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Since the early promulgation of addiction as a brain disease, I have warned that such a model could increase rather than decrease addiction-related stigma if not also accompanied by a parallel understanding of the neurobiology of addiction recovery. To that end, I joined several colleagues in calling for a recovery research agenda that includes a focus on the degree to which brain functioning is restored during the recovery process. In the intervening years, significant research has illuminated such healing processes and their implications for recovery management. The most significant of this work has been done on alcohol use disorders. The extent to which these findings are applicable to other substance use disorders remains unclear.
Addiction recovery is best viewed as a process rather than an event, but the transition into recovery can sometimes be more a cataclysm than a product of incremental steps—more a lightning strike than a process of maturational learning—and the factors that sustain recovery over time may be quite different than those that trigger recovery initiation. Where recovery stability is achieved in gradual stages and within later stages of enhanced global health and functioning in recovery, there are can be surges in growth that exert profound effects on personal identity and character and one’s relationship with the world.
Considerable efforts are underway at federal, state, and local levels to extend acute and palliative care models of addiction treatment to models of assertive and sustained recovery management (RM) nested within larger recovery orientated systems of care (ROSC). As that work proceeds, a critical question has emerged about the application of RM and ROSC to the design, delivery, and evaluation of services for children, adolescents, transition age youth, and families (CATAYF).