Scientific Developments Drive Evolution of Addiction Recovery

Over the past 50 years, the understanding of addiction recovery has shifted significantly, with scientific investigation taking on a more prominent role.

At the Cape Cod Symposium on Addictive Disorders on Thursday, John F. Kelly, PhD, professor of psychiatry in addiction medicine at Harvard Medical School, discussed recovery’s shift from culture to science. Ahead of his presentation, he spoke with Addiction Professional by email about how new knowledge has changed the way the field thinks about recovery, developments in addiction recovery science that better inform the infrastructure that is needed to address addiction, and recovery support services that enhance remission.

Editor’s note: This interview has been edited for length and clarity.

Addiction Professional: How has the concept of addiction “recovery” evolved in recent years? What new knowledge has been gained through neuroscience that changes how we think about recovery? 

Dr John L. Kelly: During the past 50 years, the concept of addiction “recovery” has evolved from its commonplace cultural meaning reflecting a broad and general process of improved health and well-being to now also being placed under greater scientific scrutiny—including formal operational definitions that can be scientifically tested—in order to understand the bio-psycho-social processes and elements involved in the recovery process.  

With new knowledge gained from neuroscience during the past 30 years, we’ve begun to understand the nature of the negative physical effects as well as the biological healing processes that occur as people enter and sustain remission from substance use disorder (SUD). The neuroadaptations and neurotoxic impacts result in changes in brain structure and function; these begin to heal naturally when people stop use of substances and Mother Nature can do her healing work.

Importantly, however, we’ve also learned that these recovery-related changes that naturally occur once the substance is absent can be accelerated through providing the right kinds of environmental conditions. You can think of this as similar to how sick plant organisms recover from trauma or disease—the right environmental conditions and ingredients can facilitate optimal photosynthesis that can aid more rapid healing. Likewise, when human organisms are placed in or can access the right supportive environmental conditions, a kind of “psychosynthesis” can occur, wherein more rapid healing can take place at biological and psychological levels. These helpful components and conditions can be categorized into social, activity, nutrition, and emotion regulation, elements which happen to nicely form the acronym SANER. One can think of these elements, then, as being the “right conditions”—a SANER approach to recovery in human organisms.  

AP: Can you provide examples of how developments in addiction recovery science are better informing the nature and scope of the type of clinical and public health infrastructure needed to address addiction? 

JK: Because of addiction recovery science discoveries related to the breadth of neurological and neuroendocrine impacts as well as the healing psychological and social factors involved in recovery and how these all respond so well to helpful SANER inputs, these have given rise to a number of treatments and services that can help heal these deficits in early recovery and help sustain remission over time. These include life-saving medications and other treatments, as well as broader community services. The “soil” in which recovery stabilizes, grows, and flourishes is essentially the social environment. Family members and close friends play important roles, as do peers with lived experience of addiction recovery who are very potent agents in modeling, facilitating, and sustaining healthful change. It is really these social elements operating in several growing recovery-oriented venues (e.g., recovery residences, recovery community centers and recovery cafes, recovery ready workplaces, collegiate recovery programs and recovery high schools, and recovery ministries) that serve as catalysts for change for many.

The fact that science has taught us also that people are susceptible to relapse and recurrence of disorder symptoms for many years even after initial remission has been achieved means also that people need ongoing encouragement and support for quite a while. This, in turn, has given rise to extended clinical care models (e.g., recovery management check-ups) akin to the long-term management of hypertension or diabetes, as well as the provision and growth of community models of recovery management operating in long-term recovery residences and recovery community centers.  

AP: What types of recovery support services have been shown to enhance addiction remission and recovery? 

JK: There are several services that are showing great promise in effectively aiding and facilitating long-term stable remission that are also showing to be highly cost-effective as well. These include mutual-help organizations such as Alcoholics Anonymous, which has proven to be extremely helpful for patients with alcohol addiction in achieving long-term remission while saving substantially on healthcare costs.  Research also shows benefits for recovery housing models and recovery community centers as they help provide stability, safety, support, and hope for a better future.

A large number of newer mutual-help organizations also have emerged (e.g., SMART Recovery, LifeRing, Women for Sobriety, Refuge Recovery, Celebrate Recovery) as have a variety of online recovery support resources. All of these are great news for offering more options to more people to find something that is appealing.  

Reference

Kelly JF. Addiction recovery: from culture to science. Presented at: Cape Cod Symposium on Addictive Disorders. Sept. 8-11, 2022. Hyannis, Massachusetts.