Addiction, Recovery From
The SAGE Encyclopedia of Abnormal and Clinical Psychology
Addiction, Recovery From
Recovery from a substance-related and addictive disorder refers to a process of change through which affected individuals learn to manage their disorder and make positive changes to improve their physical and emotional well-being and their relationships. For those with more severe substance use disorders (SUDs), this involves abstinence from substances, having a stable and safe place to live, engaging in meaningful activities, and having a social network that offers support, friendship, love, and hope for a better future.
Alcoholics Anonymous (AA), Narcotics Anonymous (NA), and other mutual-support programs describe recovery as a program of change that involves participation in a fellowship with others with similar problems, who help one another by sharing their experiences, strength, and hope. The first step of AA and NA starts with the word we, rather than I, to convey the importance of recovering with the help and support of others in the fellowship. AA and NA promote recovery from a broader perspective that involves changes in the following domains: cognitive (thinking), social (relationships and social networks), family (making amends), psychological (acceptance of addiction, character defects), and spiritual (belief in a higher power, taking the message to others).
Many evidence-based behavioral interventions for SUDs educate the individual about recovery, provide options for recovery, facilitate linkage to community mutual-support programs and recovery supports, and monitor adherence and participation in ongoing recovery activities. One type of therapy, Twelve-Step Facilitation, focuses primarily on helping the individual engage in a twelve-step program, get a sponsor, and use the “tools” of the program. Interventions such as recovery management checkups or those provided by peers in recovery (sometimes called peer mentors, peer specialists, peer counselors, or peer navigators) also help people engage in long-term recovery or reconnect after a relapse.
Pathways to Recovery
There are many pathways to recovery, and no one approach is appropriate for everyone. An individual’s pathway may include a combination of the following:
Professional treatment programs and services (detoxification, rehabilitation, ambulatory, specialty care, case management, recovery housing, ancillary services such as vocational counseling): The more severe the SUD, the more likely the individual will need more extensive treatment and higher level services to stabilize and develop a long-term plan for recovery.
Medication-assisted treatment (MAT) for opioid, alcohol, or tobacco dependence: There are several U.S. Food and Drug Administration–approved medications for these addictions; for other addictions, medications are available, but they have not yet been approved by the Food and Drug Administration. MAT is used as part of a total treatment program involving professional care and participation in a mutual-support program. Any physician can prescribe medications for alcohol or tobacco dependence. Methadone for opioid dependence can be prescribed only by a physician at a licensed narcotic addiction treatment center that also provides counseling and on-site or referral to other medical, mental health, or social services. Buprenorphine for opioid dependence can be prescribed only by physicians with training and certification to do so, either in a treatment clinic or in private practice.
Mutual support programs (twelve-step programs such as AA and NA; non-twelve-step programs such as Rational Recovery, SMART Recovery, and Women for Sobriety; or faith based approaches such as Alcoholics Victorious and Celebrate Recovery): Peer support and fellowship are important components of these programs. Mentors, or experienced group members, can “sponsor” and teach a newcomer how to use the “tools” of the program, which may include meetings with peers, recovery readings, slogans to help counteract cravings or negative thinking, and specific principles (or steps) of change.
Support from family, friends, schools, church, and/or community: A connection with others can provide the individual with an SUD support and help with all types of problems or concerns. Such involvement also helps the family deal with problems caused or worsened by an SUD that affect the family unit and individual members.
Factors Affecting Recovery
Many factors determine how an individual engages in and benefits from recovery. These include the following:
The type, effects, and severity of the SUD: More severe SUDs require longer term involvement in treatment (including medications) and mutual-support programs to aid recovery, and referral to services needed for other problems caused or worsened by the SUD (e.g., medical, social, vocational).
Any history of relapse following a period of recovery: Those who have relapsed multiple times often need help with co-occurring mental health disorders as well as developing a stable support system.
Current motivation to change and engage in the recovery process: Motivation often changes in the early phases of recovery, but as long as a client remains in treatment and recovery, there is an opportunity to overcome dips in motivation.
The impact of the SUD on the family or other significant relationships: Negativity from the family can create stressors for the individual in recovery. When families are involved in treatment and recovery, stressors and other problems can be more effectively managed.
Availability of support from families, peers in recovery, and others: Individuals who actively receive support from others and participate actively in mutual-support programs improve their odds of stable recovery.
Demographic characteristics (age, gender, sexuality, employment status, ethnicity): For example, sexual orientation can influence recovery for men with alcohol problems who report that they socialize mainly at gay bars. Or an unemployed individual may need help securing financial resources, getting job training, or getting help finding a job.
Personality factors: For example, individuals with a high degree of impulsivity are at increased risk of relapse.
The existence (and severity of) a co-occurring mental health disorder: Untreated mental health disorders such as clinical depression may affect an individual’s relapse to substance use.
Cognitive factors and impairment: Older clients with signs of dementia may need help with living arrangements and in receiving services that help them manage their daily lives despite any cognitive impairment.
Access to professional services: If a client needs medication for an opioid addiction but has difficulty finding a local provider, the risk of relapse may increase.
Ability to develop a working or therapeutic alliance with a professional: A positive alliance is one in which the client feels accepted, understood, and not judged for behaviors or mistakes. Outcome of treatment is better for clients who report better alliances with a therapist or counselor.
The Process of Recovery
Persons with an SUD have to define their personal goals and find their pathways to recovery, which should build on their strengths and resiliencies. According to Dennis Daley and Alan Marlatt, recovery is an active process in which the person with an SUD.
learns about the SUD, its treatment options, recovery, social supports, and relapse;
increases self-awareness of the impact of the SUD on self and others, motivation to change, personal coping mechanisms, and barriers to change (individuals vary in their level of motivation, which can change from day to day);
improves or learns new coping skills to manage the symptoms of the SUD, make personal or lifestyle changes, and deal with the challenges of recovery (e.g., managing drug cravings, resisting social pressures to use, managing emotions);
involves the family or a significant other if appropriate, as others can provide help and support as he or she learns ways to reduce his or her emotional or financial burden;
engages in a mutual-support program to learn “tools” of recovery to manage the day-to-day challenges, connect with peers in recovery, and engage in a process in which there is accountability to others;
learns to identify and manage relapse warning signs and risk factors by identifying both common and unique warning signs and personal risk factors, and learns to use specific strategies to not return to substance use (most clinical approaches focus on relapse prevention strategies to enhance recovery and reduce risk); and
intervenes early in a lapse or relapse to limit the damage of substance use after a period of recovery (since many relapse, preparing to take quick action can minimize the damage of a lapse or relapse).
Domains of Recovery
Not all clients are interested in recovery or making changes in their lives. Some want to quit or cut down substance use and not change, whereas others want to engage in a long-term recovery process to manage their SUD and improve their lives by making specific changes. Domains of recovery refer to areas in which change may be made. As shown in Table 1, these include physical and lifestyle; psychological and emotional; behavioral and cognitive; family; interpersonal and social; and personal growth and spiritual domains. Specific areas addressed depend on the individual’s problems and needs.
Table 1 Domains of Recovery From Substance Use Disorders
How to Measure Progress
Individuals with an SUD can measure their progress in recovery in several ways on a continuum of improved health and wellness. First is abstaining from or reducing substance use. Although some individuals do not want to achieve sustained abstinence, they reduce the amount and frequency of substance use and function better. Second is addressing the problems caused or worsened by the SUD and making changes in any of the domains of recovery (see Table 1). The third issue, which is a by-product of the first two issues, is an improvement in the quality of life. As substance use is stopped or reduced, and problems improve, individuals often experience a better quality of life, as do families.
Many factors influence treatment and recovery, which is why an individualized plan is needed. For example, a person with chronic and lifelong alcohol dependence may need medical detoxification followed by a residential rehabilitation program, a halfway house program, and then ongoing care in an ambulatory program. In addition, this individual may benefit from medications for alcohol dependence and participation in AA. Or an individual who has a mild SUD (meeting two to three symptoms of the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition [DSM-5] criteria for a substance-related disorder) may benefit from short-term counseling. This individual may make sufficient changes with brief treatment and may not need long-term involvement in recovery.
Recovery for the Family
Many resources are available to help families affected by a loved one’s SUDs. These include professional programs and services, as well as mutual-support programs such as Al-Anon or Nar-Anon. Families can benefit even if the member with the SUD refuses to get help. Support and help from professionals or other families in recovery can help them increase their understanding of the SUD and how to manage their own reactions and the emotional turmoil that families often experience.
In recent years, the U.S. Substance Abuse and Mental Health Services Administration, other organizations, and professionals have promoted Recovery-Oriented Systems of Care (ROSC). ROSC is a coordinated network of prevention, intervention, treatment, and posttreatment services that support individuals and families in recovery. ROSC aim to (a) encourage communities to develop and offer recovery-oriented activities to individuals and families and (b) encourage providers to offer integrated, comprehensive, evidence-based care that builds on the strengths and resiliencies of individuals and families. The more organizations and communities are involved in promoting recovery, the more options there are for individuals with an SUD and for their families. The U.S. Substance Abuse and Mental Health Services Administration also promotes the importance of safe and affordable housing, and employment and education opportunities for individuals with SUDs. These are associated with improvements in many areas of life for those with an SUD.
Dennis C. Daley http://dx.doi.org/10.4135/9781483365817.n19 10.4135/9781483365817.n19 Further Readings Daley, D. C., & Marlatt, G. A. (2006). Overcoming your alcohol or drug problem: Effective recovery strategies (Therapist Guide, 2nd ed. ). New York, NY: Oxford University Press. McDonald, J., & Daley, D. C. (2013). Online resources list for substance use disorders and co-occurring disorders. In A. Douaihy & D. C. Daley (Eds.), Substance use disorders: Pittsburgh pocket psychiatry (pp. 359–385). New York, NY: Oxford University Press
Contributors: Dennis C. Daley
Edited by: Amy Wenzel Book Title: The SAGE Encyclopedia of Abnormal and Clinical Psychology
Chapter Title: "Addiction, Recovery From"
Pub. Date: 2017
Access Date: April 13, 2017
Publishing Company: SAGE Publications, Inc.
City: Thousand Oaks,
Print ISBN: 9781483365831
Online ISBN: 9781483365817 DOI: http://dx.doi.org/10.4135/9781483365817.n19
Print pages: 27-30 ©2017
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