradual and every changing process. There is no end or destination, just the journey.

  • Adam Ogorek said:

    Recovering from addiction to me is ending the cycle of ups and downs, abstaining from the drug(s) that caused that damage. Ending the cycle of addiction to me is recovery.

    Recovery of the soul and spirit is two different things than recovery from addiction, but I believe it plays part in recovery for lots of addicts, but not all. There are some people who only need recovery from the addiction aspect of it.

    Using Methadone, Buprenorphine, Antabuse, etc for opioid addiction or alcohol addiction, other medications for any addiction is considered recovery, as long as those medications are being used as prescribed. I am a methadone patient and fully know that I am in recovery.

  • josephine Hughes said:

    A thanks to all you have contributed to the Recovery Support Strategic Initiative. I would like to see delineated five major dimensions. The fifth one being Spiritually as this is as important as the other four because is enforces the others. The definition of Spiritually is up to the individuals because for each it is different.
    Some may use religion and others the earth.

  • Peter J Weiden MD said:

    Challenges for a practicing psychiatrist

    I am delighted to see that SAMHSA is addressing this very challenging topic, since everyone uses the word “recovery” but there is no mutually agreed-upon definition.

    I would like to present a dilemma that frequently presents itself in day-to-day practice for psychiatrists treating persons with mental illness.

    I am refering to the ongoing debate about prognosis for persons with schizophrenia and related psychiatric disorders. There is still active debate as to whether the “natural course” of schizophrenia is one of “deterioration” or “recovery”. When practicioners tell me “well, can’t it be both depending on the individual patient?”, maybe so, but it still does not solve the problem. The reason the dilemma remains in place is that the very same practioner needs to make recommendations one person at a time, and a person cannot be “deteriorating” and “recovering” at the same time!

    Such a wide range of opinions at a senior research level, this makes it very difficult for someone in practice to know how to calibrate and anchor treatment goals. Ok, one may argue that this is up to the person, and while I agree with that, patients and families often ask for opinions about what is realistic and what is not.

    In particular, this pertains to situations where a specific goal, while desirable, would involve some risk taking.

    I think that SAMHSA needs to deal with this in its definition, since there will be serious resistance to widespread embracing in “mainstream” psychiatry until there is further understanding as to what is – or is not – acceptable levels of risk for decisionmaking when there is uncertainty about the course of the illness.

    For those interested in more details, I wrote an article on this dilemma.

    http://www.medscape.com/viewarticle/729750

    Finally, I welcome responses and feedabck but please “don’t kill the messenger”! I personally believe in recovery, but I feel it is important to deal with this concern. It seems to me that this SAMHSA effort could be very helpful in this effort.

    Peter J. Weiden MD

    • EDWARD AGUILAR said:

      WHAT MORE CAN I SAY THAT YOU ALONE HAVE ALREADY SAID. I AGREE WITH YOU IN ALL THE TOPICS. AND YES I FEEL SAMHSA BRINGS THE BEST OUT OF US. YOU AND FEEL THAT WE HAVE A MENTAL ADDICION. I HAVE BEEN TO SEE MANY DOCTORS AND I NOW SEEM TO BELIEVE THAT I HAVE SCHIZOPHENIA RELATED PSYHIATRIC DISORDERS. THIS IS ONE OF 0R DETERIORATION OR RECOVERY. SO I THANK YOU DR. PETER J. WEIDEN FOR HELPING ME LEARN ABOUT MY MENTAL ILLNESS AND IN THE CHANGS IN MY DAY TO DAY LIFE.

  • Alexandre Laudet said:

    One (regrettably long) necessary note to this fascinating and much needed discussion: Persons in recovery often say that it’s not necessary to define recovery because ‘we know’ what it is. That is 100% correct. A person in recovery can tell he/she is in recovery, so can other persons in recovery and their loved ones.
    Here is why the field needs a definition of recovery, however: the service system is increasingly moving toward a recovery orientation (rather than merely addressing symptoms) which is a good thing. That means that tax payers’ money (i.e., public funds) are going to be used to purchase services aimed at promoting recovery. Service payors and society at large then need the service providers to be accountable for the services they ‘sell’ the the states and the public. In other words we need a definition of recovery to be able to determine yo what extent service A and/or agency B indeed promote recovery just as we want to be able to know and compare hospitals’ and doctors’ track record at treating cancer or heart disease. These bench marks are critically needed to guide the provision of services, for instance when several agencies ‘compete’ for public funding to provide recovery promoting services, we must be able to look at their track record and see which does a better job to guide decisions about contracting the best agency. So while persons in recovery may not feel the need for a definition, a definition of recovery is needed to guide the development and provision of services. This requires that we identify specific dimensions that are critical to recovery, not how people get there (i.e., -path such as 12 step, meditation, medications or treatment) but the key ingredients of recovery: reduction of symptoms PLUS WHAT? (e.g., progress toward contribution to society, improved social/family relations, etc.)

  • Jerry L. Potter said:

    Almost 26 years sober, one day at a time. The human condition of relief seeking behavior has not changed since Adam ate the apple; blamed Eve who then blamed the serpent. So folks; lets take ownership of our humaness and realize that none us has the answers, can’t do it alone and need relationships. The one thing that got us where we are; are the most afraid of and yet need the most. Yes, in 12 step meetings we here a lot of rhetoric; people need to be “hear” and validated. They need to tell thier stories. To the best of my knowledge, the 12 steps still has the greatest recovery potential of 1 in 4 that make it. It still takes a Village and the problem needs to be exposed at ever increasing levels. So few know so little in any given community and we tend to hold privacy as it were a “secret”, adding to the shame of the disease of addiction.

  • Bob S. said:

    Here’s my suggestion (not that I am an expert or anything):

    Recovery from Mental and Substance Use Disorders: A process of change through which individuals work to regain the ability to function (more) normally in life, improve their health and wellbeing, and strive to achieve their full potential.

    Major dimensions essential to a life in recovery:

    Health: overcoming the mental or substance abuse disorder as well as living in a physically and emotionally healthy way;
    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.

  • Kari Bell said:

    I define recovery as life-long growth and maturity. No one person has the ability to jump on the road to recovery without first understanding the road on which he or she has been traveling. That means one (in recovery) must address the trauma and the clinician’s job is to help the client define his or her new “normal.” In my practice, I give the analogy of a tree that is wise to let go of dying leaves in order to make way for new growth, such is the case with recovery. Recovery is far different than sobriety; sobriety is simply “do not touch the substance again.” Recovery brings new meaning to what was once seen as not allowing for mistakes, in recovery there are no mistakes, only lessons in which the patient and others may benefit from through new found wisdom. In recovery much emphasis is placed on the patient becoming “the best me they can be,” and there is a nurturing from within rather than an internal desire to self-harm. It is a client-centered, strength based, trauma informed, self-discovery process, that allows for the patient to rewrite his or her own life story with a positively unpredictable ending of sober living and self-discovery.

  • Wilbur Williams said:

    In addition to the guiding principles of recovery presented in this article and the wise comments offered, I believe an essential aspect of recovery is the simple act of recognizing that a problem exist which is quite a complicated feat for someone active in their addiction. I speak from firsthand knowledge.

  • nanette catherine ford said:

    Beautiful!!!! What a relief to read such an all-encompassing definition of recovery. I was also sooo happy to read that it is about recovering from trauma, too- as more and more of my personal and professional experience is that- underneath it all, is usually some sort trauma has been experienced by the individual. thanks for including that.

  • Ellen Awai said:

    I like it. I just wish Respect was higher up perhaps even second.
    The telephone conference last week on Vicarious Trauma was great and it should be mentioned that trauma can be in all forms even problems with coworkers who do not understand working with someone with a mental health issue. Employers should be addressing these issues and offenses of the American with Disabilities Act with discrimination issues.
    Providers are only now hearing about consumer-centered recovery, imagine how long it will take for them to know what person-driven recovery is all about. We have to get the word out faster and educate everyone especially those outside of the mental health field! Mahalo!

  • Vern Kukowski said:

    I define recovery as living life as it was meant to be lived. Personal responsibility and pride in yourself and the environment in which your god has created for you. Balance in all aspects of your life. I really dislike the statements of “powerless over alcohol” or any other addiction. The physical dependency lasts only a short period of time and then it’s a psychological issue. Change the way you think! The number one thing is choice! Recovery as well as sobriety for me happened one moment in time not the disillusionment of one day at a time. I have never looked back to alcohol but rather look forward to life.Too much attention is given to saying that relapse is okay. If you relapse you are not in recovery your still in the contemplation stage, where you are thinking about recovery.

  • BJ Rowe said:

    Recovery is constant

    Change “responsibility” to “responsibilities”

  • Stephen Borchers said:

    The definition of recovery is informative; however, the most important component is missing. Spirituality! Spirituality can be found individually, but most of the time a person can experience spirituality by listening to someone’s experience, strength and hope. Spirituality is a gift to the person who is seeking it. Everyone has a chance to receive it. I personally have the experience to share. I have also have had the great experience to provide counseling/therapy to those who have gone through the debts of addiction and recovery. I see relapse in the best of us (meaning myself as well) and even after the most informative treatment plans. If spirituality is not the key part of that treatment plan, then in most case examples, relapse is inevitable.

  • Dr. David J. Mayfield C.A.T.C. 1-ll C.C.S. said:

    Recovery is finding a need and meeting it. People don’t care how much you know. but they are concern with how much you “CARE” Recovery is being a companion,guide, and accountability partner. Recovery is the giving of onself not expecting anything in return. Many people are being exploited, if they have the capacity to pay, recovery is searching out and looking for the ones who don’t have anything to offer you for your services. You cannot love people and money at the same time. God gave us people to love and things to use, when we start loving things, we start using people.

  • William Fosterr said:

    In my life I have always emphasized for myself the wonderful things that are in the giving for the giver. The concept of ‘Mutual Recovery’ is core to my thinking. The worker and society are poised to gain from the success of the recoverer. We are in this field to advance ourselves and society, not just to advance the person in recovery. I think that we should be transparent about that. What is achieved by the recoverer benefits us all. The person in recovery? That’s everybody. If one of us achieves we all achieve.

    We are in the business of improving the environment for recovery so that persons in recovery can achieve. That is our blessing on them: the environment. It is the task of society to bless. It is the task of the person in recovery to achieve.

  • Karla Lopez-Beslay, M.S. said:

    Recovery necessarily requires a paradigm shift. One’s perception of reality changes. As one see him/herself in a new light, everything around that individual is illuminated differently. Hope emerges and new opportunities become a real possibility.

  • Sherria Taylor said:

    Recovery is discovery…

    Although, I am not in favor of using the word “recovery” as it can imply weakness or something inherent rather than addressing the challenging of unlearning coping skills often times intergenerational in nature, I tend to think of the overcoming of any adverse situation or condition or ability to adapt and adjust as a process of not only self-discovery (power, strength, acceptance, etc.) but a discovery of support systems, resources, and relational strengths not previously known, received, or utilized.

    Overcoming provides one with information about self and others not previously known or experienced before. It creates a sense of a “whole new world.”

  • Gerald Katchmer, MSW said:

    Recovery is discovering me, going beyong the symptoms and causes to the source of my PAIN. The denial of this pain, fuels my thinking and addiction and helps me to create a delusion. Only by addressing my underlying traumas and experiences by going through my feelings, can I hope to discover me and recover and pierce the denial by shattering the delusion.

  • Mitchell Klein said:

    Recovery is a self-defined continually evolving process with continually evolving outcome plans. One does not have to be ill or have been given a label to get better. Recovery is not a particular method or philosophy and no particular method or philosophy is right or wrong except as defined by the individual for whom that method or philosophy is working for them, or not.

    Recovery cannot be globally defined. It can however be, individually experienced and shared.

  • EDWARD R. AGUILAR said:

    In my own recovery I had to except that I was going to die in prison. Or homeless somewhere. I findly had to except that I had a mental problem. I findly opened up to a doctor. I never went to a doctor no not even for a flu shot. No nothing, I felt I would take care of myself. I ended up using drugs on the street. but one day I went to a doctor and he put me in the hospital. while in the hospital I learned about SAMHSA. It’s been five years and I’ve learned how to recover. My self-esteem has grown in many ways. Today SAMHSA is a big part of my RECOVERY. THANK YOU !!!

  • Scott M said:

    While I agree with much of what I read here, I have to ask a simple question. Where is the commitment to abstinence from mind altering drugs?

  • Jerome Maultsby said:

    Is there really a right or wrong answer in defining recovery? I think not, for it is so much more to the dis eases that require recovery that is mostly difined by intellect. The traumatic experiences that occur at any level is where the need for recovery begins from an intellectuall perspective. However at the Soul level of the need to recover is from a Spiritual perspective. If recovery is not addressing both aspect of the self by definition, then it is out of balance in trying to define the purpose of recovery.

    So as these experiences continue to evolve, so should our discriptions of this process of recovery. Let this dialogue continue in an effort to better serve those who find themselves stuck and in need of guidance in arriving at their greatest potential to a purposefull life.

  • Terri Logan said:

    Recovery is remembering who you are and using your strengths to become who you are meant to be

  • Mitchell Klein said:

    What I believe SAMHSA was looking for were comments on defining recovery. What I have found disturbing over the years in similar dialogues is that many people want to dictate recovery rather than define it.

    One commenter wrote that they did not want the term “Behavioral Health” used and “Shame on SAMHSA for not only using that term but for being the role model for others to use it as well.” That writer said they did not have behavioral problems and resent being told they did.

    What the aforementioned writer doesn’t understand is that there are those who do believe they have behavioral problems, that they have an illness and they need help. That writer wants to remove the option of choice from those who don’t believe the same as that writer. I thought recovery was about choice, not just YOUR choice but freedom of choice.

    Another writer wrote about “The commitment to abstinence from mind altering drugs.” This assumes that the only approach to recovery involves the abstinence model. Once again, removing choice from the equation. There are viable models out there for which total abstinence is not part of what works for people. Many 12 Step adherents believe that there is only one way to recovery from addiction yet there is ample evidence out there proving otherwise.

    The anti-psychiatry movement wants to remove the choice of those who say they derive benefit from psychiatry. The anti-medication factions want to remove the choice from those who say they derive benefit from medication. Many of these so-called anti movements say they believe in freedom of choice but really mean only as long as your choice aligns with theirs. Many say “close all the hospitals” but don’t take into account those who say they got well in a hospital.

    Treatment providers have been dictating recovery for way too long. Certain factions within the so-called recovery movement are also becoming the evil they rally against by also dictating what recovery should be by discounting and ignoring the other individual’s opposing point of view and demanding the removal of their choice just as providers have been doing for multiple decades.

    Choice means choice. Not just YOUR choice. It is OK to say not to tell people they are sick but please don’t demand that if they chose to believe they are sick that they are not entitled to their point of view. Please don’t tell people that abstinence is the only way to recovery when they may believe, for them, a harm reduction model works. Recovery is about choice and that doesn’t necessarily mean YOUR choice for me.

  • Abdul Jalil said:

    Recovery is a dynamic process of surrender and regeneration. Within this phenomenal process individuals gain optimal insights into the art of living the gift of life on life’s varied terms. It enables the pursuit of happiness and liberty in the face of past traumas, current trials or tribulations, and other potential and reckless dispositions.

  • Charlton Hall, MMFT, LMFT said:

    I would disagree that recovery is solely ‘spiritual,’ as I have seen many atheists and agnostics who were quite capable of becoming abstinent.
    I suppose it depends on what you define as ‘spiritual.’ Too often I have seen cross-addiction where a person gives up substance addiction and instead becomes addicted to 12 Step programs.

  • Mary Campbell, Psy.D, MPH said:

    To begin the name: Recovery From Mental and Substance Use Disorders shows a lack of important insightn First, Mental what? If we are discussing mental HEALTH issues, then we must include the correct name: Recovery from Mental Healht and Substance Use Disorders. Second, all individuals with a mental health disorders or those who choose to use/abuse substances are the the vicitms of trauma as suggested in Guiding Principle #7. This needs to be changed to include but not limited to trauma.

  • MARTHA LIEBEMAN said:

    Recovery can be a long hard struggle, but is attainable with the help of the community, empoyeers, family and friends, however the mental health resources sometimes do not play enough of a role (waiting lists to see a Dr. or Therapist, not enough inpaitient beds ). The choice is ours, do we quietly sit by the sidelines and feel uncomforatble saying who we were or made to feel comfortable with who we are – that is part of recovery – an important part.

    Personally I have chosed not to be one of the quiet ones, I have openly said ,” I am bi-polar and that is part of who I am”. I also have chosen to “taken” on the fight with the mental health resources to fight four our rights and provide us the protection and services that we need or might need.

    I can go on forever about recovery and what is involved and what we, individualy, can do.

  • Gary Neumann said:

    Perhaps using WELLBRIETY – it means to be both sober and well. It is a word that would be inspired by a Passamagouddy elder in Maine 1995; but for native people WELLBRIETY means to live through the principles, laws, and values that indigenous cultures lived by before Europeans came to North America.

    A Mohawk elder explains:
    The difference that exists is that white doctors medicines tend to be very mechanical – The person is repaired but he is not better than he was before. Western medicine is focused more on symptom suppression.

    Identifying Strengths; Observing Nature; Uniqueness of All Things; Adapt as Needed; Harmony and Balance; Teachings and Spirituality included.

    Using the Four Directions of the Medicine Wheel
    East/Spring – Change is from Within – Individuals must heal – Changing in the Spiritual World manifests itself in the Physical World – All Native cultures believe in a supreme being – We believe that Elders are a guiding force.
    South/Summer – In order for development to occur it must be preceded by a vision – Families can begin healing – If the community starts thinking about something together that’s what the community moves towards – We believe that all tribal Nations are different from each other -The difference is our strength.
    West/Fall – A great learning must occur – Communities can Heal – In order for the youth to get well – the community must simultaneously work on it’s wellness – We believe alcohol and drugs are destroying us and we want to recover – We believe that there is a natural order running the universe.
    and Finally
    North/Winter – You must create a healing atmosphere, roots, nations can heal – the whole community must be part of the self development ad self determination process – We believe our traditional ways are knowledgeable about the Natural Order – Inside every being is the innate knowledge of well being.

    We find ourselves forced to speak about our health with language and concepts that are not our own. This is undignified, and is part of the continued acts of violence upon our sovereign language and identities. (Participant attending the Indigenous Suicide Prevention Research & Programs in Canada and the United States Conference held in Albuquerque, NM, 2006)

    We must incorporate the four levels of human growth found in Native Communities –
    Belonging – A place for all ages. A place for all kinds of people. The first level represents infancy and Childhood, a time when we need to know
    how we belong. It is the most important first lesson a person must learn to live comfortably and to work effectively.
    Mastery – Empowerment, for individuals and for the Community. The second level honors adolescence as a time of vision and mastery.
    Understanding AI/AN communities and the local contexts that inform work in partnership with other tribes/communities/governments
    Interdependence – Action, community leadership. Adults, integral and inter-dependent within their families and their communities. How do we interconnect withour environment and social network of our community.
    Generosity – Teacher / Elder, and resources in the community. Honoring our elders, (sober elders) who give their knowledge and teachings to our generations of the future. You may be an elder to someone, look at a 6 year old child and a 3 year old brother – the 6 year old is the younger brothers’ elder and he can learn from them. Look to the elders who give their knowlege and teachings to our generations of the future. Looking at our responsibilities to give back to our communities and share graciously for the next future generations.

    This is an approach that I believe in and use in my every day life and it has helped me stay in Recovery for over 24 years.

  • Gary Swoboda said:

    I would delete the phrase “live a self-directed life” and insert “allow for new approaches to living” or something of that nature. I understand what the term is suggesting, but I believe it’s too open to misinterpretation. “Self-direction” is what got many of us into trouble in the first place. We learn to work with others, both for ourselves and FOR others. We disregard stigmas and seek outside help as needed, but also develop relationships with those similarly afflicted and who have chosen to lead improved lives. By working with others, and being honest, open and willing (the HOW of recovery), we learn to develop new perspectives on life. We incorporate both psychological and spiritual tools in our recovery, recognizing spirituality as a very broad term that allows for anyone’s definition of accessing a power from within and without that enables us to be more authentic, compassionate and fulfilled human beings.

  • Efrain Baez said:

    Recovery to me is game my life back. Educate my self about my suffer ilness that need to be take care at every moment of my life because if not I can loss it in a blinking of the eyes. Re-learn a new way of life without pain.

  • Kenneth Anderson said:

    According to the NIAAA about half of people with Alcohol Dependence recover by cutting back on their alcohol intake rather than via total abstinence.
    http://www.spectrum.niaaa.nih.gov/features/alcoholism.aspx

    This same article tells us that the majority of people with alcohol dependence recover on their own without AA and without any specialized alcoholism treatment.

    Research by Prochaska and others tells us that many people who recover from addictions enter a Termination Stage where they are completely recovered rather than “still recovering.”

    Many people find their way to recovery from addiction through taking small steps toward harm reduction such as accessing needle exchange programs and safe injection sites or cutting back gradually on drinking or going on Methadone Maintenance. Many small steps can lead to complete recovery from substance dependence–not everyone changes all at once by embracing abstinence from the start.

    Any realistic definition of recovery must include harm reduction, moderation, and self-recovery.

  • Jim Hurley MFT said:

    Recovery is about having a “quality of life”; which commonly includes decent housing, employment opportunities or meaningful activity, relationships and other interests that support a person to grow and change. Services should support and include quality of life issues, not merely symptom reduction or symptom management. Reducing or managing symptoms should be in service to acquiring or accomplishing quality of life goals.

  • Jim Hurley MFT said:

    As a “guiding principle” I think it is important to distinguish the experience of recovery from the provision of services. The experience of recovery is transformative for the individuals diagnosed with mental illness; a personal transformation. The transformational experience is not inherently gained in the treatment of mental illness. What gets transformed is not how illness or symptoms are treated but, how the individual relates to having an illness or what it means to them as human beings. This distinction can also help providers and service users put into perspective what services are for; both the importance of them and how they are limited or need to change over time.

  • Cathy S Harris, MSW, rLCSW said:

    Thank you for including “trauma” in your definition of recovery! I can’t tell you how many persons I have worked with who have engaged in a process of recovery without addressing long-standing trauma issues. Often, the right questions were never asked and/or the trauma history was seen as, at best, a side issue, versus a core issue. People can obtain a level of recovery without focusing on processing through their trauma concerns, but I have seen people move beyond illness to living their BEST LIFE when they have allowed themselves to take the risk to address trauma. SAMHSA’s validation and legitimization of “trauma” is welcomed and valued by therapists and survivors like me.

    thanks again!

  • Sheri Rader said:

    I like the 10 guiding principles and the definition of recovery. Especially, the definition of recovery, and I would add to it that each day is a new day. So, wake up, be thankful for who you are, what you’ve done, and recognize where you “slipped”, but don’t dwell on the negative or the failure part; say little things like, I may not be where I want to be, but thank God I am not where I used to be! Accept reality that you are who you are…take a look at the whole you, and make choices and decisions that are not presumptuous or hasty, but will be based on positive reasons that are accepting, encouraging, supportive,and of course respectable. In closing, be thankful that you are on the road to recovery, and if you veer away, drive yourself right back onto the recovery road.

  • Robert Johnson said:

    A couple of initial reactions to reading “Recovery Defined”:

    1. I question the use of “people in addiction recovery” (commonly regarded as “person-first language”), joined with using the term “mental health consumers” (to describe persons seeking improvement/services related to mental health issues). The use of the two labels concurrently seems contradictory and unbalanced, and additionally warrants a re-boot in terms of even using the word “consumer” (a buyer, somebody that consumes something, an organism that feeds on others). This seems to deserve another look.

    2. This is related to the first listed guiding principle of “recovery.”

    “Recovery is person-driven: Self-determination and self-direction are the foundations for recovery “

    This foundational “guiding principle” seems very compatible with persons whose worldview/belief system is grounded in “western” cultural traditions and values, and who seek social, work and/or treatment environments and personal relationships consistent with western (Individualistic-based) cultural traditions and values.

    The use of the term “person-driven” (or “person-centered”) seems to imply a diminished value for persons of cultural traditions that seek and/or support health and wellness through processes that are relationship-family-community-spiritual tradition “driven, or centered,” and who tend to view approaches that are based primarily on individual-centered constructs as a barrier to healing (or “recovery”) processes.

    Thanks for the opportunity to provide feedback. It is appreciated.

  • Carol Jean Garner said:

    I believe recovery must be based in rehabilitation principles for person’s with mental health disorders and offer pratical application of an array fof kill sets that are a venue for persons to transition from what is the power of an old belief system and norm to a renewed norm rooted in their own empowerment, hope and desire to apply and persue their dreams, goals and needsfor the successful life they want to achieve.

  • Carol Jean Garner said:

    thank you for the work you are doing and the opportunity to comment.

  • Helen Anderson, PhD said:

    I have suffered from serious mental illness and self-medicated with alcohol. I did not need a higher power or a focus on spirituality to work through my issues. I fortunately had the resources to do a lot of psychotherapy. I got myself through the problems. Thus, I know I have the knowledge and control to not fall back on old ways. I don’t want a higher power to get or have the credit. Then I’d just be swapping my dependence to the higher power. I really like your defining four critical areas – health, home, purpose and community – that give one support to work through their problems. If someone wants to include “spirituality” into purpose, fine. I don’t think it needs to be there. It’s optional. I think I’m thinking along the lines of Charlton Hall’s comments.

  • Barb Anderson said:

    Recovery success, like a foot race in life, is judged not by how far you’ve gone, but by how far you’ve come (from behind).

  • Barb Anderson said:

    Same as above.

  • WILLIAM SABANG said:

    recovery is a mental, physical, and spiritual healing process from the unhealthy impacts from drug & alcohol abuse over long periods of time and towards healthier relationship with self & and others around us

  • Clayton E. Sperry said:

    Recovery is all about Re-training the brain. Taking Charge (of your Words, Thoughts and Actions). It is as old as 58 AD when Paul wrote in Romans 12:2, KJV “Be transformed by the renewing of your mind”. (Be changed, by changing the way you think, this is probably the oldest form of cognitive-behavioral thought I have come across.

  • Dorothy said:

    I encourage the support of the responses above #8; #24; #46; #49
    Thank you.

  • Dwyane Clements said:

    Recovery merges from pain and anguish. Unless you experience enough pain and suffering the idea and choice to change is non existent. Support and having some one that you can trust and will listen unbiassedly without being judgmental is also a excellent motivator in the quest for recovery

  • Adrienne Bennett said:

    I want to echo what others have said… that recovery is spiritual. To omit the spiritual aspect of recovery would be a travesty.
    Recovery is letting go of pride, of becoming vulnerable and finding strength in that vulnerability. Yes, recovery is full of paradoxes:
    —from weakness(adversity) comes strength
    —we forgive to be forgiven
    —we give it away to keep it
    —we suffer to get well
    —we surrender to win
    —we die to live
    —from darkness comes light
    —from dependence we found independence
    Recovery is daily. Recovery is about unity. Recovery is about becoming one in a family, a friend among friends, a worker among workers – taking our place in society.
    Recovery is amazing. :)

  • Jane Dyer, MSW said:

    I appreciate and agree with comments from Mitchell Klein #46 – it seems that many other responders are restating aspects of the eloquent and inclusive definition you have developed, but not adding anything new. The service access concerns expressed by several regarding those with cognitive and/or financial limitations are among the greatest challenges I have had as a helper, but I believe those are addressed within the principles of culture, community support, and respect.

  • Mitchell Klein said:

    One of the responders wrote – “If someone wants to include ‘spirituality’ into purpose, fine. I don’t think it needs to be there. It’s optional.”

    That individual doesn’t think spirituality needs to be a part of the broad definition of recovery and that it is optional. It may be optional to that particular writer but once again, how about the vast amount of people who attribute some sort of spiritual path as paramount to their recovery? It wasn’t optional to them. Several posters who do not ascribe to a spiritual aspect to recovery don’t think spirituality needs to be part of the definition. Of course not, it isn’t part of their experience.

    However, just because something isn’t part of YOUR experience doesn’t mean it shouldn’t be part of another person’s experience or that because it isn’t part of your definition it shouldn’t be part of everyone’s definition.

    I know many very spiritual people who do not believe in the concept of a deity. Most people confuse religion with spirituality. Regardless, if the definition is to be global it should encompass and embrace a diversity of ideas and not leave out things just because they don’t fit into one narrow definition.

    If someone has been using substances on a daily basis and ruining their lives and they get to the point that they only use substances on the weekend and it doesn’t majorly affect their lives I would say that is recovery for them. If someone is so depressed that they don’t leave their home and eventually, by whatever method they have chosen are able to venture out into the local park that is recovery for them. Recovery is an ongoing process. Sometimes in leaps and bounds and sometimes in tiny baby steps. Sometimes walking backwards can be part of the process as well. What is recovery for me today is not what it was 30 days ago or 30 years ago.

    I used to be serious and persistent with other things. Today I am serious and persistent about my recovery but with the ability to laugh at myself and accept others for who they are, where they are and take what I can learn from their successes and setbacks and incorporate those into my own recovery process. Recovery is NOT about rigidity or dogma. It is sad to see so much rigidity and dogma expressed by people telling others what recovery should look like.

  • Mary O'Connor, MA,MSW,LMSW said:

    Recovery is a reclaiming of the will and the finding of the best self.

  • Charlton Hall, MMFT, LMFT said:

    Actually, Clayton, Buddha had an even earlier quote concerning CBT:
    “We are what we think. All that we are arises with our thoughts. With our thoughts we make the world.” -Buddha (563 BCE to 483 BCE)
    If you choose to define ‘spirituality’ in its original meaning of the term; i.e., ‘That which inspires,’ then it is possible for atheists and agnostics to be spiritual as well. In such a case, I think that spirituality would include finding something larger than yourself to live for. In short, giving purpose to one’s life. If spirituality is thus defined, then I would agree that it is an important part of ‘recovery.’

  • Kyle D. Lloyd, BS, CPS said:

    Recovery is a process of indentifying personal strengths, inner and outer well-being, and then placing the strength and wellness at your target center and taking your “Best Shot Every Day”. It requires lots of other ingredients; however, and the better recipes call for Spirituality, Healthy Support Systems, Community Partnering, Family Reconciliation, and Balanced Lifestyle following a Nutritious Diet and Daily Activity. In some cases medication plays a roll in supporting Recovery as well as good Therapy and Psychiatric Care. Reamining in Recovery requires using good coping strategies, listening to both ourselves and Professional Counsel, and assuring that we are heard when we see our doctor or care-givers.

  • Deborah said:

    Recovery defined by Websters: to bring back to normal position or condition, to save from loss and restore to usefulness. So those of us that are affected by mental health and or substance use, abuse or dependence issues, this is important information to have shared with us. Each individual can decide what recovery is for themselves, very important peice of information. How that individual persues recovery is decided for themselves as well, another important piece of information. For some recovery may be acquired through a 12-step program, religion, counseling, education, etc. I believe it is the process that promotes change within that individual. For me it was Alcoholics Anonymous, which addressed all the areas in my life that needed change. :)

  • Doris A. Fuller said:

    Every one of us deserves and benefits from respect, hope, family support, overcoming past trauma and all the other experiences on SAMSHA’s list. However, proposing that “self-direction” is a “guiding principle” in mental illness recovery is uninformed, unrealistic and a grave disservice to the estimated 3.3 million people in America currently living with untreated schizophrenia or severe bipolar disorder.

    Individuals with untreated mental illnesses that have psychotic features have, by definition, lost touch with external reality. An estimated half of them don’t even recognize they have a condition from which they need to recover. Large numbers are tragically unable to direct even their own health, hygiene and self-preservation, much less their recovery. A “recovery support” strategy that ignores indisputable clinical realities like these discriminates against a population that is both entitled to advocacy and uniquely unable to advocate for itself.

    SAMSHA’s entire list of “guiding principles” represents an inexplicable step backward in the mental health narrative. Scientists, physicians and families have spent decades debunking behavioral explanations for mental illness with research and education about the neurological and genetic roots of these brain diseases. This agency’s exclusive promotion of feel-good social behaviors to promote recovery is not only empirically unsound but takes us back to the bad old days when there wouldn’t be schizophrenia or autism if it weren’t for “cold mothers” and there wouldn’t be depression if people would just stop feeling sorry for themselves.

    The developers of SAMSHA’s recovery principles would do well to read what Dr. Thomas Insel, the director of another federal agency – the National Institute of Mental Illness (NIMH) – wrote August 12 in “Mental illness defined as disruption in neural circuits” on the NIMH website. Wrapping up a detailed explanation of brain circuitry, cortical activity, biomarkers and other science-based/non-behavioral factors in mental illness, Insel says that “earlier notions of mental disorders as … social constructs are beginning to look antiquated….(T)here can be little doubt that clinical neuroscience will soon be helping people with mental disorders to recover.”

    Notions of recovery based on antiquated social constructs are already out of date. For the $3.6 billion that American taxpayers spend funding SAMSHA annually, those of us who live and work with mental illness and substance abuse deserve a better blueprint for recovery than behavioral kumbaya. Revisions to SAMSHA’s principles that recognize such concrete components of a recovery plan as accurate diagnosis, timely intervention, appropriate medical treatment, effective patient education, safe housing, and many others are needed if these are to provide useful guidance to anyone

    Doris A. Fuller
    Communications Director
    Treatment Advocacy Center

  • KCQ said:

    In pondering the definition of recovery, I believe we need to include a piece about changing the social norm that supports and promotes addiction and then ridicules the addict for falling victim to the social norm (in the USA we glorify excess until someone is addicted- then we frown on the person for not being able to “manage” their use/consumption etc.)…not to be simple minded, but recovery would not be as much of an issue if the social norm supporting addiction were addressed…
    So, I think we need to cure what ails the society…macro recovery…a psycho-social-spritual overhaul of the social structure…
    ~recovery is supported when the social norms (knowledge, attitudes, beliefs and behaviors) promoting addiction are challenged and changed and efforts to support recovery and the recovering person are broadly accepted and not wrought with stigma and social isolation.

  • Joseph D. Anticoli, CMS said:

    -THE SEVEN POINTS-
    “Guiding Principles of Recovery”:

     There are many pathways to recovery.
     Recovery is self-directed, transformative and empowering.
     Recovery emerges from gratitude.
     Recovery involves a willingness to change.
     Recovery occurs on a continuum.
     Recovery is synonymous with citizenship.
     Recovery has cultural dimensions; transcending shame and stigma.

    …and, this is the best defintion of Addiction Recovery I know:

    “Addiction Recovery is a voluntarily maintained lifestyle characterized by sobriety, personal health, and citizenship.”

  • Joseph M. Bowers said:

    With two of the letters in your acronym SAMHSA standing for mental health, I would assume that yours is the agency responsible for dealing with severe mental illness. Nowhere in your proposal do I see any mention of schizophrenia or bipolar disorder. There are believed to be seven million Americans suffering from these diseases-three million of whom are getting no treatment. Severe mental illness is not a behavioral issue. The causes are neurological, physical and biochemical. Approximately half of those suffering from severe mental illness are completely unaware that they have an issue which needs to be addressed. As someone who has suffered from severe mental illness, I can testify that when psychotic I am completely unable to in any way to direct my own recovery. Your ideas on recovery may be worthwhile to someone with an addiction or behavioral problem but for people suffering from mental illness they are absurd. If you have no interest in dealing responsibiy with severe mental illness, drop the MH from your acromym, and allow that responsibility to be addressed by someone else.

  • Barbara Altadonna said:

    I can only answer that question for me. I don’t believe I can answer it for anyone or that anyone can answer it for me. I can tell you what it is, but I have a more difficult time stating what it isn’t. Since everything I do is a step in the direction of recovery…all the missteps are part of recovery without them I’m not sure you can get to recovery. Recovery is often just about the ability to get through one more day, to wake up and function, wipe away tears and put one foot in front of the other. If I look at recovery as a journey than everything is part of the process.

  • Dorothy said:

    To be perfectly honest, it took some of all the above processes to help me find my way to a meaningful, productive and enjoyable lifestyle. I focus on Spirituality because it holds the most significant and consistant place in my being. For me there is a difference in religion and Spirituality. Spirituality should be without definition because it is truly a personal and intimate ‘thing’. The choice of your spiritual being is one that only you can make or not make. I understand religion is about worship of something or someone and is usually a community of believers in the same something or someone.
    For me, without giving Spirituality a promonient place in recovery, I am left out of the recovery we are trying to define here. It would appear others may feel the same way.

    Another discussion is about not wanting to be referred to as a ‘consumer’. The point there is that we purchase our services from one source or another and we pay with cash, insurance, or benefits. Making us a consumer of services.

    Thank you, for giving me the opportunity of being a part of such a monumental discussion and work on recovery.

  • Hal Plante said:

    Being a dual-diagnosed person, I have had a challenging life. I have been to prison twice in the last 30 years and countless stays in psych wards. I’ve finally
    gotten help from the VA. They have me on a cocktail of drugs that have helped me in my recovery. Until I addressed my mental health problems, I was unable to recover from alcohol abuse. I have almost 3 years of sobriety,by the Grace of God. I agree with the statements lauding spirituality as an important part of recovery. For me it is,but, continuous therapy has also been a big contributor to my success. I stay close to my group of like individuals, I have found that in unity there is strength.

  • Mitchell Klein said:

    I wonder why a certain faction of people who bastardize the concept of advocacy and who call for the abolishment of SAMHSA and who want to take away all funds from SAMHSA in order to focus only on 1% of the population would want to get into a conversation about recovery? After all, they do not believe in recovery or that people can recover. They only believe in chemical restraints and if they had their way, psychosurgery would return as well as the other implements of torture and thousands of people warehoused in state hospitals.

    These people want to dictate funding and discussion only to that 1% and tell us to forget all about recovery from addictions and every other form of disorder other than the one or two they want to have control over. These are the same people who tell us that Schizophrenia comes from cat litter and that all people who have been labeled with what they call serious illness must be medicated, monitored, registered, followed and maybe even have to wear some sort of little stars sewn on to their clothing to identify them.

    Recovery is not about force or coercion but about choice. Only a small percentage of those they say don’t have the ability to choose actually may not have the ability to choose and that, only at times. I should know – I was one of those serious and persistent people. They ignore all the research which does not agree with their point of view and live in fear of cat litter.

    I hope the freedom of open dialogue is allowed to continue and that the dictatorship of chemical restraint and cat litter paranoia doesn’t take over this forum. SAMHSA is about recovery from substance use and all psychiatric labels and not just the 1%.

    Special interest groups should have a voice in the discussion, just not the only voice. These people want to pull SAMHSA’s funding so that their voice is the only voice and we are silenced just like they want that 1% of the population silenced through chemical restraint and incarceration.

  • James DiReda said:

    What I have learned about Recovery in my 26 years of trying to practice it is that it is a process of change, and needs to involve: mind, body and spirit. Addiction is a condition that destroys these aspects of a human, and in order to recover, need to be re-built and restored.

  • Clarence Jordan said:

    At first I rejoiced that I had at last been given to believe what the source was of so much of my pain and suffering. At first I thought it easy, now that I knew what it is I’ll get treatment and everything will be alright.

    Nothing could be further from the truth. Soon I was given over to having vacant esteem for self and others; stigma will do that you know.

    Recovery for me was about defeating the true enemy within and with whom I was connected. The pathway led me to self knowledge with which I could finally begin to live that self fulfilling life so often talked about. In effect I had to increase my capacity to learn, love, live with integrity and hope.

    Self knowledge is fundamental to feeling good about whom and whose you are; only by loving those ignorant of my condition could I begin to love myself again; personal responsibility for my action relieved me of the blame game; freedom to believe in the future that I could not see is the essence of hope.

    Stigma is insidious, its poison slow acting; in many ways knowing turned out to be tougher than not knowing at all. Self knowledge eventually led to self efficacy which of course in and of itself was empowering. Recovery begins with nothing less than that; self knowledge, self efficacy and empowerment.

  • Ben Bass said:

    Is this a difinition of addiction recovery trying to encompass mental health, or a definition of mental health recovery trying to encompass addiction? Addiction recovery, becuase of the common usage of the term by people in the recovery community should have the word “abstinent” in it.

  • Jonathan Bush said:

    I beleive the word that is missing in the Recovery from mental and substance use is the Word ” EMPOWERMENT”. Recovery from both Mental and substance abuse invovles a person truly becoming empowered to understand and better deal with / handle there life issues . Also a word that would be good is “SELF EFFICACY” which is the person owe believe that they are able and have the skill to overcome/ understand/ deal with both changelles.

  • Claudia Black said:

    This recovery definition sadly excludes the four other people immediately impacted by someone’s chronic addiction and/or mental health disorders. It is solely focused on the individual with the problem, not recognizing the generational impact on the families. The reference made to families under the four guiding principles refers to family only in the context of supporting the person identified as the one with the behavioral health or addiction problem. This definition does not take into account children who are growing up or have grown up with the disease and are often out of the home when recovery occurs. It blatantly denies the impact of a complex and chronic disease, be it a mental disorder or addiction, on the family members and their own need for recovery. Family members have experienced the long term impact of adverse childhood experiences having lived with toxic stress conditions throughout their development. Each time we focus on the addict without focusing on the family we are in denial that any cycle of addiction is broken. The impact on the family member does not end or disappear just because the identified person, the addict or the one with a behavioral health care problem, may experience recovery.

  • Phil Valentine said:

    Finding a definition for recovery that most people agree with is a tall order. For years, we have worked successfully with this one – “you are in recovery if you say you are”.

  • Dorothy said:

    Mr. Jordan, your words are inspiring. They sound especially simular to my recovery walk. Continue on, you’ll never walk alone again.

  • Teresita Oaks said:

    Recovery is a nonlinear process that varies from individual to individual; it entails achieving concrete outcomes or goals which are easier to attain when choice, support and respect are given to peers.

    When asked, peer and family members defined recovery as a personal journey that consists of fulfilling an array of personal goals that lead to a better quality of life, through this journey or process, an individual gains self-sufficiency, productivity, and independence. Peer and family members described recovery as a multifaceted process, because it entails fulfilling goals in several aspects of a person’s life, such as improving physical and mental health, gaining or restoring relationships, furthering education or vocational skills, improving living arrangements and gaining employment. Therefore, each person experiences recovery differently, or as one member noted “it is self-defined.”

  • Jade Shafer said:

    I think this blog provides further evidence that recovery from addiction and recovery from mental illness still have many differences that may need to be encompassed into this definition as to not lose the identity and experience of both groups. I think SAMHSA should provide a simple, overarching definition and then two definitions for addiction and mental illness that strives to capture similarities but also provides context for differences, such as spirituality.

  • Mitchell Klein said:

    I totally agree with Claudia when it comes to the fact that when it comes to defining recovery, the family is usually left out of the equation. When people talk about tobacco use there is a rallying cry about second hand smoke but no one mentions the effect addiction and emotional behaviors have on the family and their assaulted psyches.

    As far as the continuing demand that abstinence be an integral part of the recovery definition for substance use, not all recovery models are abstinence based. There is no longer a one size fits all philosophy in the recovery community today except for those too dogmatic and rigid to have lost objectivity and tolerance. If the abstinence model worked for you that is wonderful but please, do not wish to force it down everyone’s throat as the only way to go.

    The options and choices to recover should be made available to the individual who seeks recovery and to the family whether or not the individual seeks recovery. The models should be as varied as snowflakes and fingerprints and should be utilized only for as long as they work for those working them.

  • Lou Sorrentino said:

    By way of intrdoduction, i am a Licensed Alcohol and Drug Counselor of the Connecticut Department of Public Health who has worked in the profession for 25 years. I utilize a wide spectrum of valid perspectives on “recovery.” Ultimately, the most useful is always the most personal. Here is my poetic personalized perpective titled “I Love What I Do.” Hear this and other free recovery related songs on the web at: Jango.com, Lou Sorrentino and at http://www.lousorrentino.com
    “I LOVE WHAT I DO”
    These are the times that I’m most alive; when I feel that I have arrived. This is what I’m meant to be; doin’ what I believe. When I didn’t have a clue, somehow I knew. Life doesn’t stop it, it rushes right by, like a waterfall, that I live inside. When I am in that flow, in that place, I really know, what I was meant to do. I wish the same for you!
    LIVE THE LIFE YOU’VE ALWAYS IMAGINED. PAY THE PRICE AND TAKE YOUR CHANCES. DO WHAT YOU LOVE AND LOVE WHAT YOU DO. WHEN YOUR HEART STARTS TO DANCIN’ GIVE IT ROOM AND ROMANCIN’ AND SAY WITH PASSION WHAT YOU KNOW TO BE TRUE. I LOVE WHAT I DO!
    If I see you on the road, won’t you stop if you dare? Tell me where are you goin’ to; maybe i’ve been there? Maybe we could join together what we share apart, in the language of the heart1
    i’m not waitin’ for a better time, ’cause this is my future, this is my time. All my life has brought me here; every heartachE and every fear make me stronger still. I know I will-
    LIVE THE LIFE I’VE ALWAYS IMAGINED. PAY THE PRICE AND TAKE MY CHANCES. DO WHAT I LOVE AND LOVE WHAT I DO. WHEN MY HEART STARTS TO DANCIN’, I GIVE IT ROOM AND ROMANCIN’, AND SAY WITH PASSION, WHAT I LONG TO BE TRUE, “I LOVE WHAT I DO!”

  • Mitchell Klein said:

    Just a suggestion made by someone I know…

    Why not add a “like” button similar to the ones on the social network sites? This way, people can “vote” on what they like from other posters. It would be a more accurate way to ascertain the pulse of the viewers, especially those who have chosen not to post but would like to align themselves with one opinion over another. I am sure that there are many more people visiting this dialogue than those actually posting. A “Like” button affords them the opportunity for representation. There should also be a mechanism in place whereas only one “Like” per IP address so that certain factions couldn’t stack the deck.

    Maybe that isn’t possible for this discussion but it could be done for future ones. It would lend itself to a greater representative voice.

    • Samhsa said:

      Mitchell Klein » Great suggestion. That functionality isn’t currently available on our blog. However, with this post we were hoping to drive “traffic” to our feedback site to solicit comments, which has a voting and commenting functionality that can be used for people to show support or opposition of ideas/definitions. The link is: http://feedback.samhsa.gov/forums/129063-definition-of-recovery

  • Ilene Flannery Wells said:

    A year ago today, Tall Paul, the personal account about my twin brother Paul, was published in Psychiatric Services. It chronicles Paul’s life after his initial diagnosis of schizophrenia in 1976, at the age of 16. Please read this (click on the website link) and then tell me how SAMHSA’s patient-driven idea of recovery fits in with people like Paul. In the 33 years Paul lived with schizophrenia, he never once understood he was sick. He did not have one lucid day in those 33 years. Not one. There was no recovery for Paul, if recovery means to be able to live independently, which is what the community mental health system seems to think.

    Paul had no insight into his illness, lacked the cognitive skills required to complete the daily tasks we take for granted that keep us alive, and never stopped having delusions. There are hundreds of thousands of people like Paul in this country. They are the ones who wind up homeless, incarcerated, or dead (like Paul) because organizations like SAMHSA refuse to acknowledge that some people with severe mental illness cannot direct their own treatment.

    Some people say that Recovery means to be able to live in the least restrictive environment based on one’s capabilities. I like that definition. For Paul, that would have meant staying in a facility that provided 24/7 supervision. Somewhere safe, that provides nutritious food, good health care, and programs that help the individuals feel more connected to their community, if possible. But most of all, safety to all involved is key. More people with severe mental illness are victims of crime, not perpetrators. We only hear about the ones that kill people. Paul died partly because the system failed him. We, his family, failed him too, from our ignorance. But SAMHSA should know better.

    The biggest way to enable everyone to recover to the highest level possible – and that does not mean it will always end up being able to live in one’s own apartment – is to acknowledge that some people lack the insight into their own illness – which is roughly half of all of the over 2 million people with schizophrenia. We need to tailor treatment plans differently for them than for others, who can truly take advantage of patient-driven systems.

    The Medicaid Institutes for Mental Diseases (IMD) Exclusion needs to be repealed – permanently. We need to allow patients to remain hospitalized for as long as it takes for them to recover enough to be discharged. It takes longer for some than for others, but Medicaid discriminates against people with brain disorders.

    We need better discharge/step down planning for those that can be released or stepped-down to the next level. Real criteria needs to be set and adhered to in order to determine when a person is ready to be released or stepped-down to the next level. Good transition planning needs to be developed and that would include a mechanism to stop the transition if the person is not transitioning well. Good follow-up care needs to be developed to make sure the transition is “sticking” and a mechanism to re-hospitalize or step a person back up needs to be created when it doesn’t “stick”.

    Without all of these changes, people with severe mental illness, like my brother Paul, will continue to be the “frequent flyers” in the ER’s; they will continue to cycle in and out of the county and state hospitals; they will continue to be incarcerated; and they will continue to die.

    Ask Kelly Thomas’ father what recovery means to him. It meant that Kelly Thomas was beaten to death by police.

  • Muhammad A. Basheer, ADS, CASAC said:

    Very Simply put,

    In my own opinion, Recovery is doing something diffferent or the opposite of what a person has always done to get the benefits of the “Positive Change Experience”.

  • Howard Josepher said:

    Recovery means overcoming or transcending a fragmented or distorted sense of self or reality that led to self-destructive behaviors or the inability to be responsible for one self. Recovery begins with the awareness and acceptance of a responsibility in what we are experiencing and a willingness to change. It is a process of continual, day-to-day, self-acceptance of the choices we make in how we live, how we handle our responsibilities and the events that occur in our lives. Recovery is the development of greater control of one’s mind and behavior and is evidenced by a more harmonious relationship with oneself and others.

  • Carole Baxter said:

    The ASAM article “ASAM defines Addiction as Chronic” was followed by SAMHSA’s “Recovery Redefined” on an e-mail I received. Having worked in the substance abuse treatment field since 1974, I see that both positions have merit. Interesting contradictions though. . .would be nice to see them reconciled.

  • Monica Leggett said:

    To piggy back on Jade’s comment, I think addiction recovery and mental illness recovery are two separate issues with some overlap. On the same vein, severe mental illness recovery cannot be “person-driven” when the individual is lacking any perception of illness or understanding of self-care. We have streets and hospitals and prisons filled with these people (my brother was one of them). They are not getting the best care because those who push for person-driven recovery are passing the buck to the individual and that person is not capable of driving their own care. We need to keep that in mind with any recovery model.
    Do not assume that everyone can “recover” to a level that includes independence.

  • William Devine said:

    A proposed definition: Individual recovery is achieving a successively higher level of overall wellness and independence toward sustainable self-reliance in the service of living a fulfilling, self-determined life.

  • Beth said:

    I appreciate what you are trying to achieve. But plese do not leave out those that have treatment resistant illnesses which are 20%, severe illness and
    relapse.

    There has to be provisions made for the severely ill when discussing recovery.
    It is real, but not perhaps for the entire mental health community.

    There is health care parity. But there is not parity with all health benefits such as disability policies. It is not proper for those policies to be not available for those who need it.

    Thank you.

  • George D Richards MD said:

    There appears to be a parrallel between mental illness and diabetes.Both when severe are chronic illnesses and require medication for those so afflicted to be at their best.However a mentaly well undiagnosed untreated diabetic will soon have severe symptoms that they themselves recognize as abnormal and they will seek appropriate treatment or die. About half of the seriously mentaly ill (SZ or bipolar)do not recognize the severity of their symptoms or the consequences of failure to treat them. They may not die as a result of this anosognosia,but they may be victimized or commit crimes.I am told that some 20% of those persons in our jails are mentaly ill.It would appear that they belong in hospital-like settings not jailsfor like diabetics they require appropriate medicationn and advice on how to live with their illness (cognitive therapy in the case of the mentaly ill) Like diabetes,without appropriate treatment the seriously mentaly ill do not recover to a significant degree and all other measures avail little.To me, the approach taken by the TAC (Treatment Advocacy Center) and E Fuller Torrey is one that SAMHSA should embrace.

  • Larry Ackerman said:

    Abnormal Behavior” is a tidy catchall for mental illnesses and misses the point–in mental illness and substance use disorders, the brain is unable to comply with what society would demand as “normal behavior.” To assert otherwise is to open the road to even more criminalization of the mentally ill and more abuse of us whose minds are sometimes sick with legitimate illnesses in jails and prisons.

    I am sick of the minimizing of real illness in society by folks who should know better, and the tragic mislabeling of psychosis and delusional thinking as just a “behavior problem.” Is autism a behavior problem? Is epilepsy a behavior problem? Maybe the limping of a returned injured veteran is a behavior problem… and should be punished and corrected with proper “marching lessons.”

    Timothy Souders (and countless others) died for your sins.

  • Daniel Fisher said:

    As a person who has recovered from schizophrenia, I think it is worth while to bring up that some people have shown complete recovery even from the most severe condition, ie Schizophrenia. Dr. Courtney Hardings’s long-term studies in Vermont,Showed that 40% of the 269 persons followed showed complete recovery from schizophrenia over a 30 year period. This sample was of persons with an average of 5 years inpatient stay at the state hospital. Another 28% showed very significant recovery. The researchers concluded that the optimistic attitude of the administration and providers, and community was a critical component, reinforcing the importance of hope.
    I think there should be room for a variety of descriptions of the mental health and addiction issues. Some people find it soothing and hopeful to think that the primary cause of their problems is a chemical imbalance whereas others find that view too narrow. I think that we need room for a variety of perspectives, which can then enter into dialogue. The present environment is too much one reinforcing monologue and debate. I also think that in the spirit of dialogue we should at least open conversation to a holistic perspective that allows attention be paid to the integration of mind, body and spirit. At the heart of all these points of view needs to be agency, and support for persons to be the author of the narrative of their life story.
    Finally, I hope we can support the importance of community participation in recovery and wellness. This is where recovery and wellness go way beyond symptom reduction and encompass housing, education, employment, and health care.

  • Doris A. Fuller said:

    Jade Shafer (above) is right: recovery from addiction and mental illness have many differences, and they need to be addressed if this exercise is to be credible.

    Another writer has raised the reasonable question of why we have criticized SAMHSA for disregarding the specific mental illnesses of schizophrenia and severe bipolar disorder in its “guiding principles of recovery”(and other official activities) when these conditions affect only an estimated 1% of the population.

    Aside from the extraordinary suffering many of these individuals and their loved ones experience, people with the most severe mental illnesses impact the community to a degree that is vastly disproportionate to their numbers. Here are just a few examples.

    -The cost of schizophrenia alone was estimated at $62.7 billion in 2002. About half of that was in lost wages and productivity because of unemployment. The direct and indirect economic impact of schizophrenia is about the same as the cost of stroke and about twice the impact of congestive heart failure (NIH, 2002).

    -The direct cost of caring for people with schizophrenia is estimated at 2.5% of all health care expenditures in the U.S., near the top of the average of 1.6% to 2.6% in the western world (World Health Organization).

    - Individuals with severe mental illness are conservatively estimated to make up at least 16% of jail and prison populations in the U.S. (though the Rand Corp. just reported that 42% of California’s prisoners report symptoms of mania).

    - People with severe untreated mental illness are generally estimated to make up at least 30% of the homeless population living on our streets.

    - Individuals with bipolar disorder commit 13-17% of the suicides in the U.S. Those with schizophrenia commit 10-13%.

    - People with untreated mental illness commit an estimated 10% of the homicides worldwide (and in the U.S.) and probably a higher percentage of mass homicides. The Department of Justice in 1994 estimated that in 25% of the U.S. cases in which parents were killed by their children, the child had a history of untreated mental illness.

    - Family income is reduced by the demands of caring for a loved one with severe mental illness – a cost that is “hidden” but believed to be substantial.

    We don’t expect SAMSHA to devote itself to the sliver of the population to whom the Treatment Advocacy Center is dedicated. But we do believe it is inexcusable for an agency whose formal mission is to reduce “the impact of substance abuse and mental illness on America’s communities” to completely ignore the mental illnesses that are generating the community impacts that schizophrenia and bipolar do.

    People with the most severe mental illnesses can and do recover. When they do, they and their families benefit, and society benefits. Promoting “principles of recovery” that are useless to those who are not in treatment doesn’t serve them and certainly doesn’t reduce their impact on the community.

    Doris A. Fuller
    Communications Director
    Treatment Advocacy Center

  • Larry S said:

    well here we go again professionals defining recovery and what it should be or should not be.
    the important aspect is that once i have had enough i will look for something else and due to the social, cultural and family system how many truly know ways to change. What it took was me facing death from 25 yrs of livng in the addiciton and being so full of anger and rage thinking society had wronged me when it was me all along.
    what it took for me to change was hearing others share their stories and my thinking was they know me from some place and then i discover the truth. it is about being of service and sharing experience strength and hope it is only then that i can find sobriety or recovery. this is the true meaning of recovery in order for me to recover i must first be of service and when that occurs i find that i have some unity with others. sound familiar?
    these are the legacies i live by for the last 23 yrs and if professionals want to define recovery great go for it. Just remember you dealing at times with low bottom cases and all the words don’t mean nothing until they can hear it see it or feel it then they will find some peace like i did through the legacies of each of the fellowships.

  • Martha L. King, Executive Director said:

    As we enter a new “era” for a new vision of recovery this is a great step forward. Even using the word recovery in a field too long dominated by the goal of stabilization and balance this is refreshing and hopeful. But we need to ask ourselves whose vision of recovery are we talking about? When I talk about recovery I talk about as the whole family not just the loved one’s chronic disease. The disease of addiction and/or mental health disorders is a “family disease”. The recovery (or remission) needs to be recognized and emphasized and take into account the addict, the codependent and every child who is growing up or have grown up around with the disease just like any other diseases and/or conditions whether be diabetes, hypertension, cancer…..to name a few. It is a continuum long life process for every one when the addict is restored to sanity and balance so are the family members.
    Finding support for families whose common purpose is to develop healthy relationships, Guiding Hearts with Hope was created, a support group in Hanover, Pennsylvania so the “family as a whole” can gather together to support and share with each other in a journey of self-discovery – physical, mental and spiritual. Living the program allows each of us to become increasingly honest with ourselves about our personal histories and our own codependent behaviors. Also needing to understand and teach our society to view addicts not as bad people – but as people suffering from a brain disease by removing the stigma. Recovering group of diverse individuals – drawn together by our common pursuit of a happy life and of another day without harming ourselves.
    As a member of the Parent Panel Advisory Council (PPAC) with BDAP in Pennsylvania I adovacate for change in the new vision for recovery.

  • DJ Jaffe said:

    Like most of SAMHSA’s efforts, this fails to focus on people with the most serious mental illnesses. For them, recovery is fewer days experiencing hallucinations, delusions, psychosis, and anosognosia. Fewer days homeless, incarcerated or being bounced program to program. Recovery means fewer attempts at violence to self, violence to others, suicidal ideation. SAMHSA should focus on serious mental illness rather than continuing kowtowing to worried-well. Has SAMHSA no heart?

  • R Kelly said:

    Mental illness and addiction are two completely different things. Aren’t they?

  • Helen J. Bown said:

    I am appalled and disgusted with SAMSHA’s definition of severe mental illnesses as a weakness in the character. Where are their psychiatrists who KNOW this is a medically dysfunctional brain disease, and medications together with therapy are necessary.

  • Nancy said:

    SAMHSA’s Guiding Principles of Recovery notes ‘Recovery involves indiviudal, family, and community strengths and responsiblity…foundation for recovery.
    Those w/schizophrenia and bi-polar disorders which also include anosognosia (lack of insight) are unaware of the evidence of their disability. Impaired awareness of illness is not the same thing as denial of illness. SAMHSA states “individuals have a personal responsiblilty for their own self-care and journeys of recovery” ….Studies note a large percentage of these individuals have moderate or severe impairment into their awareness of illness….when you look at a bouquet of assorted flowers you see within many colors – SAMHSA should be recognizing the vast differences within those individual’s experiencing brain disorders. The SMI -Seriously Mentally Ill are in need of professional outpatient care — rather than being allowed to decompensate and homeless living on our American streets….
    After private caps on insurance run out our loved ones are at the mercy of choices/decisions made by professionals- paid thru Medicaid/Medicare. SAMHSA these individuals also need to be recognized so they too can experience RECOVERY!!

  • Chris McClelland said:

    One of the proclamations in the SAMHSA banner is “Treatment is Effective.” Where does diagnosis and treatment come into this self-directed definition of recovery ?

  • Heather G. Miller, LCSW - Program Manager in PA said:

    I agree with the Treatment Advocacy Center’s comments. I both work in the field and am a guardian for a relative with severe mental illness. Like so many other things, the recovery model seems to “hot” right now but just doesn’t fit all situations. Is it considered a failure if someone has made progress, but hasn’t “recovered” as others have pointed out for schizophrenia etc? I think the recovery model for all sets up unrealistic expectations. We’re back to the thinking that led to deinstitutionalization…and we all know how well that turned out.

  • JAM said:

    Perhaps I am wrong, but I thought that the MH in SAMHSA stood for mental health. Two of the most terrifying and debilitating mental illnesses are schizophrenia and bipolar disorder. Any organization that has “mental health” in its title should most certainly be concerned with the most serious and persistent mental illnesses. Many of the SAMHSA “recovery principles” are useful to those who suffer from bipolar and schizophrenia, but the essence of recovery, such as the right to professional care supported by modern scientific consensus, is omitted.

    Your “recovery principles” do a grave injustice to and discriminate against the millions of Americans who suffer from major mental illnesses.

  • Joseph M. Bowers said:

    I was first diagnosed schizophrenic in 1964 at age 17. I am one of the lucky ones who has to some degree been aware of a problem, recovered and lived a fairly normal, productive life. Even so, I have much experience with the system both before and after deinstitutioalism in the mid ’70s. Based on my personal experience, I want to offer my opinion that the comments made by Ilene Flannery Wells are absolutely spot-on. I wish to second everything she said.

  • Shelly Vendiola said:

    Recovery is the process of transitioning and surviving that promotes wellness and balance…mentally, emotionally, physically and spiritually. Drawing on many principles and ways of knowing…including those of our ancestors.

  • Pat Lynch said:

    I know there are political aspects restricting the ability to mention the spiritual aspect of recovery but to describe it as “self directed” diminishes the dose required to achieve efficacious sustained and contented recovery. At the core this is a spiritual disease with emotional and physical symptoms. Until and unless we are addressing this component of recovery we fail to deal with the foundational issues of addiction.

  • Charlton Hall, MMFT, LMFT said:

    Calling addiction a ‘spiritual disease’ takes it out of the realm of science and into the realm of superstition.

  • Norman Briggs said:

    The definition and guiding principles, whether complete or not, focus on the behavioral consequences of addiction. This is an excellent opportunity to educate by referencing the recent ASAM definition of addiction as a “primary, chronic disease of brain reward, motivation, memory and related circuitry.” It is the changes in the brain chemistry that produce the behaviors by which we have typically defined the addiction. Focusing on the behaviors without acknowledging the chemical changes that cause them does little to advance our cause that addiction is not willful misconduct or a moral failing.

  • Trina Ita said:

    Recovery from substance abuse and mental illness is a personal process of change through which an individual achieves overall wellness. This healing journey is an inclusive one that is self-directed with a participating community that likely consists of, but is not limited to, healing professionals, spiritual leaders, volunteers and family.

  • martin baiada said:

    the issue with smi is people don’t learn. it’s not that they can’t learn, it’s there doing the same things over and over. what’s up with that.

  • Tim Richardson said:

    I am Tim Richardson, Coordinator of Health & Nutrition at Mental Health Consumer Concerns Inc, the oldest mental health peer-support consumer-run organization in the country. We just celebrated our 35th anniversary, this past June.

    In defining this term, I asked several consumers in my group sessions to respond in their own words, the definition that comes to mind as to what “Recovery” means to them personally. Below is a collaboration of ideas, responses and definitions by several participants to that question.

    When attempting to define “recovery”, it seems that it would have to include the concept of encompassing an attitude of attaining an overall whole health outcome. That definition would need to include all of the areas of health, which will fall into one or any of the facets of Mental, Physical, Spiritual and Social health. It would be a process of seeking and practicing any everyday goal of utilizing each or any combination of therapy, counseling, medication, social and peer support resources that would result in the qualitative, self-reliant, addiction-free and emotionally gratifying lifestyle for each individual to actually feel a clearly better and newer existence.

  • james b. said:

    recovery is my choice of lifestyle whereby I live everyday to sustain my mental, physical, spiritual, and communal sense of well being and balance through experiences and situations along my journey that always invites hope and brings me evermore closer to love…

  • Evelyn M. Howe-School of Hard Knocks-mom-In Reality said:

    Well…this scope of topic has “ruffled” a few feathers.. People have opinions to voice.after reading all of the 125 comments of the day…I have 2 pages of notes. #’s 4,36,46,51,52,62,71-75,76,79,83,90,96,101,103,106,123…just to name a few…Wow.my thoughts come from the In so doing …paragraph in recovery ..Recovery is the highway(roadmap)…resilience the (learni.ng processes) gas in the car…the person is the vehicle…who determines the cars direction…left or right …you must backup…in order to get out of the driveway !! Glance in the rearview. Mirror…but Keep your focus& your Eyes looking forward. Or we never get to leave the house!! We are the WE The People!! We. Can make change…we will ! Hugs…Evelyn

  • Lori Reynolds said:

    While the definition is a good framework for adults, it is too narrow if applied to children, youth and emerging adults. It is important that SAMHSA understand that resiliency applies to children, not recovery, AND that parents are integral to the wellness of children.

  • Martin Gordon, CSAC/ICS said:

    I like the definition because it is short and simple, however, when health is mentioned I believe that physical, mental, and spiritual health should be specified because 12 step recovery programs point out that the essence of recovery is the power of the spiriit, or spirituality.

  • Rebecca Elson said:

    Including children in recovery is important, especially if the recovering have children. Resilience in children is developed by strengthening protective factors that give children the supports to bounce back from adversity intead of turning to other means of dealing with stressors. Building strong attachment to caring adults, developing initiative to persevere in the face of difficulty and increasing self-control help children and eventually adults make choices that strengthen their lives.

  • Deacon Donald M. Clark said:

    If the human family isn’t restored to its primacy of relationship. Then, what good is recovery? Absolutely, recovery means restoral of intimacy with those who you are related to by kinship or have deep friendship with. In the USA, most people who are recoverying from co-disorders and who have been homeless for a good period of time have to rebuild their lives with former associates or be ready to conform with social norms to establish relationship with new acquaintances. Genuine recovery can be fostered tremendously by a religious experience where you don’t forsake assembly with others. Having a core faith and belonging to a church is something that a lot of Americans (80%) inherit from growing up in a family and they lose it when becoming a young adult that goes out into the world and encounters drugs, illicit sex, and other immoralities. In contrast, the added value of youth guidance programs fostered by an alliance of public agencies with churches can serve as a boon! But, what about the unchurched? Then the overall network of this country’s anti-drug policy and anti-poverty mobilization must begin to coordinate like never before. The majority of our Early Head Start and Head Start Children are doomed to a life of controversy & conflict long before they reach their late teen years if there’s no moral guidance be it secular or spiritual. Yes, as stated before by many others, the true essence of recovery is the power of spirituality. A genuine relationship . . . with God! Our comforter, the Holy Spirit . . . Can do All Things. If we would just call on him. And that’s what for real recovery is all about reaching in and then reaching out in a quest for love, and it can be found!!!

    • Thomas Mackiewicz said:

      While I agree that we need to foster greater communication between families and community, I can’t disagree more that the churches are the answers to this problem. Churches, if anything, foster less communication with our increasingly diverse populace. Most churches thrive on us verses them and generate an group/out group behaviors. I hate to keep harping about this, but until anyone can prove the existence of the supernatural, it should have no place within evidence based treatment. Invoking spirits and gods will only continue to make the mental health field seem like the field of astrology. This doesn’t even say anything about all of the blatant church and state violations taking place (one example is the governmentally funded and often court ordered 12 step treatment program. It is simply a predatory tool to indoctrinate those in need.

  • donald c. gildersleeve said:

    I’m a bit surprised that there is no mention of a ” higher power. ” 12 Step Recovery Programs are one of the most successful modalities of treatment for addicts, alcoholics, and many others, and a higher power is at the core of recovery in 12 Step Recovery Programs.
    Additionally, I’d like to see recovery as being a journey and not an event.

  • Tian Dayton said:

    Recovery: A process of personal, relational and family change through which individuals traumatized by the effects of addiction and/or mental disorders, can learn the skills of self regulation, improve their own health and well being, live a self directed life and strive to achieve their full potential

  • Donna Espinola-Rooney said:

    I believe Individuals suffering from any chronic illnesses, including substance abuse disorders, want more than just symptomatic reduction.

    Recovery means: Improved purpose and a gratifying quality of life. This would include valuable measures of wellness (maintaining healthy, stress-free, and socially prolific lifestyles) as well as the community support to sustain it…long-term.

  • Timothy McCoy said:

    I like the definition SAMSHA has written. My conflict is not having a clear definition of spirituality. So many include it, require it, talk about it and promote it but to this day I have never been given or read a good definition of it. It would help treatment providers if there were a common and true definition that we could promote as being relevant to recovery if not just a better life. I have found it to be very subjective in this field.

  • Andrea Cooke said:

    I would just change the part of the definition that mentions “self-directed life” to self-directed, balanced life” . I think it is important to feel that you have success in various areas of your life to consider yourself in recovery.

  • jamie dillon said:

    ” Recovery is not having to fight any more” this does not mean the world around the recovering person gets better the way in which he responds to the world gets better through a process of surrender and becomming honest enough with himself to recognize the need for continued daily commitment to recovery, family, Physical health and mental health to name a few.
    Recovery is not having to wake up sick anymore…..
    Recovery is being able to at least like the person in the mirror……

  • Charlton Hall, MMFT, LMFT said:

    There are hundreds, if not thousands, of atheists and agnostics who have beaten addiction without the need of any ‘spiritual’ assistance. To claim otherwise is to pathologize atheism and agnosticism. Are you really prepared to say that people who don’t share your beliefs are somehow dysfunctional?

  • DAVID BEST said:

    From a synthesis of many recovery stories in the UK (more than 1,000 and counting), the nearest i have come to capturing what is common in all of these is

    “A SENSE OF HOPE, A SENSE OF PURPOSE, A SENSE OF BELONGING AND A SENSE OF GROWTH THAT IS LINKED TO POSITIVE ASPECTS OF SELF”

    That is not all there is to recovery but it is about the only things that cover people who have incredibly diverse stories and are at different places and stages.

    I think there is a real risk that we try to cover everything and so exclude lots of people who have every right to say what Phil Valentine suggests – “I am in recovery because i say i am”

    For the research community, i think we has a core we can measure but also enables all kinds of additional components to be incorporated for individual circumstances. Thus, while family will be crucial for most people, we cannot say to people who dont have a family or who are recovering without involving their family, that their recovery is invalid!

    So a core of values and a menu of personal and additional experiences

  • Austin Nichols said:

    Recovery is the process, through which we stay sober.

  • Alan Levitt said:

    The definition must recognize that parental substance abuse or mental health problems can significantly impact children and others in the family and their need for various of levels recovery support. This is true whether or not they are living with the afflicted parent, and whether or not the parent is in recovery.

  • Timothy McCoy said:

    I wrote: My conflict is not having a clear definition of spirituality. So many include it, require it, talk about it and promote it but to this day I have never been given or read a good definition of it. It would help treatment providers if there were a common and true definition that we could promote as being relevant to recovery if not just a better life. I have found it to be very subjective in this field.
    Charlton Hall wrote: There are hundreds, if not thousands, of atheists and agnostics who have beaten addiction without the need of any ‘spiritual’ assistance. To claim otherwise is to pathologize atheism and agnosticism. Are you really prepared to say that people who don’t share your beliefs are somehow dysfunctional?
    Charlton, You prove my case very well about how subjective this “topic-spirituality” is in our field. You are assuming my beliefs when in fact I am an atheist. It is exactly your comment that makes me wonder what anyone means by the term spirituality. I am assuming that you mean religion or God when you speak of spirituality, no? That is not the definition as far as I know.

  • Let Your Voice Be Heard. Deadline Aug. 26! | Federation of Families of SC said:

    [...] The Substance Abuse and Mental Health Services Administration (SAMHSA), has just released their working definition of recovery and is seeking feedback from the public. They aimed to capture “the essential, common experiences of those recovering from mental and substance use disorders, along with 10 guiding principles that support recovery”. To view the definition, go here: http://blog.samhsa.gov/2011/08/12/recovery-defined-%E2%80%93-give-us-your-feedback/  [...]

  • Patricia L. Rembert-Anderson said:

    I agree with your proposed definition of recovery!

  • Constance Zimmer said:

    What appears to be missing from the proposed definition is a statement that “recovery” (as opposed to the process of recovery) means living like people without a mental illness live, the core elements of which are having your own place to live, a job, and a partner and/or family. The proposed definition should be revised to make clear that people will be able to achieve “recovery” in this sense, which is readily feasible with current technologies promoted by SAMHSA, including scattered site supported housing, supported employment, assertive community treatment (ACT) and peer support. In addition, the proposed definition must include the explicit expectation that service systems will be re-oriented to enable individuals to live in their own place, have a job, and have a partner and/or family.

    These elements are critical to make recovery a meaningful concept rooted in concrete expectations about what is needed to afford individuals with mental illnesses the opportunity to live full lives as members of their communities, consistent with the ADA’s integration mandate and the Olmstead decision. Without these elements, the proposed definition of recovery would enable service systems to continue treating individuals with mental illnesses living much as they have in the past, without providing the chance to live the same way that the rest of us do. The definition of recovery cannot be one that permits these individuals to remain dependent while “working on” a recovery that public service systems can and should put in their reach. Recovery must encompass more than a set of slogans about hope, respect, relationships and purpose. It must include the specific expectations above that are necessary to make these concepts meaningful.

  • Tom Kelly said:

    A definition of Recovery:

    “The extraction of something precious, from something that was once deemed worthless”

  • Zim Olson said:

    Recovery is a nice word in itself. A Dictionary should be good enough. I am not sure where the association of “Recovery” to MH for the SMI began.

    I think Freedon, Empowerment, and Opportunity(s) for where individual(s) are at, is a key ingredient to MH for the SMI. Also medications that work and empower the mind instead of just reducing symptoms is essential.

    Mental Health is a forgotten focus of our population. Talk about jobs, education, volunteerism is nice except without genuine Mental Health this is useless or fruitless. No useful or genuine outcomes besides accounting or balance results, without M.H.

    Measures of genuine M.H. are available but ignored and/or not utilized. I don’t think many MH professionals really care if their clients have genuine M.H. As long as they get some job or something and get their supervisors/administrators off their backs.

  • Ronald Fanyak said:

    To empower is a transitive verb, meaning “to give power to”. it assumes the consumer is powerless[ a victim of his/her condition] and the provider has the power. This is a barrier to self determination in the mental health services.The definition should affirm that every person has personal power as a birthright of being human.MH services supports the awareness of the consumers own life values ,their own power, and support [create opportunities for] the use of the consumer’s OWN power to achieve THEIR quality of life goals in the worlds of community living, work, learning, relationships, and re-creation. WELLNESS, A PRE-REQUISITE FOR RECOVERY, is learning to manage the health of their body, mind and SPIR IT [a sense of wellbeing; [being comfortable with self and the world]. A name for a wellness-recovery program should be POWER….Persons Owning Wellness Enabling Recovery.

  • Mindy Chettih said:

    What appears to be missing from the proposed definition is a statement that “recovery” (as opposed to the process of recovery) means living like people without a mental illness live, the core elements of which are having your own place to live, a job, and a partner and/or family. The proposed definition should be revised to make clear that people will be able to achieve “recovery” in this sense, which is readily feasible with current technologies promoted by SAMHSA, including scattered site supported housing, supported employment, assertive community treatment (ACT) and peer support. In addition, the proposed definition must include the explicit expectation that service systems will be re-oriented to enable individuals to live in their own place, have a job, and have a partner and/or family.

    These elements are critical to make recovery a meaningful concept rooted in concrete expectations about what is needed to afford individuals with mental illnesses the opportunity to live full lives as members of their communities, consistent with the ADA’s integration mandate and the Olmstead decision. Without these elements, the proposed definition of recovery would enable service systems to continue treating individuals with mental illnesses living much as they have in the past, without providing the chance to live the same way that the rest of us do. The definition of recovery cannot be one that permits these individuals to remain dependent while “working on” a recovery that public service systems can and should put in their reach. Recovery must encompass more than a set of slogans about hope, respect, relationships and purpose. It must include the specific expectations above that are necessary to make these concepts meaningful.

  • Don Brake said:

    I am 52 and am a recovering addict who is also a longtime sufferer of depression/anxiety/Bi Polar. I can’t begin to tell you that without the assistance that I received in part from our community mental health services, and the few rehabs I was engaged with, that I don’t know what would have happened to me, other than it would have been bad, and probably would have meant the end of me! So please, let’s retain these services, if not strengthen them! Thanks!

  • Mike Halligan said:

    recovery means our focus in life is no longer about the illness or treatment, the focus in life becomes centered on independence, success, having a family, being productive, paying taxes, buying a home and car, thinking and caring about others, not just on our selfish little selves. Recovery means we want to contribute to society, to our communities, we want to pay our own way and support those we love. We transition from takers to givers, from dependent to independent, while understanding our interdependence. We pay for other people’s lunch, we pick up the tab. Recovered means I’ll give to others and take care of those whom i love and those that love me. Recovery means others can depend on me, it means i am responsible, i’m an adult and if you try to treat me differently, i will let you know. Recovery means i don’t have to lie anymore and it means i can tell when i’m being lied to. I no longer need to manipulate or be dishonest, recovery means i can be me and not be afraid. Recovery means i’ve grown up, i am an adult, but i understand the child in my psyche. Being recovered means i can say no. Recovery means i can disagree and i make mistakes. Recovery means i never stop growing.

  • Susan Kibbey said:

    People with serious mental illnesses are frequently in a living hell with no obvious way out. Recovery programs would need to provide ongoing support in diverse areas: Housing, job-training and support, counseling/therapy, nutrition-training, peer support, compassionate mentorship, medication support and a huge safety net available for the inevitable setbacks.

  • Jane Rudden said:

    Recovery is overcoming barriers that prevent the individual from reaching their full potential ato be as self-caring, self supporting, and engaged in adequate family and social, leisure and spiritual pursuits

  • Carolyn Hall said:

    I have asked many times though several focus groups, “What does recovery mean to you?” I have never gotten the same responce twice. Recovery is as individual as each person is. Their journey is there own. I am getting ready to do a focus groups on, “When is Recovery enough?” It’s going to make for some interesting conversation.

  • Carolyn Hall said:

    You see, even in all the comments, recovery is different to the individuals.

  • Nate Rockitter said:

    The real issue is the difficulty in trying to define a concept based on an idividuals’ journey, regardless of the outcome of this discussion. The key is to qualify the deffinition. For example: DON’T SAY: “Recovery is……” SAY: “According to SAHSA, some components of recovery include….”

  • Sue said:

    Recovery from mental health and substance abuse disorders is defined as “a process of change through which individuals work to improve their own health and wellbeing, live a self-directed life, and strive to achieve their full potential.”

    HOW???

    How can we ever convince the “non-believers” if even the doctors don’t understand it? The longer the illness persists, the more exponentially difficult the recovery, and it is not without setback. After 35 years of a successful career, followed by three years of devasting bipolar, and nine months on the upswing before a setback, my psychiatrist has all but given up and so have I. My situation is different than most. I am older, closer to “retirement”, and can’t afford what i”m facing in the future. I live alone, i have no family. i don’t know if i would be better off recovering or giving up. I don’t see the potential anymore.

    • Samhsa said:

      Sue » If you ever feel like giving up – please call the National Suicide Prevention Lifeline: 1-800-273-TALK. The call is free and confidential, and crisis workers are there 24/7 to assist you. To learn more about the Lifeline, visit http://www.suicidepreventionlifeline.org.

  • anonymous said:

    I can’t say that I can answer to this at this point and may not be able to even by the date you have for it

  • Kathie Knoble-Iverson said:

    There has to be some mention that there needs to be big changes in the mental health service system in order for Recovery to happen.This means a huge change in the culture of organizations that often mean well but stiffel growth,control decisions,push medication,withhold alternative options,maintain stigma,promote dependency,devalue consumer opinion,etc,etc,.You cannot expcet people to thrive or recover in an environment that is oppressive.These agencies or systems must embrace, practice, and promote the Recovery philosophy from top to bottom!!!!

  • jeff rivard said:

    recovery is for the individual and the community. the community must support the individual if it wants something back. the community is the faith community, the government at all levels, friends, family, and the professional community, especially the rehabilitate professionals of the community.
    recovery is fundamentally access to basic needs such as a home, food and water, and water I would say access to healthcare and some income if indigent.
    I also believe that families are important to recovery but sometimes the recovery community must be a community and other times family must come from the rest of the community or risk placing someone in to trouble.
    I believe that every individual must have meaning, a job or volunteer position, if unable to, a task or indefinite medical supervision even in the home to provide assistance for extreme disability.
    when these things are met by individuals with help and voluntarily the final step will be a healthy personal “family” and call me silly but sometimes we all need a healthy sexual relationship.
    I do not believe eccentric behavior is bad and I believe that addictive personalities need a particular community and moderate healthy focus . all in all, leaving someone alone , unclothed, unfed, and unsafe will ultimately lead to someone being unstable.

  • Karen McLeod said:

    Recovery to me is taking ownership of my fears, anxiety and insecurities; feeling them and acknowledging them before letting them go in faith that God has a plan for me as I move forward in my journey with Him. Life is good, people recover.

  • Nate Rockitter said:

    The real issue is the difficulty in trying to define a concept based on an individual’s journey, regardless of SAMHSA’s definition. They key is to qualify the definition. For example: DON’T SAY “Recovery is……” SAY “According to SAMHSA, some components of recovery include…..”

  • Barbara Frennch said:

    For all people with mental illness and substance abuse no matter how serious their disease is “Doing the best you can” No matter if it’s just getting out of bed and fixing breakfast. That’s my definition of Recovery.

  • Christine Guth said:

    The definition of recovery must include the stated expectation that mental health services will be aimed at enabling persons to live in their own chosen residence, have a job, and live with the people of one’s own choosing.

  • Beverly Collins-Hall said:

    Native Wellness is not just the absence of disease. It is living life in a circle, embracing the teachings of the old ways, where the individual is in balance with oneself, mind, body, spirit, and emotions. It means living in harmony with oneself, others, the Creator, and with all aspects of one’s environment. It is having a sound cultural identity. Illness happens when this harmony or balance is broken. Native Americans is an example to all races of losing oneself due to assimilation. The Native concept of the medicine wheel or four directions will help to bring native and non-native people back the Creator who created them.

  • Kathleen Crowley Stratt said:

    It is exciting that (finally!) it is becoming increasingly clear (systemically) that people can, and do, heal even when faced with the most profoundly complex diagnoses. However, for the most part, the system as a whole still does not recognize, support or seek to sustain the healing process. While this proposed definition focuses on the process of seeking to heal it does not include the end result, that people can and DO actually heal. Additionally, it places the full responsibility on individuals seeking to heal, however, the system is a mess and in need of serious change. Individuals the system was designed to serve, as well as everyone working within the system AND all taxpayers (should demand and) deserve systemic change (healing outcomes) that will be contractually required and measured. The responsibility of “recovery” can not only be placed on individuals in profound pain, it must also be placed on systems. One of the best ways to counteract stigma is to truly support individuals in their unique healing process, so that, where possible, they can then exit the system (creating resources for the next person!) and live full and productive lives, of their own choosing, rather than being passive, lifelong recipients of a system with no exit strategy. I have found that it is entirely possible, as well as relatively simple, replicable and measurable, to work within the constraints of the current (highly inefficient and fragmented) system in order to activate potential and achieve profound outcomes for individuals – BUT in order to achieve this, specific systemic requirements must be required and broad accountability factors must be in place for this to happen widely and for this to become the every day outcome it can, and most definitely, should be.

  • Trudy Harsh said:

    I think mental illness is a brain disease. The brain is an organ in the body that becomes ill like all other organs in the body. It is a physical disease of which we, as a society, are often very ignorant . We don’t know the causes–or the cure, in many cases. Recovery should be when the patient becomes well. I believe that the way to recovery is medications. A possitive attitude, hope, spirituality … are all good things but they don’t cure kidney disease nor brain disease.

  • Jayette Lansbury said:

    People living w/ mental illness deserve the same as a person w/out mental illness.They desreve a home a job,friends , a social life.
    Those that sufferw/ mental illness & have a criminal justice history deserve the same.

  • Randy G. said:

    What appears to be left out from the proposed definition is a statement that ”recovery” (as opposed to the process of recovery) means living like people without a mental illness live, the prime elements of which are having ones own place to live, steady employment and a partner and/or family.  The proposed definition should be revised to make clear that people will be able to achieve “recovery” in this sense, which is readily possible with current technologies promoted by SAMHSA, including scattered site supported housing, supported employment, assertive community treatment (ACT) and peer support.  In addition, the proposed definition must include the explicit expectation that service systems will be re-oriented to enable individuals to live in their own place, have a job, and have a partner and/or family. 

    These elements are germane in order to make recovery a meaningful concept rooted in concrete expectations about what is needed to afford individuals with mental illnesses the chance to live full lives as members of society, consistent with the ADA’s integration mandate and the Olmstead decision.  Without these elements, the proposed definition of recovery would enable service systems to continue treating individuals with mental illnesses living much as they have in the past, without providing the chance to live the same way that the rest of us do.  The definition of recovery cannot be one that allows these individuals to remain dependent while “working on” a recovery that public service systems can and should put in their reach. Recovery must include more than a set of flowery slogans about hope, respect, relationships and purpose.  It must include the specific expectations above that are necessary to make these concepts meaningful

  • Dr. Mary F. Spence said:

    I think the proposed definition is great. Incorporation of cultural and systems issues, along with trauma, are key to treating this population. Family support needs to be in more than name only, as it’s clear to me that people don’t actively engage in the process of recovery without this being a substantial element, even if the ‘family’ is alternative social support. Also, the recognition that hyperboles are easily written, but only actualized through concrete events like a meaningful job, completing education programs that lead to same and satisfying connections within the community is very valuable. In addition to the tenants listed, I would add that any process of recovery includes sufficient self-care tools to prevent relapse, so as to empower the individual and lessen their dependence on outside resources.

  • Maryanne Yergovich said:

    Recovery is the conscious well-being a person achieves through treatment. Treatment should address all factors contributing to a self-destructive life-style. Successful treatment should provide all of the tools necessary to leave the bad choices in the past and empower the person to self-actualize.
    When a person is not making rational, healthy choices, loved ones should be able to get help from professionals trained in the delivery of mental health and substance abuse services. Irrational persons cannot make rational decisions.

  • greg rodd said:

    I would encourage anyone in recovery to look into The Clubhouse Movement. It is a real community of belonging and support. Members run their clubhouse along with a small staff and at their own speed get back into work,education etc. There are around 400 Clubhouses globally and the website is http://www.iccd.org. Check the international directory for a clubhouse in your area and take a tour…

  • mary catherine said:

    recovery has become a way of life for me………..i have been going to Al-anon 12 step recovery meetings and Procovery meetings for years now………there is no ME without recovery it is such a big part of who i am and who i want to become…………recovery is plain and simpl;y GOOD MENTAL HEALTH and it works when you work it and YOU ARE WORTH IT SO WORK IT!!!!!!!!!

  • Patrick Lanahan said:

    I appreciate the emphasis on the personal nature of the journey. The definition may be useful in that regard to the extent that practice improvements can better incorporate this profound truth.

    While Recovery is being defined as a noun, the elements described are all about “the verbs.” The definition seeks to describe in a universal way what is inherently personal and individual. It’s time to get serious about understanding that and getting better at supporting people as they take action to reclaim our lives. So in that sense, recovery is both the process and manifestation of what it means to be a person, living a real and profoundly unique life “of one’s own,’ in a unique and yet connected way.

    I like that the things many people take for granted as prerequisites for being able to “life a life of one’s own” are made plain as necessary for recovery– and the issue is that there are barriers for people recovering. One of the most significant of these barriers is the inability of many clinicians to appreciate the significance of these things, or the willingness of payers and regulators to stop frustrating efforts to address them.

    It seems that resiliency is too often pigeonholed around children. That’s not correct. Recovery is found in resiliency. I am in awe of the resiliency I see, when I care to open my eyes, to my fellows.

  • Chris Weinmann said:

    This seems like a lot of words; many of which, like bureaucracy itself, obfuscate rather than clarify.

    How about: Recovery from mental and substance use disorders is a process of change through which individuals improve their health and well-being.

  • Heidi Reyes said:

    What appears to be missing from the proposed definition is a statement that “recovery” (as opposed to the process of recovery) means living like people without a mental illness live, the core elements of which are having your own place to live, a job, and a partner and/or family. The proposed definition should be revised to make clear that people will be able to achieve “recovery” in this sense, which is readily feasible with current technologies promoted by SAMHSA, including scattered site supported housing, supported employment, assertive community treatment (ACT) and peer support. In addition, the proposed definition must include the explicit expectation that service systems will be re-oriented to enable individuals to live in their own place, have a job, and have a partner and/or family.

    These elements are critical to make recovery a meaningful concept rooted in concrete expectations about what is needed to afford individuals with mental illnesses the opportunity to live full lives as members of their communities, consistent with the ADA’s integration mandate and the Olmstead decision. Without these elements, the proposed definition of recovery would enable service systems to continue treating individuals with mental illnesses living much as they have in the past, without providing the chance to live the same way that the rest of us do. The definition of recovery cannot be one that permits these individuals to remain dependent while “working on” a recovery that public service systems can and should put in their reach. Recovery must encompass more than a set of slogans about hope, respect, relationships and purpose. It must include the specific expectations above that are necessary to make these concepts meaningful.

  • Sue J said:

    I am a recovering alcoholic and drug addict. When I read the definition I cringed at “self-directed”. Personally, my self-direction kept me in my addiction-it was only when I looked outside of myself that I could see a solution. For me it was a power that has changed and evolved as my journey has progressed. The beginning was watching people in 12 step meetings who had been where I was, and were no longer living in their addictions. That planted the seed of hope that I needed.

  • Danny Pritchard said:

    I’m a volunteer group facilitator at a Salvation Army Adult Rehabilitation Center. I asked my group for there input and this is the summary:

    Definition;
    The term “Process” was not easily understood and thought to be superfluous — alternate suggestions included “taking action” or “working to change”.

    The phrase “strive to achieve full potential” was summarily rejected on many levels including alluding to a “capitalistic me first orientation”. It was suggested the definition end at “a self directed life striving to achieve personal happiness and contributing to the greater good.”

    Guiding Principles in summary:
    Recovery is holistic was not immediately understood and required definition.

    Recovery is based on respect is too general.

    Recovery is supported by addressing trauma received very mixed comments many of which allude that a mans experience in not necessarily trauma. It was suggested that “self knowledge and accurate reality” somehow be included.

    Note: Guiding Principle “Recovery emerges from hope” received the strongest support.

    Certainly the input of our brothers and sisters as beneficiaries should be highly considered and it is in this spirit that I have offered.

  • Mark Ragins, MD said:

    It seems to me that the recovery movement has experienced two great moments of coalescence, of realizing that we’re on this revolutionary journey together.
    The first moment arrived in about 2003. Many recovery pioneers began bumping into each other and saw that we were working on the same ideas and that recovery was going to be the name for these ideas. Personally my ah-ha moment was when Michael Schwartz and Fred Frese brought a group of psychiatrists together in Akron Ohio. He asked me from the Village in Long Beach California and Ron Diamond from the original PACT program in Madison Wisconsin to give brief kickoff presentations about recovery. Although we’d never met or even heard of each other we could have given each other’s presentations. In that moment it became clear to me that recovery wasn’t just an innovative idea I was working on. It was something real.
    The SAMSHA consensus statement captured this coalescence:
    Mental health recovery is a journey of healing and transformation enabling a person with a mental health problem to live a meaningful life in a community of his or her choice while striving to achieve his or her full potential.
    Guiding Principles of Recovery:
    • Recovery is person-driven.
    • Recovery occurs via many pathways.
    • Recovery is holistic.
    • Recovery is supported by peers and allies.
    • Recovery is supported through relationships and social networks.
    • Recovery is culturally based and influenced.
    • Recovery is supported by addressing trauma.
    • Recovery involves individual, family, and community strengths and responsibility.
    • Recovery is based on respect.
    • Recovery emerges from hope
    Since then there have been a number of major initiatives supporting recovery based system transformation including the President’s New Freedom Commission Report, a variety of SMASHA initiatives, a VA directive, a number of state initiatives including California’s Mental Health Services Act, and a number of local efforts. We have been working on what actions promote recovery and how staff, families, and communities can support recovery. New concepts like recovery based practice and services, recovery oriented leadership, supervision, outcomes accountability, measurement, administration, and recovery based program cultures have emerged.
    We are now at a second moment of coalescence. My second ah-ha moment was earlier this year at a conference hosted by the Mental Health Center of Denver where SAMSHA brought together a group of agencies who are actively and successfully promoting recovery based services. My notes from a presentation form Yale identify 10 elements of a recovery based program:
    1. Leadership – consistently focused on recovery and based on bottom-up input
    2. Amplify consumer voices – basing decisions on consumers’ direct experiences
    3. Focus on positive psychology – hope, resilience, strengths, creativity, community building, supportive spirituality
    4. Working in partnership –staff in life coaching roles, motivational interviewing, shared decision making, self-directed care
    5. Person centered planning – goal driven, rebuilding life focus
    6. Symptom self management – WRAP, DBT, family education, advanced directives, CBT, DBT, hearing voices training
    7. Community inclusion and social roles – supported housing, employment, education, parenting, citizenship, anti-stigma
    8. Holistic wellness – risk reduction, wellness activities, integrating primary care, integrated dual diagnosis, trauma, complementary health
    9. Peer role / peer support – support groups, recovery education for consumers, peer counseling, warm lines, consumer operated programs
    10. Continuous self assessment / quality improvement – staff learning culture
    Once again, we find ourselves working on the same things. Once again it is time for SAMSHA to develop a consensus statement to capture this coalescence.
    Here are some other materials I have developed that may be useful in describing this coalescence:
    The goals of recovery can be described as:
    1. Functions may be recovered – as in the ability to read, to sleep restfully, to work, to have coherent conversations, to make love, to raise children, to drive a car, etc.
    2. External things may be recovered – as in an apartment, a job, friends, playing in a band, a spouse, a car, family relationships, TV, educational programs, etc.
    3. Internal states can be recovered – as in feeling good about oneself, satisfaction, self confidence, spiritual peace, self-identity other than mentally ill patient, self-responsibility etc.
    The things people can do to promote their own recovery include:
    1. Talk to other people instead of isolating
    2. Actually feel feelings and emotions instead of deadening them, medicating them, avoiding them, or getting high.
    3. Learn some emotional coping skills
    4. Learn to “use” medications instead of just “taking” medications
    5. Engage (or re-engage) in activities that make you more fun and interesting
    6. Take responsibility for your own life and make some changes in yourself
    7. Go to work even when you’re not feeling well
    8. Do things outside of being a mental patient and outside the mental health system
    9. Improve your physical health and wellness
    10. Love other people – family, partners, and kids
    11. Work on acceptance and forgiveness instead of blaming and vengeance
    12. Give back by helping others
    13. Find meaning and blessings in suffering and reconnect with God and spirituality.

    Practices that programs can include to support people’s recovery include:

    1. Engagement and welcoming – focus on relationship and trust building services, not requiring diagnosis or insight or medication, “meeting people where they’re at”, harm reduction, housing first, peer engagement, outreach, charity
    2. Person-centered planning and goal-driven services – Develop a shared story of their life instead of a history of their illness, identify strengths they will use to recover, assist in formulating goals we can collaborate on to improve their lives, identify barriers- often while pursuing goals, and develop shared plans to overcome barriers and achieve goals, develop goal setting skills, use a menu of services supplied by an integrated team and community
    3. Sharing decision-making and building self responsibility – develop collaborative relationship, describe service choices in their language and as it impacts their goals, “client driven services”, advanced directives, assist in learning from consequences of decisions to learn to make new choices – “don’t waste their suffering”, define respective roles in achieving goals increasing self responsibility and self reliance
    4. Rehabilitation – building skills and supports – “teach to fish instead of giving a fish”, do things with people instead of for them, exploit “teachable moment”, in vivo skill building, assist with entitlements, supports, and opportunities, psychiatric rehabilitation and psychosocial rehabilitation, clubhouses and learning roles, peer support
    5. Recovery-based medication services – goal driven medications instead of symptom driven, taking medication to improve symptoms doesn’t have to precede rebuilding lives, initially medications can be for “short term” effects until a “customer relationship” is built, getting off medications happens not when symptoms are relieved, but when they’re no longer needed to attain and maintain goals, medications enable self help coping techniques, rather than competing with them
    6. Peer support and self help – outreach and engagement, peer counseling, shared stories and humanity, peer advocacy, peer bridging, acceptance, “giving back”, peer support groups, 12-step, coping skills, self care, WRAP
    7. Adapting and integrating therapy and healing – therapeutic relationships without structure and appointments of therapy, engagement – relationship building, “corrective emotional experience”, therapy into “therapist – case manager role, creating healing environment – sanctuary, counterculture of acceptance, “therapeutic milieu”, group therapy without walls, Carl Rogers – empathy, authenticity, caring
    8. Trauma-informed care – trauma awareness, empathetic relationships, trauma healing and recovery, personal safety and boundaries, avoiding retraumatization cycles, reducing coercion, seclusion and restraints
    9. Spirituality and alternative approaches – spiritual level of healing requires faith, removing egos and agendas and coming together with God, assists with all stages of recovery (Hope – pray for help for yourself, God (or karma) will make it right, you’re not alone / God is with you, Empowerment – God give me the strength, God doesn’t make garbage / “in the image of God”, turning over life to “higher power”, Self Responsibility – moral duty, do the right thing, Meaningful roles – you’ve been put here for a reason, obligation to serve others and do God’s work), pray for others, acceptance, cleansing, forgiveness, finding the blessing, 12-step, incorporating alternative treatments – herbal, meditation, yoga, acupuncture, Chi
    10. Community integration and quality of life support services – benefits assistance, redocumentation, “supported services” – housing, education, employment, medical care, community development, “welcoming hearts”, finding a niche, meaningful roles, community inclusion, rights and responsibilities, avoiding “failures of community integration” – hospitalization, homelessness, imprisonment
    11. Graduation and self-reliance – building strengths and resilience, protective factors, gifts from their suffering, overcoming fear of losing benefits and illness roles, replacing professional supports with self help and personal supports, developing community treatment resources, “coming out” to fight stigma and discrimination
    Reasons to use recovery based practices include:
    1. When people don’t believe they have a mental illness and you want to help anyway
    2. When people don’t do what you tell them to do
    3. When people can’t be cured and have to live with significant symptoms
    4. When the illness has swallowed them up and become their identity and their whole life
    5. When substance abuse is a major issue and you want to integrate substance abuse and mental health services
    6. When their culture leads to a different understanding of mental illness and their use of services than you have
    7. When trauma is a major issue and you want to help without retraumatizing them
    8. When hopelessness and passivity have taken over
    9. When people have significant strengths and want to take on more self responsibility
    10. When people want to go on with their life in the “real world”
    Essential transformations of recovery based practice are:
    1. “Client driven” – Move from professional directed relationships emphasizing informed compliance with prescribed treatments to individualized, collaborative relationships emphasizing empowerment and building people’s self responsibility
    2. “Person centered” – Moving from centering our efforts on the treatment of illnesses and the reduction of symptoms to a holistic service of people and the rebuilding of lives
    3. “Strengths based” – Building hope for recovery upon each person’s strengths, motivations, and learning from suffering rather than upon the competence of professionals and medications to reduce or eliminate the burden of their illnesses
    Domains of a recovery based program culture include:
    1. Welcoming and Accessibility
    2. Growth orientation
    3. Consumer inclusion
    4. Emotionally healing relationships and environments
    5. Quality of life focus
    6. Community integration
    7. Staff recovery

    Billing categories for recovery based practice include:

    1. Welcoming / engagement – connecting people with staff, program and peers, relationship building, demonstrating our “usefulness” to people, engaging in collaborative goal setting, shared decision making, connecting with people through self-disclosure

    2. Crisis interventions / Responding to basic safety needs and community expulsion threats – accessing, collaborating with and/or diverting from hospitals and jails, advocating with the legal system to prevent incarceration, locating, placing in and/or paying for emergency shelter to prevent homelessness, , safety interventions – medical, substance abuse harm reduction and prevention, responding to threats of dangerousness, suicidality, and impending harm (e.g., domestic violence)

    3. Assessments – assessing goals and needs, understanding their view of themselves, mental health status assessment, Quality of Life assessment, co-occurring conditions (e.g., medical, substance abuse, developmental disability), “eligibility” determinations (voc rehab, disabled students, SSI, bus passes), fitness determinations (legal competence, child custody and driver’s license)

    4. Building and maintaining the safety net / “protective factors” – assisting in obtaining benefits and entitlements, connecting to poverty services (e.g., COA food bank, multi-service center), charity (e.g., bus tokens, food, clothes, toiletries), safe and secure housing, family connections, assisting in obtaining basic documentation (e.g., ID, birth certificate), connecting to basic social services (DPSS, SSA), connecting to cultural connections, (Native American services, UCC), connecting to spiritual strength and security (faith community)

    5. Motivating / Engaging in growth oriented activities – engaging in motivational interviewing, outreaching to isolated people, exposure to opportunities e.g., plays, sports, dances, hobbies, job fairs, schools), exploration of possibilities for the future, career exploration, core gift activities, goal visualizing, peer bridging

    6. Treating mental illnesses and substance abuse disorders to reduce barriers – helping people gain control over their mental illness, helping people identify and control their symptoms (e.g., WRAP), 12-step step work, medication services, providing psychotherapy, building emotional coping skills (e.g., CBT, coping with past traumas, anger management, relationship skills), building wellness skills (e.g., meditation, eating and sleeping routines, yoga), treatment of acute symptoms and relapses

    7. Treating physical illnesses – providing basic wound care, monitoring and treating chronic physical illnesses (e.g., diabetes, hypertension, chronic pain), medication management for physical illness medications, seizure response, physical illness education (e.g., diabetes, hepatitis), smoking cessation, promoting physical wellness (e.g., exercise and nutrition)

    8. Providing and building support – connecting to Village resources (e.g., job development, educational) and community resources ( Jewish Community Center, Gay and Lesbian Center, primary care provider, 12-step support groups, warm lines), connecting to social services (e.g., In Home Supportive Services, Family Preservation), participating together in community activities and opportunities (“giving moral support”), helping families to support them (e.g., family education, consultation, problem solving), providing help directly (e.g., “doing it for them,” adding structure to their lives, making decisions for them, ”caretaking”)

    9. Rehabilitation / Skill building – teaching, job coaching, supported models (employment, education, housing), in-vivo teaching, providing work experience, teaching self-help skills (e.g., budgeting, shopping, laundry, hygiene, medication management), helping the people build and practice meaningful roles

    10. Building personal growth and responsibility – Helping people understand and move through normal stages of life (e.g., prolonged adolescence, first parenting, mid-life crisis, empty nest syndrome), building self- responsibility (learning cause and effect, not blaming others), building self- efficacy (building the ability to positively impact one’s life), empowering people

    11. Community integration – developing and facilitating people’s connections beyond mental health and social services (Taking someone to a Mommy and Me group, helping them to join a bowling league, creating a calendar of low-cost community events), helping people discover niches, roles, and opportunities in the community, promoting being a good neighbor and citizen, helping people invest in and give to community in positive ways, helping people learn to give to others

    12. Community development – making the community a better place for people with mental illnesses, increasing tolerance and acceptance of mental illness, reducing segregation, reducing stigma, developing welcoming hearts in the community, building connections with other community social causes

    13. Promoting self reliance, separation from services, and graduation – building financial independence (getting off SSI and Section 8), obtaining private insurance, preparing for graduation, facilitating relationship changes with staff, finding and providing opportunities to give back to others still struggling, developing self-advocacy skills, developing friendship skills

    Stages of recovery based careers are:

    1. Student / Intern: Dialogue and relationship skills, Understanding impact of illnesses, Usefulness in goals, Poverty services
    2. Early Career: Collaborative medication, Trauma effects, Strengths based, Team work, Shared responsibility with clients, family impact
    3. Mid Career: Collect stories from “practice”, Develop “art” of treatment, Emotional engagement with stability and without burnout, community engagement, leadership
    4. Late Career: Numerous long term relationships / stories, Experience / patience, Mentoring
    In closing, I would like to return to my earliest conceptualization of recovery, a conceptualization that has often caught on in places where I have consulted, especially in California, but does not have nationwide exposure. I think that we can draw inspiration and wisdom from hospice, the most successful, person centered transformation in medicine, both for system transformation and for our conceptualization of recovery. When Kubler-Ross first went into the hospital and interviewed people dying of cancer, she made the same shift form illness-centered to person centered, we’re making. Instead of compassionately asking people how their illness was doing, she asked how they were doing. She asked them about what was important to them, certainly coping with their illness, but also about family, life regrets, concrete needs, preparing for death, spirituality. Over time she developed her famous set of stages (denial, anger, bargaining, depression, and acceptance) that they were going through to “die with dignity”. These were stages the person goes through, not the cancer itself. The cancer symptoms might have an effect on how they were progressing or they might not. Using those stages, hospice has built the most successful person-centered service anywhere in medicine.
    If instead of compassionately asking people how their mental illnesses are doing, we can ask them how they’re doing. We can ask about what’s important to them, certainly coping with their illness, but also about family, life regrets, concrete needs, preparing for the future, spirituality. Over time we can develop a set of stages that people go through in recovery to “live with dignity.” Here are my four stages – hope, empowerment, self-responsibility, and achieving meaningful roles (reference – Ragins, Mark “A Road to Recovery” published by MHA-LA, 2002):
    • Hope: In the blackest times of despair what’s needed first is hope as a light at the end of the tunnel, some idea that things can get better, that life will be more than the present destruction. Without hope there’s no real possibility of positive action. To be truly motivating, however, hope has to be more than just an ideal. It has to take form as an actual image of how things could be if they were to improve. It’s not so much that people will attain precisely the vision they create, since realistically most outcomes are products of chance and opportunity more than careful planning. But is does seem essential to have some clear image, if people are to make difficult changes and take positive steps.
    • Empowerment: To move forward, people need to have a sense of their own capability, their own power. Their hope needs to be focused on things they can do rather than new cures or fixes someone else will discover or give to them. It is often needed for someone else to believe in them before they’re strong enough to believe in themselves and to start focusing on their strengths instead of their losses. It also often takes some actual experience of success to really believe one can be successful. Waiting until someone is ready to move on can often be stagnating and disempowering, because “readiness” often occurs only in retrospect after something has been done successfully.
    • Self-Responsibility: At some point most people who recover realize that no one else can do it for them, that they have to take charge of their recoveries. People can, and often need, to be supported in their efforts to recover, but they can’t be caretaken or protected into recovery. Taking one’s own risks, setting one’s own goals and path, and learning one’s own lessons are essential parts of recovery. The appeals of dependency and being taken care of can derail a recovery as can being too frightened or traumatized to take risks.
    • Meaningful Roles in Life: Ultimately to recover one must achieve some meaningful role apart from the destruction. Becoming a destruction victim is not a recovered role, and frankly, neither is destruction survivor. After achieving increased hopefulness, inner strength and self responsibility, these traits are applied to meaningful roles apart from the destruction. The blackness of destruction that once seemed to swallow the person whole recedes in importance as the person’s other meanings emerge. Connectedness to other people, belonging, and feeling accepted, that may have for awhile only been possible with others who had experienced related destructions, within families, or with compassionate helpers becomes possible in a variety of contexts. The isolation and aloneness the destruction imposed is increasingly broken and life re-entered.

    These stages should sound familiar to all of us. That is because all of us have recovered from something during the course of our lives. These stages are the normal developmental stages that we all go through when we recover from some major destruction. They are not dependent on having, diagnosing, or accepting, any specific illness. But put together as a coherent series of stages, these descriptions can provide a roadmap, albeit a fluid one, of the process of recovery generally and can be applied concretely to our work in helping people recover from the destruction of serious mental illness.

  • Mike Fitzpatrick said:

    SAMHSA’s 10 “Guiding Principles of Recovery” are laudable as a vision to aspire to. Virtually everyone should be able to embrace wholeheartedly the principal that all individuals should have the opportunity to exercise self-determination and self-direction in their lives.

    Unfortunately, these principals fail to acknowledge that some people living with the most serious mental illnesses are sometimes limited or unable to exercise self determination. It is very important to do so in light of the large numbers of people living with serious mental illnesses currently falling through the cracks due to neglect and lack of needed treatment.

    The horrendous consequences of this neglect are evident in many ways, including unprecedented numbers of people living with serious mental illnesses incarcerated in our nation’s jails and prisons, extremely high numbers of people being “boarded” in emergency rooms throughout the country because there are no inpatient or crisis stabilization programs available to them, or in continuing high levels of homelessness.

    These circumstances and conditions produce the worst types of coercion and suffering imaginable. For example, correctional facilities frequently respond to people manifesting severe psychiatric symptoms by placing them in solitary confinement, sometimes for weeks, months or even years at a time.

    In many cases, these horrendous circumstances are attributable to the unavailability of services and the fragmentation of the public mental health system. However, in some cases, individuals may have symptoms so severe that they are unable to exercise informed choice.

    We recognize that mental health treatment in this country has too often been neglectful and coercive. Even worse, the experience of “treatment” has too often been characterized by abuse and neglect. These negative experiences with the mental health system are for too many people sources of significant trauma in their lives.

    The solution to these problems is a system that that is individualized, respectful, allows people to exercise personal choice and autonomy whenever possible, but also has the capacity to intervene and provide humane, compassionate assistance to people when they most need it.

    NAMI urges SAMHSA to include the following in its principals.

    First, there should be acknowledgement that not all people living with serious mental illnesses are capable at all times of exercising self-determination. The goal of assisting these individuals compassionately to reach the point where they are capable of exercising autonomy and self-determination is extremely important. But, it must be acknowledged that some people suffer horrendous consequences and the worst forms of trauma because they choose to forego treatment and assistance when they most need it. A compassionate, recovery-oriented system does not abandon those individuals most in need. Whether through ACT teams, peer counseling and supports, psychiatric advance directives, guardianships, or, as a last resort, court orders, mechanisms need to be in place to help these individuals so that they can reach the point of being able to exercise autonomy and self-determination.

    Second, SAMHSA must clearly acknowledge the critical role that families of adults living with serious mental illnesses frequently play in the lives of their loved ones. Currently, principal # 2 only acknowledges families and caregivers of children and youth as having a legitimate role. This blatantly disregards the role that families of adults assume in so many instances. NAMI’s members know all too well that families often constitute the final safety net for individuals in crisis who have been abandoned by the mental health system.

    Third, NAMI believes that it is important to acknowledge that recovery means different things for different people. For some individuals, recovery means the ability to live independently and autonomously. For others, it means the ability to live safely in the community outside of hospitals or correctional facilities. These are not static concepts – we are aware of many inspiring stories of recovery of individuals who needed intensive services and supports at one time to live in the community but no longer need these levels of support. But, it is very important in this document to recognize and acknowledge the needs of individuals who need more intensive services and supports. This is particularly a risk in the current economic climate.

    Finally, NAMI joins the Bazelon Center for Mental Health Law in urging SAMHSA to expressly acknowledge the specific services and technologies crucial to helping people achieve and sustain recovery, including supported housing, assertive community treatment (ACT), supported employment, peer supports, integrated mental health and substance abuse treatment, and others.

    Thank you,

    Michael J. Fitzpatrick, Executive Director, NAMI

  • Kevin Danko said:

    This definition is so long. Recovery is a simple word. I was not well. I got help. I got better.

    By defining it in such complex terms, we are overcomplicating the concept to the people who most need to understand it: the people who are recovering.

    I would guess that this was written by a well-meaning person who never recovered from a mental illness.

    The terms through which one recovers should not be subject to definition. If I was told there were 10 criteria I needed to meet to be considered ‘recovered’ I would have given up.

    This definition makes recovery seem out of reach.

  • Marcia L. Raines said:

    I like the opinions of # 164,163, and 160. My experiences with supports of systems is that the people who are employed mostly talk at you and disrespect the person they serve. The supports of treating the whole person instead of giving meds. The brain and being unalign may be part of the challenges of mental illness. My family supports chiropractic care. I notice a change in myself and especially my son. Using supplements/vitamins with no toxics make a difference also. I do not support meds. It was suggested by a professional to give my son meds. My son is not a experiment. He graduated from Central Catholic High School in Pittsburgh in 2011, with honors the last two years and now a residence at Duquesne University. Sometimes he may need to be redirected but he is not no meds. He is willing to accomplish his goals.

  • Darwyn Walker said:

    NAMI Comments to SAMHSA on the Definition of Recovery and Guiding Principles of Recovery SAMHSA’s 10 “Guiding Principles of Recovery” are laudable as a vision to aspire to. Virtually everyone should be able to embrace wholeheartedly the principal that all individuals should have the opportunity to exercise self-determination and self-direction in their lives.

    Unfortunately, these principals fail to acknowledge that some people living with the most serious mental illnesses are sometimes limited or unable to exercise self-determination. It is very important to do so in light of the large numbers of people living with serious mental illnesses currently falling through the cracks due to neglect and lack of needed treatment.

    The horrendous consequences of this neglect are evident in many ways, including unprecedented numbers of people living with serious mental illnesses incarcerated in our nation’s jails and prisons, extremely high numbers of people being “boarded” in emergency rooms throughout the country because there are no inpatient or crisis stabilization programs available to them, or in continuing high levels of homelessness.

    These circumstances and conditions produce the worst types of coercion and suffering imaginable. For example, correctional facilities frequently respond to people manifesting severe psychiatric symptoms by placing them in solitary confinement, sometimes for weeks, months or even years at a time. In many cases, these horrendous circumstances are attributable to the unavailability of services and the fragmentation of the public mental health system. However, in some cases, individuals may have symptoms so severe that they are unable to exercise informed choice.

    We recognize that mental health treatment in this country has too often been neglectful and coercive. Even worse, the experience of “treatment” has too often been characterized by abuse and neglect. These negative experiences with the mental health system are for too many people sources of significant trauma in their lives. The solution to these problems is a system that that is individualized, respectful, allows people to exercise personal choice and autonomy whenever possible, but also has the capacity to intervene and provide humane, compassionate assistance to people when they most need it.

    NAMI urges SAMHSA to include the following in its principals. First, there should be acknowledgement that not all people living with serious mental illnesses are capable at all times of exercising self-determination. The goal of assisting these individuals compassionately to reach the point where they are capable of exercising autonomy and self-determination is extremely important. But, it must be acknowledged that some people suffer horrendous consequences and the worst forms of trauma because they choose to forego treatment and assistance when they most need it. A compassionate, recovery-oriented system does not abandon those individuals most in need.

    Whether through ACT teams, peer counseling and supports, psychiatric advance directives, guardianships, or, as a last resort, court orders, mechanisms need to be in place to help these individuals so that they can reach the point of being able to exercise autonomy and self-determination.

    Second, SAMHSA must clearly acknowledge the critical role that families of adults living with serious mental illnesses frequently play in the lives of their loved ones. Currently, principal # 2 only acknowledges families and caregivers of children and youth as having a legitimate role. This blatantly disregards the role that families of adults assume in so many instances. NAMI’s members know all too well that families often constitute the final safety net for individuals in crisis who have been abandoned by the mental health system.

    Third, NAMI believes that it is important to acknowledge that recovery means different things for different people. For some individuals, recovery means the ability to live independently and autonomously. For others, it means the ability to live safely in the community outside of hospitals or correctional facilities. These are not static concepts – we are aware of many inspiring stories of recovery of individuals who needed intensive services and supports at one time to live in the community but no longer need these levels of support. But, it is very important in this document to recognize and acknowledge the needs of individuals who need more intensive services and supports.

    This is particularly a risk in the current economic climate. Finally, NAMI joins the Bazelon Center for Mental Health Law in urging SAMHSA to expressly acknowledge the specific services and technologies crucial to helping people achieve and sustain recovery, including supported housing, assertive community treatment (ACT), supported employment, peer supports, integrated mental health and substance abuse treatment, and others.

  • Randolph Hack said:

    Five core principles of recovery are:

    1) Purpose
    2) Hope
    3) Acceptance
    4) Responsibility
    5) Mutual Help

  • Sandra Mitchell said:

    Sandra Mitchell
    August 25, 2011 at 3:45 p.m.

    I have conquered the bi-polar manic depression “label” that was placed upon me so many years ago. It was changed to “mild depression” over 5 years ago and I feel great! What did it for me was staying in deep prayer mode. I relinquished all my feelings of depression to my Lord & Saviour Jesus Christ. I spend everyday learning from the scriptures to become what God purposed me to be. I give all negative emotions, situations to Him. In exchange, He gives me His perfect peace, His hope, His soul quenching LOVE. I realized that I was very misunderstood and that was part of the problem. I also realized that I had more physical ailments that effected my mood than anything else. So I went to a series of doctors (medical, dietary/nutrition, etc.) and a holistic doctor. Together these professionals helped me to understand how everything works together. My mind, my body and my spirit began to heal. I am now able to reach out to others, being transparent and helping them along the way to their own journey to wellness.
    Recovery should include: Education (to gain emotional intelligence, personal/character development, financial awareness, cultural competency, vocational training, Eligibility (SSI./SSDI; Medicaid insurance, etc.)), exercise, socialization, work/vocational training, volunteerism, and definitely – Spirituality (meditation/prayer/worship).
    And I agree with SAMHSA’s 10 x 10 Wellness & Reovery model. I love the part that it emerges from hope and is based on: Respect; that it empowers and involves the individual in the success of their journey to wellness, and that it includes family and community strengths and responsibility. It’s good to know that there are people out there who will partner with you and have a vested interest in helping you to become “whole”.
    Life is good, when you’re living it like it’s GOLDEN! (smile)

  • Leanna said:

    I feel that recovery is when you can do something that you formerly had a problem with a few times a year without having to do it immediately the next day, and without all the anxiety that rituals and habits cause.

  • Daniel Keeran said:

    Recovery means understanding and healing childhood experiences affecting adult life and relationships with self and others. Here is a summary of practical articles for recovery http://prlog.org/11637003

  • Chrisa Hickey said:

    I don’t know how to define recovery without defining relapse as well. Was my son’s six months of stability recovery? Is his current psychosis relapse? Is it constantly two steps forward and one step back? How does one truly define recovery from schizophrenia? Is it learning to cope with symptoms that meds and therapy can never truly make go away? Is it an end to psychosis for a week? Month? Year? Longer?

  • R Fletcher said:

    Recovery is the daily process of learning how and living a pleasing & productive daily life, with the ability to experience the highs & lows of that life without resorting to previous, unhealthy coping mechanisms.

  • Tammy L. Mazzini said:

    I am a recovering dual diagnosed college student. Recovery to me means being able to wake every day and put a smile on my face knowing I am alive. I process one moment at a time focusing my attention on the correct things at the right time period, adapting to the correct behaviors to proceed in furthering my goals towards a happier, healthier lifestyle.
    I am going about my recovery in a holistic approach taking small steps to accomplish my dreams. I am trying to further my knowledge and learn from my experiences to someday help others who are going through the same.

  • Darla said:

    As a person diagnosed as bipolar II, OCD, social anxiety and borderline personality traits I don’t really understand the word “recovery” because it seems like that means the same as healed….to me it is more of an ongoing lifelong journey hoping to have long periods of some stability but always knowing there is the possiblility to fall of the ledge at any point and that point is not always under my control…there are many outside life events that contribute to those possibilities of falling ….I don’t ever really expect “recovery” but rather look at stability and having hope for such as my goal…

  • Marc Jacques said:

    Choice, self-determination, empowerment; mental health recovery is more about discovery. Discovering new potential, new skills, and new opportunities much as it is about recovering the bits and pieces of one’s life disrupted illness. Peer delivery is fundamental to the recovery process and key to community and employment.

    Can we find a better word than holistic? Yes it means encompassing the whole person but as a buzz word it has come to mean spirituality. Holistic is so much more than just including spirituality. Maybe use the longer phrase “Recovery encompasses an individual’s whole life” rather than holistic.

    Yes, recovery emerges from hope which is the “belief” that recovery is real provides the essential and motivating message of a better future etc.– A stronger statement is that the process of recovery is now a fact. There is proof and good data that people do in fact recover. So I feel strongly that the working definition acknowledge the FACT people do recover. Best Practice good science.

  • Holly Hunsicke r said:

    The word “recovery” suggests to me a process with a beginning and an end. I have Bipolar Disorder and I have periods of time when I am symptom free. I like to call those periods when I experience a relief from the effects of the disease “remission.” When in remission, I have all the characteristics described in the guiding principles.

  • Josh Moore said:

    I think that article is great, however, I work in a facility that is not client driven but money driven. For example, I am told to go out and make the billable units, which therefore is interpreted by all the staff as “who cares if they are doing well, you need your units”. Also to enable a person to make the units, like for example going to appointments not for the sake of assisting the client but to make those dam units. So those in the same situation, do we accompany the client everywhere, not allowing them to handle it on their own, when we as the workers know they can, which can have the client think, “gee maybe I am not ready for discharge because my worker is here or not go, allowing them to prove to themselves they can do it without assistance, which means not getting the billable units and fear losing our jobs…Gee that is something to ponder about

  • Dora Opalewski Cole said:

    I worked 35 years in rural mental health. I wnet through growth and change, needless to say. Until I met and worked with Kathleen Crowley Stratt and Jean Campbell, Ph.D., I did not fully understand what recovery could mean. This was after growing up in a home with mental illness. Ms. Stratt (#164 comment)states clearly the needs in recognizing what recovery really means. The entire federal and state systems are so convoluted and confused over the many years of trying to figure out what works, they are either very political or exhausted or new due to salary or all of these. Please keep Ms. Stratt’s comment at the top of your list in consideration for recovery definition and needs for our precious population. With the cuts in MH, we are experiencing so many more incidents of law enforcement having to care or the mentally ill.

  • Irma Vera said:

    i am a daugther of an alcoholic and recovery for me is have a clear dicision about stop to be able to make all the change necesary to star for the beganing form 360 to call a new beginig for 0, learning walking in the path of recovery.

  • L Simmons said:

    What appears to be missing from the proposed definition is a statement that “recovery” (as opposed to the process of recovery) means living like people without a mental illness live, the core elements of which are having your own place to live, a job, and a partner and/or family. The proposed definition should be revised to make clear that people will be able to achieve “recovery” in this sense, which is readily feasible with current technologies promoted by SAMHSA, including scattered site supported housing, supported employment, assertive community treatment (ACT) and peer support. In addition, the proposed definition must include the explicit expectation that service systems will be re-oriented to enable individuals to live in their own place, have a job, and have a partner and/or family.

    These elements are critical to make recovery a meaningful concept rooted in concrete expectations about what is needed to afford individuals with mental illnesses the opportunity to live full lives as members of their communities, consistent with the ADA’s integration mandate and the Olmstead decision. Without these elements, the proposed definition of recovery would enable service systems to continue treating individuals with mental illnesses living much as they have in the past, without providing the chance to live the same way that the rest of us do. The definition of recovery cannot be one that permits these individuals to remain dependent while “working on” a recovery that public service systems can and should put in their reach. Recovery must encompass more than a set of slogans about hope, respect, relationships and purpose. It must include the specific expectations above that are necessary to make these concepts meaningful.

    Thank you.

  • Susan Ramaglia said:

    It is good to continue the public discussion of mental health recovery so that it becomes the expectation wherever feasible. However, I think there is a sufficient amount of research regarding recovery and what helps that we can now move the discussion forward to providing the services needed to support recover, like more transitional and regular housing, workable education and employment opportunities, evidence based practices, and plenty of peer support throughout every program. I wish that SAMHSA had more influence over Medicaid funding decisions, for example.

  • Ronnie San Nicolas, MSW, PhD said:

    Recovery is inclusive (consumers, families, community)
    Recovery is meaningful participation in a life worth living
    Recovery is having access to accommodating and available array of services
    Recovery is about personal choice
    Recovery is transformative (for consumers, families, communities)

  • Janie Lee, M.Ed. said:

    You know I can’t participate in this, take the ACT out and stop trying to be God’s and Goddesses and then maybe I can, I am so tired due to the fact that I have worked on this for such a long time, in this world I did not come into this world to live up to your expectations and you did not come into it to live up to mine, the thing of it is the Golden rule says do unto others as you would have done on to you, that has never been true for me, I have had many things done on to me that others didn’t have to live with the outcomes of and neither did they have to be held accountable for any of the damage they did to me over time and then now that I am this old they want to act like fools, no thank you, I am tired and this is better off with me not saying it, thanks.

  • AnnMarie Cunniff said:

    Having lived with clinical depression most of my life, I find that there is no true recovery for mental illness or drug or alcohol addiction. There exists a manageable state of mind. At different times in my life under many different circumstances, or during certain experiences, I have found my own ways to manage my “disease.”
    I think you have done a great job showing how people have to take responsibility for their illness and the steps they need to take for a comfortable and safe lifestyle, but to say that there is true recovery for mental stability, I believe, is erroneous; but not a bad thing.
    Like many, I have developed coping mechanisms and arrived at therapeutic levels of medication to maintain a safe existence, but the underlying PTSD that exists in my mind, surfaces when triggered by particular experiences. My clinical depression manifested as an anxiety disorder resulting in Agoraphobia for many years, after experiencing one of these triggers.
    Many mentally ill adults are high functioning and the resources for individual, high functioning adults is very limited. I found it necessary to create my own, state of recovery. It starts with a seed; sometimes one small experience that begins the process. For me it was a movie, a book, a television show, the unexplained appearance of my mother’s Bible leading me to my spiritual self, meditation, and higher education.
    A manageable mind set is always within, and it is through the individual’s search that it is found. In many cases, extreme creativity surfaces and replaces the dysfunctional mind set, relieves anxiety, and makes way for a healthy mind set, albeit temporary. I have tried to create a recovery program in my area based on the tools I have used to find a peaceful and productive mind set; because when I needed a day program to release me from Agoraphobia, none existed. There are however, many programs for the mentally challenged. There are also many for drug addicts, alcoholics, and released prisoners to integrate them back into society; and there should be, but high functioning adults with mental illness are in limbo or on their own aside from counseling and medication control. I think a greater concentration on individual care is needed to bring more high functioning adults to a safe and manageable state of mind. I hope your organization focuses some much needed attention in the direction of day programs for these individuals, and when that happens I would love to share in that experience.

  • Jenny said:

    I truly do not understand this need to conflate mental illness with substance abuse disorders. Mental illness and substance abuse are two different things. One is an imbalance in the brain that, in severe cases, almost always requires medical intervention. The other is a behavior-based disorder that is treated by support for and education about better coping behaviors. Look at the definitions of recovery you’re getting from the SA folks– acceptance of powerlessness, abstinence from mind-altering substances. How do you think it feels to me, a person who is disabled by depression, to hear those proposed as a way to define MY recovery? Listen to what is being said to you by the people you supposedly represent — we don’t see a great deal of similarity between our experiences of recovery, other than the common experience of becoming healthy after any disease. Stop forcing an unworkable paradigm on people who are already having to work harder than most to achieve healthy lives.

  • kathleen ciarpelli said:

    I would say i am 3/4 recovered. I started out with major depression and was later diagnosed with bipolar II. I work full time although this is sometimes very difficult- I sometimes have to take some time off (months) and say my seizures are acting up or I feel I will be discriminated against. When I have hypomania I feel my performance is better although I am not sleeping but i wonder what my co-workers think- i never stop talking- laugh inappropriately etc. I live with my husband but has been a big strain on our marraige. I would appear to be doing great but really struggle inside- very hard to work so much with so many emotional issues. Thanks for letting me share.

  • Marcia Mulloy said:

    After what I have been through with mental health services for both myself and another family member – whom I was forced to attempt to advocate for at the local mental health center – in the last two years, even thinking about this gives me such a huge knot in my stomach and makes me so angry, I really can’t even approach it.

  • Sue Abderholden said:

    Having family and friends, a social connection, is an extremely important part of recovery. A study conducted by Francesca Pernice-Duca found that people had an average of 2.6 family members on their social network and interacted with family members once a week. Family support was critical to recovery – helping people cope, remaining out of the hospital and improving their quality of life. Even the Substance Abuse and Mental Health Service Administration identified social support networks as a key component in the recovery process. “People in recovery also note the role of family and peer support in making a difference in their recovery.”

  • Katie Petray said:

    Consumers I know, especially my daughter Corinne, like the following paragraph,
    which is in their local brochure: “As consumers of mental health services, we
    should take an active part in our own recovery journey. Recovery can occur even
    though symptoms may reoccur.

  • Leon Judd said:

    I fully agree with the NAMI paper that explains recovery and agree that you should include this in your principles regarding recovery especially for those with serious mental illness. Also, the inclusion of families is also a critical factor in so many cases dealing with recovery and working toward healthy, happy and independent lifestyles for all those with mental illness where possible.

  • B Farar said:

    I agree with those who have suggested that the MH and SA recovery definitions should remain distinct, otherwise as here, they are blurred together (in this case with a heavy sway in the direction of SA language).
    The “Recovery occurs via many pathways” section is fine (in regards to SA), with the exception that “some” should be “many.” Most of the sections are fundamentally OK and do proactively address the policy-making decisions which will be guided by this document.
    However, there is certainly much optimist “bootstraps” mentality in the SAMSHA definition:
    “Self-acceptance, developing a positive and meaningful sense of identity, and regaining belief in one’s self are particularly important” is a good example of this. In fact, the word “meaningful,” in vogue in the ’90s MHMR days (and used twice in the definition), is contentious and so subjective as to be meaning-less.
    Likewise, the whole “Recovery emerges from hope” section is pure fluff without substance, from my experience; these must be what are characterized by the Bazelon Center for Mental Health Law as a “set of slogans.” “Hope is the catalyst of the recovery process” is entirely misguided and potentially runs counter to the success of this definition.

  • Charlton Hall, MMFT, LMFT said:

    Perhaps it would help to ask the question, “Recovery from what, exactly?”
    Is it simply recovery from abuse of a substance, or is it recovery from something else?

  • Marianne Clayter said:

    Life is so much more than taking medications every day and doing laundry once a week and having enough money to buy a few cigarettes. I urge you to consider a much more well rounded approach. All of us have had crisis. What we need is a definition that is open-ended and allows for individual recoveries instead of grouping MH together, DD together, and SA together.

  • John Tatum said:

    I have Obsessive-Compulsive Disorder. It is a mental illness, a physical illness of my brain. It is not a “behavioral health” issue. To view it in that light undermines the very stigma I have faced and been a part of all my life. Until mental illness is viewed as an illness of the brain, as diabetes is an illness of the pancreas, you will not be a help to those of mental illness. Yes, if you have diabetes there are a number of emotional and lifestyle issues that are part of living with the disease. These are part of recovery, but the bulk of recovery is a medical issue. I resent the term “behavioral health issue”. I have behavior health issues no more than a diabetic! Unfortunately my many of my symptoms of OCD may manifest themselves in behavior, but this does not make it a “behavioral health” issue. It is a MEDICAL issue!!!!!!

    It think your how emphasis on the 10 steps distract from the true path to recovery!

  • ERNST HAYMAN said:

    I SUBSCRIBE TOTALLY TO THE NAMI COMENTS ON RECOVERY. MY WIFE AND I HELP OUR WONDERFUL SON, WHO IS 47 AND HAS SCHIZOPHRENIA, AND IS DOING AS WELL AS HE CAN, WHICH TO ME IS “RECOVERY”!WITHOUT OUR HELP HE PROBABLY COULDN’T MAKE IT IN THE COMMUNITY. WE ARE NOT HIS CARETAKERS, BUT ARE THE AID HE CAN FALL BACK ON WHEN A REGRESSION OCCURS. WE ARE IN THE PROCESS OF PLANNING AID FOR HIM FOR THE TIME AFTER HIS MOTHER AND I DIE. NOT ALL FAMILIES HAVE THE WHEREWITHALL TO DO THIS OR HAVE REMOVED THEMSELVES FROM THIER PROGENYS LIFE. THESE ARE THE PEOPLE WHO WILL CONTINUE TO NEED AID IN CONTINUEING THIER RECOVERY. THE NAMI RESPONSE PUTS THIS IN BETTER WORDS THAN MINE AND I THANK YOU FOR ASKING FOR THE THOUGHTS OF US AND OUR LOVED ONES WHO ARE ON THE FRONT LINES OF ANY APPROACHS , WHICH ARE CONTINUEING TO CHANGE.

    ERNST HAYMAN

  • Gail Evanguelidi said:

    The article is asking for us to approve their definitions for recovery.

    I suggest that they are missing the recovery model for those who are not medically capable of knowing they are ill.
    Therefore the recovery model most likely to succeed will be through the legal process of the California LPS Conservatorship. This process allows forced medications which helps the person’s brain to regain the ability of processing information and experiencing reality. As distasteful as the term “force” medication might be, we must remember that everyone has a “Right to be WELL, thereby a person with no insight into their illness has a right to quality treatment which most likely will have to be forced medication.” Barriers preventing treatment must be broken down and society must acknowledge that more than 50% of those with serious mental illness will never ask for help because they are NOT medically capable of knowing they are ill. Recovery takes place when the chemicals are replenished in the brain to help foster the proper neuron connections so messages are transmitted to the central nervous system and can elicit a realistic response.

    All the definitions given for this project only address those with the ability to process the information and recognize they are ill. They need a definition for those without insight into their illness.

  • Maureen F. King said:

    Recovery is remembering who you are and using all your strengths to become the best person you can be!!!

  • Brian Jost said:

    As I once heard a mother of a someone with a psychiatric disorder say, “it should be called DISCOVERY, not recovery.” It is a never-ending journey of learning. I feel I am living in recovery. Even though I am currently experiencing stability with bipolar disorder, type 1, I may end up hospitalized again for mania at some point in my life. If that happens, I will still be living in recovery, because for me it’s about my attitude toward my psychiatric disorder, and also about having people around me who are aware of my needs. Living in recovery, for me, means that my life is moving forward despite the fact that I have bipolar disorder. Recovery means no longer being held back.

  • Helene Gelber-Lehman said:

    Any definition of recovery must include the “consistent ability” to function effectively without medication of any sort, in work, healthy relationships, family, friends, community and to be entirely self-supporting and live independently.

  • Helene Gelber-Lehman said:

    Any definition of recovery must include the “consistent ability” to function effectively without medication of any sort, in work, healthy relationships, family, friends, community and to be entirely self-supporting and live independently. Without these elements, the health care system will simply continue to pander to and subsidize the pharmaceutical industry and doctors who refuse or fail to provide the proper counseling and emotional support and emotional education or re-parenting necessary for real recovery from mental or psychological disabilities or substance abuse.

  • Melissa Linardos said:

    I think that substance abuse and mental health are intrically linked, as I have seen in my position as a mental health case manager. I see clients who are addicted to various substances, and use these substances to help manage the stressors of their daily lives. I understand why they use substances, because their mental health is still unstable. Many clients do not want to take psychiatric medications, and rely on illegal substances to help them get through. The services for AOD care need to be much more present and prevalent in communities, without months-long waiting lists. People need to be able to access these services in a very short period of time, and not wait months and months to be able to get help. Their mental health can suffer in the long run, and many even attempt suicide or engage in self-harm behaviors. I am asking that you consider the availability of these services to consumers. Thank you.

  • Tommy Gunn said:

    “Recovery”, has been used to further stigmatize people with severe and persistent Mental Illness. It has been used to justify cutting supports and services people need to remain engaged and involved in their community. The state of NC is planning to require people who remain connected to their Clubhouse for more than 18 months, to have an independant evaluation. Value Options, the company that the state contracts with to do Authorizations, is slashing authorized service hours because people have been able to remain stable and out of the Hospital through the supports of the Clubhouse. “They should be recovered by now.” When a Member of the Clubhouse with severe Schizophrenia continues to hear voices and asks why he hasn’t recovered yet, the stigmatizing effect of “Recovery” is clear. A lot of people have been harmed by the misuse of that word. The Government (SSDI) has declared the fellow above to be disabled due to his Mental Illness. He has tried hard to work, but has only been able to hold a job for a few months, further documenting his disability. However, the state wants evaluations every 6 months to see if he has “recovered” yet so that they can discharge him to isolation in this rural community with no public transportation, thus saving money. A few months ago, he spent three days in a glass cubical at the Emergency Room while 27 hospitals were contacted, trying to find a psychiatric hospital bed. All the beds were occupied by people that Value Options and the state of NC declared “Recovered,” cutting their community supports. I wish your definition would help, but I fear it will continue to be distorted for financial and political reasons. In the mean time, what should I tell my friend when he asks again, “Why haven’t I been able to recover?”

  • Steve Bell said:

    Recovery and the Mental Health Workforce by Steve Bell, Coloraod Springs, CO.

    In the business world, workforce development requires not only a clear vision of where you want the enterprise to go and
    how you propose to get there, but who are the best people to to help you arrive at a profitable destination. As we wring our
    hands about the lack of funding for providing the best mental health care for the American people, and the chronic shortage
    of qualified professionals to deliver needed services , as well as defining the role of consumer-providers we seem to shy
    away from both innovation and adequate investment in both the profit and nonprofit sectors where people in recovery from
    serious mental illness are not just playing bit parts on the stage of service delivery transformation, but are the producers,
    directors and stars of the ‘show’.
    Many of us in recovery feel consumer run organizations (CROs) are treated by the mental health care and advocacy power
    structure in America as recipients of their benevolence and hard work, instead of leaders and workers who deserve more
    than token roles in the development and delivery of community mental health services.
    Today I challenge public agencies and advocates to do three things; (1) walk the talk when it comes to recovery-based
    practices, (2) invest in consumer run organizations with large infusions of cash from all sectors of the economy to reduce
    our chronic dependence on the uncertain resources and unwieldy restrictions inherent in public funding, and (3) re-examine
    current models of advocacy that have not had a measurable impact on the reduction of prejudice and discrimination that
    continues to fester in many parts of society.
    As to the first challenge, developing a mental health workforce that is truly recovery-oriented will require more than
    evidence-based studies and journal articles or small sample focus groups. It will require that community mental health
    service providers open their doors and their minds to the true experts in the field of recovery…the end-users (the patients, the
    consumers, the clients). Are the leaders and line staff of mental health and allied service systems able to undergo the
    scrutiny of the end-users and then make changes that my peers and I can see, touch, and feel? The alternative is to keep
    talking evidence-based ‘recovery-orientation’ while those who are striving to go from system-bred helplessness to strength
    and personal power over the direction of our lives are met with indifference and tokenism in many agencies.
    Investing money in new or unconventional social service start-ups takes courage on the part of those who are hungry for
    change and no longer content with charity. Shrewd entrepreneurs are risk-takers. People moving toward recovery are also
    risk-takers. We leave the house and drive to the store to buy a few items instead of living in fear and social isolation
    inside our homes. We find the courage to say to a physician or other health care provider that the ‘treatment options’ offered
    do not work or the side-effects are unacceptable, regardless of what the Diagnostic and Statistical Manual or Physicians
    Desk Reference says. We also risk rejection when we offer unorthodox solutions to intractable workforce problems.
    In the last thirty plus years , public advocacy and education to reduce or eliminate the stigma that families and consumers
    experience due to mental illness seems to be just as prevalent as ever. And there are ominous signs on the horizon that
    social attitudes against those who suffer from what I call the ‘storms in our brains’ may be hardening, and the cage door of
    the Cuckoos Nest may swing open, ready to once again warehouse those who do not fit the social norms of American life
    and may be seen as dangerous inconveniences. Despite some battles won against stigma, we may be losing the war. A
    group of peers I met with last week raised this issue in a spontaneous discussion about ‘what helps and what hurts’ in mental
    health care. One participant, a veteran of barbaric ‘treatment ‘ in psychiatric hospitals asked, “With all the efforts and money
    spent to reduce stigma against us, why do we still continue to experience it from family and employers? Why indeed.
    We must consider that in these difficult and uncertain economic times that managed care in mental health care has failed to
    provide easy access and quality care to those who need it the most. Is our addiction to taxpayer financed services so
    entrenched that we are unwilling to encourage both consumer-providers and non-consumer providers to create new
    partnerships and alternative funding streams? America’s mental health workforce and related infrastructure cannot thrive
    unless we figure out what is not working, asking the end users what they need and want, and how such services should be
    delivered. To use a metaphor, we are ready to own some of the restaurants , design the menus, prepare the food and serve
    the customers.; instead of just clearing the tables and washing the dishes. The behavioral workforce leaders and
    innovators of America may be sitting right next to you.. It’s time to engage us, learn from us and employ us with respect.
    Find.support@RockyMountainDBSA.org 8-1-2-2011

  • Steve Bell said:

    See above entry # 196

  • Dave Lushbaugh said:

    add “timely, appropriate supports”

    Recovery from Mental and Substance Use Disorders:
    A process of change “with timely, appropriate supports”, through which individuals work to improve their own health and wellbeing, live a self-directed life, and strive to achieve their full potential.

    Also:
    The use of the term Behavioral Health Creates Stigma. It implies that people with mental illness/ brain disorders can choose good or bad behavior. Perception is reality.

  • tian dayton said:

    Recovery:

    A process of personal, relational and family change through which individuals traumatized by the effects of addiction and/or mental disorders, can learn the skills of self regulation, improve their own health and well being, live a self directed life and strive to achieve their full potential.

  • Larry Daniels said:

    It’s nice of you to try to come up with guidelines for recovery but it really isn’t necessary. If you want to come up with realistic guidelines to help people with substance abuse problems or “mental illnesses” all you have to do is ask them then listen. The important part is the listening.

  • trekkerhappy said:

    “Recovery is holistic” should be changed to “Recovery is personal
    health and wellness”. It is about an individual`s whole life
    including physical health and personal fitness.

    “Recovery is respect” should be changed to “Recovery is respect
    and equality”. It’s not just about respect for other’s with an
    addiction or disability, but viewing those struggling with substance abuse or mental health issues as equals in society.

    “Recovery emerges from hope” should be changed to “Recovery is the
    belief that overcoming one’s addiction or mental illness is possible
    and attainable.” ‘Hope’ has a connotation derived from religious faith
    in colloquial usage and I think there are better suited words
    to emphasize your meaning without alienating those that do not derive
    values from religious organizations or philosophies.

  • Susan said:

    To be “in recovery” is different that to be fully “recovered”. Recovery is to enter a process of learning and practicing the development of new life skills, finding and developing new social supports, engaging in shifting from dependence on all things outside of ourselves to seeing ourselves as independent, capable of enabling and empowering ourselves to create the life we desire and choose over that decided for us by others and their expectations for us.

    While some may always remain dependent on services and continue to struggle with life issues it is vital that it be known and the desire to live a fully recovered life is not only possible but that with purpose, intent and planning fully probable as well.

    To define only that being “in recovery” is possible is the same as the previous view that the only hope was to “manage symptoms”.

    Please do not limit those who desire more than to live “in recovery” while avoiding and maintaining dependence on services. It is time to include the idea that once struggling does not mean forever struggling. It is time that those who so choose to live outside of the labels and discrimination of the labels and system dependence be allowed to have these labels removed from their records that they may indeed integrate fully into their chosen community to live their chosen life. Stop marking people with psychiatric labels. Stop discriminating. Start respecting the human potential and empowering instead of enabling.

  • Sylvia Thompson, BA, CMC said:

    While I strongly believe in a person’s right to self-determination, I think a definition of recovery which doesn’t address the inability to do so is quite ridiculous. How can one expect individuals with mental illness/drug addiction who, BY NATURE OF THOSE DISORDERS, ARE OFTEN INCAPABLE OF TRUE INSIGHT INTO THEIR DISEASE???? Isn’t that like telling someone with epilepsy, while in mid-seizure, to “just stop shaking?”

    I expect the general public to miss that very important point but I am appalled that a mental health organization would be so short-sighted to miss that most glaring attribute of those diseases.

    We’ve all witnessed the lives of individuals who have lived (and needlessly died prematurely) in squalor and filth, struggling with a mental illness, having fallen through the cracks of a very broken system which doesn’t seem to care what their quality of life is. When will we look at the quality of life for those “self-determined” and agree that we must do for others when they ARE NOT ABLE to do for themselves.

    How many stories must we hear before real change is made?

  • Myra Clodius said:

    Recovery is when a client is stable on his medication and able to hold a job and work if that is his desire.

  • Cassandra Ando said:

    As both a consumer of mental health services and a family member, I heartily endorse and hereby incorporate into my comments the comments of Mike Fitzpatrick of NAMI at #177 above.

    Unless we acknowledge that those living with mental illnesses are not always able to make clearly considered and informed self-determinant decisions about their recovery options, we stand no chance of leading them to the point that they can do so.

    It is also important to remember that families of adults living with mental illnesses are often central to their recovery journey. Such a complete definition of recovery as SAMHSA is proposing must give more than passing mention of the role of families in recovery for adults living with mental illnesses.

  • Margaret Brammall said:

    Recovery must be preceded by awareness of one’s mental illness. One of the symptoms of some illnesses is anosognosia, i.e. lack of awareness that one has a mental illness. It is important to note that recovery can be self-directed only after this symptom is addressed, whether by medication or by other means.

  • Mark A. Davis said:

    Recovery is being a person first living with ___________ (sometimes we “suffer from” ultimately learning to live with our conditions);
    Recovery is preventing suicide;
    Recovery is healthy;
    Recovery is a KISS: Keep It Simple Sweetheart;
    Recovery is a hug;
    Recovery is naming, claiming, taming and framing It;
    Recovery is change;
    Recovery is a new direction;
    Recovery is discovery;
    Recovery is informed;
    Recovery is knowledge;
    Recovery is power;
    Recovery is a process;
    Recovery is explored;
    Recovery is deserved;
    Recovery is saving our lives and living longer;
    Recovery is peer support in action;
    Recovery is co-occurring;
    Recovery is individual and shared;
    Recovery is our past, present and future;
    Recovery is situational and environmental;
    Recovery is learned;
    Recovery is being safe, secure and satisfied;
    Recovery is knowing, growing and thriving;
    Recovery affirms diversity;
    Recovery is possible;
    Recovery is recovering;
    Recovery is both complex and simple; and
    Recovery is all of the above and more!
    Humor is the best medicine with NO copay!
    MADavis aka Miss Altered States

  • HN said:

    How stilted! Life is a process. I suggest the definition start: Rocovery is living….
    Where is recognition of the desirable features of mania?
    Why is it only the individual who must change, the support systems will benefit from recognizing and accomplishing changes too.

  • Carlton F Clark, LCSW said:

    The word “recovery” is long intertwined with one philosophy of alcohol (and later drug) treatment, and constricts the entire effort to language what we are doing, with whom, and how. I suggest ELIMINATING that word entirely. I understand this will offend and challenge those that have embraced the term over decades of work. The choice of the term is perhaps more related to turf battles and the politics of treatment funding.

    “Recover” means to come back from, or to ‘return to a normal state of mind, strength, capacity.’ The essential problem is that this language is about ‘physical things.’ “I recovered the money, my socks, the lost flashlight.” Once one recovers the lost Swiss Army knife, it remains now found and in a static state.

    Psychological and behavioral health is not physical things: they are organic events, fluid, fluctuating. People who are genuinely working on themselves have to develop the language and the self-awareness and the skills and insight to apply and apply and apply themselves to their (depressions) (hallucinations) (addictions). One rarely gets to a place of “recovered,” any more than one got to the “fully genital character” or the “fully analyzed patient” in the purely psychological or psychoanalytic schools of thought.

    Successful work on oneself becomes a practice, repetitious, of attending with awareness to various impulses, needs, cognition and emotions, and facing squarely the consequences the choices we might make in those events. One succeeds and fails and tries again and again, hoping that ‘getting defeated by larger and larger enemies’ produces an inner strength that is in evidence, obvious and apparent. Still, it takes effort upon effort, and the effort must be maintained. Just like “getting in shape” physically, one may in short order ‘lose that shape which was initially attained,’ without on-going effort. It is all about developing, and not about ‘finding something that was lost.’ The targeted activity is not a thing, an object, something that can be ‘found’. The activity is a newly informed practice.

    Thus with the word “change.” One can change a light bulb, a tire, but not one’s traits or personality or brain chemistry. Yes, one can perhaps run an hour a day, take medication, and ‘feel better’ for a time. But one must develop the capacity to work with one’s intra- and interpersonal traits through repeated activity. One practices self-observation of a specific manipulation (say, claiming that one is ineffectual, feels helpless, and needs help). One practices “dis-identification” from that trait, and cultivates other responses to a situation in which one does indeed feel helpless.

    “Overcoming…. a disease” is in an insufficient way to describe the actual tasks that we are helping one another learn and repeat.

    Summary: the selection of words implying we are working with the physical world corrupts and distorts the work we are doing and urging others to learn to do as well. It sets consumers up to misconstrue ‘failure’ as cataclysmic. The language of ‘change’ and ‘disease’ ignores the crucial fact of “development,” and of “capacities” that are gained, maintained by use. As I suggest to my clients: “these are the kind of tools that GET SHARPER only with continuing use.

  • Linda Ditter said:

    These are insightful definitions for those who recognize they are ill. Where is your definition for those who lack this ability?
    They do not just fall through cracks in the system, they careen off cliffs into vast crevaces.

  • Nebraska Division of Behavioral Health said:

    Recovery means a process of healing the mind, body, and spirit; inclusive of transformation of individuals with behavioral health conditions (consumers), family and friends, communities, and care systems to equip the person in exercising their choices and rights. This transformation or change can influence individual goals, roles, skills, attitudes that result in moving from hopelessness to hopeful life, dysfunctional relationships to quality relationships, and from illness to wellness.

    We like this definition because it gives a sense of moving towards and is very popular with Nebraskans!

  • Elizabeth Malan said:

    I totally agree with NAMI National/Michael Fitzpatrick’s comments and earnestly request that his points be integrated into your working definition of recovery. This is much to important to be overlooked!

    Thank you,
    Elizabeth Malan/NAMI Snohomish County

  • Dennis Todd said:

    To hold a job and maintain relationships.

  • A. C. Raines said:

    Here at the 11th hour of responding, I have just read 195 comments and am amazed, heartened, and distressed. What a gigantic task SAMHSA has taken on – and what diverse responses you’ve received. But isn’t that just like trying to define recovery? It surely means different things to different people and that depends so much on who you are and where you are and what illness/addiction is your main focus. I am not a professional, but I am the child of a mentally ill alcoholic, the parent of an imprisoned substance abuse addict, and my spouse was sexually abused as a child. Of course I’m co-dependent, and have the usual attendant stuff -extreme anxiety, post-traumatic stress, and a really good sense of humor. In case you are a non-believer, I have visited Hysteria, and while it is lacking in 5-star accommodations, you can’t beat the ambiance or variety of entertainment. Please don’t take offense that my remarks seem inappropriate in the light of such serious issues. I promise you, I take nothing that’s been said lightly, because if you’ve lived with any of what’s being discussed here, it certainly isn’t funny. But doesn’t recovery have to include being able to laugh – to enjoy whatever wholesome outlets are available, and to see yourself as we all really are – flawed, maybe physically unable to express even the simplest thoughts, misunderstood, angry, frustrated, sometimes overwhelmed, and essentially, human. Every person who has responded here shares one commonality – the desire to help and share. So it brings out the best in us and refines the worst in us. Regardless of whether you believe in the Creator and God of this universe or not, you have still demonstrated caring kindness, the gumption to question authority, the right to vent about “the system”, and the wisdom of your own raw and terribly painful lessons learned. God created each of us as individual beings – no two alike, and each with the freedom of choice. How any of us ever manage to get the answer is a mystery to me. You are one and all awesome – and if you ever want to take a road trip, call me. I’ll either be at the jail for visitation, the therapist’s for consultation, or my couch for the next episode of the Mentalist. Eleanor Roosevelt said, “Do the thing you think you cannot do…”. What a challenge for living!!!

  • John Podkomorski said:

    I think the wording above misses one huge point. If a person with a mental illness recognizes and accepts that they have the illness, AND if the illness has not taken away their ability to choose, THEN the descriptions work.

    Many time in serious mental illness an individual encounters the illness in a way where insight is not present, or where enough thought damage has occured in the progress of the illness that they need significant help to manage the path to recovery. That help comes from family, friends, support groups, and agencies.

    It would be much more complete to recognize the very important role that caregivers play in helping adults (not just youths and youngers) achieve recovery. Caregivers of adults are often engaged simply to help their loved-one make decisions, to keep objectives visible and active, to ensure meds compliance.

    I believe that not all people with a mental illness can fully take personal responsibility, completely on their own. This is especially true early in the onset of illness. For may, self-determinance is one of the goals to reach, but until reached, adult or not, support is required to stay on the path.

  • Jake said:

    TEST

  • Nicole J. Osborne Despres said:

    Wow. It took me hours to read all the comments, and I think I could write a book in response. Rather, I would just like to make the point that IMHO recovery does not equal, by definition, a cure. Recover is better. Better managed, perhaps, but not gone. If we recognize mental illnesses and addictions as physical/chemical abnormalities, than we must also acknowledge that we cannot simply eradicate them from a person. Through diverse methods and treatments, we can in many cases help individuals live “symptom-free” lives, but the underlying illness will still exist.

  • Steve Bell said:

    The definition of recovery from SASMHSA is ok…as far as it goes. As many of the responses indicate, spirituality is very important to recovery…to reconnect with God and the teachings of the Bible was as essential for me as family, peer support, counseling and medication and has given me hope and a sense of deep-seated peace that defies clinical or public agency definitions. I have been in recovery from bipolar disorder since 2001. I urge SAMHSA to do two things; help states and independent community providers create compassionate places for short-term and long-term residential care for those with serious and persistant MI and addictions. Some people need more than a 72 hour hold so long as (a) their civil right are protected, (b) family and friends are given better visitation opportunities, and (c) psycho-social rehab is a primary intervention. The second recommendation is; continue and expand funding for peer-run agencies to bolster recovery efforts that already work and promote promising practices everywhere in the country.

    –Steve Bell, Executive Director, DBSA Colorado, Inc.

  • Rob Morrison said:

    NASADAD Comments: SAMHSA’s Recovery Definition and Principles

    The National Association of State Alcohol and Drug Abuse Directors (NASADAD) and our component groups, National Prevention Network (NPN) and National Treatment Network (NTN), appreciate the opportunity to comment on the proposed recovery definition and principles.

    As you may be aware, NASADAD issued a policy statement in February of 2011 recommending the Substance Abuse Prevention and Treatment (SAPT) Block Grant be used to fund recovery support services. As a follow up, NASADAD discussed recovery support services during our Annual Meeting in June. We urge you to take the following points into consideration as you finalize the definition and principles:

    - More work needs to be done to understand the recovery services States are currently funding. For example, a recovery support model should be mapped from state-to-state that includes services and infrastructure.

    - SAMHSA should draw from states’ experiences with the various Access to Recovery (ATR) models which have been implemented.

    -A recovery model focused on a continuum of care that links prevention with recovery should be developed as prevention can support recovery in the following ways:
    i. Education and Advocacy
    ii. Coalition efforts to effect environmental changes
    iii. Community capacity building through recovery resource assessments
    iv. Data collection
    v. Integrating individuals in recovery into the prevention workforce

    In addition, we agree there are commonalities between recovery from mental and substance use disorders that are important to understand, particularly in the context of reimbursement strategies. It should also be acknowledged that for individuals with a mental health and substance use disorder, there may be recovery experiences that are different. This includes individuals with co-occurring mental health and substance use disorders. It is important to ensure that service strategies are developed which recognize the unique experiences of people coming from various types of recovery. For example, individuals with a primary substance use disorder are ineligible for some federal programs that are open to individuals with mental illness, and individuals with both mental illness and substance use disorder may find themselves caught between sometimes separate and fragmented service systems, so that a consumer in mental health care may not want to disclose substance use, while another in addiction treatment may be taken off needed psychiatric medications. Understanding these differences will have an impact on the delivery of care and quality of care. We believe this may be captured under the principle “Recovery occurs via many pathways,” and should be highlighted.

    Some of our members are concerned with the first principle, “Recovery is person-centered.” They would recommend the use of “individually-focused” and amending the first sentence that reads, “Self-determination and self-direction are the foundations for recovery…” While they agree people in recovery should be full participants in goal-setting, decision making and treatment planning, it should also be recognized that for many in addiction recovery, particularly at the onset of recovery, there is more of a reliance on a sponsor or group that is the foundation for recovery. Thus, self-determination and self-direction may be the goal of recovery but not the foundation.

    Lastly, we recommend exploring principles that speak to recognizing inequality and the structural lack of access to recovery capital for some populations, (e.g. racial and ethnic minorities, rural populations and LGBTQ). Even among those with addiction or mental disorders, there are fundamental health disparities and an increased disease burden in some communities. These differences will influence the starting point as a person embarks on recovery and limits choices available to the individual.

    Thank you again for your attention to this important issue. NASADAD will be considering the issue more at our NASADAD Board meeting in September. We look forward to partnering with you as you move to finalize the definitions and principles.

  • Dino said:

    at this stage of my existence, i define recovery as a pipe dream

  • Ohio Legal Rights Service said:

    The Ohio Legal Rights Service (LRS) shares the concerns expressed in many of the comments to SAMHSA about the proposed definition of recovery, including the Bazelon Center’s statement that any definition must include concrete steps toward service system changes that are necessary to make recovery possible. The LRS PAIMI Advisory Council (Protection and Advocacy for Individuals with Mental Illness) has emphasized the importance of recovery and its meaningful implementation for many years.

    Indeed, the definition and guiding principles of recovery proposed by SAMSHA are comprehensive and wide-ranging, but fail to clearly delineate a desired outcome of the recovery process. Individuals with disabilities want to live in the community fully integrated with all that the community offers; family, friends, work, school and play. Since at least 1990 at the passage of the Americans with Disabilities Act (ADA), the right to community integration has been guaranteed by law. The concomitant duty of the federal and state governments, under section 504 of the Rehabilitation Act, and Title II of the ADA is to administer its programs and services to individuals with disabilities in the most integrated setting appropriate for a person’s individual needs and abilities. This duty applies to all programs or services, including the definitions and principles that underlie such services.

    What is missing from the proposed definition is a statement that “recovery” means living like people without a mental illness live, the core elements of which are having your own place to live, a job, and a partner and/or family. The proposed definition should be revised to make clear that people will be able to achieve “recovery” in this sense, and that the recovery process can be evaluated in a concrete manner such as the number of scattered site supported housing and the amount of funding spent on services such as supported employment, assertive community treatment (ACT) and peer support. The proposed definition must include the explicit expectation that service systems will be re-oriented to enable individuals to have self-determined lives and to have real opportunities to own their own home, a job that provides a competitive wage, and friends and family. Recovery must encompass more than a set of principles, even principles that speak so eloquently about hope, respect, relationships and purpose. It must include specific and concrete outcomes and the ability to measure those outcomes against standards that we all aspire to, if these principles are to be meaningful.

    LRS is an independent state agency that is designated under federal law to protect and advocate the rights of people with disabilities. The mission of LRS is to protect and advocate, in partnership with people with disabilities, for their human, civil and legal rights.

  • Al Peraino said:

    Support from the family, employer, medical & social community are all elements that are needed to achieve recovery and integration into society for those with mental illness. When the consumer understands and knows the support is there then he/she is most likely to risk persuing their dreams for recovery.

  • Sue Santel-Fenner said:

    As a person living with bipolar disorder, I agree with The Bazelon Center’s comments about the definition of recovery. Here is what they said, and my comment is exactly the same:
    What appears to be missing from the proposed definition is a statement that “recovery” (as opposed to the process of recovery) means living like people without a mental illness live, the core elements of which are having your own place to live, a job, and a partner and/or family. The proposed definition should be revised to make clear that people will be able to achieve “recovery” in this sense, which is readily feasible with current technologies promoted by SAMHSA, including scattered site supported housing, supported employment, assertive community treatment (ACT) and peer support. In addition, the proposed definition must include the explicit expectation that service systems will be re-oriented to enable individuals to live in their own place, have a job, and have a partner and/or family.

    These elements are critical to make recovery a meaningful concept rooted in concrete expectations about what is needed to afford individuals with mental illnesses the opportunity to live full lives as members of their communities, consistent with the ADA’s integration mandate and the Olmstead decision. Without these elements, the proposed definition of recovery would enable service systems to continue treating individuals with mental illnesses living much as they have in the past, without providing the chance to live the same way that the rest of us do. The definition of recovery cannot be one that permits these individuals to remain dependent while “working on” a recovery that public service systems can and should put in their reach. Recovery must encompass more than a set of slogans about hope, respect, relationships and purpose. It must include the specific expectations above that are necessary to make these concepts meaningful.

  • Steven C. Collins said:

    Four words come to mind and are synonymous with the many definitions that complete the Recovery Web. after reading the SAMHSA recovery definitions The words, Provider, Nutrition, Health and Home stand out in my thoughts.

    Will recovery allow me to be a provider for my wife and children. Will my wife and kids have access to quality food and health insurance. Does our home have necessities that are basic ie, safety, media, appliances and reliable transportation. Will I have the ability to one day send my children to college.

    Finally, does the legal system give speedy and complete freedom from any former infractions against the law so I can search for a job and vote unburdened.
    All people deserve, “Life, Liberty, and the Pursuit of Happiness” according to our nations founders. Let us give 120% towards making our families happy. 100% we know and understand through personal recovery. Extra 20% is the vision that all our loved ones, our community, and former caregivers had hoped to see in our complete transformation. As one doctor summed up recovery in my life, “This is the way it should be”.

  • Ken Minkoff said:

    I think the definition of recovery should include reference to the condition or conditions that people are addressing in the course of their journey. This would be closer to the definition Evans provided in CT in 2002, but would include the idea that recovery involves addressing multiple issues in life, not just mental health and/or substance use conditions…trauma, health, homelessness, criminal justice, parenting, etc.

    “Recovery is a continuing process by which an individual with one or more challenging MH, SUD and/or other conditions recovers a sense of pride, self-worth, hope, dignity, empowerment, and meaning, even though the condition or conditions may persist, some symptoms and disablities may persist and the risk of relapse may persist. The ultimate outcome of recovery involves spiritual transcendence of the condition(s) associated with the achievement of a happy, hopeful, and meaningful life”

  • The Toxic Reverend said:

    Stigma Busting Strategies with Educational Self Empowerment:

    Examples
    (with peer reviewed journals cited and linked in at blogs)

    Proven (Nutritional) Program That Prevents Violence & Bullying In School’s
    http://toxicreverend.blogspot.com/2010/10/super-size-this-proven-program-that.html

    And

    Suicide – Homicide and the Biochemistry of Crime
    http://toxicreverend.blogspot.com/2008/03/suicide-homicide-and-biochemistry-of.html

    Environmental Connections: Toxic Victims or Mentally Ill ?
    The Triple Combination of Mental Health
    (Will be edited to include other combinations that apply)
    http://www.myspace.com/toxicreverend/blog/297023861

    ——

    Police shootings, Brutality & Steroid Abuse
    this posting is now aimed at busting the
    stigmas and stereotypes of cops and crooks alike.
    Pardon my macular degeneration:
    Needs editing, but the reference material is vetted and linked in
    http://www.waccobb.net/forums/showthread.php?38796-Roid-a-Cops-Police-shootings-Brutality-amp-Steroid-Abuse

    ——

    Blessings,

    Tom Krohmer
    Environmental Technologist
    Nephew of Jack Krohmer, deceased expert
    regarding the effects of radiation on humans.
    No known relationship to Jon Krohmer MD
    Chief Medical Officer of Homeland Security

    Toxic Reverend aka Tom Krohmer Google profile
    http://profiles.google.com/toxicreverend
    Toxic Reverend aka Tom Krohmer Google +
    https://plus.google.com/111485701979929741583/posts
    The Toxic Reverend – Revelations
    Less than 6% of 1,400 chemicals that threaten human health are tracked
    A 5-2-2000 Congressional Report is linked into blog of 1-23-10
    “As an Environmental Technologist I can not imagine a health care
    system that could be viable when it ignores toxic chemical exposures”
    http://toxicreverend.blogspot.com/

  • Joan Weinstock said:

    Original statement is much too abstract. Need a real Outcome approach

  • Laurel A Stroman said:

    Recovery is not just about personal changes and attitude about ourselves, but includes how we are viewed and treated by society as well. Real change, in understanding and acknowledgement of those with lived experience of mental illness as capable, independent thinkers, worthy of being treated as such is the most important thing here. I’m tired of hearing people disagree with the decisions made by my clients, just becuse they wouldn’t make the same choices. In order to function in the “real world”, persons with mental illnesses, need to be able to control what is happening in their own lives, and guess what? They will fail and make mistakes, just like the “chronically normal” will, and it’s their right to do so. What is important, is that they have the support that they need to ‘recover’ from a bad decision, just like everyone else. CBFS, is what will make it possible for these individuals to live the most ‘normal’ lives possible.

  • Steve Milligan said:

    What appears to be missing from the proposed definition is a statement that “recovery” (as opposed to the process of recovery) means living like people without a mental illness live, the core elements of which are having your own place to live, a job, and a partner and/or family. The proposed definition should be revised to make clear that people will be able to achieve “recovery” in this sense, which is readily feasible with current technologies promoted by SAMHSA, including scattered site supported housing, supported employment, assertive community treatment (ACT) and peer support. In addition, the proposed definition must include the explicit expectation that service systems will be re-oriented to enable individuals to live in their own place, have a job, and have a partner and/or family.

    These elements are critical to make recovery a meaningful concept rooted in concrete expectations about what is needed to afford individuals with mental illnesses the opportunity to live full lives as members of their communities, consistent with the ADA’s integration mandate and the Olmstead decision. Without these elements, the proposed definition of recovery would enable service systems to continue treating individuals with mental illnesses living much as they have in the past, without providing the chance to live the same way that the rest of us do. The definition of recovery cannot be one that permits these individuals to remain dependent while “working on” a recovery that public service systems can and should put in their reach. Recovery must encompass more than a set of slogans about hope, respect, relationships and purpose. It must include the specific expectations above that are necessary to make these concepts meaningful.

    Thank you.

  • Richard Stitt said:

    Please take serious the words stated by the Bazelon center for mental health law i agree with tem on this

  • Elizabeth Villalpando.Ellison said:

    Suggestions between :

    PURPOSE: …and the independence, income and resources to participate in society.

    Recovery is person driven: …exercising choice over the services and supports… …

    Recovery occurs via many pathways: Individuals are unique with distinct needs, strengths, preferences, goals, culture, and backgrounds  including trauma experiences

    NEW category:
    Recovery needs to have a safe place to be: individuals and their supports need to be able to achieve positive communication skills that allow both to be able to express their needs and desires with acceptance for input with consideration that each idea and expression is an opportunity for growth and healing.

    My apology…Just got in from travel on the road and hope this all makes sense.

  • Clarene Jordan said:

    Much of what has talked about really relates to adults. Just a mention that there are those who are most vulenerable; I’m talking about individuals with developmental disabilities who are children. The term dual diagnosis is often used to describe those individuals with co-morbid mental illness and developmental disabilities.

    Children with developmental disabilities are four times as likely to have a mental illness. Available treatment options are slim and none. As a child myself I had such a friend; you know the one that all the other kids picked on and called names. That child who others would play mean tricks on for personal amusement.

    These very vuneralble angles really need a public awareness campaign of their own, they need a community that is not only safe but one that is also nurturing and caring. We have simply got to move off dead center on this, denied of many public treatment options nothing short of community partnerships and collaboratings will do.

    We need an army of advocates equiped with the truth and armed with the spirit for developing communities of healthy living to get the job done. As the legitimate authority for all who suffer with mental illness SAMHSA should drive such a campaign but we as soldiers of recovery need also to walk the talk.

  • Doris J Meyer said:

    H.O.P.E. Health, Optimism, Perserverance, Education and Empowerment
    wrote essay in 2003 when employed by North Central Behavioral Health Systems.

  • B Sloan said:

    I wish I’d seen this in time to comment on the feedback site.

    The section on recovery and trauma is misleading. Not only are recovery from mental illnesses and substance abuse different, but often the trauma is caused by someone who is a substance abuser. For example, PTSD, a mental illness, can be a result of physical or other abuse by a substance abuser, not in the abuser, but in the abused.

    Second, recovery from mental illness should not mean that a person no longer takes a psychotropic drug. Rather, it should refer to the level of overall functioning in the recovering person. Some illnesses, just like diabetes and some heart problems, require ongoing use of medication to keep them at bay.

    As a former professional mental health and substance abuse counselor/program manager who treated patients with co-occurring mental illness and substance abuse, I have seen many people recover from both illnesses. The first “must” is to stop self-medicating with illegal substances and/or alcohol.

    The second “must” is to get a reliable diagnosis of the mental illness and treat it with appropriate drugs, alternative medicine and adjuncts such as exercise, counseling and relaxation therapy as needed.

    The third “must” is that people who live with mental illnesses are from all walks of life, educational levels, gender persuasions and economic levels. Forty percent of all people will suffer a mental illness at some point in their lives.

    Recovery is supported by a a reduction in stigma and discrimination by the public and by physicians and other providers. It’s time to make that happen.

  • Doris J Meyer said:

    Interesting, but many of us persons with poor mental health could not under stand the writings of author with, most likely, a Master’s or “Doctorate.
    Plain simple concise action plans for recovery are something we learn and use and remember. Can you define how you feel when you see a full moon?
    In the same manner, each persons recovery feels different, and
    I’m not sure if anyone has truly written how that feels. Your guidelines are great, just too detailed for my use. Thanks

  • Steve Milligan said:

    What appears to be missing from the proposed definition is a statement that “recovery” (as opposed to the process of recovery) means living like people without a mental illness live, the core elements of which are having your own place to live, a job, and a partner and/or family. The proposed definition should be revised to make clear that people will be able to achieve “recovery” in this sense, which is readily feasible with current technologies promoted by SAMHSA, including scattered site supported housing, supported employment, assertive community treatment (ACT) and peer support. In addition, the proposed definition must include the explicit expectation that service systems will be re-oriented to enable individuals to live in their own place, have a job, and have a partner and/or family.

    These elements are critical to make recovery a meaningful concept rooted in concrete expectations about what is needed to afford individuals with mental illnesses the opportunity to live full lives as members of their communities, consistent with the ADA’s integration mandate and the Olmstead decision. Without these elements, the proposed definition of recovery would enable service systems to continue treating individuals with mental illnesses living much as they have in the past, without providing the chance to live the same way that the rest of us do. The definition of recovery cannot be one that permits these individuals to remain dependent while “working on” a recovery that public service systems can and should put in their reach. Recovery must encompass more than a set of slogans about hope, respect, relationships and purpose. It must include the specific expectations above that are necessary to make these concepts meaningful.

    Thank you.

    • Ilene Flannery Wells said:

      Quoting from the Olmstead Decision…”We emphasize that nothing in the ADA or its implementing regulations condones termination of institutional settings for persons unable to handle or benefit from community settings.” and that “the ADA is not reasonably read to impel States to phase out institutions, placing patients in need of close care at risk. Cf. post, at 2—3 (Kennedy, J., concurring in judgment). Nor is it the ADA’s mission to drive States to move institutionalized patients into an inappropriate setting, such as a homeless shelter, a placement the State proposed, then retracted, for E. W. See supra, at 8. Some individuals, like L. C. and E. W. in prior years, may need institutional care from time to time “to stabilize acute psychiatric symptoms.”.

      Therefore, not only does the Oldmstead Decision uphold a person’s right to be treated in the community, it also upholds a person’s right to be treated in an institution, when appropriate.  Some people need longer than the average 6-8 days that is afforded people in a general hospital to recover enough to live in the community. By providing access to the appropriate treatment, including in-patient along with out-patient treatment and appropriate community support, there would be a better chance of recovery. Therefore, the Medicaid Institutes for Mental Diseases.(IMD) Exclusion should be repealed. By not covering in-patient treatment in a psychiatric hospital or residential drug addiction treatment facility, the Medicaid IMD Exclusion is discrimination and goes against the Olmstead Decision. http://www.paulslegacyproject.org

  • Mitchell Klein said:

    One of the responders wrote that “I find that there is no true recovery for mental illness or drug or alcohol addiction.”

    As someone with over 36 years of true recovery from alcohol and other drug addiction and over a decade free from nicotine addiction and living in the community, working and being a part of my community living with many diagnoses including those so-called serious mental illnesses (the biggies) I am saddened by that statement that there is no true recovery.

    That is the biggest problem with many in NAMI and the Treatment Advocacy Center people. They mostly believe that there is no recovery. They feel that people with a psychiatric diagnosis are carrying some sort of incurable disease (in fact, NAMI does call us carriers in one of their manuals) and we need to be institutionalized and chemically restrained by force for as long as we live. They believe that if they don’t like a behavior or the way we act they have the right to force us into shackles and incarceration whether it be physical or chemical. They would have done so with every creative, artistic and free-thinking person and imagine if there was a NAMI or a Treatment Advocacy Center around when many of the great works of art and music were being created. The genius of those artists and musicians would have been destroyed by forced treatment , medication, psychosurgery and we would not have their work to look at, listen to or enjoy today.

    How many children were locked up, lobotomized and forgotten in institutions just because many NAMI type parents didn’t like them being rebellious or moody? Imagine if the parents of Dali, Picasso, Motzart, Michelangelo, Van Gogh belonged to NAMI or were part of the Treatment Advocacy Center? What a great loss in the name of physical and chemical restraints in order to lock-down behavior by calling them symptoms.

    These so-called advocates for the so-called mentally ill want us to be like them (God forbid). Recovery is not an end but a continuing process and way of life. These draconian miscreants want us to emulate their way of thinking that there is no recovery, that no one gets well and people with bad behaviors should be locked away and physically and chemically restrained.

    Maybe someone should be discussing recovery from many in NAMI and the Treatment Advocacy Center! After all, those both appear to be incurable diseases and symptoms of the dark ages.

    I have recovered from addictions for more than 36 years. I still hear voices and still work and live in the community. I till live and love and am free from chemical restraints. I am very serious and persistent when it comes to fighting against adherents of draconian methods proven to only stifle creativity and destroy freedom. Let’s discuss recovery from many in NAMI and the Treatment Advocacy Center since we have pretty good definitions already for other recovery issues. No one seems to be talking about those other serious and persistent diseases of force and restraint and the belief that there is no such thing as recovery when there are many millions upon millions who have recovered and continue to recover despite the efforts of the brain diseases of many in NAMI and the Treatment Advocacy Center.

    Not all NAMI members are evil. There are many who are real advocates but unfortunately, many buy into those on the dark side without really looking into the entire picture. They buy into the fear mongering and lies and partial truths. They buy into the manipulation of statistics to keep the stigma going all in the name of love and caring for something they live with, fear and want to control. Many do want what is best for their loved ones but have been lied to as to what is best.

    • Ilene Flannery Wells said:

      That is absolutely false. In fact, I have been vocal about how NAMI seems to not acknowledge that for some people with the most severe and persistent mental illness, recovery to the degree where then can live on their own is not possible. That was the case for my brother who went 32 years without one day of lucid thinking. All NAMI talks about is how recovery is possible and placing people in the least restrictive setting in the community.

      Unless we realize that each case is different, and accept that a certain portion of people with mental illness, just like any other illness, do not recover fully, then we will continue to have people becoming homeless and incarcerated because they are not in the appropriate supportive housing and not properly supervised.

      The Treatment Advocacy Center members are realistic, and propose realistic methods.

  • christopher bates said:

    I am/still suffering from scitzoaffective disorder, I’ve been dealing with it since early childhood,This is not easy to deal with,nor is it easy for other’s around me to deal with,they only tollerate me from time to time,I’m far from stupid but got my paranoia that eat’s at me,Prison is no place for those who suffer like me,
    it has only made my disability worse,given me a new reason to care less about my fellow human being.so recovery you want to know what would define recovery,I can only speak for my self on this one.Recovery for me is not some pill being forced down my throat,one that puts me into this daze or sleep state for over half of the day then when i do wake up im not all there. It would be more like to show me the good side of life the good in nother person not how devious or evil we humans get/are. For I’m only a victum of my own mind
    and as of now I am soon to be 29 years into this life,I watch over my sholder constantly beliving some one is soon to trick me then make me there “friend” just to stab me in the back. I’m quite smart to a certine point easy to be decived,but then easy to find my self disregarding another’s right to belife or even live (if sever enough) so recovery, to show me the better side of life how to help your fellow human being who’s strggeling in this life. I’m only getting worse each passing year,any more i find myself fighting for the will to live.
    not to kill myself or remove myself from life but to disregard some of the more dangerious situation’s in life.Show me your best way’s you have found to live,then i will too show you a kinder, gentler Type of me.(greed is not one well way to live either)

  • C. Cohen, RN said:

    I support the Nami position which is:
    First, there should be acknowledgement that not all people living with serious
    mental illnesses are capable at all times of exercising self-determination. The goal of assisting these individuals compassionately to reach the point where they are capable of exercising autonomy and self-determination is extremely important. But, it must be acknowledged that some people suffer horrendous consequences and the worst forms of trauma because they choose to forego treatment and assistance when they most need it. A compassionate, recovery-oriented system does not abandon those individuals most in need. Whether through ACT teams, peer counseling and supports, psychiatric advance
    directives, guardianships, or, as a last resort, court orders, mechanisms need to be in place to help these individuals so that they can reach the point of being able to exercise autonomy and self-determination.

    Second, SAMHSA must clearly acknowledge the critical role that families of adults
    living with serious mental illnesses frequently play in the lives of their loved ones.
    Currently, principal # 2 only acknowledges families and caregivers of children and youth as having a legitimate role. This blatantly disregards the role that families of adults assume in so many instances. NAMI’s members know all too well that families often constitute the final safety net for individuals in crisis who have been abandoned by the mental health system.

    Third, NAMI believes that it is important to acknowledge that recovery means
    different things for different people. For some individuals, recovery means the ability to live independently and autonomously. For others, it means the ability to live safely in the community outside of hospitals or correctional facilities. These are not static concepts – we are aware of many inspiring stories of recovery of individuals who needed intensive services and supports at one time to live in the community but no longer need these levels of support. But, it is very important in this document to recognize and acknowledge the needs of individuals who need more intensive services and supports. This is particularly a risk in the current economic climate.

    Finally, NAMI joins the Bazelon Center for Mental Health Law in urging SAMHSA to
    expressly acknowledge the specific services and technologies crucial to helping people achieve and sustain recovery, including supported housing, assertive community treatment (ACT), supported employment, peer supports, integrated mental health and substance abuse treatment, and others.

    • Ilene Flannery Wells said:

      Thank you for this. NAMI also supports the repeal of the Medicaid Institutes for Mental Diseases (IMD) Exclusion which is partly responsible for the lack of access long-term treatments in an in-patient facility to those who truly need it. This has effectively created a denial of care, which prevents recovery. Even the Olmstead Decision, the Supreme Court decision that upheld a person’s right to live and be treated in the community. The following are quotes from the decision…”We emphasize that nothing in the ADA or its implementing regulations condones termination of institutional settings for persons unable to handle or benefit from community settings.” and that “the ADA is not reasonably read to impel States to phase out institutions, placing patients in need of close care at risk. Cf. post, at 2—3 (Kennedy, J., concurring in judgment). Nor is it the ADA’s mission to drive States to move institutionalized patients into an inappropriate setting, such as a homeless shelter, a placement the State proposed, then retracted, for E. W. See supra, at 8. Some individuals, like L. C. and E. W. in prior years, may need institutional care from time to time “to stabilize acute psychiatric symptoms.”. Therefore, not only does the Oldmstead Decision uphold a person’s right to be treated in the community, it also upholds a person’s right to be treated in an institution, when appropriate. 

      I have urged SAMHSA to join NAMI in their efforts to repeal this discrminatory and dangerous law. If you do not know about the Medicaid IMD Exclusion, please go to my website, http://www.paulslegacyproject.org, where I have linked to some of NAMI’s statement about it.

      Having access to apropriate treatment, and in-patient treatment if it is called for, is necessary for recovery.

  • Charlton Hall, MMFT, LMFT said:

    “Unless we acknowledge that those living with mental illnesses are not always able to make clearly considered and informed self-determinant decisions about their recovery options, we stand no chance of leading them to the point that they can do so. ”

    The problem here is that we should practice a person-centered approach to therapy. In other words, the patient should decide when they need help. Otherwise we’ve set ourselves up as the ultimate authority. Granted, people with mental disorders may not always be competent to make such a determination, but how do we know their counselors are mentally competent to make that determination?
    This is the conundrum of addiction treatment. By taking control away from the patient, we perpetuate the problem.

    • Ilene Flannery Wells said:

      The problem with lumping addiction treatment with mental illness, is that there is a significant number of people with severe forms of mental illness that also lack insight to their illness. It is called anasognosia. We need to ensure that those who are the most seriously ill and who also lack insight receive treatment.

      • joan weinstock said:

        I agree with this letter whole heartedly. Having family(3 adult sons with bipolar illness), and having worked with female prison inmates with addiction problems for 15 yrs, those with severe mental illness, even with high IQ’s, do not have the insight needed to get the proper treatment.

  • Jane said:

    I have a grown son with bipolar(newly diagnosed). He lives with me. We take it day by day. We only have each other. I have had my anxiety and moods over the years. We have suffered alot of death of loved ones together. Medications are necessary for us. Open communication, lots of patience, love and God is what we use also. I support NAMI in urging SAMHSA….VERY IMPORTANT!

  • Paul Kuhn said:

    Recovery is the achievement of a level of empowerment necessary to control outcomes regarding one’s own mental health.

  • Judith M. Craig said:

    Recovery is not complete in my experience until one is helping others.

  • Patrick Hendry said:

    It is likely that all of the comments and contributions, that have been offered by people from throughout the country, are valid. When combined with the 4 dimensions and 10 guiding principles the single sentence definition of recovery does capture the essence of the concept The reality of recovery is that while there are certain commonalities in our individual pursuits of the goal, it is a unique experience for each of us. I have read the definition in the context of applying to adults. I believe that when applied to children, recovery takes on a different set of benchmarks and even goals and it requires a similar but more specific definition.

    It is impossible to capture the full concept of recovery in a single sentence or even with the addition of 4 dimensions and 10 guiding principles, but it is possible to capture the essence and I believe that this does achieve that goal.

  • Michael Gerber said:

    I see both sides of the TAC/NIMH vs. 12 steppers debate about the role of choice. First, choice is essential in recovery. However, so is safety. Safety of the person in recovery and also safety of the community. This is the balance that needs to be considered when deciding if it is neccessary steps areto be taken to limit choice. An example would be police involvment for non-voluntary hospitilizations. Other compelling examples are from people who have commented above about having family members with schizophrenia. In this situation, the decision to limit/take away choice is a serious one, and should be addressed in the principles if not the defintion itself to recognize and emphasize its importance.

    I would a few sendtences to the “person-driven” principle section. Something after the paragraph that’s already there like, “There are times when it is apropriate for the community or health professionals to set limits on the choices of an indidual in recovery. These times are very limited and is a very serious decision and mostly involve serious chronic mental illnesses (such as bipolar and schizophrenia) when the persons safety or the publics safety is at risk. If deciding to take these steps please consult with a mental health professional, or, if this situation is forseeable, the person themselves when they are stable (like a WRAP) plan.”

    What I just wrote needs to be edited so it reads less like “mental helath professionals talking to eachother” but I believe it’s a start.

    2 more things. As for including neurology and brain chemistry, I think it’s smart for SAMHSA to leave this alone for now. As for people clamoring for the inclusion of spirituality it’s already in there in the holistic principle section. I also think it can be inferred from the definition itself. Terms like, “wellbeing” and “full potential” leave the door open to include spirituality without preaching dogma.

    I find this very interesting debate and just wish I had commented before the deadline.

  • Lisa said:

    Hope is a big part of recovery but unless it is nutured by family, friends, and a client’s treatment team it can be difficult to keep one’s hope alive

  • Canzada Twyman said:

    Canzada T.
    September 10, 2011

    First I must say everyone has such great responses to the process of Recovery. However, we all know that re is a prefix that means to do over again and the word cover is a noun meaning to conceal, this takes action. Therefore, RECOVERY is an opportunity to return to a normal condition, to change back. RECOVERY takes action and the action is a life long process of change.

    I agree that guidelines are needed and I strongly believe that the RECOVERY process is a life long spiritual journey and a daily change of action must be implemented. For every human being has, have or is RECOVERING from something.

    RECOVERY requires one to Explore within and identify with self and others. Upon exploring one will be willing to Expose his or her wrongs and become responsible for their own actions. Upon exposing and becoming responsible, one will Experience a daily change of action; a new life of HOPE, HUMILITY and HAPPINESS.

    RECOVERY is returning back to NORMAL CONDITIONS,which requires CHANGE!

  • Millard said:

    Real recovery can be defined as when a person is able to live a relatively normal life on medication and able to support themselves. If they can integrate in the community and lead a fulfilling life, then that is a great success.

  • George said:

    My brother suffered both substance abuse and schizophrenia as a young man. At the time we were unable to help him as well as we might. For us, it was impossible to separate the symptoms – for many family carers, their only experience is what they have to live with in that one sufferer close to them. Would perspective have helped? We were too busy with our immediate problems to take time out to consider.

  • Robert Arvin said:

    How in Heaven’s name could you classify Mental Illness as Behavioral…Oh maybe the SAMHSA people are smoking medicinal marijuana
    now that would make sense!!!

  • Judith Rosenberger said:

    In NYC recent reports show homelessness reduced drastically by changing to small, neighborhood, staffed shelters with services toward housing, vs. old system of mass shelters which are dislocating and anonymous. Doesn’t this apply to substance recovery too! People treated as people with needs and problems and strengths and potential rather than as pariahs to be dealt with grudgingly and at the greatest distance possible. That’s why I say again, community, membership, and respect as well as a way forward is the key, not just treating symptoms.

  • Peggy Mangold said:

    This is very informative and i will share this with our members. Thanks for all you do. Peggy Mangold President Nami Rowan, Salisbury, Nc.

  • Terri Brookshire MS, SAC-IT said:

    Recovery is the mental decision to live a safe and secure life with supportive servces that reach the end results of the stages of change.

  • Mitchell Klein said:

    Someone wrote – “How in Heaven’s name could you classify Mental Illness as Behavioral.” In order to “diagnose” a psychiatric problem, there are certain criteria one has to meet. These criteria describe what? BEHAVIORS. Despite all the posturing about neuro-biological, mumbo jumbo, there is no medical test for a so-called mental illness. Observed and reported behaviors define meeting the criteria.

    Look at the research about how many people diagnosed with schizophrenia after a while lose all so-called symptoms. Even E. Fuller Torey in his book Surviving Schizophrenia states this as a fact. Is it faith healing? Miracles? Voodoo? Why is it that a large number of people with a diagnosis of schizophrenia no longer have this condition after a number of years. Spontaneous remission?

    Those who demand that behavior has nothing to do with psychiatric diagnosis are those who demand that people given those diagnoses be medicated, over medicated to the point of losing their lives up to 25 years earlier than everyone else. It is all about chemical and physical restraints and managing behavior. If Johnny sits, rocks and drools quietly he is being a good boy. It has been proven that coercion doesn’t work. The people who say they advocate for the “mentally ill” are only advocating for behavior management and not for the best interest of the person.

  • Fernanda said:

    Recovery needs everyone help, family, society, government and YOU.

  • Todd Chang said:

    Hope should always be kept alive, and I mean always. This is a benefit for not only the one who is undergoing recovery but also those who are near and dear to him/her.

  • Ron Wright said:

    What if the person has no insurance or money for any kind of treatment or programs. Can they use a faith based program that is not certified. What I see hurts me to the core. People who need treatment are being pushed aside and ignors because of money.

    Please e-mail me some information so I can assist these people at
    rlwrightalphaprogram@msn.com
    Thank you

  • Dave Lushbaugh said:

    Mental illness is essentially biological in nature. Mental illness affects behavior and behavior can affect mental illness but mental illnesses are not behavioral. The term “behavioral health” obscures and hinders effective treatment of co-occurring disorders. Also, because behavior is perceived as a matter of choice (“good” or “bad” behavior), the very term “behavioral health” can add to the stigma and discrimination endured by people living with a mental illness.

  • Thomas Mackiewicz said:

    I agree with every aspect of this definition of recovery, but I strongly disagree that the term spirit should be included. The social sciences will continue to be thought of as junk science if we continue to use long disproven terms like “spiritual”. How can this term be included when it can’t even be defined? How can it be included when it is unproven? I really feel that in order be the most effective, we must start relying upon evidence based treatment, not ancient superstitions.

  • Deacon Donald M. Clark said:

    Candidly speaking, rather than attack the word or term “spiritual” one should seek its definition by genuinely understanding its meaning as the origination of all phenomena. A phenomenon, the interpersonal relationship between man and God. The intimacy . . . that gives the purpose of why a Creator through divine will creates a planet and populates it with all types of living beings. Beyond that creation . . . a moral and legal code is developed for the highest order of the creation to follow by obedience. Of course, since a created being can only be free if there’s a choice of will! Thus, we have why the reason why drug addiction does exist. A bad choice or severe mistake has been made by a person and for them to get their life back together redemption must be sought and that can only happen if the power of spirituality is acknowledged, and by the way SAMHSA and CSAT does acknowledge the validity of spiritual endeavors as manifest in an ecumenical environment. So, the case is closed. Clinical methods don’t work all the time but spiritual approaches do if there’s faith in prayer and in the rhema action taken. Let’s get inner city homeless substance abusers into faith-based treatment. Local churches have ministries that are just waiting for a closer relationship with SAMSA in terms of social services delivery. Then, we can proclaim the evidence or assertion about the historical facts of how science evolved? Or should I say,of how -science- devolved from what’s spiritual.
    of how -science- devolved from spiritual!

  • Judith Rosenberger said:

    Recovery: I have a mixed reaction, more positive than negative. The emphasis on wellness over symptom reduction as the end goal is important, as is the recognition of meaningful roles in society as a measure of recovery. My negative/worry side is that there is a creeping reduction of societal and professional responsibility to make these things happen. It’s fine to say it’s a goal. It’s another to fund and oversee quality of care to make this happen. A very successful recovery program in Palm Springs just closed because start up private funding (as in 8 years……a serious contribution) was not joined by public funding, hence loss of support. This was a true recovery program with educational, occupational, treatment accessing, socialization, peer support, etc. etc. all rolled into a space set aside in space donated by a college. I’m not just mourning that loss, but saying that the good pilot, with several hundred “graduates”, was not taken on as something to support and replicate. So, I wonder about rhetoric versus hard money. We all know the economics show this is a huge money saver, but the acccounting/political schisms shift the issue around and accessing funding is a nightmare if even possible.

    In sum, the recovery definition is basically very good. I agree with some blogger who are queasy about “behavioral” terminology. I also worry about the incoming ICD requirements for insurance in terms of creating mayhem plus somehow helping insurance companies dodge reimbursements. All said though, anything is an improvement the further we can get away from short-term, and egregiously self-aggrandizing and misleading private treatment as the only options.

  • Steven Herman said:

    The new website design is very efficient and much more open, as far as being able to navigate and find new and interesting topics.
    I have a suggestion that I have thought of and I know for me personally it would help tremendously. What about a information/tips/forum/etc. “page” that would inform those who wish to “get involved with or bind the communities in which they live in?” I know for me personally being somewhat young and inexperienced in the realm of “community action, etc” could and would definately use the information/tips/whatever. I have an idea on how to streghten my community and reaching out to those that will be the future generations to come, our children. I know that I could use advice and tips to strenghthen my own ideas, and I’m sure there are others that would likewise utilize the information. I know that one of the keys to dismantle and weaken the drug cartels is by educating and informing the “future generations” of children. Arming them with all the arsenal they will need to protect our society from the heartless gangsters which are disillusioned in greed. Once we can reach their hearts then we can reach and change the altered paradigms that has entrapped the minds of our youth. I am in the conceptualization phase of an idea that will hopefully take root and bloom into dismantling the plague that infects our children. I hope this sparks innovation into the minds of all those who care about the future generations to come. Together we can and will create change!

  • Richard Haden said:

    Wow — the volume of responses speaks to the difficulty of definitions. Having worked for a number of years in recovery support organizations, definitions can be problematic. Should we say addiction or substance? What about behavioral addictions? etc.

    I appreciate the efforts of SAMHSA and bood luck with that!

    -Richard

  • Alan Levitt said:

    Suppose the parent with the addiction or significant MH problem dies. Or leaves the family. Or never attains recovery. In these instances, and countless others, children and family may have endured chronic trauma-like environments, family dysfunction, uncertainty, and perhaps observed or experienced violence. Even for those whose parents are in recovery, if not supported and helped IN THEIR OWN RECOVERY FROM THESE ADVERSE EXPERIENCES, their own life trajectories, can be negatively impacted, including greatly increased chances of their own SA or MH problems.

    Collectively, these family members far outnumber the parents who have the primary problem. Yet, in the “Recovery definition” – now pages long – there is minimal emphasis that this is recovery, too. Do we need to wait until these impacted family members get worse enough to be eligible for an assigned code?

    The recovery definition exercise should clearly state and underscore, that children and youth exposed to SA or MH problems in the home need their own support and recovery (whether or not the parent with the primary problem is involved).

    Alan Levitt
    National Association for Children of Alcoholics

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