Constricted Ways of Knowing and the Loss of Recovery as a Focus of Our Institutions

“The experts on recovery are people in recovery” – Rallying Cry from the Era of the New Recovery Advocacy Movement.

We once, not long ago, had a movement in America embraced broadly across our society in which people in recovery began to inform the fledgling research on our healing. It influenced a strengths orientation within our service systems, in our governmental institutions and within our research institutions. Society began to see our true value. In that era, twenty years ago there was an understanding that in respect to recovery, academic efforts focused on pathology and narrow, academic focused evidence bases are limited by the orientation, design, measures, and conditions of the examination with the specific populations and interventions considered. It was understood that recovery occurred broadly in our society, taking different forms within indigenous communities. Doors began to open in ways that put people in recovery in a more central role to understand the processes and cultures of recovery across America.

It is true that a generation later, recovery itself remains an amorphous term. It is a noun and a verb, a state and a process, it is a culture, and it is quite often a community dynamic. As White wrote about in 2007, “Recovery as an organizing concept poses financial and ideological threats to existing social institutions and professional roles that have been granted cultural authority to manage AOD problems.” Defining it in measurable ways remains important, while all of the risks of who defines it and for what purposes remains. These risks become greater because of the limitations of academic oriented research as they become distant from the very community being measured. This leads to a loss of understanding of these nuances that can only be more fully understood when there is deep collaborative efforts with and across our various recovery communities and clear motivations that thoughtfully consider conflictual agendas.

We could dramatically improve research designs by having it viewed, measured and informed through a lens of recovery and resiliency under real world conditions. We should also consider that academic research is important but limited. As Jason Schwartz notes in respect to approaches, all ways of knowing are necessary but each limited. All require being informed by other methods of understanding regarding what is occurring and how to apply to effective interventions.

A topic William White expressed more recently in his 2024 paper, Frontiers of Recovery Research, which I had the honor of presenting for him in his stead at that auspicious event. There are multiple ways of knowing in respect to substance use conditions and their resolution. He opened up this important paper with this statement:

“Four primary arenas of knowledge, or ways of knowing, exist within the alcohol and other drug problems (AOD) arena: 1) experiential knowledge, 2) common or public knowledge—popular folklore or myth, 3) professional/clinical knowledge, and 4) scientific knowledge. Whole libraries could be filled across these domains with what has been published on addiction and its related pathologies and brief clinical interventions, but until recently, only a few shelves would suffice for what is known from the standpoint of science about the prevalence, pathways, processes, styles, and stages of long-term personal and family recovery.”

To highlight one facet of White’s paper, we still have a profound lack of evidence based and recovery informed research extending across the lifespan. We have almost no understanding of the myriads of processes and cultures of recovery that different people experience in varying communities and circumstances. Understanding these facets are  vital to our future. We should pursue the expansion of all facets of long term personal, family and also community level recovery, and we should do so in ways that are led and informed by communities of recovery. History is instructive here. In instances where the science and our care systems have become isolated from the very communities in which healing occurs, they become ineffective at supporting the recovery process from initial intervention through to long term community-based recovery. They become paternalistic and punitive over time and lose vitality and value.

We are at risk for cultural appropriation of recovery community concepts and constructs by the dominant systems as the only accepted evidence base. Processes that discount two of the four manners of understanding White delineated, experiential knowledge and common or public knowledge. This path takes us away from the community grounded efforts recovery pioneers had developed into mechanisms that replicate what they were trying to replace. We should not embrace only academically achieved knowledge, which while highly beneficial, also has significant limitations. These challenges are exacerbated by how ways of knowing are funded and who decides what is measured under which set of conditions. It all quite commonly occurs without mindful dialogue or even acknowledgement that this is what far too often transpires.

What has gradually occurred is the constricting of what our knowledgebase is to one focused almost solely on academics through our higher learning institutions by those who have the most advanced educations far afield and quite often isolated from the people and places where healing occurs. Informal community support that embraced the value, voices and energies of the entire recovery community as initially envisioned in those original RCSP grants made a lot of people very uncomfortable. One also wonders about what role implicit bias may have had in this. Some form of an institutional fear of the “inmates running the asylum” that was far too unsettling to the status quo. Such dynamics invariably leads to a drift away from recovery community-oriented solutions back into a traditional service model. It leads to a limited peer service model oriented on a constricted manner of understanding termed “evidence based.” These hobbled evidence bases are rarely constructed and informed in ways that were consistent with recovery community grounded strategies so while seemingly grounded in the scientific method, they often miss the nuances that occur in real world application.

There has been a long and sordid history of concepts and strategies to expand and effect healing in our community that has risen up out of the immense well of creativity and passion to help our friends and neighbors that overtime gets appropriated when effective or lost to simple shiny solutions and ineffective strategies that are palatable and marketable to the broader world. Are efforts becoming lost as a result of cultural theft or we become commodified for others gain, or a mix of both of these outcomes and we fail to more fully realize the benefit of recovery across our society.

To move forward and to truly expand recovery in the United States, there we must shift to a model that centers on recovery. What William White wrote quite eloquently on this in his Frontiers of Recovery Research paper:

“Assuring recovery representation within recovery research addresses three concerns: 1) the adequacy of recovery representation (beyond token inclusion), 2) the authenticity of recovery representation (avoiding the problem of “double agentry”—masking of hidden personal/institutional interests behind the claim of recovery status), and 3) diversity of recovery representation (demographic, cultural, and recovery pathway diversity).

Recovery research coproduction goes beyond representation to a state of co-ownership in which people in recovery participate with other research team members on an equal footing. This would mean that recovery representatives are involved in all aspects of a study, including topic refinement, instrument development, site selection, subject recruitment, crafting informed consent procedures, data analysis, interpretation of findings, selection of publication outlets, co-authorship or acknowledgement of contributions, selection of post-publication information dissemination outlets, and co-ownership of study data.”

I opened this piece with one of the rallying cries of the new recovery movement, people in recovery are the experts on recovery. One of the other rallying cries of that momentous era was “nothing about us without us.” The question in the air is this: How can we possibly pretend to build a meaningful body of information to support recovery efforts without authentic and meaningful collaboration between research institutions and the recovery community in every facet of examination from design through application to interventional strategies as a foundational focus to move forward this critically needed body of information?

Sources

Schwartz, J. (2023, October 17). Every response is incomplete. Recovery Review. https://recoveryreview.blog/2023/10/17/every-response-is-incomplete/

Stauffer, W. (2024, April 27). William White’s Opening Keynote to the Inaugural National Conference on Addiction Recovery Science: Recovery Review. https://recoveryreview.blog/2024/04/27/william-whites-opening-keynote-to-the-inaugural-national-conference-on-addiction-recovery-science/

White, W. (2007) Addiction recovery: Its definition and conceptual boundaries.  Journal of Substance Abuse Treatment, 33, 229-241. https://deriu82xba14l.cloudfront.net/file/195/2007-Recovery-Definition-Conceptual-Boundaries.pdf

White, W. (2024). Frontiers of Recovery Research. NIDA. Currently located at https://cda25dc8-4012-4b05-82c7-ecf74e444aaa.usrfiles.com/ugd/cda25d_6c54123b5c4e40f58204dc1fea72e825.pdf

Authors Note: The website at Chestnut Health containing the William White Papers are currently being revamped, so many prior links to his work no longer work. His 2024 Paper, Frontiers of Recovery Research appears to have been recently removed and so the link referenced in this piece is a temporary one I created so that readers can access it. I will update it when the site becomes whole again and refer his paper back to that location when it is restored.