23 Million in Recovery: Not As Positive As It Sounds

Addiction and recovery advocates, for the last decade, have used 23 million people in recovery as their primary statistic to combat stigma and raise funds. Digging into the data, however, provides a more powerful narrative that recovery leaders and advocates need to know and use. 

In 2012, 23 million Americans, or 10% of the adult population, reported being in active recovery from addiction. 

That sounds like a lot of people. The common perception is that people with addictions, despite social stereotypes, don’t live with their addiction for the rest of their lives. They overcome. 

The whole story, though, confirms that the rate of recovery in the United States has actually declined.

Since this survey’s first publication in 2012, federal agencies, national advocacy organizations, and most treatment providers have declared, “Recovery is possible!” This rallying cry combines both personal stories and sound statistical data—something the field deeply lacks. 

Skip ahead five years to 2017. A second similar survey was conducted. It asked this question: “Did you used to have a problem with alcohol or drugs but no longer do?” In 2012, the question was: “Did you once have a problem with drugs or alcohol, but no longer do?”

The 2017 findings stated 9.1% or 22.35 million adults overcame a problem with drugs or alcohol. This second study was more robust. It surveyed almost 40,000 adults versus 2,500.

While having a figure like 23 million in recovery is important, we have to look deeper. 

“Houston, we have a problem.”

Advocates like the Substance Abuse Mental Health Services Administration (SAMHSA), the leading federal agency for substance use and mental health, continue to say that 23 million Americans are in recovery and recovery is possible.

Recovery as we know it today is possible for some people. That’s true. What about everyone else? 

Unfortunately, the addiction treatment and recovery field doesn’t have the best reputation. It struggles. Social stereotypes, patient brokering scandals, Medicaid fraud, shoddy practices, and indiscernible outcomes all work against it. 

This makes the narrative of 23 million, now 22.35 million, so important to the field.

Beyond a single data point.

The 2017 study went a little deeper. It found 54% of those who responded “yes” to the question, accessed some form of assistance to overcome their alcohol or drug problem, confirming that some people do find the help they need. That’s good. 

When we go beyond the single data point is when things get interesting. 

The adult population in the U.S. in 2011/2012 was approximately 230 million. In 2016/2017, the U.S. adult population was 260 million. So, we should expect the total number of people in recovery to increase.

This is not what happened. 

In fact, the total number of people in recovery was 650,000 fewer than in 2012. In other words, the rate of recovery should have been an estimated 26 million adult Americans.

The rate of recovery in the United States declined. 

Most of the field sees 23 and 22.35 as close enough. So, the narrative and status quo remain.

It’s time for a new narrative.

In some corners, advocates want the narrative to be updated. Recovery is not possible, it’s probable. 

For those who slept through Statistics 101 in college, possible means that something is able to happen, and probable means that something is likely to happen, but the outcome isn’t certain.

That distinction makes a big difference.

Those who believe recovery is probable cite a meta-analysis of outcome studies from 1868-2011. This study reported 43-49% of people who once had a problem with alcohol or drugs eventually achieved full remission.

The many variables that surround “probable” have become the central argument when advocating for more investment, systems change, and resources. We know what makes success in recovery probable, we just don’t have enough of it.

The issue here is that in the 2017 study, 46% reported they overcame their drug or alcohol problem unassisted. Or in the words of William Cloud and Bob Granfield (who coined the term “recovery capital”) many recover naturally. 

The reality is most people who suffer from addiction either don’t seek help, recover naturally, or if they did have a problem, don’t continue to identify themselves as being in recovery. 

Tell the bigger story.

No one seems to be asking the right questions or being honest about the findings. 

The studies to-date attempted to support a narrative the addiction recovery field felt was true; recovery is possible, and most people don’t live with addiction for the rest of their life.

However, we should ask two questions: 

• Why did the rate of recovery decline? 

• What additional insights does the data provide?

The answers are an even more powerful story for advocates and policymakers.

Something happened culturally between 2012 and 2017. Something else was going on. Something which continues to alarm us in 2023.

We’re talking about drug overdose deaths. Before 2012, the number of drug overdose deaths slowly rose from year to year. In 2012, 41,502 lives were lost to a fatal overdose. That number nearly doubled five years later when 70,237 people died.

So, could a shift in the country show up in the data in a negative way?

That looks to be the case. The rate of recovery reversed at the very same time the drug overdose crisis began. This is the bigger story.

The data doesn’t support the rosier narrative, but that’s okay. While the results are devastating and negative, we see that data as a strong argument for targeted community support, value-based care, and positive change.

Candor in a time of crisis.

Unfortunately, we do not have updated data for the “in recovery” question. The last number reported is from 2017 and it cannot be used with a straight face in 2023. 

Overdose deaths for the last 12-month running projection are at 107,000. The latest NSDUH data from 2021 show that 46.3 million Americans 12+ years old can be diagnosed with a substance use disorder (up from 23.1 million in 2012, and 19.7 million in 2017). 

A statistic may reveal a bad outcome, but that doesn’t mean we should attempt to make it look pretty. In fact, we should shine a light on it. We need to understand why it is the way it is. 

Telling the whole story, the positive and negative together, is a stronger position and more powerful narrative for advocates and policymakers. 

To truly affect recovery, we need to be armed with the right tools. Commonly Well provides impactful recovery intelligence through patient-driven analytics, behavioral insights, and outcomes for addiction treatment. Discover more recovery intelligence on our blog, or contact us to see how we can work together to make more informed decisions and positive change.