There are a thousand ideas about how addiction recovery should work, it seems. Just drop by several different rehab facilities and you will see the differences for yourself. This multiplicity of approaches could breed confusion, especially among families seeking rehab for a loved one. That confusion can be quelled by reflecting on guidelines that the Substance Abuse and Mental Health Services Administration published as far back as 2012.

This slim booklet provides sound concepts that can be put to use when evaluating rehab programs. In addition to the 10 Guiding Principles noted on the cover, SAMHSA delineates four vital dimensions that support a life in recovery.

These are:

• Health
• Home
• Purpose
• Community

These four dimensions described in the booklet SAMHSA’s Working Definition of Recovery must each be addressed and developed in any person wishing to leave addiction behind. These same four dimensions are essential in the life of any sane, engaged individual. For a person coming back from years or even decades of addiction, they constitute a safe and stable path through the challenges of new sobriety.

SAMSHA comments that “health” involves overcoming or managing one’s own disease. For example, “abstaining from use of alcohol, illicit drugs, and non-prescribed medications if one has an addiction problem— and for everyone in recovery, making informed, healthy choices that support physical and emotional wellbeing.”

An addicted person loses this dimension when they lose control of their drug use or drinking. That is part and parcel of being addicted—the individual continues to make the decision to drink or use drugs despite the harm being done to their health and life. A return to sobriety means that this individual starts making better choices. If they simply stop drinking but maintain all their other harmful habits, have they really recovered from addiction?

Home refers, of course, to having a safe and stable place to live. It is a basic human need to know where you can shelter until tomorrow. It’s hard to even start on a path to recovery unless there is some safe harbor.

Purpose is a dimension that generally begins to bloom when a person is well on their way to lasting sobriety. At first, it is probably all a person can do to follow the basic dictates of whatever program they have chosen. In those early days, it’s all about them and learning to survive again. Eventually, it’s time to reach out to other human beings. This can and should lead to operating from a broader purpose. SAMSHA describes this dimension as “meaningful daily activities, such as a job, school, volunteerism, family caretaking, or creative endeavors, and the independence, income and resources to participate in society.”

As recovery progresses, manifesting a purpose in one’s actions becomes easier. So many people who have broken free from addiction turn around and help others make their way back to sobriety. Many rehabs are partly staffed by those who know what this transition is like. Helping others achieve and maintain sobriety is one of the most purposeful acts a person in recovery can perform.

In the community dimension, SAMHSA notes the importance of support, friendship, love, and hope in enabling a person to sustain their recovery. Those who have been addicted know that they have diminished the brightness of their community by buying and using drugs. Many people have had to resort to theft or other crime to maintain their addictions. Some people have sold drugs or encouraged their use. To fully walk back into the light, it’s necessary to recognize this and regain one’s place in the community. Giving support, friendship, love and hope to others rehabilitates our own spirits.

Alcoholics Anonymous and the Twelve Step Program certainly encourage finding ways to support and help others in Steps 9 and 12.

The Other End of the Scale

Sadly, not every program for addicted people embraces these dimensions. On the City Journal website, reporter Erica Sandberg describes her experience visiting outreach programs for the addicted in San Francisco. In a single afternoon, visiting three of these programs, she found only instruction in how to use naloxone to reverse an overdose, and supplies such as pipes, syringes, metal cookers, sheets of foil and straws.

She notes, “Not one person asked if I was interested in treatment. No one discussed detox or gave me a flyer with listings for local 12-step meetings. No one inquired about my physical or psychological wellbeing. I could have anything I wanted—except for help getting off drugs.”

She was visiting harm reduction programs in the city. She also describes three rehab programs that have a more well-rounded approach to the problem. These programs offer deeper dimensions of recovery such as housing and counseling. One includes a requirement that those in the program work—driving them to once again engage usefully in the life of the community.

When a program is limited to harm reduction or the minimalism of distribution of methadone or buprenorphine, that program fails to embrace these four vital dimensions of recovery. We might expect relapses to be common when these other dimensions are neglected.

For those in recovery to make it all the way back to lasting sobriety, we must help them build purposeful, engaged lives once again. They must relearn the skills that enable them to support others so they, in turn, deserve and receive support.