Recovery dissonance: negotiating recovery ambivalence in an abstinence environment

Aileen O'Gorman, Karen Black

Research output: Contribution to conferencePresentationpeer-review


The mission creep of recovery-as-abstinence into drug policy and treatment practice has had negative implications for those seeking to engage in treatment (see McKeganey, 2014; Neale et al., 2013; Wincup, 2016).

This study explores the meaning and experience of recovery from the perspective of people receiving methadone maintenance treatment (MMT) in the abstinence-focused policy and practice environment of a Recovery-Oriented System of Care in Scotland.

Qualitative semi-structured interviews were conducted with 19 participants (10 females and nine males) who were currently engaged in MMT and who self-identified as being in recovery. The interview schedule was co-produced with people with living experience of MMT. Interviews were recorded, fully transcribed, coded using NVivo and analysed on a content and thematic basis. The findings are situated within a policy risk environment framework.

Narratives of recovery indicated ambivalence and a level of cognitive dissonance as a result of contradictory experiences in MMT. Improvements in health, well-being and social relations, and greater control over substance use, were valued. However, disapproval of the participants’ long-term engagement in MMT by care providers and abstinent peers led to increased stigma and isolation. Being designated ‘unclean’ affected access to ancillary services such as mental health and trauma support and group talk therapies. As a result, broader mental health and social needs were not addressed.

This study illustrates the challenges faced by those who do not conform to treatment expectations of abstinence and whose recovery aspirations are more harm reduction than abstinence oriented. Challenging the embedded assumption that abstinence is a priority or an attainable outcome for all requires a shift in perspective from policy and practice. Awarding parity to the voices of people with living experience of substance use in shaping policy and practice would spark substantive and equitable change.
Original languageEnglish
Publication statusPublished - 2019
EventFifth Contemporary Drug Problems Conference: Rethinking ‘Change': New Theories, New Topics, New Questions, New Methods - Monash University Prato Centre , Prato, Italy
Duration: 4 Sept 20196 Sept 2019


ConferenceFifth Contemporary Drug Problems Conference
Abbreviated titleCDP
Internet address


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