Content uploaded by John F Kelly
Author content
All content in this area was uploaded by John F Kelly on Nov 20, 2015
Content may be subject to copyright.
http://informahealthcare.com/art
ISSN: 1606-6359 (print), 1476-7392 (electronic)
Addict Res Theory, Early Online: 1–5
!
2014 Informa UK Ltd. DOI: 10.3109/16066359.2014.930132
THINK PIECE
A biaxial formulation of the recovery construct
John Francis Kelly and Bettina Hoeppner
Department of Psychiatry, MGH Center for Addiction Medicine and Harvard Medical School, Boston, MA, USA
Abstract
The term ‘‘recovery’’ in the substance use disorder (SUD) field has been used generally and non-
technically to describe global improvements in health and functioning typically following
successful abstinence. More recently, however, in an attempt to reduce the stigma and
negative public and clinical perceptions regarding remission potential for individuals suffering
from SUD, ‘‘recovery’’ has been used more strategically to instil hope and to serve as an
organizing paradigm that has inspired a growing recovery movement. In addition, with
‘‘recovery’’ gaining momentum internationally within governments’ national health care
agencies, there is increasing pressure to operationalise this construct as without it, it is difficult
to develop, commission, and deliver the tailored packages of recovery support services needed
to help individuals suffering from SUD. Initial attempts to define recovery and delineate its
constituent parts have agreed on major elements, but differ on important subtleties; generally
lacking has been a conceptual grounding of these definitions. The goal of this article is to
promote further thought and debate by offering a conceptual basis for, and description of, the
recovery construct that we hope enhances clarity and measurability. To accomplish this, we
review existing definitions of recovery and offer a simplified bi-axial formulation and definition,
reciprocal in nature, and grounded in stress and coping theory, which mirrors conceptually
original formulations of the addiction syndrome.
Keywords
Addiction, policy, recovery, remission,
terminology, substance use disorder
History
Received 2 January 2014
Revised 27 May 2014
Accepted 28 May 2014
Published online 23 June 2014
Origin of the ‘‘recovery’’ construct
The term ‘‘recovery’’ in the substance use disorder (SUD)
field has been used non-technically to describe, in a general
way, improved health and functioning following abstinence
(White, 1998). More recently, in an attempt to help offset the
stigma and common nihilistic public, and often clinical,
perceptions regarding remission potential for individuals
suffering from SUD, ‘‘recovery’’ has been used more
strategically in place of ‘‘disease/disorder’’ (e.g. ‘‘addiction
recovery management’’ instead of ‘‘disease management’’) to
instil hope and to serve as an organizing paradigm that has
inspired a growing ‘‘recovery movement’’ (White, 2007). As
such, this construct has gained considerable momentum in the
USA, UK, and other countries (Substance Abuse and Mental
Health Services Administration, 2011; UK Drug Policy
Commission, 2008; White, 2007)
With ‘‘recovery’’ gaining momentum as an organizing
paradigm in many countries (El-Guebaly, 2012; Substance
Abuse and Mental Health Services Administration, 2011; UK
Drug Policy Commission, 2008; White, 2007) a need to
define this term and construct has become increasingly
necessary. Without greater clarity, it is challenging to develop,
commission, and deliver the tailored packages of recovery
support services needed to support individuals beginning
recovery. Additionally, important payers and other stake-
holders in the field are beginning to scrutinize the construct
and make it operational for purposes of measurement and
third party reimbursement for recovery support services
(Knopf, 2011; El-Guebaly, 2012). To this end, considerable
expert thought has been devoted to defining recovery (The
Betty Ford Institute Consensus Panel, 2007), resulting in
positive and welcome initial attempts to delineate the
construct and its constituent parts. The resulting definitions
and operationalisations have been many and varied, agreeing
on major dimensions, but differing on important subtleties.
Generally lacking has been a conceptual grounding of these
definitions; a recent comprehensive review on the meanings
of addiction recovery by El-Guebaly (2012) concluded that
‘‘a consensual theoretical framework of addiction recovery
remains to be elaborated...’’.
To this end, the goal of this article is to stimulate further
thought and debate by offering a theoretical basis for, and
description of, the recovery construct that we hope enhances
clarity and measurability, and stimulates further discussion.
To accomplish this goal, we review current definitions of the
recovery construct and offer a simplified bi-axial formulation
and definition grounded in stress and coping theory
(Folkman, 1984), which mirrors, conceptually, original
formulations of the addiction syndrome (Edwards, 1986;
Edwards & Gross, 1976).
Correspondence: John Francis Kelly, Department of Psychiatry, MGH
Center for Addiction Medicine, 60 Staniford Street, Boston, MA 02114,
USA. E-mail: jkelly11@mgh.harvard.edu
Addict Res Theory Downloaded from informahealthcare.com by john kelly on 06/30/14
For personal use only.
‘‘Recovery’’ as moving beyond abstinence, sobriety
and remission
One essential aspect of the recovery construct is that it is
meant to encompass broader biopsychosocial improvements
and attainments beyond substance ‘‘non-use’’, that typically
have been captured by terms such as ‘‘abstinence’’, ‘‘sobri-
ety’’, and ‘‘remission’’. The recovery construct recognizes
and incorporates these broader contextual factors that are
correlated with successful abstinence or remission. Many in
the addiction and recovery field question whether anyone has
the authority to define ‘‘recovery’’, as it signifies such a
profound and personal experience, yet, several working
definitions from various organizations have been proposed.
Table 1 outlines some of these more prominent definitions
emanating from the Center for Substance Abuse Treatment
(CSAT), the American Society of Addiction Medicine
(ASAM), the Betty Ford Institute (BFI), the UK Drug
Policy Commission (UKDPC), the Scottish Government,
and the US Substance Abuse and Mental Health Services
Administration (SAMHSA). Recovery is variously described
as a ‘‘lifestyle’’ (‘‘What is recovery? A working definition
from the Betty Ford Institute’’, 2007), a ‘‘process’’ (Center
for Substance Abuse Treatment, 2005; Substance Abuse and
Mental Health Services Administration, 2011; UK Drug
Policy Commission, 2008), or as a ‘‘state’’ (American
Society of Addiction Medicine, 2005). Most define it as
requiring abstinence/sobriety, while the others (Substance
Abuse and Mental Health Services Administration, 2011; UK
Drug Policy Commission, 2008) describe it as ‘‘sustained
control’’ and characterize it less specifically as having
attendant improvements in ‘‘health and wellness’’. Most
mention aspects of wellness, health, quality of life, and three
take an extra step in defining recovery as including elements
of ‘‘citizenship’’ or social participation.
Highly influential individuals in the addiction recovery
arena, who have provided much of the influential narrative
and explication of the recovery construct (e.g. William L.
White), have also offered their own definitions that capture
many of these same elements. White (2007) defines recovery
with a focus on the individual, consequently defining recovery
as first and foremost an individual ‘‘experience’’ (White,
2007), but otherwise contains many of these same dimen-
sions. Additional recovery-oriented organizations have chosen
not to provide an objective definition; instead, leaving it to
individual sufferers to decide for themselves (e.g. ‘‘You’re in
recovery when you say you are’’; Valentine, 2011).
The publisher of the most widely used diagnostic coding
system in the USA, the American Psychiatric Association
(APA), also briefly mentions ‘‘recovery’’, but favours the
medical term, ‘‘remission’’, to describe the process of
improvement in health and functioning. The fourth edition
of the Diagnostic and Statistical Manual (DSM) of the APA
(American Psychiatric Association, 1994) details operation-
ally defined specifiers of ‘‘remission’’ along two dimensions
of time and remission completeness (i.e. early/sustained;
partial/full remission). ‘‘Recovery’’ itself it is rarely men-
tioned, but when it is, it is specified purely in terms of
substance remission (American Psychiatric Association,
1994): ‘‘The differentiation of Sustained Full Remission
from recovery (no substance use disorder) requires consider-
ation of the length of time since the last period of disturbance,
the total duration of the disturbance, and the need for
continued evaluation.’’
SAMHSA’s (2011) working definition of recovery has
attempted to incorporate recovery from both mental illness
and substance use disorder. Elaborating further, SAMHSA
(2011) states that recovery is supported by four factors:
Health: overcoming or managing one’s disease(s) as well as
living in a physically and emotionally healthy way; Home:
having a stable and safe place to live; Purpose: meaningful
daily activities, such as a job, school, volunteerism, family
caretaking, or creative endeavors, and the independence,
income and resources to participate in society; and
Community: relationships and social networks that provide
support, friendship, love, and hope. In many ways, these
supportive factors relate to Maslow’s process of self-actual-
ization (Maslow, 1968). Maslow proposes a multi stage
process beginning with physiological needs (e.g. oxygen,
water, food), safety needs (protection from physical harm),
Table 1. Prominent addiction recovery definitions.
Source Year Definition
Center for Substance Abuse Treatment (CSAT) 2005 Recovery from alcohol and drug problems is a process of change through which an
individual achieves abstinence and improved health, wellness and quality of life
American Society of Addiction Medicine 2005 A patient is in a ‘‘state of recovery’’ when he or she has reached a state of physical and
psychological health such that his/her abstinence from dependency-producing drugs
is complete and comfortable.
Betty Ford Institute Consensus Panel 2006 A voluntarily maintained lifestyle characterized by sobriety, personal health, and
citizenship
UK Drug Policy Commission 2008 The process of recovery from problematic substance use is characterised by voluntarily-
sustained control over substance use which maximises health and wellbeing and
participation in the rights, roles and responsibilities of society
Scottish Government 2008 A process through which an individual is enabled to move on from their problem drug
use, towards a drug-free life as an active and contributing member of society
SAMHSA 2011 Recovery from mental disorders and substance use disorders is a process of change
through which individuals improve their health and wellness, live a self-directed life,
and strive to reach their full potential.
2 J. F. Kelly & B. Hoeppner Addict Res Theory, Early Online: 1–5
Addict Res Theory Downloaded from informahealthcare.com by john kelly on 06/30/14
For personal use only.
belongingness needs (e.g. love, affection, affiliation), and
esteem needs (self-confidence, self-respect from authentic
achievement). According to Maslow, once these needs are
met, one can ‘‘self-actualize’’ – that is, feel fully alive, good,
and experience meaning in life. Analogously, from an SUD
recovery standpoint, individuals may need physiological
stabilization (e.g. medically managed detoxification), safe
housing (e.g. Oxford House, sober living), a sense of
belonging (e.g. recovery community support and connection),
and self-esteem (e.g. elevated by one’s ability to sustain
remission and improve one’s quality of life). These elements
also can all be included under the heading of ‘‘recovery
capital’’ as espoused by (Granfield & Cloud, 1999). Recovery
capital (RC) is defined as the breadth and depth of internal
and external resources that can be drawn upon to initiate and
sustain recovery (Granfield & Cloud, 1999, 2004).
Areas in need of clarification
One important question related to each one of these defin-
itions on close examination is whether they are intended
merely as descriptive in a general way - of being generally
true of most individuals ‘‘in recovery’’, or whether their
component parts are designed to serve as specific facets from
which criteria are to be derived in order to categorize
someone as being ‘‘in recovery’’. This distinction is import-
ant, when scientific endpoints or third party payments are to
be defined. Yet current definitions of ‘‘recovery’’ provide
little guidance on this point.
One such area in need of clarification is the role of
personal health in the recovery process. Almost all definitions
include some mention of personal health. Definitions differ in
their specificity of how health is to be understood within the
context of the recovery process. The ASAM, for example,
suggests that recovery merely entails reaching a state of health
such that ‘‘abstinence ... is complete and comfortable’’.
Other definitions, however, are vaguer and potentially more
encompassing, such as definitions by SAMHSA and CSAT, in
which recovery is described as ‘‘a process ... through which
individuals improve their health’’ or ‘‘achieve ... improved
health’’. The question arises as to what kind of health
improvements should be considered ‘mandatory’ for an
individual to be considered to be in recovery. For example,
if an individual fails to follow dietary guidelines for exercise
and diet, would those actions entail a failure to maximize
personal health? If a person continues to smoke cigarettes,
would that individual be viewed as not in recovery? If so, the
standards applied to persons in recovery would appear to be
more stringent than the standards lived up to by the majority
of the population.
A similar concern arises in the consideration of the idea of
citizenship. Fewer definitions mention citizenship than health,
but several still do. For example, both the Scottish govern-
ment and the UK Drug Policy Commission define recovery
partially as movement towards a ‘‘life as an active and
contributing member of society’’ or a process through which
one maximizes ‘‘participation in the rights, roles and
responsibilities of society’’. These definitions may merely
reflect gainful employment, paying of taxes, or the fulfillment
of other basic societal roles. They may also, however, suggest
a more active role. The Betty Ford institute, for example,
further defines its mention of ‘‘citizenship’’ as ‘‘working
towards the betterment of one’s community’’ (The Betty Ford
Institute Consensus Panel, 2007), suggesting a far more active
societal role than the average citizen evidences. While such
activities are certainly in line with working 12-step mutual-
help organization principles, for example, and thus are likely
to support recovery, should they be necessary components of
the definition of ‘‘recovery’’? Should recovery-oriented
programs only be reimbursed if their clientele actively
contribute to the betterment of their community? Should
efficacy studies of such programs use citizenship as a main
endpoint for analysis? Not only are such endpoints difficult to
concretely define, they also impose a standard on persons in
recovery that is unlikely to be reached by the general
population, most of whom do not have the added challenges
of cognitive and affective impairment that many attempting
addiction recovery do.
Bi-axial formulation of the recovery construct
Most proposed definitions of ‘‘recovery’’ have been explicitly
stated as provisional or working definitions, and have
garnered attention and scrutiny at various levels internation-
ally (White, 2007, 2010; El-Guebaly, 2012). We believe they
capture many of the critical challenges facing individuals
engaged in the recovery process (Laudet, 2007; Laudet &
White, 2008). Some have argued that some recovery defin-
itions evoke controversy by perhaps being overly broad,
setting too high a bar for some to reach (e.g. working towards
the betterment of one’s community; The Betty Ford Institute
Consensus Panel, 2007). This complication might be avoided
by more clearly distinguishing between remission from the
SUD on the one hand, and the accruement of recovery capital,
on the other. Mirroring the initial bi-axial formulation of the
dependence/addiction syndrome (Edwards & Gross, 1976;
Edwards, 1986), below we introduce and discuss a bi-axial
formulation of the recovery construct that we hope will help
add clarity by separating remission from the disorder itself
from the positive consequences and accrual of recovery
capital that ensues from this remission, and in turn, may
support it.
In attempting initially to delineate the dependence/addic-
tion syndrome, Edwards and Gross (1976) and Edwards
(1986) proposed a bi-axial formulation of the construct with
the syndrome, per se, on one axis, and the consequences of
the syndrome – the related problems, on the other. We depict
this association in Figure 1(A), below. As the addiction
syndrome shows increasing severity and coherence, asso-
ciated problems also increase. These can include problems to
do with physical and mental health, housing, social relations,
work/educational attainment, and loss of meaning and
purpose. In a similar, bi-axial way, although not described
explicitly as such, White and Cloud (2008) describe how
addiction severity as well as the extent of available recovery
resources (‘‘recovery capital’’) both should be considered in
treatment planning. Specifically, they describe how different
types and levels of intervention and continuing care may be
needed depending not just on the degree and complexity of
the addiction problem, but also on the amount of recovery
DOI: 10.3109/16066359.2014.930132 Recovery 3
Addict Res Theory Downloaded from informahealthcare.com by john kelly on 06/30/14
For personal use only.
resources available to that individual (White & Cloud, 2008,
pgs. 5–6).
As we grapple with defining the construct of ‘‘recovery’’,
and operationally defining it, we propose a similar bi-axial
formulation which mirrors that of Edwards and Gross’ (1976)
addiction syndrome formulation and also echoes aspects of
White and Clouds’ (2008) conceptualization for use n
treatment planning. Differing from both of these former
conceptualizations, however, the model specified here is
grounded conceptually in stress and coping theory and is
intended to describe the reciprocal aspects of the two axes
involved in the recovery process following initial abstinence
and stabilization. Specifically, the key substance-related
component, ‘‘remission’’, is placed on one axis (defined
broadly along a timeline of early remission, stable remission,
sustained remission etc.); on the other axis, similar to
Edwards and Gross’ (1976) formulation of the addiction
syndrome, is placed the positive related consequences ensuing
from, as well as supporting, the achievement of these levels of
remission. Figure 1(B) proposes that as addiction remission
become more stable and prolonged, there are improvements in
physical and mental health, housing and social relations,
educational and work attainment, and an increased sense of
meaning and purpose. Crucially, however, the relationship in
our model is proposed to be reciprocal with greater recovery
capital increasing the chances of ongoing remission – a
relationship that is mediated by absolute reductions in stress
and/or an increased ability to cope with stress, as explained in
more detail below.
Contextualizing recovery: stress and coping
Clearly, the prognosis for addiction recovery is not just a
function of the severity of the illness, but also a function of
resources that one can bring to bear in aid of the recovery
attempt (White & Cloud, 2008). These two joint contributors
can be understood more generally within the Transactional
Model of Stress and Coping (Folkman, 1984). According to
this model, individuals engage in two types of appraisals
when encountering a potentially stressful situation. First, in
the primary appraisal, the significance of a situation is
evaluated as stressful, positive, controllable, challenging or
irrelevant. If it is evaluated as stressful, a secondary appraisal
takes place, in which the controllability of the stressor and the
availability of coping resources are evaluated. At the
biological hormonal system level the hypothalamic-pituit-
ary-adrenal (HPA) axis and glucocorticoids, such as cortisol,
are higher among individuals in early recovery and can
interfere with new learning increasing the risk of a stress-
induced pathway to relapse (Kelly & Yeterian, 2013; Stephens
& Wand, 2012). Applied to the recovery process, this model
suggests that because individuals encounter significant
biopsychosocial stress as they adapt and adjust to the demands
of recovery, HPA-axis sensitivity and dysfunction is likely to
result in high stress hormone (cortisol) release. Greater
availability and accrual of recovery capital will influence
resilience and coping, and help reduce and buffer stress,
including serum cortisol levels, supporting continued remis-
sion. Conceptually, then, the appraisal of, and coping with,
the stressors encountered in recovery will co-vary along with
the degree of available recovery capital. Figure 1 depicts these
two bi-axial formulations of addiction and recovery.
Stress and coping theory would predict that individuals with
less recovery capital/fewer recovery resources are more likely
to appraise situations as more stressful and be less likely to
cope with them effectively, consequently experiencing greater
distress. Therefore, we have placed ‘‘recovery capital’’ on the
x-axis in Figure 1(B), with ‘‘addiction remission’’ on the
y-axis, implying that the causal direction would be one in
which the accruement of recovery capital would result in
greater levels of remission. Clearly, however, more research is
needed to disentangle the causal relationship of these two
constructs. Their covariation is likely high, yet it remains to be
seen if their relationship is causal, and if so, if it is uni- or bi-
directional. The actual empirical nature of this relationship is
also unclear. Depicted in Figure 1(B), for example, is a 1:1
linear relationship: for every one unit in increase in recovery
capital there is a similar magnitude increase in the likelihood of
remission. However, this relationship may be curvilinear,
containing certain important thresholds. It is conceivable, for
instance, that a certain minimum of recovery capital may be
more critical in order to establish remission and gain a foothold
in recovery (e.g. detoxification, safe living environment), but
beyond that, additional recovery capital, while increasing the
probability of remission, may do so at a more gradual rate of
return. Whatever the empirical associations turn out to be, they
are likely to be complex as there will be a large array of
mechanisms at work and different individuals may use
different elements of their recovery capital to sustain remission
and build recovery over time.
Figure 1. Biaxial formulations of the (A) Addiction Construct; and (B)
Recovery Construct.
4 J. F. Kelly & B. Hoeppner Addict Res Theory, Early Online: 1–5
Addict Res Theory Downloaded from informahealthcare.com by john kelly on 06/30/14
For personal use only.
A reciprocating bi-axial definition grounded in stress
and coping theory
Stemming from this bi-axial formulation, we offer the
following that we hope provides a definition with a concep-
tual basis, intended to aid further clarity and stimulate
additional analysis and debate: ‘‘Recovery is a dynamic
process characterized by increasingly stable remission result-
ing in and supported by increased recovery capital and
enhanced quality of life’’.
We believe this definition may be useful since it under-
scores several features. First, it highlights the dynamic nature
of recovery. The word ‘‘process’’ captures this aspect too, but
adding the word ‘‘dynamic’’ emphasizes the variable nature
of the terrain encountered on the varied paths to recovery.
Second, it describes the substance use dimension as being in
‘‘remission’’ which is not synonymous with abstinence or
sobriety (i.e. ‘‘remission’’ suggests that one could be using
substances and exhibit improved functioning at a sub-
threshold level). As such, it caters to those that may be
using in a non-symptomatic manner which may foster greater
sub-cultural or international and cross-cultural utility (e.g. in
the UK). As noted, most importantly, it separates increasingly
stable remission from the disorder itself, from the important
resulting accrual of recovery capital and evokes a reciprocal
aspect whereby increasing remission enhances recovery
capital and vice versa.
Conclusion
Historically, the concept of ‘‘recovery’’ from severe alcohol
and other drug use disorders has been used in a general sense
and non-technically to describe sustained improvement from
the disorder, but has emerged recently as an organizing
construct that may help galvanize stakeholders, reduce stigma
surrounding addiction, and ultimately, increase the public
health of nations suffering under the burden of prodigious and
intransigent substance-related harms. It is often said that ‘‘the
devil is in the details’’ (and he is probably not in recovery).
Consequently, as the field scrutinizes the construct and makes
it operational for purposes of measurement and third party
reimbursement for recovery support services (El-Guebaly,
2012; Knopf, 2011), several prominent definitions have been
offered. Adding to this debate, this paper offers a new
conceptualization and definition, bi-axial and reciprocal in
nature, and grounded in stress and coping theory, intended to
stimulate further discussion and enhance focus, definition,
and clarity.
Declaration of interest
The authors report no conflicts of interest.
References
American Psychiatric Association. (1994). Diagnostic and statistical
manual of mental disorders (4th ed.). Washington, D.C.: Author.
American Society of Addiction Medicine. (2005). Public policy
statement on the state of recovery. Chevy Chase, MD, USA.
Center for Substance Abuse Treatment. (2005). National Summit on
Recovery Conference Report. Paper presented at the National Summit
on Recovery, Washington, D.C.
Edwards, G. (1986). The alcohol dependence syndrome: a concept as
stimulus to enquiry. British Journal of Addiction, 81, 171–183.
Edwards, G., & Gross, M.M. (1976). Alcohol dependence:
provisional description of a clinical syndrome. British Medical
Journal, 1, 1058–1061.
El-Guebaly, N. (2012). The meanings of recovery from addiction:
Evolution and promises. Journal Addiction Medicine, 6, 1–9.
Folkman, S. (1984). Personal control and stress and coping processes: a
theoretical analysis. Journal of Personality and Social Psychology, 46,
839–852.
Granfield, R., & Cloud, W. (1999). Coming clean: Overcoming addiction
without treatment. New York: New York University Press.
Granfield, R., & Cloud, W. (2004). The Elephant that no one sees:
Natural recovery among middle-class addicts. In J. Inciardi & K.
McElrath (Eds.), The american drug scene: An anthology (4th ed.).
Los Angeles, CA: H.W. Roxbury Publishing.
Kelly, J.F., & Yeterian, J. (2013). Mutual-help groups. In: McCrady BS,
Epstein EE (Eds.), Addictions: A comprehensive guidebook (pp. 500–
525). New York: Oxford University Press.
Knopf, A. (2011). Definition of recovery is vague, measures elusive, even
as taxpayers fund services. Alcoholism & Drug Abuse Weekly, 23.
Laudet, A.B. (2007). What does recovery mean to you? Lessons from the
recovery experience for research and practice. Journal of Substance
Abuse Treatment, 33, 243–256.
Laudet, A.B., & White, W.L. (2008). Recovery capital as prospective
predictor of sustained recovery, life satisfaction, and stress among
former poly-substance users. Substance Use and Misuse, 43, 27–54.
Maslow, A.H. (1968). Toward a psychology of being (2th ed.). New
York: Van Nostrand.
Stephens, M.A., & Wand, G. (2012). Stress and the HPA axis: Role
of glucocorticoids in alcohol dependence. Alcohol Research, 34,
468–483.
Substance Abuse and Mental Health Services Administration. (2011).
Results from the 2010 national survey on drug use and health:
Summary of national findings, NSDUH Series H-41, HHS Publication
No. (SMA) 11-4658. Rockville, MD: Substance Abuse and Mental
Health Services Administration.
The Betty Ford Institute Consensus Panel. (2007). What is recovery? A
working definition from the Betty Ford Institute. Journal of Substance
Abuse Treatment, 33, 221–228.
UK Drug Policy Commission. (2008). A vision of recovery: UKDPC
recovery consensus group (summary). United Kingdom.
Valentine, P. (2011). Peer-based recovery support cervices within
a recovery community organization: The CCAR experience. In
J.F. Kelly & W.L. White (Eds.), Addiction recovery management:
Theory, research and practice
. New York, NY: Springer.
White, W.L. (1998). Slaying the dragon: The history of addiction
treatment and recovery in America. IL, USA: Chestnut Health
Systems.
White, W.L. (2007). Addiction recovery: Its definition and conceptual
boundaries. Journal of Substance Abuse Treatment, 33, 229–241.
White, W.L. (2010). Recovery: Old wine, flavor of the month or new
organizing paradigm? Substance Use and Misuse, 43, 1987–2000.
White, W.L., & Cloud, W. (2008). Recovery capital: A primer for
addictions professionals. Counselor, 9, 22–27.
DOI: 10.3109/16066359.2014.930132 Recovery 5
Addict Res Theory Downloaded from informahealthcare.com by john kelly on 06/30/14
For personal use only.
