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Dr. Sandra Rasmussen, PhD, RN, LMHC, CAS Fellow

Williamsville Wellness
Clinical Director
Hanover, VA

Fellow Paper (Download)




An Idea Whose Time Has Come


written for


American Academy of Health Care Providers in the Addictive Disorders




Sandra Rasmussen PhD, RN, LMHC, CAS, CGAS

February 2012


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 that follows. 


Self-Efficacy Strategies with Recovery Examples




Recovery Example


Mastery Experiences


Personal success increases confidence that "I can do it again."

Ellen proudly picks up her 30-day A.A. chip. "Sixty days here I come, one day at a time."

Vicarious Experiences or Modeling

Seeing someone else with the same condition or situation succeed gives confidence to try things.

Bill sees his sponsor receive a six year medallion. "Wow! Only five years, three months, and fifteen days for me."

Social Persuasion

Expressed belief by others that "you can do it."

Jeff attends a large speaker meeting that closes with The Serenity Prayer followed by an affirmation, "It works if you work it." He joins in.

Interpretation of Somatic and Emotional Sates.

Inferences from somatic and emotional states of personal strengths and vulnerabilities.

Debra 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. (935 words)


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, D.C.: HHS.


Substance Abuse and Mental Health Services Administration (2011). Leading Change: A Plan for SAMHSA's Roles and Initiatives 2011-2014. Washington, D.C.: SAMSHA.


SAMHSA News Release announces a working definition of "recovery" from mental disorders and substance use disorders, December 22, 2011.


The President's New Freedom Commission on Mental Health (2003). Achieving the Promise: Transforming Mental Health Care in America. Washington, D.C.: The Commission.