What is recovery? Dr Michael Niss talks about recovery.

“The measure of recovery cannot be counting days of sobriety alone. It has to be more! “
Its recovery, recovery and more recovery – that is the central issue of most treatment facilities. Yet, the more I think about it, the more complex the issue becomes as we all know that the outcome of treatment is pretty poor with a single measure and the more we view recovery on a single dimension with a single pathway, the future of treatment is self-limiting.

My concern about recovery is that it has become polarized, in so much as it has a tendency to portray abstinence and maintenance approaches to drug treatment as an either/or issue. At its most extreme, it appears that recovery with the use of substitute medication is incompatible with recovery.

The debate of what recovery is, appears to have a lack of clarity and agreement about what treatment is trying to achieve and what we mean by the term “recovery”. We need to look beyond recovery and look at how the advanced knowledge of the brain can help us define what treatment is and make use of the developments of brain science. So, with that in mind, treatment is changing. Today, addiction is termed a brain disease by Dr N Valkow, Director of NIDA. This means that treatment has to incorporate knowledge of the brain to improve outcome. It means, that we need to do more to address the brain disease, it means treatment must incorporate pharmacological therapy and it means understanding neuroscience will help treatment outcome. It also means that we need to understand how Psychological interventions increase the chances of treatment success.

For instance, the gold standard of opioid addiction is pharmacological treatment, such as the use of methadone and buprenorphine as the basis of most treatments. However, it is also widely recognized that in addition to Pharmacology, the use of Psychosocial treatments enhances the treatment outcome. When we look at Psychosocial treatments, we also need to includes dealing with co-occurring disorders that may affect recovery. To this end, the use of established treatment modalities that best suits the treatment of these co-occurring disorders would need to be included, such as Cognitive Behaviour Therapy or Interpersonal Psychotherapy for Depression and medication for such disorders.

The building blocks of recovery become a full house of different services wraparound with case management. Also, to recognize the role of support groups such as AA and NA can contribute to recovery and not be limited by a polarized view of what constitutes recovery. How recovery is described has consequences, for example, denying methadone patients the status of recovery, could be limiting them a real chance of being well. We all recognize that recovery is more than just being abstinent and that long term recovery is about returning to a base line or reclaiming a disrupted life as a result of addiction. Therein lies what I feel should be incorporated in the understanding of “recovery”. The critique I have of recovery, is that recovery stops short; it should not be either/or, but include such things as occupational rehabilitation, reintegration into family and the community and how well the individual functions and maintains a life free of substance misuse. The way one achieves this should not be dependent on a definition. The measure of recovery cannot be counting days of sobriety alone. It has to be more!

Viewing recovery as more than substance free days, is achieved through treatment that includes Psychosocial treatments, Pharmacology and I would like to include support groups like AA, NA and not be posed with a contradiction of what constitutes recovery. Recovery is not a straight line either. Attending to the individual and viewing recovery as more, is clear that treatment cannot rely on only one modality, the status of recovery needs to be given with the full benefit of what we know about treatment, and how best to treat addiction.