Taking a Public Health Approach to Recovery

National Recovery Month provides a powerful reminder that recovery from substance use disorders and mental illness happens, with the right supports, realistic timeframes, a large dose of humanity, and the hope that positive change brings. Data from the National Survey on Drug Use and Health (NSDUH) estimates that, in 2024, over 23 million, or 74.3%, of adults aged 18 or older who ever perceived themselves as having a problem with use of alcohol or drugs considered themselves to be in recovery or to have recovered. The corresponding estimate for adults perceiving themselves as ever having had a mental health issue but had recovered was 45 million, or 66.9%. These millions of Americans, our family members, friends, colleagues, and neighbors, are proof that recovery happens every day.

To recognize these individuals and the hope they embody, every September, the U.S. observes National Recovery Month. Started in 1989 by the Substance Abuse and Mental Health Services Administration (SAMHSA) to recognize addiction treatment professionals, National Recovery Month has since evolved to focus on the recovery that is a positive outcome of treatment. In 2011, SAMHSA broadened Recovery Month to encompass not only recovery from substance use disorders but also mental health and co-occurring disorders, under the broad rubric of behavioral health. Starting in 2020, Faces & Voices of Recovery took over as the core organizer of Recovery Month events and in 2022, created a permanent tagline of “Every Person. Every Family. Every Community” to recognize the universal nature of recovery.

 This September, in celebration of Recovery Month, we highlight evidence-based principles of recovery to help guide policies related to substance use disorders and mental illness.

What is Recovery?

SAMHSA defines recovery as “a process of change through which individuals improve their health and wellness, live a self-directed life, and strive to reach their full potential;” and identifies four major dimensions supporting a life in recovery: Health, Home, Purpose, and Community.

• Health means overcoming or managing one’s diseases or symptoms, including substance use disorders and mental illnesses, and making informed, healthy decisions that support physical and emotional well-being.
• Home is having a stable and safe place to live.
• Purpose includes being engaged in meaningful daily activities, such as a job, education, volunteering and “having the independence, income, and resources to participate in society.”
• Community involves having supportive relationships and social networks that provide friendship, love, and hope.

Key Principles of Recovery

The awareness of common risk factors, the often long-term nature of substance use disorder and mental health conditions, and the real possibility of recovery all have significant implications for policy approaches to substance use disorders and mental illnesses. Below we share some key principles of recovery that policy-makers should keep in mind as they think about how to help more people move towards—and stay—in recovery. Recovery is not a solitary endeavor. Recovery requires resources, support, and commitments from others – and not just in the short-term.

1. Recovery is a process, not an end-goal. Decades of research have led to the broadly accepted understanding that substance use disorders and mental illnesses—especially those that are more severe—are complex, chronic diseases involving interactions of genetics, the environment, individual life experiences, and brain structures. This means their symptoms can persist for a long time or may recur after periods of stability. Extensive research has also conclusively demonstrated that trauma, adverse childhood experiences, and isolation and loneliness are shared risk factors for substance use disorders and many mental illnesses.  Since recovery is a process, we need to treat substance use and mental health disorders as lifelong, chronic illnesses that require ongoing care and monitoring. 

This also means that many people with substance use disorders and mental illnesses need resources and services over the long term. Research has demonstrated that the median time from a first treatment episode to last use was nine years for adults with a substance use disorder. A different study found that the average number of recovery attempts made among adults reporting prior problems with drugs or alcohol was 5.35, and was significantly higher for people with depression or anxiety disorders. 

This means that funding short-term withdrawal management without ongoing care or support services will not result in optimal outcomes for most people, that expecting people to have established solid recovery after 30, 60, or even 90 days of treatment is unrealistic, and that measuring outcomes of evidence-based treatments and recovery supports may need to be on the order of years, and not months. Instead, a recovery process aligned with the science calls for long-term services that include combinations of medications, counseling, therapy, and recovery check-ups, care of associated physical health conditions, peer support, case management and care coordination, recovery and other housing assistance, and other recovery supports, all delivered according to individualized needs, without judgment, and financed through reliable health insurance coverage.

2. Effective prevention recognizes Health, Home, Purpose, and Community as its focus. Effective prevention efforts cannot simply focus on avoiding individual initiation of substance use or promoting individual happiness.  Since recovery is best supported when someone has a stable home, purpose, and community, policies that reduce exposure to violence, support stable housing, food security, and economic opportunities for families, and strengthen the vitality and health of communities will be the most successful in prevention of substance use disorder.  This is why community-focused prevention programs such as Communities that Care, for example, are so effective: they focus on the community as the unit of prevention, rather than the individual.

3. To get to recovery, people need health care. For millions of people with substance use disorders and mental illnesses, effective supports and services are grounded in Medicaid. As the single largest payer of mental health and substance use disorder services in the U.S., Medicaid is a lifeline that provides access to needed medications, counseling, other behavioral therapies, peer supports, and hospital and emergency department care if that is needed. Without these services, substance use disorders and mental illness may recur, making it much harder for many people to maintain their engagement in recovery-oriented activities, such as employment, caring for a home, going to school, volunteering, or avoiding isolating themselves. Loss of Medicaid coverage, therefore, has an outsized impact on recovery from substance use disorders and mental illness. At a time when the federal Centers for Medicaid and Medicare Services, Governors, and state Medicaid programs are beginning implementation of the numerous provisions of the OBBA impacting Medicaid, it is important to bear this association in mind.

As the nation wrestles with large scale uncertainties and challenges in addressing long standing issues such as homelessness, overdoses, and suicide, National Recovery Month continues to provide hope that there is a path forward for the millions of Americans with substance use disorders and mental illness.

This understanding is critical given that September is also National Suicide Prevention Month, a time to redouble efforts to ensure people have access to effective services that can save lives and reduce cycles of trauma.

Dennis ML, Scott CK, Funk R, Foss MA. The duration and correlates of addiction and treatment careers. J Subst Abuse Treat. 2005;28 Suppl 1:S51-62. doi: 10.1016/j.jsat.2004.10.013. PMID: 15797639.

Kelly JF, Greene MC, Bergman BG, White WL, Hoeppner BB. How Many Recovery Attempts Does it Take to Successfully Resolve an Alcohol or Drug Problem? Estimates and Correlates From a National Study of Recovering U.S. Adults. Alcohol Clin Exp Res. 2019 Jul;43(7):1533-1544. doi: 10.1111/acer.14067. Epub 2019 May 15. PMID: 31090945; PMCID: PMC6602820.