Striving to Define Recovery

definitionMy thanks to Teresa McBean, executive director of the National Association for Christian Recovery for drawing my attention to a recent attempt to define “recovery” by a group of behavioral health professionals at the request of the Substance Abuse and Mental Health Services Administration (SAMHSA).

Here is their suggestion:

Recovery is a process of change whereby individuals work to improve their own health and wellness and to live a meaningful life in a community of their choice while striving to achieve their full potential. [source]

Before I offer a critique of this approach to defining recovery, it is important to remember two things. First, this group was trying to craft a unified definition that would apply both to the fields of mental health and addiction. The need for a unified definition may, however, be a consequence of SAMHSA’s complex organizational mandate rather than any actual similarities between ‘mental health’ and ‘substance abuse’. Both apples and oranges can, of course, be ‘fruit’. So it is not unreasonable to attempt a unified definition. But the differences between schizophrenia, for example, and substance dependence are huge–much larger in my view than the differences between apples and oranges. So it will be a significant challenge to find a definition that does a good job of encompassing both domains.

Secondly, this attempt at defining recovery is in part a response to difficulties experienced in trying to “expand health insurance coverage for treatment and recovery support services.” How do you talk about recovery in a way that makes it sound like something that insurance companies should be obligated to cover? How can you make “recovery” something that generates income? I think it is obvious that this effort is part of the commercialization of recovery. There is nothing new about this. It is a process that has been going on for decades. In my view there have been some significant benefits to this process—-the whole ‘treatment’ industry is a result of this process. And I don’t, in general, have any objection to expanding the availability of ‘treatment’–quite to the contrary! But I will admit that, having said that, I am deeply grateful for the wisdom of the founders of A.A. who understood how quickly problems related to “money, property and prestige” could “divert us from our primary purpose” (Tradition 6). Efforts to define recovery in order to create additional income by providing additional services is going to be a hard sell to people who have found the twelve step tradition to be helpful.

Now a brief critique in two related parts.

1) According to this definition what you must do to recover is to “work” and to “strive.” This strikes me as self-reliance, pure and simple. It is possible to stay sober, of course, by trying hard to stay sober. Many alcoholics can stop drinking for a period of time to “prove” that they are not really addicted. But is that what recovery is really about? Trying hard to not use? It makes me tired just thinking about it. Recovery is not just something we “work” on and “strive” to achieve. It is something we receive after we finally, thank-fully come to the end of all of our working and striving. If we are still relying on working and striving, we have probably not come to terms with our powerlessness. Striving to get better does not belong in a definition of recovery. It would fit better in a definition of our lives before we started the recovery process.

2) Secondly, it is difficult to imagine a definition of recovery that is more thoroughly sanitized of any reference to “God” or a “higher power”. I’m not expecting a federal agency to endorse explicitly religious language. Nor would I expect an insurance company to be obligated to provide coverage for explicitly religious practices. So it may be entirely practical, political realities that account for the absence of the God-language which is so deeply embedded in the twelve steps. But there is no hint in this definition that recovery might require even an emphasis on external “locus of control”. It is just about me trying hard. I do not claim to know how best to bridge the gap between God-language and the needs of the government and insurance companies. But I am convinced that attempting to solve the language problem by making recovery into some kind of existential self-making exercise is a reflection of a philosophical/spiritual commitment that is just as substantive as saying that recovery involves “turning my life over to God”. The language of health/wellness/potential may be at the present moment a more politically correct way of speaking, but it is no less a reflection of spiritual convictions.

If you go to the SAMHSA website you will see that in addition to a definition of recovery there is also a set of “Principles of Recovery.” It is obvious by now that the definition of recovery did not float my boat. But I think there is a lot of common ground to be found in these ‘principles’. I may find time later to talk about this in more detail but look them over for yourself. Definitions are always a difficult complicated matter–you have to pack a lot in just a few words. This particular definition seems fatally flawed to me but it feels like this group did some serious and very useful work which shows up more in the principles than in the definition.

If you are a definition junkie you might want to take a look at the new definition of addiction from the American Association of Addiction Medicine. This one feels thoroughly reductionist to me. It is a weird ‘brain disease’ when changes in family members may be as predictive of long-term recovery as changes to the brain of the diseased person. The ‘disease’ language also runs the risk of stigmatizing addicted persons. It might feel better to be ‘diseased’ than to feel ‘morally defective.’ But the stigma of ‘brain damaged’ and similar language is not far off. Notice, however, the willingness to include language of ‘transcendence’ as part of the discussion–clearly, in my view, an improvement over the SAMHSA approach to things. I’d be interested in other peoples thoughts on this. The comment section is open for business. . .

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