In the substance use space, the term “recovery” has historically been used interchangeably with “abstinence from drugs and alcohol.” However, this narrow interpretation has excluded many people who exhibit significant reductions in use and improvements in general well-being. Subsequently, the Substance Abuse and Mental Health Services Administration (SAMHSA) developed a working definition of recovery that is much broader and more inclusive: A process of change through which individuals improve their health and wellness, live a self-directed life, and strive to reach their full potential.
SAMHSA goes on to describe four dimensions that support recovery from substance use disorders and mental health conditions:
- Health: “Overcoming or managing one’s disease(s) or symptoms, and making informed, healthy choices that support physical and emotional well-being”
- Home: “Having a stable and safe place to live”
- Purpose: “Conducting meaningful daily activities, such as a job, school volunteerism, family caretaking, or creative endeavors, and the independence, income, and resources to participate in society”
- Community: “Having relationships and social networks that provide support, friendship, love, and hope”
SAMHSA’s 10 guiding principles of recovery hold that recovery
- Emerges from hope
- Is person-driven
- Occurs via many pathways
- Is holistic
- Is supported by peers and allies
- Is supported through relationships and social networks
- Is culturally based and influenced
- Is supported by addressing trauma
- Involves individual, family, and community strengths and responsibility
- Is based on respect [1]
More information on these principles can be found here.
[1] SAMHSA’s Working Definition of Recovery, pp. 4–7.
How can addiction treatment providers use the SAMHSA definition of recovery, the 4 dimensions, and the 10 guiding principles in delivery of care?
First, it can be helpful to recognize that recovery is a process for improving health and well-being. Focusing on positive developments beyond reductions in substance use, such as becoming housed, gaining employment, reconnecting with family, going back to school, identifying new social networks, and engaging in pro-social activities that bring them happiness and purpose are all activities that can and should be celebrated in the clinical environment. Success should not be measured solely by the result of a toxicology screen.
Second, when working with people with behavioral health conditions, it is especially important that we assess the four dimensions supporting a life of recovery frequently. When there are challenges in these areas, we must do all that we can to help link patients to existing clinic- or community-based services. This could include ensuring that individuals get treatment for co-occurring conditions such as hepatitis C, sleep apnea, or generalized anxiety disorder. It may also include helping individuals identify available housing supports or referring individuals to a Housing First program or recovery housing. Working with patients to identify meaningful activities that will bring them purpose in their lives is also an important part of treatment planning. When available, peer support specialists can be particularly helpful in creating new social networks. Community partnerships are critical to supporting patients in each of these domains.
Finally, re-assessment of the four dimensions of recovery supports can be helpful when a patient expresses a desire to taper or stop medication for SUD. If they describe having positive overall health and well-being, stable housing, a sense of purpose in life and economic stability, and a supportive community they can rely on – these are reassuring signs that they have the supports in place to foster ongoing recovery. However, if someone has challenges in these domains (i.e., health, home, purpose, and community), offering them the opportunity to focus on improving circumstances in that domain prior to medication taper is appropriate.