Rethinking What it Means to Recover from Addiction

My addiction was so extreme that by the end, I was injecting dozens of times a day. So I grabbed the lifeline I was thrown and attended the traditional 12-step rehab program recommended by the hospital where I underwent withdrawal.

But once I began to study the scientific data on addiction, I learned that these claims were not accurate. In fact, research shows that most people who meet full diagnostic criteria for having an addiction to alcohol or other drugs recover without any treatment or self-help groups—and many do so not by quitting entirely, but by moderating their use so that it no longer interferes with their productivity or relationships.

There is no “one true way” to end addiction—and the idea that “one size fits all” can be harmful and even deadly in some cases. Until we recognize this and celebrate the variety of recovery experiences, September’s National Recovery Month and similar efforts to promote healing will fail to reach millions of people who could benefit. During an overdose crisis that killed more than 90,000 people in 2020 alone, a better understanding of how people really do overcome addiction is essential.

Unfortunately, rehab hasn’t improved much since I attended in the late 20th century. At least two-thirds of American addiction treatment programs still focus on teaching the 12 steps and promoting lifelong abstinence and meeting attendance as the only way to recover. (The steps themselves include admitting powerlessness over the problem, finding a higher power, making amends for wrongs done, trying to improve “character defects” and prayer—a moral program unlike anything else in medicine.)

Moreover, despite the fact that the only treatment that is proven to cut the death rate from opioid addiction by 50% or more is long-term use of either methadone or buprenorphine, only about one-third of residential programs even permit these effective medicines, and around half of outpatient facilities use them, typically short-term.

Worse: when they do allow medication, most treatment centers also push people with opioid use disorder to attend the 12-step program, Narcotics Anonymous. That creates what can be deadly pressure to stop the meds. The group’s official literature says that people on methadone or buprenorphine are not “clean” and have only substituted one addiction for another.

I have been contacted by more than one family who lost a loved one to overdose because their relative had rejected or prematurely ended medication based on this view. If we don’t start to view recovery more inclusively, we are denying hope and healing to those who benefit from approaches other than the steps.

So, what does a more accurate and expansive view of recovery look like? To me, one of the most helpful definitions was devised by a group known as the Chicago Recovery Alliance (CRA), which founded the Windy City’s first needle exchange. CRA was also the first organization in the world to widely distribute the overdose reversal drug naloxone—and train drug users to save each other’s lives by using it. Naloxone (also known as Narcan) is a pure antidote to opioids: it restores the drive to breathe in overdose victims but must be given rapidly to be effective. (If used in error, it is safe: it won’t hurt people with other medical problems and typically works even if opioids have been combined with other drugs.)