Supporting Recovery: What Recent Research Tells Us

September is Recovery Month. The Substance Abuse and Mental Health Services Administration’s (SAMHSA) working definition of recovery is: “a process of change through which individuals improve their health and wellness, live self-directed lives, and strive to reach their full potential.” Other definitions are more specific about abstinence, such as the Scottish Government definition, which includes individuals moving from “problem drug use, towards a drug-free lifestyle…” (Scottish Government, 2008.). Achieving abstinence, it seems, is simply the first step toward recovery; the beginning, not the end. The rest of recovery involves making life changes that result in improved health: life with purpose and meaning that allows individuals to reach full potential and results in increased quality of life equal to that of people who do not have substantial issues with AOD.

How can family and friends best support their loved ones in recovery in their quest for a healthier, more fulfilling life? Recent studies provide some important information about the course of recovery with implications for treatment providers and peer support groups. The findings also provide some insights into how family and friends can support people in recovery as they move toward achieving the same quality of life as those who have never had AOD problems. For instance, quality of life ratings by those in recovery do not follow a steady course of improvement over the long-haul. Rather, recovery is subject to fluctuations—often pronounced—in self-esteem, happiness, and distress (Kelly, Greene, and Bergman, 2018), depending on the drug used, gender, and race/ethnicity. These study findings match those of an earlier study (Dennis, Foss, and Scott, 2007) showing that women, people of mixed race, and those recovering from opioids or stimulants tend to rate their quality of life lower in early recovery when compared to other groups. The study also found that a quality of life on par with that of people with no AOD problems took a significant amount of time: up to 15 years.

Another study examining the needs of those in recovery found that needs differed according to what stage of recovery a person is in: early, middle and late recovery. The study first identified recovery benchmarks based upon four levels of self-reported length of abstinence: less than 6 months; 6 to less than 18 months; 18 to 36 months, and more than 3 years (Laudet and White, 2010). Participants in the study identified current priorities in their recovery and life. The top priority for participants during the first two stages of recovery was “Recovery from Substance Abuse,” at 49.9% and 43.2 % respectively, followed by “Employment” and then “Family and Social Relationships.” During this time recovery efforts are focused on achieving abstinence and establishing a social network supportive of abstinence. As a result, according to the study authors, some disruption is to be expected. Family and social relationships can be subject to tension, often to the point of breaking. At three years of recovery, the percentage of participants whose top priority was “Recovery” fell to 34.1%, still the number one priority while allowing more focus on other areas of life, particularly “Physical Health,” which rose from a low of 6.8% at 8-36 months of recovery to over 20% after three years of recovery.

So, what are the main take-aways for family and friends, and even for the person in recovery? Here are five key points to remember:

1. Educate yourself: Remember first and foremost that recovery is not just about abstinence, but about improving functioning and quality of life over the long term: For friends and family it is important to remember where the person in recovery is within the process, and that you are there with them and providing support. Seek out opportunities to educate yourself about the stages of recovery so that you can provide it from a place of understanding and encouragement as they learn new strategies and coping techniques.
2. Understand that in early recovery that things may get worse before they get better: The person in your life who is in the first six months of recovery will likely experience a drop-in self-esteem and happiness as they process guilt/remorse and the impact that substance use disorder has had on their lives. This is a typical response, and with reassurance and encouragement about normal stages of recovery and support for treatment, their happiness and self-esteem will improve over time as they move through the stages of long term recovery.
3. Encourage the person in recovery to address sleep issues: In early recovery 69.3% of patients have disrupted sleep that may persist beyond their first month of abstinence (Kolla, B.P., et al. 2014.) Patients who used alcohol to help them sleep may have a preexisting sleep problem which, left untreated, could trigger a relapse. For that reason, sleep disturbances should be evaluated by a physician or other health professional who can recognize and treat sleep disorders or recommend meditation, sleep routines, and other sleep hygiene practices and habits.
4. Help them to seek gender and culturally-specific resources: Remember that women and mixed race or Native Americans face greater challenges in recovery. The challenges may be due to trauma, stigma, biological differences, psychosocial conditions, or sociocultural challenges. Those in recovery and their friends and families need to know that these differences are normal, and they should be encouraged to seek additional support and services specific to their gender, race, or culture. Such resources may be in the form of recovery support groups, written material, videos, and podcasts specific to their situation.
5. Help those in recovery from opioids and stimulants to receive additional resources for longer periods of time: The difficulties facing people in recovery from opioids use disorders and stimulant use disorders may be severe. They may have the least access to recovery resources and support, may require more resources, and may take longer to achieve sobriety. Reassurance that this is normal and providing extended support will help them to persevere through the process and reach the point where happiness, self-esteem, and quality of life improve.

Remember that friends and family of a person in recovery are in a unique position to provide support and encouragement for the process of recovery. The things we say and do can help empower healing and successful recovery, both normalizing the process and strengthening relationships along the way.

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References

Kelly, J. F., Greene, M. C., & Bergman, B. G. (2018). Beyond abstinence: Changes in indices of quality of life with time in recovery in a nationally representative sample of U.S. adults. Alcoholism: Clinical & Experimental Research, 42(4), 770-780.

Kolla, B.P., Schneekloth, T., Biernacka, J., Mansukhani, M., Geske,J., Karpyak, V., et al. The course of sleep disturbances in early alcohol recovery: an observational cohort study The American Journal on Addictions, 23 (2014), pp. 21-26

Laudet, A. B., & White, W. (2010). What are your priorities right now? Identifying service needs across recovery stages to inform service development. Journal of Substance Abuse Treatment, 38(1), 51–59. http://doi.org/10.1016/j.jsat.2009.06.003

Mountain Plains ATTC (HHS Region 8) Addiction Technology Transfer Center Network Funded by Substance Abuse and Mental Health Services Administration (Slide Deck) Retrieved from http://attcnetwork.org/regional-centers/?rc=mountainplains

Scottish Government, 2008 The Road to Recovery: A New Approach to Tackling Scotland’s Drug Problem. Centre for Substance Abuse Treatment [CSAT}, 2007.

White, W.L. (2018, June 18). Quality of Life in Early Recovery and Beyond. (Blog Post). Retrieved from http://www.williamwhitepapers.com/blog/2018/06/quality-of-life-in-early-recovery-and-beyond.html 1/3