Now that I have returned from my break, I thought it a good time to remind ourselves of the factors that facilitate recovery from addiction. Here is half of an article I wrote back in 2021 for my eBook Our Recovery Stories: Journeys From Drug and Alcohol Addiction and my Recovery Stories website. In this post, I look at a definition of recovery and then consider seven factors that facilitate recovery from addiction, using voices of people in long-term recovery. I will describe a number of other factors in tomorrow’s blog post. Reading the full article will help you appreciate why recovery communities are so important—they provide many of these factors.
You can see a link to a pdf version of the full article below. Please pass this article to as many friends and colleagues as possible.
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There have been various definitions of recovery proposed over the years. For the purpose of this article, I use a definition proposed by a leading addiction recovery advocate, historian and researcher, William (Bill) L White:
Recovery is the experience (a process and a sustained status) through which individuals, families, and communities impacted by severe alcohol and other drug (AOD) problems utilize internal and external resources to voluntarily resolve these problems, heal the wounds inflicted by AOD-related problems, actively manage their continued vulnerability to such problems, and develop a healthy, productive, and meaningful life.
There are a number of features about addiction recovery that need to be understood. Recovery is something done by the person with the substance use problem, not by a treatment practitioner or anyone else. Professional treatment or engagement in mutual aid groups may facilitate recovery, but they do so by catalysing and supporting natural processes of recovery in the individual.
The second feature of recovery from serious substance use problems is that it does not occur in isolation. The maxim ‘I alone can do it, but I can’t do it alone’ is particularly pertinent to recovery. As I will discuss later, connection to other people is a key element facilitating recovery.
Although formal treatment may help people, recovery occurs in the community rather than in the clinic. Treatment is generally the start of a recovery journey and is not needed by everyone. For those people who access local treatment services, the vast majority spend far more time in their community than in the treatment service. For those who attend a residential rehab, they continue their recovery journey upon returning to their community, where all they have learnt will be put to the test.
Recovery is a process that generally takes a long period of time and requires sustained effort. Recovery initiation and recovery maintenance are qualitatively different processes. Recovery is not a linear process. The person may make small gains followed by a major step forward. The person may falter, slide back, re-group and move forward again. Relapse is not a failure; it is part of the recovery process. It can be followed by a major move forward in the recovery journey.
Recovery is much more than just stopping use of drugs and alcohol. It is about repairing the damage caused by drug and alcohol-related problems, including problems which may have arisen as a result of poor treatment practices. It is about actively managing the person’s continued vulnerability to the problems that arose from drug and alcohol use, and the initial problems (e.g. childhood trauma) that may have been a causal factor in the person’s descent into problematic substance use.
Ultimately, recovery is about gaining and maintaining a healthy, productive, and meaningful life. It should be pointed that not everyone who finds recovery gives up all drug and alcohol use.
Recovery is better predicted by someone’s assets and strengths, rather than their deficits and weaknesses. People can make progress by identifying and building on their personal assets and strengths. Successful interventions to facilitate recovery focus on helping individuals to build recovery strengths, more often referred to as ‘recovery capital’. Recovery capital is the quantity and quality of internal and external resources that one can bring to bear on the initiation and maintenance of recovery (please see below).
Recovery from addiction is holistic. It encompasses a person’s whole life, including mind, body, spirit, family, community, culture and wider society. Treatment and support services need to address the multi-faceted needs of the recovering person. As addiction is generally a symptom of a deeper underlying problem, such as trauma, recovery is greatly facilitated by addressing such an underlying problem.
Everyone’s recovery is different and deeply personal. However, whilst there are a multitude of pathways to recovery, there are a number of key factors that facilitate recovery from serious substance use problems. The importance of these factors has been illustrated in the narratives of recovering people about their journeys into and out of addiction.
Here, I describe a number these factors, illustrating their importance using primarily quotes from the Stories in my eBook Our Recovery Stories: Journeys from Drug and Alcohol Addiction. It should be noted that many of these factors are inter-related, so there will be some degree of repetition. Many of these factors facilitating recovery are also relevant to family members and other loved ones who have been indirectly affected by such problems.
1. Hope
The first essential factor for a person to be able to recover is hope. This hope is based on a sense that life can hold more for one than it currently does, and it inspires a desire and motivation to improve one’s lot in life and pursue recovery. Hope is the catalyst of the recovery process. Without hope, there is no real possibility of positive action.
Hope is gradually diminished in people with serious substance use problems, as the problems themselves increase in number and intensity, and repeated efforts to abstain are unsuccessful. Social isolation, which often occurs when someone has a serious substance use problem, erodes hope. Not knowing anyone who has overcome similar problems leaves one feeling trapped in a world from which there is no escape.
You have to realise my state of thinking prior to that first group meeting in the treatment agency. Once I had become addicted to heroin, I did not see that there was any alternative to the life I was living. I didn’t know anyone who had overcome heroin addiction. I had never heard of anyone who had done so. I could find no information on the internet on how to give up using the drug. That was it! I just had to carry on doing what I was doing.’ Natalie
People in recovery from addiction describe the importance of having hope and believing in the possibility of a renewed sense of self (or identity) and purpose in the process of recovery. Hope is created by seeing other people find recovery from addiction, and knowing that recovery is possible, not just for others, but also for oneself. Hope grows over time. However, hope can also be squashed by poor treatment practices.
It was the first time in my life that I’d heard anyone speak about using drugs like I’d used drugs. It was also the first time I’d seen anyone who’d stopped using—actually chosen to stop, and who was at peace with their decision. I’d stopped using a lot, but always because I either had no money or no access to drugs.
The results of that first meeting, and the effect on my life, were immense. I’m certain that there is a small element of hope—or faith or some kind of spiritual flame—that burns inside us all. I believe it’s never completely extinguished, but can become so dim that it’s almost invisible to us. It was rather like that flame was fanned by my experiences at my first meetings, and I became aware again of hope.’ Simon
Hope can be fostered by recovering people, family members and friends, people working for treatment providers and other support services, and a wide range of other people.
I was sitting in a mutual aid meeting, it was the Doctors and Dentists Group, and one of the members was talking about his experiences. He was a GP like me and he had drunk in a similar way to me and he had the same kind of consequences as me and he felt the same as me. He was a few years into his recovery and I identified and connected with him to the degree that I suddenly thought, “Oh my God, if he can do it, maybe I can do it.”
I probably must have felt a mustard seed worth of hope. It was the first time I felt anything like that. I’d already tried for the best part of two years going down the medical route to try and find some sort of sobriety and this guy’s experience spoke to me in such a way that it created hope.’ David
A sense of hope is generated by focusing on a person’s strengths and assets, by using language that reflects a belief in potential and possibility, and by encouraging a person to take risks.
2. Empowerment
Recovery is something done by the person with the substance use problem, not by a treatment practitioner or other person. The major sources of power driving the recovery process are the person’s own efforts, energies, strengths, interests and hope. Treatment practitioners, and others involved in the person’s recovery journey, can facilitate the recovery process by encouraging and supporting the person’s own hopes, strengths, interests, energies and efforts.
Given the above, self-determination and empowerment are key foundations underlying recovery. To move forward, recovering people need to have a sense of their own capability, their own power. They need to regain a sense of agency, which is so often lost in the isolation and chaos of addiction. Their hope needs to be focused on things they can do for themselves, rather than on new ‘cures’ or fixes that someone else will discover or give them. The person must be the author and arbiter of their own recovery.
I understand that whatever the help that is offered, ultimately the movement from addiction into recovery has to come from deep within the individual. If I hadn’t embraced treatment and opened myself up to a painful process, it would have had little impact. Nobody could make me recover from my addiction. I had to take certain opportunities as they occurred.’ Paul
Those people trying to help a person on their recovery journey must respect and facilitate the person’s autonomy, as well as their right to make choices about the services and supports they believe will assist their recovery. People trying to help should not be controlling and coercive.
After being prescribed a low dose of methadone which failed to stop her experiencing withdrawal symptoms at work, Sapphire was seen by a more understanding and better-informed GP. She was listened to and her wishes were met.
It felt great to freely talk about what was really going on in my life. My new GP listened to what I had to say and treated me like any other (non-addict) person. She also did not repeat ad nauseam that, “Everything in my life would be rosy if I was abstinent”, which was the party line of the CDT. [ Community Drug Team]
My GP increased my methadone dose and I was able to function totally normally without having to buy any methadone on top, or without feeling like I wanted to use any other drugs. I felt like any other person…’ Sapphire
Sadly, this GP later passed away and Sapphire faced new problems with her treatment service.
As I was testing negative for all drugs other than those I was being prescribed—that is, I was not taking anything on top of my prescription—the CDT kept insisting they reduce my methadone dose. They believed that I didn’t need the same dose of methadone, as I wasn’t now using illicit or unprescribed drugs. They were ignoring the fact that it was because of this dose of methadone that I was able to abstain from other drugs and alcohol. “As the medicine is working, she needs less of it!”’ Sapphire
3. Self-responsibility
The flip side of the fact that ‘recovery is something done by the person with the substance use problem’, is that the person has to take charge of their own recovery. Although people generally need to be supported in their recovery, they can’t be care-taken or protected into recovery. Setting one’s own goals and pathways, taking one’s own risks, and learning from one’s own successes and failures, are essential parts of a recovery journey. No one else can do the work.
Being responsible for one’s own recovery means that a person has a lot to learn in order to facilitate the process, not least that recovery takes time and a great deal of effort. The person must generally learn a good deal about the recovery process, and a great deal about oneself; some of the latter might be confronting. The support of others plays an important role in these matters.
Group therapy is very helpful at giving you a new pair of spectacles through which to see the world, and very quickly I gained insight into the repetitive and self-destructive patterns of thinking and acting that had tripped me up so many times in the past.
One of the first lessons I learned was that I was responsible for my own feelings. Although now that sounds very self-evident, for much of my life I had believed that what was happening around me would determine the way I felt; as if I was passive and had no choice in how to respond to circumstances. There was a scared little kid in me who was still dictating the way I would deal with difficult life circumstances and difficult people.
Discovering that how I responded was actually down to me, and not to the circumstances I found myself in, was an eye-opener and very empowering. Treatment helped me to move away from being a perpetual victim to life’s challenges and to develop a bit more self-assurance and confidence.’ Tim
4. A sense of belonging
Recovery cannot be achieved in isolation. In fact, many people with serious substance problems have become isolated and alienated and this has a further debilitating effect on their already vulnerable psychological state. People who have had such problems need to belong and feel part of something. They need to feel the acceptance, care and love of other people, and to be considered a person of value and worth.
In the rehab, I began to feel hope and a sense of belonging. I began to believe that I could and would have a new life. I started to interact with people and make new friends, which reduced my isolation. I discovered that people cared about me and wanted to help me. I also started to learn how to live without using drugs and drinking as a coping mechanism.’ Adam
The nurses in the rehab were also a powerful positive influence, as they made us feel important. As alcoholics, we had so little self-esteem—I felt really crap about myself—and the nurses helped us to start to feel good about ourselves. Looking back, the empathy and compassion the staff showed to me was the single most important factor that helped me on my journey to recovery. People in the rehab, clients and staff, saved my life.’ Michael
Gaining a sense of belonging and acceptance can come from various sources, including a peer support group, treatment agency, workplace or volunteer group, sports club, or the church. Interacting with animals—be it with a beloved pet, during voluntary work at an animal sanctuary, or engaging in equine therapy—can also provide a sense of belonging and acceptance, and facilitate recovery.
The power of gaining a sense of belonging is emphasised by Guardian reporter John Crace in an article he wrote about his heroin addiction.
If it was rehab that got me clean, it was Narcotics Anonymous that kept me clean. Without meetings, I would have been back on drugs within days. NA gave me meaning and hope… I felt an intense sense of belonging. Like a family I had never known, who understood my life, my shame, my darkness. Anyone who had been clean for more than a couple of years was like a god to me.’
In a qualitative research project Lucie James and I conducted focused on the RAPt treatment programme in a male and female prison, we found that ‘Belonging’ was a key element identified by interviewees in changing their thinking, emotions and behaviours.
5. Being supported by, and helping others
Acceptance is just one aspect of the fifth key factor underlying recovery, being supported by others. People in recovery stress the importance of having someone believe in them, particularly when they don’t believe in themselves. They also stress the importance of having a person in recovery as a mentor or role model as they travel their journey.
I would not have been able to tackle my addiction without the treatment agency. They gave me a structure to my life. They taught me how to live again. After engaging with the treatment agency, I felt like I belonged somewhere for the first time. There was just something about the place. I loved the people, and most importantly they weren’t judging me and they were treating me like a human being. I was being supported in what I wanted to do and I was being treated like a decent person. They believed in me, when I didn’t.’ Natalie
Other recovering people, or role models, help people know what recovery looks like, give them something to which they can aspire, and provide ideas on how to overcome stumbling blocks in the recovery process.
People who are trying to overcome a serious substance use problem can more easily relate to and trust someone who has been there. Recovering people can help alleviate some of the stresses and strains the person may feel on their journey to recovery. They can also help the person find connections in the community they need to facilitate their recovery.
Ian was an important role model for me, someone I could look up to. He gave me confidence and hope, and I was able to ask him questions knowing he would give me sensible answers, providing information I could use in my life. He’s ‘been there’ and come back from a life of hell, so as far as I was concerned, I could relate to, and trust, him.’ Adam
Tom is a recovering alcoholic, so he understood what I’d been through, which meant that I could respond to him more. I was not thinking, “Oh, what a wanker, go look it up in a book.” It was important to me to know that he wasn’t looking down on me. Tom would show that he was no different to me, by telling stories of his alcohol use and then showing how he is now. He made recovery seem achievable.’ Kevin
The power of a support group, such as AA, and how its members can facilitate recovery in a variety of ways, is described by one of our interviewees.
So, a week later I went to my first official AA meeting. Scared, confused and shaking, I was greeted with nothing but warmth and empathy. As I listened to these other alcoholics talking, I realised that these people were just like me. They understood what I was going through in a way that no one really ever had before. They had fallen into the same traps as I had and suffered from the same screwy thoughts.
I actually didn’t get my recovery through traditional AA methods. I didn’t do the steps and I don’t have a sponsor. However, attending AA gave me the understanding and connection that I had been missing. It gave me the support network of people who have been there that I had never had before. It gave me wisdom through listening to others sharing their experiences. It helped me to understand a lot more about addiction. It impressed upon me the importance of gratitude and putting my recovery first. In short, it gave me a good deal of guidance and a whole lot of hope.
AA also gave me respite when in my renewed sobriety, I thought I might fall apart and drink. It gave me a safety net. And if I ever think it’s a good idea to drink again, I know exactly where to head in a moment of desperation to be talked out of it.’ Beth
The role of support and belonging emphasises that recovery is a social process and stresses the importance of relationships. It is important that these relationships are not one-sided, like the professional-patient situation in the medical model, but are reciprocal in nature, with the recovering person both giving and receiving. The practitioner-client relationship must be one of equals. Practitioners must show empathy, an ability to see the world through someone else’s eyes. The person visiting a practitioner must be able to feel safe.
In describing the importance of safety and social support in facilitating recovery from trauma, Bessel van der Kolk wrote [1]:
Being able to feel safe with other people is probably the single most important aspect of mental health; safe connections are fundamental to meaningful and satisfying lives….
… Social support is not the same as merely being in the presence of others. The critical issue is reciprocity: being truly heard and seen by people around us, feeling that we are held in someone else’s heart and mind. For our physiology to calm down, heal, and grow we need a visceral feeling of safety. No doctor can write a prescription for friendship and love: These are complex and hard-earned capacities.’
Interactions between peers, especially in the group setting, are particularly important as a recovering person can give, as well as receive, feedback. Participation in such mutual relationships gives the recovering person a feeling of worth—they have something of value to offer to others—and allows them to see aspects of themselves they may not have seen for some time due to their substance use problem. They learn more about what they are capable of and aspects of who they are, that ultimately contribute to a change in identity, from an addict to a worthwhile person. Supporting others can become a key element that facilitates one’s own recovery. It helps create a ripple effect of recovery.
Group therapy is very helpful at giving you a new pair of spectacles through which to see the world, and very quickly I gained insight into the repetitive and self-destructive patterns of thinking and acting that had tripped me up so many times in the past.’ Tim
Interacting with, and helping others, can serve other purposes that facilitate recovery.
I had spent many years without any real hope or passion in my life. The broad horizon of my youth had narrowed to a point where my life had become a place of struggle, with no real pleasure, just relief from a gnawing, constant, self-centred fear. Where everything and everybody was an obstacle to overcome, by myself, and with little energy.
I was becoming much more aware of other people, their feelings and their responses to me, and I realised that I gained real pleasure and satisfaction from helping and being useful. A key feature of the NA programme is the principle of service to others, as a way out of self-centredness. This growing awareness was described to me as spiritual in nature. I liked this idea, as I did the idea that I was enjoying a spiritual awakening. It was becoming clear to me that this 12-Step programme, whilst appearing from the outside to be rather religious in tone and language, was a series of exercises that enabled the ‘awakening of my spirit’.’ Simon
Family members are an important source of support for someone on a recovery journey. At the same time, however, family members may have been negatively affected by their loved one’s addiction and related problems, and may need their own supports.
6. Involvement in meaningful activities
Another important factor facilitating recovery involves the development of valued social roles through involvement in meaningful activities, such as described above. Through these activities, recovering people gain a sense a purpose and direction in their life—they find a niche in the community.
These meaningful activities may involve employment or volunteering, engagement in hobbies or other leisure activities, or connecting with other organisations or groups. Employment is a central way in which people can achieve more meaning and purpose in their lives and is therefore a key pathway to recovery. As described in the previous section, impacting on the lives of other people in a positive manner, ‘giving back’ as it is often called, is also important for personal recovery.
Ian and Irene decided to set up a support group for parents and carers and this initiative not only helped other people, but facilitated their own recovery journey.
… it occurred to us one night that what we could do would be to provide what we had wanted when we first discovered Robin’s addiction to heroin. Quite simply, someone to talk to, understand what we were going through, be non-judgemental, have a knowledge of drugs and addiction, and be able to act as a signpost to further help.
And so, on another cold November night, CPSG (Carer and Parent Support Gloucestershire) was conceived….
… What our experience has given us is a great insight into, and an absorbing interest in, the substance use and recovery field. We’ve been able to translate our knowledge and understanding into a service that provides help for those people (particularly family members) who have been affected by another person’s drug or alcohol use. Our ongoing work has not only been rewarding, but has also been a major factor in our own recovery.’ Ian and Irene
Iain describes the importance of engaging in a variety of different recovery-based activities.
Hundreds of people came to our first annual RAFT event and the feedback was absolutely amazing. I got the same positive feelings at this event that I got with RAFT each week, but multiplied by about a thousand. I also felt like this after the Annual UK Recovery March in Glasgow in 2010.
During the early stages of RAFT, I was introduced to the Wired In To Recovery online community. I started blogging about RAFT on Wired In To Recovery every week, either at the event or at home straight afterwards. I immediately found this blogging to be a great way to air my feelings and thoughts in a safe manner, whilst receiving thoughtful comments from people around Scotland and further afield. This was all extremely helpful to me.’ Iain
Many people in recovery describe the importance of believing in something spiritual, having faith in a higher or transcendent power. Spirituality, religion, or belonging to a faith community, represents important pathways to recovery for some people. Kevin felt that God was involved in the early stages of his recovery when he visited Livingstone’s rehab:
When I visited, I straight away decided that I didn’t want to go. It was a Christian rehab and I wasn’t a Christian. Tom, who runs Livingstone’s, asked if I wanted to have a look around anyway, so I did.
All of a sudden, a very alien, but comforting sensation, came over me. I knew beyond all doubt that it was God showing me what my life could be like if I chose to follow him. I felt at peace. I felt happy. The weight lifted off my shoulders. I was back to how I remembered feeling as a kid. I knew this was the place for me….’ Kevin
The pleasures and rewards that come from engaging in meaningful activities help foster a sense of agency, a self-belief that the person can impact on their own life. Sense of agency is closely related to empowerment.
7. Gaining recovery capital
Recovery is better predicted by someone’s assets and strengths, rather than their ‘pathologies’, deficits and weaknesses. People can make progress by identifying and building on their personal assets and strengths. Interventions to facilitate recovery must focus on helping individuals build their recovery strengths, more often referred to as ‘recovery capital’.
Recovery capital is the quantity and quality of internal and external resources that one can bring to bear on the initiation and maintenance of recovery. It takes three main forms:
- Personal (physical health, mental health, financial assets, housing, values, knowledge, self-esteem, self-efficacy, problem-solving capacity, etc).
- Family/social (support from family and other loved ones, people in recovery, and people in the wider social network, etc).
- Community (local recovery role models, full continuum of treatment and other support services, mutual aid groups, less prejudice in community, opportunities for work and volunteering, etc).
Recovery capital, both in terms of quantity and quality, plays a major role in determining the success or failure of recovery, either natural recovery or recovery assisted by treatment and/or peer support groups. People with low levels of recovery capital, for example homeless people without a job, are likely to face much greater problems in achieving recovery than people who are seeking recovery from a position of privilege. Increases in recovery capital can spark turning points that trigger recovery initiation and strengthen the maintenance of recovery.
Most people with severely depleted family and community recovery capital gain little from individually-focused addiction treatment that fails to mobilise family and community resources. In fact, long-term recovery outcomes may have more to do with family and community recovery capital than the attributes of individuals or a particular treatment protocol.
[1] Bessel van der Kolk, M.D., The Body Keeps the Score: Brain, Mind and Body in the Healing of Trauma, Penguin Group, USA, 2014.
Factors That Facilitate Addiction Recovery (pdf document)