The Heart of Addiction

How psychology drives addictive behavior.

What Does It Mean to Be "In Recovery"?

This phrase is more confusing than helpful.

Many words in the addiction field have been tossed around for years without being clearly defined or even being meaningful. "Recovered," "recovery" and "being in recovery" are examples. In most of life, "being in recovery" means a person is making progress even though s/he isn't "cured." Sometimes it is used as a synonym for "being in remission" — indicating relapse is a clear possibility (as with being "in recovery" from cancer), while other times it means "on the path to a definite cure" — as in being in recovery after surgery. Neither of these usages is problematic, so long as we all understand what is meant. But in the addiction field, the term has been used in a third way in 12-step programs. There, it is traditional for people to refer to themselves as "in recovery," no matter how long they have been abstinent from their addictive behavior and no matter how well they are doing in life. Partly, this is the same as saying they are "in remission," based on the idea they can always suffer a relapse. But too often, being "in recovery" has come to mean something different: that they are on what they declare is the right path. When used this way, folks are condemned as not "in recovery" if they drop out of 12-step programs or are thought to not be "working the program" adequately. When "recovery" is used this way, it is more a political statement than a factual or medical one.

People suffering with addictions should ignore the agendas of anyone attempting to define whether they are "recovering" or "recovered." They would be better off thinking of their addiction as a repetitive behavior that arises with great force at key moments when they feel overwhelmingly helpless. These moments can be predicted and avoided once they know just what their emotional vulnerabilities are. However, there will always be some risk of becoming overwhelmed, and responding with the old behavior. To this extent, it is true that anyone with addictive behavior is never "cured." But we are all at risk of repeating old behaviors (in my field it's called "regressing"), whether these old behaviors are addictions or anything else that used to be part of our solution to life. That's not a specific feature of addictions, it's just the way humans are. It makes no more sense to label oneself as "recovering" forever from an addiction, than it does for a person who used to be depressed to forever be "recovering" from depression, or a person who has been cancer-free for 15 years to still define herself as a cancer patient. It certainly makes no sense to define "recovering" in terms of whether you are in one treatment approach or another. Addiction is a terrible symptom, but it is not who you are, and once you understand how it works emotionally in you so it doesn't sneak up on you, there is no reason to dwell on what words you use.

[A version of this post appears in my answer to a question on the "Ask an Expert" section of the website, The Fix.]

Lance Dodes, M.D., is an assistant clinical professor of psychiatry at Harvard Medical School.

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