What 9,341 voices teach us about what being in recovery is all about

We talk about recovery as if everyone knows what it is. Treatment centres promise it, commissioners try to measure it and millions of people pursue it, often with everything they have left. The trouble is that for decades, we’ve been working with definitions that don’t match the lived reality. We’ve equated recovery with abstinence or reduced it to a vague idea of “wellness” or a “healthy lifestyle.”

But, when thousands of people in recovery were asked what it really meant, what they described had less to do with abstinence or even wellness and more to do with a way of being: telling yourself the truth, taking responsibility and learning to stand more firmly in your own life.

That’s worth sitting with for a moment. Because it means we’ve been aiming our services, our measurements, and even our language at the wrong target. And if we’re serious about helping people recover, we need to listen harder to those who already are.

Listening at scale

In 2014, Dr. Lee Ann Kaskutas and her team embarked on an ambitious mission: to move beyond the vague definitions of recovery that had dominated the field and instead listen to the voices of those who had actually lived it.

Their "What Is Recovery?" study reached an unprecedented 9,341 people, representing every conceivable path to recovery, who were asked to describe their own definition and meaning of recovery. Some had gone through formal treatment programmes, others had found their way through 12-step groups, therapeutic communities or medication-assisted approaches. Still others had achieved recovery entirely on their own, through what researchers call "natural recovery."

What unfolded offered a fresh lens on an often-misunderstood experience.

When the data was analysed, four distinct domains of recovery crystallized, each containing multiple elements that people consistently endorsed as central to their recovery definition.

Abstinence in Recovery seemed like it would be the cornerstone, and indeed, nearly 80% said "no use" definitely belonged in their recovery definition. But this was just one piece of a much larger puzzle. And not the most important one.

Essentials of Recovery captured the fundamental shifts in how people navigate life: being honest with oneself, handling negative feelings without substances, dealing with situations that once felt overwhelming and developing healthy relationships where nobody is being used.

Enriched Recovery reflected a turning outward, living a life that contributes to society, developing inner strength, taking responsibility for what one can change and reacting to life's ups and downs with newfound balance.

Spirituality of Recovery encompassed gratitude, giving back, helping others avoid addiction and feeling connected to something larger than oneself, though notably, this had little to do with organized religion.

Overall, the six most endorsed elements as definitely belonging in their definition included three components of “essential recovery” (being honest with myself, handling negative feelings without using drugs or alcohol, being able to enjoy life without drinking or using drugs) and three components of “enriched recovery” (a process of growth and development, reacting to life’s ups and downs in a more balanced way, taking responsibility for the things I can change).

Interestingly, elements containing the notion of spirituality consistently had low endorsement and a relatively high proportion of “may belong in others’ definition”.

What struck researchers most was how stable this four-factor structure remained regardless of how people had achieved recovery, how long they'd been in recovery, or whether they were currently abstinent.

The fundamental architecture of recovery appeared to be universal.

Taking it a step further

This was a breakthrough: recovery could no longer be reduced to “not using.” It was a multifaceted process, lived across inner and outer worlds. Yet even within this sweeping definition, questions remained. If recovery is so varied, are there elements that unite everyone? Or does recovery mean something different to different groups?

Fast-forward to 2023, when Dr. Sarah Zemore and her colleagues decided to answer that by digging deeper into the same rich dataset. They asked a more pointed question: What elements of recovery are so central and widely shared that they transcend all differences in background, substance of choice or recovery pathway?

Their approach was methodical and demanding. They identified 30 different subgroups within the original sample: gender based, different racial and ethnic groups, people with varying levels of education and addiction severity, people with other co-morbidities, those who'd used treatment versus those who hadn't and many others.

For an element to be considered "core" to recovery, it had to be endorsed by at least 80% of people and rank in the top 10 across every single subgroup. Out of dozens of possibilities (167 to be more precise) only four such elements emerged:

recovery is a process of growth and development

recovery means being honest with oneself

recovery requires taking responsibility for what one can change

recovery involves reacting to life’s ups and downs in a more balanced way

Alongside these, four other prevalent elements appeared, nearly universal: committing to abstinence or non-problematic use, the ability to enjoy life without substances, handling negative emotions without them, and living a life that contributes to others.

Notably, those items that ranked in the top 3 overall (ie, a process, honesty, and responsibility) also ranked within the top 3 in most (21 of 30) subgroups, demonstrating their wide acceptance. The prominence of these elements, collectively, may reflect recognition of the damage that addiction inflicts in each of these specific areas. Restoration of what was lost then becomes the hallmark of recovery.

There’s something interesting that I found myself pondering on, when I stepped back and looked at these findings. Almost all of the “core” and “prevalent” elements people chose sit squarely in the realm of personal or human capital. What’s missing are the social, community and material foundations that we know are so often decisive: housing, work, supportive networks. It seems that when people define recovery for themselves, they speak about who they are becoming, not what resources they have. Yet in practice, we know both are essential. Inner change without outer support rarely lasts.

The Way Forward

What emerges from this research is a picture of recovery that is both more complex and more hopeful than traditional definitions suggest. Recovery isn't simply about stopping a destructive behaviour, but rather about reconsidering one’s identity, seeing things in a new light and embracing a new way of living. This understanding doesn't diminish the importance of abstinence for many people, but it places addictive behaviours changes within a broader context of human flourishing.

Perhaps most importantly, this research demonstrates that despite the diversity of paths to recovery, there is indeed a shared understanding among those who have lived this experience. Recovery may be deeply personal, but it's not entirely relative. At its heart, it involves reclaiming authenticity, building emotional resilience, committing to growth and finding ways to contribute to something larger than oneself.

For the millions of people affected by addiction, whether personally or through loved ones, this research offers both validation and hope. It confirms that recovery is possible, that it's profound and that it involves becoming not just someone who doesn't use substances or engages in addictive behaviours, but someone who has learned to navigate life with honesty, responsibility and purpose.

And if you commission, design or deliver services build recovery environments that reflect what people actually live. Understand what change means for people, then resource, deliver and measure that.