Abstract
Long-term recovery (LTR) refers to changes occurring over five years or more. This study aimed to establish a typology of individuals in LTR from the perspectives of various stakeholders. Using a qualitative phenomenological approach, semi-structured interviews were conducted with individuals in recovery from substance and behavioral addictions (n = 30), family members (n = 8), and professional therapists (n = 9). The findings identified five distinct types of individuals in LTR: the Fighter, the Avoidant, the Wanderer, the Devout, and the Comrade. These types differ based on identity, recovery goals, and strategies. The study suggests recovery identity acts as a transitional stage, aiding individuals in stabilizing and resuming typical activities. This typology captures the multifaceted nature of addiction recovery, incorporating insights from prior research on identity and recovery strategies. It offers potential for tailoring therapeutic interventions to meet the diverse needs of individuals in recovery.
Introduction
Recovery from addiction is a lifelong process, that involves in-depth identity work for years after the start of cessation (Flaherty et al., 2014). It is a protracted journey that unfolds in stages (Martinelli et al., 2023; The Betty Ford Institute Consensus Panel, 2007). The Betty Ford Institute Consensus Panel (2007) distinct three phases of recovery—each with its own objectives and emphases: early recovery (lasting from 3 to 12 months), which is primarily concerned with abstaining from substance use and preventing relapse; sustained recovery (1–5 years of abstinence), which places a greater emphasis on enhancing life stability; and stable recovery (over 5 years of abstinence), which focuses on skill-building and personal growth.
Significant changes in self-perception, language, and cognition accompany the long-term recovery (LTR) process (Rodriguez & Smith, 2014). In addiction recovery, the identity issue is crucial, as drug users contend with fragmented and inconsistent identities shaped by social exclusion and everyday interactions (Song & Ren, 2021). As highlighted in a meta-analysis by Kemp (2019), addiction damages one’s sense of self, and recovery involves rebuilding one’s identity in parallel with physical healing and changes in relationships. Recovery involves detaching oneself from drug use and, distancing oneself from addictive behaviors, and restoring or forging a new identity (Biernacki, 1986; von Greiff & Skogens, 2021). A change in self-perception occurs during the recovery process, as one adopts a “recovering” social identity, in an effort to prevent relapse (Dingle et al., 2015; Kemp, 2019; Reith & Dobbie, 2012; von Greiff & Skogens, 2021). However, some individuals in recovery perceived conflict between their sense of self and the perception of twelve-steps’ approach on recovering identity; they felt they no longer needed such support, as they had moved past their addiction problems.
Another aspect related to identity concerns stigma and self-stigma among individuals in recovery. Public stigma on addictive disorders suggests that individuals with alcohol or substance dependence are viewed more negatively than those with a gambling disorder (Hing et al., 2016). However, the internalization of stigma among individuals with gambling issues tends to follow a similar pattern to that of those struggling with alcohol or drug dependence (Gavriel-Fried & Rabayov, 2017). Studies of recovery from gambling disorder have identified certain external and internal processes in this regard, with individuals either relying on others, or taking personal initiative for recovery (Vasiliadis & Thomas, 2018). Overall, researchers view addiction as a journey of “identity loss and gain,” highlighting the crucial role played by identity reconstruction in the recovery process (Best et al., 2016; Dingle et al., 2015). Considering the existing knowledge on the significance of identity transformation in the process of recovery, the present study examined the various types of individuals in LTR, and the identity transformation that occurs once recovery has been established.
Multiple Perspectives About Recovery
Stakeholders vary in their insights into the recovery process. While recovering individuals emphasized identity change (Dekkers et al., 2020), family members focused on functional and behavioral changes (Andersson et al., 2018). Family members also typically view abstinence as the sole path to recovery, while the individuals in recovery believe that abstinence, while crucial, is not the sole determinant of success (Laudet & White, 2010): Indeed, relapses are sometimes seen as opportunities for valuable learning (Kougiali et al., 2017). Furthermore, While therapists embrace the medical approach, prioritizing symptom reduction and enhanced functioning. (Mountain & Shah, 2008), Individuals in recovery see recovery as a continual process that involves building a meaningful life through alternative activities and strong social bonds (Pickering et al., 2020).
Addiction and Addiction Recovery Typologies
Past studies in this field have mostly focused on the typology of individuals who use substances (Babor et al., 2006; Chassid-Segin et al., 2020; Harrington et al., 2014; Skelding et al., 2024; Sutherland et al., 2018), with only limited investigation of the typology of LTR individuals (Witbrodt et al., 2015). Gueta, Chen, and Ronel (2021) discuss the LTR patterns of individuals who have achieved recovery independently (as opposed to through therapy interventions by others). They found that these divergent pathways to LTR involve different mechanisms: individuals who managed their own recovery (self-changers) adopted an intrinsic locus of maintenance, while those who went through an established program (treatment changers) were reliant on an extrinsic locus of maintenance. White and Kurtz (2006) defined certain recovery types (abstinence-based, moderation-based, medication-assisted), initiation contexts (solo, peer-assisted, treatment-assisted), and initiation spiritual frameworks (religious, spiritual, secular). In a quantitative study, Witbrodt and colleagues (2015) identified five distinct categories of individuals in LTR, based on their recovery perception: 12-Step Traditionalist; 12-Step Enthusiast; Secular; Self-Reliant; and Atypical. However, while that study added to the knowledge about various distinct recovery styles, it was mostly defined in terms of levels of recovery in 12-step programs.
The Present Study
While previous studies focused solely on the individuals in recovery’s perspective (Bathish et al., 2017; Goshorn et al., 2023; Gueta, Chen, & Ronel, 2021; Hibbert & Best, 2011; Kougiali et al., 2017; Martinelli et al., 2020; Pettersen et al., 2023), the present study examined LTR from multiple perspectives—namely, those of family members, therapists, and recovering individuals. In addition, while previous studies investigated a particular form of addiction (Dekkers et al., 2020; Di Maggio et al., 2022; Gueta, Chen, & Ronel, 2021; Martinelli et al., 2023), the present study examined various types of addictions (substance and behavioral), in a bid to gain a deeper understanding of the processes of LTR
Method
To gain insights into the typology of LTR from addiction, this study adopted a qualitative phenomenological design, with a view to examine the recovery experiences through the lenses of various stakeholders. Accordingly, it encompassed individuals in recovery from various addictions, family members of such individuals, and therapeutic staff. Phenomenology offers rich and detailed insights, providing authentic portrayals of the complex process and enabling a deep understanding of individuals’ lived experiences (Alhazmi & Kaufmann, 2022) shedding light on the various paths and meanings attributed to recovery. This approach enabled a comprehensive understanding of the factors that contribute to and sustain LTR from substance and addictive behaviors.
Participantsֿ
A total of 47 individuals took part in the study, divided into three distinct groups. The first was thirty individuals (17 men and 13 women) in LTR from addiction to substances (including alcohol and/or drugs, n = 25), or gambling (n = 5). The second was of nine therapists working at addiction centers (5 men and 4 women), and the third was of eight family members (all female) of individuals who have been in recovery from various addictions for five years or more. Among the latter, five were intimate partners of the recovering individuals, and three were mothers of such individuals. Notably, ten participants from the recovering individuals’ group, and two family members, were also consultants at addiction centers.
Participants in all groups ranged in age from 27 to 82 (m = 46). The mean age for individuals in recovery was 43.7 years, for family members 52.4 years and for addiction therapist 46.7 years. All individuals undergoing recovery had begun treatment at the age of eighteen years or above. The cultural background of the sample varied: eleven were immigrants, and 37 were natives. All participants in the study reported having completed high school (or above) and were of a middle-class socioeconomic background.
Tools
A semi-structured, in-depth interview approach was adopted as the research technique. Separate interview guides tailored to each participant group were used, to addressing its particular issues. For example, recovering individuals were asked: “What helps you stay on track with your recovery today? Have you tried various recovery tools in the past?” The interview guide for family members included questions such as: “What happens to the recovering individual during the recovery process?” Therapists were asked about their treatment interventions—such as: “Did you notice any changes in the instruments that you use during the treatment?”
Interviews were conducted as open conversations—initially in accordance with the interview guide, then adapted based on the information gathered. This approach encouraged participants to provide a profound expression of their perspectives and enabled a nuanced understanding of the phenomena involved. After the interview, each participant completed a demographic questionnaire via a Qualtrics form.
Procedure
Initially, participants were contacted by staff members whom they are already acquainted with, or a consultant, by telephone. Once they consented to be interviewed, the researchers made contact with them, briefing them on the research objectives and arranging interviews—either online, or in person, to suit the participant’s preferences and geographical constraints. The snowball technique was utilized to broaden the range of participant pathways. Participants were told at the outset of the interview that it was being recorded and signed an Informed Consent form. All participants in the study took part voluntarily and did not receive any financial compensation for their participation.
The interviews varied between one to 2 hours in duration.
Data Analysis
To identify distinct types of recovering individuals after multiple readings, the interviews were analyzed verbatim, and initially grouped into eight subcategories of recovering types. The interviews were then reread, and each participant’s suitability was assessed in terms of primary and secondary types. The reduction of these types to five was determined by this division, since some categories had insufficient participants. Key recovery parameters (identity, recovery goal, and main recovery strategy) were then established for each type. To ensure quality standards in qualitative research, the Lincoln & Guba’s model of data verification was used, by focusing on credibility, transferability, dependability, and confirmability (Lincoln & Guba, 1985; Thomas & Magilvy, 2011), backed by the interviews, detailed descriptions, date triangulation, and continuous reflection. To minimize subjective perception and bias, the first researcher engaged in a continual reflective process throughout the study by consulting with her research colleague, and writing detailed field notes.
Ethical Declaration
The study was approved by the Institutional Review Board (IRB) of the authors’ university. All participants provided written informed consent. The interviews were conducted voluntarily, and participants who felt distress could withdraw at any time. The participants’ wellness was further ensured throughout and after the interview through various counseling techniques (Chen & Gueta, 2019). Every response was handled with the utmost confidentiality, and professional assistance was provided when needed.
Since the first researcher is a social worker at an outpatient clinic, she was familiar to most staff and patients. A research assistant conducted interviews with all study participants who had had prior contact with her. All identifying personal details of the participants in the study has been altered, and all the names cited in this article are pseudonymous.
Findings
The analysis suggested a new typology of LTR from various addictions, based on five distinct paths of LTR, that we have dubbed “the Fighter,” “the Avoidant,” “the Wanderer,” “the Devout,” and “the Comrade.” (These pertain to the phase of LTR, as opposed to the initial stages of recovery where there are shifts and transitions between various strategies). Although this division into five different types could reflect Merton’s approach (Heckert & Heckert, 2004) we underlined that our study is phenomenological and conducted not in line with Merton’s theory. Moreover, The five types are differentiated based on three primary parameters: identity, recovery goals, and central recovery strategies.
The Fighter
The first type of recovering individual, based on the accounts provided by the study participants, views addiction recovery as a battle. They identify themselves as fighters who view their recovery as a struggle for survival, and for identity, and self-preservation. The Fighter’s recovery goal is to fight against all odds. Their primary strategy is to gain agency, in order to establish a distinct and autonomous identity for themselves—an activist approach stemming from a change in mindset, from perceiving themselves as a victim, to adopting the role of a warrior. These study participants described addiction as a period when they felt they were victims, due to the daily struggle for physical and emotional survival. Miri (an individual in recovery for 6 years from alcohol) described it as follows: “I felt like a victim in life, and I truly felt that God had something against me […] Today, I am not a victim; I have a choice.”
LTR, in contrast, was described as a battle, in which the individual in recovery assumes the role of a fighter. As Yael (an addiction therapist for over 20 years) put it, “the transition from victim to fighter is an important therapeutic goal.” The accounts given by family members also reflected the view of recovery as a struggle of the recovering individual with other people’s views and various internal influences. Naomi (a family member, substance, 6 years) described it as follows: She persevered, despite the criticism from her family and friends. [...] Today, I understand how difficult this is. The terror exists between who you are inside and the gaze of your surroundings. After criticizing her throughout the process, I think only now do I understand the difficulty of recovery.
Recovering individuals who perceived themselves as fighters also used military terms to describe their approach to dealing with obstacles. Kobi (an individual in recovery for 10 years from gambling) stated that he used all his powers to sustain his recovery: “I will fight tooth and nail for my recovery, and not go back to the hell I was in.” The militaristic language was also apparent in the participants’ description of their interactions with peers. One of the terms used was “brothers in arms”—as Michael (an individual in recovery for 8 years from gambling) put it: It’s like warriors getting together every now and sharing their battlefield experiences, that no one else can understand. These are experiences that persist, and it is critical to process them in therapy. [...] It’s akin to a fault on a computer disc, causing images to blur, and memories to remain unforgotten. You also need to go somewhere that help you cope.
Viewing addiction through a trauma lens drew parallels between individuals in recovery and army veterans. The recovering individuals saw their substance abuse history as traumatic, and consider their recovery journey as a way of addressing these past experiences
The Avoidant
The Avoidant type was another that emerged from the participants’ interviews. For the Avoidant, the primary objective of LTR is to alleviate the significant anxiety associated with the fear of relapsing. And maintaining the same strategies that they had adopted in early recovery—such as regular attendance of group sessions (3–5 times a week). Orit (an individual on recovery for 20 years from substance) gave an account that reflects the caution underpinning the recovery process: “You have to be watchful and conscious—but not through daily anxieties. It means you just have to be vigilant and remember. I remember where I came from my origins and my destination, yet my life isn’t particularly exciting.”
Other participants, inspired by fear of relapse, described their avoidance as a pattern of behavior. For example, Nathanel (an individual in recovery for 10 years from alcohol) said: I avoid alcohol; my entire family is aware of my allergy. If they ask, “Is there such a thing?” Yes, some people are allergic to dairy products or peanuts, and I have an allergy to alcohol. […] It scares me a lot. I keep telling myself that at my child’s wedding, I will drink. Maybe I’ll be drinking by the time my first grandchild is born. I keep saying, “When might I be relapse?”
Nathanel was describing his profound anxiety at the heart of his recovery, even after ten years of sobriety, while his wife Shirley (a family member, 10 years of alcohol) reflected that maintaining a routine and lifestyle were crucial to his recovery: He tries to be good, to do things, and be a part of something good. As I’m talking to you now, I’m thinking to myself, “Maybe this is his recovery.” Maybe that’s how it is—for example, I think recovery is about going to meetings once a week, but that may not be the case with his recovery.
For certain individuals, disengaging from the realm of addiction ensured their sustained recovery over time. As Tahila (a family member, 6 years in recovery, substance) put it: He doesn’t use it, because he seems to have created some sort of block. Like, there’s a wall. I mean, there’s a barrier between him and his addiction. [...] He avoids keeping track of days, because he believes it’s best not to dwell on them. He fears that obsessing over it might increase the risk of relapse. So he’s created a wall. It’s as if the addiction doesn’t exist anymore.
Family members and therapists found it more challenging to accept when their recovering loved one persisted in the same avoidance patterns and strategies throughout the LTR process. For example, Simon (addiction therapist, 10 years of experience) said: A person can only listen and learn when they are crushed; but when they are no longer at that stage, if they feel there is nothing that they can be told, or taught, they stop developing. The remain stuck. So basically, recovery is the ability to constantly seek, learn, develop, and grow.
It is apparent that therapists focus their treatment on individuals who exhibit hallmarks of a Fighter or Wanderer, and encourage constant growth. They supported progress, so found it difficult to accept the Avoidant type, while individuals in recovery found avoidance patterns and strategies to be helpful in their road to recovery.
The Wanderer
To articulate their LTR process, some participants used the dialectic of journey and path. They self-identified as “Wanderers,” because of their continual growth and shifting in coping strategies. The main recovery goal was growth, which they equated with the essence of life—as Gabi (an individual in recovery for 22 years from substance) described it: I think that a person’s development is their happiness—and stopping that development is death, it’s their tragedy: The moment someone decides that they’re no longer developing (from whatever external reason), they have begun to die...
According to the participants, the journey includes obstacles along the way, and coping properly with addiction entails being able to continue switching between the various challenges. Gilad (an individual in recovery for 16 years from substance and gambling) explained it as follows: Addiction is beyond our control. In recovery, we have a sense of responsibility, but no control. Responsibility involves going on a journey. Control is saying, “I want it exactly this way—and if it’s not, I’m not interested.” If I haven’t reached the hilltop, the process doesn’t seem interesting. Being involved means dealing with issues that arise along the way.
According to the participants, the recovery process for the Wanderer type involves a constant desire to progress, while evaluating the various needs as they emerge. The interviews revealed the importance of engaging in various therapeutic practices, in a bid to foster personal growth during the LTR process of addiction. Katya (an individual in recovery for 7 years from substances and alcohol) said: “I want to go on and develop. I may want to start some kind of couple’s therapy—because I’m constantly trying to be progressing.” The main strategy for maintaining LTR involved changing treatment techniques to suit the circumstances, and self-determined goals. Throughout the interviews, the Wanderers described various types of treatments they had undergone after a long period in NA groups—such as psychological therapy, couples therapy, trauma intervention, and various therapeutic and spiritual techniques to display that progress. While the various treatment methods were in response to evolving needs, they also converged to form a customized set of tools for LTR. As Sonya (an individual in recovery, 6 years, substance) explained: My life revolves around recovery: I have certain tools from the previous therapist, from the day center, and from my current therapist. I have the steps: I do 12 steps, and lead step groups.
The Devout
The fourth type of individual in recovery identified from the interviews focused on strict compliance with the rules, or a predetermined plan, in a bid to survive—even after their recovery had stabilized. As Oren (an individual in recovery for 10 years from gambling), who also works in a therapeutic community, explained: Addiction recovery requires a great deal of patience, as well as persistence. […] Addicts are used to receiving everything instantly. If you don’t persist and do everything slowly and thoughtfully, you won’t succeed. The main goal of recovery is to slow down, persist, and be patient.
The Devout individual has found that persistence and adhering to the same treatment strategies that were effective in the beginning were crucial to their sustaining long-term recovery. Rebecca (a family member, 10 years, gambling) mentioned that her husband’s attendance at support groups had gone down from seven times a week to only two, but that this consistent participation is fundamental to his recovery. He’s never given up on the groups. Today, he goes twice a week, and he also sponsors many people, and leads a group. And I believe that’s what keeps him on the straight and narrow, still.”
Individuals in recovery also described stability as an important strategy in their recovery process, as Rami (an individual in recovery for 9 years from substance) described: “What works for me is that I have something stable in my life—which is the groups”.
The Devout individual creates a clear distinction between individuals who suffer from addiction and those who do not, resulting in the formation of a “recovering identity” that separates them from the rest of society to ensure their recovery. Azriel (an individual in recovery for 11 years from substance) stated: I don’t have anyone in my life who is not in recovery. I have nothing to do with anyone else. During my studies, I meet people, but I never develop close friendships with them [...] When I fly abroad, I go to places where there are NA gatherings; for example, when I go to Paris or London, I go directly to a group meeting.
Doggedly pursuing the recovery strategies was a consistent theme among this cohort of individuals in recovery. Even when they encountered challenges, they reverted to the same strategies that had initially helped them in their recovery.
The Comrade
The fifth identified category of individuals in recovery—dubbed “Comrades”—sought to achieve a sense of belonging as their primary goal in the recovery process. The sense of belonging characteristic of these type of individuals in recovery is expressed in their desire to be part of a community of individuals in recovery, part of their family, and beyond that, part of human society. This stands in contrast to their experience during addiction, which was marked by a focus on “self-centeredness.” The ability to shift their focus from themselves to a broader human experience, to empathize, and to participate was significant as a strategy for long-term recovery. Therefore, their primary recovery strategy was to offer support and kindness to others, thereby gaining a heightened sense of purpose and personal enrichment. Sasha (an individual in recovery for 8 years from substance) described it humorously: My mother once told me, “You’re like Putin—everyone on the street who sees you says hello.” Because I used to attend a lot of groups, many people knew me. […] For me, that connection represents the power of recovery.
While the Devout individual created a barrier between themselves and non-usesrs to sustain their LTR, the Comrade views interaction as a significant step toward their personal growth and progress. For the Comrade, the key focus in the recovery process is the establishment of a strong sense of belonging and mutual support—both among the recovering individuals themselves and among their family members. As Odelia (a family member, 12 years, gambling) stated, “I believe that the most important tool is sharing. [...] that you have people who support you.”
The Comrade noted that both the ability to help others and to receive support from them were highly important for their recovery process. In this regard, a significant focus was on relinquishing self-centeredness as a recovery strategy. Dan (an individual in recovery for 9 years from substance) recounted a daily occurrence that exemplifies and promotes his recovery: … Instead of opening the window and swearing at him, I asked him, “Is everything alright?” He told me, “Listen, bro, it’s my first day at work; I made a mistake; I forgot to buy gas for the car.” I went back through the entire traffic jam again and brought him two L of gas. His eyes shone. At that point, I thought it was worth living a whole life of suffering for this moment.
Various Perspectives on Types of Recovering Individuals
In summary, when considering the various stakeholders who took part in this study, it is apparent that therapists focus their treatment on individuals who exhibit hallmarks of a Fighter or Wanderer, and encourage constant growth. For example, Simon (addiction therapist, 10 years of experience) said: A person can only listen and learn when they are crushed; but when they are no longer at that stage, if they feel there is nothing that they can be told, or taught, they stop developing. The remain stuck. So basically, recovery is the ability to constantly seek, learn, develop, and grow.
Apart from the therapists, family members also found it more challenging to accept when their recovering loved one persisted in the same avoidance patterns and strategies throughout the LTR process. They supported progress, so found it difficult to accept the Avoidant type, while individuals in recovery found avoidance patterns and strategies to be helpful in their road to recovery.
Discussion
To gain comprehensive insights into the diverse aspects of LTR, the present study encompassed a variety of stakeholders: individuals in recovery, family members of recovering individuals, and addiction therapists. The findings suggest that individuals in recovery from various addictions initially employ similar treatment techniques (e.g., NA fellowship). However, once they attain stability, they develop unique recovery styles that are characterized by distinct sets of identity, goals and strategies. One potential interpretation of this is that individuals undergoing recovery might adopt a certain “recovery social identity” to protect themselves from relapse (Dingle et al., 2015; Frings et al., 2021; Kemp, 2019). Our findings indicates that this recovery identity functions as a transitional phase, that helps these individuals to find and embark on their own LTR path once it stabilizes.
The purpose of this study was to establish a typology of individuals in LTR from the perspective of various stakeholders, based on sustained and LTR from a variety of addictions. It identified five distinct paths— the Fighter, the Avoidant, the Wanderer, the Devout, and the Comrade—each characterized by a distinct type of recovery, based on three main parameters: identity, recovery goals, and key recovery strategies.
Fighters describe their recovery goal as a battle, and their bond with peers and brotherhood as crucial to their fight against addiction. Previous studies have found that instances of trauma often coincide with addiction (Devries et al., 2014; Meulewaeter et al., 2019)—a finding consistent with past studies of recovering individuals in prison. NA meetings have been found to serve as a symbolic tool for prisoners to express and shape their masculinity, as well as a platform for demonstrating their transformed and reformed masculine identity (Gueta, Gamliel, & Ronel, 2021). This description aligns with a military mindset, that military veterans often use to resolve traumatic situations during their military service and share their traumatic experience through community support and interpersonal relationships. But unlike previous studies, the present one found that developing a warrior’s identity was not exclusively a male experience, but present in women as well, in a bid to strengthen their identity and sense of independence and foster their recovery.
The Avoidant is the kind of person who seeks, at all costs, to avoid relapsing to addiction. Gueta, Chen, and Ronel (2021) described avoidance as the primary strategy of such individuals for dealing with the risk of relapse in LTR, whereby recovering individuals choose to distance themselves from their previous social networks, to avoid interactions with substance users. The present study showed that while avoidance is a prevalent strategy among individuals in LTR, it only applies to certain type of recovering individuals.
The Wanderer sees recovery as a journey, and uses a range of therapeutic interventions to accomplish various goals along the way. The need for growth and change has been described as characteristic of long-term recovery (Martinelli et al., 2023; The Betty Ford Institute Consensus Panel, 2007), but in the present study it has been found to distinguish only certain types of individuals in the recovery process.
The Devout individual adheres to a particular program that they have deemed to be essential to their journey of recovery, by diligently following its guidelines. Continuing participation in support groups such as Alcoholics Anonymous or Narcotics Anonymous plays a vital role in maintaining their LTR (Dingle et al., 2015). One potential reason for adopting this strategy may be a desire for consistency and logical connection. The sense of coherence functions as both a coping mechanism for stress, and as a type of recovery capital in LTR (Chen & Gueta, 2020).
The Comrade type of recovering individual perceives recovery as a societal objective, thus highlighting the importance of associating only with other recovering individuals to sustain LTR. Previous studies have noted the important role of social mechanisms in recovery processes (Collinson & Hall, 2021; Dingle et al., 2015; Kemp, 2019; Reith & Dobbie, 2012; von Greiff & Skogens, 2021)—but our study revealed that the social mechanism is adopted as a primary strategy for recovery only by certain individuals in LTR.
Gubrium and Holstein’s (2000) concept of troubled identity emphasizes the manner in which individuals negotiate and navigate the impacts of their identities in relationship to social issues such as addiction. The discursive environment of the problem is influenced by a variety of discursive resources, including support groups, profession, own experiences, relatives, close friends, policies, and media, which can be contradictory. This identity work is shaped by these resources. Considered as an “identity project,” successful recovery depends on broad changes to personal orientations and behavior (Koski-Jannes, 2002). A crucial phase of addiction therapy is moving from a substance-using identity to a recovering one (Dingle et al., 2015). Webb et al. (2020) found that recovery activities provide a crucial environmental context for identity change by fostering a sense of belonging, self-reflection, and opportunities for personal growth. They suggest that identity shift is evident in a growing distance from recovery identity reflected in the transition from a social identity to a more individual and agentic identity. Gueta and Chen (2021) highlighted differences in identity construction between individuals who received treatment and those who did not: those without treatment minimized risk and distanced themselves from other users, while those who received treatment distanced themselves from their former identities, adopted the disease model, and embraced the necessity of treatment. The present study found that in the initial stage, individuals shift toward an identity of a recovering individual, but this identity is characterized by different between recovery goals and various recovery strategies among different individuals in recovery.
Upon analyzing the various stakeholders, it becomes apparent that therapists prioritize and focus their intervention on individuals who exhibit traits of the Fighter, and the Wanderer. A possible explanation for therapists’ preference for certain recovery styles lies in their frequent encounters with individuals in the early stages of recovery, when addiction is most acute and life’s hardships are strongly felt. Therapists thus view this recovery style as appropriate even in later stages, although they often do not see patients once their recovery stabilizes. Additionally, in the Israeli context, this preference may also reflect broader national security concerns. Drug use has traditionally been framed as a law enforcement issue, resulting in a drug policy that prioritizes abstinence and punitive measures over harm reduction (Boni-Noah, 2019).
Family members also encountered difficulties in accepting the Avoidant type, and advocated for continual progress, whereas recovering individuals saw avoidance as an occasionally effective tactic on the road to recovery. These findings align with previous studies (EnglandKennedy & Horton, 2011), which found that individuals in recovery see the process of recovery as more complex and protracted than family members of individuals in recovery. Moreover, previous studies have highlighted the significance of Wanderer-like growth in LTR (The Betty Ford Institute Consensus Panel, 2007). However, it is plausible that growth entails the formation of a unique identity pattern of behavior and acknowledging strategies that benefit only a particular type of individuals in LTR.
The primary contribution of this study lies in its conceptualization of various modalities of behavior in the context of long-term recovery. This typology can help addiction therapists in classifying various types of individuals in LTR, and providing tailored interventions for each type, thereby enabling flexibility in long-term recovery. The adaptability of this strategy has been proven to be effective in the rehabilitation of individuals with diverse types of addictions (authors).
However, it is important to note that there are certain limitations to consider. Firstly, the research sample consisted of a small number of individuals with behavioral addictions. Future studies should examine whether various behavioral addictions—such as compulsive eating, sex addiction, and gambling addiction—share similar patterns of recovery, or if distinct types emerge. Second, the process of formulating the typology may have overlooked specific recovery strategies, due to their unique nature.
This study delineated various recovery styles. Future research may investigate the relationship between various factors, including age, familial status, migration and other demographic characteristics, and their influence on the adoption of diverse recovery styles. While the current study examined stable recovery and the types and strategies associated with this stage, the findings suggest that the period preceding stable recovery involves transitions between types. Future research could explore how recovery types and strategies evolve over time before stabilizing into a specific recovery style. Investigating these transitional phases could provide deeper insights into the dynamic nature of the recovery process and the factors influencing the consolidation of specific recovery styles.
Conclusion
In summary, our study investigated the dynamics of long-term recovery (LTR) by examining various perspectives (individuals in recovery, their family members, and addiction therapists), with particular focus on how individuals in LTR from substance and behavioral addiction maintain stable recovery. The study identified five distinct types with regard to recovery practices and objectives: the Fighter, the Avoidant, the Wanderer, the Devout, and the Comrade. The identification of distinct types enhances our understanding of the multifaceted nature of recovering from addiction, and highlights the unique characteristics that vary from one individual to another. Therapeutic interventions at various stages of recovery may utilize this typology to tailor treatment to the specific needs of individuals.
Footnotes
Declaration of Conflicting Interests
The author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.
Funding
The author(s) received no financial support for the research, authorship, and/or publication of this article.
