Science Debates Dropping the Word “Recovery”

We write a lot about the measurement and exact definition of recovery on this blog, so I won’t rehash all the discussions here. But I will update readers that (based on my attendance at a recent researcher convening) the young recovery science field is still very much debating the term and that two camps – Drop “Recovery” and Keep “Recovery” – are split on whether “recovery” should be measured, defined, or even uttered during client engagement.

It’s worth exploring what these camps believe and where these opinions come from to better understand the state of the wider “recovery science” field.

The Drop “Recovery” Camp

Here the solution to a long-wrestled problem seems so simple. If the 20+ year endeavor to define recovery hasn’t produced reliable measures of status or prevalence, wouldn’t it be better to drop it entirely? Recovery Droppers point to studies like a survey of over 1,300 people who resolved a significant addiction problem. Over a quarter of the sample never identified as being in “recovery.” What about them?

Recovery Droppers argue that the 12-steps and abstinence are implicit to the term – at least in the eyes of help seekers – and that turns people off. They prefer the word “resolution” or forgo a label in favor of something more nebulous like “goal exploration” to engage clients. And they might be right – in a 2024 survey asking 6,515 U.S. adults what “recovery from opioid misuse” means, the public’s answers centered on abstinence and formal treatment.

Recovery Droppers are not always coming from harm reduction. They’re also clinicians working with young adults and teens, who feel the word is too permanent, too dire for many young people’s understanding of their substance problems. In a recent study interviewing youth in Canada, some liked the term, while others thought it was “too big”, “too scary,” because it suggested having to get everything right or else face “total failure.” This falls in line with trends in collegiate recovery to espouse wellness and goal setting over the big R.

This is all worth paying attention to and brings up the question: Is this how youth have always felt (but were too afraid to say), or is this a generational shift? Recovery science tends to have this problem of being two steps behind where the community is going. So, are we moving in the right direction by staying attached to the term?

The Keep “Recovery” Camp

The other side would say, yes, it is incredibly important to hold onto this term. Recovery Keepers point to various, community-led efforts to define recovery that have not been for naught. Federal entities now refer to its definitions when deciding funding. Recovery stigma has fallen as the public becomes more educated about it. Clearly, something is important about the word.

And, falling in line with the “two-steps behind” phenomenon, people are using the term “recovery” regardless of whether science continues to follow it. Courts, child welfare agencies, housing programs already operationalize it in ways that affect people’s rights and access to resources. Imagine a nightmarish scenario where a decision to grant a parent custody depended on a recovery capital score. It’s already happening in Wisconsin: reaching Milestone Two in Rock County’s phased family treatment court explicitly involves demonstrating an “increase in recovery capital” on a standard recovery capital assessment.

The genie is out of the bottle. Whether we like the term or not, some large proportion of people who resolved a problem identify with it, and it appears to accrue more and more power. Can we operationalize it? Can we measure it? Can we predict it, accurately? These questions will continue to be asked of science and opting out may not be an option.

Is “Recovery” the Field’s Identity? A Link Between Science and Community?

For the wider recovery science field this debate represents an identity crisis. In 2018, the National Institute on Drug Abuse sought to build a network of infrastructure to study the various recovery support services that have developed organically in communities. This project became The Consortium on Addiction Recovery Science (CoARS). Recovery housing, peer recovery support, recovery community centers all became areas of focus for the funded network, legitimizing “recovery” and bringing together science and the recovery community in a way never done before.

But you saw two approaches to studying recovery: Some were interested in working right alongside community supports, capturing their wisdom, and celebrating them (e.g., the “Advancing the Science on Recovery Community Centers” project). But others were more interested in challenging the status quo. Projects like I-STARR pointed out that existing recovery services weren’t accessible to all people and sought to change it. They recognized subpopulations, like people using Suboxone or those under the age of 30, who rarely fit into the classic recovery paradigm. Science, in this way, could widen recovery for all.

So when we say “recovery science” and label it a subfield, what do we mean? The Recovery Keepers, I think, are those who are trying to keep the science very close to what exists, to hold up a mirror to the swath of recovering Americans who do consider themselves in “recovery” and utilize “recovery” support, to avoid missing their voice. The Recovery Droppers wish to expand what this whole process of resolving a drug problem and finding a better way of life really means, and sometimes they make the same argument: science is missing a large swath of what exists by focusing so much on a single term.

We can probably have both, right? Something in the middle? Time will tell. But as a colleague pointed out to me, the fact that we care so much is a sign that we will find the right way, eventually.