A while back, David Best and Dan Lubman published an article called ‘The Recovery Paradigm: A Model of Hope and Change for Alcohol and Drug Addiction’. I had reason to read it again this week and found much to encourage me in it. Here are some key messages from the piece with my comments in italics.
Recovery trajectories
in 2005, Dennis et al published longitudinal data from a sample recruited from a public treatment program in the United States suggesting that the average time from substance initiation to stable recovery is around 27 years.
We need long term supports for individuals. We need new ways to try to accelerate recovery while keeping people as safe as possible.
According to a review of international evidence conducted for the Centre for Substance Abuse Treatment ‘epidemiologic studies show that, on average, 58% of individuals with chronic substance dependence achieve sustained recovery’, although rates varied from 30–72%. however, as Warner argued, for mental health, this may not mean full remission. Rather, it may involve transcending their symptoms to lead a meaningful and fulfilling life, including making a valuable contribution to family, community and society.
Recovery is a reality and has knock-on effects beyond the individual.
Quality of life
In the UK, Hibbert and Best interviewed former alcoholics who had been abstinent for at least year. not only was there clear evidence of ongoing recovery growth, but those who were more than 5 years sober and in active recovery had better social quality of life scores than the general public.
Recovery improves quality of life.
In a follow up study in Glasgow of 205 former alcoholics and heroin addicts in recovery, the strongest predictors of higher life quality were engaging in more activities (volunteering, education and training, work and family) and more time spent with other people in recovery.
To improve quality of life in those seeking recovery, encourage involvement in structured activity in the community and connect them to other recovering people.
People matter
One of the most important things we know about recovery is that other people matter. the resolution of severe alcohol and other drug problems is mediated by processes of social and cultural support. Both general and abstinence specific social support influence recovery outcomes, but abstinence specific support appears to be most critical to long term recovery.
People need people to recover. Abstinence-specific support is important. (Though abstinence is not a prerequisite for recovery).
In a randomised trial of alcoholics completing residential detoxification, participants underwent either ‘standard case management’ or ‘network support’ – with the aim of the latter being to add at least one sober person to the social network of the detoxed drinker. Relapse rates in the network support condition were 27% lower than in the standard treatment condition, emphasising the key role of peer support in enabling long term recovery, and the core underlying principle of ‘social contagion’.
Peer to peer connection has a powerful influence on outcomes and reduces relapse rates. Recovery is infectious.
So does harm reduction
As addiction careers typically exceed a quarter of a century, a range of interventions will be required at different times. it is crucial to support and engage those with long term alcohol and other drug problems until they are ready to make lasting changes. this includes offering harm reduction approaches.
Harm reduction is key to supporting people on recovery journeys and should be a fundamental offer in services.
Professionals can help
Health professionals can instil hope that recovery can occur and should be mindful that their relationship can be a critical ‘turning point’ in the patient’s recovery journey, acting as a ‘bridge’ to groups and individuals who successfully model recovery, and involving family members.
Professionals can support individuals to change direction and to connect them to mutual aid and other community recovery resources (e.g. Lived experience recovery organisations [LEROs]).
Recovery rights are civil rights
We have learnt in recent years that recovery does not happen in isolation and that recovery can have the strength of a social movement akin to the civil rights movement.
Still happening, though my observation is that it is still at the ‘storming’ phase with too many factions and frictions, albeit achieving progress overall.
Summing up
Although addiction is a chronic relapsing disorder most people recover, with flow-on benefits to both individuals and communities. Within the mental health field, adoption of a recovery model can bring about significant benefits for individuals and families, can inspire hope in communities and is a cost-effective approach to delivering interventions. This approach readily lends itself to the treatment of addiction
Continue the discussion: @DocDavidM
Best DW, Lubman DI. The recovery paradigm – a model of hope and change for alcohol and drug addiction. Aust Fam Physician. 2012 Aug;41(8):593-7. PMID: 23145400.
Photo credit: gustavfrazao under license