On the go? Listen to the audio version of the article here:

In recent years, the recovery model, or recovery approach, has become widely popular in addiction and mental health treatment systems. This shift has come as part of a broader social movement away from long-term institutionalization of persons with addictions or mental health issues.

I thought I would summarize what I’ve recently learned about the recovery model since I’ve been coming across it more frequently lately in the health care setting. I believe the recovery model is changing the way addiction is dealt with and hope that its principles continue to become widely adopted in the field.

What Is The Recovery Model?

According to The Substance Abuse and Mental Health Services Administration,

“Recovery is a process of change through which people improve their health and wellness, live self-directed lives, and strive to reach their full potential.”

This means treatment is focused on empowering people to support their own self-directed path of recovery. In doing so, the person is supported so they can reach their full potential.

This approach is distinct from authoritarian approaches to treatment whereby the individual is prescribed a rigid path of recovery, in addition to a narrow definition of what a successful recovery means.

Supporting someone with an addiction based on a recovery approach involves four components:

Health: The person’s health is considered by managing any diseases and supporting activities that allow them to physically and emotionally flourish.

Home: The person’s sense of safety and security is considered, supporting their sense of a stable place of residence.

Purpose: The person’s sense of purpose is considered, supporting their sense of meaning and contribution to their broader social context.

Community: The person’s sense of community is considered, supporting their sense of belonging and social connection.

What Are The Guiding Principles of Recovery?

According to the SAMHSA, there are ten guiding principles of recovery:

1. Recovery is person-driven. This means allowing the person to drive their own recovery, including defining their personal goals for recovery. It means supporting their autonomy, allowing them to take action without coercion or manipulation.

2. Recovery is supported by addressing trauma. This means understanding addiction as a common response to coping with traumatic events in one’s life. Creating a safe, non-judgmental environment allows the person to feel comfortable sharing these underlying issues.

3. Recovery emerges from hope. This means supporting hope by helping the person break down their long-term recovery goals into short-term manageable ones, making the process seem more realistic and clear.

4. Recovery is based on respect. This means maintaining an attitude of respect toward the person without the attitude of judgment or blame that can further stigmatize the individual, driving them into further isolation.

5. Recovery is culturally based and influenced. This means considering the person’s culture in supporting their treatment. It also means adopting their own understanding of their culture rather than your own predetermined idea of it.

6. Recovery is holistic. This means considering the biological, psychological, and social forces involved in recovery, supporting healthy development in each of these domains.

7. Recovery occurs via many pathways. This means there are multiple paths to recovery, and each person needs to be supported in their own path, whether it involves abstinence-based practices or harm reduction. Also, various therapeutic styles need to be considered since no one method is appropriate for every person.

8. Recovery is supported by peers and allies. This means recognizing the role of peers who are in various stages of their own recovery from similar issues. The recovery model makes the distinction between experts by profession and experts by experience. Both are considered valuable.

9. Recovery is supported through relationship and social networks. This means recognizing the power of social connection, considering ways to support the person by facilitating further social ties to develop a sense of belonging.

10. Recovery involves individual, family & community strengths & responsibilities. This involves supporting the person in their social roles, allowing them to maintain a sense of purpose through family connections or contribution to a broader community.

Does The Recovery Model Work?

Research on the recovery model supports its effectiveness. According to a 2010 study on treatments for Schizophrenia:

“A growing body of research supports the concept that empowerment is an important component of the recovery process and that user-driven services and a focus on reducing internalised stigma are valuable in empowering the person with schizophrenia and improving the outcome from illness.”

According to a Systematic Review on the recovery model:

“The recovery processes that have the most proximal relevance to clinical research and practice are: connectedness; hope and optimism about the future; identity;
meaning in life; and empowerment (giving the acronym CHIME)”

The recovery model is distinct from models of addiction treatment based on confrontation and strict authoritarian control. Approaches based on confrontation have been largely discredited and are often harmful.

According to the book, Treating Addiction: A Guide for Professionals:

“The American detour into a denial-busting confrontational style for addiction treatment was, from our perspective, an aberrant wrong turn justifying treatment practices that would be blatantly unprofessional and unethical in any other area of health care, and clinical trials of such approaches have yielded uniformly negative results”

The recovery model is an effective approach to addiction treatment because it fosters a person’s internal locus of control, intrinsic motivation, and a sense of self-efficacy.

An internal locus of control means a person has the sense that they are in control of their life. This is important because someone suffering from an addiction is experiencing the complete opposite. Addiction can enslave someone, taking away their sense of control.

The principle of person-driven recovery places responsibility on the other person for their recovery, allowing them to practice taking control over their life. An internal locus of control develops as a byproduct of rising to the occasion and noticing the small wins.

The recovery approach also develops a person’s sense of intrinsic motivation. This is the most powerful form of motivation. It is a person’s deep internal drive, distinct from extrinsic motivation, which is only based on a person’s desire for an external reward or to avoid punishment.

Trying to make someone change through manipulative rewards or punishments may work, but the result is often temporary. Once the external force is removed, the person resumes old habits. The person-driven principle in the recovery approach fosters this internal drive for recovery, leading to long term success.

The recovery approach is also effective because it develops a sense of self-efficacy. This is the sense that you can achieve success, as opposed to the sense that you are helpless. Someone suffering from addiction may often experience a sense of helplessness when it comes to recovery.

The person-driven approach combats a sense of hopelessness and helplessness by empowering the person to actively direct their recovery, allowing them to gain a sense of accomplishment along the way, building their trust in their own capacities.

How Do You Implement The Recovery Model?

All of this probably sounds pretty good, but you may be wondering how you actually do a recovery approach. The recovery model is fairly abstract and philosophical, but it is meant to be guiding spirit for existing treatment tools and techniques, not a treatment method on its own.

In other words, the recovery model is a broad overall approach to compassionate person to person relationships and can be applied through Evidence-Based Practices in addiction treatment.

The evidence-based technique of Motivational Interviewing is highly compatible with the recovery model in addiction treatment. The spirit of motivational interviewing is deeply aligned with a recovery approach. As stated by its founders:

“Motivational interviewing is a way of being with a client, not just a set of techniques for doing counseling.”

On a technical level, it involves engaging the person through active listening, asking open-ended questions, encouraging them to talk about their desired goals, and collaborating with the person to support them as they begin taking action toward these goals.

I discuss specific techniques adopted from the motivational interviewing literature in my article, “The Ultimate Guide to Helping Someone Change.”

For a detailed tutorial of motivational interviewing techniques, I highly recommend doing the free online modules hosted by the British Medical Journal: Motivational interviewing in brief consultations.

Conclusion

The recovery model has been transforming addiction and mental health treatment, offering a more effective and humane approach to working with persons who are interested in improving the quality of their lives.

It recognizes the value of overall health, a stable home, a sense of purpose, and a sense of community belonging and support.

If you’re interested in reading more on this topic, I’ve recently written an article, “How to Help Someone With an Addiction,” describing a recovery approach to supporting a loved one or a client. It is applicable for non-professionals and professionals working in the field.

If you are interested in obtaining professional training in the recovery model in addiction, you can sign up for the NAADAC Recovery to Practice (RTP) Certificate Program.