Idea Whose Time Has Come
American Academy of Health Care
Providers in the Addictive Disorders
Sandra Rasmussen PhD, RN, LMHC, CAS, CGAS
In August 2011, the
American Society of Addiction Medicine defined addiction as a primary, chronic
disease of brain reward, motivation, memory and related circuitry. Genetics,
together with bio-psycho-social-spiritual factors, account for the likelihood
an individual will develop addiction. What
a challenging time to be an addiction professional! It is the best of times as
we affirm the vision of the Substance Abuse and Mental Health Services Administration
(SAMHSA) that prevention works, treatment is effective, and people recover. It
is the worst of times because we acknowledge the individual, family, and social
costs of addiction when not prevented, left untreated, or poorly managed. Let me draw your attention to recovery: an
idea whose time has come.
What is recovery? Recovery is a journey not a
destination, so say millions of men and women. Most addiction professionals
consider recovery more of a process than an outcome. We agree! Recovery is a
process that begins with change, stopping an addictive behavior or reducing
addiction harm; proceeds by way of developing a different, better way of life:
a lifestyle; and advances through the
experience and expression of well-being:
a life with purpose and meaning. Relapse complicates the recovery process.
Ten years ago, influenced in part by the philosophy of
Alcoholics Anonymous, the New Freedom Commission on Mental Health established
by President George W. Bush proposed a shift from the traditional medical
psychiatric model of care toward the concept of recovery.
The report, Achieving the Promise:
Transforming Mental Health Care in America, boldly recommended recovery
from mental illness as the expected outcome from a transformed system of care.
Recovery refers to the process in which
people are able to live, work, learn, and participate fully in their
communities. For some individuals, recovery is the ability to live a fulfilling
and productive life despite a disability. For others, recovery implies the
reduction or complete remission of symptoms. Science has shown that having hope plays an integral role
in an individual's recovery. (2003, p. 7)
In December 2011, SAMHSA defined "recovery" from mental
disorders and substance use disorders as a process of change through which
individuals improve their health and wellness, live a self-directed life, and
strive to reach their full potential. SAMHSA identified four dimensions that
support a life in recovery: health,
home, purpose, and community.
Let me describe a best-practice model for addiction
recovery, beginning with four assumptions:
- Recovery is more than behavioral change.
- Recovery embraces both self and surroundings.
- Management strategies and actions guide recovery.
- Self-efficacy promotes personal recovery.
Because recovery is more than a behavioral change,
effective strategies and actions for recovery address both person and
environment. Person includes the physical, mental, emotional, and spiritual
elements of self; environment is the physical and social world that surrounds
person: people, place, and things. The ecological model of Healthy People 2020
illustrates the scope of recovery well and reflects both self and surroundings.
Because addiction is a chronic disease, addiction
management not cure is the goal of recovery. Public health protocols for chronic disease management together with
Twelve Step philosophy support this approach. An effective chronic disease
(addiction) management program is a pro-active, population-based approach that
addresses chronic diseases (addiction) early in the disease cycle to prevent
disease progression and reduce potential health complications. Successful
chronic disease (addiction) management programs are evidenced-based, use
multiple strategies and interventions; are patient-centered; empower
individuals to increase control over and improve their health; promote
collaboration among providers, organizations, individuals, families, and
community groups; and include an evaluation component to ensure that programs
are achieving their objectives. We find support for management of addiction in
Step One of most Twelve Step programs: our
lives had become unmanageable.
Self-efficacy promotes personal recovery. According to Bandura, behavior, cognition, and environment affect one
and other. The self system is the way we perceive, evaluate, and regulate our
behavior to achieve our goals and most of the demands of our environment. Self-efficacy is similar to confidence and
can be described as the belief that we can achieve and succeed at what we do:
that is, be effective. Most of us remember the story The Little Engine That Could and the powerful refrain: I think I can, I think I can, I think I can.
Self-efficacy beliefs determine how people feel, think, and motivate themselves
and behavior. We develop self-efficacy through mastery experiences, vicarious
experiences, social persuasion, and interpretation of somatic and emotional
states. See the self-efficacy strategies and recovery examples in the table
Strategies with Recovery Examples
success increases confidence that "I can do it again."
proudly picks up her 30-day A.A. chip. "Sixty days here I come, one day at a
Vicarious Experiences or Modeling
someone else with the same condition or situation succeed gives confidence to
sees his sponsor receive a six year medallion. "Wow! Only five years, three
months, and fifteen days for me."
belief by others that "you can do it."
attends a large speaker meeting that closes with The Serenity Prayer followed
by an affirmation, "It works if you work it." He joins in.
of Somatic and Emotional Sates.
from somatic and emotional states of personal strengths and vulnerabilities.
tries to practice HALT on a daily basis. Do not get too hungry, angry,
lonely, or tired.
Yes, people recover! As addiction scientists, scholars,
and practitioners, let us consider a recovery model that embraces an ecological
paradigm, employs management strategies and actions, and encourages
self-efficacy. Let us affirm and advance recovery: an idea whose time has time.
American Society of Addiction Medicine (ASAM). Public Policy Statement: Definition of Addiction, August 15, 2011.
Bandura, A. (1997). Self-efficacy: The exercise of control. New York: W.H. Freeman.
Health and Human Services. (2008). Report on Recommendations for Framework and
Format of Healthy People 2020. Washington,
Substance Abuse and Mental Health Services
Administration (2011). Leading Change: A Plan
for SAMHSA's Roles and Initiatives 2011-2014. Washington, D.C.: SAMSHA.
News Release announces a working
definition of "recovery" from mental disorders
and substance use disorders, December 22, 2011.
President's New Freedom Commission on Mental Health (2003). Achieving the Promise: Transforming Mental Health Care in America.
D.C.: The Commission.