Introduction: This paper examines life experiences before and during addiction recovery in a large sample of treated and untreated persons in Flanders (Belgium). Methods: A total of 343 participants in recovery from alcohol and/or illicit drug problems (≥3 months) completed the 2022 ‘Life in Recovery’ survey online. Participants were categorized into four groups based on their engagement with treatment services: (1) unassisted recovery, (2) mutual aid support only, (3) formal treatment only, and (4) formal treatment and mutual aid support. The questionnaire was supplemented with open-ended questions about facilitators and barriers to recovery. Findings: Group comparisons revealed significant differences in the severity of dependence and living conditions (recovery strengths and barriers, SABRS) during addiction between those in recovery without treatment and the treatment groups. However, similarities in strengths, barriers, and quality of life during recovery were observed across all groups. Differences in barriers during recovery were attributed to variations in initial conditions rather than treatment engagement. The complementary qualitative analysis revealed that the four clusters experienced similar factors as facilitating and hindering recovery. Discussion: These findings suggest that while various pathways can lead to recovery, those involving formal treatment and mutual aid support may be particularly valuable for individuals facing greater initial barriers and fewer strengths during addiction, highlighting treatment as an important but not universally necessary source of recovery capital.
AshfordR.BrownA.RydingR.CurtisB. (2020). Building Recovery Ready Communities: The Recovery Ready Ecosystem Model and Community Framework. Addiction Research and Theory, 28(1), 1–11. https://doi.org/10.1080/16066359.2019.1571191
2.
BeaulieuM.TremblayJ.BaudryC.PearsonJ.BertrandK. (2021). A systematic review and meta-analysis of the efficacy of the long-term treatment and support of substance use disorders. Social Science & Medicine, 285, 114289. https://doi.org/10.1016/j.socscimed.2021.114289
3.
BestD.SondhiA.BrownL.NisicM.NagelhoutG. E.MartinelliT.van de MheenD.VanderplasschenW. (2021). The strengths and barriers recovery scale (SABRS): Relationships matter in building strengths and overcoming barriers. Frontiers in Psychology, 12, 663447. https://doi.org/10.3389/fpsyg.2021.663447
4.
BestD.SondhiA.PattonD.AbreuV.MartinelliT.BellaertL.VanderplasschenW.NisicM. (2024). A cluster analysis of European life in recovery data: What are the typical patterns of recovery experience? [Article; early access]. Drugs: Education, Prevention & Policy, 9, 1–9. https://doi.org/10.1080/09687637.2024.2311841
5.
BestD.VanderplasschenW.NisicM. (2020). Measuring capital in active addiction and recovery: The development of the strengths and barriers recovery scale (SABRS). Substance Abuse Treatment, Prevention, and Policy, 15(1), 40. https://doi.org/10.1186/s13011-020-00281-7
6.
BestD.VanderplasschenW.Van de MheenD.De MaeyerJ.ColmanC.Vander LaenenF.IrvingJ.AnderssonC.EdwardsM.BellaertL.MartinelliT.GrahamS.HamerR.NagelhoutG. E. (2018). REC-PATH (recovery pathways): Overview of a four-country study of pathways to recovery from problematic drug use. Alcoholism Treatment Quarterly, 36(4), 517–529. https://doi.org/10.1080/07347324.2018.1488550
7.
Betty Ford Institute Consensus Panel. (2007). What is recovery? A working definition from the betty Ford Institute. Journal of Substance Abuse Treatment, 33(3), 221–228. https://doi.org/10.1016/j.jsat.2007.06.001
8.
BunaciuA.BliucA.-M.BestD.HennessyE. A.BelangerM. J.BenwellC. S. Y. (2023). Measuring recovery capital for people recovering from alcohol and drug addiction: A systematic review. Addiction Research and Theory, 32(3), 225–236. https://doi.org/10.1080/16066359.2023.2245323
9.
CloudW.GranfieldR. (2008). Conceptualizing recovery capital: Expansion of a theoretical construct. Substance Use & Misuse, 43(12-13), 1971–1986. https://doi.org/10.1080/10826080802289762
10.
DayE.ManitsaI.FarleyA.KellyJ. F. (2023). A UK national study of prevalence and correlates of adopting or not adopting a recovery identity among individuals who have overcome a drug or alcohol problem. Substance Abuse Treatment, Prevention, and Policy, 18(1), 68. https://doi.org/10.1186/s13011-023-00579-2
11.
De MeyerF.BencherifN.De RuysscherC.LippensL.VanderplasschenW. (2024). Self-change from problems with alcohol and drugs: A scoping review of the literature since 2010. Drug and Alcohol Review, 43(6), 1349–1360. https://doi.org/10.1111/dar.13834
12.
ElmsE.SavicM.BathishR.BestD.ManningV.LubmanD. I. (2018). Multiple pathways to recovery, multiple roads to well-being: An analysis of recovery pathways in the Australian life in recovery survey. Alcoholism Treatment Quarterly, 36(4), 482–498. https://doi.org/10.1080/07347324.2018.1490158
13.
FanA. Z.ChouS. P.ZhangH. T.JungJ.GrantB. F. (2019). Prevalence and correlates of past-year recovery from DSM-5 alcohol use disorder: Results from national epidemiologic survey on alcohol and related conditions-III. Alcoholism: Clinical and Experimental Research, 43(11), 2406–2420. https://doi.org/10.1111/acer.14192
14.
FerriC. P.MarsdenJ.DE AraujoM.LaranjeiraR. R.GossopM. (2000). Validity and reliability of the Severity of Dependence Scale (SDS) in a Brazilian sample of drug users. Drug and Alcohol Review, 19(4), 451–455. https://doi.org/10.1080/713659418
15.
FifeS. T.GossnerJ. D. (2024). Deductive qualitative analysis: Evaluating, expanding, and refining theory. International Journal of Qualitative Methods, 23, 16094069241244856. https://doi.org/10.1177/16094069241244856
16.
González-SáizF.Domingo-SalvanyA.BarrioG.Sánchez-NiubóA.BrugalM. T.de la FuenteL.AlonsoJ. (2009). Severity of dependence scale as a diagnostic tool for heroin and cocaine dependence. European Addiction Research, 15(2), 87–93. https://doi.org/10.1159/000189787
17.
GossopM.DarkeS.GriffithsP.HandoJ.PowisB.HallW.StrangJ. (1995). The severity of dependence scale (SDS): Psychometric properties of the SDS in English and Australian samples of heroin, cocaine and amphetamine users. Addiction, 90(5), 607–614. https://doi.org/10.1046/j.1360-0443.1995.9056072.x
18.
GossopM.MarsdenJ.StewartD. (2002). Dual dependence: Assessment of dependence upon alcohol and illicit drugs, and the relationship of alcohol dependence among drug misusers to patterns of drinking, illicit drug use and health problems. Addiction, 97(2), 169–178. https://doi.org/10.1046/j.1360-0443.2002.00028.x
19.
GranfieldR.CloudW. (1999). Coming clean: Overcoming addiction without treatment. NYU press.
20.
HeiligM.MacKillopJ.MartinezD.RehmJ.LeggioL.VanderschurenL. (2021). Addiction as a brain disease revised: Why it still matters, and the need for consilience. Neuropsychopharmacology, 46(10), 1715–1723. https://doi.org/10.1038/s41386-020-00950-y
HewittA. J. (2007). After the fire: Post traumatic growth in recovery from addictions. University of Bath.
23.
HubbardR. L.CraddockS. G.AndersonJ. (2003). Overview of 5-year followup outcomes in the drug abuse treatment outcome studies (DATOS). Journal of Substance Abuse Treatment, 25(3), 125–134. https://doi.org/10.1016/s0740-5472(03)00130-2
24.
JohannessenD. A.NordfjærnT.GeirdalA. (2019). Change in psychosocial factors connected to coping after inpatient treatment for substance use disorder: A systematic review. Substance Abuse Treatment, Prevention, and Policy, 14(1), 16. https://doi.org/10.1186/s13011-019-0210-9
25.
KaskutasL. A.RitterL. A. (2015). Consistency between beliefs and behavior regarding use of substances in recovery. Sage Open, 5(1), 1–10. https://doi.org/10.1177/2158244015574938
26.
KellyJ. F.BergmanB.HoeppnerB. B.VilsaintC.WhiteW. L. (2017). Prevalence and pathways of recovery from drug and alcohol problems in the United States population: Implications for practice, research, and policy. Drug and Alcohol Dependence, 181, 162–169. https://doi.org/10.1016/j.drugalcdep.2017.09.028
27.
KellyJ. F.HumphreysK.FerriM. (2020). Alcoholics Anonymous and other 12‐step programs for alcohol use disorder. Cochrane Database of Systematic Reviews, 3(3), CD012880. https://doi.org/10.1002/14651858.CD012880.pub2
KlingemannJ. I. (2012). Mapping the maintenance stage of recovery: A qualitative study among treated and non-treated former alcohol dependents in Poland. Alcohol and Alcoholism, 47(3), 296–303. https://doi.org/10.1093/alcalc/agr163
LaudetA.HillT. (2015). Life experiences in active addiction and in recovery among treated and untreated persons: A national study. Journal of Addictive Diseases, 34(1), 18–35. https://doi.org/10.1080/10550887.2014.975615
32.
LawrinsonP.CopelandJ.GerberS.GilmourS. (2007). Determining a cut-off on the severity of dependence scale (SDS) for alcohol dependence. Addictive Behaviors, 32(7), 1474–1479. https://doi.org/10.1016/j.addbeh.2006.09.005
33.
MarcovitzD. E.McHughK. R.RoosC.WestJ. J.KellyJ. (2020). Overlapping mechanisms of recovery between professional psychotherapies and Alcoholics anonymous. Journal of Addiction Medicine, 14(5), 367–375. https://doi.org/10.1097/adm.0000000000000601
34.
MartinG.CopelandJ.GatesP.GilmourS. (2006). The severity of dependence scale (SDS) in an adolescent population of cannabis users: Reliability, validity and diagnostic cut-off. Drug and Alcohol Dependence, 83(1), 90–93. https://doi.org/10.1016/j.drugalcdep.2005.10.014
35.
MartinelliT. F.NagelhoutG. E.BellaertL.BestD.VanderplasschenW.van de MheenD. (2020). Comparing three stages of addiction recovery: Long-term recovery and its relation to housing problems, crime, occupation situation, and substance use. Drugs: Education, Prevention & Policy, 27(5), 387–396. https://doi.org/10.1080/09687637.2020.1779182
36.
MellorR.LancasterK.RitterA. (2021). Examining untreated and treated alcohol problem resolution in an Australian online survey sample. Drug and Alcohol Review, 40(6), 1037–1046. https://doi.org/10.1111/dar.13257
37.
MillerW. R.WilbourneP. L. (2002). Mesa grande: A methodological analysis of clinical trials of treatments for alcohol use disorders. Addiction, 97(3), 265–277. https://doi.org/10.1046/j.1360-0443.2002.00019.x
38.
NealeJ.NettletonS.PickeringL. (2014). Gender sameness and difference in recovery from heroin dependence: A qualitative exploration. International Journal of Drug Policy, 25(1), 3–12. https://doi.org/10.1016/j.drugpo.2013.08.002
39.
Price-RobertsonR.ObradovicA.MorganB. (2017). Relational recovery: Beyond individualism in the recovery approach. Advances in Mental Health, 15(2), 108–120. https://doi.org/10.1080/18387357.2016.1243014
40.
SmartR. G. (2007). Natural recovery or recovery without treatment from alcohol and drug problems as seen from survey data. In KlingemannH.SobellL. C. (Eds.), Promoting self-change from addictive behaviors (pp. 59–71). Springer Science + Business Media. https://doi.org/10.1007/978-0-387-71287-1_3
41.
SteaJ. N.YakovenkoI.HodginsD. C. (2015). Recovery from cannabis use disorders: Abstinence versus moderation and treatment-assisted recovery versus natural recovery. Psychology of Addictive Behaviors, 29(3), 522–531. https://doi.org/10.1037/adb0000097
42.
TörrönenJ. (2022). Relational Agency and Identity Navigation in Life Stories on Addiction: Developing Narrative Tools to Analyze the Interplay Between Multiple Selves. International Journal of Qualitative Methods, 21, 16094069221078378. https://doi.org/10.1177/16094069221078378
43.
UK Drug Policy Commission. (2008). The UK drug policy commission recovery Consensus group: A vision of recovery. UK Drug Policy Commission.
44.
van den BrinkW. (2005). Verslaving, een chronisch recidiverende hersenziekte. Verslaving, 1(2), 47–53. https://doi.org/10.1007/BF03075325
45.
VanderplasschenW.RappR. C.De MaeyerJ.Van Den NoortgateW. (2019). A meta-analysis of the efficacy of case management for substance use disorders: A recovery perspective. Frontiers in Psychiatry, 10, 186. https://doi.org/10.3389/fpsyt.2019.00186
46.
Van NieuwenhuizenC.Janssen-de RuijterE. A. W.NugterM. (2017). Handleiding manual manchester short assessment of quality of life (MANSA). Stichting QoLM NL.
47.
Van SteenbergheT.ReynaertD.RoetsG.De MaeyerJ. (2020). Ervaring werkt?!. Acco.
48.
WhiteW.CloudW. (2008). Recovery capital: A primer for addictions professionals. Counselor, 9, 22–27.
49.
WitkiewitzK.PfundR. A.TuckerJ. A. (2022). Mechanisms of behavior change in substance use disorder with and without formal treatment. Annual Review of Clinical Psychology, 18, 497–525. https://doi.org/10.1146/annurev-clinpsy-072720-014802
