The Truth about Recovery from Substance Use Challenges

All too often the “war on drugs” feels like a war on people who use drugs. We know that not everyone who uses drugs develops a dependence on them. There is also broad agreement that there are multiple paths to recovery – different people need different things to achieve wellbeing.

So, let’s start with some level setting.

The 2020 National Survey on Drug Use and Health showed that nearly 60 million people reported using illicit drugs in the past year and about 41 million of these folks were classified as needing substance use treatment during the previous 12 months. Like those with other medical illnesses, people with a substance use challenge can and do recover.

A study by the Recovery Research Institute at Harvard University has found roughly 22.3 million Americans live in recovery after some form of substance use challenge. A separate study by the Centers for Disease Control and Prevention and the National Institute on Drug Abuse, published in 2020, found three out of four people who experience addiction eventually recover.

With so many people in recovery, we must do a better job of changing the narrative and instilling hope for people with a substance use challenge. We must eliminate the formidable barriers to treatment that complicate their road to recovery and make more pathways to recovery available. The federal government recently released a report that shows the Mental Health Parity and Addiction Equity Act continues to be flouted by insurance companies.

“Clearly, we don’t have the well-defined treatment infrastructure that we need to address this particular challenge,” Dr. Rahul Gupta, director of the White House Office of National Drug Control Policy, told me this month during a segment of the National Council’s video series, Wellbeing Wednesdays.

Unfortunately, our nation’s prevention programs, early intervention programs and recovery supports are woefully underfunded and not as readily available as they should be. Boosting prevention, treatment and recovery would go a long way toward reducing the rising number of overdose deaths.

It’s also important to point out that recovery may look different for everyone. Many people don’t seek a formal treatment program, according to the study by the Recovery Research Institute. That study found that many people believe “abstinence is not necessary to achieve recovery.” In fact, the Substance Abuse and Mental Health Services Administration’s working definition of recovery doesn’t even include the word abstinence.

For many people, recovery is a life-long process that includes periods of return to use. We must support people in all aspects of their recovery and be equipped to offer them the services and supports they need when they need them. We fail when we ignore that fact and punish and stigmatize people instead of supporting them.

We understand that chronic illnesses include highs and lows. Sometimes a person with diabetes eats chocolate cake. It does not mean they are a failure, but that they have had a setback. The same is true for people living with a substance use challenge.

For many people, harm reduction strategies offer lifesaving services and supports through early intervention initiatives. Fentanyl test strips successfully detect the presence of illicit fentanyl, which has become increasingly prominent. Synthetic opioids, primarily fentanyl, remain the most lethal problem we face in the overdose crisis, and synthetic fentanyl can be 50 to 100 times more powerful than morphine, according to the National Institute on Drug Abuse.

We can also do a much better job of making the overdose-reversal drug naloxone available.

A study published earlier this month in The Lancet Public Health concluded that distribution and accessibility of naloxone needs to be increased and expanded in almost every state to more effectively combat opioid overdoses and prevent more overdose deaths. A separate study in The Lancet found that 1.2 million Americans are expected to die of opioid overdoses between 2020 and 2029.

“Almost every overdose death can be prevented with naloxone,” Dr. Gupta told me.

Dr. Gupta’s observation is a reminder that you can’t recover if you’re dead.

We will only make more progress in efforts to eliminate deaths from alcohol and other drug overdoses if we embrace the wide-range of evidence-based strategies, recovery-oriented systems of care, treatment and support that help people recover. We can also succeed if we build compassionate systems of care that meet people where they’re at, rather than leaving them stranded and alone.

Recovery happens.

We should help people to achieve that goal.


Charles Ingoglia, MSW
(he/him/his) President and CEO
National Council for Mental Wellbeing
See bio