The emergence of recovery as an organizing paradigm for addiction treatment and the larger arena of behavioral health care underscores the need to measure both early recovery initiation and stabilization and the prevalence of long-term recovery maintenance. Such measurement is critical in evaluating addiction treatment as a system of care and monitoring broader dimensions of community health.
Efforts to measure recovery are challenged by the lack of professional and cultural consensus on the definition and measurement of key constructs (recovery, remission, abstinence, and subclinical/asymptomatic/controlled/moderate use) and by conflicting rates of recovery—rates reported across clinically and culturally diverse populations in studies marked by widely varying methodologies, follow-up periods, and follow-up rates. Of particular import is the wide divergence between portrayals of the natural course of alcohol and other drug (AOD) problems in community populations and portrayals of such problems in clinical populations following specialized addiction treatment. These divergent portrayals constitute the ultimate “apples and oranges” of the AOD problems arena.
The question of recovery stability and prevalence is more than an academic one. The constant media onslaught of celebrities heading back to “rehab” after their latest falls from grace has produced a public unsure of exactly what “recovery” means and whether it is really
attainable for all, or for only a few “morally enlightened” exceptions to the rule. The failure of a celebrity to achieve stable recovery garners great cultural attention, while the masses of those
in long-term recovery pass invisibly through our culture each day. Recovery surrounds us in our
neighborhoods, our businesses, our schools, and our houses of worship, but we do not see it. We see instead the highly visible fruits of the problem. The pessimism flowing from such selective attention feeds misunderstanding and fuels stigma and its far-reaching consequences.
This paper reviews 415 scientific studies of recovery outcomes (79 community studies,
276 adult clinical studies, and 60 adolescent clinical studies) conducted with clinically and
culturally diverse populations in multiple countries over the past century. This review provides preliminary answers to five of the most important questions about recovery from alcohol and
other drug problems.
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