Why the Need for Recovery-based Care?

A resonating message I have picked from many people affected by serious substance use problems over the years is their desperate need for hope (that they can recover) and understanding (of how to recover). Here is a blog I originally posted in May 2013.

There is a dearth of readily accessible information on how to achieve recovery, information that is also relevant to the day-to-day struggles and obstacles that people face in trying to overcome addiction and related problems. Many people do not know anyone who has recovered from addiction. Many find the treatment system to be disempowering and lacking in hope.

This website has been developed in order to help people find the hope and understanding that will facilitate their recovery. I also want to help improve our current system of care and help create a better understanding of recovery and recovery-based care.

Here is an article I have written which summaries some of the key themes in which I have been concerned over the past decade.

1. Nature of the problem
Research has shown that professional treatment can help people overcome serious substance use problems. However, far too few people in our treatment system are overcoming serious substance use problems, in large part due to shortcomings in society’s system of care.

For example, treatment services provide periods of short-term care that help some people initiate a process of recovery, but there is generally no continuity of care that helps the person maintain their recovery in the community. Recovery from addiction often requires long-term support.

A second major problem is that much of the current treatment system focuses on managing symptoms, rather than helping a person gain the best possible life they can for themselves. [1] People who find a value and meaningful life in their community are much less likely to relapse back into substance use.

As a result of such shortcomings, many people cycle in and out of treatment, the well-known revolving door phenomenon, and, for many people, the treatment system is disempowering and lacking in hope.

Shortcomings in society’s system of care have a number of negative consequences for people with substance use problems and their families.

Firstly, people receiving treatment are often blamed by the system if they relapse. (The idea that this relapse is due to a failure of the service is rarely considered by the system). Where else in the health care system are people discharged from treatment for showing a symptom (i.e. relapse) of their disorder?

Secondly, the lack of success of treatment adds fuel to the prejudice and stigma that exists in society towards individuals and families affected by substance use problems. Prejudice and stigma are strong barriers to recovery from addiction, as being accepted as ‘normal’ by so-called normal society is a key factor helping people recover from addiction.

Thirdly, poor treatment outcomes also lead to a more widespread false belief that addiction is a problem from which people rarely recover. This false belief helps destroy hope in individuals affected by substance use problems, the very thing they need to recover from addiction. (Many practitioners have not seen anyone recover from addiction—people who recover often do not return to their practitioner, meaning that the latter only see treatment ‘failures’).

Recovery for many people is not just about recovering from the damage caused by substances. It is also about recovering from the damage caused by a disempowering treatment system, medication received in treatment, stigma, poverty and social exclusion. The consequences of addiction are generally more difficult to overcome than the addiction itself.

2. Recovery and recovery-based care
The situation need not—and should not—be like this. Many people do recover from substance use problems, some overcoming the most difficult of life circumstances and the majority without accessing professional treatment.

The lived experience of recovering people, along with findings from scientific research, has given us considerable insights into the recovery process and into how to improve the way that society helps people overcome substance use problems. (Sadly, little of this information is circulated, either to people in need of help and or to those people providing help).

Experts now recognise the need to transform our systems of care for addiction, shifting away from systems based on pathology and symptom management to ones that promote hope and recovery. Recovery is about people (re)building meaningful and valued lives, where they can realise their aspirations, be treated with respect and dignity, and contribute to society. It is a journey, a deeply personal and unique process of change.

The recovery model differs from the medical model, on which most addiction treatment is currently based, in that it emphasises empowerment of the person, the importance of peer support, and involvement of family members in helping the person find recovery. It focuses on strengths and assets of a person, not their weaknesses and deficits, and goes beyond symptom management.

Recovery-based care is person-centered, rather than focused on the problem (addiction). The person drives the recovery process, having been provided with resources that enable informed decisions, and often working in partnership with professionals and/or peer supporters. The recovery model embraces and transcends both harm reduction and abstinence-based approaches and does not seek to be prescriptive as to what a person needs at any part of their recovery journey.

Two key features of recovery have led to the important maxim: ‘I alone can do it, but I can’t do it alone.’ Firstly, recovery is something that comes from the person—they do the work. Treatment practitioners don’t ‘fix’ a person, they catalyse the person’s self-healing processes. Secondly, people very rarely do recovery alone. They do it with the support of people in their environment. Recovering people play an important role in helping other people recover.

Rather than focusing on treatment, as does our current system of care, the recovery model places greater emphasis on the physical, social and cultural environment in which people live their lives. It recognises that a multitude of factors within a person’s psychological being and their environment (at family, community, national levels) influence a person’s path to recovery.

Treatment is just one resource that a person may utilise to build on their strengths and resilience as they take responsibility for their long-term recovery, health and wellness. A person does not recover due to brief periods of treatment in an office—they recover as they live their lives in their social world, in their community.

3. The new Recovery Movement
A new Recovery Movement in parts of the US and UK is facilitating a much-needed shift to a recovery-based system of care, which is leading to many more people recovering from addiction (and a greater cost-effectiveness of the care system). An increase in peer support and the development of recovery communities is not just leading to recovering people helping each other get better, but is increasing hope (that recovery is possible) and facilitating a climate of empowerment and understanding.

A culture of recovery is developing in places, which is helping people extricate themselves from a culture of addiction. These communities are focusing on solutions (rather than problems) and learning from the experiences of recovering people. Treatment is being linked to recovery resources in the community to facilitate long-term recovery.

However, despite the positive impact of the recovery approach, there has been a strong resistance to recovery-based care in many places, in part due to vested interests [2]. Many treatment services do not wish to change, sometimes laying claim to being recovery-based after doing little more than changing workers’ titles. Drug companies, and many psychiatrists and doctors, see the recovery model as a threat to the medical model and their continuing domination of a large tranche of treatment. Genuine recovery-based initiatives often struggle financially, as most funding goes to treatment services.

As will be discussed in a later blog, these sorts of problem have been overcome in parts of the world. For example, the US state of Connecticut has been pioneering recovert-based care for a number if years. People in the city of Philadelphia in the US transformed their mental health addictions system to one based on recovery, a $1 billion system caring for over 100,000 people.

Similar changes will occur elsewhere in the world, as recovery-based care system is not only more effective than our current system, but is also a necessity in a society where the demands on our behavioural healthcare systems are becoming overwhelming.

[1] Most people who develop a serious substance use problem are self-medicating in response to the psychological pain caused by a lack of long-term social integration, family problems, early abuse and other traumas, homelessness, drug withdrawal, emotional difficulties, or just trying to find meaning and relationships in a society where feelings of community and commonality are disappearing.

[2] It has been argued that many addiction care systems are wounded and need to recover. Research has shown that such systems and their practitioners can take on some of the characteristics of the disorders they are expected to treat, e.g., denial, projection of blame, grandiosity, self-centeredness, preoccupation with power and control, and manipulation. It is ironic that addiction care systems expect their ‘clients’ to change, but are often not capable of changing themselves.