‘Building the science of recovery – what I have learned goes far beyond our studies (Part 1)’ by Alexandre Laudet

IMG_3049Hi, I’m Alexandre. I’m an addiction recovery scientist. I’m not in recovery.

Seeking to do science on recovery, rather than addiction, has been a liability with the National Institute of Health (NIH), American scientists’ primary source of research funding. Not being in recovery has cost me points in many sectors of the recovery community.

Most often, I feel professionally ignored at best, by colleagues who do so-called ‘real’ research – on treatment, medication or vaccine development, or (the pinnacle of research stardom), the brain …

Yet, I can’t seem to want to do anything else. I am hooked on trying to build a science of recovery. Why am I doing this?

I ‘fell’ into the addiction field by accident in the summer of 1994 when I was hired as project director for an NIH funded study of a comprehensive treatment model for addicted mothers.

I didn’t know anything about addiction or drugs except that my father had told me when I was young that if I did drugs, he’d kill me. Living in a strict European household several decades ago, I believed him. It saved my life. I am pretty certain that had I fallen into drugs, I would not have gotten up, not in one piece anyway…

Back to 1994. I liked the work. I could see this as a career. But I couldn’t fathom how people focused on pathology (addiction) and what was viewed as ‘failure’ (i.e. research centering on whether or not people relapse). It seemed a bit of a bummer to be frank.

When I plan something I haven’t done before – visit a new country or buy a car – I turn for advice to people who did it successfully. Of course, I also read negative reviews of products and hotels to be alerted to shortcomings, but we know the shortcoming of addiction: it destroys lives and it’s hard to kick.

What we don’t know is how people do well? And why?  So I set out to read quantitative research on people doing well. There wasn’t much. I do see now that the few researchers adopting a truly long-term approach, chiefly teams lead by Moos and Hser, were indirectly looking at recovery processes. They just didn’t call it that.

But that was it. The term ‘recovery’ wasn’t really on the radar at the time anyway, not among academics and scientists. ‘Recovery’ was a 12-step term and many in polite society hadn’t made up their mind about whether 12-step is a cult or an association of losers.

I’m an explorer more than anything else, so I liked the idea of branching into an area that no one had truly developed before. Funding went well early on (about ten years ago); congress had recently doubled the NIH’s budget and funding was somewhat less competitive than it is now, meaning that scoring in the 10th percentile gave you hope you may get funded. I got funded. A few times.

Getting NIH funded is a privilege in my opinion. You get taxpayers’ money to look into scientific questions that you (and reviewers) find interesting. Our NIH funding enabled my team and I to recruit several samples of hundreds of individuals at various stages of recovery and follow them over several years.

With all the evidence pointing to substance use disorders being a chronic condition, it goes without saying that recovery is a process and documenting this process requires long-term studies (regrettably, these tend to be very costly and therefore difficult to get funded).

As it stands, the bulk of what we know about recovery comes from people recruited in treatment programs and it bears almost exclusively on the first six months to a year after treatment. What exactly happens after that isn’t clear, yet we need to find out to inform policy and the development and evaluation of recovery support services as emphasized in President Obama’s drug strategy.

Though our work hasn’t exactly changed the world (yet!), I sincerely believe some of our studies will come to be regarded as significant to the broad ongoing shift to a chronic care, wellness based (i.e. recovery) paradigm in the addiction field.

Much of our more important findings have come from directly asking people to tell us about their experiences – rather than relying solely on standardized measures that impose the researcher’s preconceptions and topics of interest on study participants.

Our field has much to learn from the views and experiences of the people in our research studies – and society has much to learn from the recovery experience, as I discuss in Part 2 of this blog. Therefore, I am a firm believer in the importance of combining quantitative and qualitative methods, which boils down to incorporating people’s experiences in their own words with more ‘rigorous’ methods such as established research questionnaires.

Using this combined approach, we identified the critical importance of quality of life (QOL) to recovery and documented its role in predicting substance use/abstinence over time.

Put simply, it goes like this: quality of life is very poor in active addiction, it gradually starts improving when people enter recovery and these gains – a place of one’s own, a clear mind, a healing relationship with family – are greatly valued. The fear of going back to how life was in active addiction sustains the motivation to stay away from drugs and alcohol, i.e. it helps people stay in recovery.

Life keeps getting better as recovery progress, as we recently documented in the Faces & Voices of Recovery ‘Life in Recovery’ survey discussed later, and people do not want to lose that. Quality of life was a key dimension incorporated in the provisional definition of recovery issued by the Betty Ford Institute panel to which I was honored to contribute. Previously, most research focused only on studying improvements in quality of life as a result of recovery; our work showed that the relationship between the two goes both ways.

We also documented people’s priorities in recovery, areas where they are experiencing difficulties and how that changes over time. We – society as a whole, but also loved ones of people in recovery and people in recovery themselves – tend to assume (or hope) that once someone stops drinking and/or taking drugs, everything falls into place (‘just say no’). ‘Things not happening fast enough’ in recovery is actually a challenge for many, as we documented among people in addiction recovery who have a mental health disorder.

More recently, in one of our long-term studies, we reported that in addition to working on one’s recovery (that remains a top priority at all stages of the recovery process), other areas including relationships, education/training, family and housing, become more of a priority and a challenge as recovery progresses. Notably, employment is as much a priority as is sustaining recovery once people have been in recovery three years or longer.

The Life in Recovery survey I conducted with Faces & Voices or Recovery, the largest recovery grassroots organization in the U.S., was the first large-scale nationwide study of people at various stages of recovery. Our key goal was to begin documenting the changes that happen in all the areas of life typically affected by active addiction (health, work, finances, family and involvement with the criminal justice system) as a result of being in recovery.

As summarized in the survey report, we found that relative to when they were actively addicted, people experience dramatic improvements in all areas of life. Equally noteworthy, these improvements continue as recovery is sustained. In other words, life gets better in recovery and it keeps getting better.

On a more pragmatic note, survey findings also document the benefits of promoting recovery from addiction to individuals as well as to the nation’s health and finances.

Alexandre Laudet, Ph.D., is Director of the Center for the Study of Addictions and Recovery at the National Development and Research Institutes, Inc. You can follow her on Twitter as @AlexandreLaudet.