What Should Count as Success in Addiction Care?
I entered recovery as a transitional age youth, with my relationship with my family pretty much nonexistent after the progression of my substance addiction led me down a dark path toward isolation. By the grace of God and through the love and service of those in my recovery support community, I was able to build a solid foundation in recovery, develop resilience and find a sustainable path toward becoming a sober man who values honesty, accountability, love, faith, compassion, gratitude and humility.
Learning not to pick up a drink or a drug was only the beginning.
The recent HHS and SAMHSA voluntary pledge on behavioral health quality and best practices caught my attention. I support its goals around access, evidence-based care, measurable outcomes, accountability and long-term wellness. The definition of success has to reflect what it really takes for someone to build a life in recovery.
Looking back, the things that reflected my progress were staying sober, learning how to live a new life based on service, becoming employable and responsible, repairing the damage I had done and building a community that supported my recovery and held me accountable. A completed treatment episode would have shown that I crossed one important threshold, but most of the change that enabled me to sustain my recovery came later.
Many people know how to get sober. The struggle is being able to remain sober over the long haul and learning how to live successfully in recovery.
During the last ten years at Awakening Recovery, I have watched men and women come to us after several attempts to stabilize. Some know the language of recovery very well. Consistently living by those principles once the immediate crisis passes is a much deeper and more durable process.
One size does not fit all in recovery. What I have seen produce the best long-term outcomes is for people in recovery, especially with co-occurring disorders, to be in the same safe place with the same recovering people, doing the same recovery based things for as long as possible - optimally, at least a year to build a solid foundation and a walkable path.
This gives your mind, body, and spirit a chance to heal from the effects of chronic substance addiction. One solution is to actively, consistently, and with integrity engage in a recovery process that helps bring about a fundamental change in your thinking, feelings, and actions in a way that will enable you to live a successful sober life, one day at a time.
People with substance addiction seeking recovery typically want a quick fix to their struggles with immediate gratification, thinking that is the easier softer way or at least a familiar way to live their life in their active addiction. My experience, and what I have seen in those I have helped, is that a durable recovery process takes hard work as people are often also trying to heal from the layered, complex, and deep damage that has been done during years of active addiction.
The things we typically don't want to engage in are the most imperative and crucial - such as honesty, open-mindedness, willingness, patience, and humility. This requires doing the consistent and hard work that has depth and weight to uncover, discover, and discard the maladaptive thinking and behavior that keeps us in our addiction and instead embrace the honesty, hope, faith, and courage it takes to awaken to a new way of life - and ultimately enables sustainable recovery.
According to SAMHSA's National Outcome Measures, outcomes already include abstinence, employment or education, housing stability, social connectedness, treatment retention and criminal justice involvement. These measures, especially when taken together and followed over time, can give us a much better picture of what is happening in someone's life than admissions, discharges and days of service alone.
Recovery is a dynamic process that makes changing demands over time, which is why I believe outcomes should be followed at 30 days, six months, one year and beyond.
Research involving recovery residences has connected stronger engagement and retention with growth in recovery capital, the personal, spiritual, social and community resources that help a person sustain recovery. A recent systematic review of recovery housing also found comparative evidence of benefits in abstinence, income, employment and cost-effectiveness, while calling for stronger research.
Follow-up will never be perfect. People lose contact, some return to illicit substance use and sometimes another intervention is not possible until that person seeks recovery again. Providers and funders cannot control every part of another person's recovery, but they can take responsibility for the quality of their work and learn what happened after the person left.
At Awakening Recovery, we have work to do here too. We are continuing to evolve how we understand what happens after residents leave our homes. Are they sober, housed, connected and working? Are they continuing to build their recovery foundation? We need honest answers, including the difficult ones.
Taking all of the above into account, I believe we can hold providers accountable and still understand that meaningful change takes time. The measures we choose will influence what gets funded, so following people beyond a clinical treatment episode can help us make better decisions about long-term recovery housing, coordinated care and continuing support. Defining success in a way that reflects how recovery actually unfolds over time would give the behavioral health quality pledge real weight for people and families trying to build and sustain new lives in recovery.
