Consistency Between Beliefs and Behavior Regarding Use of Substances in Recovery

Abstract

This paper addresses the assumption that pathways to recovery from substance abuse and dependence, and the language used to define one’s relationship to substances, translate to actual beliefs and behaviors in terms of substance use. We draw on social representation theory, and use data from a large web-based study (n=9,341) whose goal was to understand how individuals in recovery define what recovery means to them. We often hear people say that they are “in recovery,” and present findings now provide empirical evidence of the prevalent meanings of this ubiquitous expression. The belief that recovery is abstinence was broadly held in our sample, especially among those exposed to treatment and 12-step self-help groups and who define themselves as in recovery—and most (but not all) of such individuals are complete abstainers (no alcohol or drugs). In contrast, among the “self-changers” who did not attend treatment or self-help groups, the most common self-definition was used to have an alcohol or drug problem but don’t any more, half of whom believe that recovery is abstinence while half do not, and only one-third are abstainers. Findings are of public health relevance, as it is estimated that among American adults alone, 10% report having had alcohol or drug problems but no longer do (The New York State Office of Alcoholism and Substance Abuse Services (OASAS), 2012). In line with the central concepts of social representation theory, people’s pathways to recovery have a strong effect on how they define themselves and their behaviors and beliefs, but it is not universal.

Concept analysis of recovery from substance use

“…The proposed definition can be open to interpretation, reflective of the idea that recovery approaches must be individualized to accommodate context, culture, personal beliefs, and severity of substance use. Those with more severe substance use may require abstinence or sobriety, while that may not be realistic or necessary for others (Kaskutas & Ritter 2015;White 2007;Witkiewitz et al 2020). The differences in individuals and the subsequent need for individualization is also reflected in Gonzales et al (2012) who show how youth do not subscribe to substance dependence chronicity models and perceive recovery as a lifestyle change that often does not include abstinence.…”

“…Alcoholics Anonymous, founded in the 1930s on the back of the temperance movement, has long been a proponent of abstinence and 12-step recovery programmes (Witkiewitz et al 2020). Kaskutas and Ritter (2015) showed that exposure to 12-step recovery programmes made participants more likely to identify abstinence as recovery or belonging in recovery definitions. Witbrodt et al (2015) showed that people who are believe in the 12-step recovery programmes are more likely to align themselves with a definition of recovery as abstinence and spirituality, while people who did not follow a 12-step programme were more likely to not endorse abstinence or spiritual elements of recovery.…”

“…Abstinence, a term often associated with recovery, falls under this category, although there is disagreement on whether abstinence from substances is necessary for recovery. Ultimately, the agreement on abstinence not being a requirement for recovery (Ashford et et al 2020), as well as studies that show inclusion of abstinence in definitions may be related to exposure to abstinence messaging (Kaskutas & Ritter 2015;Okrant 2019;Witbrodt et al 2015), led to the conclusion that abstinence is not necessary for the definition of recovery from substance use but may be included in some individuals' definition of recovery. Ashford et al (2019), Kaskutas et al (2014), and White (2007) further discuss how there is a separation in recovery understanding and definitions between those with severe substance use disorders, defined by those that meet the DSM criteria for substance dependence and those with less disruptive forms, where severe cases may require abstinence and intervention (White 2007).…”

Life History Theory and Recovery From Substance Use Disorder

“…People appear to recover from SUDs via multiple pathways that may include detoxification, residential intensive treatment, residential supported recovery community reintegration facilities, outpatient services, and mutual-aid groups (Covington, 2002; Green, 2006; Kelly et al, 2017; Sun, 2008). Pathways to recovery may be abstinence-based or moderation-based and may be medication-assisted (Kaskutas & Ritter, 2015; White, 2012). People experience recovery progress inside and outside of treatment contexts.…”

Combining medically assisted treatment and Twelve-Step programming: a perspective and review

“…In effect, most studies on Twelve-Step programs have been carried out in the context of follow-up on treatment programs, where AA or NA were only one part of a panoply of interventions applied (22,23). One approach to circumventing this limitation has been the solicitation of retrospective observations from persons who have reported prior recovery experiences (24). This approach, however, does not necessarily address persons who have been relieved of substance problems with some Twelve-Step attendance but do not self-identify as "in recovery.…”