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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  • Kevin Nasky, DO

    What would your definition of recovery be, Dr. Lundberg?

    • David Behar

       The alternative to the Recovery movement I will call coercive rehab. The Air Force added an hour of training for its supervisors, and cut the suicide rate by a large fraction, forcing people into ordinary evaluations and treatment. An unexpected side benefit was a cut in the murder rate (likely from decreased alcohol use). Civilians copied this approach in the form of Assertive Case Management and had similar results in the civilian sector.

      Consider an analogy. A soldier loses both legs and refuse rehab. He wants to lay around and to feel hopeless. He has seen only one such injury. He knows nothing about what can be done. An assertive, pushy nurse forces him into rehab, to learn new skills, and to have a life that is rich, fulfilling, and nearly as good as the one before his loss. She has seen a thousand such injuries, and is an expert. To have the patient take charge of his management is ridiculous, when you have an expert available.

      • Anonymous

        Yes, typical of the mental death profession, the current SS thugs in our growing totalitarian police state like Stalinist Russia with forced treatment, commitment and drugging based on the “word” of a bunch of psychopathic malignant narcissists who created the mental death profession for social control only to silence and destroy anyone who sees through them and certainly not helping anyone in any medical or healing way whatever. 

        How horrific.  Avoid such NAZI DOCTORS (book by Dr. Jay Lifton) like the plague they are!

        • Anonymous

           Dietrich: Where are you? In the Fourth Grade? Can’t you do better than these personal remarks. You are merely scoring points for the other side.

          OK. The patient is responsible for his treatment or refusal to get treatment. He then acts up, gets arrested, and held accountable for his mentally ill behavior in jail, where he does not get adequate treatment. That is why the Recovery Movement is so irresponsible.

          • Anonymous

            Look who is talking about abuse, personal remarks, acting childish, attacking others for their opinions, etc.!  I have done tons of reseach on this topic, so instead of trying to intimidate others with your gestapo approach in a supposed free country/democracy, I suggest you check out some of the FACTS that I included in my comments.  You, on the other hand, are just spouting off based on your commandant military police state dictatorship attitude without researching anything at all!

            While you are at it, check out books on psychopaths by Dr. Robert Hare, Dr. Paul Babiak, Dr. Martha Stout, Dr. John Clarke and others and see if you see the similarities with yourself.  This is one of the greatest threats to society.  Malignant narcissists are pretty evil too!  You are correct that psychopaths and other character disordered people are dangerous under the influence of alcohol, but they are also dangerous sober.  Most psychopaths are not serial killers, but rather, are our next door neighbors, spouses, family and coworkers who wear a “mask of sanity” (see Dr. Hervey Cleckley’s THE MASK OF SANITY, a major classic on psychopathy, which formed the basis of the work of Dr. Robert Hare, the world’s foremost authority on psychopathy who developed the international test for it, THE PCL-R).  Dr. Hare regularly consults with law enforcement and the FBI worldwide.

            Check out SSRI antidepressants and other psych drugs causing violence with many lawsuits being won for “involuntary intoxication.”  Dr. Peter Breggin, Psychiatrist, just won a case for a teenager who stabbed a friend while “under the influence” of lethal Prozac among others.  Dr. David Healy, Psychiatrist, has also exposed the dangers of psych drugs and the suicide and violence risks of SSRI’s.  TIME MAGAZINE published a list of the top 25 drugs causing the most violence and most of the top ones were psych drugs, especially SSRI antidepressants.  What is worse is the book, THE EMPEROR’S NEW DRUGS, highlighted in last week’s 60 MINUTES TV show, exposed how these lethal drugs are no better than placebo, but psychiatry in bed with BIG PHARMA conned the public to believe otherwise and still do about all their poison, deadly drugs.  There are no chemical imbalances and “mental illness” genes either desite their lies to the contrary they admit when forced.  See book, THE GENE ILLUSION.

            Dr. Stanton Peele has written a great book, THE TRUTH ABOUT ADDICTION AND RECOVERY, exposing the fact that addiction has more to do with one’s failure to find worthwhile positive goals rather than some genetic disease or other bogus theories.  Also, the book, THE BETRAYAL BOND, by Dr. Patrick Carnes explores the connection between abuse and trauma fueling addiction with all of it needing to be addressed.  THE VA has recently announced that psychiatric “treatment” or psych drugs for combat veterans suffering PTSD have been proven worthless and dangerous, so they will need to seek other treatments.

            I find it amusing that you hate the so called recovery movement so much when the mental death profession has highjacked AA or 12 step groups and forces its victims to participate whether they want to or not as part of their bogus expensive treatment that AA provides for free.  I applaud SAMSHA for its humane, enlightened approach to addictions of all kinds that is a major improvement over the usual abusive tactics of the mental death profession.  The real mentally ill are those in psychiatry still trying to push their evil eugenics theories to create new Holcausts and racial cleansings throughout the world.

            But, I will stop wasting my time with the likes of someone like you who pretends to know everything while being totally ignorant of the facts.  I’ll match my research and knowledge to yours any day of the week.  Heil Hitler!!

          • Anonymous

             The authorities you relied on are marginal and have all been debunked. The overwhelming majority of patients take these medications because they help them function and stay safe. Most have undergone several on-off trials, whether intentional or by neglect, and experienced relapses. The left wing, Obama appointed  ideologues at SAMSHA want bigger government, and to keep people sick, and needy of more ineffective treatment, not less treatment. To your Sieg Heil, I reply V Tech. Untreated, Cho generated massive government make work. Treated, he would have generated nothing for the left wing big government rent seeker. He would have graduated, gotten married, and found a job.

            I hope the psychiatrist resist the Recovery Movement to their utmost, to defend clinical care.

          • Anonymous

            Glad you are showing your right wing NEO FASCIST true colors.  Do you wear a swastika?

            You are showing your redneck ignorance by claiming the authorities I cite have ben debunked, etc.  How sad as you attempt to dictate your sick views on such vulnerable people.    You probably don’t even have a high school diploma since you obviously are incapable of doing research!

            Again, Cho like all too many others got the best care the mental death profession provides: dangerous lethal drugs prescribed with a bogus stigma from the junk science DSM based on a 15 minute meeting and 10 minute med checks every few months thereafter as the so called patient deteriorates and becomes permanently disabled.  At times, they also become suicidal, manic or homicidal thanks to lethal psych drugs.  Books like award winning journalist Robert Whitaker’s ANATOMY OF AN EPIDEMIC expose the truth of how the mental death profession destroys its victims by not only failing to help with the original problems, but also, causing masses of permanently disabled people on SSI disability payments.  Thus, the taxpayer must pay for the billions in bogus treatment to fill the coffers of the mental death profession in bed with BIG PHARMA and corrupt government hacks and then the massive permanent disablility government payments to those they permanently disable.  Talk about Obama wanting BIG GOVERNMENT.  The right wingers have robbed everything and everyone for their corporate welfare while destroying our country and others in the process like fighting bogus wars and spreading their medical menace throughout the world.

          • Anonymous

             Cho did well while in treatment. He went untreated for two years thanks to PC and left wing ideologues, controlling our campuses now.

            Whitaker’s book contains a basic error of ascertainment. That mistake makes it misleading to patients. If gets patients to stop their treatment, Whitaker should be responsible in court. If you express an opinion, you are immunized by the First Amendment. Once you get people to do things, you are a guideline maker with a legal duty to do no harm.  The family of anyone stopping medication after reading his book, who causes or suffers harm should sue him for negligent guideline making.

          • Anonymous

            This is garbage about Cho.   The Columbine shooters were on toxic psych drugs like all too many others.

            Whitaker simply puts forth studies by many high level psychiatrists, government mental health agencies and others of the supposed best sources of psychiatry.  The studies themselves show that the toxic poisons passed off as medications not only do not help with any of the symptoms of the bogus stigmas from the junk science DSM, but made the so called patients far worse and mostly permanently disabled for the most part if they continued on these poisons for any length of time.

            The studies also showed that those who escaped psychiatry and its poisons, atypical and other antipsychotics in particular known to cause brain damage and tons of damage to one’s body as well as early death by about 25 years. tended to RECOVER unlike those tortured and medicated by psychiatry.

            Studies have also shown that those in third world countries not preyed on by psychiatry who have stress breakdowns stigmatized here as schizophrenia or the latest garbage can fraud fad stigma, bipolar, tended to RECOVER for the most part unlike the stigmatized and drugged with poisons in the U.S.  So, perhaps it is the mental death profession and its cohorts in crime who should be sued for their fraud against this nation and the enormous damage they’ve done to their so called patients.  But, as you make clear, psychiatry is about social control and has nothing to do with health at all and least of all the health of those they victimize, abuse, torture, punish, intimidate and rob of all their human, civil and democratic rights in the GUISE of health and medicine. 

            It is BIG PHARMA that does most studies and most if not all negative information is hidden and/or spun to make toxic, useless drugs appear to have efficacy when many do not like SSRI antidepressants and others. Many psychiatrists and academics have been bought out by BIG PHARMA to tout useless, deadly drugs that Senator Grassley exposed in Congress not too long ago including drug company front group, NAMI and others.
            So, let’s end this so called discussion since you don’t know what you are talking about.  Whitaker just presents the facts and allows his readers to choose whether or not to take medications.  He does not tell them to stop, but the evidence of the massive harm done is all too clear.

          • Anonymous

             Millions of  people disagree with this view based on their personal experiences going on and off medication.  The reason for that is that you are putting out false propaganda by left wing government make work rent seekers. The alternative to medication are huge government state hospitals where people are calmed down by being wrapped in ice cold sheets. That is the hidden agenda behind the anti-medication witch hunt.

            Columbine was  long planned, and prepared terrorist act. That began long before any medication was tried. There was no evidence of intoxicated or agitated behavior. They were cool as cucumbers. They were more influenced by video games. They had no meds in their bodies. Had they been on tranquilizers, Columbine would not have happened. They would have been less paranoid and grandiose, less angry.

            In any case, out of the mainstream, biased extremists will never be allowed to dictate to patients what they can and cannot take. Nor will government functionaries ever be allowed to dictate clinical care, including severe violations of the states mental health acts. I strongly urge all doctors sued by mental patients to file cross claims against these little dictators. Deter them. You may be immunized for your wrongheaded irresponsible views by the First Amendment, they are not.

  • Bornagainscholar

    Seems the definition is quite fitting. Is it not the goal to get addicts and people suffering from mental disorders to live a normal and productive life? Of course I am not a doctor but I am a recovering heroine and crack addict. All of the addicts I know I would consider in “recovery” if they were living a normal and productive life and were substance free of course.

  • Nonmaleficence

    I agree with the feeling of being underwhelmed by these guiding principles of recovery. It doesn’t give the clinician any better of an idea of how to treat the recovering addict. They merely listed a multitude of factors that are applied to everyday encounters. We might as well tell the patient the guidelines state that attending yoga classes is more beneficial than seeing their physician.

  • David Behar

    I consider the recovery movement to be an irresponsible threat to the safety of patients and to the safety of the public.  Any doctor sued for its consequences, should file a cross claim against the insurance or government program imposing it from above. By their coercive tactics, they have formed a master-servant relationship with providers, and should be sued.

    One word rebuttal for these irresponsible ideologues. V Tech. They would have Cho, the mass murderer, run his own treatment. The would “respect” his refusal of treatment for two years before he killed 25 people.

    • Anonymous

      How vile to instigate mass hysteria and mobbing against the so called “mentally ill” thanks to bogus biological psychiatry with its fraud witch hunt stigmas in the junk science DSM to push the latest lethal drugs on patent in bed with BIG PHARMA that destroy countless lives.   As with most if not all school and other public shooters, Cho had been under the so called “care” of the mental death profession and once they subjected him to their bogus “treatments” claimed he was fine and sent him off with predictable results if the mental death fiends would only tell the truth.  It is well known that most if not all psych drugs and especially SSRI antidepressants cause suicide, violence, mania and a host of other dangerous effects the mental death profession then uses to falsely claim the victim really was bipolar to push a more deadly stigma and cocktail of lethal drugs like antipsychotics and so called mood stabilizers (epileptic drugs fraudulently used with suicidal consequences) like Depakote still on patent.  A recent list of the 25 top drugs causing the  most violence  published in TIME consisted mostly of psych drugs and Chantix promoted for quitting smoking.

      Anyone familiar with the mental death profession knows enough to ask whether the latest school or public shooter/killer was on lethal psych drugs with the answer mostly if not always yes.

      I applaud the new model of recovery above since the mental death profession through its fraud stigmatizing “bible” DSM by revelation rather than any science blames the victim with its bogus disorders with the latest fad frauds ADHD and bipolar, the latest garbage can diagnoses to destroy their victims and make them permanent profit centers for the mental death plutocracy.  So called bogus biological psychiatry with its joke of a medical model with the DSM consisting of social fads VOTED in by the white male old boy network elite of psychiatry is the real menace that should be exposed and abolished.l

      Most real experts know that addictions are all too closely tied to past and present abuse related trauma like many other symptoms of emotional distress or mental INJURIES the mental death profession lies and denies to colllude with its fellow abusers in the power elite.  See Dr. Judith Herman’s classic work, TRAUMA AND RECOVERY, Dr. Carole Warshaw, psychiatrist and domestic violence expert exposing how the mental death profession destroys women and child victims of domestic violence and many others.  Another excellent book exposing these crimes is THE BETRAYAL BOND by Dr. Patrick Carnes.

      Though most government agencies have colluded with the mental death profession in bed with BIG PHARMA, the above model of recovery at least recognizes that past and present abusers need to be idenitified since they do all to destroy their victims with psychological and other terror including character assassination so when their victims start showing the resulting stress breakdown or mental/physical INJURIES including self destructive self medicating, the abuser then has the mental death profession to help him put the final nails in the coffins of the abused trauma victims by labelling them crazy.  Obviously, only psychopathic malignant narcissists could do this to abused, mobbed, bullied victims from domestic, work and other abuse, so they are the ones who are crazy and should be treated as such with the public protected from the likes of THEM and not their victims like Cho.

      • Anonymous

         The overwhelming majority of suiciders, murderers, and murder victims do not have any psychiatric medications in their system, save for one, alcohol. Dietrich offers only ipse dixits. He also has the temerity to know what is good for others choosing to get psychiatric care for themselves or for their loved ones before serious mental illness destroys the person and the family. Most violent people, whether violent against self or others, are under-treated, and need to forced into taking medication and treatment. All data about successful reductions in suicide and murder involve forcing people into treatment, and monitoring and enforcing adherence. .

  • Anonymous

    Vague to an extreme.

  • Anonymous

    Vague to an extreme.

  • C Modelewski

    I’m not a huge fan of what SAMHSA came up with. Peer recovery groups have come up with some better things. I think I see where they are trying to go with it, though. For a very long time, people were sent the message that recovery was not possible. There was no chance at living life like someone without a disorder. You were forever dependent on your mental health providers – they called your landlord when the water got shut off, they called your primary care doctor if you had a problem with the prescription he or she gave you, they went through your budget to make sure you’d have money at the end of the month. Getting off benefits was out of the question, because it would not be possible to work. Learned helplessness was rampant.

    I have not seen private mental health professionals take this attitude. When I first went in to therapy, I was expected to go into recovery. I was expected to take care of myself. I had a say in what medications I took. My treatment plan was based on my goals and not what the therapist thought was best for me. I was treated with respect and like an intelligent person.

    A year later, I took a position at a community mental health agency. It was culture shock. Many of the clinicians treated the people they worked with like children. They set all of their doctor appointments, gave them rides everywhere, and constantly said, “They’re sick, and they never do things for themselves. If I don’t do it, it won’t get done.” Treatment plans had little to do with what the person wanted, and often times people didn’t want anything. They had no goals. Many were in case management for years, even after they were stable. They were afraid to move forward independently, and many were discouraged from leaving services.

    In my three years there, I saw clinicians struggle with the idea of the recovery movement. Some did not feel it was realistic, and they fought the concepts – spouting off on how the people they worked with were too sick to get better.

    There were some very good clinicians where I worked, and the people they worked with improved quickly. And I do not doubt there are private mental health professionals who feel their clients should be forever dependent on them. While SAMHSA’s description is vague, the point they are trying to make is that it is possible to lead a regular life like everyone else, and that the person is responsible for their recovery. There are a lot of people who were never told that.

    Hopefully the folks at SAMHSA get some feedback from peer supports, clients, and people receiving mental health services from the public system on how this definition is lacking. Acknowledging the movement is a good start, at least.

  • Anonymous

    I have had substance use disorders (alcohol, amphetamines, barbiturates, caffeine, codeine, nicotine) and have engaged in harmful use of other substances (cannibis, cocaine, hallucinogens, heroin, and various inhalents). I have had addictions / harmful dependence to other compulsive behaviors.
    I have been treated for depression (with medication, individual outpatient care, group therapy, as well as inpatient treatment / psychotherapy). As an adolescent I was hospitalized twice following suicide attempts involving overdosing with prescription narcotics, one involving a coma and Intensive Medical Care intervention and treatment.
    Additionally, I have exhibited symptoms of ADHD (originally ADD with hyperactivity) since preadolescence and in a residual way throughout my life (I’m currently age 62).
    Since receiving inpatient treatment (in 1981) for alcohol dependence, I have been abstinent from all harmful substance use, except nicotine which I continued to use until 1996, and caffeine which I continue to use daily.
    I attend AA regularly and practice the principles outlined in the 12 steps*, with the goal of remaining alcohol and drug free, while trying to live free from all other harmful behaviors, making progress, recognizing that as a human, perfection is not realistic. {*I have attended / participated in other group forums – EA, NA, SAA, OA, RCA, and AlAnon.} 
    I am aware of various treatment methods, practices, and philosophies. Some I find useful, others not.
    In my case, I believe that it is accurate to say that I am a recovering alcoholic and addict, and in remission from severe / chronic mental illness. I believe it is significant that I had to stop all use of alcohol, before I experienced ongoing recovery and something like a normal life. 

    I do not compare my life or attempts to live a normal life with the lives of adults who have never had chronic dependencies and / or mental disorders.

    Finally, I believe that we, as a nation, will benefit more from seeking methods of preventing and treating these conditions than using them as platforms for political drama and social controversy. I appreciate all of the help I have received and will continue to attempt to help others.

  • David Behar

    Meredith Kendall: V Tech. 

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