Rethinking recovery

Abstract

There has been renewed discussion about the notion of 'recovery' in drug policy and treatment service delivery. If we are to make 'recovery' more rewarding and appealing, we should consider the views of people who use drugs, and interrogate the underlying premises and constitutive effects of treatment policies and practices.The issues raised by McKay [1] resonate with an ongoing debate in the international drug policy field regarding 'recovery'. While the notion of 'recovery' is not new [2], in recent years there has been renewed discussion about 'recovery' as an organizing concept in drug policy and treatment delivery [3][4][5]. 'Recovery' is described frequently as a complex and contested concept [6] which eschews definition [3]. Despite the contentious debate, there has been increasing agreement that 'recovery' means more than abstinence or reduction in substance use, and should encompass improvements in other areas of clients' lives, including housing, relationships, employment, participation and wellbeing [6,7].However, as the work of Neale and colleagues [7][8][9] has shown, conceptualizing, defining and measuring the broad set of outcomes that might constitute 'recovery' is not without its challenges. Recognizing that clinicians and clients may differ in their understandings of 'recovery' and in their assessment of the relative importance of specific outcomes would appear to be essential. By examining how clients' views differed from those of treatment providers, Neale and colleagues [9] found that many of the measures of 'recovery' put forward by treatment providers were problematic. Clients suggested that the measures identified required them to 'become superhuman', and did not capture sufficiently the complexity of their embodied experiences or circumstances. I suggest that this disjuncture between how clients and clinicians view 'recovery' not only re-emphasizes the value of including the voices of people who use drugs in policy processes and treatment systems [10][11][12], but also raises other questions which require critical consideration.First, it might be necessary to interrogate the assumptions and conceptual premises which lodge within the concept of 'recovery' [13]. The measures put forward by treatment providers in Neale's study [7] accord with McKay's [1] concerns and other definitions of 'recovery' developed by experts internationally [14,15], by focusing not only upon reduced drug use and improved health, but also upon notions of citizenship, roles and responsibilities. As I have argued elsewhere [3], underpinning this idea is a set of neoliberal assumptions about work, productivity and what it means to live a 'contributing life' which fail to take into account the differences in the normative and social contexts of people's lives. Moreover, it implies that people who use drugs who are not 'in recovery' always already exist somehow outside of community and cannot live meaningful and fulfilled lives. Neale and colleagues [6] suggest that there are a range of alternative terms, such as 'dis...

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