The Recovery We See – Healing Across the Spectrum of SUDs  

A decade ago, there was a viral moment on social media called “the Dress,” millions of people saw the picture here and chimed in on what color that they perceived the dress to be. It has its own Wikipedia reference. Viewers either see a black and blue dress, or white and gold dress. One article postulated how it may relate to a lifetime of sleep wake patterns. It demonstrates how we perceive things differently in ways we often are not even aware of. In response to the dress viral moment, there were studies done on how the human brain may process color differently. Early rising larks (like me) are more likely to interpret an ambiguous image as being lit by the short-wavelength light they’re used to seeing and thus more likely to see the dress as white and gold. Late night owls tend towards long-wavelength, artificial lighting, and would thus see the dress as black and blue. For the record, I see it clearly as a white and gold dress, which is consistent with the theory described in the paper. So, we may be subtly influenced by a lifetime of experience of how our eyes gather light. I see parallels here in respect to substance use condition healing.

The defining of recovery is a contentious space. Oceans of ink have been spilt on attempts to define recovery. What we all “see” when we think of recovery relates to all the associations we have with that word across the spectrum of experience. Like the dress color controversy, there are a lot of strong opinions on what it encapsulates and how to define recovery. The overarching definition used by SAMHSA, is inclusive of both mental health and substance use conditions even as most acknowledge that mental health recovery and substance use recovery can have very different dynamics. Unlike the dress controversy, a lot of lives hang in the balance in respect to the healing of a substance use condition. It is simply untenable to not develop more concise terms.

For me, recovery is a lifesaving process that redefined my life in ways that I honestly believe led me to be a better version of who I am as a person. The journey out of addiction shaped me in ways I don’t think I would have had in any other way. What is called in the literature on post traumatic growth as a life changing process, or as what researcher Dr David Best terms “better than well.” It is also true that in active addiction, with a cognitively impaired brain, I would see recovery as threatening to the destructive trajectory I was on yet which I was loath to abandon even as it was killing me. Once my brain was sufficiently healed, the chance I gave myself through recovery became clearer to me as an existence preserving choice that changed the entire trajectory of my life. Others with less severe forms, may not even identify with the term recovery or require the kinds of all-encompassing life changes that people like me, with a recovery identity require and not even like the term.

We use the term recovery to describe any healing across the full spectrum of substance use conditions, from mild to severe. A mild SUD can generally be moderated in a way that defies a severe SUD and is often life threatening if attempted. Like color, healing from an SUD is on a spectrum yet we call it all one “color,” lumped under the term recovery. This creates a restrictive binary conceptualization of healing across the full range of substance use conditions. Perhaps this relates to why defining this spectrum of healing has failed so miserably.

Some view the word as so tarnished that it should be abandoned. We have somehow managed to remove the value of what recovery is for many of us with the severest form have transformed our lives through recovery, which we identify with so deeply it is our identity. We fought so hard to foster the understanding of our value to society, yet in just a few short years, a very different and mixed message about recovery being inclusive of harmful drug use is being articulated. This new message comforts a society uncomfortable with people who do not use drugs to get high, which is increasingly our preferred national pastime. This is likely exacerbated by applying the term recovery across more mild forms of the condition in which moderation is possible but remains life threatening to people with the severe forms of the condition.

We often hear the assertion that recovery is defined by the individual, which empowers the individual but is not at all useful in respect to developing care frameworks to understand and increase healing efforts across this spectrum. Can we imagine asserting that people are in remission from cancer when they say they are? Of course not. We could not advance oncology care with such an ambiguous standard. Nor can we advance in the field of SUD care and support to encompass a full range of healing with this vague standard. We need to define things with greater specificity to move forward.  

Perhaps we could improve conceptualize the healing from the continuum of a SUDs like we understand the dress pictured above. When I see a gold and white dress, I understand that there is a phenomenon occurring with a markedly different visual experience for other people. What color dress people see is a function of how our eyes are accustomed to gathering light. Let’s figure out a way to honor that in ways that affirm healing from a substance use condition and use different terms to describe what is occurring across the spectrum of healing from the continuum of SU conditions and understand that this healing is very much dependent on variables, including the severity and type of the problem.

To better conceptualize recovery, we may want to reconsider how we think about SUDs and the limitations of our current language. As my colleague Jason Schwartz argues, we should consider returning to conceptualizing addiction as a different kind of problem SUD instead of degree of severity. There are differences in respect to low to moderate SUDs, in comparison to severe SUDs, what we historically termed addiction. It is vital for us to develop a framework for categorizing the healing process on a continuum that sustains room for all the variations of healing, including the most severe forms. Our nomenclature around flourishing in resolving a mild or moderate forms of an SUD may vary significantly from recovery from a severe SUD. A new taxonomy would be helpful for our entire system to improve how we conceptualize and understand healing from the spectrum of substance use conditions.

We require a level of categorization of what healing from an SUD looks like and terms to discuss it so as to avoid additional confusion or to falsely attribute what we think people are saying because of our imprecise language. I experience challenges due to the imprecision of our recovery definition language often. I agree with what Austin Brown said in his thoughtful post a few years back “Reflections on Current Debates Regarding Recovery Definitions.” He notes that we need a scientific definition of recovery, but that great care must be taken to center such a definition around how survivors of addiction view themselves. Like dress, we have varied views, and a viable definition of healing from an SUD must encapsulate lived recovery views in ways that make sense for all of us. Challenging but certainly possible.

You may say it does not matter, but it does. Bill White has written about the importance of the debate over how we define recovery over the years, here is one article, and here is another he has written. As he notes that a lot rides on how we define recovery, what gets in and what gets left out. Industries thrive or wither based on these terms. Dr. Austin Brown noted in the piece linked above that the opioid crisis brought a lot money and interest into the recovery space and that simply being an expert in a medical realm does not make someone an authority on recovery. Dr David McCartney wrote a piece a few years back called You’re all going to hate the word ‘recovery”. I agree with his statement in his piece “it is not possible to have a reliable single tool that measures recovery. Recovery is a complex process and not fundamentally a clinical journey, but a social one that doesn’t fit under the microscope easily.”

I am not going to pitch a new definition of recovery here. I respect what anyone has to say about their own healing experience. Yet we don’t define cancer remission scientifically based on individual perception, it has an accepted classification model that is subject to change as we learn new things about it. Cancer as a pathology and its treatment is very different from recovery, yet both must be grounded in science for us to support forward progress in helping people heal. Perhaps we could start with encapsulating the experiences of all persons who have resolved from a mild to severe SUD to establish a framework for a new taxonomy of healing based on our collective lived experience.

We could start by asking each other what we see and why we see it that way rather than filling the word with our own associations and being mindful not to make false assumptions of what others experience. As my colleague Brian Coon thoughtfully articulates in his writings on the stages of healing, the care we provide for what are long term conditions remains brief and we have failed to measure the spectrum of long term wellness. He suggests longitudinal research on “ten thousand addiction patients comprehensively assessed over decades, prospectively, and we were innovating to do that, as I have outlined previously (developing indicators, developing measures, and comprehensively assessing them over the long term as we proceed) we might even innovate in our clinical treatment technology.”

Through such focused effort, we may well also understand the variation of healing and the kinds of things people do to heal and thrive over the long term that are critical to forward progress. I am reminded of the Harvard Happiness Study which unfortunately was limited to men initially, now includes women but still lacks racial diversity and remains centric to whites. If we replicated such a longitudinal study of healing across diverse communities of those who heal from an SUD, we would without doubt develop a much deeper understanding of what to do to address our most serious public health crisis across all communities.

So, what is the healing from an SUD that we see, how does it relate to our own experiences and how much room do we make to accommodate the variation of healing outside of our experiences? Can we develop more precise language to describe this healing? Is there hope for common ground established in such a way as to sustain common identity and goals while also honoring our different experiences? We stand to gain a great deal if we can bridge these gaps and articulate a taxonomy of healing from the spectrum of substance use conditions that exist. To see this healing more completely, we must develop language to more effectively describe it. It may be the single most important thing we can do at this juncture.  

Sources

Best, D. (2024). The reality of addiction recovery is more positive than we might think. Leeds Trinity University. https://www.leedstrinity.ac.uk/blog/blog-posts/the-reality-of-addiction-recovery-is-more-positive-than-we-might-think.php

Brown, A. (2021, April 3). Reflections on Current Debates Regarding Recovery Definitions. Recoveryreview.blog; WordPress.com. https://recoveryreview.blog/2021/04/03/reflections-on-current-debates/

Coon, B. (2024, July 31). Addiction and the Stages of Healing – full text version. Recoveryreview.blog; WordPress.com. https://recoveryreview.blog/2024/07/31/addiction-and-the-stages-of-healing-full-text-version/

Coon, B. (2024, August 9). Podcast episode #68: “Recovery-Informed Research and Theory.” Recoveryreview.blog; WordPress.com. https://recoveryreview.blog/2024/08/09/podcast-episode-68-recovery-informed-research-and-theory/

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McCartney, D. (2021, May 17). You’re all going to hate the word “recovery”. Recoveryreview.blog; WordPress.com. https://recoveryreview.blog/2021/05/17/youre-all-going-to-hate-the-word-recovery/

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Schwartz, J. (2022, January 19). Substance Use Disorders as a category. https://recoveryreview.blog/2022/01/19/substance-use-disorders-as-a-category-3/

Waldinger, R., & Schulz, M. (2023, January 19). What the Longest Study on Human Happiness Found Is the Key to a Good Life. The Atlantic. https://www.theatlantic.com/ideas/archive/2023/01/harvard-happiness-study-relationships/672753/ 

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Related piece originally posted in June 2021 HERE