Recovery real-talk, MAT part two

 I created this chart system to delineate recovery from abstinence.

	Not Abstinent	Abstinent
Not in Recovery	1	2
In Recovery	4	3

Zone 1. People who are ‘Not abstinent’ and ‘Not in Recovery’ include the most obvious substance use disorder examples. Examples include unfortunate souls depicted in media tropes. The very popular reality show Intervention illuminated the typical syndrome of active addiction. Where ‘Not Abstinent’ and ‘Not in Recovery’ overlap… that zone describes a person who is consuming psychologically damaging, impairing substances at the cost of enriching activities, even to the point of terrible shame; and not putting in any obvious effort to diminish or discontinue the pattern. A person may be contemplating solutions to the problem. Nonetheless when a person is in this quadrant, they are making a problem worse, not better. Even in the worst corner of substance use disorder, this actively-using/not-trying-to-stop person will eventually find themselves in ‘late-stage’ addiction; using their drug and hating it, usually hating themselves. They eventually start planning their pro-recovery moves.

Zone 2. People who are “Abstinent’ and ‘Not in Recovery’. This quadrant makes you think. Are there people who are not using at all but would not be considered ‘In Recovery’? 

Let’s go through a few examples.

First, let’s take the satisfied drug/alcohol user who loses access to their DOC. A person in prison may be abstinent for months at a time. It’s an easy proposition to assert: “he aint in recovery just because he aint been using… he’s in the solitary housing unit!” Likewise, a teenager who gets sent to live with their relative… the kid says “I don’t even want to smoke weed any more. It’s been three whole weeks since I smoked up. I’m not even testing positive for THC. When can I come home? I promise I’m gonna quit, I mean stay-quit, you know what I mean. What did you do with my bongs? I have friends I’d like to give them to instead of just throwing them away.”

It’s pretty likely that a person can be abstinent but carries intent and plan to resume substance consumption when the circumstances allow. We like to wager that internal motivation will strike in a moment of epiphany, which does happen. Yet sometimes it doesn’t. Sometimes a person is clean and sober but …‘just for today’. I don’t mean to cast too much shade. ‘Just for today’ is an effective strategy for early days of behavior change. Yet any given day might the day that “today is NOT a day I stay clean and sober”. Furthermore, from time to time, abstinence-based recovery is indistinguishable from ‘will power’, which has never been up to the addiction challenge. Will power in a severe substance use disorder is a bowl of wet noodles in a car accident. To summarize, external motivation can create an abstinent person, but that does mean they’re in recovery.

Second among the ‘Abstinent, Not in Recovery’ crew is the nefarious ‘dry drunk’. This person may be pleased to be entirely clean and sober, but is not meeting other standards for recovery – which I will discuss later. It might suffice to say that a person can be successfully abstinent whilst displaying various despicable addict-like behaviors and habits that confound the observer. It’s easy to imagine… “He’s clean and sober but you’d never know it.” These sorts of Abstinent/Not in Recovery folks exist. To encapsulate the concept, an experienced substance use disorder professional understands that a strong recovery won’t be hidden and drug/alcohol screens are not better evidence of progress then what you can observe and measure in behavior and lifestyle.

Zone 3. ‘Abstinent, In Recovery’. Here is the group that inspires. The traditional winners. So far, the reader will have no doubt that I support opioid replacement therapy and advocate for harm reduction. I must correct that assumption. There are too many valid examples of people who fail to manage buprenorphine, methadone, etc. In the 12-step recovery rooms, we can find people who found medication assisted treatment untenable. It’s been said “If a scientist somewhere invented a pill that I could take once a day that would make me feel perfectly normal, eliminate all my cravings and allow me to live a normal life, it couldn’t work on me; because I’d end up taking more than one and eventually ramp up to handfuls at a time.” This anecdote exemplifies that some people, through honest self-reflection and trial and error, don’t pretend that anything other than abstinence will help them. Abstinence-based recovery is possible and gets more plausible the more social support the person has. The bottom row of my chart happily invites all comers. ‘In Recovery’ is the ocean that accepts all rivers and creeks.

Zone 4. ‘Not Abstinent, In Recovery’.

Finally, my dear readers; colleagues and laypeople; substance users, former and current; the quadrant of the moment… yes there are people ‘in recovery’ who use mind altering substances. They exist although you won’t meet them in typical recovery communities. They are not welcome at Narcotics Anonymous. “The only requirement for membership is the desire to stop using” … how generous (sarcastic)… hey, what do you want, NA isn’t for everyone (authentic). But at NA, in my areas, its typical practice that NA groups ask you to only listen if you’ve used today, and that includes prescribed opioids. And you don’t go to more than a couple AA meetings if ‘cutting back’ was your goal. And you won’t feel comfortable discussing your proud move from fentanyl to just weed, will you? But that’s an achievement indeed! To those folks in recovery “I salute you for your hard work. I hope your loved ones know the changes you’ve made. The addiction carwash didn’t work out for you and that’s fine. Keep getting it.”

To righteously discuss this addiction-recovery spectrum please consider the life-style recovery perspective. The following list does not represent a breakthrough in mental/behavioral health. It’s a modest observation.

Regardless of the person’s current substance use, recovery means: 1. Honest self-reflection; 2. Self-care and dignity; 3. Enriching activity; 4. Good friends and authentic intimacy; 5. Reasoned priorities; 6. Diminished obsession with the drug of choice. There may be other categories of wellbeing to consider but I stand behind these six.