What does recovery mean to you? Definition, goals, and experiences from the recovering community

1. What does recovery mean to you? Definition, goals, and experiences from the recovering community Alexandre B. Laudet Center for the Study of Addiction and RecoveryNational Development and Research Institutes, Inc. William L. White Chestnut Health Systems/Lighthouse Institute Keith Morgen Center for the Study of Addiction and RecoveryNational Development and Research Institutes, Inc. Funded by NIDA Grant R01 DA14409 & by the Peter McManus Charitable Trust Correspondence: laudet@ndri.org

2. BACKGROUND • The voice of the addiction recovery community is growing rapidly • Recovery is emerging as a central organizing paradigm for addiction researchers, providers of addiction treatment and recovery support services, and for grassroots recovery advocates • However, the construct of recovery remains largely unexplored and ill-defined. • A critical step to identifying factors that promotes and threatens recovery, to understanding the process and to identifying outcome domains that are relevant to the population under study is to elucidate how the recovery is defined and lived in the recovery community.

3. STUDY OBJECTIVES This study draws on the experience of persons self-identified as “in recovery” from severe poly- substance use from one month to 10+ years and combines quantitative and qualitative methods: • To examine recovery definition, goals, strategies, challenges and supports; and • To explore differences in these concepts as a function of gender, race, prior exposure to formal treatment and to 12-step fellowships, addiction severity, age and length of time in recovery.

4. THE PATHWAYS PROJECT • A five year NIH-funded investigation of factors associated with stable recovery over time ongoing in New York City • Naturalistic prospective design • Eligibility criteria: (1) self-reported abstinence of one month or longer; and (2) not currently in residential treatment. • Voluntary participation based on informed consent • Semi-structured interviews lasting approximatively 2 hours • 311 persons in recovery from one month to 10+ years

5. STUDY METHODS and ANALYSES • Open-ended answers coded independently by 2 researchers; inter-rater reliability = .92 • Descriptives of findings for the entire sample • Subgroup analyses: means comparisons for continuous variables (age, severity and length of recovery), chi-squares for categorical variables (gender, race, prior exposure to formal treatment and to 12-step)

6. PATHWAYS STUDY SAMPLE:SUMMARY • Primarily members of inner-city ethnic, underserved minorities • Long & severe history of (primarily) crack and/or heroin use • Almost all are polysubstance users • Self-identified as ‘in recovery’ from one month to 10+ years • 31% HepC+ and 24% HIV+ • Almost all have used formal addiction treatment services and 12-step fellowships

7. SUBSTANCE USE: LENGTH, SEVERITY & CURRENT STATUS GENERALLY LONG & SEVERE HISTORY OF POLYSUBSTANCE USE Years regular use of alcoholMean = 17.4 St. Dev = 10.6 Years regular use of drugs Mean = 18.7 St. Dev = 12.0 Dependence Severity a Mean = 11.6 St. Dev =2.4 Time since last used (median) …. Alcohol (median) 35 months (range = .1 to 301) Illicit drugs (median) 38 months (range = 1 to 292) aSheehan DV & Lecrubier Y (2002) Mini International Neuropsychiatric Interview. University of South Florida – Tampa. Possible Score range: 0 to 14. Primary substance only

8. RECOVERY DEFINITION: Forced choice item

9. HOW TO RESOLVE ADDICTION? Forced choice

10. RECOVERY DEFINITION – Open-endedbHow would you define "recovery from drug and alcohol use"? RECOVERY GOES BEYOND SUBSTANCE USE bAdd to < 100% because up to 3 answers were coded

11. POSITIVE ASPECTS OF RECOVERY Open-endedbRECOVERY IS A BETTER LIFE bAdd to < 100% because up to 3 answers were coded

12. GREATEST CHALLENGE IN RECOVERY - Open-endedFor many, SUSTAINING RECOVERY is challenging

13. HOW DEAL W/ GREATEST RECOVERY CHALLENGE? –Open-endedb,cSEEKING SUPPORT #1 STRATEGY TO DEAL WITH RECOVERY CHALLENGES bAdd to < 100% because up to 3 answers were coded cAmong those experiencing a challenge: N = 201

14. SOURCES OF SUPPORT IN RECOVERY - Open-endedb FAMILY AND FAITH GREATEST SOURCES OF RECOVERY SUPPORT bAdd to < 100% because up to 3 answers were coded

15. HIGHLIGHTS OF SUBGROUP DIFFERENCES RECOVERY GOALS • Compared to other races, Caucasians less likely to endorse total abstinence from D&A as recovery goal • Age and gender: no significant differences in recovery goals • Prior exposure to formal treatment and to 12-step fellowships associated with higher likelihood to endorse total abstinence as recovery goal • Individuals in early recovery less likely to endorse total abstinence as recovery goal • Higher lifetime addiction severity associated with higher likelihood to endorse total abstinence as recovery goal • In open-ended, individuals with longer recovery more likely to define recovery in terms of a new life than in terms of substance use RECOVERY CHALLENGES • No significant difference in likelihood of reporting ‘no recovery challenge’ in term of addiction severity or length of recovery • Greater addiction severity associated with greater likelihood to report “fear of using” as a challenge • Longer time in recovery associated with greater likelihood to report “making up for lost time” as a challenge

16. HIGHLIGHTS OF SUBGROUP DIFFERENCES (2) STRATEGIES TO DEAL WITH CHALLENGES • Longer recovery associated with greater likelihood to cite ‘stay focused’ as a coping strategy to recovery challenges SOURCES OF SUPPORT • Individuals without prior formal treatment history more likely to report relying on self (e.g., motivation) and less likely to cite recovering peers as source of support

17. SUMMARY OF FINDINGS • Recovery goes beyond substance use; it is the path to a new life, improved living conditions and positive experiences (research and clinicians currently mostly focus on abstinence as key outcome) • Recovery is a process toward self-improvement • While some participants report no challenge, many do, especially sustaining recovery (not using) • Seeking support is the most frequently cited strategy to deal with recovery challenges • Family and Spirituality/faith are cited as greatest sources of support

18. IMPLICATIONS FOR ENHANCING RECOVERY OPPORTUNITIES • Need to involve the recovery community in the research endeavor and to tap its experiences to gain a greater understanding of the phenomenology of the recovery experience – goals, ideals, challenges and useful resources • Need to broaden the scope of investigation beyond substance use to global functioning (quality of life, well-being, psychosocial) • Need to identify core elements of the recovery experience (‘universals’) as well as culture-specific aspects (e.g., recovery goals may differ in countries where harm minimization is embraced) • Address such issues as: • What sources of support can be made available to individual who have neither family nor faith available?