For over 20 years, the Substance Abuse and Mental Health Services Administration (SAMHSA) has fostered recovery and social inclusion for Americans with mental and/or substance use disorders. Over the years, it has become increasingly apparent that a practical, comprehensive working definition of recovery would enable policy makers, providers, and others to better design, deliver, and measure integrated and holistic services to those in need.
In 2011, SAMHSA released a working definition to help translate recovery from a worthy ideal to a concrete reality. In collaboration with stakeholders in the field, SAMHSA led an effort to develop a working definition of recovery, along with four dimensions of recovery and 10 guiding principles.
The definition is the product of a year-long effort by SAMHSA and a wide range of partners in the mental health and addiction fields to develop a working definition of recovery that captures the essential, common experiences of those recovering from mental disorders and substance use disorders, along with major guiding principles that support the recovery definition. SAMHSA led this effort as part of its Recovery Support Strategic Initiative.
SAMHSA’s working definition of recovery from mental disorders and substance use disorders is as follows:
“A process of change through which individuals improve their health and wellness, live a self-directed life, and strive to reach their full potential.”
The first step in developing the recovery definition occurred in August 2010 when SAMHSA convened a meeting of peer leaders from the mental health and addiction recovery communities. Together, these leaders developed a draft definition and principles of recovery to reflect common elements of the recovery experience for those with mental disorders and/or substance use disorders.
In the months that followed, SAMHSA worked with the behavioral health community and other interested parties in reviewing drafts of the working recovery definition and principles with stakeholders at meetings, conferences, and other venues. In August 2011, SAMHSA posted the working definition and principles that resulted from this process on the SAMHSA blog (http://blog.samhsa.gov/2011/05/20/recovery-defined-a-unified-working-definition-and-set-of-principles/) and invited comments from the public via SAMHSA Feedback Forums. The blog post received 259 comments, and the forums had over 1000 participants, nearly 500 ideas, and over 1,200 comments on the ideas. Many of the comments received have been incorporated into the current working definition and principles.
Through the Recovery Support Strategic Initiative, SAMHSA has also delineated four major dimensions that support a life in recovery:
Health: Overcoming or managing one’s disease(s)—for example, abstaining from use of alcohol, illicit drugs, and non-prescribed medications if one has an addiction problem—and, for everyone in recovery, making informed, healthy choices that support physical and emotional wellbeing;
Home: A stable and safe place to live;
Purpose: Meaningful daily activities, such as a job, school, volunteerism, family caretaking, or creative endeavors, and the independence, income and resources to participate in society; and Community: Relationships and social networks that provide support, friendship, love, and hope.
Guiding Principles of Recovery
Recovery emerges from hope: The belief that recovery is real provides the essential and motivating message of a better future – that people can and do overcome the internal and external challenges, barriers, and obstacles that confront them.
Recovery is person-driven: Self-determination and self-direction are thefoundations for recovery as individuals define their own life goals and design their unique path(s).
Recovery occurs via many pathways: Individuals are unique with distinct needs, strengths, preferences, goals, culture, and backgrounds (including trauma experiences) that affect and determine their pathway(s) to recovery. Abstinence is the safest approach for those with substance use disorders.
Recovery is holistic: Recovery encompasses an individual’s whole life, including mind, body, spirit, and community. The array of services and supports available should be integrated and coordinated.
Recovery is supported by peers and allies: Mutual support and mutual aid groups, including the sharing of experiential knowledge and skills, as well as social learning, play an invaluable role in recovery.
Recovery is supported through relationship and social networks: An important factor in the recovery process is the presence and involvement of people who believe in the person’s ability to recover; who offer hope, support, and encouragement; and who also suggest strategies and resources for change.
Recovery is culturally-based and influenced: Culture and cultural background in all of its diverse representations (including values, traditions, and beliefs) are keys in determining a person’s journey and unique pathway to recovery.
Recovery is supported by addressing trauma: Services and supports should be trauma-informed to foster safety (physical and emotional) and trust, as well as promote choice, empowerment, and collaboration.
Recovery involves individual, family, and community strengths and responsibility: Individuals, families, and communities have strengths and resources that serve as a foundation for recovery.
Recovery is based on respect: Community, systems, and societal acceptance and appreciation for people affected by mental health and substance use problems – including protecting their rights and eliminating discrimination – are crucial in achieving recovery.
The Patient Protection and Affordable Care Act (ACA)—often referred to as health reform—is changing how Americans access health care. In the coming years, these changes will affect many people with substance use and mental health conditions. Health reform presents significant opportunities to make a positive impact on health and behavioral health systems, services, and payer sources. By defining recovery, SAMHSA hopes to position recovery at the center of efforts to design, deliver, and finance services for those with mental health conditions and addiction problems. In this way, SAMHSA is helping to ensure that person-centered, recovery-oriented supports and services are available for all who need and want them.
For further information about the SAMHSA working recovery definition, the four recovery dimensions, and the 10 guiding principles of recovery please visit: http://www.samhsa.gov/recovery/
Several States have already adopted SAMHSA’s working definition in their efforts to implement recovery-oriented service systems. SAMHSA continues to promote the adoption of recovery-oriented behavioral health services through programs such as the following:
Bringing Recovery Supports to Scale Technical Assistance Center Strategy (BRSS TACS): BRSS TACS helps states, providers, including peer providers, systems and program administrators, policy-makers, and others adopt and implement policies and practices to support the adoption and implementation of recovery support services and systems. BRSS TACS provides training, technical assistance, and resources tailored to specific needs. For further information, contact BRSS TACS@center4si.com.
Recovery To Practice (RTP): RTP answers two questions: What is “recovery” in relation to mental disorders and substance use disorders? And, what implications does recovery have for transforming behavioral health practice to become “recovery-oriented”? RTP is developing curricula on recovery for peer specialists, psychiatrists, psychologists, nurses, social workers, and addictions counselors. For further information: www.samhsa.gov/recoverytopractice/
National Recovery Month: Recovery Month promotes the societal benefits of prevention, treatment, and recovery for substance use and mental disorders, celebrates people in recovery, and lauds the contributions of treatment and service providers, and promotes the message that recovery in all its forms is possible. For further information go to: www.recoverymonth.gov/
Partners for Recovery (PFR): PFR seeks to improve services, systems of care, and supports; and provides technical assistance to those who provide services to prevent and treat substance use and mental health conditions. PFR’s “focus area” on recovery contains a wide array of resources and materials. (www.partnersforrecovery.samhsa.gov/recovery.html)
SAMHSA is also including the definition, dimensions, and principles of recovery in some of its Requests for Applications (RFAs) for grants and contracts and is taking a variety of additional steps to promote adoption and implementation of recovery-oriented supports and services.