What’s the Difference Between Treatment and Recovery?

By Dirk Hanson 06/16/11

If someone is taking methadone for their heroin addiction, or smoking cigarettes after quitting alcohol, are they still “in recovery?”

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Getting off the hook.
Photo via thinkstockphotos

Treatment people and recovery people don’t look at addicts the same way. As Alison Knopf writes in Alcoholism and Drug Abuse Weekly, “The treatment field has been taken to task by many in the recovery field for not having focused on recovery, but instead just focusing on the episode of treatment itself.” Meaning that once the short-term effects of drug and alcohol abuse have been dealt with in a 30-day stay at a rehab center, treatment, as such, is effectively over. If you finish treatment abstinent, you have “graduated.” Help with what follows—the long-term recovery process, otherwise known as the rest of your life—then largely consists of a parting exhortation to attend local AA meetings: Goodbye and good luck.  As A. Thomas McLellan of the Center for Substance Abuse Solutions at the University of Pennsylvania deftly notes, the most honest response is that treatment providers aren’t being paid to offer recovery services. “They were told they’d be paid for 30 days. You want recovery with that too?”

As for addicts themselves, Alexandre B. Laudet, an addiction and recovery expert, told Alcoholism and Drug Abuse Weekly, “A person in recovery doesn’t care how it’s defined.” And that is certainly true, up to a point. But McLellan argues that the vagueness surrounding the concept of recovery can be a problem. “If you are going to buy recovery services, you have to know what you are buying.”

Specifically, are you buying abstinence? In 2005, the Substance Abuse and Mental Health Services Administration (SAMHSA) defined recovery from alcohol and drug problems as “a process of change through which an individual achieves abstinence…” The Betty Ford Center, with help from McLellan, developed its own definition of recovery as “a voluntarily maintained lifestyle comprised of sobriety, personal health and citizenship.”

So, yes, officially, you have to be abstinent to be “in recovery.” Abstinence, Laudet told the magazine, was not as deeply entrenched in European recovery programs. U.S. policy makers favor abstinence as a yardstick because “it’s easy, it’s black and white, they’re using or they’re not using.” While admitting the need for measurable standards, Laudet said: “Who am I to say you kicked heroin but you are still smoking cigarettes?”

Susan Weiss, acting director of the Office of Science and Policy Communications at the National Institute on Drug Abuse (NIDA), said Alcoholism and Drug Abuse Weekly was “right in observing that ‘recovery’ lacks a standard definition by the drug abuse field. Even the question of whether total abstinence is necessary or if reduced drug use is sufficient has been difficult to achieve consensus on… There is also no firm ‘time’ beyond which a person is considered to have recovered, partly because we do not have an actual biomarker—or objective measurement indicating restored brain function or pharmacologic treatment response—showing that the person has recovered and is no longer vulnerable to relapse.”

Fair enough. Until we develop better tests of how abstinence and relapse alter brain function in addicts, we won’t know enough to go all black and white on the issue. Here’s a common test case: If someone is taking methadone or buprenorphine for their heroin addiction, are they “in recovery?” Yes, said Dr. Weiss, they would be “considered in recovery by NIDA as long as they are not abusing drugs and are functioning in their communities and their lives.”

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Dirk Hanson, MA, is a freelance science writer and the author of The Chemical Carousel: What Science Tells Us About Beating Addiction. He is also the author of The New Alchemists: Silicon Valley and the Microelectronics Revolution. He has worked as a business and science reporter for numerous magazines and trade publications including Wired, Scientific American, The Dana Foundation and more. He currently edits the Addiction Inbox blog. Email: [email protected]