What is Recovery?

Does abstinence equal recovery? Certainly sobriety is the goal of most people who enter treatment.  Most people celebrate their years of sobriety and consider that a marker of recovery.  Certainly, length of sober time is something to be celebrated. But is it an end in itself?

Recently, the Substance Abuse Mental Health Services Administration published an advisory on the use of buprenorphine in the treatment of opiate use disorder (the new term for opiate addiction).   A quote from Thomas McLellan and William White, addiction experts in England, was included in the advisory. It states in part “Neither medication-assisted treatment of opioid addiction nor the cessation of such treatment by itself constitutes recovery. Recovery status instead hinges on broader achievements in health and social functioning – with or without medication support. “

This isn’t a negative view of medication assisted treatment for opioid addiction. On the contrary, the advisory supports the safety and efficacy of medication assisted treatment (primarily use of buprenorphine/naloxone preparations) when used in a treatment setting with appropriate monitoring. The quote simply points out that taking medication alone does not really constitute recovery.  I think that can be generalized to suggest that abstinence alone does not really constitute true recovery.

So what is recovery? Have you known someone who achieved abstinence but still seemed to have the same lifestyle they had before sobriety? Chaotic relationships, poor judgment, inability to hold a job – all symptoms of failure to really grow emotionally.

In my opinion, people who really recover from addiction have been able to finally figure out what their values are, what is important to them in the big picture of life. They get beyond daily frustrations, minor setbacks, dysfunctional family relationships because they have bigger goals.

They begin to think about what they believe in, what is important to them, and what contribution they want to make to mankind. Their worldview broadens beyond their day to day experience.

This may not be easy to achieve, especially for people who grew up in very dysfunctional families where the focus was on day-to –day survival. They haven’t had the luxury of thinking about life beyond their own daily existence, especially if they are still involved with their family.

That is really where therapy, sponsors, and group support can make a big difference.   That is why most good medication assisted treatment programs insist on therapy along with the medication.

Certainly abstinence is a key element in recovery. You can’t have recovery without it. But true recovery is much more than that.   What do you think constitutes recovery?


Are You Sleeping?

Don’t you wish!   Nothing contributes more to a bad day than lack of sleep. That guy who gave you the finger when you passed him on the way to work this morning probably is sleep deprived. Insomnia doesn’t just affect the person suffering from it. Ask the spouse who has to deal with a cranky, foggy, depressed partner day in and day out.

According to the American Academy of Sleep Medicine, about 30% of the population has some symptoms of insomnia, while 10% have symptoms severe enough to cause problems with daytime functioning.

Sleep apnea is one of the more widely known sleep disorders. It is characterized by loud snoring and periods of several seconds to a minute of apnea (no breathing) during sleep. There are the parasomnias which are disorders of sleep behavior. For example, sleep-walking, sleep-paralysis (waking from sleep and feeling unable to move), sleep-terrors, and sleep-eating disorder (yes, it actually exists) are some of the parasomnias.  The most common sleep disorder, though, is plain old primary insomnia. It’s the inability to sleep for no clear reason.  For some people, the difficulty is getting to sleep. Once they get to sleep, they’re OK. For others, the problem is staying asleep. Some people have both problems. Others seem to be sleeping, but the sleep quality is not good. They don’t reach the deep levels of sleep, and in spite of seemingly sleeping, they feel just as tired and cranky as if they hadn’t slept a wink.

There are medications for primary insomnia out there, for example Ambien, Restoril, Lunesta. However, none of them are really recommended long-term, and the new ones are expensive. It can be difficult to get insurance plans to pay for them.  If all else fails, taking a sleep medication is probably better than not sleeping. However, many of these medications lose their effectiveness after awhile, or they don’t work for some people, or they have side effects such as very vivid dreams.  Ambien in particular is known for causing bizarre behavior during sleep or the day after taking it.   There is some potential for dependence as well. When people have been taking these for a long time, it’s hard to tell whether they still have the sleep problem or they’ve become dependent on the medication and can’t sleep without it.

It is possible to treat insomnia without medication. The most common techniques are called stimulus control therapy and/or sleep restriction therapy.   Stimulus control therapy involves managing possible stimuli that could affect sleep.  For example:

  • No caffeine after 6:00 pm or even earlier for those who are really sensitive
  • No alcoholic beverages after 6:00 pm. Though alcohol tends to make people sleepy, as it is metabolized during the night, it actually shortens the sleep cycle.
  • Minimize stimulating activities just before bed such as exercise or reading emotionally charged material.
  • If you aren’t sleeping, don’t just lie in bed. Get up until you feel sleepy. Don’t watch TV because some of the light from TV and even cell phones is the same frequency as sunlight.
  • Don’t oversleep the next day to compensate. Get up at the same time each day.
  • Don’t watch the clock. You don’t need to know what time it is. Put your clock out of sight.

If that isn’t successful, sleep restriction therapy may be the next step. This is usually best done in conjunction with a sleep therapist.  You will keep a sleep diary for a couple of weeks. Then, based on your actual sleep time, your sleep will be restricted to that amount of time. So if you really are only sleeping 5 hours, your therapist will have you go to bed at 12:30 and get up at 5:30.   Sleeping during the day is not allowed. Usually after a period of strictly following this regimen, the sleep cycle begins to normalize and bedtime can be moved back slowly.  See this YouTube video by author Lois Maharg illustrating sleep restriction therapy. Check out her book, The Savvy Insomniac, and her website, thesavvyinsomniac.com.



Of course many factors influence sleep. Some good resources are:


American Sleep Association – http://www.sleepassociation.org


WebMd – www.webmd.com/sleep


The Sleep Foundation – http://www.sleepfoundation.org