Life in Recovery Survey showed that of those in stable recov ery 794 are

Life in recovery survey showed that of those in

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Life in Recovery Survey showed that, of those in stable recov- ery, 79.4 % are engaged in meaningful activities; this made them twice as enmeshed within the wider community than individuals not in recovery (Best et al. 2015 ). Recovery is ultimately not about reversal of pathology but the growth of wellbeing as an intrinsically social process that is embedded in local communities. It is not only the developmental pathway of recovery but the mechanisms of change that challenge 'brain disease' as a sufficient explanation for recovery (irrespective of the utility of the BDMA in explaining onset). Kelly ( 2017 ) has argued that, not only is Alcoholics Anonymous strongly associated with positive recovery outcomes, but that this peer-delivered mutual aid approach works primarily through its impact on social networks (for men) and changes in abstinence self- efficacy (for women). This is consistent with a social identity approach showing that recovery initiation and maintenance are most strongly explained by the transition from using to recovery groups. This is consistent with a re-analysis of Project 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 social groups. Not only does the success of mutual aid and peer-sup- ported pathways challenge the idea of biological determinism in addiction, it also challenges the implicitly moral argument of partial determinism in which addicts are 'lesser' in their choices resulting from the draining of will and volition that addiction is perceived to cause. Recovery also contributes to the 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 the power of pharmaco-solutions in a latter-day version of anti- psychiatry. Recovery is a contested concept but one that shifts the timeline of addiction understanding, its locus and its mechanisms and that promotes self-determination and strength-based choices. Bioethical implications of the brain disease model of addiction Frederick Rotgers Modern bioethics rests upon four basic principles of practice: respect for autonomy, nonmaleficence, beneficence, and just- ice (Beauchamp and Childress 1989 ; Childress 1997 ). Of these, respect for autonomy tends to trump the others when it comes to situations involving whether or not a person should receive treatment for addiction, and whether or not addicts are competent to make decisions about various aspects of their lives. The principle of respect for autonomy states that in any decision-making on the part or on behalf of an individual, specifically in clinician-patient relationships, the clinician s duty is to respect the autonomous choice of the patient. Autonomous choice can be defined as personal rule of the self by adequate understanding while remaining free from controlling interferences by others and from per- sonal limitations that prevent choice
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