Recovery in the 21st Century: From Shame to Strength

Through the "war on drugs," the just-say-no campaign, and into the early years of this century, the overarching approach to substance use disorders (SUDs) called for a single outcome (abstinence) and a single methodology (spiritual connection with a higher power) as the remedy for SUDs. Those who did not become permanently abstinent or rejected the spiritual approach were seen as "not ready" or "in denial."A seismic shift in thinking about "addiction" and "recovery" began in earnest in the 1990s. In 2005, the Substance Abuse and Mental Health Services Administration brought together leaders of the treatment and recovery field for the historic National Summit on Recovery to develop broad-based consensus on guiding principles for recovery and elements of recovery-oriented systems of care.Major changes associated with the recovery-oriented approach include viewing SUDs as chronic, rather than acute, problems that require long-term support and focusing on recovery management rather than disease management. Complete abstinence is not an absolute requirement for wellness for all persons with SUDs. There are "many pathways to recovery," not only the 12-Step approach (White & Kurtz, 2006). Sustained recovery is self-directed and requires personal choices, the support of peers and allies, and community reinforcement as well as a strength-based approach and the use of research-based interventions. This Perspectives column addresses the historical context for the transformation toward a recovery-oriented system of care, highlights federal efforts to promote recovery-oriented approaches, and describes recovery-oriented terminology to reduce misconceptions, labeling, and stigmatization and promote recovery for individuals, families, and communities.