What is Recovery? 5 Classes of Recovering Individuals

Recovery is defined as: The process of improved physical, psychological, and social well-being and health following cessation or reductions in substance use.

Understanding these different recovery dimensions from the perspectives of those with first-hand experience can inform national and international recovery agendas and policies.

Witbrodt and colleagues used data from the “What is Recovery?” project, an internet-based survey of 9341 people who identify as being in recovery, having recovered, in medication-assisted recovery (e.g., taking methadone), or having had a problem with alcohol or drugs (but no longer do), to see how definitions of recovery distinguish the very people they refer to.

The survey asked individuals to rate 39 elements of recovery as they pertain to their personal definition of recovery with the following scale:

definitely belongs in your definition of recovery
somewhat belongs in your definition of recovery
does not belong in your definition of recovery, but may belong in other people’s definition of recovery
does not really belong in a definition of recovery

The recovery elements were then grouped into conceptual domains—abstinence, spirituality, essentials of recovery, enriched recovery, and uncommon elements—for the purpose of the analysis. Elements that were rated as a 1 (definitely belongs) or a 2 (somewhat belongs) were considered to be personally endorsed by participants. The authors derived five classes of participants from the survey data: 12-step traditionalist, 12-step enthusiast, Secular, Self-reliant, and Atypical. The sample (n = 9341) was over half female, and about three quarters of participants were over age 35. Alcohol was the primary problem substance. Three-quarters self-identified as “in recovery”, and most participants were in their self-defined status of recovery for over 5 years.

5 Classes of Recovering Individuals:

12-step traditionalists (n = 4912):

12-step traditionalists (n = 4912) comprised the majority of the sample and were the most abstinence-oriented group with the greatest percentages of participants indicating abstinence elements belonged in their recovery definition
Over 90% of participants in this class were currently abstinent from both alcohol and drugs.
85% of participants had attended over 90 12-step meetings. (This class strongly endorsed spirituality elements, for example, 93% would definitely include “open-minded about spirituality” and 91% would definitely include “feeling connected to a spiritual force” in their definitions of recovery. This class also strongly endorsed all 15 essential elements of recovery (e.g., “dealing with mistakes” and “taking care of my mental health”) and all 10 enriched recovery elements (e.g., “improved self-esteem” and “learning how to get support I need”) with at least 90% of participants selecting “definitely belongs” for all elements in these domains. Over 80% identified as being “in recovery.”
Strongly endorsed all 15 essential elements of recovery (e.g., “dealing with mistakes” and “taking care of my mental health”)
Strongly endorsed the 10 enriched recovery elements (e.g., “improved self-esteem” and “learning how to get support I need”) with at least 90% of participants selecting “definitely belongs” for all elements in these domains.
Over 80% identified as being “in recovery”

12-step enthusiasts (n = 2014):

Similar to the 12-step traditionalists with strong endorsement of abstinence elements
Lower percentage of participants reported abstinence from both drugs and alcohol (85% for 12-step enthusiasts vs. 91% for 12-step traditionalists)
Lower proportion attending over 90 12-step meetings was slightly lower for this class (80% for 12-step enthusiasts vs. 85% 12-step for traditionalists)
The endorsement of spirituality elements was more moderate as compared to 12-step traditionalists with higher percentages selecting “somewhat belongs”
Personally endorsed all essential elements, but to a lesser degree (i.e., fewer “definitely belongs” and more “somewhat belongs”) than the 12-step traditionalists
Strongly supported four enriched elements (“process of growth and development, “reacting in a more balanced way”, “taking responsibility”, and “living a life that contributes”) with over 90% selecting “definitely belongs”
75% identified as being “in recovery”

Secular class members (n = 980):

Lower endorsement of abstinence elements as compared to 12-step traditionalists and enthusiasts
Less than two thirds were abstinent from both alcohol and drugs; about a quarter still consumed alcohol
less participation in 12-step meetings with only 38% attending over 90 meetings
Endorsement of spirituality elements was relatively low with more responses of “may belong in other’s definition” and “does not belong” than seen with the previous two classes
endorsed one unusual element—“recovery is physical and mental in nature and has nothing to do with spirituality or religion”—with over three quarters selecting “definitely belongs” or “somewhat belongs”
endorsed a majority of the essential elements though to a lesser degree than 12-step traditionalists and enthusiasts
90% strongly endorsed half of the enriched elements, including the same four endorsed by 12-step enthusiasts
characterized by younger age and shorter duration of recovery status as compared to the other five groups
60% identified as being “in recovery,” while 20% selected “used to have a problem”

Self-reliant class members (n = 1040):

Over 75% of participants in this class were currently abstinent from both alcohol and drugs.
higher proportion that attended more than 90 lifetime 12-step meetings than the secular group (65% vs. 38%)
generally endorsed spirituality definitions, but about a quarter selected “may belong in others’ definition” for a majority of these elements
low endorsement of essential elements and support for enriched recovery elements compared to the previous groups
labeled “self-reliant” due to low endorsement of the following: “learning how to get support”, “helping other”, “giving back”, “being able to have relationships”, and “having non-using friends”
75% identified as being “in recovery”

Atypical class members (n = 382):

mixed support for abstinence elements with the lowest percentages of the overall study population selecting “definitely belongs”
75% of participants in this class were currently abstinent from both alcohol and drugs.
Support for spirituality elements was mixed
Over 60% reported that “religious in nature” does not belong in their definition of recovery. Support for essential and enriched elements of recovery was not strong overall
highest reported rate of natural recovery (>10%)
50% identified as being “in recovery”

IN CONTEXT

There are approximately 25 million individuals in remission from substance use disorders in the United States alone.

Although remission is conceptualized as having met—but no longer meeting—DSM criteria for substance use disorder, this may be conceptually distinct from recovery. However, it appears that few individuals consider themselves as being in recovery who are not in remission from substance use disorder (SUD).

This study provided an important framework for distinguishing between different profiles of recovering individuals through the creation of 5 classes.

As treatment programs and methodologies change over time, so may definitions of recovery. For example, 12-step traditionalists, the largest class in the study, represents an older generation that focuses on following the 12-steps of Alcoholics Anonymous. As non-12-step mutual-help groups (e.g., SMART Recovery) become more accessible, recovering individuals may be more likely categorized in the secular group, which in this sample, was generally younger and had fewer years in recovery.

On the opposite end of the spectrum, the atypical class constituted the smallest proportion of the sample and had the lowest endorsement for most elements, which points to a group of individuals that is hard to target but who may still be in need of supportive services.

With this greater understanding of what recovery means to certain individuals, continuing care and supportive services might be tailored towards specific audiences.

While the emergence of different recovery profiles in this study cannot be linked to changes in the addiction and recovery field over time, the findings of this study provide a means for grouping individuals in recovery.

NEXT STEPS

Future studies may look at replicating this methodology with survey data from other populations to see if participants cluster into similar classes. Since 59% of the study population reported alcohol only as their primary substance of choice, it is important to investigate definitions of recovery in populations using primarily other drugs.

BOTTOM LINE

For individuals & families seeking recovery: Treatment services work differently for different people. It may be important to think about your definition of recovery, so services can align to those preferences. Recovery elements endorsed by a large proportion of participants in all classes included “being able to enjoy life” and “taking responsibility”. Focusing on common elements such as these can help give you sense of what to encourage.
For scientists: The recovery classes derived from this study may be specific to this survey population. In order to generalize these classes to the U.S. population, replication of this study with a representative sample of individuals in recovery would be necessary. For example, a substantial majority of individuals were over 35 years old, though the modal patient in SUD treatment is 29 or younger. After better establishing recovery definitions for a broader population, future studies and programs can incorporate these ideas.
For policy makers: Understanding the variety of recovery experiences and definitions is particularly important with recent promotion of recovery as “a formal area of focus” by the Office of National Drug Control Policy. This is essential for the expansion of community-based strategies for long-term recovery support.
For treatment professionals and treatment systems: Understanding your patients’ definition of recovery may help when targeting the right services for them. In contrast, there are elements of treatment that still might need to be offered irrespective of how a patient defines their recovery

CITATIONS

Witbrodt, J., Kaskutas, L. A., & Grella, C. E. (2015). How do recovery definitions distinguish recovering individuals? Five typologies. Drug and alcohol dependence, 148, 109-117.