Measuring Recovery from Substance Use or Mental Disorders Workshop Summary (2016) / Chapter Skim
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4 Defining and Operationalizing Recovery from Substance Use
4 Defining and Operationalizing Recovery from Substance Use
Pages 23-40
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From page 23... ...
The Washingtonian Temperance Society was a nonsectarian group with methods centered around public testimonials and a public temperance pledge. The idea was that recounting one's past and affirming the present changed people's identity, and this is echoed in later views of the role of self-definition and a public proclamation of being recovered.
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From page 24... ...
The studies have used a variety of approaches to study recovery, including developmental or life-course approaches, clinical indicators, and behavioral indicators in clinical and cohort studies. Grella discussed these approaches in detail, along with two longitudinal studies that she worked on, along with the What Is Recovery?
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From page 25... ...
What is the role of life events that occur at different stages of the life cycle? Grella noted several constructs that are particularly relevant in this research: natural recovery, turning points, and recovery capital.1 Natural recovery refers to 1 See Granfield, R., and Cloud, W
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From page 26... ...
This could include access to treatment services, 12-step groups, a supportive family, friends, and social networks. Grella discussed an early study by Winick2 that was influential in framing how the field thinks about changes associated with the recovery process, and which coined the term "maturing out" of narcotic addiction.
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From page 27... ...
Traditionally, this factor was not included in the definition, but that approach is changing, and there is a need to better understand whether people who are in medication-assisted treatment think of themselves as being in recovery. Another set of studies described by Grella was Vaillant's longitudinal studies of male heroin addicts and alcoholics.4 His study samples included comparison groups and were followed over many decades.
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From page 28... ...
Among individuals with a lifetime substance use disorder, early remission is at least 3 but less than 12 months with no symptoms, except craving, and sustained remission is at least 12 months with no symptoms, except craving. Grella began by discussing several studies that focused on clinical indicators of recovery using data from the National Epidemiologic Survey on Alcohol and Related Conditions (NESARC)
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From page 29... ...
As discussed earlier, she noted, one conceptual challenge is related to deciding whether recovery requires strict abstinence or whether partial, nonproblematic substance use can be included. One study led by Dawson and her colleagues used NESARC data to look at this question by classifying respondents into categories of recovery based on the DSM criteria.6 Among those with lifetime alcohol use disorder, Dawson and colleagues created the following categories, according to past-year status: • Still dependent: met three or more positive criteria for alcohol dependence.
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From page 30... ...
was negatively associated and smoking cessation was positively associated with drinking cessation among all age groups. Another study described by Grella revisited the maturing–out theory using longitudinal NESARC data.8 Vergés and his colleagues analyzed data for individuals who in the follow-up wave met criteria for a drug use disorder in order to examine whether rates of persistence changed with age.
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From page 31... ...
Grella also discussed two longitudinal cohort studies that her group at the University of California at Los Angeles conducted. In one study, men with a history of heroin dependence who participated in the California Civil Addict Program between 1962 and 1964 were followed for more than 30 years, in three waves of interviews.11 The study defined stable recovery as 5 years of sustained abstinence from heroin.
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From page 32... ...
. Grella noted that the main difference in this study's approach was the use of a sample that did not originate from a clinical setting, but rather from the general population, using an Internet recruiting method.
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From page 33... ...
, they are an important group to pay attention to because they are younger and may be tapping into changing social trends, including changing definitions of recovery, and the fact that recovery options are more diversified than they used to be. Finally, the atypical class, the smallest group in this analysis, was characterized by less endorsement of spirituality and abstinence and high intolerance for recovery being religious in nature.
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From page 34... ...
asked whether the identity of being in recovery is applicable in the same way to recovery from mental illness disorders as it is to recovery from substance use. From a sociological perspective, adopting an identity requires the availability of certain kinds of social supports or social structures.
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However, there was also discussion of abstinent versus nonabstinent recovery, which she agreed would require further study. She said that this is not typically the focus of dialogue in substance use recovery.
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From page 36... ...
Mueser noted that this is an interesting difference between substance use and mental health recovery, because "recovery work" as a concept would not come up in the context of mental health. Laudet and her colleagues also asked the sample entering outpatient treatment about priorities and found that staying clean and employment 15 Laudet, A.B.
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From page 37... ...
Laudet said that the community-based New York City study also evaluated stress and quality-of-life satisfaction as a function of abstinence duration.17 These factors are important because stress is one of the main predictors of relapse. The study found that stress decreases significantly as a function of the duration of one's recovery from drug and alcohol problems.
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From page 38... ...
For outpatient clients, quality-of-life satisfaction at the end of treatment predicted level of commitment to abstinence, which has been found in other studies to predict actual abstinence.20 Mueser remarked that the association between abstinence and improvements in various life domains makes sense. However, it is important to remember that many people have co-occurring substance use and mental health disorders, and for these people improvements are less likely to automatically happen when they stop using.
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From page 39... ...
DEFINING AND OPERATIONALIZING RECOVERY FROM SUBSTANCE USE 39 sometimes increased participation, such as returning to work or school, dating, or parenting, can also be a precursor to a decrease in symptoms in the mental health context. This outcome may also be true for substance use.
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