Defining Recovery—How Harm Reduction Can Change Abstinence-Only Thinking

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What is “recovery”? As a policy reform advocate, I was fortunate to have an in-depth conversation with the Director of the new Office of Recovery branch of SAMHSA. This is a critical time to move forward and have policymakers and the public agree on what recovery means for millions upon millions—as the overdose death toll rises, and the clock ticks, and billions pour in from the American Rescue Plan.

As recently as the War on Drugs, we have seen plain definitions of this word radically change our lives. These debates weave through our history. Each new definition carries the same potential when policymakers and politicians use the term to guide services to people with a substance use disorder (SUD). So, I share my experience as a person in recovery, as a former prosecutor, and as an advocate for reform.  Like getting well itself, the road is not singular, direct, or uniform. 

Our country began on a road to ruin when it decided that people who used drugs and had substance use disorders were criminals. Their policies incarcerated the sick, devastated the poor, and divided our people. Key decisions of their fate were steered, in part, by understandings of recovery that defy the facts. While we may not yet agree on what recovery is quite yet, we know what doesn’t work.

A Road to Public Ruin

Early on, we chose the traditional view: Recovery as abstinence from all drugs (and alcohol). Unfortunately, this definition fails to mention all the positive changes that come about before you reach that perfect sobriety. It neglects to acknowledge that everyone’s experience with substances is different. And, it declines to admit that it treats addiction as somehow separate from every other mental health disorder—punishing, stigmatizing, and excluding it from compassionate care.

What lies at the end of this definition’s rope is our current reality. We see hundreds of thousands of preventable deaths each year. We witness coercive treatment that doesn’t work. We hear endless tales about the evils of morally corrupt “addicts”—without any idea about how to change our situation. Some ask for harsher sentences and stricter conditions. These voices are begging to hit bottom and continue the alienating practices that have led us here.  

The truth is every step counts. Abstinence-only thinking leaves out all the ways that we can come closer to sobriety—in our own way. Addiction—like all other mental and physical health disorders—exists on the spectrum: people can recover from one dangerous area of their drug use without complete sobriety. We must recognize small victories as recovery. When we do, it motivates more positive change.

In our work at Indiana Center for Recovery, we recognize the autonomy of the person in front of us: in wanting better for themselves, they are already in recovery. And, that’s why SAMHSA uses “quality of life” as its measure of recovery. 

A Path of Lesser Pain

Politicians, your grandfather, or your priest may not agree with this, but SAMHSA defines recovery as “a process of change” t.

This definition emphasizes that recovery is a process, rather than a state of achievement. In that sense, it is never finished. And, in harm reduction, we are never finished making the world a safer place to be. We already practice the principle: we always wear our seatbelts, we avoid too much sugar, and we stay home in the pandemic. People with SUDs need us to recognize their humanity—beyond the question of whether they used drugs today—and offer them help as we do with anxiety, depression, and medical disorders.

We must wake up: A person who uses drugs is a person. Those who use drugs with a SUD have the right to care as well as life-saving therapies—just like any other. When we let people choose their care and decide what they need to improve their lives, we see better outcomes because hope takes root: there is a path of lesser pain for everyone. The research is there.

A Return to Freedom

As a former Cook County prosecutor, I think back to the legal definition of recovery as a “getting back” and “vindication of a right.” It means that you have been made whole and recognized in a final judgment. So, what is there to win when I say, “I am in recovery”? I return to my human bond with every other American. It is a way of showing that I am a part of the story rather than some villain or hopeless soul. 

When we define recovery as a process, a step toward progress, and a way of being—we fight the stigma that has isolated us from each other. I’m in full support of all means necessary to achieve wellness, and we must give a voice back to the “addicted”—those we have spoken for.  

We all want to recover. Many of us are in recovery. And, many more should have the chance to live in freedom from addiction. It begins by seeing the humanity of addiction and remembering that in our care for the disease—and in our words.

—Chad Sabora

Chad is co-founder and executive director at MoNetwork. He is also Director of Government and Public Relations at Indiana Center for Recovery, a healthcare leader using the latest, evidence-based practices to treat substance use and co-occurring mental health disorders.

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