I've heard so much about assessment, treatment, relapse prevention and the difficulties of staying sober and the "need" to be in recovery but next to nothing is said about just what recovery is. Besides blood work etc. are there any more or less objective criteria that could be used to indicate someone in "recovery" ?

John Simpson

Dear John:

Recovery is a word taken from medicine but that has been given it's own special meaning in the neo-AA "medical" treatment of alcoholism -- where it means abstinence. That's it. Everything else good imputed to recovery is secondary or tertiary to the idea that the alcoholic is simply not drinking any more, which is the sine qua non of treatment. For 12-steppers, the word "sobriety" is equivalent to "abstinence," even though abstinence following treatment is unusual and the majority of no-longer alcohol dependent subjects in the NIAAA's NLAES study are continued drinkers.

In fact, several analyses have pointed out that abstinence is not always associated with positive psychological outcomes (the most famous such work, by Gerard and Saenger, from the ARF in Toronto, is now three+ decades old). Even Vaillant -- in his paean to the disease theory, AA, and abstinence -- points out that abstinent alcoholics tend to take on new dependencies in alcohol's place. For Vaillant and others, this is assumed to be an improvement in life (although Vaillant's view of mental health prior to his becoming an AA groupie, represented by his major work, Adaptation to Life, very much viewed compulsive behaviors as all being of a type.) A recent analysis has found greater impact on mortality from smoking than drinking among treated alcoholics (R.D. Hurt et al., Mortality following inpatient addictions treatment, JAMA, 275:1097-1103, 1996).

Your question reminds me of how kooky this definition of recovery is. Clearly, any sensible view of alcoholism, even (or especially) if viewed as a disease, would be to see how it affected the overall functioning of the human being, rather than whether it produced abstinence. This is the idea behind the concept of "harm reduction."

Best,
Stanton

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