We are very good at counting when people attend addiction treatment. We are much less certain about what happens to them afterward.
We can measure admissions, days in residential care, counseling sessions, and successful discharges. We know whether someone completed 28 days or stayed for 90. What we have been much less successful at measuring is whether that treatment eventually translated into recovery.
That question is beginning to receive considerably more attention from the federal government. In January 2026, the White House launched the Great American Recovery Initiative, which calls for greater coordination across treatment, recovery support, housing, employment, and reentry services. It also places greater emphasis on measurable long-term outcomes (The White House, 2026). SAMHSA has moved in a similar direction, emphasizing long-term recovery, accountability, and measurable results rather than simply counting services delivered (Substance Abuse and Mental Health Services Administration [SAMHSA], 2026a).
I think there is something fundamentally right about that shift. Addiction treatment should eventually be judged by whether people are building lives that are more stable and sustainable. The difficulty is that measuring recovery is much harder than measuring attendance. Before we begin paying for outcomes, we have to decide what an outcome actually means.
Treatment Is Only the Beginning
One of the problems with the current system is that treatment and recovery are often treated as though they are the same thing. I have come to believe that many facilities we call treatment centers function more like triage centers. I do not mean that as criticism. Good acute treatment can be lifesaving. It can detox and stabilize someone, begin an assessment, introduce new ways of thinking, and establish resources for what comes next.
That work matters, but it is still the beginning.
A person does not normally learn how to live a fundamentally different life in 28 or 30 days. The National Institute on Drug Abuse has long described recovery from addiction as a long-term process that often requires continuing care after formal treatment ends (National Institute on Drug Abuse [NIDA], n.d.). What we sometimes call successful treatment may therefore be better understood as successful stabilization.
Residential treatment also removes someone temporarily from many of the situations in which recovery will eventually have to function. Family conflict is reduced. Work pressure may disappear. The daily schedule is largely controlled by someone else. That structure can be useful, particularly in early recovery, but it is not the same as learning to create structure independently.
The real test begins when the person goes back into ordinary life and has to apply what was learned under less controlled conditions. Understanding coping skills in a group is different from using them while dealing with job loss or conflict at home. Recovery becomes more meaningful when those skills are tested in the situations that previously led to substance use.
Environment plays an especially important role here. People develop behavioral patterns around certain places, people, and routines. Over time those patterns can become remarkably automatic. Someone who repeatedly used drugs in a particular environment may understand intellectually that returning there is dangerous, yet still experience the pull of familiar behavior once they are back inside it.
In the beginning of addiction, someone may go somewhere to be around people and drugs happen to be there. Later, they may go there for the drugs and the people simply happen to be there. Recovery requires reversing that process, and that reversal is often uncomfortable because the familiar environment may feel safer even when it is not healthy.
This is one reason recovery residences can play such an important role. A good recovery residence allows someone to begin living in ordinary society without being completely on their own. They can work and begin managing their own responsibilities while still returning to an environment organized around recovery. The residence provides accountability while the person gradually develops more internal structure.
That is different from simply providing a sober bed. The purpose should be to help residents become increasingly capable of managing their own lives rather than remaining dependent on external rules. A 2025 systematic review found recovery housing associated with improvements in abstinence and employment compared with usual continuing care. Some criminal-justice outcomes also improved, although the authors noted that stronger research is still needed (Vilsaint et al., 2025).
If government financing is moving toward long-term outcomes, recovery residences may deserve considerably more attention because much of the work of recovery occurs after formal treatment has ended.
What Should Recovery Actually Measure?
Abstinence matters. Continued substance use can destabilize nearly every other part of someone's life, and it would be a mistake to minimize its importance. At the same time, abstinence alone is an incomplete description of recovery.
SAMHSA describes recovery in broader terms that include health, home, purpose, and community (SAMHSA, 2024). That is much closer to how recovery appears clinically. In the first months, progress may show up in very basic ways. A person begins remembering appointments, arriving on time, and maintaining a routine. Those changes may appear small, but they reflect improvements in executive functioning and behavioral regulation.
As recovery progresses, the markers change. We begin asking whether the person is becoming healthier and more stable. Relationships may improve. Financial decisions may become less chaotic. A recovery network may begin replacing the isolation that often accompanied addiction.
Over time, however, one of the most important measures becomes how the person responds when something goes wrong.
What Happens After a Setback Matters
A return to substance use is serious, and with opioids it can be deadly. Still, one episode of substance use does not automatically tell us that treatment failed. NIDA has long recognized that relapse can indicate a need to resume or modify treatment rather than proof that previous treatment was ineffective (NIDA, n.d.).
The more useful question is what happens next.
Does the person continue using and drift back toward old behavior patterns, or do they examine what happened and make adjustments? A weakness in the recovery plan may require additional therapy. The living environment may need to change. Support may have gradually disappeared without anyone noticing.
The important point is that recovery is not demonstrated only by avoiding problems. It is also demonstrated by how someone responds when problems occur.
The same is true of ordinary setbacks. Someone six months into recovery may lose a job. That event alone tells us very little. The important information comes from the response. A person who processes the loss, makes adjustments, and begins moving forward again is demonstrating resilience. Someone who responds by returning to an old environment and abandoning recovery-oriented behavior is moving in another direction.
The event is not the outcome. The response to the event tells us more.
That is why I believe recovery eventually needs to be evaluated as a pattern rather than a collection of pass-or-fail events. One warning sign may mean very little. Several warning signs occurring together may indicate that the person's recovery is beginning to deteriorate.
The Risk of Paying for Outcomes
This is where value-based funding becomes complicated. Whenever money is tied to outcomes, organizations become highly motivated to produce whatever numbers are being rewarded. Sometimes that improves care. Sometimes it changes behavior in ways no one intended.
If abstinence becomes the dominant measure, programs may become reluctant to serve patients with repeated relapses. If employment is weighted too heavily, organizations working with people who have significant disabilities may appear less successful. If treatment completion becomes the central metric, programs may become excellent at producing completions without necessarily becoming better at producing recovery.
Government systems naturally prefer outcomes that can be counted. Recovery is harder because much of what matters appears as a pattern developing over time.
The same problem can occur with the phrase evidence-based treatment. Evidence-based care is important, but the term is sometimes interpreted too broadly. People may hear it almost as though a behavioral intervention functions like a prescription medication: identify the diagnosis, provide the treatment, and expect a predictable result.
Behavioral health rarely works that cleanly.
Evidence tells us that an intervention has produced benefit for a particular population under certain conditions. It does not mean everyone will respond or that every person is appropriate for the same intervention. It also does not mean that completing an evidence-based program proves that recovery has occurred.
Government should continue expecting treatment to be grounded in evidence. We should simply avoid confusing evidence that a treatment can work with evidence that a particular person is actually getting better.
Medication for opioid-use disorder requires the same kind of nuance. Buprenorphine and other medications have strong evidence supporting their effectiveness. They improve treatment retention and reduce illicit opioid use (NIDA, 2018). That evidence should not be minimized.
Medication, however, is not designed to perform every part of recovery. It does not automatically repair damaged relationships or create healthier coping patterns. It cannot by itself change the environment surrounding the person. Those are different problems that may require different interventions.
The same principle applies to harm reduction. Naloxone and overdose-prevention efforts save lives. Keeping someone alive is essential, but keeping someone alive cannot become the entire definition of successful addiction policy. Survival creates the opportunity for recovery. The next question is whether the person's life begins moving in a healthier direction.
Measure Recovery, Not Attendance
That is why I am cautiously encouraged by the federal government's increasing emphasis on long-term outcomes. There is value in asking whether people are actually recovering rather than simply asking whether they completed a program.
The difficult part will be choosing the right measurements.
The government can ask the right question and still choose the wrong answer.
Replacing “Did this person complete 30 days of treatment?” with “Did this person remain perfectly abstinent for the next year?” may simply exchange one overly simple metric for another.
The better question is whether the person's life is moving in the direction of recovery.
Consider someone three years after treatment who has experienced a divorce and changed jobs. They have gone through a period of depression and had one brief return to substance use. At the same time, they maintained housing and stayed engaged in treatment. Their relationships improved, and they repeatedly returned to recovery-oriented behavior after setbacks.
I would consider that a successful outcome.
Not because the person's life became easy or because recovery followed a straight line. It was successful because the person gradually developed the ability to experience life without repeatedly returning to the patterns addiction had built.
That is much harder to measure than treatment attendance.
It is also much closer to what recovery actually is.
If the government's changing approach to addiction financing helps move the system toward measuring that kind of progress, it could represent a meaningful step forward. But it should be the beginning of the discussion, not the end of it.
References
National Institute on Drug Abuse. (2018). Medications to treat opioid use disorder. National Institutes of Health.
National Institute on Drug Abuse. (n.d.). Seeking drug abuse treatment: Know what to ask. National Institutes of Health.
Substance Abuse and Mental Health Services Administration. (2024). About recovery. U.S. Department of Health and Human Services.
Substance Abuse and Mental Health Services Administration. (2026a). SAMHSA strategic priorities. U.S. Department of Health and Human Services.
The White House. (2026). Great American Recovery Initiative. Executive Office of the President.
Vilsaint, C. L., Tansey, A. G., Hennessy, E. A., Eddie, D., Hoffman, L. A., & Kelly, J. F. (2025). Recovery housing for substance use disorder: A systematic review. Frontiers in Public Health, 13, 1506412. https://doi.org/10.3389/fpubh.2025.1506412