Editorial

Use of the term “recovery” when it comes to addiction has a long history. Its use remains virtually invisible in the scientific literature however. The bulk of what we know about addiction processes emanates from research conducted in the United States and other “developed” nations; most of the work adopts a Western perspective and tends to focus on symptoms and the effectiveness of professional treatment at reducing symptoms. This literature has been useful in guiding policy and funding decisions and service development as well as refining theory that contributes to innovations in treatment. However, there are critical gaps in the addiction knowledge base, chiefly the pervasive underrepresentation of research on the wellness perspective and on recovery.

To date, addiction researchers, treatment providers, and public and private funders of services have emphasized the absence of symptom (i.e., abstinence from drugs and alcohol in the United States). Wellness goes beyond absence of illness (Breslow, 2006; World Health Organization, 1985). ¹ Recovery goes beyond not using drugs or alcohol. A participant in one of our studies defined recovery thus:

My definition of recovery is life. Cause I didn't have no life before I got into recovery.

Ultimately, recovery is about quality of life. The more forward thinking of my colleagues have been advancing this argument for some time (McLellan, Chalk, and Bartlett, 2007; McLellan, McKay, Forman, Cacciola, and Kemp, 2005) and encouraging researchers, treatment providers, and payors to consider personal and social health as key outcomes in treatment evaluation studies. Most recently, a preliminary consensus definition of recovery was put forth as “a voluntarily maintained lifestyle characterized by sobriety, personal health, and citizenship” (Belleau et al., 2007) with the goal of developing assessment tools and recovery-oriented services, eliminating discriminatory policies, and opening the dialogue among addiction researchers, treatment providers, and the recovery community. In this regard, the addiction field can seek guidance from the broader mental health field, where recovery has gained importance in service delivery and research as a bona fide outcome to be promoted and measured; a working definition of mental health recovery was set forth in the New Freedom Commission on Mental Health: “Recovery refers to the process in which people are able to live, work, learn, and participate fully in their communities” (New Freedom Commission on Mental Health, 2003). Understanding recovery and identifying factors that promote or hinder it will require a number of paradigm shifts for addiction professionals, including moving from an acute care model to a chronic or long-term approach, and shifting the focus of research and service provision from symptoms to wellness (Laudet, 2007).

One of the best-kept secrets is that long-term recovery is a reality for millions of individuals worldwide. Sensation-seeking societies such as ours are more likely to be mesmerized by the bad behavior of Hollywood royalty and assorted public figures than by the private success stories of formerly substance-dependent men and women who meet the daily challenge of facing life, responsibility, and themselves without drinking or using drugs. We must not let the media emphasis on the tribulations of active addiction obscure the fact that, for most, regardless of income, race, gender, or “primary substance” (so-called drug of no choice), recovery is attainable and sustainable through a long and at times challenging road. The private, oftentimes secret nature of recovery is due in large part to the strong social stigma that remains attached to addiction and casts a shadow on the many individuals who have emerged from their private struggles. In the recovering individual, most of us do not yet see triumph over adversity and the hope of others still suffering but a person who is a day away from returning to drug use (Peter Hart Research Associates, 2004). Nonprofit advocacy organizations such as Faces & Voices of Recovery are working to address the stigma and resulting discrimination of addiction that hinders access to employment, housing, and education among others, for recovering persons. Making recovery a bona fide topic of dialogue and scientific inquiry is also required to disseminate the message of hope that can launch suffering individuals and their families on the recovery path. This special issue of Substance Use and Misuse devoted to recovery is a small effort in that direction.

In virtually every culture since the dawn of times, mood-altering substances have been used—for religious, spiritual, or social rituals. In virtually all cases, a number of individuals “misuse” the substance, while their fellow denizens partake in moderation. Different countries and cultures have adopted varying approaches to this “problem” with far-ranging implications for the place of individuals with addiction in each society and how, by whom, and with what expectations and opportunities for recovery they are treated. The many different approaches to people with alcohol and drug use–related problems have also resulted in drastically different consequences on lives saved (or not) and on a nation's health, including in the areas of infectious disease—HIV/AIDS, tuberculosis, hepatitis C, and sexually transmitted infections (STIs)—and safety, like traffic fatalities, domestic violence, and drug-related crime. For example, the availability of evidenced-based drug treatment such as opioid agonist therapy (methadone and buprenorphine) and harm minimization interventions for injection drug users has critically affected HIV prevalence worldwide. This ranges from remarkably low rates in countries that adopted aggressive prevention strategies early on—e.g., Australia (Laudet and Storey., 2006), although recent trends suggest an increase in new incident cases (Kontominas, 2007) to rates as high as 50% or more among drug users in the Russian Federation (Toussova, Verevochkin, Heimer, and Kozlov, 2007), where the government continues to prohibit the use of opioid agonist therapy (Mendelevich, 2006). As global trade and traveling increases, one country's problem is no longer its problem alone; it is our problem. Identifying feasible solutions to these global problems is our responsibility—individually and collectively. The following papers constitute a small sample of the type of work that is needed to move toward a comprehensive knowledge base about recovery from addiction to drugs and alcohol.

In seeking papers for this special issue, the goal was to cover a broad range of perspectives and disciplines with emphasis on works that are less frequently represented in scientific journals such as this one. To that end, I sought to include work conducted outside the United States and representing non-Western perspectives, studies bearing on various populations (adolescents; families; dually diagnosed persons; individuals dependent on alcohol, drugs, and pathological gambling; Mexican immigrants; Native Americans), disciplines other than research (e.g., ethics and policy), and studies using qualitative as well as quantitative methods. The works included in this volume speak to addiction recovery issues in the United States, Italy, Russia, Australia, and New Zealand as well as to the Native perspective in North America; they describe not only state of the art research on various treatment modalities and other recovery resources but also policy and the impact of policy on recovery opportunities and the ethical aspects of discourse on recovery.

This publication has its own perspective that is doubtlessly well known to most of its readers and its past contributors. In addition, contributors to this issue were asked to adopt a perspective that is not always familiar to our field, that of recovery. All contributors were asked to define the term and to discuss the implication of their writings or findings to promoting recovery. In the process of preparing our papers, most of us were called upon to question the assumptions underlying our work and the discipline from which we hail. We all learned much from the process; the expression “mental yoga” comes to mind. I am deeply grateful for the opportunity to create an entire issue of this journal on a topic that is only beginning to emerge as a valid area of scientific inquiry and discourse. I am also grateful to each of the contributors to this special issue for graciously indulging me in putting a positive bend on their work and extracting from it critical implications for how we as researchers, clinicians, policy makers, and as a global society can contribute to fostering and promoting wellness among those who wish to pass from the darkness of addiction to the light of recovery.

Fiat lux!

Notes

¹ The WHO defines health as “an individual's perception of their position in life in the context of the culture and value systems in which they live and in relation to their goals, expectations, standards and concerns.” (World Health Organization Quality of Life Group, 1995, p. 1403).