The Continuum of Treatment and Recovery
Written by Robert Ashford, MSW, PhD-C
Published on October 15, 2020
At one of the early 12 step meetings I attended, I mentioned having begun my recovery in a treatment center. A sage old-timer solemnly intoned, “Treatment is Dis-covery, not Re-covery”. I came to learn that, according to the Traditions, treatment was an “outside issue” to the 12 step fellowships. However, we wouldn’t have the treatment we have today without recovery. Before the advent of Alcoholics Anonymous, people with alcohol use disorder were imprisoned in asylums and lobotomized. It could be said that the way we approached treatment for many years was to try to reverse engineer the recovery method that was discovered by two people with alcohol use disorder. Even today, one is hard-pressed to find treatment for substance use disorder that does not incorporate the teachings of the 12 step programs.
The relationship between substance use treatment and recovery is complex. Most clinical substance use treatment services are organized in a linear fashion to comprise what is known as the Continuum of Care, which starts with prevention, then intervenes at a point determined by an assessment of need and incrementally reduces the frequency, duration and intensity of the intervention over time. This intervention is intended to assist the individual in initiating recovery, which is identified as one of the later points on the continuum. Recovery, however, is not an event, nor is it a linear process, and that’s where things get interesting.
Recovery can be initiated at any time and at any stage of treatment or level of care. It can be initiated before or without treatment, or delayed until long after treatment; it can occur spontaneously, in episodes and usually happens more than once for most individuals. There are several identifiable styles of recovery initiation and recovery maintenance, and as many recovery identities as there are people in recovery. There is incredible diversity and variety of the recovery experience.
For this reason, it’s difficult to know which aspects of treatment are most effective and lead to recovery. What we do know is that recovery happens in the community. and treatment is more effective when social determinants of recovery are supported. Supporting these social determinants while reducing risk factors before substance use disorder occurs is prevention, and our communities are infused with prevention programming and tools. In a similar fashion, our communities should be recovery-ready in order to fully support a continuum of treatment and recovery.