I was listening to a client the other day, and his story went something like this:

“I was in The Program for a year, then I stopped going to meetings for two years; so I havent’ used for three years, but I only have a year of recovery”. Here is a person who was able to maintain recovery for three years, but only gives himself credit for one; because he has been taught that his recovery is invalid if he was not “working a program”. Twelve step programs, and very often treatment centers which disseminate their views, teach people that abstinence alone is not recovery; there must be a “program”, whose ostensible goal is to improve one’s spiritual condition. And, while abstinence alone is deemed insufficient, abstinence is considered a prerequisite. Combine this with the commonly espoused idea that the 12 step program is the only way to achieve recovery, and the result is the very concept of recovery being held hostage by a segment of the recovery community, jealously guarded behind the fortified walls of institutions and conferred only upon those who meet the criteria of the dominant ideology.

SAMHSA has a very broad definition of recovery: “…a process of change whereby individuals work to improve their own health and wellness and to live a meaningful life in a community of their choice while striving to achieve their full potential.” This working definition was released in 2011, and reflects the progress in treatment and acknowledges multiple pathways to recovery; the 2005 version included the word “abstinence”, aand the Betty Ford Institute definition of 2007 used the word “sobriety”. Betty Ford has since merged with Hazelden, and the new recovery conglomerate has embraced medication-assisted treatment, although the bulk of their materials still reflect the 12 step/spiritual ideology.

President Obama’s administration has taken bold steps to address the substance use epidemic in this country, specifically the opioid crisis. Human Services Secretary Sylvia Burwell said, “We need to lift people out of opioid-use disorder through medication-assisted treatment” and the agency is revamping the regulations to allow more doctors to use medically proven, life-saving treatments for those addicted to heroin or prescription painkillers. I have been known to say that it is hard to recover when you are dead. However, it’s also hard to recover when you go to a “recovery support” meeting and get no recovery support; or even worse, be told that your recovery is invalid, your spirituality is invalid, and in some meetings not even be allowed to speak or recognize your time in recovery.

The treatment industry has, for the last fifty years or longer, been the primary feeder for 12 step meetings. This free, unregulated system of recovery support has been written into millions of clinical aftercare plans. What are we all going to do as treatment methods evolve to include a broader definition of recovery? The only setting in which change may come more slowly than the treatment industry may be the 12 step community. In Narcotics Anonymous, this issue has been debated for years; in Alcoholics Anonymous, it is somewhat newer, although that fellowship went through a similar controversy during the advent of antidepressants, when fundamentalist sponsors told their sponsees that they needed to be medication-free to be “sober”.

The definition of recovery has been held hostage for too long by the abstinence-only crowd. As the body count from our opioid epidemic rises, lives depend on the release of this hostage so that recovery can be truly accessible to all.