Hot topics in addiction and recovery
What were the hot topics, burning themes and searing subjects in addiction recovery in 2022? I thought it might be interesting to take a look at the talking points on Recovery Review in 2022.
Although the writers are very different people and we span the Atlantic, all of the contributors to Recovery Review have a keen interest in recovery from addiction and write passionately on relevant issues.
Each blog typically gets read scores of people reading it and often many hundreds – amplified when they are posted elsewhere. I hope that as well as passing on evidence, we also make people think.
So, what were we talking about in 2022 and does that tell us anything about what is really important in the field? More importantly, what’s the relevance to those seeking recovery and those supporting them to move on? I’ve done a not-very-scientific analysis of the most frequent themes across the blogs which is represented in the graph below.
Without doubt, the most commonly recurrent issues were around harm reduction and recovery. While Recovery Review consistently acknowledges the importance of harm reduction and emphasises that there is no need for polarisation, there remain tensions between the two. Many blogs pick this up and examine what those tensions are, how they hold us back and by what means they might be resolved.
Several of us were inspired by Eric Strain’s editorial which highlighted how we let people down when we leave them with “anything less than flourishing”. The concept and importance of flourishing and wellbeing as goals in treatment, support and recovery was the next most prevalent theme.
The issue of stigmatisation of those with addiction was woven through last year’s blogs but also how this can apply those in recovery and sometimes to those of us working in addiction treatment and support who self-identify as being in recovery. This can lead to voices being dismissed and perspectives being judged harshly and in a damaging way.
Although not a new theme, the big-picture perspective on recovery trajectories and longer-term journeys takes us away from categorising treatment as ineffective, abstinence as unobtainable and helps us to address therapeutic nihilism. Better research on long term outcomes for those with substance problems gives us even more hope for those we work with. This was mentioned many times on our blog pages.
Other key topics included the challenges of finding a meaningful and workable definition of recovery that suits recovery communities, treatment and support providers and academics. Recovery as a concept, arguably held most legitimately and strongly by recovery communities and those in mutual aid groups seems to be getting rebranded in ways that make it less meaningful. It could be it is losing its utility (hence the interest in the concept of flourishing).
Tied into this are the next three themes – whether or not addiction is a disease and why that matters, the often unhelpful blurred line between mild and severe substance use disorders and the value or otherwise of having abstinence as a goal.
The remainder of the topics are pretty evenly represented across the year – threads around hope and despair; the opioid crisis; MAT, residential treatment, evidence for recovery; recovery housing, recovery communities and organisations; lived experience; families and the tension between what individuals and families want vs. what’s on offer.
Within 2022’s content are so many inspiring and challenging quotes. Some of these are from us and others are from people we are quoting. I’ve selected just a few that particularly caught my attention below.
Our failure to forcefully advocate that patients need to flourish is tacitly acknowledged through interventions such as low threshold opioid programs, provision of naloxone with no follow up services, and buprenorphine providers who only offer a prescription for the medication.
Eric Strain via Bill Stauffer
It seems to me that basing [the designation of addiction] on public reactions is the tail wagging the dog, and that unstable, conflicting messages probably contribute to pessimism and stigma. If that’s true, the best strategy is to just describe it accurately and focus on other targets for stigma reduction.
Though our treatment systems have yet to fully adapt to healing the whole family, most clinicians understand and even stress the relational component of recovery. Obviously, recovery is not, and cannot be solely about the person overcoming addiction.
Policy has focused on short-term treatment and harm reduction strategies, critical, lifesaving elements of an effective care system, yet we have seen minimal investment in community-based recovery efforts. If we expanded investment in long term recovery in ways that meet the needs of the recovery community, we could save more lives, strengthen families, and heal communities.
If we want to build community-based services that meet the needs of our recovery community, we have to design funding around what works for these communities
Recovery from opioid addiction is also more than remission, with remission defined as the sustained cessation or deceleration of opioid and other drug use/problems to a subclinical level—no longer meeting diagnostic criteria for opioid dependence or another substance use disorder. Remission is about the subtraction of pathology; recovery is ultimately about the achievement of global (physical, emotional, relational, spiritual) health, social functioning, and quality of life in the community.
William White via Jason Schwarz
The linking of abstinence to moralistic and judgmental attitudes and practices plays into culture war battles that consume too much energy and attention within the field.
It occurs to me there may be a relative match or mismatch between the helper’s notion of what addiction is understood to be, and the purpose of the help as defined by the person seeking help.
Perhaps the most important insight in recent recovery history is that recovery community, through collaborative effort leads to restoration not only in individual lives but supports healing across entire communities, in all their diversity.
It isn’t mercy. If someone genuinely did not choose to do wrong then compassion for that person isn’t mercy—it’s justice. And conversely, if you can only have compassion on someone if you believe she did not choose her misdeeds, then you’ve defined mercy out of existence. You’re not forgiving—you’re saying there was never anything to forgive.
Eve Tushnet via Jason Schwartz
How easily compassionate and well-intentioned responses to addiction can devolve into something that resembles an addiction hospice. And, when we construct addiction hospices, we shouldn’t be surprised that people die.
Here’s to a rich, thought-provoking, enlightening and inspiring 2023 on Recovery Review.
Continue the discussion: @DocDavidM
Photo Credit: d1sk@istockphoto under license