The Recovery Ecosystem

Introductory Paragraph

This article is the first in a series of articles designed to address the science of recovery. It covers the definitions and dimension of recovery, as outlined by SAMHSA. It also introduces the concept of recovery capital. The various scales at which recovery capital can be built matches the socio-ecological model detailed in the prevention science article titled "Address Risk & Protective Factors for Individuals, Families, and Communities." The recovery ecosystem is complex and requires intention to be applied at each scale (individual, family, social, and community). Aligning prevention science and recovery science in comparable multi-scale approaches will be a significant element in bridging prevention and recovery efforts and in advancing work that is coordinated across the full continuum of care.

Key Information

Definition and Dimensions of Recovery

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." The four major dimensions that SAMHSA has identified which support recovery include:

• 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.

It is noteworthy that these four dimension span the socio-ecological model -- individual, family, social, and community.

Recovery Capital

Recovery Capital is a crucial component for sustained recovery. It has been defined as the quantity and quality of internal and external resources that one can bring to bear on the initiation and maintenance of recovery. For too long, most of the aspects of recovery capital were either random or only reserved for individuals who had these resources readily available. Recovery capital is not dependent on socioeconomic status, and socioeconomic status is not an accurate indicator of either high or low recovery capital. Since change in one's home or work environment may not be possible for everyone, many individuals return to family or community environments that are unsafe or recovery-hostile. Returning to a problematic home life or to a community which has a culture of alcohol and other drug use, can place stress on recovery capital. Faces & Voices of Recovery provides a breakdown of the scales of recovery capital and their role in sustaining recovery:

• Personal. This includes an individual’s physical and human capital. Physical capital is the available resources to fulfill a person’s basic needs, like their health, healthcare, financial resources, clothing, food, transportation, and safe and habitable shelter. Human capital relates to a person’s abilities, skills, and knowledge, like problem-solving, education and credentials, self-esteem, the ability to navigate challenging situations and achieve goals, interpersonal skills, and a sense of meaning and purpose in life. See the SAFE Solutions article titled "Increase Support for Individuals in Recovery” for more information on building personal recovery capital.

• Family/social. These resources relate to intimate relationships with friends and family, relationships with people in recovery, and supportive partners. It also includes the availability of recovery-related social events. SAFE Solutions has two articles related to family/social recovery capital. The first, titled "Expand Community Support for Impacted Families" focuses on the family, and the second article titled "Strengthen Peer Recovery Support Services and Programs" addresses the role of peers in the broader social dimensions.

• Community. This includes attitudes, policies, and resources specifically related to helping individuals resolve substance use disorders. Community resources can include recovery support institutions, such as recovery high schools, college recovery programs, recovery housing, and recovery ministries. Likewise, agencies and employers can bring resources to sustain recovery and early intervention programs, such as drug courts and employee assistance programs. See the SAFE Solutions article titled "Create Recovery-Ready Communities," for more detailed information on building recovery capital at the community scale.

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.

Impactful Federal, State, and Local Policies

Partners for Recovery published a report that provides information regarding the funding sources that support recovery support services throughout the continuum of care. The report includes an overview of federal, state, and private funding and highlights practices for obtaining funding.

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

• SAMHSA published "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 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 also provides video trainings which promote recovery-oriented services and supports by highlighting new knowledge areas, hot topics, and cutting-edge programs, and it has a website titled "Recovery Resources for American Indian and Alaska Natives" with resources addressing recovery support within AIAN communities.

• 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.

• SAFE Project offers a suite of resources across the recovery ecosystem:
  • Bridging Prevention and Recovery is a new evidence-based program 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) uses a Training of Trainers model to equip participants to train Certified Peer Recovery Specialists and Supervisors to navigate the complexities associated with providing support to individuals who are justice-involved.
  • "Recovery Supports for People in the Criminal Justice System" is a Safe Solutions article that provides information about strategies to support people in this population -- who have unique recovery needs. 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.
  • "Improve Recovery Housing" is a Safe Solutions article which addresses the 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.
  • "Improve Education, Job Training, and Employment for People in Recovery" focuses on 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.
  • "Expand Collegiate Recovery Programs" provides information on how to help students balance recovery and higher education. This includes therapy, sober housing, and substance-free events. There is a related aSAFE Solutions article on recovery high schools.
  • "Expand Harm Reduction Practices" is a SAFE Solutions article focused on 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.
  • "Expand Access to Medication-Assisted Treatment" is an article focused on the role of MAT to provide a whole-patient approach to recovery. MAT is primarily used for addiction to opioids, such as prescription pain killers and heroin. MAT utilizes FDA-approved medications to help sustain recovery and prevent or reduce opioid overdose.

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.

• Oregon This case study highlights steps which advanced a "recovery-ready ecosystem" in the city of Eugene.

• Texas. Recovery Texas is a state-wide movement provides recovery support specialists, screenings for substance use and mental health, and digital recovery support such as meetings, meditation, and yoga.