The Global Position Paper on Recovery (GPPR)

This paper evolved through a collaborative process initiated during discussions during the CND annual session in Vienna in March 2023, based on fostering co-production and adopting a coordinated, evidence-based, and comprehensive approach to defining and understanding recovery. The methodology involved a survey distributed to key international groups, networks and actors (Appendix 1). This resulted in 49 completed surveys that were analysed using a thematic approach, reviewed and ratified by a team of senior academics. The initial draft was reviewed and refined by a core group of members of the RSPC at an international meeting in Madrid, in October 2023. Subsequently, it was subjected to rigorous review and disseminated globally for comment and amendment.

It was possible to identify a global consensus around the goals and meaning of recovery, conceptualized in three pillars: 1) strengths; 2) barriers; and 3) systems needed to optimize the positive effects of strengths on individuals and communities while simultaneously reducing barriers. These three pillars are the basis for our future action plan.

Recovery as a strength-based concept and its goals

Recovery is a personalized process of building strengths over time and creating opportunities that allow individuals to build their own recovery capital, defined as the breadth and depth of internal and external resources that can be drawn upon to initiate and sustain recovery from alcohol and drug problems (Cloud and Granfield, 2008). Throughout these global consultations, a central ‘strengths pillar’ emerged emphasizing improved health and well-being, promoting self-reliance and autonomy, and recognizing that recovery is a flexible, personalized journey and process. The approach to recovery is framed from a public health perspective, ensuring inclusivity and not leaving anyone behind, regardless of their progress.

We believe in the transformative power of recovery, through community reintegration, offering opportunities, and building networks that foster positive contributions to society. A major strength of recovery is demonstrating that stable recovery, meaning five years in stable remission, is being ‘better than well’ and that recovery communities can challenge stigma by making a positive contribution at a community level.

Rooted in the belief that recovery is possible for everyone, and involves living self-directed lives, individuals are striving to reach their full potential. These aspirations span multiple life domains, through fostering better personal relationships and creating environments that are safe, supportive, and non-judgmental, rebuilding trust, and the pursuit of purpose and meaning in life.

We want to underline that recovery is a journey, a process of reclaiming life which not merely entails breaking free from addiction itself but transcending where the person was before their addiction. Most individuals seeking recovery aspire to resolve their substance dependency and lead drug-free lives. This however does not exclude people whose goals are not focused only on abstinence. Generally for recovery to happen, services and systems must show a commitment to a continuum of care and long-term support to initiate and sustain recovery. To do so, they need to address personalized and individualized goals around substance use and other health and social domains.

Leveraging the lived experiences and resilience of individuals who have successfully navigated recovery from substance use disorders can be a powerful resource and strength. By actively engaging, equipping, developing, and promoting people with lived experience, the focus is on empowering others to recover, addressing underlying factors that contribute to their challenges and improve prevention of relapse.

The consultation highlighted the importance of prioritizing personalized care that incorporates treatment, recovery support and reintegration objectives to individual characteristics.

Overcoming obstacles to recovery

Community and policy barriers play a pivotal role in limiting the reach of recovery. Prioritizing social connections, family involvement, and stable employment is key, as are suitable housing options, while balancing government strategies to focus on both treatment and recovery support, and to allow individuals to overcome recovery barriers. Collaboration between clinical, outpatient and inpatient services, and post treatment recovery services will lead to a more effective support system. We understand that recovery is a complex process fraught with obstacles that must be addressed to ensure success. These challenges can be categorized into key barriers.

Stigma and Discrimination: Stigma associated with addiction often deters individuals from seeking help. To tackle this issue, communities need to implement anti-stigma protocols to create supportive environments, reducing victimization, and challenge social inequalities by promoting access to positive community resources for people at all stages of the recovery process.

Access to Treatment and Support: Comprehensive treatment, inclusive recovery communities, and vital social and health services are essential for recovery. Sustained recovery requires diverse support and efforts to eliminate access disparities. Beyond substance use disorders treatment, securing housing, employment, education, community assets, and health and social support are critical for building and sustaining recovery capital, promoting well-being, and fostering community belonging.

Diversity and Vulnerable Groups: Special attention should be given to diverse and vulnerable groups, such as individuals of colour, women, especially pregnant women and women with children, the elderly, homeless individuals, those with learning difficulties and acquired brain injury, the LGBTIQ+ population, individuals in criminal justice system and prisons, and those with physical and mental health issues who experience more barriers.

Education and Awareness: Play a pivotal role in breaking down barriers to recovery. Training peers, professionals, and community members, in recovery curricula strengthens and enriches the level of support provided. Improving cooperation between the criminal justice system and treatment staff through mutual education is crucial.

Generating structural change

There is a clear recognition that overcoming barriers and building strengths requires changes in systems, processes, policies and, in some cases, laws, to create the conditions for recovery to flourish. We recognize the need for building Recovery-oriented Systems of Care (which is based on the idea of integrated and personalized support systems in a given geographic area and outlined in Sheedy and Whitter, 2009). This idea has been further developed in the model of Inclusive Recovery Cities (which extends the concept of Recovery-Oriented Systems of Care to include public engagement, social enterprise and active citizenship; Best and Colman, 2018) Key building blocks for this approach include:

Partnership Models Recognizing the Process: Recovery needs evolve throughout different stages of the process, requiring varying and sequential support configurations. A multi-faceted holistic system, emphasizing community partnership, must foster personalized pathways to recovery to accommodate these changing needs.

Involvement of Peers and Communities in Pathways: The role of lived experience expertise through peer support, and not only through mutual aid fellowships, but through visible recovery groups and communities, need to be at the heart of the recovery-oriented systems of care that are developed in each locality, with appropriate support and training provided.

Evidence-based recovery: We recognize that collaboration between academics, practitioners and experts by experience is needed to generate a robust, empirically driven and culturally sensitive evidence infrastructure for recovery that can be adapted to meet local needs and contexts.

Funding: Recovery is a long-term dynamic process of change. Therefore, vital revisions are needed to policy and funding that facilitate long term recovery centered approaches and sustainable resourcing. An improved architecture of authentic recovery assets, resources, approaches and supports are needed which are reliant upon new funding supports linked to robust evaluation and development.

Integration of recovery across demand reduction: To optimize recovery outcomes, it is imperative to ensure that strategies and support are integrated within and across the traditional continua of care and throughout the various stages of the recovery process, encompassing primary prevention, harm reduction, early intervention, treatment, post-treatment monitoring, and long-term recovery management, thus creating a comprehensive continuum of care for individuals and families.

Global consultations have resulted in a consensus around the following key recommendations:

Domain 1: Service delivery and recovery support services

Recovery requires establishment of a collaborative, multidisciplinary approach among healthcare professionals, therapists, and counselors with equal status and value given to peers and people with lived experience of recovery.

There is a need to create more networks of institutions and organizations aiming to enhance resource accessibility for individuals in their recovery pathways. Access to these services should be equitable, affordable, and readily available.

Education and training for professionals, and for the peer community, are key to maintaining high standards of care within recovery support services. Meaningful quality standards must be established to ensure individuals benefit from consistent and effective care methods and models.

To foster recovery effectively, it is crucial to develop tailored programs that address diverse needs while acknowledging cultural factors such as race, gender, age, ethnicity, and religion; reduce stigma among minoritized groups; enhance representation of these groups in leadership roles, and prioritize their voices in resource allocation decisions to redress racial inequities. A focus should be placed also on people in the criminal justice systems and there should be possibilities to provide alternatives to incarceration and punishment (UNODC and WHO)

Comprehensive and rigorous ongoing research and program evaluation are essential to support the clinical and public health utility of diverse recovery support services, aiming to assess their individual, family, social, health and economic benefits and identify "best practice" models tailored to the dynamic needs of various constituencies.

Domain 2: Public policy

Balanced and comprehensive state and public policies should be created to eliminate stigma and support recovery through early detection, effective treatment, and social reintegration.

Raising awareness initiatives are needed to reduce stigma among the general public and dispel myths and stereotypes about addiction recovery, and should address not only individual stigmatization but also societal stigma and its impact on families.

Policies should be developed to enable successful reintegration back to society by addressing factors like employment, housing, education and health related needs, the need to support re-integration services could be strengthened to cover the huge gap in the provision of these services.

Domain 3: Community and lived experience involvement

Recovery representation in the design, delivery, and evaluation of all addiction-related polices and service practices needs to be assured as well as representation that meet the criteria of scope, authenticity and diversity

It is imperative to forge landscapes in local communities in which recovery can flourish via support and evaluation of new recovery support institutions extending beyond mutual aid groups and professionally-managed addiction treatment; and support of recovery cultural production via recovery-inspired language, history, rituals, art, music, theatre, sports and leisure, etc.

The GPPR aimed to establish a consensus document on recovery, emphasizing both individual and societal dimensions and outlining three pillars and ten recommendations for future efforts in shaping policies and practices. These recommendations focus on the achievability of recovery, the necessity for diverse support and multiple pathways, and the importance of addressing stigma while enhancing recovery-oriented care systems, research, and training for professionals. This marks the initial step in forming a consensus and an RSPC, working collectively to operationalize and implement the core principles outlined above. To advance these principles, the next steps involve promoting and signing this consensus document, fostering a global environment that prioritizes and supports recovery, and ensuring integration, accessibility, gender sensitivity, trauma-informed, and cultural appropriateness.

Research team: David Best, Mulka Nisic, David Patton, Boro Goic

Academic peer review: Brandon Bergman, Emily Hennessy, John Kelly, Wouter Vanderplaschen, William White

Observers*: UNODC, Croatian Institute of Public Health, Office for Combating Drugs of the Government of the Republic of Serbia, VNGOC

Input provided by: Actis; ARTM Macau; Ascent; Aspire; Association Proyecto Hombtre; Association Proyecto Hombre; CIJ; Celebrate Recovery; Clínica Integral Nueva Vida; Colombo Plan Drug Advisory Programme; Creative Start Arts in health; CIC; Croatian Institute of Public Health; Dalgarno Institute; Dianova; Drug Free America Foundation, Inc.; Drug Policy Centre; Ecett-Networks; Equipping Hearts; Europe Teen Challenge; Freedom Drugs And HIV program; Freelance service; Greenfield Hospital of Psychiatry; Inspire180; ISAAC; Journey NGO; World Federation Against Drugs- WFAD; Latin American Federation of Therapeutic Communities (FLACT); Leeds Trinity University; Michigan Medicine; NA; NPC; Proyecto Hombre in Galicia; Proyecto Hombre in Huelva; Proyecto Hombre in La Rioja; Proyecto Hombre in Valencia; PSUP; Public Foundation of Hope; Recovery Research Institute, Massachusetts General Hospital and Harvard Medical School; Resilient Soul Services, Inc; RIO; RUN - Recovered Users Network; Teen Challenge; The Carpenter's Arms (Midlands) Trust; The Well Communities; Trevi; Unified Initiative for a Drug Free Nigeria; University of Derby; UP Association Slovenia; Whitestone; Zajednica Pape Ivana XXIII

Signatories (balance on 14/03/2024)

Recovery allies: 345 endorsements (not listed)

Organisations: 162 endorsements:

(Angola) Associação para Integridade de Crianças e Jovens em Angola; (Argentina) Fundación para la Promoción de la Salud Humana; (Australia) Gold Coast Addiction & Treatment Rehab; Dalgarno Institute; (Bangladesh) Barnaly; Dhaka Ahsania Mission; Life Centre; Srishty drug addiction centre; Asroyneer drug addiction treatment centar; ATM Asraful Hoque; Ahsaniya mission female drug treatment and rehabilitation center; Sober life drug treatment center; Alor Poth; DTC Gazipur; Safe Home Rehabilitation Center; Renasaince rehab; Ahsania Hena Ahamed Monojotno Kendro; MD Samsujjaman; Ankur drug treatment centre; Meghabati; Society for Social Peaceful Life; (Belgium) EURAD; Foundation for a Drug Free Europe; European Federation of Therapeutic Communities; (Bosnia and Herzegovina) Kontakt homini; Community Mental Health Center Prijedor; Udruženje" Početak" Tuzla; Celebrate Recovery; TZ Marjanovac; Centar za zaštitu mentalnog zdravlja Istočno Novo  Sarajevo; (Cameroon) Beryl Engomi Ewoko; Basic Assistance Humanitarian Orgazation; Bring light save life; (Canada) Spirit Builders; Drug Prevention Network of Canada; British Columbia Addiction Recovery Association; The Last Door Recovery Society; Sally Lee-Emotional Resilience; North Wind Wellness Centre; (Congo) Conseil de facilitation et gestion locale; Opadec; Congo charity and development; Synergie des Femmes de la Société Civile; (Croatia) Association PET PLUS; Udruga Vida Rijeka; Udruga Porat; Association Ne-ovisnost; (Estonia) Avatud Lootuse Fond SA; Nordic Alcohol and Drug Policy Network; (France) Parents contre la drogue; (Georgia) Center for Information and Counseling on Reproductive Health – Tanadgoma; (Greece) Kethea; ( Hong Kong) The Society for the Aid and Rehabilitation of Drug Abusers; (India) Nilgiris exnora; Fourth Wave Foundation; National Association of Professional Social Workers in India; Muskan Foundation; (Indonesia) Assistance and Empowerment Foundation for Papuan Community; (Ireland) Coolmine Therapeutic Community; Recovery Academy Ireland; National Voluntary Drug & Alcohol Sector; (Italy) San Patrignano; (Jordan) The Jordan Anti Drugs Society; (Kenya) Community anti-drug Coalitions of Kenya; Action against drug abuse; Reachout Centre Trust; Soberlife International; Slum Child Foundation; Kenya Economic Youth Network; Sinam – Sinam; Uhai Kenya; Graceful Youth Recovery Centre CBO; Mtaani Youth Sports Development; (Korea South) World Woman's Christian Temperance Union; (Kyrgyzstan) Plus Centre; (Lebanon) Nusroto Association; (Liberia) Drug Policy Coalition of Liberia; (Macau S.A.R.) Associacao Reabilitacao Toxicodependes de Macau; (Malaysia) Asian Recovery Network; Organization for Addiction Prevention Treatment and Rehabilitation; (Maldives) Girindhaa; Journey; (Montenegro) Municipality of Pljevlja-Office for Prevention of Addictive Diseases; Preporod; Kancelarija za prevenciju narkomanije; Moja Šansa je i Tvoja Šansa; (New Zealand) Odyssey House Trust; (Nigeria) Center for Peace Advancement and Socio-Economic Development; Center for youths mental health and drug abuse prevention; The Eye Opener Youth and Women Foundation; Centre for Human Rights and Climate Change Research; YAHI Foundation; Youths for Peace Building& Development in Africa; A Mite Care Foundation; Secure the future international initiative; (Norway) Actis; FFHR-Foreningen for helhetlig ruspolitikk; World Woman's Christian Temperance Union; (Pakistan) Peace Inn; New World Hope Organization; Life Foundation; Sahkar Social Welfare Association; Government college women university Sialkot; (Portugal) Ares do Pinhal; (Russia) LLC "Ne zavisimost"; (Rwanda) Anti-drugs & Doping group; (Serbia) Association Izlazak; Office for Combating Drugs of the Government of the Republic of Serbia; Teen Challenge Serbia; (Sierra Leone) Social Linkages or Youth Development and Child Link; (Singapore) Singapore Anti-Narcotics Association; Mentassist; (Slovenia) Institute for Research and Development "Utrip"; (South Africa) Social Transformation Action Defined; Knysna Alcohol and Drug Centre; Ubuntu Addiction Community Trust; (Spain) Association Proyecto Hombre; Proxecto Home Galicia; Grupo Netpc Maresme S.L.; (Sri Lanka) Mercy Community Centre Horana; (Sweden) Recovered Users Network; Drug Policy Centre (NPC); Swedish Narcotics Officers Association; IOGT-NTO; World Federation Against Drugs; LP-Verksamheten; Junis; European Cities Against Drugs;The Swedish Youth Temperance Organisation; Anhörigföreningen för närstående till alkohol- och drogberoende; LP-Vannernas Kamratforening; (Switzerland) Dianova International; (Tanzania) Crisis Resolving Centre; Blue Cross Society of Tanzania; (Uganda) Care First Recovery Homes Uganda; Focus on Recovery Uganda; (United Kingdom) Faces & Voices of Recovery UK; Sheffield County Council; The Well Communities; Double Impact Services; SAM Recovery Swansea; Across Atlantic; ISAAC; (United States) Carlton Hall Consulting LLC; Hawai's Friends of Restorative Justice; Drug Free Collier; Recovery Research Institute; Community Alliances for Drug Free Youth; Hope nation; Smart Approaches to Marijuana; Drug Free America Foundation Inc; World Federation of Therapeutic Communities; DJC Solutions, LLC; Foundation for Drug Policy Solutions; She Recovers Foundation; Behaivior AI; Georgians for Responsible Marijuana Policy; (Zambia) Elevated Initiatives; Ndola Nutrition Organisation; (Zimbabwe) Purpose international ministries; Heart In Passion;

*Observers do not necessarily agree with all the content of the GPPR