One of the most difficult challenges facing the historian is evaluating a series of linked events while they are still unfolding and while their long-term import remains unclear. That is a challenge I regularly face in recounting recent threads within the evolving fabric of addiction treatment and recovery in the United States.
This brief essay risks identifying emerging trends I believe to be of enduring historical significance. Here are 12 advancements within the history of addiction recovery that mark the opening years of the 21st century.
1. The international growth and philosophical diversification (secular, spiritual, religious) of addiction recovery mutual aid societies. This trend is expanding recovery support choices and stirring calls for researchers to formally map the multiple pathways, styles, and stages of long-term addiction recovery.
2. Scientific research confirming the widespread phenomena of natural recovery (people resolving alcohol and other drug problems without the aid of professional intervention or participation in recovery mutual aid groups), particularly among people with lower problem severity/complexity/chronicity and higher recovery capital. The prevalence of natural recovery is spurring discussion about how this style of recovery could be professionally and publicly legitimized, promoted, and supported.
3. The explosive growth of virtual recovery communities and technology-based recovery support resources that are dramatically increasing accessibility of recovery support. The potential import of this technological revolution within the history of recovery support is incalculable.
4. The political and cultural mobilization of people in personal/family recovery and their allies via a new recovery advocacy movement. This movement has exerted, and continues to exert, a profound influence on drug policy, the level of social stigma attached to addiction and addiction recovery, and the status and design of addiction treatment and recovery support services.
5. Emergence of recovery as a new organizing paradigm within the alcohol and drug problems arena, including federal, state, and local agencies granted cultural ownership of alcohol and other drug problems. This marks a shift in focus from pathology (etiology, course, and consequences) and intervention (methods of brief biopsychosocial stabilization) to a focus on lessons drawn from the lived experience of long-term personal/family recovery.
6. Challenges to extend acute and palliative care models of addiction treatment to models of assertive and sustained recovery management (RM) (across the stages of personal and family recovery) that are ideally nested within larger recovery oriented systems of care (ROSC). Most debates about the relative merits of various addiction treatments for the past two centuries have addressed issues within the acute care model; RM and ROSC constitute fundamental challenges to the historical design of addiction treatment.
7. Promising experiments in conceptual and practice integration across ideological divides within the addictions field, including efforts to integrate prevention, harm reduction, early intervention, treatment, and recovery support services (e.g., the integration of medication assisted and psychosocial approaches to addiction treatment). Particularly promising are strategies that integrate time-sustained clinical and mutual aid models of intervention with environmentally-focused public health models.
8. Recovery-focused service integration initiatives between addiction treatment and allied systems (e.g., primary medicine, psychiatry, child welfare, criminal justice, etc.). Of these, efforts toward the tri-directional integration of primary medicine, psychiatry, and addiction treatment are of profound significance in supporting early recovery initiation and long-term recovery maintenance.
9. The development of new recovery support institutions (e.g., recovery centers, homes, schools, industries, ministries, cafes, etc.) and new recovery support roles (e.g., recovery coaches) that fall outside the historical rubrics of recovery mutual aid groups, addiction treatment, and traditional helping roles. These new institutions and roles stem from an understanding of the ecology of recovery—the belief that the tipping point of recovery is determined as much by community recovery capital (the physical, psychological, and social space within which recovery can flourish) as by intrapersonal factors.
10. The growth of an ecumenical culture of recovery that transcends one’s identification with a particular treatment or recovery mutual aid enterprise, resulting in people in recovery seeing themselves as “a people” whose collective stories are expressed through recovery-infused history, language, values, symbols, rituals, music, literature, art, cinema, theatre, and sport. This blossoming culture of recovery is particularly valuable to those who have been enmeshed in the culture of addiction. The culture of recovery provides a world in which sustainable recovery can be physically and socially nested.
11. The recognition that recovery can be socially contagious. This is spawning systematic efforts to reduce environmental obstacles to recovery and increase the density of recovery carriers within local communities via assertive community outreach and recovery-focused professional and public education. (Recovery carriers are people whose quality of life and character—genuineness, hopefulness, and helpfulness) attract others to the recovery lifestyle.
12. Recovery research advancements, including research scientists and clinical leaders focusing their research portfolios on the experience, prevalence, and processes of addiction recovery. Particularly noteworthy is a new generation of MA and PhD students focusing their theses, dissertations, and future research plans on the study of addiction recovery.
Some years ago, I addressed my professional colleagues with the following observation:
What we know about alcohol and drugs, addiction, and the short-term treatment of addiction fills libraries, and this knowledge has helped many people start their recovery journey. But what we know as a professional field about long-term personal and family recovery from addiction from the standpoint of science and clinical practice could at best barely fill a few scant shelves within such libraries….As communities of people in long-term recovery turn to addiction scientists and clinicians in search of guidance on such issues, we find little recognition of our existence and little guidance. So we turn to each other and wonder collectively why, after decades of addiction research, our most basic questions about recovery remain unanswered.
That world is changing, based on the recent trends noted above. The 21st century might well become the century of recovery—yes, for the addictions field, but more importantly for individuals, families, and communities across the globe. Perhaps this will also be the century when the world begins to heal itself. Each of us has a potential role to play in this healing process.
by William (“Bill”) White
Emeritus Senior Research Consultant at Chestnut Health System
Read all of Bill White's Blog Posts on his website here www.williamwhitepapers.com