Recovery

Recovery from mental disorders and/or substance use disorders is a process of change through which individuals improve their health and wellness live a self-directed life, and strive to reach their full potential.

Four dimensions of supporting recovery

To achieve lasting recovery, people recovering from mental and substance abuse disorders need to have support in these four areas of their lives:

Health—Overcoming or managing one’s disease(s) or symptoms and making informed, healthy choices that support physical and emotional wellbeing

Home—A stable and safe place to live

Purpose—Meaningful daily activities, such as a job, school, volunteerism, family caretaking, or creative endeavors, and the independence, income and resources to participate in society

Community—Relationships and social networks that provide support, friendship, love, and hope

Guiding Principles of Recovery

Recovery emerges from hope:The belief that recovery is real provides the essential and motivating message of a better future—that people can and do overcome the internal and external challenges, barriers, and obstacles that confront them. Hope is internalized and can be fostered by peers, families, providers, allies, and others. Hope is the catalyst of the recovery process.

Recovery is person-driven: Self-determination and self-direction are the foundations for recovery as individuals define their own life goals and design their unique path(s) towards those goals. Individuals optimize their autonomy and independence to the greatest extent possible by leading, controlling, and exercising choice over the services and supports that assist their recovery and resilience. In so doing, they are empowered and provided the resources to make informed decisions, initiate recovery, build on their strengths, and gain or regain control over their lives.

Recovery occurs via many pathways: Individuals are unique with distinct needs, strengths, preferences, goals, culture, and backgrounds— including trauma experience — that affect and determine their pathway(s) to recovery. Recovery is built on the multiple capacities, strengths, talents, coping abilities, resources, and inherent value of each individual. Recovery pathways are highly personalized.

They may include professional clinical treatment; use of medications; support from families and in schools; faith-based approaches; peer support; and other approaches. Recovery is non-linear, characterized by continual growth and improved functioning that may involve setbacks. Because setbacks are a natural, though not inevitable, part of the recovery process, it is essential to foster resilience for all individuals and families. Abstinence from the use of alcohol, illicit drugs, and non-prescribed medications is the goal for those with addictions. Use of tobacco and non-prescribed or illicit drugs is not safe for anyone. In some cases, recovery pathways can be enabled by creating a supportive environment. This is especially true for children, who may not have the legal or developmental capacity to set their own course.

Recovery is holistic: Recovery encompasses an individual’s whole life, including mind, body, spirit, and community. This includes addressing: self-care practices, family, housing, employment, transportation, education, clinical treatment for mental disorders and substance use disorders, services and supports, primary healthcare, dental care, complementary and alternative services, faith, spirituality, creativity, social networks, and community participation. The array of services and supports available should be integrated and coordinated.

Recovery is supported by peers and allies: Mutual support and mutual aid groups, including the sharing of experiential knowledge and skills, as well as social learning, play an invaluable role in recovery. Peers encourage and engage other peers and provide each other with a vital sense of belonging, supportive relationships, valued roles, and community. Through helping others and giving back to the community, one helps one’s self. Peer-operated supports and services provide important resources to assist people along their journeys of recovery and wellness. Professionals can also play an important role in the recovery process by providing clinical treatment and other services that support individuals in their chosen recovery paths. While peers and allies play an important role for many in recovery, their role for children and youth may be slightly different. Peer supports for families are very important for children with behavioral health problems and can also play a supportive role for youth in recovery.

Recovery is supported through relationships and social networks: An important factor in the recovery process is the presence and involvement of people who believe in the person’s ability to recover; who offer hope, support, and encouragement; and who also suggest strategies and resources for change. Family members, peers, providers, faith groups, community members, and other allies form vital support networks. Through these relationships, people leave unhealthy and/or unfulfilling life roles behind and engage in new roles (e.g., partner, caregiver, friend, student, employee) that lead to a greater sense of belonging, personhood, empowerment, autonomy, social inclusion, and community participation.

Recovery is culturally-based and influenced: Culture and cultural background in all of its diverse representations—including values, traditions, and beliefs—are keys in determining a person’s journey and unique pathway to recovery. Services should be culturally grounded, attuned, sensitive, congruent, and competent, as well as personalized to meet each individual’s unique needs.

Recovery is supported addressing trauma: The experience of trauma (such as physical or sexual abuse, domestic violence, war, disaster, and others) is often a precursor to or associated with alcohol and drug use, mental health problems, and related issues. Services and supports should be trauma-informed to foster safety (physical and emotional) and trust, as well as promote choice, empowerment, and collaboration.

Recovery involves individual, family, community strengths and responsibility: Individuals, families, and communities have strengths and resources that serve as a foundation for recovery. In addition, individuals have a personal responsibility for their own self-care and journeys of recovery. Individuals should be supported in speaking for themselves. Families and significant others have responsibilities to support their loved ones, especially for children and youth in recovery. Communities have responsibilities to provide opportunities and resources to address discrimination and to foster social inclusion and recovery. Individuals in recovery also have a social responsibility and should have the ability to join with peers to speak collectively about their strengths, needs, wants, desires, and aspirations.

Recovery is based on respect: Community, systems, and societal acceptance and appreciation for people affected by mental health and substance use problems—including protecting their rights and eliminating discrimination—are crucial in achieving recovery. There is a need to acknowledge that taking steps towards recovery may require great courage. Self-acceptance, developing a positive and meaningful sense of identity, and regaining belief in one’s self are particularly important.

Sources: In December 2011, the Substance Abuse and Mental Health Services Administration (SAMHSA) released a working definition of recovery and a set of guiding principles, representing the culmination of a lengthy process that began with an August 2010 Dialogue Meeting and ended with a formal public engagement process in August 2011. Based on additional stakeholder input and dialogue with consumers, persons in recovery, family members, advocates, policy-makers, administrators, providers, and others, SAMHSA issued a slightly revised working definition and principles in March 2012.

SAMHSA recognizes there are many different pathways to recovery and each individual determines his or her own way. The revised definition and principles give more emphasis to the role of abstinence in recovery from addictions, and indicate that an individual may be in recovery from a mental disorder, a substance use disorder, or both. The definition and principles are intended to help with the design, measurement, and reimbursement of services and supports to meet the individualized needs of those with mental disorders and substance use disorders.

SAMHSA's Working Definition of Recovery (PEP12-RECDEF)
This brochure introduces a working definition for recovery from mental disorders and substance use, along with 10 guiding principles intended to help advance recovery opportunities and help clarify these concepts for peers, families, funders, providers, and others.

Self-help/recovery recources:

Recovering Your Mental Health: A Self-Help Guide (SMA-3504)
This booklet offers tips for understanding symptoms of depression and other conditions and getting help. Also details the advantages of counseling, medications available, options for professional help, relaxation techniques, and paths to "positive thinking.” 2001. 32 pp.

Recovering Your Mental Health: Building Self-Esteem - A Self-Help Guide (SMA-3715)
This booklet gives practical tips on ways to improve self esteem that includes activities that help people feel good about themselves and a list of other resources.

Recovering Your Mental Health: Making and Keeping Friends - A Self - Help Guide (SMA-3716)
This booklet provides suggestions for making and keeping friends and a list of other resources.

Recovering Your Mental Health: Dealing With the Effects of Trauma - A Self-Help Guide (SMA-3717)
This booklet focuses on helping individuals cope with traumatic events and makes suggestions of how they can take charge of their own recovery. It also provides a list of additional resources.

Recovering Your Mental Health: Developing A Recovery and Wellness Lifestyle - A Self-Help Guide (SMA-3718)
This booklet gives helpful tips on how individuals can think about areas of their lives that may need to be changed and possible changes they could make. Additional resources are also included.

Recovering Your Mental Health: Speaking Out for Yourself - A Self-Help Guide (SMA-3719)
This booklet addresses ways in which individuals can become self-advocates by taking control of the decisions that affect their lives. It provides simple assertiveness tips and other resources.

Recovering Your Mental Health: Action Planning for Prevention and Recovery - A Self-Help Guide (SMA-3720)
This booklet discusses strategies to help individuals learn how to consistently do those things that help in their recovery. These strategies were developed by people who experience emotional or psychiatric symptoms. Additional resources are also provided.

Recovery-oriented system of care (ROSC)

The behavioral health treatment field is moving toward a recovery-oriented approach that involves linkages to other systems along with a full array of treatment and recovery services that encourages people and families to initiate and remain in treatment and sustain their recovery. Beyond the provision of traditional clinical/medical services, this approach includes networking with other systems, peer recovery support organizations, and other organizations that can provide needed services to those seeking recovery from substance use disorders.

Recovery management refers to person-centered and self-directed approaches for substance abuse (including alcohol and drug) treatment and recovery services. Recovery-oriented systems of care (ROSCs) support this approach to care, building on the personal responsibility, strengths, and resilience of individuals, families, and communities to achieve sustained health, wellness, and recovery from alcohol and drug problems. ROSCs offer a comprehensive menu of services and supports that can be combined and readily adjusted to meet the individual's needs and chosen pathway to recovery. ROSCs encompass and coordinate the operations of multiple systems, providing responsive, outcomes-driven approaches to care, and require an ongoing process of systems improvement that incorporates the experiences of those in recovery and their family members.

A ROSC is a coordinated network of community-based services and supports that is person-centered and builds on the strengths and resilience of individuals, families and communities to achieve abstinence and improved health,wellness and quality of life for those with or at risk for alcohol and drug problems.

The establishment of ROSC is a relatively new concept in the substance use disorder field. The central focus is to create an infrastructure or ‘system of care? with the resources to effectively address the full range of substance use problems within communities, from harmful use to chronic conditions. The specialty substance use disorder field provides the full continuum of care (prevention, early intervention, treatment, continuing care and recovery) in partnership with other disciplines, such as mental health and primary care, in a ROSC. A ROSC supports the premise that there are many pathways to recovery and encompasses a menu of individualized, person-centered, and strength-based services within a self-defined network. By design, a ROSC provides individuals and families with more options with which to make informed decisions regarding their care. Services are designed to be accessible, welcoming, and easy to navigate.

Through education, communities are strengthened by recovery-oriented activities that can prevent inappropriate substance use before it occurs. Education also raises awareness about the disease, dispels myths that foster stigma and discrimination, and provides early intervention for those at risk of developing substance use conditions.

Recovery-oriented systems of care and services are characterized by the following principles:

Person-centered: Recovery-oriented systems of care will be person-centered. Individuals will have a menu of stage-appropriate choices that fit their needs throughout the recovery process. Choices can include spiritual supports that fit with the individual’s recovery needs.

Family and other ally involvement: Recovery-oriented systems of care will acknowledge the important role that families and other allies can play. Family and other allies will be incorporated, when appropriate, in the recovery planning and support process. They can constitute a source of support to assist individuals in entering and maintaining recovery. Additionally, systems need to address the treatment, recovery and other support needs of families and other allies.

Individualized and comprehensive services across the lifespan: Recovery-oriented systems of care will be individualized, comprehensive, stage-appropriate, and flexible. Systems will adapt to the needs of individuals, rather than requiring individuals to adapt to them. They will be designed to support recovery across the lifespan. The approach to substance use disorders will change from an acute-based model to one that manages chronic disorders over a lifetime.

Systems anchored in the community: Recovery-oriented systems of care will be nested in the community for the purpose of enhancing the availability and support capacities of families, intimate social networks, community-based institutions and other people in recovery.

Continuity of care: Recovery-oriented systems of care will offer a continuum of care, including pretreatment, treatment, continuing care and support throughout recovery. Individuals will have a full range of stage-appropriate services from which to choose at any point in the recovery process.

Partnership-consultant relationships: Recovery-oriented systems of care will be patterned after a partnership-consultant model that focuses more on collaboration and less on hierarchy. Systems will be designed so that individuals feel empowered to direct their own recovery.

Strength-based: Recovery-oriented systems of care will emphasize individual strengths, assets and resiliencies.

Culturally responsive: Recovery-oriented systems of care will be culturally sensitive, competent and responsive. There will be recognition that beliefs and customs are diverse and can impact the outcomes of recovery efforts. In addition, the cultures of those who support the recovering individual affect the recovery process.

Responsiveness to personal belief systems: Recovery-oriented systems of care will respect the spiritual, religious and/or secular beliefs of those they serve and provide linkages to an array of recovery options that are consistent with these beliefs.

Commitment to peer recovery support servuces: Recovery-oriented systems of care will include peer recovery support services. Individuals with personal experience of recovery will provide these valuable services.

Inclusion of the voices and experiences of recovering individuals and their families: The voices and experiences of people in recovery and their family members will contribute to the design and implementation of recovery-oriented systems of care. People in recovery and their family members will be included among decision-makers and have oversight responsibilities for service provision. Recovering individuals and family members will be prominently and authentically represented on advisory councils, boards, task forces and committees at the Federal, State and local levels.

Integrated services: Recovery-oriented systems of care will coordinate and/or integrate efforts across service systems to achieve an integrated process that responds effectively to the individual’s unique constellation of strengths, desires and needs.

System-wide education and training: Recovery-oriented systems of care will ensure that concepts of recovery and wellness are foundational elements of curricula, certification, licensure, accreditation and testing mechanisms. The workforce also requires continual training, at every level, to reinforce the tenets of recovery-oriented systems of care.

Ongoing monitoring and outreach: Recovery-oriented systems of care will provide ongoing monitoring and feedback with assertive outreach efforts to promote continual participation, re-motivation and re-engagement.

Outcomes-driven: Recovery-oriented systems of care will be guided by recovery-based process and outcome measures. These measures will be developed in collaboration with individuals in recovery. Outcome measures will reflect the long-term global effects of the recovery process on the individual, family and community, not just remission of biomedical symptoms. Outcomes will be measurable and include benchmarks of quality-of-life changes.

Research-based: Recovery-oriented systems of care will be informed by research. Additional research on individuals in recovery, recovery venues and the processes of recovery, including cultural and spiritual aspects, is essential. Research will be supplemented by the experiences of people in recovery.

Adequately and flexibly financed: Recovery-oriented systems of care will be adequately financed to permit access to a full continuum of services, ranging from detoxification and treatment to continuing care and recovery support. In addition, funding will be sufficiently flexible to permit unbundling of services, enabling the establishment of a customized array of services that can evolve over time in support of an individual’s recovery.

Sources:

Sheedy C. K., and Whitter M., Guiding Principles and Elements of Recovery-Oriented Systems of Care: What Do We Know From the Research? HHS Publication No. (SMA) 09-4439. Rockville, MD: Center for Substance Abuse Treatment, Substance Abuse and Mental Health Services Administration, 2009.

Recovery-Oriented Systems of Care (ROSC) Resource Guide. U.S. Department of Health and Human Services, Substance Abuse and Mental Health Services Administration and Partners for Recovery (September 2010).

Recovery Management (RM) is a philosophical framework for organizing addiction treatment services to provide pre-recovery identification and engagement, recovery initiation and stabilization, long-term recovery maintenance, and quality-of-life enhancement for individuals and families affected by severe substance use disorders.

The Recovery Management (RM) model of addiction treatment shifts the focus of care from professional-centered episodes of acute symptom stabilization toward the client-directed management of long-term recovery. It wraps traditional interventions within a more sustained continuum of:

Pre-recovery support services to enhance recovery reading
In-treatment recovery support services to enhance the strength and stability of recovery initiation, and
Post-treatment recovery support services to enhance the durability and quality of recovery maintenance.

Within the framework of a Recovery-Oriented System of Care (ROSC), recovery management provides treatment and recovery supports to individuals with severe substance use disorders. This targeted approach to a specific population differs from the overarching role of a ROSC. As has been described, a ROSC serves those with or at risk for substance use problems. The persons served within a ROSC encompass the general population, at-risk populations, harmful users of alcohol and drugs, those with dependence, and those with chronic dependence.

Recovery management is often described as typifying the shift from an acute care model, which treats medical conditions in an intensive short-term manner, to a chronic care approach reflecting a service commitment to long-term supports and wellness.

Recovery management engages individuals with chronic substance use conditions and assists the person in managing efforts to achieve long-term recovery. Individuals and their families are empowered to seek supports specific to meet the needs of the person. There is no formula or set of rote practices that serve everyone. Different persons require different resources. It is the role of recovery management to coordinate access to resources and foster engagement.

General principles of a recovery management approach include the following:

Recovery focus: Emphasis on recovery processes over disease processes by focusing on an individual’s strengths and abilities and instilling hope.

Empowerment and self-direction: Assumption of responsibility by each client for the management of his or her long-term recovery process.

Destigmatization of experiences and services: Fighting of stigma at the community and personal levels through respect for the individual’s experience with mental and/or substance use disorders and the promotion of recovery.

Utilization of evidence based practices and new technologies: Application of treatment and support interventions at all stages of the recovery process that have proven through research to be the most effective tools; adoption or adaptation of new advances in technology in addressing behavioral health issues.

Service integration: Addiction, mental and physical health problems are often all present, and each may impact the other. Services should address all needs and be delivered in a seamless, holistic and integrated manner.

Recovery partnership: Progressive shift in the role of the professional from treatment “expert” to “recovery consultant” and the development of a recovery management partnership with the client.

Development and utilization of family and community support: Enhancement of the availability of and capacity for family and community (i.e. social networks, faith based institutions, cultural organizations, employees) supports to individuals recovering from behavioral health disorders and extension of the locus of service delivery to the natural environment of the client.

Ongoing support and monitoring: Emphasis on continuing care and life-long support of recovery; on-going monitoring, feedback and encouragement; linkage to indigenous supports; and early re-engagement and re-intervention when necessary.

Continual evaluation: Assessment and evaluation are ongoing activities as opposed to marking the beginning and conclusion of a service or treatment episode. Emphasis on client involvement in the design and evaluation of their own services and systems of supports to ensure they are matched to their individual needs as they evolve through the stages of recovery.

Sources:

White, Willliam L. Recovery Management and Recovery-oriented Systems of Care: Scientific Rationale and Promising Practices. Jointly published by the Northeast Addiction Technology Transfer Center, the Great Lakes Addiction Technology Transfer Center, and the Philadelphia Department of Behavioral Health/Mental Retardation Services, 2008.

Additional information on Recovery Management can be accessed via the following websites:

http://www.nattc.org/learn/topics/rosc/recoverymanagement.asp

http://www.attcnetwork.org/learn/topics/rosc/resources.asp#rm

Additional resources:

http://partnersforrecovery.samhsa.gov/rosc.html
Fostering and developing Recovery-Oriented Systems of Care is a priority of SAMHSA/CSAT. In support of this priority, regional meetings were held across the country to assist States and communities in developing, strengthening, and implementing Recovery-Oriented Systems of Care. Several resources, available via this website, were developed and disseminated through the regional process to advance recovery-oriented approaches and provide information on Recovery-Oriented Systems of Care.

http://www.williamwhitepapers.com/
The purpose of this site is to create a single location where such material may be located by those interested in the history of addiction treatment and recovery in the United States. Those papers selected for inclusion contain all of the articles and monographs authored by William White on the new recovery advocacy movement, recovery management and recovery-oriented systems of care.

http://www.facesandvoicesofrecovery.org/
Faces & voices of recovery is a national organization of individuals and organizations joining together to support local, state, regional and national recovery advocacy by increasing access to research, policy, organizing and technical support; facilitating relationships among local and regional groups; improving access to policymakers and the media; and providing a national rallying point for recovery advocates.

www.attcnetwork.org/greatlakes
Great Lakes Addiction Technology Transfer Center (GREAT LAKES ATTC) is part of the ATTC Network, serving Illinois, Indiana, Michigan, and Ohio. The Network is funded by the Substance Abuse and Mental Health Services Administration’s Center for Substance Abuse Treatment, with special funding from the National Institute on Drug Abuse. As a nationwide, multidisciplinary resource for professionals in the addictions treatment and recovery services field, the ATTC Network serves to:

Raise awareness of evidence-based and promising treatment and recovery practices
Build skills to prepare the workforce to deliver state-of-the-art addictions treatment and recovery services
Change practice by incorporating these new skills into everyday use for the purpose of improving addictions treatment and recovery outcomes

Recovery information and publications found on the Great Lakes ATTC website can be found here.