Guest blog post by Dr Stephan Arndt, University of Iowa, USA and Editor-in-Chief of Substance Abuse Treatment, Prevention, and Policy
We know very little about long-term recovery from alcohol and other drug use disorders. As the Director of the U.S. National Institute on Drug Abuse, Dr. Nora Volkow recently noted, “Most of the research that has been done up to now has focused on that immediate intervention that would allow a person to stop taking drugs. Much less is known about recovery.”
We know next to nothing about the demographics, epidemiology or life experiences of people in recovery – how they fare in the world, who they are or what their lives are like once they stop using alcohol and other drugs. We also really do not know about the process of sustaining recovery after people stop meeting criteria for a substance use disorder. Most studies stop following people a short time after they leave clinical treatment. Yet we know from NESARC and the National Survey on Drug Use and Health that the majority of people in recovery haven’t used professional treatment to get well. There are, at least, a couple of reasons for this failure to research recovery. One is that to date, research hasn’t reflected the understanding of addiction as a chronic health condition. If a person ceases to have an immediate problem, they are no longer of interest. Another factor is the stigma and discrimination, real or perceived, involved with having been labeled an “addict” or “alcoholic”.
Formal sanctions against people with substance use disorders, from the government, employers, insurance companies continue even when a person enters the recovery process. Some sanctions are life-long despite the end of alcohol and other drug use. Although some might view sanctions as a deterrent, we do not know their effects on discouraging people from alcohol and other drug use or their effects on recovery. Thus, while some policies may be well intentioned, we do not know if they help or hinder individuals, communities and the nation.
With a recent emphasis of peer and community engagement in medicine and policy making, we also do not know the best way to involve people in recovery in decision making. This was the topic of a recent paper (https://www.substanceabusepolicy.com/content/7/1/47) in Substance Abuse Treatment, Prevention, and Policy. Similarly, we do not know the effectiveness or cost differentials for peer recovery support organizations and the services they are delivering.
Like a child before they reach the cognitive stage of object permanence (when the object goes behind a partition, it ceases to exist), science and the funders of science seemed to act as if people who recover from addiction cease to be of interest. It is time we look on the other side.