Key messages:

• Recovery from problematic substance use is a highly personal journey toward wellness, satisfying relationships, engagement in community, and a sense of meaning and purpose. Although setbacks happen, people can and do recover.
• Many people recover from problematic substance use without help, but individuals are more likely to experience long-term recovery if they have access to a combination of counseling services, peer- and community-based recovery supports, and medication.
• A recovery-oriented approach to counseling accepts that recovery from problematic substance use has many pathways and works with the individual's chosen recovery goal. That goal could be abstinence, controlled use, or somewhat reduced use.
• People with problematic substance use should have access to recovery-oriented systems of care (ROSCs), where providers offer these individuals treatment, recovery support, and other services and take a long-term, coordinated, and holistic approach to addressing their substance use–related problems.
• Certain counseling approaches can be effective at helping individuals with problematic substance use maintain their recovery regardless of their chosen recovery pathway. These include harm reduction, trauma-informed approaches, motivational approaches, family therapy, cognitive–behavioral therapy, contingency management, mindfulness and acceptance-based approaches, and psychoeducation.
• Peer support services enhance counseling by connecting individuals in recovery to nonclinical professionals who have lived experience with problematic substance use, behavior change, and recovery.
• Four major domains that support a life in recovery are health, home, purpose, and community. Counselors can help their clients recover from problematic substance use by connecting them to a range of tools and resources in these domains.
• An organization interested in adopting a recovery-oriented approach should reorient its mission statement, policies and procedures, staff training, and measures of client outcomes around consumers and their recovery needs and goals.
• An organization interested in becoming a member of a ROSC should take steps to actively link to other resources within the community that can provide recovery support in areas that the organization itself may not currently offer.
• Including people with lived experience in recovery from problematic substance use in an organization's staffing and treatment planning can support successful, sustainable implementation of recovery-oriented practices.