BLOG & NEW POSTINGS November 21, 2014Bill White PREDICTING ADDICTION/RECOVERY TRAJECTORIES

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It has become fashionable by commentators in the addictions arena to point to research studies confirming three linked findings: 1) the course of alcohol and other drug (AOD) problems are highly variable rather than inevitably progressive, 2) the majority of people experiencing substance use disorders and broader patterns of AOD-related problems resolve these challenges without specialized professional care or mutual aid assistance, and 3) the majority of such resolutions occur through deceleration of the frequency and intensity of use rather than through complete and sustained abstinence. Those findings, drawn from studies of community populations, have been used to buttress attacks on addiction treatment, Alcoholics Anonymous and other abstinence-based mutual aid organizations, the conceptualization of addiction as a disease, and the characterization of addiction as a “chronic” disorder. There is within these critiques an implied underlying tone of moral indictment: “If such large numbers of people resolve AOD problems without the need for abstinence and professional assistance, then why can’t you?” The tone of moral superiority in which this question is posed suggests that such problems could be resolved if one would just “Suck it up and deal with it!”
The idea that some people can resolve alcohol problems on their own via an exertion of will is not a new one and is outlined clearly in the basic text of A.A.–authored before most contemporary critics were born. Such self-will and moderated approaches had not worked for early AA members, but AA made no effort to deny that option to others. In fact, AA took quite the opposite position.
Then we have a certain type of hard drinker. He may have the habit badly enough to gradually impair him physically and mentally. It may cause him to di a few years before his time. If a sufficiently strong reason-ill health, falling in love, change of environment, or the warning of a doctor-becomes operative, this man can also stop or moderate, although he may find it difficult and troublesome and may even need medical attention. (Alcoholics Anonymous, 1939, p. 31)
If anyone, who is showing inability to control his drinking, can do the right-about-face and drink like a gentleman, our hats are off to him. Heaven knows we have tried hard enough and long enough to drink like other people! (Alcoholics Anonymous, 1939, p. 42)
AA literature makes no claim that the collective experience of AA members constitutes a universal truth applicable to the broader universe of all alcohol problems. By distinguishing themselves (“real alcoholics”) from problem drinkers, early AA members defined their own recoveries in terms of abstinence and mutual support because that is what had been successful in their experience.
So if there are potentially two worlds of AOD problems reflected in the divergent conclusions of epidemiologists and clinicians, what separates those who naturally mature out of AOD problems without professional or peer support and those for whom AOD problems become prolonged, life-threatening medical disorders? Having closely observed both patterns for nearly half a century, I believe there exists a “clinical cluster” that predictively distinguishes those whose AOD problems are most likely to become the most severe, complex and enduring and that are less amenable to natural recovery and moderated resolution. This cluster includes the following elements:
* Family history of AOD-related problems
* Early age of onset of AOD use
* Euphoric recall of first AOD use
* Atypically high or low drug tolerance from onset of use
* Historical or developmental trauma: cumulative adverse experiences with traumagenic factors (e.g., early onset, long duration, multiple perpetrators, perpetrators from within family or social network, disbelief or blame following disclosure)–without neutralizing healing opportunities
* Adjustment problems in adolescence that contribute to adult transition problems, e.g., instability in education, employment, housing, and intimate and social relationships
* Multiple drug use
* High risk methods of drug ingestion (e.g., injection)
* Co-occurring physical/psychiatric challenges
* Enmeshment in excessive AOD-using family and social environments, and
* Low levels of recovery capital (internal and external assets that can be mobilized to initiate and sustain recovery).
Each of these factors constitutes a risk factor for the development of severe and prolonged AOD problems, but such risks are dramatically amplified when combined. Not everyone sharing such risk factors will develop severe and chronic addiction, and some lacking such factors will still experience prolonged addictions. Some in the former group will also resolve their AOD-related problems without professional or formal peer assistance. But addiction is a disorder of odds, and one’s odds of escaping addiction and achieving recovery without help from others decline in tandem with the accumulation of risk factors and the absence of factors that protect and promote resiliency.
In my professional experience, the prospects of natural recovery and problem resolution via moderation decline in tandem with the increased number and intensity of the above factors. The “apples and oranges” comparison problems can be minimized, if not transcended, if we realize that findings from studies of the resolution of AOD problems among persons without these risk factors cannot be indiscriminately applied to those who possess such characteristics, and vice versa!

‘Psychiatric Drugs: More Dangerous Than You Ever Imagined (A New Video)’ by Peter Breggin MD NOVEMBER 21, 2014 BY DAVID CLARK


Peter Breggin is a very special man and has been detailing the dangers of biological psychiatry and psychiatric drugs for many years. Here is a video he posted on Mad In America.
‘We are facing a tragedy of enormous proportions! Psychiatric drugs of every kind are exposing people to long-term risks of a declining quality of life, apathy, chronic disability, and even shrinkage of the brain.
When they try to withdraw from the drugs, they are likely to find themselves afflicted with new symptoms of drug-induced harm that the medications were suppressing. Then they may find it physically and emotionally painful, and even dangerously unsafe, to withdraw from these psychoactive medications.
“Psychiatric Drugs are More Dangerous than You Ever Imagined” is the newest video in my series of Simple Truths about Psychiatry. It provides a simple, direct and inescapable warning about this epidemic of harm induced by psychiatric drugs.
It underscores my conclusions from many decades of scientific research, most recently described and documented in Brain-Disabling Treatments in Psychiatry, Second Edition (2008) and Psychiatric Drug Withdrawal: A Guide for Prescribers, Therapists, Patients (2013).
To that accumulating data and analysis, I would add Bob Whitaker’s landmark scientific discussion of drug-induced disability in Anatomy of an Epidemic (2010).
The video sounds a necessary alarm about this growing tragedy, involving millions of people and their families, who never foresaw the disabling results of taking psychiatric drugs and giving them to their children.’

Saturday, November 22nd, 2014 Focus: I refuse to cause or prolong harm.


Refusing to cause or prolong harm would already create the spiritual revolution that our world needs. Wars could not be waged. Children could not be deserted, starved or abused. Women and children could not be trafficked and enslaved. Nation-states could not torture and murder. Women and men could not “solve” their problems through violence and corruption. Terror could not reign if that simple truth were to be engraved across our hearts and taken seriously.

Are we capable of this? Are we capable of hearing and heeding? A commentary from Confucian teacher Meng Tzu, who died in 289 BC, would suggest this is so. “If a person sees a child about to fall into a well, he will be moved by mercy. Not because he wishes to make friends with the child’s parents or to win praise but because the child’s cries pierce him. This shows that no one is without a merciful, tender heart.”

It is in allowing our hearts to be pierced and opened that we become fully human. Choosing a more abundant and generous way of life, choosing empathy, kindness and forgiveness, we would begin to know what it means to honor life. We would begin to know what unconditionality amounts to. There is no valid withdrawing from harm, or recognizing the devastations that “harm” causes, without first remembering and desiring love.

Excerpted from the article:
Do No Harm! Easier Than Love Thy Neighbor?
Written by Stephanie Dowrick.

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RECOMMENDED BOOK OF THE DAY

Seeking the Sacred: Transforming Our View of Ourselves and One Another
by Stephanie Dowrick.

Can changing our view of ourselves and others affect the world? Bestselling author Stephanie Dowrick’s major new book is a compelling look at how we can transform the world by seeing the extraordinary everywhere we look, both without and within. Through her intimate, beautiful, and encouraging writing, Stephanie shows that it is only in altering our perception-seeing all of life as sacred-that we will challenge the usual stories about who we are and what we are capable of being.

Click here for more info or to order this book on Amazon.
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‘What does a person need in their environment in order to recover?’ by Mark Ragins NOVEMBER 20, 2014 BY DAVID CLARK

Mark Ragins believes there are four important things an environment must have to facilitate mental health recovery.
1. Relationships, as it is very difficult to recover alone. This is a little more complicated than you might think, as many people distance themselves from someone with mental health problems. A clinician may do this by talking about the illness rather than the person.
People must commit themselves to having a normal conversation with a person with mental health problems.
2. Inclusion, a person with mental health problems needs to be part of normal life. They need to be part of family gatherings, of work settings and social settings. If a person is excluded from life, it is much more difficult to recover.
3. Compassion, this means that a person’s heart must go out to you, not feeling sorry for you, but actually to know what is like to be you. They need to be empathetic. An environment needs people who see the world from the side of people with mental health problems.
4. Acceptance, people need to accept someone with a mental health problem just as they are, as a person with symptoms of a mental health problem.
Mark points out that whilst many people might accept a person in a wheelchair or with Down’s syndrome working in a store, far fewer accept someone with a mental illness in the same situation. Wouldn’t it be nice if that attitude changed? Many more people would recover.

Wednesday, November 19, 2014 Focus: I set small goals and set myself up for success.

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To get somewhere, you first have to know where you want to go. What physical goals are you striving toward? What kind of person do you want to become?

Having these answers sets your intentions, helps focus your efforts, and provides you with tangible ways to measure the results.

Set small goals. Set yourself up for success; for example, schedule your workouts at a time when you’ll be most likely to do them. Turn your attention away from negative thoughts.

Excerpted from the article:
Nine Keys to a Healthier, Happier You
Written by Mark Allen & Brant Secunda.

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RECOMMENDED BOOK OF THE DAY

Fit Soul, Fit Body: 9 Keys to a Healthier, Happier You
by Mark Allen and Brant Secunda.

Let’s face it: fitness goes far beyond how long it takes to walk or run a mile. When you’re stressed out, emotionally drained, overworked, overweight and underappreciative of your physical body, you can’t get much of anything accomplished—at work, at home, on the race track, wherever and in whatever capacity. Put simply, when you’re spiritually unfit, life is a greater challenge. That mythical “balance” you’ve always dreamed of achieving is just that — a myth. But not anymore. Brant and Mark have integrated their wisdom into one book, providing practical tools you can adapt to your lifestyle and achieve results you never thought possible.

Click here for more info and/or to order this book on Amazon.
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Tuesday, November 18th, 2014 Focus: I find practical and visible ways to leave a meaningful imprint on the world around me.

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If you ask yourself right now what you did last week that was exceptional, you’ll probably have to think a while. When you establish the asking of the two questions — what did you do last week and what will you do next week — as an integral part of your life, it can change your approach to everything you do. It steadily raises your sights about what you are capable of.

On Tuesday, you may be thinking, “But I haven’t done anything really exceptional yet this week.” This may prompt an inner response, such as, “Then I’d better think of something exceptional to do!” This heightens curiosity about the possibilities for taking new actions. You’ll be more likely to find yourself actively seeking ways to give the world more of your best, instead of just hoping for them.

Although studies indicate that people who regularly think ahead tend to experience more frequent leadership opportunities and career advancement, this mechanism is about something deeper than the external trappings of success. It serves as a reminder that it is up to each of us to keep finding practical and visible ways to leave a meaningful imprint on the world around us and on the lives of the people we care most about.

Excerpted from the article:
The Most Exceptional Thing You’ve Done Today
Written by Robert K. Cooper.

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RECOMMENDED BOOK OF THE DAY

The Other 90%: How to Unlock Your Vast Untapped Potential for Leadership and Life
by Robert K. Cooper.

Dr. Robert Cooper, a neuroscience pioneer and leadership advisor, urges us to take a radically different view of human capacity. We are mostly unused potential, he says, employing less than 10 percent of our brilliance or hidden talents. The Other 90% is your guide to new territory and new challenges. In easy-to-follow steps, he explains how to develop and apply the art and science of your hidden capacity.

Click here for more info and/or to order book.
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BLOG & NEW POSTINGS November 14, 2014 – Bill White THE BOUNDARIES OF “RECOVERY”


In 2007, I penned an essay published in the Journal of Substance Abuse Treatment (JSAT) on the definition and conceptual boundaries of addiction recovery. The essay was prepared for the Betty Ford Institute (BFI) Consensus Conference that produced its highly influential definition of recovery that was also published in JSAT in 2007 and subsequently updated in 2010. The BFI definition was followed by others in the U.S. (e.g., Center for Substance Abuse Treatment) and the U.K. (e.g., U.K. Drug Policy Commission)–reflecting the emergence of recovery as a new organizing paradigm in the alcohol and other drugs (AOD) policy and service practice arenas. Since that time, considerable discussion has ensued on the definition of recovery and its import for people seeking resolution of AOD problems, affected families, the professional and research communities, and AOD policy makers.
Work to date on defining recovery from addiction has focused on three essential ingredients. The first definitional element is resolution of the AOD problem, though disagreement continues over whether this requires 1) complete and enduring abstinence from ALL addictive substances, 2) reduction of AOD use and its consequences to subclinical levels (diagnostic remission), or 3) progress towards 1 or 2. The second recovery ingredient, focused on broader dimensions of quality of life, consists of measurable improvements in global health and social functioning. The third definitional element of recovery consists of positive changes in the person-community relationship–what the BFI consensus panel referred to as “citizenship” and the UK Drug Policy Commission referred to as “participation in the rights, roles and responsibilities of society.” While there is wide consensus that recovery is more than a dramatically altered person-drug relationship, consensus has yet to be reached on these additional defining ingredients and how to best measure the degree to which they are achieved.
Three recent developments are noteworthy within these ongoing discussions. First, a landmark survey of more than 9,000 people in recovery has just been published by Dr. Lee Ann Kaskutas and colleagues. The majority of those surveyed defined recovery in terms of 1) abstinence (no use of alcohol, non-prescribed drugs or misuse of prescribed drugs), 2) recovery essentials (e.g., self-honesty, drug-free coping, avoiding other destructive dependencies), 3) enriched recovery (e.g., personal growth and development, inner strength and harmony, social contribution, self-care), and 4) spirituality of recovery (e.g., gratitude, service, tolerance, self-transcendence). Of interest based on the discussion below is the minority position among those surveyed of what was NOT included in their personal recovery definition: no use of alcohol (5.5%), no misuse of prescribed medication (7.8%), and no use of non-prescribed medication (11.7%). More than a quarter of those surveyed believed that nonproblematic use of alcohol or drugs belonged or somewhat belonged in the definition of recovery.
A second development of note is the assertion of harm reduction perspectives on defining recovery. Ken Anderson, founder and CEO of HAMS (Harm Reduction, Abstinence, and Moderation Support), in a presentation at the 2014 National Harm Reduction Conference, challenged the traditional definition of recovery by asserting that, 1) recovery means “no impairment, distress, no problems,” which means that recovery can entail “abstinence or non-problematic use” and “that abstinence or a spiritual program are NOT requirements for being in recovery.” This view is further illustrated in a recent blog by Maia Szalavitz posted on substance.com. Maia asserts: “Addiction, as I see it, is compulsive use or behavior despite negative consequences–and if you have resolved that condition in any way that leaves you socially and occupationally healthy in a stable way, you are ‘in recovery’.” The question now being raised is whether abstinence is best viewed as the goal and defining essence of recovery or as one style of addiction recovery–and perhaps the style best suited for those with the most severe, complex, and chronic substance use disorders.
A third development is emergence of the question: Can people be considered “in recovery” “recovered,” or “recovering” from addiction when they continue to be dependent on a drug (nicotine) that continues as a major contributor to disease and death among those recovering from other drug dependencies? Interestingly, 32.5% of people in recovery in the study by Kaskutas and colleagues believed that no use of tobacco belonged or somewhat belonged in the recovery definition. This view dovetails efforts by David Macmaster and others to confront the role that the professional addiction treatment field and addiction recovery mutual aid organizations have historically played in enabling nicotine addiction. (I have outlined in earlier papers for people seeking recovery and for addiction professionals the research findings on the nicotine addiction morbidity and mortality among people seeking recovery from other drug dependencies.)
The personal stakes are high in this process of defining recovery. Everyone affected by and concerned about AOD problems should have a place at the table in which such definitions are forged. As I noted in 2007:
Imposed or self-embraced words that convey one’s history, character, or status have immense power to wound or heal, oppress or liberate. At a personal level, a definition of recovery will attract or repel people seeking to resolve AOD problems, provide a benchmark for when this state of recovery is achieved, and convey directly or indirectly what actions are required to sustain this status. A particular definition of recovery, by defining who is and is not in recovery, may also dictate who is seen as socially redeemed and who remains stigmatized, who is hired and who is fired, who remains free and who goes to jail, who remains in a marriage and who is divorced, who retains and who loses custody of their children, and who receives and who is denied government benefits (White, Journal of Substance Abuse Treatment, 2007, p. 230).
Efforts to define recovery within the AOD problems arena involve multiple dangers, including 1) defining recovery so broadly that the value of abstinence is obscured, particularly for those with the most severe AOD problems, and 2) defining recovery so narrowly as to deny the viability of alternatives to abstinence, particularly for those with less severe, developmentally transient AOD problems. Personal/family health and public health will be greatly enhanced by recovery definitions that address the whole spectrum of AOD problems and their available solutions.

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