Recovery Pluralsim

stancesBill White has a new post challenging the recovering community to be more pluralistic and let go of notions that there is one path to recovery:

Embracing recovery pluralism is not an embrace of recovery relativism in which opinions and preferences completely dominate facts. To be tolerant of the varieties of recovery experience is not to say we must blindly accept all proffered approaches to recovery as equal. All must be subject to investigation and all held accountable for recovery outcomes. Recent efforts to define recovery have focused on three essential elements: 1) the resolution of alcohol and other drug problems (most often measured by enduring abstinence), 2) improvements in global health (e.g., physical, emotional, relational health; quality of life and functioning), and 3) positive community reintegration (citizenship). All proposed pathways to recovery must be accountable for the degree to which they facilitate or fail to facilitate change across these three zones of recovery experience. That accountability comes through the experiences of individuals, families, and communities as well as through the rigor of scientific studies. At the moment, no recovery approach has outcomes so high as to warrant the claim of being THE recovery pathway.

5 thoughts on “Recovery Pluralsim

  1. Fortunately, AA has no opinions on outside issues.
    It’s curious to me that so many people want AA to accept different approaches, definitions and outcomes. They, including White, seem unwilling to accept AA’s singleness of purpose.


  2. As for the “rigor of scientific study,” most science is not ready for prime time and shouldn’t be used as an absolute or a guide for decision-making.

    Let’s focus on medicine for a minute. We can assume that the science of medicine is more concrete than the science of addiction treatment and recovery. So what can we discern from evidence-based medicine?

    Dr. Eric Topol, the former Chairman of Cardiovascular Medicine at the Cleveland Clinic, writes, “A buzzword in medicine is ‘evidence-based.’ If something is evidence-based, then it has some kind of sanctified quality and must be a good thing for patients….the Institute of Medicine, a prestigious group of physician experts and researchers, weighed in on the question and determined that any valid evidence supports “well below half” of the practices of medicine.”

    Dr. Topol goes on to write about what he calls “flawed evidence-based medicine.” He notes that “…the right assumption in reviewing any new data presented to consumers is to question it…consider the new findings null and void unless you are thoroughly convinced the evidence is compelling.”

    He adds: “I coined the term “litter-ature” to denote that too much of the medical literature is littered with misleading and false-positive findings.”

    In the field of addiction, I see a trend toward bowing to the research gods. Questioning research results, especially by referencing years of personal experience, is most often met with disapproval and sometimes a public dressing-down.

    The phrases “evidence-based” and “best practices” litter professional conversations, but one never sees the evidence produced for group examination. We don’t routinely dissect evidence and question the validity of studies.

    Our greatest achievement in the addiction field won’t be finding the next hot “recovery experience,” but rather the same old boring concern: “How do we increase compliance among alcoholics and addicts?”

    It is a rare person who works an enthusiastic program of recovery and fails. Tying outcomes to “recovery experiences” is misleading; outcomes are more accurately tied to compliance. So when someone says outcome studies show that AA only keeps 30 percent of alcoholics sober, I know it really means that only 30 percent of alcoholics work an enthusiastic program of recovery. I’d like to know how to better engage the other 70 percent.

    As Dr. Topol points out: “Only fifty percent of patients actually adhere to their prescriptions.” As a result, do we claim the medicine is only effective for 50% of the people who take it?


    1. Hi Debra,

      Your comment got caught in the spam filter. I just found it. Any future comments should appear immediately.

      I couldn’t agree more with your concerns about the bias in research. The problem is often compounded by the way it’s reported.

      What I appreciate in Bill’s post is the call for research that is focused on quality of life for the patient rather than benchmarks that suit the researcher (or other business interests).

      I loved this in your comment:

      Questioning research results, especially by referencing years of personal experience, is most often met with disapproval and sometimes a public dressing-down.

      You’re so right. And, the irony that many of the same people verbalize great concern over stigma.

      I have no objection to research on other pathways, but I also agree with you, that we have an approach that works and much more energy should be invested in helping patients successfully pursue that approach.

      Also, as someone who has experienced addiction, I’m willing to celebrate anyone who achieves full recovery. (I’ll also celebrate partial recoveries, but encourage them to keep working on achieving full recovery.)

      Thanks for the comment. All the best, Jason


  3. Fortunately, AA has no opinion on outside issues, so the recovering community can safely ignore White, et al. AA’s singleness of purpose makes other methods irrelevant.
    Despite what public health wonks might hope, the 12 Step community doesn’t have to “accept” anything, much less pluralism.


    1. I think I hear you expressing concern about outsiders pushing AA to redefine recovery? I’d have just as strong a reaction. I didn’t read it that way.

      I think Bill is encouraging people across recovery paths to stop arguing about which path is best and join together to challenge stigma–kind of like the Council of Federated Organizations pulling together members of CORE, NAACP, SNCC and SCLC to work together in the civil rights movements. (Of course AA could not and would not participate as an organization.)

      While AA having no opinions on outside issues and the singleness of purpose makes other paths irrelevant, Bill Wilson repeatedly reminded members that they have no monopoly or cure-all. While I don’t now of him saying it explicitly, I read his comments as encouraging respect and happiness for any alcoholic who finds a solution to his/her drinking problem.

      20 years ago I remember a lot more antagonism between fellowships and paths. I don’t know if things have changed or if it’s the circles I travel in, but it seems, to me, like it’s much better than it used to be.


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