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SAMHSA’s Definition and Guiding Principles of Recovery – Answering the Call for Feedback

22 December 2011 90 Comments

As part of SAMHSA’s efforts to provide stakeholders the opportunity to comment on the working definition of recovery and related guiding principles, several public feedback forums were run during the period August 12- 26, 2011. In addition to the forums, feedback was also submitted via the comments on the Recovery Defined – Give Us Your Feedback blog post.

The response to our request for feedback was tremendous and clearly demonstrated the field’s interest and concern on this important issue. The blog post received 259 comments.  The two forums combined had over 1,000 participants, nearly 500 ideas, and over 1,200 comments on the ideas. Over 8,500 votes were also cast in support of the ideas on the forums.

SAMHSA appreciates the many thoughtful responses and suggestions received.  All ideas were given careful consideration, and suggestions were incorporated into the final definition and principles (see below). Of particular note, we have added a preamble to the definition and principles emphasizing that there are many different pathways to recovery, and we have highlighted the importance of hope as the catalyst to the recovery process.

SAMHSA will disseminate the definition and principles as a resource to policy-makers, systems administrators, providers, practitioners, consumers, peers, family members, advocates, and others.   The definition and principles are intended to help with the design, measurement, and reimbursement of services and supports to meet the individualized needs of those with mental disorders and substance use disorders.

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SAMHSA’s Working Definition of Recovery from

Mental Disorders and Substance Use Disorders

The Substance Abuse and Mental Health Services (SAMHSA) recognizes there are many different pathways to recovery and each individual determines his or her own way. SAMHSA engaged in a dialogue with consumers, persons in recovery, family members, advocates, policy-makers, administrators, providers, and others to develop the following definition and guiding principles for recovery.  The urgency of health reform compels SAMHSA to define recovery and to promote the availability, quality, and financing of vital services and supports that facilitate recovery for individuals.  In addition, the integration mandate in title II of the Americans with Disabilities Act and the Supreme Court’s decision in Olmstead v. L.C., 527 U.S. 581 (1999) provide legal requirements that are consistent with SAMHSA’s mission to promote a high-quality and satisfying life in the community for all Americans.

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

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

  • Health: overcoming or managing one’s disease(s) 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 emerges from hope: The belief that recovery is real provides the essential and motivating message of a better future – that people can and do overcome the internal and external challenges, barriers, and obstacles that confront them.  Hope is internalized and can be fostered by peers, families, providers, allies, and others.  Hope is the catalyst of the recovery process.

Recovery is person-driven: Self-determination and self-direction are the foundations for recovery as individuals define their own life goals and design their unique path(s) towards those goals.  Individuals optimize their autonomy and independence to the greatest extent possible by leading, controlling, and exercising choice over the services and supports that assist their recovery and resilience. In so doing, they are empowered and provided the resources to make informed decisions, initiate recovery, build on their strengths, and gain or regain control over their lives.

Recovery occurs via many pathways: Individuals are unique with distinct needs, strengths, preferences, goals, culture, and backgrounds  including trauma experiences  that affect and determine their pathway(s) to recovery. Recovery is built on the multiple capacities, strengths, talents, coping abilities, resources, and inherent value of each individual.  Recovery pathways are highly personalized.  They may include professional clinical treatment; use of medications; support from families and in schools; faith-based approaches; peer support; and other approaches.  Recovery is non-linear, characterized by continual growth and improved functioning that may involve setbacks.  Because setbacks are a natural, though not inevitable, part of the recovery process, it is essential to foster resilience for all individuals and families. Abstinence is the safest approach for those with substance use disorders.  Use of tobacco and non-prescribed or illicit drugs is not safe for anyone.  In some cases, recovery pathways can be enabled by creating a supportive environment. This is especially true for children, who may not have the legal or developmental capacity to set their own course.

Recovery is holistic: Recovery encompasses an individual’s whole life, including mind, body, spirit, and community.  This includes addressing: self-care practices, family, housing, employment, education, clinical treatment for mental disorders and substance use disorders, services and supports, primary healthcare, dental care, complementary and alternative services, faith, spirituality, creativity, social networks, transportation, and community participation.  The array of services and supports available should be integrated and coordinated.

Recovery is supported by peers and allies: Mutual support and mutual aid groups, including the sharing of experiential knowledge and skills, as well as social learning, play an invaluable role in recovery.  Peers encourage and engage other peers and provide each other with a vital sense of belonging, supportive relationships, valued roles, and community.  Through helping others and giving back to the community, one helps one’s self.  Peer-operated supports and services provide important resources to assist people along their journeys of recovery and wellness.  Professionals can also play an important role in the recovery process by providing clinical treatment and other services that support individuals in their chosen recovery paths.  While peers and allies play an important role for many in recovery, their role for children and youth may be slightly different.  Peer supports for families are very important for children with behavioral health problems and can also play a supportive role for youth in recovery.

Recovery is supported through relationship and social networks: An important factor in the recovery process is the presence and involvement of people who believe in the person’s ability to recover; who offer hope, support, and encouragement; and who also suggest strategies and resources for change.  Family members, peers, providers, faith groups, community members, and other allies form vital support networks. Through these relationships, people leave unhealthy and/or unfulfilling life roles behind and engage in new roles (e.g., partner, caregiver, friend, student, employee) that lead to a greater sense of belonging, personhood, empowerment, autonomy, social inclusion, and community participation.

Recovery is culturally-based and influenced: Culture and cultural background in all of its diverse representations  including values, traditions, and beliefs  are keys in determining a person’s journey and unique pathway to recovery.  Services should be culturally grounded, attuned, sensitive, congruent, and competent, as well as personalized to meet each individual’s unique needs.

Recovery is supported by addressing trauma: The experience of trauma (such as physical or sexual abuse, domestic violence, war, disaster, and others) is often a precursor to or associated with alcohol and drug use, mental health problems, and related issues.  Services and supports should be trauma-informed to foster safety (physical and emotional) and trust, as well as promote choice, empowerment, and collaboration.

Recovery involves individual, family, and community strengths and responsibility: Individuals, families, and communities have strengths and resources that serve as a foundation for recovery.  In addition, individuals have a personal responsibility for their own self-care and journeys of recovery.  Individuals should be supported in speaking for themselves. Families and significant others have responsibilities to support their loved ones, especially for children and youth in recovery.  Communities have responsibilities to provide opportunities and resources to address discrimination and to foster social inclusion and recovery.  Individuals in recovery also have a social responsibility and should have the ability to join with peers to speak collectively about their strengths, needs, wants, desires, and aspirations.

Recovery is based on respect: Community, systems, and societal acceptance and appreciation for people affected by mental health and substance use problems  – including protecting their rights and eliminating discrimination – are crucial in achieving recovery.  There is a need to acknowledge that taking steps towards recovery may require great courage. Self-acceptance, developing a positive and meaningful sense of identity, and regaining belief in one’s self are particularly important.

SAMHSA has developed this working definition of recovery to help policy makers, providers, funders, peers/consumers, and others design, measure, and reimburse for integrated and holistic services and supports to more effectively meet the individualized needs of those served.

Many advances have been made to promote recovery concepts and practices.  There are a variety of effective models and practices that States, communities, providers, and others can use to promote recovery.  However, much work remains to ensure that recovery-oriented behavioral health services and systems are adopted and implemented in every state and community.  Drawing on research, practice, and personal experience of recovering individuals, within the context of health reform, SAMHSA will lead efforts to advance the understanding of recovery and ensure that vital recovery supports and services are available and accessible to all who need and want them.

90 Comments »

  • Paul Kern said:

    Just read your article about people’s responses to the concept of Recovery. Been in the movement since mid-1980′s. Am disappointed that mental health system in northwest overly reliant on using medications and have not followed the path(s) outlined above. Push here is to merge3 with healthcare systems and let medical prescribers and hospitals/hmo’s dictate the course of treatment.

    • Dupatta boutique said:

      Well recovery is very much dependent on the patient’s will power as well.because if a patient is psychologically thinks he is well.he will be well.

  • Daniel Brady said:

    Like the draft, need to talk about recovery in the sense of managing a a chronic disease. The goal is to manage the illness with the best tools available. The outcome is to have as meaningful, pleasant, and productive life as we can.

    • TK said:

      People need to get away from the disease mentality. There are too many arguments in support of choice. There are too many documented cases of spontaneous remission after long periods of heavy drinking to counter the disease approach. When alcohol is not present no disease can be physically identified. Disease boxes the individual which is destructive to recovery.

      • Mia @ FeelingSexy said:

        We are the best doctors for ourselves. No one could know us better than us.
        I totally agree with Tk. If we are mentally prepared for recovery, it will come by itself. But it needs a lot of great desire and working on ourselves.

  • Doug D said:

    How unfortunate that SAMHSA had to define “Recovery” as a process rather than an outcome.
    “A life in recovery,” as you put it, is not what people want or need. People want a life – period – a life that has nothing to do with the mental health system.
    You’re undemining real recovery when you define it as a life-long process, you also minimize the reality that life is a struggle for everyone and that people with a diagnosis should view their continuing struggles through the distorted lens of diagnosis, disease or illness.
    When you ask the right questions you will find that the vast majority of people who have been diagnosed with some sort of “mental illnes” or “psychiatric disability” want to support themselves and live independently of the mental health/social service system.
    Here’s a concrete, outcome-oriented defintion: Recovery has been reached when the individual is able to support themselves and live independently of mental health/social service systems while pursuing happiness and the quality-of-life that he or she desires.

    • Brandon J. said:

      “Vast majority” or not, the idea is to have a definition that is applicable for everyone living along the continuum of mental disorders and substance use disorders. You speak the concerns of a big group within a population, for sure, but there are some who need to live with the mental health/social service system in one capacity or another. The hope, I imagine, is that service can be painlessly integrated in lives of whomever needs it as opposed to forcing everyone out of it.

  • Jack Whalen said:

    I didn’t see a category for Baby Boomers and their life long addicitons of alcohol and drugs that started in the Woodstock era. I know you are familiar with these statistics but I will repeat them for any readers who are not.
    “America’s hidden epidemic” is a term the scientific community uses to identify the estimated 4.5 million Baby Boomers who continue to drink alcohol and abuse substances beyond 50.
    A 2010 study reported that people 50-59 increased their drug use by 4 percent in 2009, the highest of any age group. The study went on to say 90 percent began using drugs before they were 30 when the Woodstock generation was growing.
    The problem continues to worsen as 10 thousand Baby Boomers turn 65 every day.
    I have written a memoir of life in this generation including my 10 year recovery. Is there a particular publisher or literary agent sympathetic to our cause that I could notify. In the meantime I am trying to create awareness via Twitter.
    Thank you.
    Jack Whalen

    • Uncle Ronnie said:

      Glad to see others remember the very large group who is aboot to enter retirement under NO umbrell a of addiction recovery… some of us opem our heart, experience and training in addiction recovery as well as our years in recovery experience and progress. THX Uncle Ronnie In Christ Jesus – Dir GSM La Pine basin

    • Elaine Barr said:

      I would love to read your story….not as a publisher, but as one of the Baby Boomers you speak about.

  • Michael Gross, MD said:

    In my opinion, this definition of recovery will not lead to effective budgeting of state and federal funds to assist individuals in their recovery from addictions and mental disorders; nor will it provide much guidance to their families and communities as they rebuild from the damage left in the wake of these problems. First, the definition does not place an appropriate emphasis on the scientific method in developing new concepts of these conditions; there is barely a reference to the modern neurobiological theories of these disorders. It does not emphasize that evidence-based methodologies have been developed to evaluate treatments and procedures, and does not point out what the most effective approaches for recovery appear to be in 2011-2012. The definition is unfortunately so broadly inclusive, even-handed, descriptive, and comprehensive of all processes related to recovery that it provides very little guidance for focusing governmental efforts. Considerable progress has been made in the past 50 years in the understanding and treatment of many of these disorders but for some reason the knowledge gained is not included. As a community psychiatrist and a former member of a research group at NIH I am disappointed, even stunned.

    • Cliff McGlotten said:

      I believe that Dr. Gross’s sentiments are well grounded. Some addictions and many mental disorders such as schizophrenia, bipolar,and schizoaffective disorders etiology may very well be influenced by biological and genetic based factors combined with social factors. For such disorders social supports are necessary for recovery but so are evidence based therapies and medications.
      Cliff McGlotten LCSW
      NAMI-TX Veterans Liaison NVC

  • Judson Bliss said:

    Two comments:
    1. They use the term “non-linear”, but it seems a bit out-of-place in the sentence, “Recovery is non-linear, characterized by continual growth and improved functioning that may involve setbacks.” I don’t think this statement really captures the nature of feedback.

    2. I’m puzzling over recovery beginning with hope. I think that, if this is the case, too often we simply begin with being compassionate (just to be clear, I think compassion is important). However, I wonder where the hope comes from? Hope in what, that someone has compassion toward me? If I have a serious mental illness, am homeless, have burned all of my family bridges, and my illness preventing me from taking my meds (so I self-medicate), what hope do I have? These are very real issues.

  • Frances Purdy said:

    While the definition has included some of the feedback, I am stunned that the definition barely addresses the issues faced by children and their need to be supported in developing resiliency skills. The definition talks about “families” but does not even mention “parent” or “parent support” as a means for enhancing protecting factors. Use of substances and challenges to mental health begins overwhelmingly during childhood and much can be done before the onset of overt problems. When programs support parents, children, and young adults in developing positive emotional health patterns and are really accepted (funded), then we may be able to reduce the extensive need for “adult recovery” programs. At the very least, programs for young adults and adults built on the concept of resilience would approach recovery as a healthy process with family and community support rather being driven a goal defined by the mere absence of illness.

  • f10f1111 said:

    Like the draft, need to talk about recovery in the sense of managing a a chronic disease. The goal is to manage the illness with the best tools available. The outcome is to have as meaningful, pleasant, and productive life as we can.

  • Ron Unger said:

    While the document sounds very positive when read superficially, it seems to me it is still contaminated with the kind of thinking which actually makes it harder for people to achieve a full recovery.

    The document rightfully recognizes and highlights “the importance of hope as the catalyst to the recovery process.” But it then goes on to downplay the hope that anyone might fully recover and so no longer be defined in relationship to “their” mental disorder.

    It does this by defining recovery as “A process of change through which individuals improve their health and wellness, live a self-directed life, and strive to reach their full potential.” While this sounds positive and all, it is important to note that they are defining recovery as a “process” and not a possible endpoint.

    If one thinks about the common sense meaning of the term recovery, for example recovery from a cold, or from a broken bone, there is both a process of recovery, and an end state of being recovered. During the process of recovery one can still be defined as having the cold or the broken bone, though it is less pronounced as the recovery process proceeds: then at the end of the process, one is recovered, and the cold or broken bone is history.

    I think SAMHSA’s definition deliberately downplays the possibility, or hope, that people can achieve that kind of recovery in regard to mental disorders. In doing this, they are lining up with a defective mental health system that has long been criticized for lacking exits – for example, there is a DSM criteria for being diagnosed with bipolar, schizophrenia, etc., but no criteria for being diagnosed as having recovered, and people are routinely discouraged from even thinking along those lines. SAMHSA’s current definition offers hope that one can enter a process of recovery, but no hope at all that one can finish the process and eventually be as or more healthy mentally than before one was diagnosed.

    I also dislike the aspect of the definition where they say that recovery is the process in which individuals “live a self-directed life, and strive to reach their full potential.” I think we humans generally attempt to live a self directed life, and strive to reach our full potential. This stuff is not unique to “recovery.” By reframing this normal human striving as part of the process of recovery, SAMHSA is creating the expectation that an individual will always have to strive against the “mental disorder” to reach his or her full potential, and this reduces hope that the person can ever come to not be defined by the disorder.

    A person who is recovered on the other hand will still have to strive to meet his or her full potential, but that will just be the striving that we all have to do, it isn’t defined in terms of the “disorder” that one once seemed to have, and it is a process of life, not of recovery from a disorder.

    SAMHSA goes on to say that “Recovery pathways are highly personalized. They may include professional clinical treatment; use of medications; support from families and in schools; faith-based approaches; peer support; and other approaches.” This is all true as far as the recovery process goes – people do recover in many different ways – but if SAMHSA had been willing to discuss the end point of recovery, it might have had to look at how completing recovery would have to include getting to a place of no longer needing treatment. After all, one doesn’t need cold medication when one has finished recovery from the cold, or a cast when one has recovered from a broken bone. If SAMHSA had opened up a discussion about how the mental health system should work toward complete recovery, instead of just getting people engaged in the process of recovery and then stuck forever in that process, it then would have been forced to address the topic of how to help people get to a point where they don’t need treatments like medications, how to get off medications, etc. And this is apparently too controversial for SAMHSA to take on.

    Finally, while SAMHSA does mention the need to address trauma in the recovery process, it fails to address the possibility that trauma may have played a causal role in creating the “disorder” that the person experienced, and the importance of recognizing that fact in recovery. The document merely states that trauma can be a “precursor” to the disorder, as though it just happened to go along with it. Apparently SAMHSA is still bowing to those who want to see mental disorders as strictly biological, and would be too threatened by any recognition that trauma can cause the experiences and behaviors that get diagnosed by the DSM.

    SAMHSA is certainly more progressive than many other agencies, but at the same time, it is way behind where it should be. I look forward to the day when SAMHSA can help the mental health system orient itself toward recognizing that people’s “mental disorders” often have their origins in what happens to them, and toward helping people fully recover to a point where they don’t need treatment and they don’t need to define themselves as being in a process of recovery, but instead just in a process of living.

    • Rick Eash, CI said:

      Ron, your points are well made.
      As a “recovered alcoholic/addict” I agree that there must be an end game in the recovery process. In the forward to the Big Book of Alcoholics Anonymous it says that we have “recovered from a seemingly hopeless state of mind and body”.
      The difficulty in defining the term “recovered” as it relates to mental illness or substance dependence is that “recovered” does not mean “free of disease”.
      Recovered is akin to spirituality in that you can’t quantify it, but you know it when you feel it

    • David Dickson said:

      I cannot agree more with you, Mr. Unger.

      In my substance abuse/dependence practice, I define recovery as the process in which the SYMPTOMS of abuse/dependence are lessening. I consider a person RECOVERED when they are no longer suffering from the symptoms of the disease(s).

      When I recovered from pneumonia, I did not continue to identify myself with the disease (I’m not a “pneumoniac”), I also do not identify myself with the disease of addiction anymore, as I haven’t suffered from the SYMPTOMS for over 20 years.

      I have an allergy to poison ivy. I have to avoid it. I am not, however suffering from my allergies to poison ivy.

      I have found that labeling people “addicts” or “alcoholics” for life takes away that “hope” that recovery emerges from. They would rather continue to fight the symptoms by themselves than be sentenced to a life-long “process” of recovery, with no end in sight.

      • TK said:

        I recently completed a book addressing my 35 years as a drinker, baby boomer, and now a recovered alcoholic. I created my own holistic program and ended an addiction that was trauma based. I took a lot of time in research and reflection understanding how myself and others in their generations became addicted and how many current treatment protocols are limiting and are compromising long term outcomes. I concluded there are many attitudes and beliefs and iconic terms that are archaic and limiting which support success rates or lack thereof.
        I think people need to understand how current environments are laying the foundation for future addiction that go beyond the traditional categories that are used to define traits of an alcoholic. Education will be important and a vehicle needs to be created to avoid the potential problem to the millions of boomers expected to fall into a category. I wrote as a layman who drank for decades but fell hard later when a series of traumas that took me to an addictive state. My adult environment was a precursor to what I experienced.
        Bravo for your approach on recovery. I would your patients enjoy a high success rate.

    • Sandra said:

      Mr. Unger,

      From my own experience with recovery from both alcohol addiction and co-morbid mental health conditions, I disagree with your premise that one can fully recover from thes “disease” of addiction and many mental health conditions. That does not discourage me or diminish the hope that I will be able to successfully manage my diseases and live a fully functional and fulfilled life. However, I do see addiction as a disease, akin to diabetes, hypertension… both of which are progressive and more so when one does not continue to manage/treat the disease properly from the time of diagnosis; and perhaps even cancer – in which all of these diseases have periods of remission and recurrence/relapse.

      In the long definition of addiction, which was adopted by ASAM last year,(http://www.asam.org/research-treatment/definition-of-addiction) it makes this point in focusing the definition on the neurobiological basis of addiction and states although relapse (recurrence) to the active disease state is not inevitable, there is always that risk. Hence one may be in remission (recovery), but not cured and will always have to manage the disease to minimize the risk of relapsing into the active disease.

      In regards to your comment that the document merely mentions trauma as a precursor…I think it is well established (through evidence based research) that trauma of many sorts causes neurobiological changes within the brain, and can indeed be the precursor to mental health and addiction diseases. I think this document follows well with the definition offered by ASAM, not only emphasizes the biological basis, but also the genetic, psychosocial, envioronmental and social factors that contribute to the disease of addiction.

  • Uncle Ronnie said:

    As the entire world continues to service with adduction symptoms with little direction to the corretions to access! Not untending to bring this up,,, here. However, the flood of individiual reasons “WHY ones “wants/needs to self Medicate ought to be present in any/all recovery definitions… the link between can not be put aside. My own reasons to self Medicate eaamples for some I speak with as to the”WHY” namy relate to and are able to observe in others prior to deep addiction. Later Thx for all the efforts to save many of us… be not forgetfull of our creator in all of this. WE are all subject to a variety of addictions… many only hert the ones you love… Uncle Ronnie In Christ Jesus – Dir GSM La Pine – Certified Christian counseling – Suicide prevention and Addiction Recovery miniteries

  • Steve Byrd LADC said:

    The definition is incomplete and represents the reason relapse often occurs. It is living a self directed life that is the problem where addiction is concerned. This definition faills in its holistic approach to include a spiritual component that is absolutely necessary for sustained recovery.

    • LordFanny said:

      Explain to me how Spirituality doesn’t fall into the “Purpose” category outlined above. Notice that “learning your purpose” comes with working the 11th Step. It’s no coincidence.

      You’ve never met an atheist in your 12 Step groups? You know, that one person who uses the group or the principles themselves as the Higher Power or Good Orderly Direction that the program proscribes? In my area, that guy’s the resident old timer – with almost THREE Decades of Recovery.

      The 12 Steps give us a life worth living, not a life standing around a coffee pot for 12 hours a day.

      And if you read your literature a bit more closely, you’d see a few things about diversity in there.

  • Emma Goldman said:

    I’d like to second all the comments made by Ron Unger, above, and add another:

    SAMHSA’s use of the following language is disturbing and problematic:

    ■Health: overcoming or managing one’s disease(s) as well as living in a physically and emotionally healthy way;

    Those of us who are trauma survivors (the vast majority of people with psychiatric labels) do not have “diseases” – we are recovering from injuries. Also, many people who have psychiatric labels but are NOT trauma survivors also do not identify their emotional distress as a “disease.” The theory that mental and emotional distress are “diseases” is just that – an unproven theory- and there are many other theories that work for people. By using “disease” and “illness” language, SAMHSA is chosing one unproven theory out of many.

  • Linda said:

    Watch your grammar. Such definitions as these become iconic; therefore, they should be correct. The statement is “A process of change through which individuals improve their health and wellness, live a self-directed life, and strive to reach their full potential.”

    The subject of the relative clause that begins with “which” is the plural “individuals.” “Health” and “wellness” are “non-count” nouns (like gravel or rice)so they work as they are in the sentence. But, all that follows are adjective modified “count-nouns” which should be expressed as plurals, so “live a self-directed life . . . ” should be “live self-directed lives and strive to reach their full potentials.”

  • Laurie said:

    It seems one of the challenges is in trying to come up with a single definition that crosses the worlds of substance abuse- where lifelong abstinence has traditionally been seen as part of a lifelong reovery process, and the world of mental illness, which doesn’t have a history of the lifelong recovery process paradigm.

    I’m concerned about the statement,”Abstinence is the safest approach for those with substance use disorders.” Relapse from abstinence is common (85% of formerly opioid dependent people relapse within a year of going drug-free) and relapse is life threatening. For some people abstinence is safest, and for others, medication-assisted-treatment may be a better option.

    As long as there is still a raging divide between those who support “drug-free” vs. “medication-assisted” approaches, people mean different things by abstinence, so it is not a helpful term. If I’m on bup or methadone and not using unprescribed drugs, I may consider myself abstinent, yet a drug-free program or sober house might not let me live there.

    I recommend changing that language.

  • Dr. Kathy said:

    Finally, recovery is a cycle of awareness. We journey through life with all of our the trauma and good times. How we are able to cope depends on numerous things that we come into contact with. At time to pain is so great that one turns to alcohol or drugs to kill the pain. We as counselors need to recognize that we walk the walk with our clients and that their recovery is at their pace and their realization that the events that brought them into the world of addiction do not disappear overnight with yet another magic pill or counseling session. The wheel of recovery has many spokes, all of which enter into the picture of having one’s wholeness to go on and to become all one can be and is called to be.

  • Randy said:

    uh…. guys?

    Do the words “not drinking or using drugs” have any relevance to a definition of “recovery?”

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  • billp said:

    In the late 60′s I heard a tape made by an Oklahoman cowboy; whose words I brought to the Eastern US with me. I am still hearing the story every now and then. The man asked: “what do you get when you sober up a drunkern horse thief? His answer: “a sober horse thief”.

    No one speaks about “bottoms” anymore; but it is these ‘bottoms’ that create the climate for someone to endure the “pain of change” to actually become ‘self directed’ in a postive and lasting way. Character defects and shortcoming endure into the ‘being’ sober life.
    And there are ‘few’ who are willing to ‘feel that pain’ to get to the other side of it.

    With that said; I like the definitions given above; save for the absence of recognition that ‘pain’ is involved in each and every one of those definitions.It seems no one wants to admit or define that process. Except for administering some anti depressants or amphetamines to ‘kill’ that pain; which probably only delays the process.

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  • David Berry said:

    I am particularly pleased with the wording that supports abstinnance for substance abuse. In my 17 years of practice and studies, I have found that those that defend the so called “Harm Redcution” practice have motives that drive their philosophy. Upon inquirey, I have found that they have unrespolved personal issues (they are using), they are using or suffer from co-dependency and enabling tendencies in their own lives. If one does not have the the clicncal skills andabilites to dignose the extint of the neurological damage done by previous drug or alcohol use, and they support and condoned “controlled use” they contribute further to the neurological damage. This is malfeasance and some might say malpractice. I have never had, out of the thousands of pateints I have treated, anyone return to using and their life improved, in any area. It just doesn’t happen over the long term.

    • ALS said:

      Wow!!!! Those are major statements you are making by slandering the “Harm Reduction” Modality and the thousands that work in community behavioral health systems. I can definitely appreciate the fact that Methadone or Bup Tx do not usually turn out to be an end point to recovery but “opioid replacement therapy” services save millions from death everyday. So, as a professional and a recovering addict not on a “medically controlled or assisted harm reduction model of recovery” One most definitely agree that MMT or Bup Tx is a very valid approach in steping towards a full recovery and saving lives.If you don’t agree maybe TIP 43 can explain it better to you or you might need some higher education sir.No offense intended.

  • Alida Schuyler said:

    I have the feeling that my favorite guiding principle paragraph “Recovery occurs via many pathways” is going to get some heat since it didn’t insist that abstinence should be the only recovery goal but mere named it as the safest goal.

    As it is now, with 90% or more of the treatment programs being abstinence-only program, there is very little help for the person who would like experience fewer problems related to drinking or drugging but who may not be ready to quit. I believe insisting on abstinence has the unintended effect of causing people to wait longer to seek help. Waiting longer to seek help means that person and their families, employers, communities all suffer longer.

    When people have the option to try moderation or harm reduction, they face their problems sooner. Some go on to opt for abstinence and use 12-step support. Others are able to reduce their use enough to stay out of jails, hospitals, and keep their families. Some continue to have problems but that is also true of grads of abstinence-based programs.

    It is important to define recovery in a way that keeps options open so that people to get help sooner. SAMSHA, be a leader and don’t give in to pressure to define recovery as abstinence.

    • David Dickson said:

      Alinda:

      Would you believe that you are going to get support from someone who had to achieve complete abstinence to recover from his own dependence? I have been clean/sober for over 28 years and have worked in the field for about 25 years. I agree with you that complete abstinence is not the path for everyone.

      First of all, I have seen many people who were in “Substance Abuse” programs that were actually ABUSERS and not DEPENDENT. It is strange to me how we use those two so interchangeably, when they are two quite different conditions. This, I believe, is because substance abuse mimics the early stages of substance dependence. But if the only tool you have is a hammer, all your problems look like nails. So everyone gets the same treatment.

      The AA Big Book (and no, I’m not gonna “thump” it at you) is admittedly written for the “real alcoholic.” It specifically talks about moderate and some heavy drinkers that can quit with ease or even return to moderate use. Those people are obviously not chemically dependent. I have found many abusers can stop abusing (and abstain or moderate) when they address life issues and find better coping mechanisms.

      The treatment industry, in large part created and staffed by “real alcoholics” (and “real addicts”), has been driven by notion that what works for one works for all. Unfortunately, I have seen many people who have been treated for a dependence when they did not really have that condition.

      Similarly, there are many people who cannot “completely give themselves to (the) simple program” (of AA). What do we do with these people?? Do we kick them out of our programs because they can’t stay clean?? Do we refer them to a higher level of care, only to be kicked out of that program, too? Do we allow them to stay in our program, even though they continue to use?

      I don’t like the idea of recommending that someone who is addicted to substances continuing to use substances. It would not have worked for me. However, as a clinician, I want to see their symptoms (and consequences) lessen in intensity. In some cases a harm-reduction model can effect those goals much better than I can with my abstinence-based approach. If that is what it takes to get someone on the road to a personal “recovery” from addiction, then so be it.

      • TK said:

        I would agree with David to a point. Ultimately treatment has to be designed for the individual to separate mental health issues, chemical alteration, addictive thinking patterns that have evolved from longer term drinking, control issues, etc.
        The 12-step approach works affectively for some, and I understand why for that type of individual. It is also a platform that tells an individual they need to do so to gain sobriety, so it is a form of labeling manipulation.
        Statistically, comparing that group’s outcome to those able to consume in moderation is dramatic, especially when considering issues like increased FosB protein presence, sensitization and chemical alteration.
        To me, addressing addictive thinking patterns and behaviors through education is the key to addressing long term sobriety, along with source identification and resolution. Also key is the development of an emerging or new thought process and resultant behaviors through higher order learning. Resolution for this example, is moving far and away from the issue as it once existed. As education advances, I feel the need for supporting long term in-recovery principles will decline.

    • Sandra said:

      I believe the document states that abstinence is the safest approach to recovery, meaning that those with other mental health conditions, may be at risk of developing an addiction to a different substance (than their primary substance of choice), if medications with addictive potential are used in the treatment of the mental health disorder.

  • Bill said:

    I agree with Randy, who said:
    uh…. guys?

    Do the words “not drinking or using drugs” have any relevance to a definition of “recovery?”

    This definition is way too watered down and inclusive. Unclear as to the need to have a working definition for recovery that includes Addictions, Mental Health and Trauma victims. At the end of the day, this definition is so inclusive it says nothing at all

    • David Dickson said:

      Bill:

      When speaking of Substance Abuse Disorders, “recovery” may NOT necessarily mean not using mood altering substances.

      When speaking of Substance DEPENDENCE disorders I think it should include abstinence from use of all mood-altering substances except those that are medically indicated and prescribed by a physician who has full knowledge (and understanding) of the client’s previous substance dependence disorder.

      Just saying…

  • Scott said:

    “Recovery is non-linear, characterized by continual
    growth and improved functioning that may involve setbacks.”

    In my opinion this statement has the “feel” that for the dependent and many near dependent patients (for that matter many other lifestyle change processes and illness treatment), that recovery is something that is a steady process of growth that may (or may not) have a setback.

    Even though the term non-linear is used, “continual” and “may involve setbacks” need to be changed as setback is the norm, especially in early recovery and relapse rates are high.

    The ASAM in it’s definition of addiction states “Persistent risk and/or recurrence of relapse, after periods of abstinence, is another fundamental feature of addiction…”

    Even though SAMSHA’s current working definition of recovery is one that stresses hope, I think it understates the difficulty in the recovery process. In my opinion, and in agreement with many others, it ignores evidence-based concepts and the current knowledge base about the disease of “addiction”, these should have been woven into the statement.

    Finally, the statement “Individuals optimize their autonomy and independence to the greatest extent possible by leading, controlling, and exercising choice over the services” Really? Most of the patients we see are referred (coerced) by drug court, DSS, CPS, and the like which require abstinence as an outcome, harm reduction or moderation are not even on the radar.

  • Diana said:

    Recovery starts with desperation, not hope.

    I’m not confident that Mental Health and Addictions should be lumped together in defining Recovery, but I understand that you are coming from a broader perspective.

    Thanks for all your hard work and continued efforts. Overall, you did an exceptional job on a massive topic with much controversy.

  • Duane Sherry, M.S., CRC-R said:

    It’s time to transform the mental health system as we know it -

    http://discoverandrecover.wordpress.com/mental-health-freedom-and-recovery-act/

    Duane Sherry, M.S., CRC-R

    • TK said:

      Duane, I agree. With that in mind, there is a website called Research Gate, which is a world wide brain trust comprised of experts seeking advancement and improvement and resolution for all types of diseases, disorders, health, anti-aging, etc. I highly recommend that anyone who can contribute or wants to advance research in a significant way, join it.

  • Are You My Peer and Does it Really Matter? | Policy Research Associates Corporate said:

    [...] last year SAMHSA issued a new definition of recovery and support services.  This definition includes peers with lived experience in the [...]

  • SAMHSA’s Working Definition of Recovery from Mental Disorders and Substance Use Disorders | Policy Research Associates Corporate said:

    [...] LaVerne mentioned in her Are You My Peer? blog post on 5/24, SAMHSA recently developed a working definition of recovery and established guiding principles that support recovery from mental and substance use [...]

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  • Chethan Reddy said:

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  • Integrating Physical & Behavioral Health Services to Save Lives » AZ Dept. of Health Services Director's Blog said:

    [...] contract will be responsible for delivering both preventative, acute and primary care along with Recovery-based behavioral health services for folks in the public behavioral health system in Maricopa [...]

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  • Hussam said:

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  • adam said:

    Vast majority” or not, the idea is to have a definition that is applicable for everyone living along the continuum of mental disorders and substance use disorders. You speak the concerns of a big group within a population, for sure, but there are some who need to live with the mental health/social service system in one capacity or another. The hope, I imagine, is that service can be painlessly integrated in lives of whomever needs it as opposed to forcing everyone out of it.

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  • Mark said:

    I believe substance abuse is actually a form of either disolving reality or trauma from the use of drugs. I also believe 70% of disolving drug use tendencies is a constructive restructure of social groups. You are who you hang with is a short and direct understanding.

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  • Allen said:

    Grate article!Even though the term non-linear is used, “continual” and “may involve setbacks” need to be changed as setback is the norm, especially in early recovery and relapse rates are high.

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  • ilahiler said:

    I believe the document states that abstinence is the safest approach to recovery, meaning that those with other mental health conditions, may be at risk of developing an addiction to a different substance (than their primary substance of choice), if medications with addictive potential are used in the treatment of the mental health disorder.

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  • Lunar Land said:

    Recovery must encompass from the first day to make your mind, body and soul stronger. With out starting from these three principles of our existence, you will always make decisions based on emotions, which will always be the incorrect choices. Good Luck and stay strong to everyone!!!

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