The First Numbers to Prove Recovery Works

An ambitious national survey out today aims to quantify how recovery from addiction benefits us all. Experts dispute the validity of the data, but can at least agree that this is a good start.

Getting the measure of recovery photo

A new survey shows that recovery is good for you—and for your family, friends, coworkers and even the USA. This may sound like a no-brainer. But the "good" part has never actually been measured, and as it turns out, the numbers do hold some surprises. They also make a watertight case against stigma, according to Faces and Voices of Recovery (FAVOR), the advocacy group whose "Life in Recovery" report was released today.

There’s no shortage of research into how addiction crashes lives. But those interested in how recovery reboots lives will find little reading material. Because of healthcare's focus on the causes and costs of substance use disorder, combined with widespread social disapproval of addicts, the research community has largely ignored the many success stories.

Inspiring anecdotes about post-addiction life are all well and good, but when advocates meet with policymakers, they need cold, hard facts. FAVOR's survey—the first-ever large-scale study on recovery—is a start at digging up the data about the dramatic gains in life functioning made by people in recovery.

Yet outside researchers, while praising the study as a first step, question the data's immediate value, due to limitations in the way the survey was done. The results almost certainly present a picture that is rosier than reality, they say. "The data we can take from this study is of modest value," says Arun Singh, DO, unit chief of the inpatient Addiction Recovery Services program at the Weill Cornell Medical Center. "I can't really say how it applies to my knowledge of recovery."

Judge for yourself. Here are the survey's highlights:

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Finances: Financial problems, like debt and bankruptcy, were reduced by half after recovery. Over 80% of sober folks paid taxes, compared to just more than half in active addiction. By contrast, only about 54% of the general population paid income taxes. That's right: When tax day arrives, the entire country acts like the much-maligned active addict.

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Family Life: Participation in family activities increased by 50%, while domestic violence decreased from over 40% to 10%. In the general population, domestic violence affects 25% of women and 7.6% of men

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Health: Two-thirds of those in active addiction had untreated mental health problems, but those numbers decreased by a factor of more than four with recovery. Visits to the ER decreased by a factor of 10. Predictably, people in recovery ate healthier, exercised more and got regular medical checkups. While 39% of active addicts lacked health insurance, only 20% of those in recovery went without coverage—a bit more than the 15.7% of Americans with no insurance.

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Legal Problems: Arrests fell tenfold, jail time sevenfold. Problems stemming from DWIs and damaged property dropped significantly. Only 5% of those in recovery were arrested—marginally more than the 4.4% national arrest rate.

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Work and School: Half of those surveyed had been fired while addicted. However, for those in recovery, employment increased by 50% and instances of missed work or poor job reviews fell. Twice as many people in recovery started their own businesses and furthered their education. 87% reported steady employment, making their unemployment rate about twice as high as the latest 7.6% national average

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Civic Involvement: Voting among people in recovery increased significantly, while volunteering jumped nearly threefold. 87% cast ballots, well above the 53.6% of Americans who took part in last year's presidential election. With 84% of people in recovery volunteering, this survey showed that they dedicate far greater service than most Americans, who volunteer at a rate of 26.8%.

Such improvements may be expected, but to have them quantified begins to capture the details of recovery-related transformations, FAVOR Executive Director Patricia Taylor says.

With 84% of people in recovery volunteering, they dedicate far greater service than most Americans, who volunteer at a rate of 26.8%.

Researchers and clinicians agree that the survey begins to fill a void in information. "For people in long-term recovery, there isn't any data describing the positive changes that occur," Singh says. Most recovery research is limited to small populations at specific clinics.

Large-scale studies also help clarify what works best in recovery, says Warren Bickel, PhD, director of the Addiction Recovery Research Center at Virginia Tech Carilion Research Institute. Such details as the extent of life improvements after a few years in recovery could help determine if there's a time threshold for successful recovery. Bickel gives the example of studies done on weight loss, which showed that only people who both dieted and exercised saw any benefits. Similarly, the specific effects of recovery "are only obvious in hindsight," he says.

Only one other large-scale recovery study has been done, according to Bickel: a 2004 study with a similar number of subjects (4,422 vs. the 3,228 in FAVOR's survey) that looked primarily at the degree to which recovering alcoholics had stopped abusing alcohol.

By contrast, the FAVOR research gives numbers to "lifestyle" effects. “The results can give hope to individuals struggling with addiction and to family members that think it's never going to get better," says Alexandre B. Laudet, PhD, who heads the Center for the Study of Addictions and Recovery at National Development and Research Institutes (NDRI), a public health research nonprofit that helped FAVOR develop and administer the survey. (Donations from FAVOR's 30,000-plus members funded the study.)

The data can also help advance the large goals of the recovery movement, in which FAVOR plays an important role. Its priorities include:

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Fighting Stigma: "I hope these findings get policymakers to consider those in recovery not as people with clouds over their heads, but as people who contribute, pay taxes and vote, and deserve the same respect as anyone with a disease," Laudet says.

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Legislation: End housing, employment and other policies and regulations that discriminate against people in recovery.

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Research: Invest more federal funds in recovery-specific studies at the National Institutes of Health and other research organizations.

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Resources: Include recovery issues in local, state and national agencies that address addiction. Healthcare programs like Medicaid should provide access and funding for recovery treatment.

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Awareness: Launch a public awareness campaign about the benefits of recovery—and of the people in recovery.

The economic findings are especially useful. "The only way to convince the public and policymakers about the impact of recovery is to show its effects on the pocketbook," Laudet says. Recovery saves the nation money on costly ER visits and addiction-related legal problems, while returning addicts to work and the tax rolls.

Yet the numerous limitations of the study may limit its effectiveness as an advocacy tool. "I wouldn't necessarily take this data and show it to a congressman," Singh says.

The biggest problem is that the study drew from a group of people who are far from representative of the nation’s recovery population, he says. FAVOR recruited members of its own site and via interested organizations and individuals. They were mostly college educated, employed and white—a highly advantaged group relatively free of non-addiction discrimination, he says. Such a privileged population is more likely, for example, to have above-average tax-payment rates.

In addition to sampling bias, only those familiar with FAVOR would have completed the survey, and those respondents received incentives to do so. They earned a 10% discount at FAVOR's online store, which sells recovery-related media and advocacy materials. FAVOR fans could be more likely to agree with the group's mission and therefore more likely to emphasize the positive. (To help combat reporting bias, FAVOR mixed positive and negative items.)

The research did not follow individuals as they proceeded from addiction through recovery. Instead, it provides a "snapshot" of different individuals at a single point in time. This method, by comparing people who were addicted or began recovery in different years or even decades, could also have warped results, Bickel says. "Could it be that there are generational differences in recovery?" he says. "Whether recovery in the younger population is different is a worthwhile question."

The study also failed to differentiate responses by substance. All these limitations should make clinicians, as well as advocates, somewhat wary of the study's results, Singh says. Given the organization's resource limitations, this study was likely the best they could do, he adds.

Still, he praises FAVOR for opening a dialogue on the subject of recovery research and the importance of doing larger and better-funded studies. "What's good about it is, there seems to be a signal coming through showing the benefits of recovery," he says. "If you presented this data to the NIH, and said, 'We're getting a signal,' they might fund future, prospective studies."

Bickel agrees. "A ‘snapshot’ study is a worthwhile beginning. This is usually how these things start,” he says. Bickel's center is designing a study of roughly 3,500 people longitudinally, with yearly follow-up, drawing from the International Quit & Recovery Registry, which covers all 50 states and 17 countries.

Advocates, of course, are all for further research. "We need long-term studies," Laudet says. "We don't know how much the nation saves when people are in recovery."

Michael Dhar is a medical and science writer who has written for Livescience.com, Science & Medicine, Iowa Outdoors and various medical and research institutions.