NYAPRS Note: Thanks to SAMHSA’s Dennis Romero, this report should be required reading for mental health providers who need to learn critical insights from people with histories of alcohol and other drug problems. The report “examines focus group and interview findings and offers greater insight into people's individual journeys of recovery. Read about the terminology individuals in recovery use to describe their experiences, the range of pathways to healing that exist, and the barriers and supportive influences involved in the recovery process.”
Pathways to Healing and Recovery:
Perspectives from Individuals with Histories of Alcohol and Other Drug Problems
This report discusses the findings from a qualitative study funded by the Substance Abuse and Mental Health Services Administration‘s (SAMHSA‘s) Center for Substance Abuse Treatment (CSAT). Focus groups and individual in depth interviews (IDIs) were conducted to provide greater insight into and perspective on the process of recovery from addiction to alcohol and other drugs. The study specifically seeks to gain a deeper understanding of the recovery process; to explore the terminology that individuals in recovery use to describe their own processes; to become more knowledgeable about the range of recovery pathways; and to more fully understand the barriers to successful recovery and the influences that support it.
Methods. Four focus groups were held, with a total of 24 participants across all four groups. In addition, nine IDIs were conducted, for a total of 33 participants. Individuals were screened to recruit two study groups: a younger adults group,
ages 18–30, and an adults group, ages 31 and over. Participants were required to have had a history of alcohol problems, drug problems, or both, and to have been maintaining a healthy lifestyle for no less than six months. The study recruited individuals who had used traditional and/or non-traditional therapies and supports to achieve their healthy lifestyles. Each focus group lasted approximately two hours. Participants were paid $75 to cover their time and
travel costs. The focus group participants were led through the discussion in a topic-by-topic format, with the opportunity for general discussion and a more indepth conversation on specific topics.
Terminology: “addiction” is a commonly used term, and “recovery” is widely understood and accepted. Notwithstanding extensive efforts to allow participants to define the terms of the discussion related to their history of alcohol and other drug problems and their current status, -”addiction” and -”recovery” emerged as the most commonly used words. -”Addiction” emerged as the word used by most individuals to define a dependence on a substance, although some described -”addiction” as a clinical term. While the term -”recovery” was widely understood and accepted to describe when someone has overcome a dependency, some individuals did not associate themselves with the term nor use it. The term -”recovery” was familiar and comfortable for individuals whose pathways were 12-step-based and who had participated in either mutual aid groups or treatment programs based in 12-step traditions. Those who chose non-12-step-based methods (e.g., natural recovery, cognitive-behavioral therapy, or addiction energy healing) often preferred other terms such as -”quit,” -”healed,” and the past tense form of the word: - ”recovered.” Participants provided rich descriptions of the experiences they associated with each of these terms.
Addiction. Descriptions of addiction often focused on a feeling of being out of control, and involved accounts of trauma and pain, unhealthy behavior, lying to both oneself and others, and self-loathing. Participants often related feeling a
sense of loneliness and despair while in the throes of their addiction.
Recovery. In contrast, recovery was described as having control of one‘s life, being honest with oneself and others, and experiencing independence and happiness. Many said that managing their disease is a daily struggle, but they are now in control of their lives rather than being controlled by their addiction.
Honesty and responsibility are important aspects of the recovery process. Many said they had to take responsibility for themselves and their behavior before they could attain wellness. Themes of health and healing emerged from most
accounts of an individual‘s recovery process.
Differing views were expressed on whether one must abstain from alcohol in order to be in recovery. The majority of participants believed one must abstain from alcohol and other drugs to be in recovery, but a minority believed it is
possible to drink moderately. This group was largely made up of younger adults who did not view 12-step programs as their primary pathway to recovery. Some explored alternative pathways and saw themselves as ―”healed.”
Others described themselves as in recovery from particular substance(s) that they were addicted to (e.g., cocaine, prescription medications, methamphetamines), and said that because their addiction did not include alcohol they are able to drink moderately with friends and family and maintain their recovery.
Recovery pathways. In discussing the recovery process, participants mentioned a variety of pathways:
- Natural recovery
- Mutual aid groups, 12-step based programs (e.g., Alcoholics Anonymous
- (AA) and Narcotics Anonymous (NA)
- Mutual aid groups, non-12-step based programs, (e.g., Women for
- Sobriety, and SMART Recovery)
- Faith-based recovery
- Cultural recovery (e.g., traditional Native American sweat lodges)
- Criminal justice (e.g., incarceration, drug court)
- Outpatient treatment
- Inpatient treatment
- Bodywork (e.g., yoga, traditional Chinese medicine, and Addiction Energy
- Other therapies (e.g., art or music) and giving back
Multiple pathways. While some participants said they used only one of the pathways listed above, the majority used two or more pathways on their road to recovery, both concurrently and sequentially.
Each must find the “right” pathway. One of the most important lessons to emerge during the discussion of pathways is the importance of finding the right pathway or pathways for the individual. Many discussed trying multiple methods
to address their addiction, and failing, often several times, before they found the pathway that worked for them.
Most participants explained that the ―right pathway‖ frequently involves participation in both traditional and non-traditional services and supports over many years, or, for some individuals, over a lifetime.
Complex views of 12-step based programs. The discussion of the importance of finding the right pathway revealed widely differing and complex views on 12-step programs. Because of the widespread availability of these programs, nearly all of the participants have attended a meeting at some point.
While many participants have found 12-step programs essential to their recovery, others have felt excluded by the program, or felt a lack of personal connection with the program and participants.
Barriers and supports to effective recovery. Participants listed numerous barriers and supports encountered during the recovery process. A barrier for one person, such as the police and criminal justice system, was a support for another. Moreover, in many cases a participant listed the same entity, such as family or friends, as both a barrier at one point and a support later in the individual‘s recovery. One of the most significant barriers participants repeatedly
stressed was the lack of services and support options. They said they often struggled over years and decades to find the right pathways before achieving recovery.
Messages and insights for the public and policymakers. Participants felt that the public and policymakers lack an understanding of addiction and recovery from alcohol and other drugs. They would like to see a richer understanding of the issues that are critical in recovery, including the importance of treatment options in lieu of incarceration, and the importance of reducing discrimination by educating the public and policymakers about the disease of addiction. They also stressed the importance of prevention to reduce the likelihood of this disease occurring in future generations.
Above all, participants expressed gratitude that they were able to achieve recovery, and believe that with the right support others can also obtain longterm recovery.