The Five S’s of Addiction Recovery:
Structure, Supervision, Spirituality, Social Support, and Substitution
Ted Kradzinski BA and Jeremy Frank PhD., CADC
Note: I encourage people in recovery to commit their experiences to paper—doing so not only documents the process but helps the individual, and me, to identify what aspects of recovery prove most helpful. The following article is an outgrowth of this therapeutic journaling. The “Five S’s” it discusses are central to the way I work as a drug and alcohol counselor and psychologist, and recommend working, with recovering people. I thank and commend Teddy for collaborating with me to produce a personal account of addiction, recovery, and insights gained through, and about, the Five S’s and their contribution to his recovery. While most of the words herein are Ted’s, I have added and edited some to include elements of George Vaillant’s evidence-based research into these factors which I call the Five S’s of Addiction Recovery. As this is lengthy, we’ve divided it into five respective blogs with Ted describing his personal experience with each of these factors (or S’s). We encourage all people seeking change in their substance use, whether their goals are abstinence or moderation, or those looking for change in other mental health areas and general well-being to explore the ways in which they are engaged in these vital areas of life. —Jeremy Frank, Ph.D., C.A.D.C., Psychologist and Certified Alcohol and Drug Counselor.
Addiction is a phenomenon that touches the lives of people from all walks of life and from all around the world. It does not discriminate. However, while addiction has become a pervasive part of our collective consciousness—one that threatens our well-being as a culture—it, in many ways, remains a mystery. How should we define addiction? What can we do about it? How can something that demands so much attention, something that kills so many of our loved ones, remain so elusive? Our struggle to find answers leaves us asking questions with no clear answers. Is addiction a moral problem? Is it purely biological? Psychological? Social? Spiritual? In truth, it is probably all of these things and more, creating a web of apparent causes so broad that, paradoxically, seemingly contradictory factors may be not only present but relevant. For example, many people consider spirituality and science to be opposed to another, but widespread experience indicates that both play a positive role in recovery. Are they wholly separate or do they bleed into one another, albeit in ways that we do not yet understand?
My experience leads me to argue for overlap between the spiritual and scientific. I have struggled with a vicious heroin addiction for seven years. I have been in and out of recovery, desperately trying to figure this thing out. I have found no quick fix; instead, I have surrendered my consciousness to the conclusion that more will be revealed. Fortunately, there is resolution in this irresolution. Accepting this gray area is an antidote for my unrelenting appetite for drugs and alcohol.
We do understand certain aspects of addiction and have reached a common consensus that addiction is, in fact, a disease. However, this understanding has not yielded any concrete, one-size-fits-all solutions to the fatal problem of addiction. Things that cause tragic death typically demand solutions. With people dying from addiction every day, we cannot delay action until every aspect of the disease is understood. Therefore, I want to discuss five factors that are of tremendous help in guiding an authentic journey into and through recovery and all that follows. These are by no means a cure, but they are a foundation for improved opportunities to find freedom from affliction. In his article titled, “Alcoholics Anonymous: Cult or Cure?”, George E. Vaillant states that “The suggested mechanism of action of AA is that it employs four factors widely shown to be effective in relapse prevention in addictions: external supervision, substitute dependency, new caring relationships and increased spirituality” (Vaillant 2005). In our practice and in our recovery we have adapted George Vaillant’s four factors to arrive at the five S’s of recovery: structure, supervision, spirituality, social support and substitution. All of the factors mentioned here are intrinsic parts of the Alcoholics Anonymous program. Therefore, it can be posited that AA is a solid place to facilitate recovery. While I believe that AA is not for everyone, I believe that it can be for everyone. For those that don’t take to AA or who have fundamental differences with the AA program, instead focussing on the 5 S’s can be a clear path to recovery.
I use the following analogy when discussing whether AA is necessary for recovery: if I needed to cross the ocean and a storm was brewing, I could very well go into the woods and try to make my own canoe. There may be benefits to accomplishing this on my own, but I might very well die in the process. In contrast to building a canoe for myself, I could take advantage of an existing cruise-ship that actively invites me aboard, provides me with safety, and promises a proven strong likelihood of crossing the ocean successfully. AA is like that cruise-ship.
I will now explore the five aspects of AA’s approach that were central to my personal experience of recovery: structure, supervision, spirituality, social support, and substitution. This first blog will discuss the element or factor of, “Strucutre.” The subsequent four blogs will address the remaining factors spirituality, social support, and substitution.
It is important to note that in his research described in the paper entitled, “Alcoholics Anonymous: Cult or Cure?” (Vaillant, 2005), the author finds that not all factors are essential to any one individual’s successful recovery. In each case, an individual may not be strong in one area of recovery but as long as he or she is balanced and doing well in the other areas, a successful recovery may be achieved. Likewise, any one of these factors was not found to be wholly sufficient for recovery. For example, if spirituality is not your thing, that may be fine as long as you have structure, supervision, social support and substitutes for your addiction. It is not enough though, to only focus on one aspect of recovery. Saying that you will focus on the structure of work and career alone in order to help you moderate or control your drinking is not sufficient. Throwing yourself into the social support of your significant other alone without the other elements of a successful recovery will not likely end well.
I have always resisted any kind of structure. Instead, I’m inclined to go with the flow and improvise my way through life guided by intuition and inspiration. This remains my approach to life, but my way of connecting to and using intuition and inspiration have changed. Structure has allowed me to “flow” in an optimal, high-functioning way. As a musician, I like to improvise. Over time, however, I’ve found that bringing a degree of structure to the process of improvisation helps the “magic” happen. A soulful commitment to a composition leaves room for inspired improvisation. For me—and, I suspect, many others—it is easier to improvise within a solid, structured framework. It seems safe to suggest that a brilliant scientist will work best in a state-of-the-art laboratory. Structured recovery is like this laboratory.
Having a daily routine helps my recovery and gives me a sense of freedom to do what makes me feel inspired. Every day, upon waking up, I set aside an hour for a morning ritual of yoga, meditation, and prayer. I continue with stream-of-consciousness journaling, aiming for at least three pages of content. The balance of the day proceeds according to what life demands, but I advance through it with the momentum that comes from starting the day with a consistent routine.
I also commit to scheduling recurring activities throughout the week. I go to the gym several times weekly. I set aside time to play music. I meet with my AA sponsor. I attend group therapy on Tuesday nights…I could go on and on. With that said, my life does not feel overly structured. But the amount of structure it has makes all the difference. I imagine that others may benefit from relatively more structure while others may need less, but I’m certain structure can be a source of help for all.
There used to be no structure whatsoever in my life—I wanted to focus only on being a full-time musician. Despite that, I hardly ever played music. Instead, I found myself in a cycle of depression that led to inertia, and inertia that led to greater depression. I used drugs and alcohol to numb the pain of watching my dreams of being a musician pass me by. Now, in contrast, I find that I play music more often because my days are structured. Music-making is integrated into my schedule, which leads to more quality time practicing my craft. Successfully committing to music required structure, and the same goes for recovery and AA. If I do not commit to AA—or anything that impacts my life positively but requires effort—I might give in to laziness. However, not committing to AA has resulted, repeatedly, in dire consequences for me. Indeed, I am lucky to still be alive. Structure is a source of freedom. I am beginning to accept this paradox.
Five S’s of recovery: additional recovery factors
Vaillant, G. E. (2005). “Alcoholics Anonymous: Cult or Cure?” Australian & New Zealand Journal of Psychiatry, 39(6), 431–436. https://doi.org/10.1080/j.1440-1614.2005.01600.x
Miller, W. R., A. Forcehimes, M. J. O’Leary, and M. D. LaNoue (2008). “Spiritual direction in addiction treatment: two clinical trials.” Journal of Substance Abuse Treatment, 35(4), 434-42.
Suttie, J. (n.d.). “Drug Addiction, Social Connection, and the Brain.” Retrieved from https://greatergood.berkeley.edu/article/item/drug_addiction_social_connection_and_the_brain