There is a ton of discussion in the addiction treatment and recovery space about outcomes, specifically recovery outcomes or “successful” outcomes. When calling a rehab, parents, spouses, and loved ones want to know that a treatment center’s outcomes are or what are its success rates. Insurance companies want to pay for treatment (or often not pay for treatment) based on the outcomes a treatment center has with their patients. Outside of the field, society wants to know why the addiction treatment space has such high “relapse rates” or “poor outcomes.” Part of this conversation revolves around the definition of “recovery” and what does that even look like. The new battle cry by many is “you’re in recovery when you say you are”, while many long-standing people in recovery, often members of 12 Step fellowships, often disagree, stating that is not the case.
This is one of the issues within behavioral health, the understanding or definition of what terms mean. Because both as a society at large, and as a specific industry, there is no true understanding of what “recovery” is, or even what a “successful recovery outcome” looks like.
Does successful recovery mean abstinence? It did for many years. The overall understanding was a successful outcome for a treatment center of a person in recovery meant that a person staying away from substances equated to success. However, is that really the case? It is certainly better than that person returning to active addiction, but as many in the 12 Step rooms can tell you, long-term sobriety does not always equal success. In fact, it’s often heard in the 12 Step rooms that the longer someone stayed sober, often the more “sicker” they became if they didn’t engage in the 12 Step fellowships program of action (the 12 Steps.) This means that while a person stayed away from substances, they didn’t take spiritual action to grow. They didn’t actually find recovery, they just found sobriety. But the terms and definitions of the 12 Step community do not apply to everyone.
One of the biggest issues in identifying what a successful recovery outcome is for a person is that substance use disorder is a spectrum. Not everyone that needs or enters treatment is an “alcoholic” or an “addict” as defined by the 12 Step fellowships. These people are what the 12 Step fellowships consider the “hopeless variety” in need of spiritual help. These people, in order to find “success”, typically need to find recovery that includes long-term sobriety and freedom from all mood and mild altering substances. They fall on the extremely severe end of that substance use disorder spectrum. But what about those that fall on the less severe, the mild or moderate levels of that SUD spectrum? What about those individuals with co-occurring disorders, many of whom are actually self-medicating? What about the young adults that may be on the mild end of the spectrum, that certainly have issues with substances and whose lives aren’t working, but who may not actually need long-term sobriety. They certainly need recovery, but perhaps not the typical 12 Step recovery. What about people with severe mental health or psychiatric issues who are actually managing (often poorly) their symptoms through substances? They need to find a healthier way to manage the mental health and psychiatric symptoms, but they are certainly not the same as someone on the moderate or severe level of the substance use disorder spectrum, so how do we define recovery and a successful recovery outcome for them? And in an even greater discussion, how we as a field and as an industry define recovery for individuals with different clinical issues, but who both need treatment and recovery?
Just as we know that treatment cannot be a one-size-fits-all model, we also must understand that a recovery outcome cannot be black and white and the same for everyone. So, when someone asks, “What are your success rates?” or “What are your recovery outcomes?”, while a necessary piece of information in behavioral health and addiction treatment, this is a bigger undertaking than anyone seems to realize. Two 25-year-old female African Americans with alcohol use disorder or two 37-year-old Caucasian men with opioid use disorder may both look the same, but they may have two completely different sets of clinical issues. And, let’s say they have very similar clinical issues, the clinical approach that works for one may not work for the other. While we like to identify substance use disorder as a disease and a medical issue (it is), it is more complex than many medical issues, and as a behavioral disorder, we don’t have blood tests, scans, and other medical testing to determine exactly what the issue is and the best way to treat it. It’s, unfortunately, more complex and ever-changing. So with all this complexity and difficulty, how can we even define “recovery” or what a “successful recovery outcome” looks like?
We don’t have a definitive answer (and it’s doubtful, if anyone is truthful with you about it, they have one either.) However, we have some theories and principles we like to go by and inform our patients when it comes to what a successful recovery outcome looks like. We do not mean is equates to sobriety, although it can. We often think for many patients that sobriety is necessary, but it is simply the very starting point for recovery.
We believe a successful recovery equates to a higher quality a life that includes meaning, fulfillment, purpose, and direction. We know, that’s vague. And therefore, it further supports the idea that a successful recovery outcome cannot be simple or black and white. It involves patient-centered care and the recovery from the clinical issues each patient is dealing with individually. So how can we help define a successful recovery outcome? We believe it includes recovery, meaning a positive change in a person’s life. Often, that does mean sobriety. Sometimes it means a person recovers from their trauma or learns to live a healthy lifestyle which also includes ongoing mental health issues. It can include ongoing medication management. It often includes ongoing involvement in Alcoholics Anonymous, Narcotics Anonymous or other 12 Step fellowships, but almost always includes involvement in some community-based mutual support group. It often includes the integration of healthy lifestyle habits like fitness, nutrition, yoga, or other healthy practices. But we know it goes further than that and is often supported by getting one’s life on track through the learning, development, and implementation of basic life skills and practices like daily hygiene, budgeting and money management, community involvement and engagement, restoring or developing new relationships with family and social circles, and some form of spiritual practices. However, going even further, we believe that quality of life means engaging in interests, furthering academic goals and objectives, and developing a life purpose through work and career.
So how do we define a successful recovery outcome? Well, it means someone has gotten their life on track and is following their dreams, developing and supporting their talents, and working towards their life goals. It means developing a community, through healthy relationships with their family and friends. It means working towards or achieving their academic goals and then through gainful and fulfilling employment. It means achieving a sense of self-observation and awareness, an ability to handle emotions in a healthy way, and express a desire to give back and help others in some form or fashion. It means learning to set goals, working to achieve them, and if a failure occurs, it does not destroy what has been built along the way. It means old attitudes, ideas and behaviors that were often negative and self-defeating have been replaced by healthy attitudes, ideas and behaviors that support helpfulness, thankfulness, gratitude, happiness, and love. It means learning to react to people and situations in a healthy way. It means hope and freedom. Sometimes it means sobriety and sometimes it does not, but it always means finding a high quality of life that one can be happy with and proud of living.
So, what are some ways to quantify this? Does the person say they are in recovery? What does that look like? Are they in school or employed? How does their employer say they are doing at work? Do they have a relationship with their family? How do their parents, siblings, and/or spouse report that relationship is going? Do they show up for their family, for their job, for their life responsibilities? Are they sober? If not, what does that look like? Are they financially self-supporting? If not, why? Are they taking care of themselves in terms of medical issues? Are they engaging in preventative medicine? Do they have an ongoing routine of health and fitness to includes healthy habits and healthy outlets for stress? Are they engaged in either ongoing community support or clinical/therapeutic support? What is their level of reporting happiness and fulfillment in their lives?
We know, it’s hard to put what a successful recovery outcome looks like in a box, but addiction is a chronic, complex illness and we need to start finding ways to quantify successful outcomes. However, the idea that we can generally check some genetic boxes to say “this patient is successful” in a way that we can test to say that treatment has been successful because a patient gets a cancer-free diagnosis shows a fundamental misunderstanding of addiction, mental health, and behavioral health as a whole. If treatment must be patient-centered and individualized to be effective, then we must also individual recovery outcomes for each patient. To do any less does a terrible disserve to an already hopeless, disenfranchised patient population. Recovery, whatever that means in the specific situation of the individual, is absolutely possible, but as treatment providers, it is our job to show each individual the tools to find recovery and support them as they find it. In doing so, we make sure that not only is recovery possible, but a high quality of life is as well, and a high quality of life filled with happiness, productivity, health, meaningful connections, purpose, and direction.
If you or someone you know needs help for addiction or co-occurring disorder issues, please give us a call. Maryland Addiction Recovery Center offers the most comprehensive dual diagnosis addiction treatment in the Mid-Atlantic area. If we aren’t the best fit for you or your loved one, we will take the necessary time to work with you to find a treatment center or provider that better fits your needs. Please give us a call at (410) 773-0500 or email our team at [email protected]. For more information on all of our drug addiction, alcohol addiction and co-occurring disorder services and recovery resources, please visit our web site at www.marylandaddictionrecovery.com.