Life in Recovery Surveyshowed that, of those in stable recov-ery, 79.4%are engaged in meaningful activities; this madethem twice as enmeshed within the wider community thanindividuals not in recovery (Best et al.2015). Recovery isultimately not about reversal of pathology but the growth ofwellbeing as an intrinsically social process that is embeddedin local communities.It is not only the developmental pathway of recovery butthe mechanisms of change that challenge 'brain disease' as asufficient explanation for recovery (irrespective of the utilityof the BDMA in explaining onset). Kelly (2017) has arguedthat, not only isAlcoholics Anonymousstrongly associatedwith positive recovery outcomes, but that this peer-deliveredmutual aid approach works primarily through its impact onsocial networks (for men) and changes in abstinence self-efficacy (for women). This is consistent with a social identityapproach showing that recovery initiation and maintenanceare most strongly explained by the transition from using torecovery groups. This is consistent with a re-analysis ofProject MATCH data (Longabaugh et al.2010) and is predi-cated on the transition in norms, values and beliefs associ-ated with switching from using to recovery-oriented socialgroups.Not only does the success of mutual aid and peer-sup-ported pathways challenge the idea of biological determinismin addiction, it also challenges the implicitly moral argumentof partial determinism in which addicts are 'lesser' in theirchoices resulting from the draining of will and volition thataddiction is perceived to cause.‘Recovery’also contributes tothe challenge to the BDMA in the sense that, as well as char-acterising a personal experience, it summarises a pre-figura-tive political movement that resists medical labelling and thepower of pharmaco-solutions in a latter-day version of anti-psychiatry. Recovery is a contested concept but one thatshifts the timeline of addiction understanding, its locus andits mechanisms and that promotes self-determination andstrength-based choices.Bioethical implications of the brain disease modelof addictionFrederick RotgersModern bioethics rests upon four basic principles of practice:respect for autonomy, nonmaleficence, beneficence, and just-ice (Beauchamp and Childress1989; Childress1997). Ofthese, respect for autonomy tends to trump the others whenit comes to situations involving whether or not a personshould receive treatment for addiction, and whether or notaddictsarecompetenttomakedecisionsaboutvariousaspects of their lives. The principle of respect for autonomystates that in any decision-making on the part or on behalfof an individual, specifically in clinician-patient relationships,the clinician’s duty is to respect the autonomous choice ofthe patient. Autonomous choice can be defined as‘personalrule of the self by adequate understanding while remainingfree from controlling interferences by others and from per-sonal limitations thatpreventchoice’
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