Recovery Framework

Smoke and Mirrors: Helping Families Through the Maze of Substance Abuse


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Research shows that approximately 58% of all substance users will achieve lasting recovery (Sheedy and Whitter 2009). Recovering from addiction is a slow and difficult process characterised by periods of relapse. Understanding the process and key predictors of recovery can help us to develop the skills and knowledge to facilitate the recovery process amongst parents who use substances.

What is recovery?

In the 1980’s two physicians, McLellan and O’Brien (1986), defined addiction as a chronic, relapsing condition that was similar in duration and management to other conditions such as diabetes or asthma. They argued that short-term detox solutions often failed addicts and sustained the physical and social problems caused by addiction. Recovery is now seen as an ongoing process rather than an accomplished state that is characterised by connectedness, hope, identity, meaning (and purpose) and empowerment (Leamy, Bird, Boutillier, Williams and Slade 2011).

The Substance Abuse and Mental Health Administration (SAMHSA) of Australia define the recovery from drug and alcohol problems as “a process of change through which an individual achieves abstinence and improved health and well-being”. Expanding on this definition, SAMHSA articulates twelve “Guiding Principles of Recovery” (presented in Table 1) that emphasise that recovery is multi-dimensional, ongoing and that with the support of the community is possible.

1. There are many pathways to recovery

2. Recovery is self-directed and empowering

3.  Recovery involves a personal recognition of the need for change and transformation

4. Recovery is holistic

5. Recovery has cultural dimensions

6. Recovery exists on a continuum of improved health and wellness

7. Recovery is supported by peers and allies

8. Recovery emerges from hope and gratitude

9. Recovery involves a process of healing and self-redefinition

10. Recovery involves addressing discrimination and transcending shame and stigma

11. Recovery involves (re)joining and (re) building a life in the community

12. Recovery is a reality. It can, will and does happen.

Table 1: Principles of Recovery (SAMHSA)


What does recovery involve?

The typical time it takes to move from substance misuse to stable recovery is 27 years (Best and Lubman 2012). Recovery is therefore a long- term process that requires a range of options at different times. There is no one single strategy that will work for all substance users. It is important to continually engage with people with addiction problems until they are ready to make lasting change. For recovery to commence individuals need:

  • a safe and threat free place to live
  • freedom from acute physical and psychological distress including the absence of intense cravings
  • access to clear and accurate information about educational and vocational courses and community and professional supports
  • freedom to make choices and decisions about their welfare

Once the recovery process has begun, it is important to:

  • manage immediate physical and mental health issues including access to medications (such as buprenorphine, methadone and anticraving drugs)
  • manage immediate life stressors (such as helping them with housing stress, relationship stressors and parenting stressors)
  • connect people recovering with counseling services to help them address underlying feelings of self worth and past experiences
  • instill hope that change and recovery are possible
  • connect people recovering with individuals or groups who successfully model recovery
  • connect people recovering with family members and peers who can support them.

After the start of the recovery process individuals will need ongoing support and aspirational goals to make long- term sustainable changes to their life.


What is recovery capital?

Recovery involves individual changes in beliefs about the attractiveness of reduced use or abstinence and improved coping skills and practical abilities. Recovery from substance misuse does not happen in isolation. It relies on the connection between an individual and the community in which they live. Communities have a responsibility to be supportive of an individual’s efforts to change, and provide opportunities for them to be involved in community functions and networks. Recovery is thus an issue of social connectedness.

The more time people spend with other people in recovery and the more time they spend engaging in meaningful activities, the better their recovery outcomes are likely to be. The degree to which individuals are able to engage in meaningful activities and move towards recovery is related to a range of internal and external personal, social and community factors which can either support or impede their attempts to change. These factors are collectively known as recovery capital.

Recovery capital consists of three primary components: personal recovery capital; social recovery capital and; collective recovery capital. These components are all interlinked. The key dimension of each aspect of recovery capital is outlined below in Table 2 below.

Personal recovery capital

Positive emotions

Capacity for emotion regulation

Spirituality

Self-efficacy and confidence

Coping skills

Personal belief

Social recovery capital

Positive social support networks

Connectedness with community

Collective recovery capital

Availability and access to resources within the local community

Table 2:Types of recovery capital

Recovery capital helps individuals develop a sense of efficacy; physical health and wellbeing; provides positive social networks; creates access to role models and social learning, and instills a sense of hope and positive vision for the future.


How is recovery a social justice issue?

Research shows that substance users in remission are only slightly less stigmatised than active substance users. Stigma directed towards substance users can create a gap and perceived inequality between substance users and community members. Stigmatising attitudes and behaviours can prevent substance users from accessing the social or collective recovery capital required for their recovery. In this sense recovery is a social justice issue. Breaking down the negative stereotypes and judgments about the worth and value of people trying to recover is crucial to the provision of health and social supports and for them to develop the sense of purpose and value they need to start and sustain their journey of change


What does our knowledge of recovery mean for practice?

At the organisational and systems level, statutory child protection agencies need to develop practices that values work with families affected by

substance misuse and provides space and opportunity to build connections with families. Specifically, practice should encourage engagement with families which:

  • includes opportunities to actively listen to all stakeholders, including families, particularly in shared decision making processes
  • are outcome focused, problem-solving and always clear on the organisational expectations
  • involves real collaboration with a coalition of key and diverse partners that can assist at the family or systems level
  • involves real commitment to work with parents, children and families over the long term, if required, and supports the belief that change is possible
  • supports the inclusion and reintegration of substance users into family and social networks

At the individual/practitioner level, the way individual workers engage with substance using parents and their families plays an important role in

facilitating a therapeutic recovery environment.  When working with substance

users it is important to try and remember the following key practice principles:

  • be relationships focused – think beyond the individual and consider all of their other relationships
  • provide clear, appropriate and accurate information about options available to support the development of an appropriate therapeutic environment
  • be clear about expectations and the changes required of substance users
  • provide opportunities for individuals to participate in and make decisions about their own lives
  • support shared decision making and include family members when ever possible
  • demonstrate effective communication and listening skills
  • be prepared to engage with parents and families over the long term–change takes sustained support and time
  • offer hope for and belief in an individuals capacity to change
  • be non-judgmental and respectful of the complexity and length of the recovery process
  • take an active role in connecting people with appropriate recovery supports.

To learn more about the recovery paradigm please watch  Professor David  Best  and  Mary Ivec’s presentation at the Research to Practice seminar.


References

Best, D and Lubman, D. (2012) the recovery Paradigm: A modle of hope and change for alcohol and drug addiction. Australian Family Physician: 41 (8); 593-597.

Leamy, M., Bird, V., Boutillier, C.L., Williams, J. & Slade, M. (2011) ‘Conceptual framework for personal recovery in mental health: systematic review and narrative synthesis’. The British Journal of Psychiatry. 199: 445-452

O’Brien C., and McLellan, T. (1986) Myths about the treatment of addiction, The Lancet 1986; 347:237-240.

Sheedy,C and Whitter, M. (2009). Guiding principles and elements of recovery- oriented systems of care: What do we know from the research? HHS Publications No (SMA) 09-4439. Rockville, MD. Centre for Substance Abuse and Treatment, Substance Abuse and Mental health Services. 2009.