Utility or futility? Toward an operational definition of addiction ‘recovery’

Abstract

The ‘recovery’ construct has received growing scrutiny over the past 20 years as individuals and organizations have tried to define what ‘recovery’ is, or should contain, as something distinct from remission. Yet, despite goals to improve definitional clarity and utility, confusion has persisted hindering attainment of objective epidemiological recovery prevalence rates, as well as its utility as a helpful decision tool in important legal and social determinations (e.g. child custody). We argue that the basis for confusion lies in four major areas: 1. Whether we are talking about an objective vs subjective definition; 2. What elements should be included in an operational definition at what threshold for what duration; and, whether abstinence or remission should be the basis - or even part - of a such a definition; 3. Whether we are describing recovery as a process vs a categorical endpoint (‘in recovery’ vs ‘not in recovery’), similar to remission, or both; and 4. Who cares? To what end and for whom are we endeavoring to operationally define recovery and what ultimate added clinical and public health utility is there in a formal definition. This paper describes the background surrounding the creation of the initial formal descriptive recovery definition and discusses these points in the hope of decreasing confusion and increasing future definitional utility. In conclusion, it is argued that for the purposes of estimating objective recovery prevalence and in guiding important social determinations, only narrower definitions may be feasible, with more elaborate multidimensional definitions being reserved for descriptive purposes.