Have been listening and reflecting as of late on where the recovery movement has come from and where we are headed next. We have faced and endured many challenges, both internal and external to the movement. We have done so by remaining focused on our common purpose. Basic tenants of recovery such as tolerance, humility and service to others have served us well by keeping us relatively unified over the years. We must remain vigilant and focused on our own core values and protect them so we can sustain our efforts for generations to come. It is important to do so even as we work to establish areas of common ground with other groups wherever possible. Collaborative efforts can only be effectively conducted if we are clear on both our shared interests and mutually respectful of areas our perspectives and interests may diverge. This latter point is critically important if we are to avoid being co-opted and our movement culturally appropriated into other agendas. Mutual respect with groups we work with is important to avoid the risks of losing our own focus and being co-opted or having the recovery culture appropriated.
One area we need to be united on is the definition of recovery from addiction. Recovery from addiction has similarities to recovery from mental health. We embrace our similar experiences, yet some elements of recovery from addiction are unique and central to our recovery identity. Most of us agree it involves cessation of drug and alcohol use other than as prescribed to support the process of healing. It also involves a process of personal growth and elements of good citizenship. Movement towards wellness by a person experiencing substance misuse is something to be embraced even as we know that it is not the same as recovery.
To elaborate, movement towards wellness for a person such as moderation can work well for a person who is misusing drugs and alcohol. The same approach can end tragically, even in death for those of us who are fully addicted. There is also a long history in the recovery movement of failed moderation attempts as a way to differentiate the ability to moderate from loss of control over substance use. Labeling reduced drug misuse as recovery can be disastrous. Additionally, we risk the loss of recovery identity by it becoming so watered down that it will cease to have a functional meaning.
We need to develop the science of recovery to the point in which we can differentiate between a substance misuser who can benefit from moderation from a person in an early stage of addiction for which this intervention is likely to fail. We need to develop better language to both support and differentiate these two states. A system that can support moderation for persons for whom this is a viable path who are not addicted but experiencing misuse and also the experience of an addicted persons for whom abstinence is necessary to move into a state of recovery is fundamentally important.
Harm reduction is another area in which there is tremendous overlap with the recovery movement in respect to our goals and opportunities to collaborate. We have a long history of early engagement with addicted persons, it is in our heritage. It is a central element in our history since the first 12 step call. Recovery support services have long been focused on engaging with people where they are at, and we are seeing ever more opportunities to do so in the future. Recovery advocates across the country are finding significant areas of shared goals with harm reduction proponents. Social justice issues like eliminating mass incarceration and inhumane treatment of persons with substance use conditions are also issues in which there seem significant alignment. Naloxone, syringe exchanges and other harm reduction strategies can preserve life and provide an opportunity for engagement for a person who is opioid dependent.
These harm reduction strategies are vitally important pathways to engage those of us who are addicted in order sustain life with the goal of recovery. Yet, it has also been said that we want to meet people where they are at, but not leave them there. It must be acknowledged that most persons who have an opioid use disorder are addicted to multiple drugs and will suffer greatly even to the point of death unless they are supported into a full recovery process. As this is the case, simply acknowledging drug use as a human right in such a circumstance can be tantamount to palliative care for some of us. We want more for our brothers and sisters trapped in addiction, even as we acknowledge that all people deserve to be treated with dignity and respect.
Professionalization of recovery support services is a third area we should proceed with caution. We envision a system of care that embraces long term recovery as the probable outcome of care given the proper care and support. 85% of those of us who get to five years of continuous recovery are likely to stay in recovery for the rest of our lives. We want to build a recovery care continuum to support this vision for all people. It requires traditional treatment and beyond, including lower intensity community-based recovery support services. Other groups across the nation are also beginning to embracing this vision.
Building out a system of care that will support more Americans reaching the five year recovery threshold will mean formalizing peer support as well as embracing our long history of volunteer service across our communities. Having a competently trained recovery coaches to develop and work in these systems is critical. We share common cause with government entities, funders and credentialing groups who wish to ensure effective and ethical service by a well-trained workforce. We caution against over-professionalization of peer services and the abandonment of having the recovery community in the driver’s seat to ensure that peer services remain authentic and grounded in the community that peer services were born out of over the last two decades. Professionalized peer credentials developed and facilitated without the recovery community in the driver’s seat risk losing legitimacy and value to the very community that these services were born out of.
These concepts are not without controversy. I showed this post to a number of people I respect before posting and the feedback I got was very positive. I expect that there are those who may see it otherwise, that is okay too. We should grapple with these issues in a respectful and open manner in a broad conversation within our own communities and seek common ground wherever we can. We can work collaboratively and respectfully with other interest groups without walking lock step on all issues. It can only be accomplished if other groups are respectful of our perspectives even where we diverge with them. Groups that become militant and demand we must take all of their positions or face consequences are not good partners. Groups that act this way should be kept at arm’s length until such time as they respect our differences as much as they value our support.