Recovery: Can You Have It Your Way?

Written by Geoff Kane, MD, MPH. Posted on
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People on paths of addiction recovery — and those who dedicate their professional lives to helping others get on such paths — often think of recovery as a spiritual practice. 

These stakeholders might discuss their own sense of spirituality, perhaps referring to relationships or connectedness, and they might engage in practices such as meditation, which many consider spiritual. But they routinely avoid taking positions on how other people ought to understand and practice spirituality. They welcome atheists and agnostics. They consider it up to the individual to decide, for example, whether to incorporate God, prayer, and/or religion into their spiritual lives.

Even though stakeholders who promote recovery encourage people in need of recovery to practice spirituality in whatever non-hurtful ways are meaningful to them, they tend to be less open-minded toward how those same people pursue “recovery.” Stakeholders generally have strong, and sometimes conflicting, views on how people emerge from addiction.

Practical wisdom and medical-scientific knowledge about addiction and recovery have been accumulating for decades. The points of view and knowledge bases of persons in recovery and of addiction treatment professionals draw from all that, but what portions of this base individual members of these groups know or consider important differs as well as overlaps. Persons in recovery and treatment professionals debate among themselves how to best define recovery and what to recommend that the willing person do or not do to achieve recovery.

The bone of most contention among participants in these debates seems to be how strictly to interpret “sobriety” and “abstinence” that most stakeholders agree are essential aspects of recovery. Historically, abstinence has been interpreted in all-or-nothing fashion, which makes it problematic to find a place in recovery for individuals who abstinence from their drug of choice is inconsistent, or who continue to use tobacco, or whose stability requires medication, especially a medication with addition or abuse potential such as methadone or buprenorphine. “Harm reduction” connotes clinical and social achievement to some, but distasteful compromise to others. Concepts such as “partial recovery,” “recovering vs. in recovery” and “addiction as a chronic disease with varying durations of remission” have been proposed but not widely adopted.

Can we find a more unifying way to think about addiction and recovery? A framework that respects the diversity of those affected, yet also respects the laws of nature that govern addiction and recovery? We know enough about the nature — the neurobiology– of addiction and of recovery to know that people seeking recovery do better when they work with nature by avoiding addictive substances and cultivating positive interpersonal relationships. Those who resist nature by ignoring those two actions tend to stay stuck in addiction– and judge themselves harshly for their lack of progress. They strive to fix things on their own, without realizing that what works in nature is not arbitrary.

We might, for example, imagine each willing person as getting on a path of recovery, equipped as necessary with tools such as medication or residential treatment to provide traction and support on their journey. They will be more likely to make progress on that journey with our acceptance and encouragement, and perhaps with gentle reminders to take action — after all, they are on a path, not a moving sidewalk. Can we respect variability and honor persistance?