5/10/2014 The Tricky Business of Defining Addiction Recovery | Psychology Today

http://www.psychologytoday.com/blog/inside-rehab/201405/the-tricky-business-defining-addiction-recovery 1/4
So whats the definition of recovery or sobriety? How long should a
person be free of problematic involvement with alcohol and drugs to truly
be recovered or sober? Abstinence, as in using no alcohol or drugs of
abuse, has most typically been the defining criterion of recovery, often
measured by counting time and awarding coins for sober or clean*
birthdays at Alcoholics Anonymous (AA) and other 12-step meetings. The
founders of AA also emphasized emotional sobriety that is,
The Tricky Business of Defining Addiction Recovery
Who Determines What It Takes to Call Yourself Sober? YOU Do
Published on May 2, 2014 by Anne M. Fletcher, M.S., R.D. in Inside Rehab
The Tricky Business of Defining Addiction Recovery
Who Determines What It Takes to Call Yourself Sober? You Do
One out of every 10 American adults consider themselves to be in recovery from alcohol or drug
problems, as suggested by nationally representative findings released by the Partnership at
Drugfree.org and the New York State Office of Alcoholism and Substance Abuse Services . Thats
according to respondents affirmative answer to the question, Did you once have a problem
withdrugs or alcohol, but no longer do? In fact, many of these individuals may consider themselves
recovered not in recovery.
Related Links
Is It In the Genes?
Screening for an
Alcoholism Gene
Whimperers
Anonymous
The Natural History of
5/10/2014 The Tricky Business of Defining Addiction Recovery | Psychology Today
http://www.psychologytoday.com/blog/inside-rehab/201405/the-tricky-business-defining-addiction-recovery 2/4
recognizing that you have to make important changes in your life aside
from just saying no in order to stay sober.
Professional Attempts to Define Sobriety
In 2007, a consensus panel convened by the Betty Ford Institute defined
recovery as a voluntarily maintained lifestyle characterized by sobriety,
personal health, and citizenship with sobriety referring to abstinence
from alcohol and all other non-prescribed drugs. It should be noted,
however, that the Diagnostic and Statistical Manual of Mental
Disorders (DSM-5) that most experts and treatment facilities use to
diagnose substance use disorders defines sustained remission (aka
"recovery") as having at least a 12-month period when none of the DSM-5
criteria have been met. All of the criteria focus on problematic behavior,
such as lack of ability to cut down, difficulties at work and home, and
relationship problems, not on abstinence. And to be in remission, the
focus is on the original drug of choice and not on whether you are using
another substance. So you can be in remission/recovered from an alcohol
use disorder but still have a nicotine or cannabis use disorder.
In a 2012 issue of the Journal of Addiction Medicine, Nady el-Guebaly,
MD from the University of Calgary in Canada summarized his findings
from searching peer-reviewed literature addressing general principles of
recovery and those based on research, using the key words recovery
from addiction. He noted that most recent definitions of recovery go
beyond the concept of abstinence, encompassing more global
improvements that often occur in life. For instance, Native American
counselors have coined the term wellbriety to define recovery as
sobriety plus global health or quality of life.
Addiction scholar, William White, MA proposed his own meaningful
definition of recovery in 2007 in The Journal of Substance Abuse
Treatment, as follows: Recovery is the experience (a process and a
sustained status) through which individuals, families, and communities
impacted by severe alcohol and other drug (AOD) problems utilize
internal and external resources to voluntarily resolve those problems,
heal the wounds inflicted by AOD-related problems, actively manage their
continued vulnerability to such problems, and develop a healthy,
productive, and meaningful life.
Note that none of these definitions stipulates a specific route to recovery
such as attending treatment or following the 12 steps. The Betty Ford
consensus paper directly states, Indeed, one of the important purposes
of this initial definition is to promote exploration of different ways to
achieve recovery.
Certainly, everyone, whether in recovery or not, would do well to strive for
an increasingly meaningful and productive life and to consider the various
definitions and suggestions that have emerged over the course of human
history about living a good life. However, those with substance use
Alcoholism
Hammered at Work
Find a Therapist
Search for a mental
health professional
near you.
City or Zip
Find Local:
Acupuncturists
Chiropractors
Massage Therapists
Dentists
and more!
City or Zip
5/10/2014 The Tricky Business of Defining Addiction Recovery | Psychology Today
http://www.psychologytoday.com/blog/inside-rehab/201405/the-tricky-business-defining-addiction-recovery 3/4
disorders should be encouraged to focus on aspects of recovery that are
meaningful to them not follow any specific definition of recovery. If they
count time in recovery, they should be supported in doing so in any way
they see fit. If they take it upon themselves to make changes, they, in
turn, should get to decide when the changes they make are sufficient and
how to "count" or track them.
Recognizing Progress When a Problem Waxes and Wanes
Recognizing that periods of abstinence may be punctuated by interludes
of using again, its often difficult to pinpoint a specific recovery date. So
who are we to decide that recovery requires complete and enduring
abstinence? At Practical Recovery (Dr. Horvaths treatment system),
counting time in sobriety is not required because recovery for any one
individual may include periods of using again.
In discussing this topic, William White rightly notes, Imposed or self-
embraced words that convey one's history, character, or status have
immense power to wound or heal, oppress or liberate. A particular
definition of recovery, by defining who is and is not in recovery, may also
dictate who ishired and who is fired, who remains free and who goes to
jail, who remains in a marriage and who is divorced, who retains and who
loses custody of their children, and who receives and who is
deniedgovernment benefits.
Consider how demoralizing it is for a man who, after nine years of
abstinence, has a night at the bar when his wife dies, and is subsequently
told by a support group sponsor that hes lost his sober time and has to
start counting all over again. What about the drug court client who after
three years of abstinence suffered a material loss, went through a period
of depression, and subsequently drank for a weekend? She was found
under-the-influence by her probation officer, and her original sentence to
state prison was executed. Having committed no criminal act, her new
offense was that her recurrence of addiction led to violation of her court
order to be abstinent. (This was an actual case).
Focusing on what recovery is or is not and whether someone is or is not
in recovery and for how long can actually get in the way of progress.
(People with chronic back or heart problems typically dont think about
achieving complete recovery; they learn to manage their chronic
conditions, which usually include some recurrence of symptoms.) Whats
most important is that those with substance problems continue to
recognize and address their problems and the issues that may or did lead
to any recurrence. For individuals who want to count time in some way, we
very much like the notion of having people track when their recovery was
established as suggested in the documentary film, Anonymous
People by Greg Williams. Individuals can determine their own
definitions of established however, we view it as the time at which you
recognize you have a drug or alcohol problem and seriously begin taking
steps to do something about it.
5/10/2014 The Tricky Business of Defining Addiction Recovery | Psychology Today
http://www.psychologytoday.com/blog/inside-rehab/201405/the-tricky-business-defining-addiction-recovery 4/4
Moreover, you never lose any sober time you accrue, no matter what.
An earlier version of this article was co-authored with Tom Horvath,
Ph.D. and published in 2013 in the Practical Recovery professional
newsletter. After Inside Rehab was published, I served as a
consultant to Practical Recovery.
*Although commonly used, clean is rather a pejorative term, because the
implication is that youre dirty or unpure when using.
Photo credit: Gajus - Fotolia.com
Follow me on Twitter @annemfletcher for regular updates on
addiction, weight control, psychology, and health
(www.annemfletcher.com )
Copyright: Anne M. Fletcher

243
Like
StumbleUpon
1
4 13
Share