What is recovery? With Dr. Katie Witkiewitz

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Six percent of American adults say they are “in recovery” from a problem with alcohol or other drugs, but it’s not always clear exactly what that means. Even among researchers who study the concept, the definition of “recovery” is far from settled: does it require abstinence? does it necessarily involve lofty concepts like spirituality and citizenship? is the main point the absence of problems, or is there more to it than that?

Dr. Katie Witkiewitz is a psychology researcher who, for many years, shied away from studying recovery in her academic work. Recently, however, her work on the patterns and predictors of substance use problems has led her back to that loaded term, and she has since arrived at a broader and more encompassing definition of recovery than you might expect. We talk about why she advocates for an expanded and transformed understanding of recovery, how she makes sense of the phenomenon of addiction, and how the research on such foundational questions, while extremely complex, hold out tremendous hope and possibilities for healing.

Katie Witkiewitz is Regents' Professor of Psychology and a Scientist at the Center on Alcohol, Substance use, And Addictions (CASAA) at the University of New Mexico. She received her Ph.D. from the University of Washington in 2005. She is also a licensed clinical psychologist and has worked extensively on developing and disseminating a novel psychotherapy for substance use disorder: mindfulness-based relapse prevention. Her website is https://abqresearch.org/ and you can find her on Twitter.

In this episode:

- A driving commitment for her work: “Everyone's doing the best they can at all times, with what we have in front of us, and there are causes and conditions that bring us to the places where we are."
- Katie’s surprising research findings on just how many people do well after treatment for alcohol use problems—including fairly large proportions who improve their well-being in non-abstinent recovery (see her paper What is Recovery?)
- Historical perspectives on the definition of recovery (see also this 2019 piece from the recovery science research collaborative)
- Upwards of 80% of people with Substance Use Disorder never get treatment. Why? Katie suggests that a lack of nuance about the many paths to recovery might be one important barrier. (see also Andrew Tatarsky on “Harm Reduction Psychotherapy”)
- How to talk about an expanded conception of recovery while still respecting and celebrating the benefits of traditional 12-step recovery.
- Disparities, paternalism, and racism in the research on substance use disorders, and her thoughts on some ways to ameliorate those problems.
- Some practical tips for avoiding common thinking traps about substance use problems, like the “abstinence violation effect” (aka the f*ck-it effect).
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