Recovery is the process of becoming well. In terms of general health, it is often considered a return to healthy function following an illness or accident.
In mental health this does not accurately reflect recovery for people who see it as an ongoing endeavour instead of an end destination. Here recovery is more ideological and involves taking positive action to implement lifestyle changes that improve wellbeing.
The concept of recovery as a lived experience was first popularised in Alcoholics Anonymous (AA), through the 12-step programme it advocates. Its success resulted in the proliferation of 12 step programmes to other areas of addiction, for example, Narcotics Anonymous (NA) and Gambling Anonymous (GA). Moreover, the positive testimonies of people in addiction recovery describing experiencing a meaningful life encouraged health professionals to start looking at where people with mental health problems could also embark on a process of personal change. One that could build resilience for living a happy and satisfying life, irrespective of the limitations presented through illness.
Recovery as an approach in mental health takes a broader view of the person than is seen in traditional psychiatry, one that does not aim to treat symptoms or adjust for deficits, instead promoting self-management and the re-assertion of control. A substantial body of knowledge now exists on the use of recovery-based approaches within mental health services. This importantly has the backing of empirical evidence to demonstrate its efficacy. A review of the material resulted in a valued and respected framework for understanding personal recovery known as CHIME: Connectedness, Hope and optimism about the future, Identity, Meaning in life, and Empowerment.
This framework lists five significant and supporting components of recovery and has become an important tool for gauging recovery in addition to offering a model for developing interventions and evaluating clinical endpoints. The CHIME model has proved to be adaptable, for example, C-CHIME considers using creativity to promote recovery, CHIME-A is an adaptation specifically for adolescents and children, and CHIME-D considers recovery in terms of the difficulties overcome.
This presented the opportunity to consider what can be appropriated from this model and returned to where the idea of recovery started – addiction. One such study used CHIME-D to look at recovery in terms of the difficulties overcome, however this found that difficulties did not generally fall into their own classification, instead being more relevant to the other components of CHIME. Here we discuss an adaptation to the model that includes a sixth dimension important to addiction recovery, Growth, resulting in G-CHIME.
If the five components of CHIME fit so succinctly with addiction recovery, then why adapt the model to incorporate a dimension for growth? Perhaps this is best explained by the stages of change model commonly referenced in the field of addiction, where personal growth is recognised through a series of changes that demonstrate an individual’s disposition to learn, improve and continue to develop, rather than remain in the same mental and emotional state.
This willingness to adapt and learn, to personally grow, is a fundamental principle in 12-step programmes, where recovering addicts are encouraged to keep an ongoing inventory of their conduct and when appropriate accept responsibility for wrong doings and make positive changes to support a morally strong and motivated way of living. In psychological terms, this is an example of practising reflective thinking, where an individual can compassionately look at their strengths and weaknesses and use this evaluation to constructively inform their future choices. Furthermore, research has shown this is an essential ingredient for personal growth and development. For recovering addicts, following a path of continuing self-improvement, along with having the ability to enact constructive change, safeguards recovery. Negative behaviours and ways of thinking are reflected on, unhelpful ways are left behind, to be replaced with more positive equivalents that strengthen recovery.
For practitioners working with people in recovery, such as those engaged with addiction services, the G-CHIME model is multi-faceted. It can be used for targeted interventions when it is felt that an individual has a deficit with one or more of the components, for example, promoting mutual aid meetings and recovery activities for clients feeling lonely or disconnected or running workshops to help clients who are prone to negative bias foster a more hopeful and optimistic outlook in decision making and goal setting. Similarly, it could be extended as a treatment approach, in a similar way to that seen with the Five Ways to Wellbeing, where the components are grouped together to offer a more holistic package of support, in this case encouraging a broader perspective on resilience in addiction recovery.
G-CHIME can provide an itinerary for raising client awareness and educating them on the key aspects of recovery, as well as helping them understand where personal responsibility lies. As a framework, it offers a structure for assessing client development, as well as tracking progress over time to support addiction recovery as long-term endeavour. Matching appropriate scales to the six components of G-CHIME, such as, the Perceived Hope Scale, the Office for National Statistics personal wellbeing questions, or the meaning in life questionnaire, will enable practitioners to evaluate the personal resources held by their clients for each of the components.
The G-CHIME model is currently being used to study addiction recovery through a series of first-hand accounts of addicts living in recovery. Each story is unique to the experience and circumstances of the individual author. For each, a structured interview is conducted based on the six components of the G-CHIME model. This provides a basis to standardise the different accounts in relation to the common and necessary components of successful addiction recovery. In addition to this, G-CHIME is being used to promote the use of positive psychology in addiction treatment services, to disseminate positive addiction recovery to clients as an achievable lifestyle choice.
Recovery as a recognised approach to improving wellbeing started in addiction services and offered an alternative way to live. An approach that when transferred to mental health helped shape how people with mental illness were viewed and treated. This has seen a move from an assumed dependence on traditional psychiatric treatment to one that supports and encourages people with mental health problems to live a meaningful and satisfying life that is not defined by the challenges presented through illness.
From this, important knowledge has been acquired about the components necessary to support recovery, resulting in the advent of the CHIME model. G-CHIME takes the existing recovery components of Connectedness, Hope and optimism in the future, Identity, Meaning in life, and Empowerment, and adds Growth. This adaptation enhances it for addiction recovery where personal growth and development are a necessary part of sustaining recovery as a prolonged lifestyle choice. We commend it to colleagues.
Lisa Ogilvie is a PhD student and Jerome Carson is professor of psychology at the University of Bolton
The CHIME model represents five necessary components for mental health recovery – these are equally important, with an enduring body of research that is testament to this.
Connectedness, a key component in recovery communities that offers a supportive alliance to recovering addicts. This is evident in the local, national, and international membership of organisations such as AA and NA.
Hope and optimism about the future, summarised by the well-known AA recovery adage ‘living a life beyond your wildest dreams,’ which conveys a message of what recovery means to those living it. Describing an addict’s transition to a happy and free life beyond the constraints of addiction, where everyday possibilities are seen as attainable.
Identity, in 12-step programmes, the starting point is admitting you are powerless in addiction. Identifying as an addict is part of the recovery process, along with the transformation that happens in identifying as someone who lives in recovery, as opposed to someone defined by addiction.
Meaning in life, lost to those in active addiction, when purpose is driven by obsession with a substance or substances. Finding meaning is important to experiencing a renewed enthusiasm for life, and is necessary in having the aspiration to maintain recovery. Research has shown that meaning in life correlates with the longevity of recovery.
Empowerment, is minimised in addiction where choice is narrowed, having been limited by unhealthy behaviours and thought patterns relied on. The freedom of having a choice no longer restricted by active addiction is empowering. This is apparent in the many accounts recounted by recovering addicts telling of mended relationships, a return to education, finding employment, and forming