‘There are a number of key factors that we know are essential for facilitating recovery from serious substance use problems. The importance of these factors has been demonstrated by listening to the narratives of recovering people about their journeys into and out of addiction.
The first essential factors for a person to be able to recover are hope and a sense of belonging.
Hope is based on a sense that life can hold more for one than it currently does, and it inspires a desire and commitment to pursue recovery. People in recovery describe the importance of having hope and believing in the possibility of a renewed sense of self and purpose in the process of recovery.
Hope is created by seeing other people find recovery, and knowing that recovery is possible, not just for others but also for oneself.
Recovery cannot be achieved in isolation. In fact, many people with serious substance problems have become isolated and alienated and this has a further debilitating effect on their already vulnerable psychological state.
People who have had such problems need to belong and feel part of something. They need to feel the acceptance, care and love of other people, and to be considered a person of value and worth.
Acceptance is just one aspect of the third key factor underlying recovery, being supported by others.
People in recovery stress the importance of having someone believe in them, particularly when they don’t believe in themselves. They also stress the importance of having a person in recovery as mentor or role model as they travel their journey.
Role models help people know what recovery looks like, give them something to aspire to, and provide ideas on how to overcome stumbling blocks in the recovery process. They can also help the person find connections in the community they need to facilitate their recovery.
The role of support and belonging emphasises that recovery is a social process and stresses the importance of relationships. It is important that these relationships are not one-sided, like the professional-patient situation in the medical model, but are reciprocal in nature, with the recovering person both giving and receiving.
Participation in such mutual relationships gives the recovering person a feeling of worth – they have something of value to offer to others – and allows them to see aspects of themselves they may not have seen for some time due to their substance use problem.
They learn more about what they are capable of and aspects of whom they are, that ultimately contribute to a change in identity, from an addict to a worthwhile person.
The fourth key factor important for recovery involves the development of valued social roles through involvement in meaningful activities.
Through these activities, recovering people gain a sense a purpose and direction in their life – they find a niche in the community.
The pleasures and rewards that come from engaging in meaningful activities help foster a sense of agency, a self-belief that the person can impact on their own life. Impacting on the lives of other people in a positive manner is also important for personal recovery.
Giving back and helping others plays an important role in the healing process. Sense of agency is closely related to empowerment.
These meaningful activities may involve employment or volunteering, engagement in hobbies or other leisure activities, or connecting with other organisations or groups. Employment is a central way in which people can achieve more meaning and purpose in their lives and is therefore a key pathway to recovery.
Many people in people describe the importance of believing in something spiritual, having faith in a higher or transcendent power. Spirituality, or belonging to a faith community, represents important pathways to recovery for some people.
Understanding is essential to recovery. People need information and education about the: nature of their problems (e.g. addiction); the range of interventions they can use to help them manage or overcome these problems; opportunities that allow them to exercise their strengths and assets; supports they can use to facilitate their recovery journey.
They must be given the opportunity to learn from the narratives of other recovering people, and to learn self-management skills that help them cope with situations that might lead to relapse.
Recovering people (and their loved ones) need the most intimate knowledge of what is most effective in helping the process of addiction recovery, so that they can make informed choices of what is best for them as their recovery journey unfolds.
Research has consistently shown the seventh factor to be key to recovery: a change to a positive sense of self (or positive identity).
People with serious substance use problems lose a lot of the roles or personal characteristics that help define their normal identity (e.g. loving son, athlete, generosity, intelligence) as their dependence on their substance(s) increases, relationships wither and isolation increases.
Eventually, their identity as viewed by others may become “a useless, dirty addict”. They will also have personal views of what they have become and these views can lead to lowered self-esteem or even intense hatred of oneself.
As the process of recovery unfolds, the person starts to regain elements of their old identity and/or elements of a new identity. These changes operate at both an external level (what others perceive of you) and
internal level (what you think about yourself).
Interestingly, many people in long-term recovery (and others around them) comment on their becoming a better person for having gone through the recovery process. This is not surprising, given the intense and painful journey that recovering people have taken and the great deal of self-analysis that has been undertaken.
These factors may have little relevance to a person if they do not have basic needs satisfied, cf. Maslow’s Hierarchy of Needs.
Basic physiological needs (e.g. air, water and food) are required for survival, clothing and shelter for protection from the elements. Safety needs also need satisfying, and the person may need help with their physical health and psychological well-being, as well as help relating to financial and legal issues.
These more basic needs are part of what we call recovery capital: internal (e.g. physical and mental health, self-esteem, resilience) and external resources (e.g. family support, peer support network) that one can bring to bear on the initiation and maintenance of recovery.
People with low recovery capital and more severe substance use problems are likely to require more support in finding recovery than other people.
These eight factors promote two other factors that promote behavioural change and the recovery process: self-esteem and commitment to change.
They also interact with a number of other intrapersonal (e.g. denial, responsibility, dealing with trauma, resilience, self-acceptance and forgiveness) and extra-personal factors (e.g. prejudice, stigma, social inclusion, culture) that play a role in recovery, but which I have not included here to avoid overcomplicating matters in this article.’
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