Recovery? Stages of Healing? How to move forward?

We’ve got an interesting collection of ideas forming on this blog in recent months.

What is recovery?

In a post discussing recovery and harm reduction, I laid out a few competing definitions of recovery and discussed how these competing definitions may define recovery as a process, a direction, or an outcome.

This post also explored the potential consequences of some of these approaches.

Recovery as a process and direction

One of our contributors, Austin Brown, supports a definition that frames recovery as a process and direction (rather than a destination). He envisions this definition as a foundation of a new science of recovery.

It is purposefully broad, and casts a wide net. The reason for the broad scope of the definition is that in order to understand the variety of recovery trajectories, we must first define the parameters of what we are talking about, then, collectively, we must track different trajectories in specific ways. Over time and in aggregate, recovery will define itself.

So . . . they start with this very broad net that would include clinical and community populations. He envisions then being in a position to understand subtypes and pathways.

Stages of Healing?

More recently, Brian Coon proposed a new model called the Stages of Healing. He doesn’t say so in his series of posts, but from private conversations I know that thinks of it as an alternative to recovery models.

He’s of the opinion that recovery should be left to the personal and social domains. He’s expressed concerns that researchers will louse it up. (Look here for more on the co-opting of recovery in mental health care.)

So, what does he envision?

I would like to suggest it would be helpful to have perhaps 10,000 or more current addiction treatment patients evaluated on comprehensive measures of wellness (covering biological, psychological, social, and spiritual indicators), and for that evaluation to be prospective and continuous over the years of each individual’s lifespan. 

His model focuses on a clinical population, meaning it’s more likely to emphasize higher severity and chronicity. It avoids the thorny issue of defining recovery, like Austin’s model, would be agnostic about the treatment or recovery approach.

Learning from mental health recovery

These models are ways to study treatment and recovery. Both will probably take years to tell us much about how to facilitate recovery. I’m very interested in establishing an evidence-base that could diffuse some of the culture war hot spots within addiction and recovery treatment, research, and advocacy, but I’m not as patient as those guys. I’m interested in opportunities to navigate these waters today.

A while back, I discussed Pat Deegan’s Power Statements for mental health patients as a potential model for empowering and engaging patients in treatment decisions.

Her discussion of recovery is compelling. Here are a few observations about it:

  • Recovery is about quality of life rather than symptom counting/measuring.
  • Recovery from mental illness cannot be produced from a treatment done to a patient.
  • Professionally directed treatments can actually undermine recovery.
  • Self-care is an essential element of recovery.
  • Shared decision-making in treatment is essential.
  • In the context of that shared decision-making, providers and patients will be co-investigators in finding a pathway to recovery.

Listen to her talk about her recovery at around 37 minutes.

I find her advocacy and education to be exciting and inspiring. However, I’d be ambivalent about transferring her whole model to addiction recovery. There are parts of it I find really exciting and I’m 100% ready for, and there are other parts I have more ambivalence about because they seem too fuzzy and might result in a shift from the “better than well” concept of recovery to something more like a permanent disability to be managed.

When I reflect on why I find it so inspiring for mental illness, but I’m ambivalent about it for addiction recovery, some of it has to do with the nature of the illness being discussed—that addiction is an illness that people routinely achieve full, sustained remission from, while serious mental illness may be a disability to be managed. And, some of it has to do with the context—that mental health is trying to establish recovery, while addiction is trying to maintain recovery. (Or grow, or protect. Depending on who you talk to.)

So . . . I’ve already introduced you to Deegan’s power statements. Her model for personal medicine is an important tool for patient and providers working as co-investigators finding pathways to recovery.

Personal Medicines are non-pharmaceutical activities and strategies used to decrease symptoms and increase personal wellness. Personal medicine falls into two broad categories: those activities that give life meaning and purpose, and self-care strategies. You can learn more about it at 47:47 in the video above or in the video below.

Personal medicine is a powerful concept because:

  • Personal medicine emphasizes that medication is not recovery, and that recovery requires more of the patient than taking medicine.
  • Personal medicine makes the patient an active agent in their own recovery. Recovery becomes a responsibility for the patient.
  • Personal medicine doesn’t require waiting for medication to work.
  • Where medication has undesirable side-effects, personal medicine may allow patients to reduce doses or medications to improve quality of life.
  • Personal medicine can enhance self-efficacy and personal medicine is likely to have broader benefits than medication. (For example, where a medication might narrowly address depression, personal medicine that uses social engagement or physical activity is likely to have benefits that go well beyond their depression.)

Deegan’s passion for recovery and her tools seem to set the stage for recovery as a process and a destination. I imagine that an embrace of her co-investigator approach, with tools like power statements and personal medicine could help us navigate our way through divisions that plague the field and complicate the experiences of patients and families.