The Recovery Ecosystem

Introductory Paragraph

Recovery support can look like many different things for individuals on their pathway to recovery. This is a crucial component of viewing SUD as a chronic disorder requiring long-term care. Individuals entering recovery through treatment, the criminal justice system, or on there own often face many challenges in early recovery. It is important that communities identify needs, examine what supports are available, and ensure those with the greatest need have access to these supports. Individuals who do not have these needs met are more likely to relapse. Communities that fund these supports help those in early recovery re-engage with the community, increase self-esteem, and become highly productive members of their communities. Providing effective recovery supports prevents relapse, the need to engage additional treatment and other services, and reduces the numbers of overdose. Communities that have invested in recovery supports have seen a substantial return on their investment both in financial and human terms.

SAMHSA defines recovery as "a process of change through which people improve their health and wellness, live self-directed lives, and strive to reach their full potential." SAMHSA also identifies four major dimensions that support recovery:

• Health — overcoming or managing one’s disease(s) or symptoms and making informed, healthy choices that support physical and emotional well-being.
• Home — having a stable and safe place to live.
• Purpose — conducting meaningful daily activities and having the independence, income, and resources to participate in society.
• Community — having relationships and social networks that provide support, friendship, love, and hope.

Key Information

The recovery journey does not start in one place. Recovery is a critical asset that communities need to invest in, including removing barriers so recovery can be sustained. Recovery-oriented approaches involve a multi-system, person-centered continuum of care where a comprehensive menu of coordinated services and supports is tailored to individuals' recovery stage, needs, and chosen recovery pathway; the goal is to promote abstinence and a better quality of life.

There are four primary domains in which recovery can be improved:

• Connections. Many recovery strategies come under the broad umbrella of improving connections. Isolation is the enemy of recovery. Connection includes regular contact with others in recovery across a number of peer-led support organizations. Connection includes access to direct support from peer recovery specialists and recovery coaches. Connections within the family are vital to help the family recover and to be able to support family members in recovery. Other connections include those made in the wider community and even regional/national organizations that can help foster connection to others who provide support for individuals in recovery.

• Recovery Housing. Perhaps the most basic support needed is housing and food. Without this there can be no security or the ability for focus on health and recovery. In many cases going home is not a safe option for those new to recovery. A stable housing situation is foundational and allows growth and progress in other areas to take place. There is a need to be able to find safe, affordable, and supportive recovery housing options in communities across the country.

• Education and Job Training. Finding meaning and purpose in one's life is important to all, but is especially critical to a person who has not found, or has lost, that purpose. The ability to get and hold a job, get a promotion, improve one's education, and become independent are all important needs for people in early recovery. Safe Solutions includes resources and information designed to help people in recovery develop the tools they need to find that purpose and achieve their goals.

• Collegiate and High School Recovery Support. Many in early recovery find recovery while still in high school or college. Many others enter high school or college after beginning their recovery journey. Building an infrastructure of recovery support within these specific communities is another area of focus, where it is possible to learn both where programs currently exist and the tools used by others to create these supports at colleges and high schools.

Here is a summary of specific recovery supports that communities can provide:

• Sober Living - Helps individuals transfer from treatment to independent living. For some individuals, returning to their previous living environment can be unsafe or not conducive to their recovery. Sober living offers individuals a safe, peer-to-peer recovery-oriented home with structure, accountability, and support. Typically, there are household duties in sober living that need to be fulfilled including rent, chores, curfew, etc. For more information about strategies for improving recovery housing, please see the Your Safe Solutions -- "Recovery Housing" page as well.

• Vocational Training - Substance use disorders could result in loss of job, job abandonment, or legal issues that may add additional barriers to obtaining employment. Vocational training can provide on-the-job training, remedial training, college training, and resume building. For more information about improving education, job training, and employment for people in recovery, please visit Your Safe Solutions -- "Improve Education, Job Training, and Employment for People in Recovery."

• Collegiate Recovery Programs - Helps students balance recovery and higher education. Provides support to students such as therapy, sober housing, and substance-free events. For more information on strategies to expand recovery schools and collegiate recovery programs, please see Your Safe Solutions page -- "Expand Recovery Schools and Collegiate Recovery Programs."

• Recovery Coaches - are people who have lived experience of substance use disorder and/or mental health conditions who provide non-clinical recovery support to their peers. They are not sponsors or alcohol and drug counselors. Recovery coaches can also be called Peer Recovery Specialists. There is a certification process that solidifies the Recovery Coach/Peer Recovery Specialist workforce.

• Peer-Based Recovery Support - Giving and receiving nonprofessional, nonclinical, peer-to-peer assistance to achieve long-term recovery from substance use disorders. Alcoholics Anonymous (AA) is the most common support group and is based on the 12 steps. All Recovery brings people together from multiple pathways of recovery. SMART Recovery or Self Management and Recovery Training, is guided by the 4-point program. The clients find and develop the power within themselves to change and lead fulfilling lives. For more information about how to strengthen peer recovery support services and programs, please see Your Safe Solutions -- "Peer Recovery Support Services & Programs."

• Harm Reduction - Harm reduction is a set of practical strategies and ideas aimed at reducing negative consequences associated with drug use. Harm Reduction is also a movement for social justice built on a belief in and respect for, the rights of people who use drugs. For more information about strategies to expand harm reduction practices, please also see Your Safe Solutions -- "Expand Harm Reduction Practices."

• Medicated Assisted Treatment/Therapy (MAT) - uses medication and counseling to provide a whole-patient approach to recovery. Medications are FDA approved. MAT can help sustain recovery and prevent or reduce opioid overdose. Primarily, MAT is used for addiction to opioids, such as prescription pain killers and heroin. For more information on expanding access to MAT, please see Your Safe Solutions -- "Expand Access to Medication-Assisted Treatment."

• Criminal Justice - Substance use disorder and the justice system have a complex history. It is estimated that about one-half of state and federal prisoners misuse drugs or are addicted to drugs, but few typically receive treatment while incarcerated. For more information about strategies to support people who are criminal justice involved, please visit Your Safe Solutions -- "Recovery Supports for People in the Criminal Justice System."

Relevant Research

• Nora's Blog on the Director's page of NIDA highlights recent advances in the science of drug use and addiction. For example, in evaluating the relationship between abstinence and relapse, it is noted that setbacks are regarded as a failure, leading to the perception that the client is starting all over, when in fact, a return to use may strengthen someone’s resolve to recover.

• This article provides a systematic review of nine different studies that examined peer-delivered recovery support services.

• Although AA is the most well-known peer recovery support program, there are other pathways that provide support. This article gives alternatives to the 12-steps.

Impactful Federal, State, and Local Policies

• The Mainstreaming Addiction Treatment Act of 2021 removes the requirement that a health care practitioner apply for a separate waiver through the Drug Enforcement Administration (DEA) to dispense certain narcotic drugs (e.g., buprenorphine) for maintenance or detoxification treatment (i.e., substance use disorder treatment).

• Oregon passed a Drug and Addiction Treatment Act whose purpose is to make screening health assessment, treatment and recovery services for drug addiction available to all those who need and want access to those services; and to adopt a health approach to drug addiction by removing criminal penalties for low-level drug possession.

Available Tools and Resources

• Faces & Voices of Recovery (Faces & Voices) conducted the first nationwide survey of persons in recovery from alcohol and other drug problems. The purpose of this survey was to document the benefits of recovery.

• SAMHSA Recovery from Substance Use and Mental Health Problems Among Adults in the United States. This brief report presents self-reports of recovery among adults aged 18 and older in the United States who thought they ever had a problem with their use of drugs or alcohol and/or mental health. These findings provide a clearer characterization of the factors associated with recovery among adults and how future efforts can foster a whole-health approach to sustain recovery from mental health and substance use conditions.

• SAMHSA provides a treatment finder that connects people with licensed treatment providers who specialize in substance use, addiction, and mental health. SAMHSA also provides video trainings that promote recovery-oriented services and supports by highlighting new knowledge areas, hot topics, and cutting-edge programs.

• SAFE Project provides a variety of resources for recovery:
  • Bridging Prevention and Recovery Program is a new evidence-based program model designed to provide substance use disorder professionals with a step-by-step process to facilitate sustainable integration of these two approaches in communities that have traditionally been siloed.
  • Integrated-Forensic Peer Recovery Specialist (I-FPRS). This Training of Trainers equips participants to train Certified Peer Recovery Specialists and Supervisors to navigate the complexities associated with providing support to individuals who are justice-involved.
  • Treatment and Family Support Locator assists individuals and their loved ones in finding the best treatment for their needs, as well as programs, supports, and other services for friends and family of people caring for individuals with substance use disorder and/or mental health challenges. The locator is a collaboration between SAFE Project and the Partnership to End Addiction.

Promising Practices

• Connecticut Community for Addiction Recovery (CCAR) supports all things recovery -- no matter what stage of recovery. The CCAR website helps people navigate the recovery community by providing support services and connections to people in recovery. They offer telephone recovery support, virtual support meetings on different recovery topics, peer recovery training, and a coffee lounge. They also have five recovery community centers throughout the state.
• The Hazelden Betty Ford Foundation has a series of virtual services. On-line outpatient addiction programs encompass addiction treatment, family services, community solutions, prevention and early intervention, recovery support, and mental health services.
• Recovery Texas. This state-wide movement provides recovery support specialists, screenings for substance use and mental health, and digital recovery support such as meetings, meditation, and yoga.