The threats to health that occur during active addiction have been widely communicated in the popular media and in the scientific literature, but the health profile of people in long-term recovery from substance use disorders remains something of a mystery. While one might assume that physical and emotional health rapidly improves following recovery initiation and stabilization, a health survey of Philadelphia and surrounding counties just published in the Journal of Psychoactive Drugs reveals a more complex and ominous picture.
In 2010, the Philadelphia Department of Behavioral Health and Intellectual disAbility Services contracted with the Public Health Management Corporation (PHMC) to incorporate recovery-focused items into PHMC's 2010 Southeastern Pennsylvania (SEPA) Household Health Survey of Philadelphia and four surrounding counties. The survey results reveal a recovery prevalence rate in the adult population of 9.45%--recovery defined in the survey as once having but no longer having an alcohol or drug (AOD) problem. That recovery prevalence rate is comparable to U.S. national surveys that have measured the rate of remission from substance use disorders, e.g., the percentage of adults who meet lifetime criteria for a substance use disorder but did not meet such criteria in the past year. The Philadelphia and national studies confirm the presence of a large population of people (more than 20 million in the U.S.) who have resolved a significant AOD problem. This large population of people quietly and invisibly living out their lives in long-term recovery defies the pessimism about recovery fueled by the media obsession with celebrities recycling through rehab or dying from drug overdoses.
The Philadelphia survey goes beyond affirming the significant prevalence of recovery in the general population to provide a detailed profile of the health of people in recovery. The results are sobering. People in recovery, compared to citizens not in recovery, are twice as likely to describe their health as poor and report higher rates of asthma, diabetes, high blood pressure, obesity and past-year emergency room visits. They are also more likely to report lifetime smoking (82% vs. 44%), current smoking (50% vs. 17%), exposure to smoke in their residence, no daily exercise and eating fast food three or more times per week. In terms of resources to address health concerns, people in recovery compared to the general population reported greater family/social isolation, lower income, less insurance coverage, and less likelihood of past year health screenings, primary health care and dental care.
A detailed review of these findings reveals the many burdens all too often brought into the recovery process--burdens that if unattended can plague personal health and quality of personal and family life for years to come. The findings also reveal the roles past and present nicotine addiction plays in these health problems. And they reveal the limited natural resources available to many people in recovery to address these problems. So what do these findings reveal about the state of professional care for AOD problem in the United States?
At a systems level, they expose a model of care that functions as an emergency room to provide acute biopsychosocial stabilization but is not designed to provide long-term health management for people in recovery. The management of other chronic health disorders (e.g., diabetes, hypertension, etc.) is viewed as requiring the management of global health (e.g., management of co-occurring medical conditions, diet, exercise, psychosocial stressors) over a prolonged if not lifelong period of time. It is time--no, past time--the treatment of the most severe and complex AOD problems was reconceived in this same way. Such approaches would move beyond brief episodes of symptom amelioration (recovery initiation and diagnostic remission) to the promotion of global health and quality of personal, family and community life in long-term recovery.
At its most practical level, the survey findings suggest that every person entering recovery should have an ongoing relationship with a primary care physician who is knowledgeable about addiction recovery and who can serve as an ongoing consultant on the achievement of health and wellness. It also suggests the need for addiction professionals and recovery support specialists to serve as a source of collateral encouragement and guidance in this process. It is time we broadened our vision beyond what we can subtract from people's lives in the short run to encompass what can be added to enrich those lives in the long term. And it is time we defined recovery to encompass smoking cessation. People in self-proclaimed addiction recovery continue to die in great numbers from nicotine addiction. They are dying of the conceptual blindness that sees no contradiction between present nicotine addiction and claimed recovery status. Through our silence, addiction professionals and peers in recovery participate in those deaths--collective acts for which we will be judged harshly in historical retrospect. (Can you hear the future voices: "Celebrating addiction recovery in smoke-filled rooms What the hell were they thinking back then?!")
At a personal level, the Philadelphia survey is a call for each person in recovery to take ownership of his or her health. Such ownership includes a physical inventory of the legacies of addiction and making amends for the injuries and neglect inflicted on one's own body. Those inventory and amends processes often produce a deep and enduring commitment: "With stable feet and cleared vision, I will begin and sustain the process of healing myself--and I will reach out to help heal others."