Recovery
Reducing the Supply of Drugs and Related Harms of the Drug Market to Сommunities
Intervention and Treatment
Summary: Twenty-three million Americans are in recovery, demonstrating that substance use disorder can be and is often overcome. 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.” There are four dimensions of recovery: health, home, purpose, and community. To sustain recovery, individuals must have community and support services, including housing, support networks, and gainful employment. It is vitally important for individuals in recovery to build “recovery capital” to address the physical, psychological, social, and spiritual disturbances that characterize substance use disorders. Recovery is an ongoing process of growth to achieve the outcome of a substance-free life that allows an individual to reach their full potential. The only viable long-term solution to our addiction crisis is to get more people with substance use disorder into sustained recovery, shifting the industry to focus on outcomes, such as the number of people in recovery, rather than inputs, such as the number of participants offered treatment. The recovery field should further establish an evidence base.
Recovery is something that you have to work on every single day and it’s something that doesn’t get a day off.
– Demi Lovato, singer and actress in recovery
- All 50 states will operate a recovery-ready workplace initiative by 2030, up from 13 in 2021.
- The number of peer-led recovery community organizations will be increased by 100% by 2030, from 221 in 2021 to 442 in 2030.
- The number of certified recovery residences will be increased by 50% by 2030, from 7,448 in 2021 to
11,172 in 2030.
SAMHSA concluded, “recovery housing is associated with a variety of positive outcomes for residents including decreased substance use, reduced likelihood of return to use, lower rates of incarceration, higher income, increased employment, and improved family relationships.” The U.S. Department of Labor stated the benefits of recovery- ready workplace policies include “an expanded labor force, increased worker well-being, decreased turnover, improved productivity, and reduced health care costs.”
Too many Americans do not have access to wrap around recovery support services and face challenges related to finding employment and housing. Those in recovery may face stigma, potentially undermining their ability to achieve and sustain recovery. Relapses may occur along one’s recovery journey, yet many may lack a support system in place to get back on track.
The National Institute of Environmental Health Sciences noted that employers who hire workers in recovery save an average of more than $8,500 in annual costs related to absenteeism and healthcare utilization; avoid $4,088 in annual turnover and replacement costs; and “reduce absenteeism as workers in recovery are absent 13.7 less days per year compared to workers with a SUD.” The White House Office of National Drug Control Policy agreed, “Adopting recovery-ready workplace policies is also critical for businesses seeking to expand and strengthen their workforces and improve their bottom line.”
Specific Recommendation 8Recovery should incorporate the recognized benchmark of five years sustained remission from addiction, achieved through individualized combinations of treatment and support, with interventions as needed.
Summary: Protocols should be established to support addiction recovery the same way as cancer remission, as evidenced by sustained remission over a five-year period.
DESCRIPTION: The recognized benchmark for sustained remission from addiction is five years, as is cancer remission. Early recovery is met within the first 12 months of recovery, sustained recovery is met between 12 months and 5 years, and stable recovery is achieved after 5 years. If we provided oncology services in short duration, single-focused interventions, and then dropped people out of care after a single round of treatment without regard to the outcome, cancer outcomes would look a lot like what addiction outcomes do now.
There are many pathways to recovery, including through the use of medications for substance use and other co-occurring disorders. There is no wrong door to recovery. Despite these differences, these pathways share the aim of improving quality of life and enhancing overall wellness as identified by the individual, including freedom from other compulsive behaviors and dependencies.
If we treated addiction as aggressively as we did cancer, we would offer people multiple interventions and supports until we found individualized combinations of treatment and support that work for them. Medication and non-medication options need to be available within the array of services offered, as well as support for mental health issues. Once they got into remission, we would connect them with support and follow them over time to ensure that they remained in remission, intervening as needed. Insurance companies will play a role in this process.
We need to concurrently reverse our deep cultural perceptions about people who experience addiction and those in recovery. Americans must know that recovery can be the probable outcome for individuals with a substance use disorder.
This approach should include the establishment of recovery centers in every community—places where people in recovery support each other. Services needed in recovery generally diminish in intensity over time based on an individual’s needs. In the event of a resumption of use, more intensive services should be resumed without arbitrary limits from insurers. Once an individual achieves stable recovery, they will be provided with an annual recovery check-up at least through the five-year mark, when the return to active addiction is unlikely.
Specific Recommendation 9Recovery takes place in community – at times starting in treatment – where people can access culturally, spiritually, and developmentally appropriate services and supports that help them.
Summary: Community integration has long been the foundational element in building and sustaining recovery. Funding and support to sustain community-based support has not historically received much traction, given that our care system has been oriented toward acute treatment. Efforts to expand recovery community would require a fundamental shift to acknowledging and supporting community as the primary healing agent in the recovery process. Reorienting our systems in this way would harness a largely untapped resource and augment the capacity of our treatment systems to effect healing for those impacted by addiction.
Description: Recovery initiatives have expanded to include services and supports beyond our acute, fragmented care systems. Recovery-oriented supports include recovery housing programs, recovery community centers, recovery high schools, and recovery community programs, among others like family support programs. To help more Americans achieve and sustain recovery, policymakers must:
- Meet people where they are and give them a hand up – We must ensure that every person in America can get help when they need it and we keep supporting their healing over the long term, starting at the moment of contact and continuing after their completion of treatment. Individuals must be integrated into support networks, including peer support with appropriate accountability measures that will help them sustain recovery. It is also important to support the individual’s loved ones and educate them on how best to support those in recovery.
- Reorient our care and support systems to center recovery – Since 2000, efforts have been made to develop Recovery-Oriented Systems of Care (ROSC). To move our systems towards ROSC, we would need to uphold the fundamental right of people who have experienced addiction. Those in recovery need to be meaningfully involved in the systems of healing within our care systems. This must include authentic inclusion in the design, implementation, facilitation, and evaluation of policies and programs that impact our lives. To ensure quality, recovery community organizations should have a form of accreditation, as recovery houses do.
- Focus systems on expanding recovery capital – Expand our conceptualization of addiction and its remedies and leverage resources to communities of recovery in order to support the development of Recovery capital at the micro, mezzo, and macro levels. Recovery capital includes all the strengths and resources that people bring to the recovery process; it is made up of all the assets, both material and non-material, that can help an individual start and stay in recovery. Similar to the concept of social capital, a focus on expanding it reduces deteriorative facets in communities while augmenting determinants of healing.
Specific Recommendation 10Ongoing investment in a structure that utilizes a strength-based approach, delivers the right care and support when and where people need it to, promotes the development of recovery capital, and achieves abstinence is needed to achieve recovery.
Summary: Policymakers must expand the recovery infrastructure, including recovery community organizations (RCOs) system, recovery housing, collegiate recovery and a myriad of ancillary support that work for and are nested in the diverse communities who use them.
Description: Policymakers must make investments in the network that support individuals on their journey to recovery. These steps include:
- Research Recovery: Too often, recovery-oriented initiatives lack supportive data. We need empirical data to understand the diversity of our communities of recovery in order to understand inherent strengths, critical thresholds in the recovery process and the myriad of dynamics that encompass the experience of recovery. Longitudinal studies on recovery will help us understand the diversity of strengths and barriers across the recovery ecosystem. This will assist us in identifying promising practices for additional research and establishing an evidence base for recovery. Moreover, the demonstration of positive outcomes will help ease the insurance reimbursement process, ultimately helping to increase access.
- Invest in our SUD Peer Workforce: Our workforce crisis has been deepening over the course of a generation. Low wages, high administrative burden and a lack of career pathways are long-term challenges. In recent years, we have also seen that many of our most senior workers retire and are not replaced with people who make a career of this work. We have made it harder for people with lived experience to enter our workforce, in part as a result of stigma associated with SUD recovery. The peer worker rung is at this point the most likely point of access to a career in our field. We need to retain and grow these workers through apprenticeship programs and loan forgiveness options, while ensuring credentials are standard, meaningful, and consistent. We need to invest in supervision so that they are retained over an entire career. To do this, we should understand that the peer workers of today will potentially be program CEOs of the future if we properly invest in their growth and development.
- Change how we fund recovery-oriented programs: We fund senior centers in communities across America because we understand that investing in older adult communities is an inexpensive and effective way to strengthen and support these members of our community. This is accomplished outside of the fee-for-service model. We fund the centers, not the services, because it is the center that engages the community in their own wellness. We need to fund the recovery community in a similar manner. Policymakers should focus on capacity expansion, particularly for reaching justice- involved individuals and underserved areas, including rural areas. Policymakers should develop a hybrid funding model that is sustainable, including through Medicaid.