In the world of recovery, there are few words that are more telling (and more misunderstood) than recovered. It is a controversial term, never heard in academic or clinical settings, but used almost exclusively in the Big Book of Alcoholics Anonymous. In fact, the Big Book does not even use the term recovering. How are we to understand this difference in terminology?
For the addict, the struggle to maintain sobriety is both mental and emotional. Addicts use drugs to regulate their emotions. That means that for addicts, substance abuse is a matter of affect regulation. We use drugs to regulate how we feel. No matter how bad our external circumstance (e.g., homelessness, divorce, unemployment), we can escape our pain by getting high. Worse still, when we are sober, we are also plagued by intrusive thoughts of using. These thoughts can occur at any time, regardless of how we feel or what is going on (good or bad) in our lives. We refer to this as the mental obsession – the recurring irrational thought of getting high.
Because the obsession frequently leads to relapse, treatment centers dedicate a lot of time to teaching their clients how to combat it. This explains why cognitive behavioral therapy (CBT) is the default modality in most treatment centers. Clients are told that they must “learn to identify triggers and warning signs”, “think through the drink”, or “play the tape through.” This a treatment modality that tacitly assumes that sobriety is a matter of self-knowledge and vigilance. Sadly, it has proven to be largely ineffectual.
Most addicts will tell you that they simply cannot think through the drink. The obsession is simply too powerful, too overwhelming. It is an irrational state. This means, at certain times, addicts simply cannot call to mind any of the myriad reasons (e.g., children, probation status, health) why they should not use. And while some addicts can maintain sobriety despite being assailed by the obsession (i.e., the “white knucklers), most of us cannot.
The great promise of the Big Book is that one can be recovered – free of the mental obsession. Usually this occurs after the completion of the 9th Step, after making restitution, or amends, to those people one has harmed. So, while an addict cannot directly address the obsession to drink, he can overcome it by indirect means. That is, by embarking on a spiritual path – one that involves surrender, self-examination, confession, restitution, prayer/meditation, and service – one experiences a “psychic change” or “new mind.” One is freed of the mental obsession to do drugs. It is what the New Testament calls a metanoia, or a “turning of the mind.”
So why isn’t the term recovered more widely used? Mostly, because the overwhelming majority of people who claim membership in one of the various 12 Step fellowships do not practice the very exercises that gave rise to the movement. It has been that way for a very long time. There is also the issue that many clinicians and academic programs lack the background and/or training to understand a modality that is essentially spiritual or transpersonal. This is not to say that everyone who attempts the steps becomes recovered. There are many distressing failures. But we do claim that although recovered addicts are but a small percentage of the overall whole, they are numerically significant. There are thousands of recovered opiate addicts, and their numbers steadily increasing. There is hope.