Recovery

What is recovery?

Recovery is cited, within "Transforming Mental Health Care in America, Federal Action Agenda: First Steps", as the "single most important goal" for the mental health service delivery system. The Ontario Government's discussion paper "Every Door is the Right Door", envisions a system-wide shift from services focusing on treatment to services focusing on healthy development, recovery, and harm reduction. Concurrent disorders, like single mental health or substance use problems, can be successfully treated. Many people can make a good recovery.

Recovery is a journey of healing and transformation that enables a person with a mental health and substance abuse problem to live a meaningful life in a community of his or her choice while striving to achieve his or her full potential. Recovery can be defined in many ways. It is most often measured in terms of symptom reduction and quality of life, with a major goal of treatment being to help people living with concurrent disorders to continue on with their everyday lives the very best that they can and in ways meaningful to them..

It is difficult to say when a person with concurrent disorders is "fully" recovered; recovery is more of a process than a specific end point or destination. Saying someone has "recovered" often depends on a consensus between the person who has experienced substance use and mental health problems, their health care providers, and family members, however it is ultimately the person with the substance use and mental health problems who drives and assesses the process. The definition of recovery can be different from person to person, but a good reference in all cases should be that a person is confidently in recovery when they feel they have reached a good balance for themselves in terms of symptom reduction, behavioural stability and an overall improved quality of life. 

Each person has a different idea about what recovery means to them, however as a rule the key goals when considering concurrent disorders treatment are:

• Managing mental health symptoms
• Reducing or ending substance use
• Reducing the risk of relapse back to either disorder
• Improving school, work or daily life
• Improving relationships

Many people measure recovery by their success in overcoming the particular challenges faced in each of these domains. While it is true that these are very valuable goals, recovery is still more than this. Recovery is a process; it depends as much on attitude as it does on following a treatment plan. The process of recovery can therefore also include:

• Improving self-confidence
• Developing (or re-gaining) hope and optimism about the future
• Setting and working toward achievable goals
• Making changes to practical aspects of one's life such as housing, lifestyle or employment situations

It is important to remember that a client in recovery is not necessarily "cured." People may still have symptoms and struggle with various problems during their recovery, and a relapse of substance use or mental health problems is often part of the process.

Recovery takes time and while a person may experience wonderful improvements in his or her mental health symptoms and substance-using behaviour, recovery from concurrent disorders may actually take a very long time, indeed much if not all of your life. And this should be viewed as being okay - as long as the person's quality of life has improved, that's all that matters!

Ten fundamental recovery concepts

The following ten concepts have been identified by the Substance Abuse and Mental Health Services Administration of the United States (SAMHSA) as being fundamental in a person's journey to recovery:

• Self-direction: Individuals lead, control, exercise choice over, and determine their own path of recovery by optimizing autonomy, independence, and control of resources to achieve a self-determined life. By definition, the recovery process must be self-directed by the individual, who defines his or her own life goals and designs a unique path towards those goals.
• Individualized and person-centered: There are multiple pathways to recovery based on an individual's unique strengths and resiliencies as well as his or her needs, preferences, experiences (including past trauma), and cultural background in all of its diverse representations. Individuals also identify recovery as being an ongoing journey and an end result as well as an overall paradigm for achieving wellness and optimal mental health.
• Empowerment: People have the authority to choose from a range of options and to participate in all decisions-including the allocation of resources-that will affect their lives, and are educated and supported in so doing. They have the ability to join with other people experiencing mental health and substance use problems to collectively and effectively speak for themselves about their needs, wants, desires, and aspirations. Through empowerment, an individual gains control of his or her own destiny and influences the organizational and societal structures in his or her life.
• Holistic: Recovery encompasses an individual's whole life, including mind, body, spirit, and community. Recovery embraces all aspects of life, including housing, employment, education, mental health, addiction, healthcare treatment and social services, complementary and naturalistic services, spirituality, creativity, social networks, community participation, and family supports as determined by the person. Families, providers, organizations, systems, communities, and society play crucial roles in creating and maintaining meaningful opportunities for people to access these supports.
• Non-linear: Recovery is not a step-by-step process but one based on continual growth, occasional setbacks, and learning from experience. Recovery begins with an initial stage of awareness in which a person recognizes that positive change is possible. This awareness enables the consumer to move on to fully engage in the work of recovery.
• Strengths-based: Recovery focuses on valuing and building on the multiple capacities, resiliencies, talents, coping abilities, and inherent worth of individuals. By building on these strengths, people with mental health and substance use problems leave stymied life roles behind and engage in new life roles (e.g., partner, caregiver, friend, student, employee). The process of recovery moves forward through interaction with others in supportive, trust-based relationships.
• Peer support: Mutual support-including the sharing of experiential knowledge and skills and social learning-plays an invaluable role in recovery. People in recovery encourage and engage other people in recovery and provide each other with a sense of belonging, supportive relationships, valued roles, and community.
• Respect: Community, systems, and societal acceptance and appreciation of individuals with mental health and substance use problems -including protecting their rights and eliminating discrimination and stigma-are crucial in achieving recovery. Self-acceptance and regaining belief in one's self are particularly vital. Respect ensures the inclusion and full participation of people with mental health and substance use problems in all aspects of their lives.
• Responsibility: People have a personal responsibility for their own self-care and journeys of recovery. Taking steps towards their goals may require great courage. People in recovery strive to understand and give meaning to their experiences and identify coping strategies and healing processes to promote their own wellness.
• Hope: Recovery provides the essential and motivating message of a better future- that people can and do overcome the barriers and obstacles that confront them. Hope is internalized; but can be fostered by peers, families, friends, providers, and others. Hope is the catalyst of the recovery process. Recovery from mental health and substance use problems not only benefits individuals with mental health and substance use needs by focusing on their abilities to live, work, learn, and fully participate in our society, but also enriches the texture of community life. Communities reap the benefits of the contributions individuals with mental health and substance use problems can make, ultimately becoming stronger and healthier communities.

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What are some strategies to stay well?

Working with the treatment and support team and sticking with the treatment and recovery plan

Getting the person healthy is the main goal of his or her treatment and support team. The person's doctor, case manager, and the other people who work with the person will support him or her through his or her recovery.

The person, his or her family and the treatment and support team will develop a treatment and recovery plan. It may include taking medication, having regular appointments and participating in various workshops and other activities. Each person's treatment and recovery plan will be unique and based on the person's specific needs.

Sometimes people will not want to follow their treatment and recovery plan. The reasons for this can vary. Sometimes the person may not agree with their treatment and support team that drugs and/or alcohol are really such a serious problem, or are just not ready to fully give them up. Sometimes medications are recommended but may cause unwanted side effects. Sometimes the treatment and recovery plan works so well that the person thinks they don't need to adhere to it anymore and backs away from various aspects of the plan. Sometimes it is just hard to maintain vigilance over one's health, or the person's needs may change so that the previous treatment and recovery plan doesn't work as well as before.

All of these are valid reasons for not wholeheartedly embracing the treatment and recovery plan others have helped set out with the person. That said, staying engaged with one's professional support system is a very key aspect of recovery, so being open and honest with one's treatment and support team and working with them to address issues as they arise is a good way to maintain health in the long term. The chance of a complete and lasting recovery is much better with the right treatment and support over time.

Setting up a routine

Establishing a routine can go a long way towards improving a person's health in the long term. An effective routine could include regular meal times, enough time set aside for personal and self-care, established times for work and rest, and regular social events and family time.

Knowing approximately what each day will look like helps people predict when things are going to happen and helps to reduce anxiety and stress.

Setting priorities among one's responsibilities and focusing on completing those responsibilities first each day can also help to avoid and reduce stress.

Setting goals

Having goals is good for everyone, whether or not one is living with concurrent disorders. Goals can be big or as small. Maybe preparing a nutritious meal might be the day's goal. Perhaps the goal of the day is applying for a job. Whatever the goal, it is important to make sure that it is realistic.

For a big goal it is often easier to break the goal down into smaller parts. For example, if a person's goal is to go back to school, the parts could include finding out how much class time and workload the person can handle, deciding which school to go to, enrolling in classes, and so on. Doing so can make larger goals seem less big. This way they are easier to achieve.

Taking time out to relax and manage stress

Managing stress is a crucial aspect to improving a person's health for the long term. Learning some tricks to reduce stress can help a person to better cope with daily problems. Also, learning to manage stress will help one more effectively deal with 'big' stressors like moving or changing jobs. Positive life events can be stressful too. Holidays, weddings, and birthdays bring their own set of stressors, even if they are celebrations that people really enjoy.

One of the best ways to manage stress is to take time out to relax. Everyone should make sure there is some time in their schedules every day to do the things they enjoy. This could be time to go for a walk, read a book, or do hobbies.

Taking up a hobby

Hobbies are good for a lot of reasons. Hobbies help keep people from being bored. They can also be rewarding and are a good way to get out and meet others. Taking up hobbies that involve other people can be a good way to make some new friends. Doing sports or taking part in group hikes can be good social hobbies. If artistically inclined, many communities offer arts classes through agencies and local colleges.

Keeping in touch

Staying in touch with friends is important. Friends can be a support and they can keep a person in contact with what's going on in the world. People should be encouraged to pick up the phone or send emails to their friends to let them know they're around and interested in staying connected.

Include family

Some people feel like they want to be private about what they are going through. It is important to include family in the process of recovery. Families typically care and most often want to know what is going on so they can help. If talking with family is not an option, people should be encouraged to talk to trusted friends instead.

Maintaining overall health

There are several aspects of lifestyle that include diet, exercise, physical and mental well-being, social life, work life, and so on. Keeping a healthy lifestyle is a good idea for anyone. Most often having a healthy life means one has a balanced life. Leading a balanced life can be hard to do because sometimes one area of life encroaches on others. It can be incredibly hard to strike a healthy balance when a person is trying to take care of him/herself, work or do school, stay socially active, eat properly, and exercise - and this list doesn't even include all the other responsibilities people have!

A good way to start leading a balanced lifestyle is to start with the basics. This can be things like physical activity and nutrition. Being physically active is especially important because some of the medications you may be prescribed may cause weight gain. Being physically active is one of the best ways to deal with the weight gain from medications. Being physically active doesn't necessarily mean having to exercise in the traditional sense. It just means having to move around more. Walking, biking, hiking, swimming, skiing, and snowboarding are all good physical activities. Kicking a ball around or playing catch gets one moving. Dancing is another good way to get moving. Getting active with friends often makes it easier to get moving.

Nutrition is the other basic part of living a healthy lifestyle. Eating nutritious and delicious food helps people to have more energy and feel better in general. Eating lots of fruits, vegetables and whole grain foods is always a good idea. Avoiding a lot of sugary foods is also a good idea. The highs and lows of a sugary diet can bring on mood swings. Including a lot of protein and fibre in your diet is a good thing too. Generally a healthy diet means that eating a balance of foods. This can include some junk food from time to time!

Educating oneself

Learning about what is happening to oneself is one of the keys to good health. There are a number of good resources available to learn about concurrent disorders and taking care of oneself, many of which stress why medication is so strongly recommended for the majority of people as well as strategies for avoiding drugs and alcohol. Education helps people understand their symptoms which helps them cope with them better.

One of the best ways for people to educate themselves is to ask their treatment and support team as they are there to support people through the process of recovery. They will be happy to answer any questions they can, and if they don't have the answers, they should direct people to sources that do.