Maintenance Factors are those activities and influences that serve to stabilize, consolidate and strengthen longterm recovery from alcohol and other drug problems (Humphreys, et al., 1995). Recovery maintenance factors include: geographical/social disengagement from the culture of addiction; negotiation of entry into the sober world; development of a sobriety22 based social support system; institutional re-connection (family, church, school, workplace, pro-social community organizations); non-drug-related leisure activity; resolution of family distress/conflict; improved relationships with parents or children; positive response from significant others, family and friends; a stable economic support system; solidification of new identity; and the use of “justifying rhetorics” (personal rationales for abstinence) (Schasre, 1966; Moos, et al., 1979; Tuchfeld, 1981; Granfield and Cloud, 1999; Sobell, Ellingstad, and Sobell, 2000; McIntosh and McKeganey, 2002). Overall, recovery maintenance factors are generated through the diminishment of pain and global improvements in multiple areas of life functioning, including the enhancement of meaningful and pleasurable activities and relationships (Blomqvist, 1999; Larimer and Kilmer, 2000; Humphreys et al., 1995; Tucker et al., 1994; King and Tucker, 1998). The number and quality of pro-recovery relationships is predictive of recovery maintenance (Margolis et al., 2000; Gordon and Zrull, 1991; Stall and Biernacki, 1986; Laudet and Savage, 2001).
Making Amends are acts of restitution performed by recovering people for the harms they inflicted on others during the pre-recovery years. This ritual emerges from three of A.A.’s Twelve Steps: Step 8: “Made a list of all persons we had harmed, and became willing to make amends to them all”; Step 9: “Made direct amends to such people wherever possible, except when to do so would injure them or others”; Step 10: “Continued to take personal inventory and when we were wrong promptly admitted it”; Making amends—repaying the literal and symbolic debts accrued in addiction—diminishes guilt and anchors recovery upon the values of responsibility, justice and citizenship. This process also opens up the potential for atonement and forgiveness. In A.A., amends are made only when doing so would not injure others (see Restitution).
Manual-Guided Recovery are written documents that proceduralize the steps of addiction recovery so that such recoveries can be self-initiated and self-managed over time without the use of professionally-directed treatment services or involvement in formal mutual aid societies (see Solo Recovery).
Mass Abstinence is the resolution and prevention of alcohol and drug addiction through the collective decision of a people/community/culture to reject all consumption of alcohol and other drugs (Badri, 1976). Such mass action has often been the result of broad social movements (the American temperance movement), cultural revitalization movements within disempowered communities (See Willie, 1989; Chelsea and Chelsea, 1985; Taylor, 1987; Williams and Laird, 1992), or through religious reformation movements. Maturing Out (See Natural Recovery)
Medication-Assisted Recovery is the use of medically-monitored, pharmaceutical adjuncts to support recovery from addiction. These include detoxification agents (e.g., clonidine), stabilizing agents (e.g., methadone), aversive agents (e.g., disulfram), antagonizing agents (naloxone), and anticraving agents (acamprosate, naltrexone). They also include medications used to lower risks of relapse via symptom suppression of one or more co-occurring physical or psychiatric disorders. The use of such medications in the context of treatment is known as pharmacotherapy. The stigma attached to medication-assisted recovery (e.g., methadone) is being countered by wider dissemination of the research supporting its scientific efficacy as well as through the growing participation in recovery advocacy activities of people who have successfully achieved medication-assisted recovery. One goal of such advocacy is to have people in medication-assisted recovery recognized as legitimate members of the recovery community.