"In recovery, people lead full, productive and healthy lives." --Laudet, 2013, Life In Recovery Survey
Scientific knowledge about addiction recovery has been based historically on short-term treatment follow-up studies, point-in-time membership surveys of recovery mutual aid fellowships, and small qualitative studies of the recovery experience. The value of these early studies was limited by the uncertainty to which their findings could be applied to the larger pool of people who have resolved alcohol and other drug (AOD) problems. A new generation of in-depth surveys based on large community samples is broadening our understanding of the prevalence, pathways and styles of long-term addiction recovery.
First, a series of rigorous epidemiological studies reported remission rates for AOD-related problems (those once meeting but no longer meeting diagnostic criteria for a substance use disorder). These studies revealed a substantial U.S. population in remission from a substance use disorder and underscored differences in AOD problems between clinical and community populations.
Then, surveys were conducted of how the general public perceived "recovery" from severe alcohol and other drug problems. A 2004 Faces and Voices of Recovery public survey conducted by Hart Research and Coldwater Corporation (See 2004 Recovery Survey) revealed that the majority of the U.S. public understood "recovery" to mean that a person with a history of AOD problems was "trying to stop using alcohol and drugs", with only 22% understanding "recovery" to mean that the person was now free from addiction. Pessimism toward recovery was also revealed in the 50% who thought people seeking treatment for addiction would be unable to achieve life-long recovery. A similar 2008 SAMHSA survey of the U.S. population revealed a slightly more optimistic view, with approximately three-quarters of those surveyed believing recovery was possible for those experiencing problems with alcohol, cannabis or prescription drugs, but only 58% believing recovery was possible for problems related to the use of heroin, cocaine, and methamphetamines.
Most recently, researchers conducted population-based surveys of people in recovery to determine the characteristics of those in recovery and to profile the commonalities and varieties of recovery experiences. These studies include:
2002: Pathways to long-term recovery survey of the Connecticut Community of Addiction Recovery (Laudet, Savage, & Mahmood)
2007: New York City meaning of recovery survey (Laudet)
2013: U.S. Faces & Voices of Recovery Life in Recovery Survey (Laudet)
2014: U.S. What is Recovery survey (Kaskutas, Borkman, Laudet, et al.; Witbrodt, Kaskutas & Grella)?
2015: Australian Life in Recovery Survey (Best & Savic)
2015: U.S. survey of students in collegiate recovery programs (Laudet, Kimball, Winters, &Moberg)
2015: UK Life in Recovery Survey (in process)
Below are 20 tentative conclusions that can be drawn from these studies.
1. Between 25-40 million Americans once experienced but no longer experience significant alcohol and other drug-related problems.
2. People in recovery are quite diverse in terms of age, gender, race, ethnicity, living environment (urban, suburban, rural), education, employment, and history of military service.
3. There is considerable variation in personal understandings of the meaning of recovery among people self-reporting recovery status. While the majority of persons surveyed define recovery in terms of abstinence, a minority (12% of the Kaskutas et al. 2015 study subjects) view moderated use as consistent with their understanding of recovery.
4. Moderated strategies of problem resolution are associated with less severe AOD problems. Abstinence-based strategies are associated with greater problem severity, complexity and chronicity, and with prior failed attempts at moderation.
5. Abstinence as a preferred recovery strategy increases with age and duration of recovery, adding weight to earlier studies noting that abstinence is a more stable pattern of long-term remission than moderated use (See Ilgen et al. 2008; Dawson, et al. 2007) and may produce greater long-term benefits (see Kline-Simon, et al, 2013).
6. There is considerable variation in how people describe the change in their AOD use, e.g., recovered, recovering, in recovery, medication-assisted recovery, or used to have a problem but don't anymore.
7. The longer people are in recovery and the more 12-Step meetings they have attended, the more likely they are to view no use of tobacco as part of their recovery definition--an important historical shift within American communities of recovery.
8. Self-identified people in recovery report substantial recovery duration, with 67% in the U.S survey respondents reporting 5 or more years of stable recovery at the time of the survey and 32% reporting 20+ years in recovery.
9. People in recovery report considerable variation in type of recovery support resources. In the 2013 U.S. survey, 71% had received professional treatment, 18% reported the use of medication to support recovery, 95% reported 12-Step participation and 22% reported participation in a non-12-Step recovery support group. Combining multiple sources of recovery support is common.
10. People in "natural recovery" (without aid of professional treatment or recovery mutual aid participation) are under-represented in recovery surveys (only 4% of the Kaskutas et al. 2014 Survey participants), perhaps because "recovery" is often not central to their personal identity.
11. People in "natural recovery" are less likely to self-define themselves using recovery language (recovered, recovering, in recovery) and more likely to see themselves as once having, but no longer having, an AOD problem.
12. Most self-identified people in recovery view recovery as a lifelong process, while a minority view addiction/recovery as a past chapter of their lives that they have now transcended.
13. Most self-identified people in recovery view recovery as far more than altered patterns of AOD use. Such broader dimensions of recovery include enhancements in global (physical, emotional, relational) health, repair of the person-community relationship (e.g., citizenship), and enhanced life meaning and purpose. Recovery definitions of people in recovery also often include dimensions of character and lifestyle (e.g., honesty, balance, positive coping, helping others).
14. The majority (57%) of people participating in the life in recovery surveys in the U.S. report a history of both alcohol and other drug use, with 29% reporting alcohol use only and 13% reporting only drugs other than alcohol.
15. Nearly all (98% in Kaskutas et al. 2014 study) people participating in Life in Recovery surveys meet DSM-IV criteria for alcohol or drug dependence--a much higher rate than that reported in the epidemiological studies reviewed by White (2012).
16. Most self-identified people in recovery report prolonged years of AOD use and addiction prior to recovery initiation, e.g., 18 years of prior addiction in the U.S. survey and 12.5 years of prior addiction in the Australian survey.
17. Most self-identified people in recovery have experienced significant consequences related to their AOD use, e.g., physical/emotional/occupational/financial/family/legal problems, etc.
18. Most people in recovery in the U.S. report dramatic improvements in quality of life (QOL), with QOL ratings of good (22%), very good (43%), or excellent (28%).
19. Physical/emotional/relational health and quality of life improve with the duration of recovery.
20. Recovery reaps substantial social rewards, e.g., enhancement of housing stability, improvements in family engagement and support, educational/occupational achievement, debt resolution, and community participation and contribution, as well as dramatic reductions in domestic disturbance, arrests/imprisonment, and health care costs.
A recovery advocacy movement was launched in the late 1990s in the U.S. whose kinetic ideas included the following three propositions: 1) Recovery is a reality (in the lives of millions of individuals and families), 2) There are multiple pathways of recovery, and 3) Recovery can give back much of what addiction has taken from individuals, families, and communities. Modern epidemiological studies and recent life in recovery surveys are offering empirical support to these declarations in what is a most interesting intersection of experiential knowledge and scientific knowledge.
Best, D. & Savic, M. (2015) The Australian life in recovery survey. Turning Point.
Dawson, D. A., Goldstein, R. B., & Grant, B. F. (2007). Rates and correlates of relapse among individuals in remission from DSM-IV alcohol dependence:A 3-year follow-up. Alcoholism: Clinical and Experimental Research, 31(12), 2036-2045.
Faces & Voices of Recovery. (2001). The road to recovery: A landmark national study on the public perceptions of alcoholism and barriers to treatment. San Francisco, CA: Peter D. Hart Research Associates, Inc./The Recovery Institute.
Ilgen, M.A., Wilbourne, P.L., Moos, B.S., & Moos, R.H. (2008). Problem-free drinking over 16 years among individuals with alcohol use disorders. Drug and Alcohol Dependence, 92, 116-122.
Kaskutas L.A.,Borkman, T., Laudet, A., Ritter, L.A., Witbrodt, J., Subbaraman, M., Stunz, A., & Bond, J. (2014). Elements that define addiction recovery: the experiential perspective. Journal of Studies on Alcohol and Drugs, 75, 999-1010.
Kaskutas, L. A. & L. Ritter (2015). Consistency between beliefs and behavior regarding use of substances in recovery." International Journal of Self Help and Self Care, January-March. 1-10.
Kline-Simon, A. H., Falk, D. E., Litten, R. Z.,Mertens, J. R., Fertig, J., Ryan,M., &Weisner, C.M. (2013). Posttreatment low-risk drinking as a predictor of future drinking and problem outcomes among individuals with alcohol use disorders. Alcoholism, Clinical and Experimental Research, 37(S1), E373?E380.
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Laudet, A., Harris, K., Kimball, T., Winters, K.C., & Moberg, D.P. (2015). Characteristics of students participating in collegiate recovery programs:A national survey. Journal of Substance Abuse Treatment, 51, 38-46.
Laudet, A., Savage, R., & Mahmood, D. (2002). Pathways to long-term recovery: A preliminary investigation. Journal of Psychoactive Drugs, 34, 305-311.
Office of Communications (2008). Summary Report CARAVAN Survey for SAMHSA on Addictions and Recovery. Rockville, MD: Office of Communications, Substance Abuse and Mental Health Services Administration.
Subbaraman, M. S. & J. Witbrodt (2014). Differences between abstinent and non-abstinent recovery from alcohol use disorders. Addictive Behaviors, 39(12), 1730-1735.
White, W.L. (2012). Recovery/Remission from Substance Use Disorders: An Analysis of Reported Outcomes in 415 Scientific Studies, 1868-2011. Great Lakes Addiction Technology Transfer Center, Philadelphia Department of Behavioral Health and Intellectual disAbility Services Mental Retardation Services and Northeast Addiction Technology Transfer Center.
Witbrodt, J., Kaskutas, L.A., & Grella, C.E. (2015). How do recovery definitions distinguish recovering individuals Five typologies. Drug and Alcohol Dependence, 148, 109-117.