A recent paper on collegiate recovery experiences highlights an important dynamic in recovery advocacy, recovery science, and recovery policy.
I’ve commented a lot on the conceptual boundaries of recovery in the blog — the relationship between addiction (or SUD or other compulsive behaviors) and recovery; whether recovery is a process, a direction, or an outcome; when does it begin?; when does it end?; does recovery require abstinence? from what?; who determines its boundaries?; are the appropriate boundaries contextual? (research, treatment, advocacy, community education, recovery peer services, harm reduction, harm reduction peer services); etc. (More here, here, here, and here.)
Bill White spoke to the many of the challenges here:
Defining recovery also has consequences of great import for those competing institutions and professional roles claiming ownership of AOD problems. Choosing one word over another can shift billions of dollars from one cultural institution to another, e.g., from hospitals to prisons. Medicalized terms such as recover, recovery, convalescence, remission, and relapse convey ownership of severe AOD problems by health care institutions and professionals, just as words such as redeemed and reborn, rehabilitate or reform, and stop and quit shift problem ownership elsewhere. It is important to recognize that rational arguments for particular definitions of recovery may mask issues of professional prestige, professional careers, institutional profit, and the fate of community economies. The answer of who has authority to define recovery will vary depending on the question, “define for what purpose?” Given that defining recovery could generate unforeseen and harmful consequences, efforts to define recovery should include broad representation from: 1) individuals and family members in recovery, 2) diverse recovery pathways and styles, 3) diverse ethnic communities, and 4) policy, scientific, and treatment bodies, including leaders of the major institutions that pay for behavioral health care services.
Source: White, W. (2007) Addiction recovery: Its definition and conceptual boundaries. Journal of Substance Abuse Treatment, 33, 229-241.
It’s important to note that drawing/maintaining boundaries around recovery shouldn’t translate to invalidating or arguing with people who identify as in recovery. It might make sense to use one definition when engaging individuals and another when designing programs.
The paper uses 16 qualitative interviews to better understand the recovery experiences of students on an Canadian college campus, framing it as an important matter because, “Students in or seeking recovery from addiction are an equity-deserving group who face unique challenges in colleges and universities that create barriers to seeking and maintaining recovery.”
One of the themes identified was multiple recovery pathways and identities. Some narratives might be characterized as “traditional” recovery narratives. However, some students questioned whether “recovery” wast the right identity for them.
Student 8, who was recovering from self-harm, sex addiction, cannabis, and gambling, had difficulty embracing the recovery identity, because of their understanding of recovery being abstinence-based (e.g., Alcoholics Anonymous [AA]):
“To be honest, there is a negative connotation with recovery because it’s usually associated only with substance use. Or addiction to alcohol and AA.”
Along similar lines, Student 7 was unsure if they were in recovery because they were addicted to video games and not drugs.
“I’m not even sure why I’m here [at this interview], because for [with regards to recovery] for substances, none.”
Burns, V. F., Strachan, T., Sinclair, I., & Hadad, N. (2024). “Recovery is Complicated”: A Qualitative Exploration of Canadian University Students’ Diverse Recovery Experiences. Alcoholism Treatment Quarterly, 1–18. https://doi.org/10.1080/07347324.2024.2347241
This provokes questions about who is encouraging the adoption of this recovery identity and why. The article doesn’t answer this question, though it does point to some benefits.
In the discussion section of the paper, the authors discuss the expectations that programs become more inclusive in terms of recovery pathway, recovery identity, whether they currently use AOD, and integrate harm reduction as a more inclusive approach.
This paints a picture of a circular process:
- Someone encourages students who don’t identify as in recovery to identify with recovery and affiliate with recovery programs.
- These students contribute to changes in the conceptual boundaries of recovery. (Beyond addiction, into SUD and other behavioral health problems. Beyond abstinence, into harm reduction and ongoing AOD use, including heavy drinking.)
- Collegiate recovery programs are expected to expand their inclusion criteria, services, and programming to integrate these students. (But is this demand artificial, because of step 1?)
It’s worth recalling that these programs originate from the experience that college campuses are a recovery-hostile environment, and there was a perceived need to develop specialized programs to support these recovering students because student health services emphasize moderation and harm reduction.
Recovery Review 