By William L. White
A significant portion of people who resolve alcohol and other drug (AOD) problems do not embrace a recovery identity—do not see themselves as recovered, recovering, or in recovery. I first suggested this in Pathways from the Culture of Addiction to the Culture Recovery (1990) and later in a co-authored essay on the varieties of recovery experience (White & Kurtz, 2006), but had nothing but years of observation and anecdotal stories to support it. When I was asked about the prevalence of adoption or non-adoption of a recovery identity among people who had resolved AOD problems, no data were available to inform that question. Thanks to a just-published study by Dr. John Kelly and colleagues of the Recovery Research Institute, there is now data that addresses that and related questions.
The Kelly-led research team surveyed a representative U.S. population sample of people who had resolved a significant AOD problem during their lifetime and determined the extent to which such individuals adopted a recovery identity and whether such identification had changed over time. Here are some of their major findings.
*Of the 45.1% of people who had resolved an AOD self-identified as “in recovery”, 39.5% had never seen themselves as being “in recovery”, and 15.4% once identified as being “in recovery” but no longer embraced a recovery identity. Of all people with recovery identification at some point in their lives, 25% no longer embrace a recovery identity.
*People who had resolved an AOD problem and who also currently embraced a recovery identity were more likely to have been diagnosed with a substance use disorder (SUD), diagnosed with a mental health disorder, treated for a SUD, and more likely to have been involved with a recovery mutual aid group—all potential proxies for greater problem severity and complexity.
*People who had resolved an AOD problem who never saw or presently do not see themselves “in recovery” offered several reasons for not embracing a recovery identity: 1) self-perceived lower problem severity, 2) self-perceived ability to function in spite of AOD problems, 3) ability to stop AOD use without peer or professional help or, for some, success in decelerating use to escape AOD-related problems, 4) seeing AOD problem resolution as a past chapter of their life—a past decision—and not a present struggle, and 5) a desire to avoid the “sickness” label.
*Quality of life indicators did not differ across the three groups (current recovery identity, rejection of recovery identity, once embraced but now reject recovery identity).
The Kelly group study confirms the variations in recovery identity among people who have resolved a significant AOD problem. It appears that people with lower problem severity may resolve AOD problems without embracing a recovery identity, while people with greater problem severity may find it helpful to embrace such an identity as a mechanism of stable recovery maintenance. Also of note is the portion of people who evolve out of a recovery identity over time. These include people who may have once been involved with a recovery mutual aid group but who have sustained problem remission after cessation of such active participation. I have discussed these populations in earlier blogs HERE and HERE.
What is becoming apparent and confirmed in multiple studies is that AOD problems exist of a broad spectrum of problem severity with quite different lifetime trajectories—from risky use, binge use, sustained heavy use, and compulsive use. Problem resolution strategies and personal styles vary greatly across this spectrum. The question facing addiction treatment as a social institution and recovery community organizations is this: Do we seek cultural ownership of all AOD problems or only the most severe and complex of such problems?
If the treatment field embraces responsibility for all AOD problems, then our knowledge base, our change and support technologies, and our public messaging must be dramatically broadened and become far more nuanced. If the field restricts itself to the most sever and complex AOD problems, then we need to clearly define the boundaries of our expertise, practice only within those boundaries, and make it clear that other social institutions are responsible for AOD problems marked by lower severity, complexity, and chronicity. Unintended harm can come from indiscriminately applying models of care and support designed for high problem severity and low recovery capital typical of late state SUDs to people with low problem severity and high levels of recovery capital—and vice versa!
The Kelly recovery identity study also has important implications for how we communicate to the public and policymakers about AOD problems. As the Kelly research team suggests, “AOD public health communication efforts may need to consider additional concepts and terminology beyond recovery (e.g., “problem resolution”) to meet a broader range of preferences, perspectives, and experiences.”
Are the addiction treatment and recovery support fields capable of reaching people within this broader spectrum of AOD problems? Are they ready to embrace broader pathways and styles of AOD problem resolution? The fact that less than half of people who have resolved a significant AOD problem see themselves as “in recovery” is a striking finding. Are we ready to introduce ourselves to the other half and face the challenges such contact will inevitably bring to prevailing ideas and service practices? What do you think?
Kelly, J. F., Abry, A. W., Milligan, C. M., Bergman, B. G., & Hoeppner, B. B. (2018). On being “in recovery”: A national study of prevalence and correlates of adopting or not adopting a recovery identity among individuals resolving drug and alcohol problems. Psychology of Addictive Behaviors, August. doi: 10.1037/adb0000386
Kelly, J. F., Bergman, B., Hoeppner, B., Vilsaint, C., & White, W. L. (2017). Prevalence, pathways, and predictors of recovery from drug and alcohol problems in the United States Population: Implications for practice, research, and policy. Drug and Alcohol Dependence, 181, 162-169.