I have colleagues that use the terms real recovery or true recovery and, lately, as the use of medications for addiction treatment have become more accepted, I’m hearing it more and more. Frankly, it’s getting annoying.
So let me say clearly here and now, I do not know what real recovery is. At least I don’t know what real recovery is for anyone else, not for you, not for my colleagues, not for any of my patients.
Is someone in real recovery if they are taking a medicine and not going to meetings? Does real recovery depend on the quality of their relationships? Does real recovery depend on their economic productivity? Does real recovery depend on anything that anyone outside of them can come up with to judge them on? I think not.
So how should we define recovery in someone who is living with a chronic illness? Let’s ask nature.
Going on From Here
There are three ways any of us can go regarding any aspect of our lives from this moment on. We can get worse; we can stay the same; or we can get better. There just aren’t any other possibilities in the next moment. No matter which direction we go in that moment, unless we cross a permanent line called death, there will be another moment with the same three possibilities.
Can we all agree that getting worse is not recovering? Can we agree that getting better is? I hope so, but our field has swung for the fence for so long, there are many of us who live by the motto, “The good enough is the enemy of the best.” So like beauty, we believe recovery is in the eye of the beholder, or in this case, the mind of the beholder. So many believe that if a person is just improving and hasn’t achieved the beholder’s level of recovery, then it isn’t real. I doubt we’re justified to believe that. What possible business of mine could it be what you think your recovery should be? So if you think your recovery is sufficient with slow improvement, or even just staying steady, who am I to claim that you aren’t in real recovery because you haven’t hit my goal yet?
And while we’re on the subject of who gets to decide, can we mention something else that is the individual’s choice? I’m referring to what to measure. I have seen people who were introverts told they haven’t improved their relationships enough because they weren’t more like the extrovert who was judging them. I have seen people told that they weren’t in real recovery because they weren’t living up to their full job potential. Again, who am I to decide what it is that you want to improve when you ask for help?
How we Got Our Ideas
So where do we get our ideas about recovery? We have a long history with that word. We, in this field, feel we own it. But Medicine was using that word before the Big Book was written. The reason the word is in Alcoholics Anonymous at all was because the author saw his and others’ behavior with alcohol as a disease. The behavior, and the feelings that he felt had led to the behavior, stopped, so he said they had recovered. But it seemed to those early recovering folks that daily work was required to maintain their recovery so some felt that “recovering” was better than “recovered.” Either way we started to confuse the actions they took to be the recovery. Bill Wilson didn’t say that. He said they had recovered as a result of the actions they took. I’m sorry he’s not here to ask if he’d have felt he had recovered if he’d be able to get the change he desired by taking medication. I think 1934 Bill would have said yes and 1960 Bill would have wondered.
This is because Bill, like so many who have had recovery without the aid of medication, found it through a spiritual change. 1934 Bill didn’t see that coming and 1960 Bill would have wondered if he’d have sold himself short by taking a medicine. That’s my colleagues’ argument. That if we give medicine, the patient will feel good enough and never get to that spiritual recovery. That may very well be something to regret. But my own spiritual understanding, and this is purely personal and not meant to be a benchmark for anyone else, is that each person has his own relationship with the universe, that I have little or nothing to say about your path, and that if spiritual awakening is in your path, I am not powerful enough to stop it. Neither is a medication.
So where does that leave a physician treating addiction? Do we just let all the patients decide on the treatment and do whatever they want? Do we just give them drugs? No. What we do, and what the patients and the payers expect of us, is to use our experience and expertise to help the patient come up with a treatment plan with a goal consistent with arresting progression of the illness and guide them through it.
Now make no mistake, I’m making it sound a lot simpler than it is. There will be differences of opinion about what to measure. There may be disagreement with the payers. There are a lot of complications. But if we don’t keep the simple goal in mind, how can we expect to navigate the minefield of complications ahead.
So what is real recovery? I don’t know. I know people ask for help. I know they have financial relationships with the people who pay for their care. I know everyone, including me, has opinions about what they need. But most of all I know this: I am not God.
I am neither the patient’s creator nor his boss. I don’t get to make him do anything. And in this powerlessness I’ve found a comfortable place.
Of course I’m also not in a position to tell my colleagues what to do. So if you don’t want to give people medicine unless they’re going to meetings or stopping smoking or getting a job, okay. You get to say that. But say that. Just that. “I won’t give you medicine less you______. ” You don’t get to dress up your choice as a universal mandate and say “I won’t give you medicine less you’re in real recovery,” because you don’t know what it is either.