The map is not the journey

Yesterday I was reviewing a section on recovery capital for our training programme, and I remembered a discussion with a colleague from a few months back. Experienced, thoughtful, clearly someone who has given years of herself to this work. She was talking about a client who since leaving treatment has secured stable housing, a steady job, and has started to reconnect with his family. “He’s doing so well,” she said. “He’s really in recovery now.”

You see, what she was describing is recovery capital. Not recovery per se. These two are not the same thing, but somewhere in the last decade, we started treating them as if they were. And this overlapping of these two terms is one I hear quite often. And it could costs people.

Granfield and Cloud coined the term recovery capital in the early nineties. They defined it as the breadth and depth of internal and external resources that can be drawn on to initiate and sustain recovery. Housing. Income. Relationships that are actually relationships rather than wreckage. A sense that your life has some point to it. Self-belief, which is harder to build than the other things and takes longer to notice when it’s there.

It was a genuinely useful idea. It broke treatment out of its narrow fixation on symptoms and made space for looking at the whole person. But useful ideas sometimes have a habit of getting stretched. Someone uses a concept to start with, and gradually it becomes a thing to measure, and then measuring it starts to feel the same as measuring the underlying thing, and somewhere in that drift the original distinction gets lost. We started measuring recovery capital and calling the measurements recovery outcomes.

The two things are not the same.

Recovery, and I’ll be blunt about this because I think we sometimes dance around it in professional contexts , is about the relationship with the addictive substance or behaviour. Whether that relationship has changed. Whether the hold has loosened. What has actually happened inside someone when the thing that was running their life stops running it.

That’s the core of it. The job, the flat, the family, the morning routine etc., those things matter, sometimes enormously. I’m not dismissing any of them.  They make recovery more likely to last. But they sit around recovery; they don’t constitute it. However, in most interviews I had for my PhD paper exploring what sustains people’s recovery over time, they played a peripheral role. 

I’ve worked with people who had all of those things. The whole stack. Employment, money galore, stable home, someone to come back to in the evenings, nobody checking too closely. And yet they still drinking most nights, because the actual relationship with alcohol hadn’t changed. The addiction was still running the same old sequences, just doing it in a nicer kitchen. Outcome measures said fine. Nothing was fine.

I’ve also worked with people who had almost nothing. One of them, years ago, I’ll call him D, he wouldn’t mind me saying this, was sleeping at a mate’s place, estranged from his kids, no job, no income to speak of. On paper he looked like a poor prognosis. But something had actually happened within him. He wasn’t using, and unlike some of the people I worked with who weren’t using, he knew why. He’d changed what the substance meant to him rather than just managing not to take it. That’s a different thing, and it’s the thing that matters most.

I’ve thought a lot about why this confusion is so persistent.

I think it’s because capital is tangible and recovery, mostly isn’t. You can see the housing, record the employment, note the support network. The internal work of recovery, the identity rebuilding, the daily negotiation with cravings, the slow and often non-linear process of becoming someone whose life doesn’t depend on the substance, that’s harder to observe. Harder to put in a box on a form.

There’s also something about hope, which is not nothing. When we see circumstances improving around someone we’ve worked hard with, something in us settles. We want this for people. We’ve trained ourselves to care about it. And so we read what we see as what we hope is happening, because the alternative, that is the possibility that the conditions are improving while the core thing isn’t, can be uncomfortable to admit.

Very few recovery outcomes tools out there are making the distinction between these nuances intentionally.

The Substance User Recovery separate elements observing the relationship with addiction such as motivation to change, abstinence, self-efficacy craving management etc., from what it explicitly names as enablers: self-care, quality of relationships, material resources, outlook on life, a sense of meaning and purpose etc. Two distinct domains. Neither treated as a substitute for the other.

The Recovery Index for Gambling Disorders does the same. Gambling reduction and urge coping over here. Life functioning and relationship quality over there. The distinction is deliberate.

When services collapse those two domains into one, they lose the ability to see clearly. They can end up applauding the conditions around recovery while the actual recovery is going nowhere. Worse, they can miss the people doing the real work, the ones without the visible markers, who don’t show up well on the dashboard, who don’t get counted because the numbers say nothing’s happening yet.

So, there are two questions we need answer.

What is this person’s actual relationship with their addiction right now?

What resources do they have available to support the recovery they’re trying to build?

Those are different questions. Neither one answers the other, both matter deeply, and conflating them doesn’t serve anybody, least of all the people we’re trying to help.

The more recovery capital someone has, the better their odds, that’s well evidenced. Capital lowers the gradient, provides a catch when things slip, makes the whole thing more sustainable over time. But sustainable recovery still needs recovery inside it. Capital builds better ground for something to grow in. The growing itself is, well… a different thing.

D rang me a few years later. He had put down the deposit for a flat by then, had a stable job, got engaged - the whole picture. He said: “The outside stuff took a while. The inside stuff had to come first.” He had almost no recovery capital when he started doing the real work. Services would have looked at his situation and worried, and fairly. But the inside thing was happening. The outside things came when they came, at their own pace.

That’s the sequence, in my experience. Not always. But often enough that it matters which way round we think about it, and which one we measure, and call what.