Whole person recovery from substance use disorder: a call for research examining a dynamic behavioral ecological model of contexts supportive of recovery

Abstract

Background: Abstinence has long been considered the defining feature of recovery from substance use disorder, with a focus on individual level factors associated with abstinence rather than identifying individual and socioecological factors that support recovery. This paper proposes greater consideration of dynamic behavioral ecological influences on recovery and offers an expanded contextualized approach to understanding and promoting recovery and predicting dynamic recovery pathways. Methods: Conceptual and empirical bases are summarized that support moving beyond research, treatment, and policy agendas that focus narrowly on the individual as the fundamental change agent in recovery and that emphasize changes in substance use as the primary outcome metric. A model is presented that expands the scope of recovery-relevant variables to include dynamically-varying ecological contexts that variously support or hinder recovery along with an expanded scope of functional and contextual outcome variables. Results: Examining behavior patterns through time in changing environmental contexts that include community and neighborhood-level variables and social determinants of health is critical for understanding recovery and developing multi-level interventions to promote change. Molar behavioral and ecological perspectives are needed to understand how recovery is influenced by broader contextual features in addition to individual determinants. This paper provides concrete recommendations for the pursuit of this broadened research agenda. Conclusions: Individual pathology-based approaches to understanding and promoting substance use disorder recovery are too narrowly focused. This review calls for greater consideration of the dynamic behavioral ecological and temporally extended contexts that contribute to harmful substance use and systemic changes necessary to promote and sustain recovery.