Background: History is incredibly important to how we understand ourselves, where we came from, where we stand now and to assist us in determining our pathways forward. Few things are more important to me than understanding the New Recovery Advocacy Movement and to support efforts to move us towards an expanded recovery community across America.  As addiction is arguably our most profound public health challenge, recovery in all its diversity offers the greatest hope of restoration at the individual, family and community level. 

This year marks the twentieth anniversary of the historic 2001 Recovery Summit in St. Paul Minnesota. I felt that one of the most important contributions I could do would be to collect some of the recollections and thoughts of recovery leaders who were present at this historic event. I have developed a series of questions I hope to ask as many attendees as I can locate over the course of the coming months. My goal is to document their recollections on what the summit meant to them, the accomplishments of the new recovery advocacy movement that rose out of this historic summit and thoughts for the future.

Bill White, the widely regarded recovery movement historian, writer, researcher, streetworker, counselor and elder stateman of recovery who started working in it in 1969 has generously agreed to be my first respondent. I am deeply grateful to Bill for his life work on addiction and recovery and for his willingness to mentor and support so many of us across this movement nationally, myself included.

Questions to Bill White and his responses:

• Who are you and what brought you to St Paul at that time?

I am a person in long-term addiction recovery who has worked in the addictions field for more than 50 years in such roles as outreach, counseling, clinical supervision, recovery research, and teaching. I have also spent most of those years researching and writing about the history of addiction treatment and recovery in the United States. I am currently Emeritus Senior Research Consultant at Chestnut Health Systems.

By the late 1990s, I was convinced the addictions field needed to shift its central organizing framework from a focus on addiction pathologies and brief clinical interventions to a focus on the prevalence, pathways, styles and stages of long-term personal and family recovery. I also was advocating the extension of brief clinical models of treatment to a model of sustained recovery management nested within a larger recovery-oriented system of care.  As a recovery historian, I had begun to document the rise of new and renewed grassroots recovery community organizations (RCOs) and what I was labeling a “new recovery advocacy movement.” In 2000, I began writing papers on this emerging movement, drawing on my experience working with these new RCOs and my consultations and presentations to those RCOs funded under CSAT’s newly developed Recovery Community Support Program (RCSP). At this time, I was also serving on the Board of Recovery Communities United in Chicago, one of the RCSP grantees.

In early 2001, I was asked by William Cope Moyers (Johnson Institute) and Jeff Blodgett (Johnson Institute’s Recovery Alliance project) to participate in a planning meeting to explore the possibility of a national recovery summit that culminated in the St. Paul Recovery Summit in October 0f 2001.    

• Is there a particular moment or memory that stands out to you from that summit?

I have vivid recollections of the wonderful presentations and the working sessions at the Summit, but those are not what most stand out for me. What mattered was that we were there together as “people in recovery”—an identity that transcended all other identities and boundaries. At that meeting, we became “a people” apart from our affiliation or lack of affiliation with any particular recovery mutual aid group or any other personal or professional identities we might claim. By the time I arrived in St. Paul in 2001, I had been in thousands of meetings without ever sensing that any of those events were history making.  The Recovery Summit in St. Paul was different. There was electricity in the air from the moment we gathered and I distinctly remember thinking at one point that what we were doing could mark a new chapter in the history of addiction recovery—a line in time between that in the future would demarcate “before” and “after.”  You see, many of us knew of each other but we had never gathered as recovery advocates. The energy generated by finally placing so many of us in one place was amazing. That energy and its resulting shared vision is what I most remember. 

• What did you see as the motivating factors that brought you all together for that historic summit twenty years ago?

The historical context was important. There was awareness of the failure of earlier organizational efforts such as the Society for Americans in Recovery (SOAR) and calls for extending the historical work of the National Council on Alcoholism and Drug Dependence (NCADD). The Summit was in many ways a call to take recovery advocacy into the 21^st century. We had lived through the demedicalization, restigmatization and intensified criminalization of addiction in the 1980s and 1990s that resulted in the mass incarceration of addicted people. The Summit was a backlash against such practices led by people who offered living proof of an alternative. New grassroots and renewed RCOs were popping up around the country. The summit was an acknowledgement of their existence and an expression of their aspirations. Since 1998, The Center for Substance Abuse Treatment (CSAT) had provided seed money to a small cadre of RCOs via its Recovery Community Support Program (RCSP). The Summit was a way of extending that effort far beyond those few CSAT-funded funded RCOs. In some ways, the Summit was also a protest against the addiction treatment industry—the sense that people with severe, complex, and long-standing addictions were being recycled through brief episodes of care for financial profit of treatment organizations without regard to their need for long-term personal and family recovery support. Many of us had reaped the benefits of treatment, but we were also painfully aware of its limitations and the need for more vibrant and recovery-focused models of care. There were also groups like White Bison and the Recovery Association Project that were calling for us to move beyond clinical models of care to models of community organization and cultural revitalization. All of these influences stirred within the pot of the 2001 Recovery Summit.   

• How have we done in accomplishing those early goals? What do you see our greatest successes to date are?

What we have witnessed in the 20 years since the St. Paul meeting is in many ways far beyond what we could have dreamed of at that time.

We have witnessed the international growth and diversification of secular, spiritual, and religious recovery mutual aid groups as well as innumerable special needs support groups.

We have witnessed the cultural and political mobilization of people in recovery and their allies at a level that would have been unthinkable in 2001. And we are doing this in diverse cultural communities—far beyond that found in earlier recovery advocacy efforts. That we would have so many RCOs in the U.S. and that we would witness tens of thousands of people in recovery marching in public recovery celebration events was beyond what we could have thought possible during our deliberations in St. Paul.

We have launched major anti-stigma campaigns, including interrogating and challenged the language and images through which AOD problems have been historically expressed. These campaigns have normalized addiction recovery and broadened the pathways of entry into recovery in communities across the country. Early kinetic ideas within the recovery advocacy movement have garnered wide cultural and professional acceptance, e.g., “Recovery is a reality for individuals, families and communities,” “There are multiple pathways of recovery and ALL are cause for celebration,” “Recovery flourishes in supportive communities,” etc.

We have seen a dramatic expansion in new recovery support institutions: recovery community centers, recovery residences, recovery high schools and collegiate recovery programs, recovery-friendly workplaces, recovery ministries, recovery cafes, recovery-focused sports and adventure venues, recovery-focused art and music festivals, and on and on. This is recovery community building at its finest. We had only a glimmer of that in 2001. The recovery advocacy movement has been the engine driving such institution building—a critical step for any sustainable social movement.    

We have witnessed a dramatic increase in recovery representation with alcohol- and drug-related policy venues and the parallel emergence of recovery as a new organizing paradigm within the alcohol and drug problems arena. That we would have authentic recovery representation at the highest levels of state and federal drug policy was only a dream in 2001. Today, we are closer to that dream than ever before.

We have witnessed substantial work in extending acute care (AC) models of addiction treatment to models of sustained recovery management (RM) nested within recovery-oriented systems of care (ROSC), with a particular emphasis on precovery outreach and post-treatment recovery support checkups and support.  Peer-recovery support services provided across the stages of recovery mark a new conceptualization of the traditional addiction treatment continuum of care.

We are today witnessing efforts to integrate primary prevention, harm reduction, early intervention, primary treatment, and long-term recovery support services. We are now placing recovering peers in hospitals emergency rooms and other settings where addicted people experience their greatest vulnerability for harm.   

We have helped through our advocacy efforts to expand recovery research funding through NIH, inspired a vanguard of research scientists to focus their careers on recovery research, and supported the work of such new institutions as Harvard’s Recovery Research Institute.

I believe all of the above rest on the vision and strategies emerging from the 2001 Recovery Summit in St. Paul. These are all things I did not think I could witness in my lifetime.  

• What did we miss if anything looking back at those goals?

The original vision was pretty bold and comprehensive but there were areas of shifting emphasis in the years that followed as the movement matured. I think the most important of these was more fully embracing affected families within leadership roles within the movement, more intensified efforts to extend recovery advocacy within communities of color, and a greater emphasis on environmental strategies of recovery support. The latter was helped by exploration of such concepts as recovery capital, community recovery, and recovery contagion as well as through efforts to inject a recovery orientation within prevention and harm reduction services.

• What are you most concerned about in respect to the future?

When a social movement articulates many goals, there is always a danger that one goal comes to dominate the whole movement. I am concerned that the rapid growth of funding for peer recovery support services could obscure and minimize our work in other areas, particularly recovery advocacy. And, of course, there are always the dangers of professionalization and commercialization of social movements as well as the danger that such movements can be hijacked by more powerful forces in their operating environment. When a movement achieves success, there are efforts to expand (dilute) its boundaries to serve other interests. We see this with the ever-expanding definition of recovery, and with treatment and other traditional organizations competing for funds devoted to peer recovery support services. During rapid expansion, there is always the risk of bad actors exploiting the movement for their own ends with the movement being then harmed by unethical and criminal conduct. Funding availability within emerging social arenas in which there is little regulatory oversight or lack of a strong ethical foundation is a psychopath’s dream. I still worry about the influence of the treatment industry on recovery advocacy. If we simply regress to the marketing arm of the addiction treatment industry or become a superficial appendage providing post-treatment recovery support, the new recovery advocacy movement will have failed and new advocacy efforts will be needed in the future. And of course, we always have the challenges of organizational sustainability, leadership development, and leadership succession. These are normal risks shared by all social movements. 

• What would you say to future generations of recovery advocates about what we did and what to be cautious of / your wishes for them moving forward?

I want them to know that those of us at the 2001 Recovery Summit were there to accept a torch passed to us from recovery advocates of earlier decades. We have tried to faithfully carry that mission forward and now place it in the hands of new generations. I want them to respect what their recovery ancestors have done without being bound by that history. I also want them to remember that recovery advocacy is not a program of personal recovery and that history is strewn with the bodies of those who thought otherwise. This work cannot be done without a foundation of care for self and care for those closest to us: We cannot carry light into the community while our own home is shadowed in darkness. We must continue to assert the primacy of personal recovery as the foundation for recovery advocacy. We set out in 2001 to change the world and in a real sense we have achieved that and in doing so experienced meaning and purpose in our own lives. We could not do more than wish recovery advocates of the future the same.  

References links to the 2001 St Paul summit –

• State of the New Recovery Advocacy Movement – Bill White (2013) Link HERE
• A Day Is Coming: Visions of A New Recovery Advocacy  Movement Bill White (2015) link HERE

I’ve been watching a really interesting twitter discussion about the conceptual boundaries of recovery. One branch of the discussion got into recovery as a process and as an outcome. It reminded me of this post from 2019.

Yesterday, we began to revisit the concept of recovery-oriented harm reduction. Why recovery-oriented harm reduction and not just recovery? 13 years ago, recovery-oriented harm reduction was thought of as a bridge between harm reduction and treatment or recovery. Today, in some circles, it might invite questions about why one would want to maintain a distinction between harm reduction and recovery.

Defining harm reduction

Harm Reduction International defines harm reduction this way:

Harm reduction refers to policies, programmes and practices that aim to minimise negative health, social and legal impacts associated with drug use, drug policies and drug laws. Harm reduction is grounded in justice and human rights – it focuses on positive change and on working with people without judgement, coercion, discrimination, or requiring that they stop using drugs as a precondition of support. Harm reduction encompasses a range of health and social services and practices that apply to illicit and licit drugs. These include, but are not limited to, drug consumption rooms, needle and syringe programmes, non-abstinence-based housing and employment initiatives, drug checking, overdose prevention and reversal, psychosocial support, and the provision of information on safer drug use. Approaches such as these are cost-effective, evidence-based and have a positive impact on individual and community health.

Harm reduction emerged in response to the failures of medical, public health, and addiction treatment systems to meet the needs of people currently using alcohol and other drugs. Harm reduction saves lives and has challenged other systems (like my own) to face their shortcomings and biases and improve our services. Harm reduction is an essential part of the service continuum and its existence has created pressure to improve the care delivered by other systems.

Defining recovery

There have been several proposed definitions of recovery by academics, professional associations, panels, federal agencies, and state agencies. The trend among these definitions is toward more porous conceptual boundaries and greater inclusion. The first wave of attempts to define recovery seemed to originate from a sentiment like the following, “There are people out there who are doing what you call recovery. They just are not doing it in 12 step groups or they are using medication to assist their recovery. They are just using another pathway to get to the same destination (i.e. outcome). To exclude this people from the boundaries of recovery is inaccurate and wrong. And, by the way, you might want to wrestle with whether there are ways in which your thresholds are too low (e.g. tobacco use and other unhealthy behaviors). Recovery is less about the pathway and more about the destination/outcome.” The best example of a definition arising from this wave is from the Betty Ford Consensus Panel:

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

The next wave of definitions seemed to arise from something like, “What you’ve thought of as recovery is way too narrow. It shouldn’t be confined to addiction. There’s a whole spectrum of problems and changes within the context of those problems that constitute recovery. It’s not a outcome at all. It’s a process, and anyone engaged in a process to improve their wellness is in recovery. Recovery is the pathway not the destination/outcome.” SAMHSA’s definition is an example of this is type:

A process of change through which individuals improve their health and wellness, live a self-directed life, and strive to reach their full potential.

Another, more recent, example is from the Recovery Science Research Collaborative:

Recovery is an individualized, intentional, dynamic, and relational process involving sustained efforts to improve wellness.

Process, direction, outcome?

Long before researchers and scholars took an interest in recovery, recovering people have described recovery as a process. What’s interesting here, is that I think recovering people have thought of recovery as a process and a destination/outcome. Some might think of it as a process that leads to an outcome, while others might think of it as an outcome maintained by a process. Whatever the case, both elements are considered essential. The Betty Ford Consensus Panel definition integrates a lifestyle (destination) that is voluntarily maintained (process). This more recent wave of definitions emphasize a process and a direction (“improvement . . . striving . . . full potential” and “sustained efforts to improve wellness”) rather than an outcome or destination.

Does it matter?

In is paper on the conceptual boundaries of recovery Bill White observed:

Defining recovery also has consequences of great import for those competing institutions and professional roles claiming ownership of AOD problems. Choosing one word over another can shift billions of dollars from one cultural institution to another, e.g., from hospitals to prisons. Medicalized terms such as recover, recovery, convalescence, remission, and relapse convey ownership of severe AOD problems by health care institutions and professionals, just as words such as redeemed and reborn, rehabilitate or reform, and stop and quit shift problem ownership elsewhere. It is important to recognize that rational arguments for particular definitions of recovery may mask issues of professional prestige, professional careers, institutional profit, and the fate of community economies. The answer of who has authority to define recovery will vary depending on the question, “define for what purpose?” Given that defining recovery could generate unforeseen and harmful consequences, efforts to define recovery should include broad representation from: 1) individuals and family members in recovery, 2) diverse recovery pathways and styles, 3) diverse ethnic communities, and 4) policy, scientific, and treatment bodies, including leaders of the major institutions that pay for behavioral health care services.

So . . . yes, it matters. A lot. To a lot of people and a lot of interests. I don’t presume any nefarious motives. I imagine everyone believes their definition will ensure more people recover or will protect recovery from a harmful erosion of its boundaries. In some cases, they wish to extend it to include mental illness and other problems. In other cases, they wish to include people who are taking steps toward change, but have not yet crossed the threshold into traditional notions of recovery. Others want to secure the status of MAT patients within the boundaries of recovery. Others see opportunities for stigma reduction and political action by enlarging the number of people in recovery. Others see opportunities to address the needs of people with lower severity problems. Others may see progress on stigma reduction benefiting people in recovery but neglecting people who still use alcohol and other drugs. Others see the concept of recovery as imbued with moral panic and wish to challenge that. There have been attempts to address some of these issues and bridge the divide between harm reduction and recovery. Scott Kellogg has proposed a model he calls gradualism. He describes it as follows:

[Gradualism] seeks to create a continuum between the world of harm reduction interventions and the abstinence-oriented treatment field. Again, this approach differs from other calls for integration (Denning, 2001; Marlatt et al., 2001) because there is a much greater emphasis on making abstinence the eventual endpoint of most harm-reduction enterprises. This paradigm would combine the harm reduction emphases on outreach to the addicted, incremental change, and gradual healing with the abstinence-oriented therapeutic perspective that the use of substances in an addictive or abusive manner is antithetical to the growth and wellbeing of humans.

Bill White has proposed the concept of precovery, which he described this way:

Precovery is a recovery incubation period arising during active drug use that moves one from the center of addiction to the edge of addiction. Experiences within this stage prepare us for the potential break-up of the person-drug relationship and move us close enough to the recovery territory to feel its contagious pull. Brief sobriety experiments within this boundary region do not constitute sustainable recovery, but they have the potential to incrementally move us to the center of the recovery experience and the physical and cultural world in which that experience is nested. The center of recovery is a region of stability and safety within the recovery process.

These models embrace harm reduction, but not as recovery. They embrace harm reduction as a path to recovery.

Why does it matter?

Why does it matter if harm reduction is placed inside the definition of recovery? There are a few concerns:

• It defines recovery in a way that is contrary to the lived experience of cultures and communities that have identified with the concept.
• This tension between professionally developed definitions and organic, indigenous definitions is likely to alienate communities of recovery rather than engage them. Bill White suggested that the job of professionals “is to do what the community at any given moment cannot do.” It is our role to fill gaps, address unmet needs, support the community, or even try to facilitate the creation of new communities, rather than try to bend the community to our vision of a better community.
• These definitions fail to consider who “recovery” is important to and what its redefinition might mean to them. For example, consider the founding of AA. The date of Dr. Bob’s achievement of sobriety (or, recovery) is considered to be founding date of AA. By some of the proposed definitions, Dr. Bob was in recovery for some time prior to this. One could argue that he was in a “individualized, intentional, dynamic, and relational process involving sustained efforts to improve wellness.” Was this period of time recovery to him? His wife? His children? His coworkers? His patients? If that period is characterized as recovery, what does that do to the relationship between all of these people and the concept?
• “Recovery” is an attractive label for a reason. It’s become associated with wellness, citizenship, and other positive attributes. It’s clear that these attributes do not accurately described many people traditionally considered to be “in recovery” and may exclude others who do live up to those attributes. However, extending the label too far risks eroding the positive associations that make “recovery” attractive in the first place.

Tomorrow’s post will revisit the parameters of recovery-oriented harm reduction.

UPDATE: One more relevant thought from a recent post. I believe, if these new definitions take root, recovering people will feel a need to establish typologies of recovery or select a new word to convey the identity they share. Productive discussion around typologies is likely to become very challenging. The need for typologies stems from the desire to distinguish one type from another, and use them. How might they be used? They would likely be used to organize research and programming around each type. This means these typologies would be used in inclusion/exclusion criteria for everything from research to treatment to recovery housing to collegiate recovery programs to physician health programs to state or unstated hiring practices. And, if there was success in establishing typologies, wouldn’t that bring us back to our starting point?

Previous posts in this series

We should fight to ensure our patients and this field does not accept anything less than flourishing – that should be the goal we bring to our work in research and clinical practice.

Eric Strain

I grew up in Glasgow, a city whose motto, as every schoolchild was taught, is ‘Let Glasgow flourish’. I think primary school was probably my first introduction to the word flourish which my dictionary tells me means ‘to grow luxuriantly, to thrive, to be in full vigour and to bloom’. 

Tyler Vanderweele widens this definition^[1] and makes the point that, applied to human lives, flourishing encompasses happiness and life satisfaction, meaning and purpose, character and virtue, and close social relationships. 

When I reflect on this deeper meaning, the elements chime with me. These are the things that matter most to me. They certainly matter to the patients I look after and support who are trying to achieve recovery from substance use disorders. Most people would probably agree; these things are important.

It’s puzzling then that much of the biosocial literature looking at recovery from physical and mental health conditions does not consider such issues, concerning itself with narrow end-points and measurements, perhaps because these are of more interest to researchers than they are to the people with the conditions, or simply that they are easier to study.

Eric Strain took up this theme recently in a valedictorian editorial^[2] in the journal Alcohol and Drug Dependence on the subject of purpose and meaning in the context of opioid deaths. He expressed his concerns:

The substance abuse field in both its research as well as treatment efforts is not giving due consideration to flourishing. We need to renew our efforts to give meaning and purpose to the lives of patients.

While praising the essential goal of reducing opioid overdose deaths, Strain argues that this is ought to be a starting point – not an end point. 

If a patient with a significant leg wound has the bleeding stopped with a compress, the medical field does not declare victory. Providers clean the wound, stitch it, arrange for physical therapy for the leg, and work to maximize the functioning of the person.

His wish is that we focus on helping not just to reduce drug deaths, but on helping people grow and flourish. Perhaps with the recent debates over the definition of ‘recovery’ and the controversies surrounding it, we could focus on flourishing as a concept.

With the patient’s consent, I have a series of pictures on the noticeboard in my office which capture images of an ex-service user at three stages in his recovery journey. The first was taken on the day of admission to rehab, the second on his discharge and the last a couple of years later. It’s hard to believe it’s the same person, such is the physical transformation. 

Now while this is impressive, it’s not nearly as impressive as the things the picture cannot capture – his wellbeing, his enthusiasm, his self-esteem, the pride in his business, his willingness to help others, the quality of his relationships – all as important to him as his physical health and appearance.

So, how much flourishing really is going on in treatment settings? Professor David Best recently wrote^[3]:

Recovery is frequently blocked not through failings of the person themselves but through the stigmatising attitudes of a range of ‘professionals’ who stymy the ambitions of their clients and whose own scepticism about recovery colours and corrupts their work.

Now, I am fortunate to work in a wider NHS treatment environment and also with voluntary sector partners where I am much more likely to see the opposite of this, but sadly, I have also heard stories more widely (some very recently) from patients and their advocates of blocks to recovery and therefore, blocks to flourishing. Lack of hope and ambition for clients/patients is often at the heart of such barriers, though so are issues of work overload and inadequate resources.

In medical school, I learned that health is not merely the absence of disease. In the same way, recovering from substance use disorders cannot only be about reduction in deaths, essential though that is, or reduction in crime, reduction in substance use, reduction in blood borne virus transmission etc. As I’ve argued before, we have to square worthy public health goals with what matters to the individual and their family – namely, the key elements of flourishing. These are the positives that need to accrue at the same time as the negatives recede.

In a 2017 article in the Journal of the American Medical Association^[4], Vanderweele and colleagues point out that focussing on the health of the body might conflict with other goals that are actually important to individuals. They also argue for the value of the benefits of population-level flourishing and of making flourishing relevant to clinicians too, to prevent burn-out.

There are tools to measure flourishing which could compliment those which capture recovery capital and outcomes, but it is the concept and potential of moving to a model predicated on the value of flourishing that engages me. In Scotland, much effort has gone into developing a trauma-informed workforce. I wonder if we did the same with flourishing in mind – a flourishing-oriented professional group perhaps – if we would see transformation in both the workforce and in the quality of service-users’ lives.

Professor Best reminds us that recovery is often achieved through ‘an intense series of interactions that generate hope and trust.’ This week I’ve seen several rehab patients with non-addiction related health issues. When seeing them I think I’ve been interested, cheerful and thorough, but now I wonder what would happen if I had gone into every consultation with that goal in mind – the generation of hope and trust and a desire to see them flourish beyond helping them solve their minor ailments. 

I realise I sometimes fall short in this regard, but also that it won’t be that difficult for me to do a bit better. What if all of us in the field took that approach with everyone? What if we did not accept anything less than flourishing as an outcome? I think this might have a profound effect not just on those we work with, but on ourselves too.

Continue the conversation on Twitter @DocDavidM

^[1] VanderWeele TJ. On the promotion of human flourishing. Proc Natl Acad Sci U S A. 2017 Aug 1;114(31):8148-8156.

^[2] Strain EC. Meaning and purpose in the context of opioid overdose deaths. Drug Alcohol Depend. 2021 Feb 1;219:108528.

^[3] Best, D. 2021 Research and the Recovery Movement. https://www.rec-path.org/blog/research-and-the-recovery-movement-science-and-advocacy

^[4] VanderWeele TJ, McNeely E, Koh HK. Reimagining Health-Flourishing. JAMA. 2019 May 7;321(17):1667-1668.

Medications for Opioid Use Disorder Infographic
This infographic shows the different types of medications prescribed for opioid overdose, withdrawal, and addiction.

Medications for opioid overdose, withdrawal, and addiction
Medications for opioid overdose, withdrawal, and addiction are safe, effective and save lives.

The National Institute on Drug Abuse supports research to develop new medicines and delivery systems to treat opioid use disorder and other substance use disorders, as well as other complications of substance use (including withdrawal and overdose), to help people choose treatments that are right for them.

FDA-approved medications for opioid addiction, overdose, and withdrawal work in various ways.

• Opioid Receptor Agonist: Medications attach to opioid receptors in the brain to block withdrawal symptoms and cravings.
• Opioid Receptor Partial Agonist: Medications attach to and partially activate opioid receptors in the brain to ease withdrawal symptoms and cravings.
• Opioid Receptor Antagonist: Medications block activity of opioid receptors in the brain to prevent euphoric effects (the high) of opioids and alcohol and help reduce cravings.
• Adrenergic Receptor Agonist: A medication that attaches to and activates adrenergic receptors in the brain and helps alleviate withdrawal symptoms.

Four cards show medications prescribed to reduce opioid use and cravings.

• Methadone available in daily liquid or tablets. Brand names are Dolophine® and Methadose®. Generics are available. 
• Naltrexone available in a monthly injection. Brand name is Vivitrol®
• Buprenorphine available in daily tablet or monthly injection. Brand name is Sublocade®. Generic tablets are available. 
• Buprenorphine/Naloxone is available in daily film that dissolves under the tongue or tablet. Brand names are Zubsolv® and Suboxone® and generics are available.
• Lofexidine treats withdrawal symptoms and is a tablet taken as needed. Brand name is Lucemyra®. 
• Naloxone reverses overdose and is available as an emergency nasal spray or injection. Brand name is Narcan® and generics are available.

Medications for Opioid Use Disorder Infographic
This infographic shows the different types of medications prescribed for opioid overdose, withdrawal, and addiction.

Medications for opioid overdose, withdrawal, and addiction
Medications for opioid overdose, withdrawal, and addiction are safe, effective and save lives.

The National Institute on Drug Abuse supports research to develop new medicines and delivery systems to treat opioid use disorder and other substance use disorders, as well as other complications of substance use (including withdrawal and overdose), to help people choose treatments that are right for them.

FDA-approved medications for opioid addiction, overdose, and withdrawal work in various ways.

• Opioid Receptor Agonist: Medications attach to opioid receptors in the brain to block withdrawal symptoms and cravings.
• Opioid Receptor Partial Agonist: Medications attach to and partially activate opioid receptors in the brain to ease withdrawal symptoms and cravings.
• Opioid Receptor Antagonist: Medications block activity of opioid receptors in the brain to prevent euphoric effects (the high) of opioids and alcohol and help reduce cravings.
• Adrenergic Receptor Agonist: A medication that attaches to and activates adrenergic receptors in the brain and helps alleviate withdrawal symptoms.

Four cards show medications prescribed to reduce opioid use and cravings.

• Methadone available in daily liquid or tablets. Brand names are Dolophine® and Methadose®. Generics are available. 
• Naltrexone available in a monthly injection. Brand name is Vivitrol®
• Buprenorphine available in daily tablet or monthly injection. Brand name is Sublocade®. Generic tablets are available. 
• Buprenorphine/Naloxone is available in daily film that dissolves under the tongue or tablet. Brand names are Zubsolv® and Suboxone® and generics are available.
• Lofexidine treats withdrawal symptoms and is a tablet taken as needed. Brand name is Lucemyra®. 
• Naloxone reverses overdose and is available as an emergency nasal spray or injection. Brand names are Narcan® and Kloxxado® and generics are available.

This publication is available for your use and may be reproduced in its entirety without permission from NIDA. Citation of the source is appreciated, using the following language: Source: National Institute on Drug Abuse; National Institutes of Health; U.S. Department of Health and Human Services.

I appreciate the reflections in Dr. Jana Burson’s most recent blog post.

In particular, the following caught my attention:

“I hear abstinence-only proponents criticize medications for opioid use disorder, and I think to myself, ‘If you only knew how much some people benefit from methadone/buprenorphine, you would change your mind.’ When I hear people who support medications for opioid use disorder talk badly about 12-step recovery, I think the same thing. ‘If you could only see the great benefits some people get from these recovery meetings, you wouldn’t be so harsh.'”

The above excerpt reminds me of those early members of Alcoholics Anonymous who were referred to as ‘bridge members.’ These individuals had experience with addiction to alcohol and addiction to other drugs. As a result, they were able to serve as a bridge between the “straight alcoholic” and “straight addict,” despite the differences that tended to separate them (cultural, legal/illegal status of their conditions, lived experiences, and relationship to society).

I appreciate Dr. Burson’s reflections on navigating the tensions between her professional training, personal recovery, and professional practice. And of serving as a bridge between different recovery experiences.

Event Description

May is National Drug Court Month!

Download NADCP’s toolkit for safe ways your court can celebrate

In May, the treatment court community will once again come together to celebrate National Drug Court Month. This year’s celebration will look a little different again, but May is still a great opportunity to celebrate the lifesaving work you do, engage our stakeholders, and inspire our communities.

NADCP’s National Drug Court Month Toolkit is here to assist you with your planning. This year, we want to highlight the individual stories of those we serve.

Inside the toolkit you’ll find a wealth of information, including:

• NADCP’s Share Your Story campaign
• Sample social media messages
• A National Drug Court Month proclamation template
• Tools to write effective op-eds and media advisories
• Unique and safe event ideas

As always, NADCP is here to serve you. If you need assistance beyond what’s in the toolkit, just ask! We want to amplify your work to the nation, so be sure to tag us on social media, and send us the photos and media stories you collect. Let us help your community tell its treatment court story!

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Science evolves through collaboration, debates, support, and refutations between scientists. This fact is no less true in the science of recovery. Recent discussions regarding new boundaries in the definition of “recovery” illuminate the mechanics of what scientists, clinicians, and people in recovery feel are essential characteristics of recovery. As one of the authors regarding the Recovery Science Research Collaborative definition of recovery, this article will enter into the fray that Dr. Coon has done such a good job narrating and challenging here at Recovery Review. In doing so, I hope to offer some guidance to this process while also allowing this public debate to continue unabated and uncontested in so far as my own opinion is concerned.

I want to highlight that the recent debates between Kelly & Bergman and Witkiewitz et al. regarding the definition of recovery mark an official epoch in recovery science development. I would say that this current debate signals an official departure of recovery science; we are emerging out from underneath the shadow of addiction science. In this sense, we should pause and celebrate. It’s happening y’all!

In our 2017 paper on the definition of recovery, one of our main hopes involved shifting the impetus for defining recovery back to the independent scientific community, away from government agencies and the treatment industry. For too long, the scientific study of recovery was hindered by these forces. In the past, meaningful research on recovery required vast amounts of energy to escape the gravitational pull of private industry, non-profit treatment monoliths, and government authority of organizations like the NIH and SAMHSA. This was particularly true if scientists wanted to access funding for research. Millions of dollars were available to study addiction as a social problem, but to study recovery meant one had to take on articulations of recovery that were either reductive, too diffuse, or one-dimensional.

What’s important to consider is that while we are creating and debating a definition to be used for scientific purposes, such definitions should inform, reflect, and compel us toward the lived experience of survivors and the ways in which they themselves would define recovery.

Scientists with lived experience in recovery were indispensable to this effort. What’s important to remember about the RSRC definition is that the collaboration itself was composed of an interdisciplinary partnership whereby most of the contributors to the definition have personal recovery experience, either as people in recovery or with family ties to those with addiction and recovery experiences. Those without personal experiences had long time experience working within organic, clinical, and community recovery spaces. Their authority stems from a fusion between their scientific careers, professional practice, and lived experience. And the message of their 2017 paper is clear: any definition of recovery must be accompanied with data that is holistically informed and crosses multiple life spheres.

The current debate notwithstanding, the general equation for accurate capture of recovery should include personal variables, social variables, ecological improvements, ideally captured over longitudinal time. In short, improvements in the relationship with the self, improvements with the relationships with others, and the subsequent positive alterations to one’s life conditions, all captured longitudinally, offer the ideal framework for research design.

Recovery is a relational event; we must understand that how we define recovery also defines those relationships. Functional improvements are essential, as are long-term health outcomes. Still, neither is more important than how the individual senses their own healing and how that healing is perceived by those whose lives revolve around such an individual. And, as a scientist, whether we can measure this relational space is our methodological challenge. However, this challenge does not give us the right to define things that are easily manageable and intellectually satisfying to ourselves, our institutions, or our funders. The experience of recovery (ie., what we are trying to study) is felt at the kitchen table, in playing catch with one’s children, in showing up to a previous commitment, being emotionally available to support a partner or friend. Recovery experience involves feeling good about these events, in seeing life around oneself improve due to intentionally seeking to improve one’s health as a way of life.

White (2007) noted the tremendous amount of vested interests reliant on the definition of recovery. From treatment to enormously influential governmental and non-governmental organizations, how scientists define recovery affects treatment design, funding, insurance reimbursement, outcome benchmarks, and a whole host of other systems. Given these stakes, in recent years, scientists have noted two key facts. The first is the importance of utilizing lived experience in recovery conceptualization, definition, and measurement. The second is the emerging necessity for the study of recovery to evolve into a branch of science that separates the analysis of recovery from the science of addiction pathology.

Elementary to the justification of recovery science as a distinct branch separate from addiction science is the fact that while addiction itself is a pathology denoted by biological, psychological, and social forms of dysfunction. Recovery, on the other hand, is highly relational, social, and cultural. And while physical and psychological improvements occur (or assisted with therapy and medication), such improvements are often secondary “side effects” to intentional social, relational, and participatory community actions. It is important to understand that social involvement, social health, a sense of connection and meaning are all primary goals for those seeking recovery.

To put it another way, while it is essential to understand the manner and means by which an individual is stricken by addiction, such information is not necessarily a requirement for recovery to occur. This feature of recovery is unique. This uniqueness is because recovery occurs in the real world entirely outside of the clinical and scientific space as a cultural and community effect. People recover all the time without knowing the precise nature of their problem. And yet, if we want to inform the world as to what recovery entails, we must not look for answers stemming from our own understanding of addiction per se. Furthermore, when theories and definitions keep us from seriously considering the experience of recovery in-situ, we must consider the value of such concepts and what our motives may be for using them. Often, this reflexivity has to be an intentional part of the methodological process.

Recovery is enacted, embodied, and lived. Recovery is not a benchmark or an outcome, but rather, recovery is a verb, a state, and a way of being.

Even when recovery is assisted through clinical or medical intervention, recovery manifestation predominantly occurs outside of these spaces. Recovery support occurs through informal social networks, non-professional recovery communities, and public, non-profit organizations. Recovery is not reliant on clinical, medical, or even scientific understanding of recovery itself for healing to occur. To summarize precisely: recovery is defined, enacted, facilitated, and sustained by many forces outside of academic, clinical, and medical space. As such, scientists, medical researchers, and clinicians have been obliged to create fusions with social institutions outside their zones.

However, at times in the past, scientists and medical practitioners have taken this as a license to validate or invalidate forms of recovery experience, to define recovery for their own purposes. This encroachment is a fundamental ethical concern that recovery science must closely monitor. This monitoring and policing of our propensity to encroach on recovery community and culture is our principal ethical obligation.

With the rising opioid crisis, we saw a renewed influx of money and interest into the recovery space. We saw medical professionals for the first time taking seriously the needs of people who struggle with addiction. And while these are significant developments, they do not supplant the existing institutions, communities, definitions, and conceptualizations that have classically defined recovery– any changes in such descriptions and conceptualization must ultimately come from those who have survived addiction disorders (i.e., lived experience). And more precisely, medical professionals and clinicians seeking to address the issues wrought by the pathology of addiction should not be confused or conflated with the lived experience of recovery. This is particularly true of medical specialists- meeting the medical needs of an at-risk population in the midst of a wave of overdose wrought by a tainted drug supply have little experience or authority to weigh in on what qualifies recovery more broadly. Specialization should not be mistaken for generalization.

No matter how well-intentioned scientists may be, and no matter how intimately they may be familiar with recovery, they should be cautious about straying too far from how the people they study define their sense of healing and how these survivors have achieved that healing. This scientific humility will go a long way in the future. The science of recovery requires a de-colonial mindset for the researcher. In this way, recovery science itself requires an ethical reliance on recovery values themselves. We must be honest, self-reflexive, open-minded and we must be concerned and committed to those we study in greater proportion than our own desires for research success. We cannot impose artificial constructs on a community that would disavow such constructs. Why? Because it is a form of oppression and erasure of which western science has a long and tragic history. Let’s not make the same mistake here.

In closing, I would offer a helpful consideration. First and foremost the challenges of capturing lived experience, cultural practices, and social healing are not without precedent. Rather than asking how we can study recovery in ways that may be acceptable to science, journals, funders, and the like, we should instead ask ourselves how we can study recovery in ways that are acceptable to those who are living the experience itself. There is a tremendous amount of scholarship around this, but many of us will have to step outside the rigid structures of our disciplinary fields in order to do this. As an example of broadening our repertoire, it may be time to polish off the ideas of moral psychological realism that posit theory and definitions should come from real-world experience and daily life, and event sampling techniques.

At any rate, as always, I am reinvigorated by these recent debates and I look forward to watching this unfold among my esteemed colleagues and peers.