With Jim Savage, LCDC


Teen Substance Abuse: Defining Recovery

September 28, 2016

When dealing with substance use disorder, the term "recovery" gets thrown around a lot. "His recovery is going OK." We're concerned about her recovery." "You need to focus on your recovery!"  We all want our teens who have developed a substance use disorder to "be in recovery", but what exactly does this mean?

Becoming clear and improving public understanding about this key issue when it comes to adolescent services can go a long way towards improving overall success rates when dealing with teen substance abuse. To the contrary, not understanding what the overall goal is when treating a drug problem plays a significant role in contributing to the alarming rate of recidivism seen in the field of adolescent substance abuse treatment.

First of all, we need to be clear about what we're talking about "recovering" from. Severe substance use disorder can become a chronic brain disease that requires a specific treatment, and "recovery" is paramount.  The key here is to understand the difference between degrees of severity. Not every teen who abuses drugs is becomes addicted. The teen with a mild substance use disorder should be able to change his or her behavior relatively easily with effective intervention, and be able to avoid further trouble relative to substance use. On the other hand, recovery from full-blown addiction can be likened to being in remission from a terminal illness, and should be considered with the same gravity.

Here are a few important points to understand about recovery:

1. Simply "not using" is not necessarily "recovery”. Addiction is a complex disorder that involves not just physical, but  mental, emotional, and spiritual factors as well. I frequently use the phrase, "You're either in recovery or you're in your disease—there's no in-between." A person does not have to be using to in their disease. Accordingly, just because someone stops using does not automatically mean they are in recovery.

2.  The road to recovery is a long-term process. Simply going through one 4-8 week program, whether inpatient or out, is not all that is required for successful treatment of an addiction problem. There is a continuum of care that needs to be followed that involves graduated step-downs in level of care. The addict requires long-term structure that reinforces the significant amount of behavioral change required to establish successful recovery.  

Having run an IOP (outpatient treatment program) for 10 years, I became familiar with the process of teens (and parents) getting out of residential treatment and feeling they've already done enough for their "recovery". The importance of ongoing care is discounted and all too frequently the substantial investment of time and money in residential treatment goes up in smoke, so to speak.  In other words, it's one thing to go through a program and get to the point of acknowledging the need for recovery—it's another thing to demonstrate the ability to accomplish this. And there's no way around the fact that this can only be demonstrated over a period of time. What will things look like six months or a year from now?

3. New behaviors. Another common phrase around recovery circles is "The only thing that's got to change—is everything." Advances in understanding how addiction affects the brain helps explain the importance of what is referred to as relapse prevention planning, a significant aspect of substance abuse treatment. This ranges from avoiding anything that can trigger cravings (friends who use, listening to music associated with drug use, places where drug use occurs such as concerts or parties, etc.) to adopting new character traits, such as honesty, respect, humility, discipline, and integrity. It may sound too good to be true, but reality is these are characteristics of a recovering person, in large part by virtue of utilizing the 12-Step program, which is widely accepted as an essential component for overcoming addiction.

Treatment programs introduce these ideas, but getting clients to follow through with this is another story. There is a difference between understanding the full implications of what is involved with successful recovery and committing to this and what amounts to an extremely watered down version of this that may include attending a few support meetings and being drug tested.

The bottom line: There is a big difference between completing a treatment program and being in recovery.

While a specific definition for "recovery" may be ambiguous, suffice it to say "you know it when you see it." Recovery is not living from drug test to drug test, accepting continued defiance and limit testing, with no movement towards reestablishing trust and confidence in your child. Rather, when a teen is moving towards recovery, parents are for the most part thrilled because things are going well. Communication is open, effort is being seen, and setbacks are not regarded as hopeless because there is consistent forward movement being realized as well. Parents see the development of a new social network that truly supports recovery, along with a change in values and priorities.

"Recovery." It only makes sense that we understand what this is if it is identified as a goal to be attained.