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Surgeon General’s Report Summary – Chapter 5

Surgeon General’s Report Summary – Chapter 5
Surgeon General’s Report Summary – Chapter 5

Recovery advocates have created a once-unimagined vocal and visible recovery presence, as living proof that long-term recovery exists in the millions of individuals who have attained degrees of health and wellness, are leading productive lives, and making valuable contributions to society. Meanwhile, policymakers and health care system leaders in the United States and abroad are beginning to embrace recovery as an organizing framework for approaching addiction as a chronic disorder from which individuals can recover, so long as they have access to evidence-based treatments and responsive long-term supports. Pg. 5-1

Remission and Recovery

In general health care, the term remission is used to describe reduction in disease symptoms to “normal or ‘sub-clinical’ levels”. This can have different meanings depending on the individual. Remission for one person may be going from binge drinking in college, to drinking one or two drinks per day. For another person, remission may mean complete abstinence from alcohol or drugs, while integrating a recovery program into their lives. Individuals with severe substance use disorders may also follow a cycle of abstinence and relapse before remission is sustained.

For individuals with severe substance use disorders, part of being “in recovery” includes remission, and a change in their viewpoint, individuality, and conduct. These changes become part of who they are, and how they live their life.

Many definitions of individual recovery are used throughout the world. Listed below are some examples:

  • The Betty Ford Institute Consensus Panel defines recovery as a voluntarily maintained lifestyle characterized by sobriety, personal health, and citizenship
  • The Substance Abuse and Mental Health Services Administration (SAMHSA) defines recovery as a process of change through which individuals improve their health and wellness, live a self-directed life, and strive to reach their full potential
  • American Indians: recovery is inherently understood to involve the entire family and to draw upon cultural and community resources
  • European Americans: define recovery in more individual terms
  • Blacks or African Americans: are more likely than individuals of other racial backgrounds to see recovery as requiring complete abstinence from alcohol and drugs
  • Pg. 5-3

In some communities, recovery is aligned with a certain religion, while in others like AA, recovery is considered spiritual, not religious. Communities like LifeRing, Secular Recovery, SMART Recovery, and Secular Organization for Sobriety see recovery as a nonspiritual course.

In recent years, the term recovery has been expanded to include mental illness. In a study of individuals with schizophrenia, as well as some co-occurring substance use disorders, the term recovery was often characterized by increased hope and optimism, and greater life satisfaction. Pg. 5-3

Values and Beliefs Related to Recovery

Some examples of values and beliefs associated with the recovery movement are:

  • People who suffer from substance use disorders (recovering or not) have essential worth and dignity
  • The shame and discrimination that prevents many individuals from seeking help must be vigorously combated
  • Recovery can be achieved through diverse pathways and should be celebrated
  • Access to high-quality treatment is a human right, although recovery is more than treatment
  • People in recovery and their families have valuable experiences and encouragement to offer others who are struggling with substance use
  • Pg. 5-4

These values and beliefs may be incorporated by workers in treatment facilities, relatives, medical professionals, and individuals with substance use disorders.

Differing Views In Recovery

There are many ways to define recovery, and many avenues into recovery. Some choose 12-step-oriented groups such as AA and NA, while others find support and help through non-spiritual recovery groups, family, friends, or church, and treatment centers. Some individuals dispute the efficacy of some avenues over others.

An example of this dispute is medication assisted recovery. For some, using medication is viewed as substituting or replacing one drug for another, or the use of medication does not align with philosophies of recovery. Members of the National Alliance for Medication Assisted Recovery or Methadone Anonymous state they are practicing medication-assisted recovery. Pg. 5-4

Some individuals do not consider themselves a part of a recovery movement, nor being “in recovery”, if they no longer meet criteria for a substance use disorder.

Varying Perspectives In Recovery

A study of over 9,000 individuals with prior substance use disorders shows how perspectives in recovery vary. Of the individuals who participated, 98 percent met formal criteria for a severe substance use disorder, and three-quarters considered themselves “in recovery”.

Abstinence

  • 86 percent saw abstinence as part of their recovery.
  • The remainder either did not think abstinence was part of recovery in general or felt it was not important for their recovery
  • Endorsement of abstinence as “essential” was most common among those who were affiliated with 12-step mutual aid groups.

Personal Growth

  • “Being honest with myself” was endorsed as part of recovery by 98.6 percent of participants
  • Other almost universally-endorsed elements included “handling negative feelings without using alcohol or drugs” and “being able to enjoy life without alcohol or drugs”
  • Almost all study participants viewed their recovery as a process of growth and development, and about two-thirds saw it as having a spiritual dimension

Service to Others

  • Engaging in service to others was another prominent component of how study participants defined recovery
  • Service to others has evidence of helping individuals maintain their own recovery
  • A survey of more than 3,000 people in recovery indicated that fulfilling important roles and being civically engaged… became much more common after their substance use ended
  • Pg. 5-5

Estimating the Number of People “In Recovery”

Estimating the number of people “in recovery” can be a challenging task. For example, individuals who once met diagnostic criteria for a mild substance use disorder do not consider themselves to be in recovery. This result can have two possible consequences:

  • First, the number of people who are in remission from a substance use disorder is, by definition, greater than the number of people who define themselves as being in recovery.
  • Second, depending on how survey questions are asked and interpreted by respondents, estimates of recovery prevalence may differ substantially. Someone who once met formal criteria for a substance use disorder but no longer does may respond “Yes” to a question asking whether they had “ever had a problem with alcohol or drugs,” but may say “No” when asked “Do you consider yourself as being in recovery?”
  • Pg. 5-5

Possibly, because of this, abstinence or remission are used more often to define recovery, rather than the word “recovery” when measuring outcomes in community and clinical studies.

In one analysis, from a summary of data from six large studies, 10.3 percent (with a range of 5.3 to 15.3 percent) show remission from a substance use disorder of any severity among adults in the United States. In another national survey, comparable results showed that 10 percent of adults say “yes” when asked “Did you once have a problem with drugs or alcohol but no longer do?” This roughly translates to 25 million adults in the United States who are in remission. The percentage of adolescents in recovery is not yet known.

Despite negative stereotypes of “hopeless addicts,” rigorous follow-up studies of treated adult populations, who tend to have the most chronic and severe disorders, show more than 50 percent achieving sustained remission, defined as remission that lasted for at least 1 year. Despite these findings, widely held pessimistic views about the chances of remission or recovery from substance use disorders may continue to affect public opinion in part because sustained recovery lasting a year or longer can take several years and multiple episodes of treatment, recovery support, and/or mutual aid services to achieve. By some estimates, it can take as long as 8 or 9 years after a person first seeks formal help to achieve sustained recovery. Pg. 5-6

It is estimated that roughly 35 percent of adolescents achieve sustained remission. This estimate was found in studies published since 2000. While studies have been conducted on the rates of sustained remission among adolescents, data is short-term because of short follow-up periods and/ or small trials used. Early intervention and detection can benefit a young person, and help them achieve remission faster, despite the lower remission rate.

Available Recovery Support Systems

There are many Recovery Support Systems (RSS) available. The following is a general list of recovery support services that are available. If you would like to read more information regarding these services, please see the Chapter link at the end of this post. This information can be found on pages 5-8 to 5-15

  • Mutual aid groups: Alcoholics Anonymous (AA), Narcotics Anonymous (NA), SMART Recovery, Al-Anon Family Groups
  • Recovery coaching
  • Recovery housing
  • Recovery management: Recover management check-ups, telephone case monitoring
  • Recovery community centers
  • Recovery-based education: Recovery high schools, recovery in colleges

Social Media and Recovery Centered Activities

A growing trend within the last few years has been increased recovery presence on social media and other on-line sources. Today, recovery groups are available on various social media platforms, as well as personal and professional blogs. While research is still in the preliminary stages, this type of support has been found useful for receiving recovery support, and coinciding with relapse prevention.

Another growing trend is recovery centered activities. These types of activities are focused on celebrating recovery, and offering an alternative to drugs or alcohol. Research is inconclusive as to the efficacy of these activities over other Recovery Support Services.

To view the PDF file of this chapter, please follow this link: https://addiction.surgeongeneral.gov/chapter-5-recovery.pdf

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