How Helpful is the 2022 Definition of Recovery from the NIAAA?

The NIAAA (National Institute on Alcohol Abuse and Alcoholism) recently published a definition of recovery.

Here’s the recovery definition from that paper:

Recovery is a process through which an individual pursues both remission from AUD and cessation from heavy drinking.  Recovery can also be considered an outcome such that an individual may be considered ‘recovered’ if both remission from AUD and cessation from heavy drinking are achieved and maintained over time.  For those experiencing alcohol-related functional impairment and other adverse consequences, recovery is often marked by the fulfillment of basic needs, enhancements in social support and spirituality, and improvements in physical and mental health, quality of life, and other dimensions of well-being.  Continuous improvement in these domains may, in turn, promote sustained recovery.

Hagman, B., & Falk, D., Litten, R. & Koob, G. (2022). Defining Recovery From Alcohol Use Disorder: Development of an NIAAA Research Definition. American Journal of Psychiatry. 179. 10.1176/appi.ajp.21090963.

In my opinion the paper is important for our field.  Why do I think it’s important? Well, it’s:

• a more recent definition
• from a major academic/research body with national and international weight
• the kind of definition that is rooted in measurement and lends itself to scientific use
• not a recovery definition that is rooted in mere ideas and expressed in ways that are not measurable

The NIH released a videocast discussing the definition.  If you click that link and scroll down, you’ll easily find it.

Overall I find the NIAAA definition of recovery remarkable because it states:

1. recovery is a process
2. recovery is also an outcome
3. people can be considered “recovered”
4. spirituality is included in the list of things that might improve
5. physical health, mental health, and various dimensions of well-being are included
6. continuous improvements may in turn help stabilize recovery
7. both heavy drinking and its harms are outside of recovery

From a perspective more particular to my exact thinking, this new recovery definition from NIAAA…

• aligns with similar attempts to define addiction through empirical means
• emphasizes the importance of harms of use even when the person has no use disorder
• and seems to accommodate some difficult realities in our field including that we:

1. fail to study drop outs, no-shows, and those that pass away;

2. fail to have long-term care structures for routine maintenance checks, and

3. are usually trained in siloed specialty work and not a wholistic model as well.

Plus, it:

• has a health and wellness focus (and to me that asks if addiction treatment and recovery are even relevant if we die from cigarette smoking)
• accommodates my notion that we need a lifelong study of all people in care for moderate to severe SUD to help find all relevant bio-psycho-social-spiritual markers of improvement.
• implies a project lasting across lifetimes of researchers and clinicians (aimed at both the problem side of addiction and the wellbeing side of recovery) while enveloped inside a world-level academic, clinical, and research collaboration
• seems to recognize the change process is personal, dynamic, and non-linear.
• accommodates the idea that no “gold-standard” addiction treatment exists as long as the so-called “gold-standard” methods we have allow, ignore or under-treat tobacco use
• implies or allows that “recovery” is a meta-topic deserving its own full empirical evaluation.
• agrees that continuing “very heavy drinking” and also meeting an improved definition of recovery are not congruent
• agrees that neither abstinence nor its lack should distract us from ensuring stable wellbeing.
• highlights that alcohol is toxic.
• notes that a clinical structure with a minimum of 5 years is needed for severe, complex, and chronic SUDs.
• recognizes that spirituality is a domain of human existence and should be included in clinical care of addictions.
• and recognizes that data is recursive to care, our systems,. and our very methods of understanding.

In closing, I’ll say that when I read the definition I liked it right away for a lot of reasons. And one of the main reasons is that to me (as a working clinician with an academic/research bent) it seemed to hold common sense, practical clinical reality and value, and help with measuring. And another main reason is because it seems to hold space for

• harm reduction approaches,
• incrementalism of long/slow change, and
• addressing people at different stages of change, and of treatment, on a per-problem basis.

And something like that seems tight enough and yet messy enough that it might actually help us move forward.

What do you think?