Recovery signals a dramatic shift in the expectation for positive outcomes for individuals who experience mental and substance use conditions or the co-occurring of the two. Today, when individuals with mental and/or substance use disorders seek help, they are met with the knowledge and belief that anyone can recover and/or manage their conditions successfully. The value of recovery and recovery-oriented systems of care is widely accepted by states, communities, health care providers, peers, families, researchers, and advocates including the U.S. Surgeon General, the National Academy of Medicine (NAM), and others.
SAMHSA's working definition of recovery defines recovery as a process of change through which individuals improve their health and wellness, live self-directed lives, and strive to reach their full potential.
Hope, the belief that these challenges and conditions can be overcome, is the foundation of recovery. A person’s recovery is built on his or her strengths, talents, coping abilities, resources, and inherent values. It is holistic, addresses the whole person and their community, and is supported by peers, friends, and family members.
The process of recovery is highly personal and occurs via many pathways. It may include clinical treatment, medications, faith-based approaches, peer support, family support, self-care, and other approaches. Recovery is characterized by continual growth and improvement in one’s health and wellness and managing setbacks. Because setbacks are a natural part of life, resilience becomes a key component of recovery.
The Four Major Dimensions of Recovery:
- Health: overcoming or managing one’s disease(s) or symptoms, and making informed, healthy choices that support physical and emotional well-being
- Home: having a stable and safe place to live
- Purpose: conducting meaningful daily activities, such as a job, school volunteerism, family caretaking, or creative endeavors, and the independence, income, and resources to participate in society
- Community: having relationships and social networks that provide support, friendship, love, and hope
Recovery and Resilience
Resilience refers to an individual’s ability to cope with change and adversity. Resilience develops over time and gives an individual the capacity not only to cope with life’s challenges but also to be better prepared for the next stressful situation. Psychological resilience, the ability to cope with adversity and to adapt to stressful life events, varies widely from person to person and depends on environmental as well as personal factors. It refers to positive adaptation, or the ability to maintain mental and physical health despite participating in stressful situations. Resilience is playing up those protective factors so they can outweigh the risk factors. Optimism and the ability to remain hopeful are essential to resilience and the process of recovery.
Because recovery is a highly individualized process, recovery services and supports must be age appropriate and offered over the life course and flexible enough to ensure cultural relevancy. What may work for adults in recovery may be very different for youth or older adults in recovery. For example, the promotion of resiliency in young people, and the nature of social supports, peer mentors, and recovery coaching for adolescents and transitional age youth are different than recovery support services for adults and older adults.
Recovery and Relationships
The process of recovery is supported through relationships and social networks. This often involves family members who become the champions of their loved one’s recovery. They provide essential support to their family member’s journey of recovery and similarly experience the moments of positive healing as well as the difficult challenges. Families of people in recovery may experience adversities in their social, occupational, and financial lives, as well as in their overall quality of family life.
These experiences can lead to increased family stress, guilt, shame, anger, fear, anxiety, loss, grief, and isolation. The concept of resilience in recovery is also vital for family members who need access to intentional supports that promote their health and well-being. The support of peers and friends is also crucial in engaging and supporting individuals in recovery.
Peer support assists individuals to engage or stay connected to the recovery process through a shared understanding, respect, and mutual empowerment. Peer support extends beyond the reach of clinical treatment into the everyday environment providing non-clinical, strengths-based support. This relationship can help lay the foundation for SAMHSA’s four dimensions of recovery.
SAMHSA advanced recovery support systems to promote partnering with people in recovery from mental and substance use disorders and their family members to guide the behavioral health system and promote individual, program, and system-level approaches that foster health and resilience; increase housing to support recovery; reduce barriers to employment, education, and other life goals; and secure necessary social supports in their chosen community.
Recovery support is provided in various settings. Recovery support services help people enter into and navigate systems of care, remove barriers to recovery, stay engaged in the recovery process, and live full lives in communities of their choice.
Recovery support services include culturally and linguistically appropriate services that assist individuals and families working toward recovery from mental and/or substance use problems. They incorporate a full range of social, legal, and other services (PDF | 409 KB). that facilitate recovery, wellness, and linkage to and coordination among service providers, and other supports shown to improve quality of life for people (and their families) in and seeking recovery.
Recovery support services may be provided before, during, or after clinical treatment, or may be provided to individuals who are not in treatment but seek support services.
These services, provided by professionals and peers, are delivered through a variety of community and faith-based groups, treatment providers, schools, and other specialized services. The broad range of service delivery options ensures the life experiences of all people are valued and represented.
For example, in the United States there are 34 recovery high schools that help reduce the risk in high school environments for youth with substance use disorders. These schools typically have high retention rates and low rates of students returning to substance use.
Additionally, SAMSHA's Bringing Recovery Supports to Scale Technical Assistance Center Strategy (BRSS TACS) advances effective recovery supports and services for people with mental or substance use disorders and their families.
Supporting recovery requires that mental health and addiction services:
- Be responsive and respectful to the health beliefs, practices, and cultural and linguistic needs of diverse people and groups
- Actively address diversity in the delivery of services
- Seek to reduce health disparities in access and outcomes
Cultural competence describes the ability of an individual or organization to interact effectively with people of different cultures. To produce positive change, practitioners must understand the cultural context of the community that they serve, and have the willingness and skills to work within this context. This means drawing on community-based values, traditions, and customs, and working with knowledgeable people from the community to plan, implement, and evaluate recovery activities.
Individuals, families, and communities that have experienced social and economic disadvantages are more likely to face greater obstacles to overall health. Characteristics such as race or ethnicity, religion, low socioeconomic status, gender, age, mental health, disability, sexual orientation or gender identity, geographic location, or other characteristics historically linked to exclusion or discrimination are known to influence health status.
SAMHSA is committed to addressing these health disparities by providing culturally and linguistically appropriate mental health, prevention, harm reduction, treatment, and recovery support programs. This commitment is reinforced through the agency’s disparity impact statement that monitors programs and activities to ensure that access, use, and outcomes are equitable across racial, ethnic, and other under resourced populations.
SAMHSA's Office of Behavioral Health Equity (OBHE) advances behavioral health equity by reducing disparities in racial, ethnic, LGBTQIA+, and other under-resourced communities across the country by improving access to quality services and supports that enables all to thrive, participate, and contribute to healthier communities.
OBHE was established to improve access to quality care and in accordance with section 10334(b) of the Affordable Care Act of 2010, which requires six agencies under the Department of Health and Human Services (HHS) to establish an office of minority affairs.
Through SAMHSA’s grant programs, data is gathered to assess the effectiveness of recovery supports delivered by peers with specific populations, and to identify program models that best address the needs of individuals in recovery.
The Office of Recovery was established to evaluate and initiate policy, programs and services with a recovery focus and ensure the voices of individuals in recovery are represented. The Office will support the growth and expansion of recovery support services across the country.
A national clearinghouse and resource for recovery-oriented care across the mental health, substance use, and co-occurring domains, the Office promotes a recovery-oriented system of care working in partnership with recovery community leaders, tracking progress over time and identifying to resolve barriers to system transformation.