Week One Discussion & Knowledge Exchange Forum: Exploring the Recovery Paradigm

Comment IconWelcome to Week One of the 6th Annual Addiction Day Conference & Networking Fair: Advancing Recovery within Addiction & Mental Health Website Discussion & Knowledge Exchange Forum

This week’s discussion and knowledge exchange will revolve around Exploring the Recovery Paradigm. By participating, your opinion will be incorporated into the conference’s plenary panel discussion. There are two ways to participate:

  • The first is through an anonymous survey, located within this post.
  • The second is by adding a reply to the bottom of this post! Let us know your views on the topic and add to the interactive discussion in the comments section!

Click the “Read More” button below to participate! The discussion topic, brief literature scan, anonymous survey, and the comments section are available within.

We would like to give special acknowledgement to the 6th Annual Addiction Day Presenters who have contributed to advancements relevant to this week’s discussion topic:

Lori Ashcraft

Nady el-Guebally

Mark Griffiths

Alexandre Laudet

Exploring the Recovery Paradigm

Although the term Recovery is commonly heard and often referenced as a desired goal within the Addiction and Mental Health community, there is no single universally agreed upon conceptualisation of what defines Recovery. 

(Siu, Ng, Li, Yeung, Lee & Leung, 2012).

We would love for you to share your thoughts and opinions on this idea in the comments section at the bottom of this post!

Brief Literature Scan:

This week’s introductory selection of publications has been selected on the basis of the academic content within highlighting:

  • the numerous organizational reports/position statements (WHO, American Society Addiction Medicine, SAMHSA, Mental Health Commission of Canada, USHHS, Commonwealth of Australia),
  • and the many valued authors active in conceptualizing Recovery.(Leamy et al, 2011; Sheedy & Whitter, 2009; Eegan, 1996; Anthony, 1993; Betty Ford Institute Consensus Panel, 2007; UK Drug Polcy Commission, 2008; Laudet, 2007; Laudet, Morgen, White, 2006; Coyhis, 1999, etc)

The planning committee would like to emphasize that the articles selected are in no means an exhaustive list of the literature on this topic, and are in no means preferable to others. Rather, the articles selected are simply to generate discussion. In respect of copyright legislation, we can only include publications available within the public domain. We warmly welcome you to reference publications/resources/web profiles of your choice in the website discussion & knowledge exchange forum!

  1. Best & Lubman. (2012). The Recovery Paradigm: A model of hope and change for alcohol & drug addiction.
  2. Siu, Ng, Li, Yeung & Leung. (2011). Mental Health Recovery for Psychiatric Inpatient Services: Perceived Importance of the Elements of Recovery.
  3. El-Guebaly  (2012). The meanings of Recovery from Addiction: Evolution & Promises.
  4. Laudet. (2007). What Does Recovery Mean to You? Lessons from the recovery experience for research and practice.
  5. Griffiths, M. http://nottinghamtrent.academia.edu/MarkGriffiths
  6. Aschraft, L. http://www.labome.org/expert/usa/recovery/ashcraft/lori-ashcraft-1271494.html
  7. The Australian Government’s National Standards for Mental Health Services (2010). Principles of Recovery Oriented Mental Health Practice.

Click the links above to view the publications.

Anonymous Opinion Survey

To participate in our anonymous survey, please click the following link: http://www.surveymonkey.com/s/QCD3PYY

Website Discussion & Knowledge Exchange Forum

We would love to hear your thoughts/reflections/suggestions regarding this week’s topic of discussion: Exploring the Recovery Paradigm. Please reply in the comments section below to add your thoughts on this topic. Your post may not appear immediately, as an administrator must approve all posts in an effort to combat automated spam.

We ask that all responses posted on the 6th Annual Addiction Day website are respectful of others and adhere to appropriate communication etiquette.

 

 

11 comments

  1. Jenn C says:

    I am appreciative of the above comments, as they speak to the complexity of addiction and recovery and the challenges we, as health care providers and researchers face when working to integrate clinical practice, policy, and research.

    In the systemic literature review by el-Guebaly, a study by Laudet et., al 2006, hypothesized five ingredients of recovery capital which included social supports, spirituality, life meaning, religiousness, and 12 step affiliation. These ingredients caused me to reflect on my own clinical practice and the “ingredients to recovery capital” that often present in my clinical work.

    It has been my clinical experience (not based on hard science) that recovery often includes a period of stabilization, an increased ability to regulate and tolerate emotions, meaning making, and reconnection. Stabilization often includes sobriety from all substances of abuse and/or dependence, the activation of internal and external resources, and the understanding of addiction as a chronic disease and recovery as a long-term process. Viewing recovery as a long-term process is very difficult for many patients and requires well timed motivational interventions. If not addressed early in treatment, the inability to view recovery as a long-term process can be a significant barrier to moving forward and achieving larger treatment goals.

    The increased ability to regulate and tolerate emotions is a crucial aspect of “Emotional Sobriety,” as referred to by Wilson, 1958. I frequently hear references to the “dry drunk” and “White knucklers” who achieve sobriety but struggle to recognize the benefits of this. Many of my patients speak to the importance of managing their emotions, to further their sobriety, especially where concurrent disorders are involved.

    Meaning making often includes increased spirituality, improved self-awareness (on a cognitive, emotional, and behavioral level), personal growth, and an understanding of the barriers preventing change. As a clinician, it has been extremely important to keep the recovery paradigm in mind while facilitating this stage of the work.

    Reconnection. As mentioned in several others posts, a recovery community and the return to healthy, productive, and meaningful activities including employment are important for self-worth and lasting recovery.

    While the above mentioned components are common in my work, I recognize that recovery often has a different meaning based on the patient and it is important to keep these unique perspectives in mind.

    What are the ingredients to recovery other clinicians are noticing?

  2. edward kemp says:

    The key to recovery from any addictive substance,whether it be alcohol or drugs, is for the addict to understand she is powerless over that substance and her life has become unmanageable.(ie. step one of alcoholics anonymous). It is important for the addict to learn her addiction is a disease, not simply a matter of will power.
    The success of the recovery process is improved if the addict has the opportunity to attend a formal recovery program followed by the support of a program such as Alcoholics Anonymous. Even following this, there is not a guarantee of success because of the devastation of the disease.
    A successful recovery program will allow the addict to effectively contribute to society and fully enjoy family and friends.

  3. I’ve published extensively about the recovery paradigm (link to articles: http://www.ncbi.nlm.nih.gov/myncbi/browse/collection/9368202/?sort=date&direction=descending)
    as it stands although we still lack rigorous studies to support it empirically in its comprehensive entirety, the key elements are consistent with the extant research, for instance, role of peer support, need for ongoing support for more than…90 days of treatment, the holistic approach recognizing that recovery requires improvements in all life areas negatively impaired by active addiction. In a word, it’s a heck of an improvement on what we are doing now! It needs to be implemented fully and evaluated as a system, which includes coordination across agencies; that takes $ and that takes willingness. Thus one of the places to start is to get providers and service (and research) funders on board without making it sound like what they have been doing their entire career was ‘wrong’ . Healthcare advances as a function of emerging science. We know know addiction is a chronic brain disorder, let’s treat it as such. Too many people still deep down, view addiction as a weakness or a crime. Is diabetes a crime? is asthma a weekness? does one ever graduate from diabetes treatment (after 30 days?) stay tuned, you’ll hear me rant on this at the conference if you don’t stop me:)

    • Daniel Scott says:

      Hi Alexandre Laudet
      You have made a very impressive contribution to the Recovery literature related to addiction. I am wondering: What is your view on applying recovery principles to all the other chronic brain disorders seen in our mental health services?

  4. AddictionStudent1 says:

    This is an interesting website! I am a student, and currently taking a course on addiction.

    I appreciate your comment Bill as I think tobacco/nicotine is rarely considered when “addiction” is discussed.

    In my class, we all seem eager to talk about substance addictions, and especially interested in discussing behavioural addictions, but tobacco/nicotine addiction is almost the “forgotten” or “boring” addiction.
    I am not sure why that is!?

  5. Daniel Scott says:

    Ethics is about conflicts of human values which affect the well-being of others. Implementing recovery in Addiction and Mental Health involves significant conflicts of values and I think we need to explore and use the powerful tools of understanding provided by ethical inquiry.
    Alberta’s Provincial Health Ethics Network (PHEN) described ethics as “a systematic examination of the attitudes and behaviours of people towards each other”. The University of Alberta Handbook of Health Ethics stated that “ethical decisions take into account not only the facts but also what is important, the sacrifices we may need to make, and how our choices affect those around us.” The authority of ethics is in the acknowledgment of our inter-dependence and obligation to respect others. PHEN described Health Ethics as involving discussions about treatment choices and care options that individuals, families, and health care providers must face. It also requires a critical reflection upon the relationships between health care professionals and those they serve, as well as the programs, systems, and structures developed to improve the health of a population. Health ethics includes careful consideration about the allocation of resources, and reflecting on the complex moral choices arising from on-going health care restructuring and advancing technology. It also entails a critical, political, and ethical analysis of the definition and the determinants of health.”
    I think that implementing recovery without this ethical inquiry is a bit like cooking in the dark.

    Reference: Bioethics Centre (1997) A Handbook of Health Ethics, University of Alberta. Edited by Dr. John Dossetor and Donna Cain.

    • Tuxephoni says:

      Hi Daniel.
      If I can echo support for your statement “Implementing recovery…involves significant conflicts of values and I think we need to explore and use the powerful tools of understanding provided by ethical inquiry..”,

      and if I may…

      add to your list of ingredients for “how to avoid cooking in the dark” ……Culture.

      I like how White & Bishop (2006) emphasize the impact of widely divergent cultures and how the subsequent variability in our understandings derived within:
      •religious terms (sin and redemption),
      •spiritual terms (hunger for meaning & personal transformation),
      •criminal terms (immorality and redemption)
      •disease/medical terms (sickness and recovery),
      •psychological terms (flawed thinking, coping & maturation),
      •and socio-cultural terms (historical trauma/oppression & liberation)

      defines, and even somewhat dictates treatment strategies/interventions/philosophies that can only be congruent with that culture’s understanding.

      …in some ways culture could be considered the “spice” in Daniel’s Recovery kitchen!!!

      However, I am a horrible cook!!! And although variety is the spice in life…I personally become terrified that unless there is very clear cut, non-ambiguous instructions, my culinary efforts are most certainly doomed for failure…..a concern I would say Laudet (2006) very eloquently raises in relation to the Recovery paradigm!

      “Recovery is a ubiquitous concept but remains poorly understood and ill-defined, hindering the development of assessment tools necessary to evaluate treatment effectiveness”…(Laudet, 2006, p. 243).

      I guess in short.., my wondering for this week is:

      In order to advance Recovery with Addiction & Mental Health do we need to establish an Alberta definition (even though we know fully well that it will not be all encompassing) in order to ensure the implementation of recovery oriented services across the populations and care continuum?

      References:
      Laudet, A. (2006). What does recovery mean to you? Lessons from the recovery experience for research and practice. http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2083562/
      White & Bishop (2006). Linking Addiction Treatment & Communities of Recovery. http://dbhids.org/assets/Forms–Documents/transformation/BillWhite/2007RecoveryCommunityLinkageMonograph.pdf

      • Daniel Scott says:

        Hi Tuxephoni,
        In the article provided on this page by Dr El-Guebaly there is a reference to research on how people with addictions define recovery. Various ingredients were identified but they were seen as means to an end rather than the end itself. He stated that the end is usually the “reclaiming of the self” that had been lost to addiction.
        I think that mental illness also involves much loss and that “reclaiming of the self” is a strongly evocative way to define recovery.
        I realize that this hardly a clear cut non-ambiguous definition but perhaps we need a definition that inspires more than it prescribes. (I am not good at following recipes either)

  6. Daniel Scott says:

    The word, ‘hope’, is deeply rooted in language and history with a wealth of meaning. It is not a type of behavior, affective state, or a cognitive function. It is not a symptom, a trait, or any measurable condition. The influential report of the Canadian Senate, Out of the Shadows at Last: Transforming Mental Health, Mental Illness and Addiction Services in Canada described recovery as being about hope and pointed out that “for many individuals, it is a way of living a satisfying and productive life even with limitations caused by the illness; for others, recovery means the reduction or complete remission of symptoms related to mental illness”. In other words, for some people recovery is about living well despite the illness and for others it is about a cure. These are two very different positions.
    When looking at hope in literature, it soon becomes apparent that many metaphors have the same contradiction- for example, “hope is a rope” and “hope is grasping at straws”. Jevne stated that the explanation seems to be that there are two levels of hope that are fundamentally different but can co-exist.
    In the first level are the specific hopes that are goals or desires. These could include hoping for a new car, winning the lottery, or for a medical cure. We frequently do not get what we want at this level.
    The second level has not yet been fully described. Jevne described it as the “hoping self”. It is a self with a developmental history and can endure any setback or failure of first level hopes. It is part of the essence of being who we are and does not depend on what happens to us or what we do. Jevne stated that this hoping is to being, as coping is to doing. Wellness is due to having hope, not just about what we can cope with. Healthcare literature tends to deal with the conscious and observable components of hope that are related to specific desires but often overlooks the hoping self.

    References: Jevne, R. (1993). Enhancing hope in the chronically ill. Humane Medicine, 9(2), 121-130.
    Jevne, R. (1991). It all begins with hope. San Diego, CA: LuraMedia.

  7. Daniel Scott says:

    I have heard discussions about recovery that became conflicted over roles. On one side are those advocating for clients as the being the experts on their lives and best able to make treatment choices. On the other side are those who believe the role of clinical staff is to provide clinical expertise needed to make treatment choices.
    Words are the tools of thought. We need new tools to implement recovery in Addiction and Mental Health. Social anthropology uses the concepts of ’emic’ and ‘etic’.
    In ethnographic research, the etic is the external view of someone not experiencing the situation. Assumptions related to the etic perspective include normative values, objective risk of harm, and provide a social sanction for treatment.
    Emic refers to a description of the situation as understood by the person experiencing and living in it. People have a unique perception of their self, the challenges to self, and their ways to overcome those challenges. They may have perceptions that originated in socially determined values but those perceptions are always filtered through personal values and realities.
    The limitations of etc assumptions are becoming increasingly clear in healthcare. Clients are much more than their diagnosis or normative label. Clinicians who see only the diagnosis or label are not only missing the person but their clinical effectiveness is greatly undermined. Important views on the situation provided by emic and etic expertise are lost when both perspectives are not brought together in the clinical process.
    The increasing use of qualitative research methodology in the past few decades has provided new ways of understanding and exploring experience. One of the lines of research is about the emic experience of clinicians. We are not completely objective and external to the clinical situation despite our etic language. Some situations may even have strong challenges to our sense of self and vulnerability. On the other hand, the vast amount of information easily accessible on the internet has given some clients an etic expertise on a diagnosis that may surpass the clinician’s knowledge.
    Our roles are shifting and we need new conceptual tools to explore the full potential of recovery based care.

    Reference: Spiers, J. (2000) New perspectives on vulnerbility using emic and etic approaches, Journal of Advanced Nursing, 31(3), 715- 721.

  8. Bill L says:

    Addiction seems to be defined by resulting human behaviours and some brain chemistry changes seen on PET scans that result in some form of harm to the user. Some substances produce more damage than others. For example, tobacco causes a huge human toll of illness but the addicting culprit, nicotine, is not the direct causitive agent and it does not cause any social, emotional, intellectual or physical impairments. Drivers do not receive impairment charges ” under the influence of nicotine” yet nicotine is considered to be the most addictive substance.
    Questions: redefine addiction? Drop nicotine off the list of addictiction causing substances? Is there an objective measure available of the relative addictive-damage of the usual addictive substances?

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