The Tricky Business of Defining Addiction Recovery –
The Tricky Business of Defining Addiction Recovery –
Who Determines What It Takes to Call Yourself Sober? You Do
One out of every 10 American adults consider themselves to be in recovery from alcohol or drug problems, as suggested by nationally representative findings released by the Partnership at Drugfree.org and the New York State Office of Alcoholism and Substance Abuse Services. That’s according to respondents’ affirmative answer to the question, “Did you once have a problem with drugs or alcohol, but no longer do?” In fact, many of these individuals may consider themselves “recovered” – not “in recovery.”
So what’s the definition of recovery or sobriety? How long should a person be free of problematic involvement with alcohol and drugs to truly be recovered or sober? Abstinence, as in using no alcohol or drugs of abuse, has most typically been the defining criterion of recovery, often measured by ”counting time” and awarding coins for sober or “clean”* birthdays at Alcoholics Anonymous (AA) and other 12-step meetings. The founders of AA also emphasized “emotional sobriety” – that is, recognizing that you have to make important changes in your life aside from “just saying no” in order to stay sober.
Professional Attempts to Define Sobriety
In 2007, a consensus panel convened by the Betty Ford Institute defined recovery as a “voluntarily maintained lifestyle characterized by sobriety, personal health, and citizenship” with “sobriety” referring to abstinence from alcohol and all other non-prescribed drugs. It should be noted, however, that the Diagnostic and Statistical Manual of Mental Disorders (DSM-5) that most experts and treatment facilities use to diagnose substance use disorders defines sustained remission (aka "recovery") as having at least a 12-month period when none of the DSM-5 criteria have been met. All of the criteria focus on problematic behavior, such as lack of ability to cut down, difficulties at work and home, and relationship problems, not on abstinence. And to be in remission, the focus is on the original drug of choice and not on whether you are using another substance. So you can be in remission/recovered from an alcohol use disorder but still have a nicotine or cannabis use disorder.
In a 2012 issue of the Journal of Addiction Medicine, Nady el-Guebaly, MD from the University of Calgary in Canada summarized his findings from searching peer-reviewed literature addressing general principles of recovery and those based on research, using the key words “recovery from addiction.” He noted that most recent definitions of recovery go beyond the concept of abstinence, encompassing more global improvements that often occur in life. For instance, Native American counselors have coined the term “wellbriety” to define recovery as sobriety plus global health or quality of life.
Addiction scholar, William White, MA proposed his own meaningful definition of recovery in 2007 in The Journal of Substance Abuse Treatment, as follows: “Recovery is the experience (a process and a sustained status) through which individuals, families, and communities impacted by severe alcohol and other drug (AOD) problems utilize internal and external resources to voluntarily resolve those problems, heal the wounds inflicted by AOD-related problems, actively manage their continued vulnerability to such problems, and develop a healthy, productive, and meaningful life.”
Note that none of these definitions stipulates a specific route to recovery such as attending treatment or following the 12 steps. The Betty Ford consensus paper directly states, “Indeed, one of the important purposes of this initial definition is to promote exploration of different ways to achieve recovery.”
Certainly, everyone, whether in recovery or not, would do well to strive for an increasingly meaningful and productive life and to consider the various definitions and suggestions that have emerged over the course of human history about living a “good life.” However, those with substance use disorders should be encouraged to focus on aspects of recovery that are meaningful to them – not follow any specific definition of recovery. If they “count time” in recovery, they should be supported in doing so in any way they see fit. If they take it upon themselves to make changes, they, in turn, should get to decide when the changes they make are sufficient and how to "count" or track them.
Recognizing Progress When a Problem Waxes and Wanes
Recognizing that periods of abstinence may be punctuated by interludes of “using again,” it’s often difficult to pinpoint a specific recovery date. So who are we to decide that recovery requires complete and enduring abstinence? At Practical Recovery (Dr. Horvath’s treatment system), “counting time” in sobriety is not required because recovery for any one individual may include periods of “using again.”
In discussing this topic, William White rightly notes, “Imposed or self-embraced words that convey one's history, character, or status have immense power to wound or heal, oppress or liberate. … A particular definition of recovery, by defining who is and is not in recovery, may also dictate who is…hired and who is fired, who remains free and who goes to jail, who remains in a marriage and who is divorced, who retains and who loses custody of their children, and who receives and who is denied government benefits.”
Consider how demoralizing it is for a man who, after nine years of abstinence, has a night at the bar when his wife dies, and is subsequently told by a support group sponsor that he’s lost his sober time and has to start counting all over again. What about the drug court client who after three years of abstinence suffered a material loss, went through a period of depression, and subsequently drank for a weekend? She was found under-the-influence” by her probation officer, and her original sentence to state prison was executed. Having committed no criminal act, her new “offense” was that her recurrence of addiction led to violation of her court order to be abstinent. (This was an actual case).
Focusing on what recovery is or is not and whether someone is or is not “in recovery” and for how long can actually get in the way of progress. (People with chronic back or heart problems typically don’t think about achieving complete recovery; they learn to manage their chronic conditions, which usually include some recurrence of symptoms.) What’s most important is that those with substance problems continue to recognize and address their problems and the issues that may or did lead to any recurrence. For individuals who want to count time in some way, we very much like the notion of having people track when their recovery was “established” as suggested in the documentary film, “Anonymous People” by Greg Williams. Individuals can determine their own definitions of “established” – however, we view it as the time at which you recognize you have a drug or alcohol problem and seriously begin taking steps to do something about it.
Moreover, you never lose any sober time you accrue, no matter what.
An earlier version of this article was co-authored with Tom Horvath, Ph.D. and published in 2013 in the Practical Recovery professional newsletter. After Inside Rehab was published, I served as a consultant to Practical Recovery.
*Although commonly used, “clean” is rather a pejorative term, because the implication is that you’re “dirty” or “unpure” when using.
Photo credit: © Gajus - Fotolia.com
Copyright: Anne M. Fletcher