Over the last few months, there has been a surge in the support of alternative pathways to recovery as opposed to the zeitgeist of the 21st century, mutual aid peer support group abstinence-based recovery (otherwise known as AA or others). As a person in long-term recovery, whose recovery follows this popular path, I find it alarming that the strongest dissenters of the alternative paths to recovery come from those like me. Support for alternate paths to recovery does not stop at the written and verbalized word though, evidenced by the President’s recent plan to earmark over $1.1 billion for the opioid crisis in this country. While POTUS’s plan seems to be made to curb the drastic increase in accidental drug poisoning deaths in the United States, I would argue that the individual support comes from a different place all together.
We live in a world today that has an estimated 23 million Americans in “long-term recovery”. While the estimations are just that, estimates, let us take the number at face value and accept as true. Of these 23 million an estimated 18 million describe their “recovery” as once having had a problem with drugs and alcohol, but now no longer due. Of this same number an estimated 1.3 million are self-report AA members. For the sake of argument, let us add another 700,000 in other mutual-aid groups, for a total of 2 million who identify as using the most popular pathway to recovery, though not the only ones I would imagine that subscribe to abstinence-based recovery definitions. That leaves roughly 3 million that utilize ancillary means or definitions of recovery from substance use disorders. So what do we have exactly? 10% of the estimated American’s in long-term recovery identify as mutual-aid recoveree and from the evidence available, subscribe to an abstinence-based definition of recovery. 90% then would be labeled as “alternative” path takers. This leads us to an important point – is the best way to describe this over whelming majority as alternatives, or are they more to the point the most prominent prospects in popular pathways? Why are those advocating for all paths to recovery defending the notion that there is more than one acceptable path, when in fact, the evidence available and the numbers do not lend themselves to argue any other point but that? If anything, it would seem that those in abstinence-based recovery need to defend that their path is a successful alternative to the popular norm.
The truth is the whole premise is faulty. There should not be paths, or roads to recovery. Instead, we should have treatment plans that are catered specifically for the needs of the individual. Recovery shouldn’t be marred by the treatment taken to get there, but celebrated once it is achieved. We have a patient population that is in the millions that regardless of causation has a treatable medical condition which needs to vary according to the needs of that individual. We have for decades been forced to have the argument whether or not addiction, classified as severe substance use disorders, is in fact a disease. Regardless of the advocate or person in-recovery (abstinent or otherwise) we all, by and large, believe this to be a truism. Other truisms? Mental Health Concerns like major depression disorder and bi-polar disorder are diseases resulting from variations from the norm in the human brain. However, the mental health advocacy field does not have the same arguments that we do; the argument that recovery looks one specific way. Mental health advocates have reached consensus that recovery looks like a patient-directed plan that encapsulates medication, vocational skills, primary health care, and peer-based services. The treatment for mental health illness often looks like stabilization, medication management, nutritional changes, pro-social engagement, and empowerment of the individual. When this path is different from person to person, they aren’t persecuted or shamed for following an “alternative” path but supported and encouraged to achieve recovery, or improved functioning and self-fulfillment. The same landscape can be seen in the treatment of most chronic diseases, save one – substance use disorders. We have this fight singularly in our field, and it is not only because we cannot agree as engaged stake holders on what recovery is or isn’t – it is because we also can’t agree on what “disease” means.
To compare to mental health concerns again, it has been some time since I have heard of bi-polar disorder being brought on by a spiritual deficiency. I hear it daily when in reference to someone with an active substance use disorder. Time and time again, rhetoric that we must view substance use disorders as a disease and treat it as such permeates, but in fact it never really happens. As this continues, accidental drug poisonings continue to rise with a lack of substantial options and preventive measures and we are no closer to adequate medical treatment of substance use disorders than we were in the 1940’s.
As a field, we can continue to argue amongst the very nature of recovery as fervently and as often as we want to. Doing so does nothing but divide us, and ignore the fact that recovery is person-centric and individually defined. As we continue to argue, we must also realize that we will never truly have “disease treatment” until we view substance use disorders as a disease that is rooted in brain chemistry, and not in the ethos of something intangible. Hundreds of thousands will continue to die unnecessarily as one symptom of an active substance use disorder continues to remain – ego. Unfortunately, as the cliché goes, we cannot have our cake and eat it too. Substance use disorders are either a medical concern or they are not; treatment is either holistic and dynamic, or it is not. Otherwise, we will continue to be relegated to the self-help section of the bookstore, rather than a semester-long course of education during hospital residency.