Defining recovery from mental disorders and substance use disorders

Are you a recovering alcoholic?

Be honest.

How about a recovering nicotine addict, or recovering from an addiction to some illegal drug, or maybe addiction to gambling, or sex, or football, or even your computer screen, or Angry Birds?

I have worked in the addiction field most of my professional life. For me, addiction to a chemical includes physical and mental dependence, tolerance, withdrawal, and, of course, drug seeking behavior, despite recognized adverse consequences of use. This kind of chemical addiction is forever; it does not go away.

So, I was excited to see that the Substance Abuse and Mental Health Services Administration (SAMHSA), after many months of study, hearings, and input from thousands, on December 22, 2011, issued a new working definition of “recovery” from mental disorders and substance use disorders.

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.”

The new SAMHSA guiding principles state that recovery:

  • Emerges from hope
  • Is person-driven
  • Occurs through many pathways
  • Is holistic
  • Is supported by peers and allies
  • Is supported through relationships and social networks
  • Is culturally based
  • Is supported by addressing trauma
  • Involves the individual, family, and community
  • And is based on respect

Please forgive me for being underwhelmed.

Do you like apple pie? Is motherhood good? It seems to me that both this definition and the guiding principles simply describe how to live a successful human life.

How do these statements advance our knowledge about anything, clarify misunderstandings, chart a path for patients and professionals, or guide payers?

I guess the problem was their very process of writing a definition; too many cooks in the kitchen.

Suggestion for SAMHSA: acknowledge that you have nicely described how normal humans should try to live. Fine. Now try to deal with recovery from disorders of mental health, substance abuse, and addiction.

Maybe you need to divide the topics instead of creating an unhelpful, one-size-fits-all amorphous lump.

George Lundberg is a MedPage Today Editor-at-Large and former editor of the Journal of the American Medical Association.

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