Recovery: People, Places, and Time

Readers who have followed this blog series are aware of my sustained interest in the ecology of recovery, particularly the role of recovery space/landscapes within local communities, and the stages of long-term personal and family recovery. A just-published article by Lena Theodoropoulou in the International Journal of Drug Policy offers some intriguing insights into these topics. Below are notes on what I have drawn from the key ideas in her article.

Addiction recovery is an experience of emotional and social connections that prompts a radical renegotiation of the person-drug relationship.

Addiction recovery is far more than an intrapersonal process of change. Recovery is a series of interacting processes that unfold over time in physical, social, and psychological spaces that protectively incubate or suffocate recovery efforts.

These processes most often unfold in fits and spurts over time. Episodes of recovery testing (sampling) often precede the achievement of recovery stability.

Addiction (desire for the drug) and recovery (desire for change) co-exist, and their relative balance dictates both addiction and recovery experiences. Emotional and social connections constitute the push and pull forces of addiction and recovery–the “tipping points” that dictate the final chapters of one’s personal story.   

Addiction recurrence is a temporary or sustained breach in the emotional and social connections that initiate and sustain recovery. Addiction recurrence is “the outcome of the interrupted relationship between a subject and a recovery space.”

Brief treatment episodes offer fragile connections capable of inciting hope for recovery. The question is whether brief treatment episodes result in durable connections that can sustain passage from recovery initiation through the later stages of recovery. 

Brief episodes of biopsychosocial stabilization without sustained recovery support can leave one “trapped in repetition and broken connections.” (See HERE for my take on this.)

“All encounters between the service and the user matter” as they “constitute components of an ongoing turning point.” Evaluating treatment effectiveness based on a single brief course of service fails to measure the effects of service relationships and activities on the course of long-term recovery.

“By positioning the focus on the connections that become possible within the recovery space, healing becomes a socio-political rather than an individual process, ‘accomplished less through personal therapeutics and processing of painful memories than through small-scale, tentative restoration of trust and support’.”

Recovery must be viewed within the context of time: “There is using time, harm reduction time, recovery time, and accordingly relapse time, all of them part of the recovery assemblage.” The process of moving through these time zones is not always linear.

Recovery must be viewed in the context of space—a transition from using space to recovery space—a deterritorialisation of active addiction, the avoidance of people, places and things that anchor one to the addiction experience.

Unraveling the chronicity of addiction is a sociopolitical problem, not a medical one.

I hope we hear a great deal more from Lena Theodoropoulou. We can learn a lot from her observations on treatment services in the UK and Greece. 

Reference

Theodoropoulou, L. (2020). Connections built and broke: The ontologies of relapse. International Journal of Drug Policy, https://doi.org/10.1016/j.drugpo.2020,102739.