BLOG & NEW POSTINGS May 4, 2018 -Bill White- RECOVERY SUPPORT FOR PEOPLE IN MEDICATION ASSISTED RECOVERY: SUGGESTED STRATEGIES

In the last blog, we explored why people in medication-assisted treatment (MAT) for alcohol or opioid use disorders experience special obstacles to long-term recovery, why individuals using medication support may be in particular need of peer recovery support services, and why some individuals denied access to medication support could benefit from integrated models of medication and psychosocial support. In my communications with addiction treatment and recovery community organizations, I regularly urge the full integration of psychosocial and medication support options and suggest three broad strategies for increasing medication support for people in MAT within the current dichotomized context of recovery support.

The first strategy is to collaborate with existing recovery mutual aid organizations and local recovery support institutions to increase access to these resources by patients in MAT. This strategy requires a foundational understanding of the history, evolution, and current policies and practices within these groups related to people who are on prescribed medications as part of their treatment for addiction. You will want to know if there are formal or unwritten exclusion policies/practices, any restrictions on membership rights (e.g., ability to speak in meetings, lead meetings, perform service roles) placed on people in MAT, and the degree to which individuals in MAT will be either stigmatized or warmly welcomed within each available group. It is important in this regard to recognize the high variability across meetings within each recovery fellowship and to identify medication-friendly groups with whom you can collaborate. Working within the service structures of these organizations to directly address the needs of people in MAT can help widen doorways of entry and acceptance. Such efforts are enhanced when combined with a sustained campaign of public, professional, and patient/family education on MAT and medication-assisted recovery, the latter enhanced by eliciting stories from individuals and families in long-term recovery whose recoveries were aided by MAT.

The second strategy is to expand access to mutual aid groups specifically designed for people in MAT. Such groups as Methadone Anonymous or local MAT support groups operating under various names (e.g., Ability, Inspiration and Motivation, AIM) can provide medication-specific recovery support without the stigma sometimes encountered in other groups related to the use of medications as an adjunctive recovery support. The downside of these groups is they may be less accessible and less stable than mainstream groups, e.g., fewer face-to-face meetings, less meeting stability, and shorter periods of recovery stability of those attending. MAT-specific support groups tend to flourish in communities in which other support groups are hostile towards medication, but weaken as these other groups become more accepting of people in MAT. The challenges of accessing such resources have led many people in MAT to seek support online rather than within their local communities. Such resources include http://www.addictionsurvivors.org/ and https://www.dailystrength.org/group/suboxone-support-group. A related recovery support strategy is to use parallel support groups that may aid recovery, e.g., support groups for people living with HIV/AIDS or Hep C, groups for trauma survivors, etc.

The third strategy involves providing open-ended peer-recovery support services (PRSS) through the auspices of an addiction treatment, recovery community, or other service organization. An example of such an effort is the M.A.R.S. Project, a federally-funded program providing peer recovery support to patients in medication-assisted treatment (MAT) for opioid addiction. (See interview with M.A.R.S. Director Walter Ginter.) M.A.R.S. is a collaborative project of Albert Einstein College of Medicine in New York City, Yeshiva University, and the National Alliance for Medication-Assisted (NAMA) Recovery. Such efforts can exist as independent projects or be integrated into existing organizations. They can serve as permanent alternatives to existing mutual aid groups where such groups are absent or hostile to MAT or serve as a source of transient support until independent and medication-friendly recovery mutual aid groups can be locally established. Treatment organizations could provide such services over time within three phases: 1) an open-ended and professionally-direct continuing care group, 2) a support group led by former MAT patients under the auspices of an alumni association, and 3) spinning the alumni-sponsored group off as an independent member-run recovery mutual aid society. Such phased efforts can provide services on an immediate basis to those in need of such support while at the same time expanding peer-based recovery mutual aid resources that can operate independently from other organizations.

It is my contention that the future of addiction treatment lies with the expansion of the treatment menu, evaluating the efficacy of individual treatment components, and finding the most potent combinations and sequences of services that can support personal and family recovery across the stages of recovery and across diverse cultural contexts. For many, that will involve integrating medication support and a broad spectrum of psychosocial supports.

References

Galanter, M., Seppala, M., & Klein, A. (2016). Medication-assisted treatment for opioid dependence in twelve-step-oriented residential rehabilitation settings, Substance Abuse, 37(3), 381-383.

Gilman, S. M., Galanter, M., & Dermatis, H. (2001). Methadone Anonymous: A 12-Step program for methadone maintained heroin addicts. Substance Abuse, 22(4), 247-256.

Ginter, W. (2012). Methadone Anonymous and mutual support for medication-assisted recovery. Journal of Groups in Addiction & Recovery, 7(2-4), 189-201.

Glickman, L, Galanter, M., Dermatis, H., Dingle, S., & Hall, L. (2005). Pathways to recovery: Adapting 12-step recovery to methadone treatment. Journal of Maintenance in the Addictions, 2(4), 77-90.

Krawczyk, N., Negron, T., Nieto, M., Agus, D. & Fingerhood, M.I. (2018). Overcoming medication stigma in peer recovery: A new paradigm. Substance Abuse, February, DOI: 10.1080/08897077.2018.1439798.

McLellan, A. T., & White, W. L. (2012). Opioid maintenance and Recovery-Oriented Systems of Care: It is time to integrate. Invited commentary on Recovery-oriented drug treatment: An interim report by Professor John Strang, Chair of the Expert Group. (DrugLink, July/August, pp. 12-12). London, England: The National Treatment Agency.

Obuchowsky, M., & Zweben, J. E. (1987). Bridging the gap: The methadone client in 12-Step programs. Journal of Psychoactive Drugs, 19(3), 301-302.

Tonigan, J. S., & Kelly, J. F. (2004). Beliefs about AA and the use of medications: A comparison of three groups of AA-exposed alcohol dependent persons. Alcoholism Treatment Quarterly, 22(2), 67-78.

White, W. L. (2011). Narcotics Anonymous and the pharmacotherapeutic treatment of opioid addiction. Chicago, IL: Great Lakes Addiction Technology Transfer Center and Philadelphia Department of Behavioral Health and Intellectual disAbility Services.

White, W., Campbell, M. D., Shea, C., Hoffman, H. A., Crissman, B., & DuPont, R. L. (2013). Co-participation in 12 Step mutual aid groups and methadone maintenance treatment: A survey of 322 patients. Journal of Groups in Addiction & Recovery, 8(4), 294-308.

White, W. L., & Torres, L. (2010). Recovery-oriented methadone maintenance. Chicago, IL: Great Lakes Addiction Technology Transfer Center, Philadelphia Department of Behavioral Health and Mental Retardation Services, and Northeast Addiction Technology Transfer Center.

Post Date May 4, 2018 by Bill White

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RECOVERY SUPPORT FOR PEOPLE IN MEDICATION ASSISTED RECOVERY: THE CONTEXT-April 27, 2018 By Bill White

How can peer addiction recovery supports, including access to medication-friendly mutual aid meetings, be increased for people in medication-assisted treatment (MAT)? That is a question of increasing import to people working in addiction treatment and recovery community organizations.

In this first of a two-part blog, we will briefly explore why people in MAT experience special obstacles to long-term recovery, why individuals using medication support may be in particular need of peer recovery support services, and why some individuals denied access to medication support could benefit from integrated models of medication and psychosocial support.

Participation in secular, spiritual, and religious recovery mutual aid societies and other peer-based recovery support institutions increases rates of substance use disorder remission and enhances global health and social functioning. There are FDA-approved medications that reduce addiction-related morbidity and mortality and enhance health and social functioning. Psychosocial (professional and peer) support and medication support have historically evolved as separate service organizations with their own respective philosophies about the nature of and solutions to severe alcohol and other drug problems. Fully integrating intensive psychosocial support and a full menu of pharmacotherapy choices is historically rare within the addictions field, but interest in such integration is increasing.

There are very few research studies on the experiences of MAT patients seeking participation in mainstream recovery mutual aid societies. Existing studies report high rates of past participation in 12-Step recovery groups and positive self-reports of the effects of such participation, but also note hostile attitudes toward MAT, restrictions on level of participation due to MAT status, and encouragement to progressively lower medication dosage or cease MAT. These studies also note decisions by some MAT patients to not disclose their MAT status to sponsors and fellow group members or to migrate to a fellowship less hostile to MAT (i.e., methadone and buprenorphine maintenance patients seeking support in Alcoholics Anonymous meetings rather than Narcotics Anonymous meetings). Secular and religious alternatives to 12-Step groups exist, but have been historically focused on recovery from alcohol use disorders. Mutual aid groups specifically developed for people in MAT for opioid addiction exist (e.g., Methadone Anonymous), but have been marked by instability, slow growth, and unavailability in many communities.

Similar obstacles are often encountered as MAT patients seek participation in other recovery support institutions (i.e., recovery homes), but some new recovery support institutions have exerted special efforts to extend a warm welcome to those in MAT (e.g., recovery community centers, recovery cafés, etc.). Increased access and warm welcome within mutual aid groups and other indigenous recovery support institutions could significantly elevate long-term recovery outcomes of MAT patients.

The longstanding anti-medication bias within recovery mutual aid societies has resulted in exclusion, discouragement, and second-class status of people seeking support from many of these mainstream mutual aid groups. The stigma attached to medication within these groups is rooted historically in fraudulent claims and iatrogenic effects of many medications prescribed as cures or treatments for addiction during the nineteenth and twentieth centuries. Misconceptions about the nature of medications used in MAT, inadequate dosing policies, high rates of concurrent alcohol and illicit drug use, and low quality of overall care within under-resourced opioid treatment programs has further heightened stigma attached to MAT. This anti-medication bias is slowly decreasing within both addiction treatment and recovery mutual aid settings as a result of improved quality of MAT, research on MAT effectiveness, and increased involvement of current and former MAT patients within the recovery advocacy movement.

A substantial portion of people seeking treatment for alcohol or opioid use disorders in the U.S. are not offered pharmacotherapy as a treatment service. A 2014 study by Volkow and colleagues noted that only 50% of private addiction treatment centers offered medication, with only 34% of patients in centers offering medication support actually receiving medication as part of their treatment. Similarly, less than 5% of U.S. physicians are waivered to prescribe buprenorphine for the treatment of opioid addiction. Among programs that do offer medication support, only a minority offer a full spectrum of addiction pharmacotherapies. A 2018 analysis of data from more than 12,000 addiction treatment centers in the U.S. revealed that only 41.2% of reporting centers offered at least one of three primary medications used in the treatment of opioid addiction (methadone, buprenorphine, and naltrexone), and only 2.7% of facilities offered a choice of all three medications.

Far too many people with alcohol and opioid use disorders are being repeatedly recycled through ever-briefer episodes of traditional abstinence-based treatment without achieving long-term recovery stability. (Forty-seven percent of patients admitted to addiction treatment in 2014 had one or more prior treatment admissions, and 13% had 5 or more prior treatment admissions). The above-noted anti-medication bias, the under-representation of physicians and other medical personnel within the addiction treatment workforce, and limited medication options may well contribute to such recidivism.

Many of the individuals undergoing multiple treatment episodes suffer from substance use disorders that are severe, complex, and chronic, with clinical assessments revealing non-existent or severely eroded family and social recovery supports. These are the patients who are being repeatedly recycled through treatment that does not address the complexity of their needs. It is doubtful that medication alone will alter the trajectory of their problems any more than non-medical treatments alone have, but a fully integrated combination of such approaches combined or sequenced over time across the stages of recovery might well have such potential. It is time that proposition was rigorously tested.

The majority of people admitted to medication-assisted treatment in the U.S., particularly office-based treatment of opioid addiction with prescribed buprenorphine, receive minimal, if any, peer recovery support services or assertive linkage to community-based, recovery mutual aid organizations. There are growing calls for and increased clinical experiments integrating medication support and professionally-delivered or peer-based psychosocial support, particularly in response to the recent surge in opioid addiction and its related death toll.

Substantial populations of people in MAT for alcohol or opioid dependence continue use alcohol, un-prescribed opioids, and other unprescribed drugs while in treatment. Others achieve abstinence from non-prescribed drugs, but fail to achieve larger gains in global health and social functioning. An expanded menu of psychosocial and peer recovery supports could potentially affect improvements in each of these areas.

The majority of people who commence MAT will eventually discontinue medication support, a substantial portion within the first year of medication support. Seen as a whole, the major problem with MAT is not that people remain on it too long as is often argued, but that most patients do not remain on it long enough to obtain stable recovery or sustain recovery following cessation of medication support.

Following cessation of MAT, there is increased risk of addiction recurrence, addiction-related medical disorders, arrest, and drug-related death. Providing peer support throughout the treatment process, providing all patients who are tapering with increased professional and peer supports, and conducting post-treatment monitoring and re-intervention on all MAT patients, regardless of discharge status, could potentially reduce post-treatment morbidity and mortality.

There is also an increased risk of drug-related death for people treated for opioid addiction in abstinence-based programs during the days, weeks, and months following discharge. Intensified post-treatment psychosocial support and, where indicated, combining such supports with medication support, could potentially reduce the prevalence of such deaths.

I have observed people undergoing addiction treatment for more than half a century. It is my view that many people fail in MAT due to a lack of psychosocial supports, and that many fail in traditional abstinence-based programs due to the absence of medication support. It is past time to pilot integration initiatives that rigorously evaluate the extent to which unique combinations or sequences of these interventions can improve recovery outcomes and for which clinical populations such combinations may be most needed and effective.

Treatment of chronic and severe primary health disorders involves a broad spectrum of potential interventions uniquely combined and sequenced to match the unique needs and responses of each patient. The treatment choices available to the cancer patient, for example, may include, surgical interventions, radiation, chemotherapy, pharmacotherapy, hormone therapy, immunotherapy, stem cell transplant, bone marrow transplant, gene therapy, and a minimum of five years of post-treatment monitoring with re-intervention at the earliest signs of cancer recurrence—as well as adjunctive physical therapy, dietary changes, patient and family education and peer support groups. To treat cancer offering a single fixed intervention for all patients or even the same small cluster of treatment activities would be considered professional incompetence and legal malpractice. Why then is offering a single primary intervention or limited cluster of interventions (“the program”) the mainstream of clinical practice in addiction treatment? And why are the treatments used determined not by objective clinical criteria and individual needs but by the randomness of the treatment program one enters and the narrow cannon of clinical beliefs one encounters there?

It is my contention that the future of addiction treatment lies with the expansion of the treatment menu, evaluating the efficacy and effectiveness of individual treatment components, and finding the most potent combinations and sequences of services that can support personal and family recovery across the stages of long-term recovery and across diverse cultural contexts. For some, that will involve integrating medication support and a broad spectrum of psychosocial supports.

Next Week: Increasing Recovery Support for People in Medication Assisted Treatment: Suggested Strategies

Post Date April 27, 2018 by Bill White

THE ROLE OF MEDICINE IN ADDICTION TREATMENT-April 19, 2018- By Bill White

Imagine seeking assistance from a health care facility and being told that you have a progressively debilitating and potentially fatal medical disorder (one widely recognized in the research community as a brain disease), but then discovering that no physician or other medical personnel will be involved in the assessment, diagnosis, acute treatment, or continued monitoring of your condition. Imagine that the vast majority of organizations specializing in treatment of your condition have no affiliation with a hospital or other primary healthcare facility. Imagine the existence of FDA-approved medications specifically for treatment of your condition, but that you will not be informed about nor have access to these medications as part of your prescribed treatment. These are precisely the circumstances encountered today by the majority of people entering addiction treatment in the U.S.

There are more than 18,000 facilities in the United States that specialize in the assessment and treatment of substance use disorders. Surveys of these facilities reveal a low complement of physicians on staff, with nearly half having no physician availability. Publicly funded programs that constitute the bulk of addiction treatment services in the U.S. are particularly lacking in physician services and access to pharmacotherapy as a treatment adjunct.

Physicians are critically needed as part of the multidisciplinary teams involved in addiction treatment. Some of the more important functions they perform include:

*Diagnosing the presence, severity, and complexity of substance use disorders, particularly in distinguishing these disorders from other medical and psychiatric conditions which may manifest as, be masked by, or be self-medicated by excessive alcohol and other drug use.

*Diagnosing and treating acute medical and psychiatric conditions that result from or co-occur with substance use disorders—conditions that if left untreated pose a significant burden within the recovery process.

* Assessing and addressing the physical and emotional toll addiction has exacted on family members.

* Participating in, if not leading, development of a personalized plan for acute stabilization and a more comprehensive plan of sustained recovery management for the patient and family.

* Evaluating the role medications could potentially play in detoxification, acute stabilization, and long-term recovery management.

* Providing guidance on the management of chronic primary health care problems and promoting recovery-enhancing wellness activities, e.g., smoking cessation, diet, and exercise.

* Educating patients and families on the addiction and recovery processes.

* Supervising other members of the treatment team.

* Providing regularly scheduled post-treatment recovery check-ups as part of the long-term recovery management plan.

If you or a family member must enter treatment for a substance use disorder in a program that does not have physician services, I recommend the following two steps.

1) Involve your primary care physician (PCP) in the treatment process. Inform your PCP of the following: you are entering addiction treatment, you would like your PCP to be available for consultation regarding that treatment, you will provide your PCP copies of all records related to your treatment, and you would like your recovery status regularly evaluated through all future check-ups. If you do not have a primary care physician, make obtaining a PCP a priority as part of your treatment /recovery plan.

2) Consider engaging a physician trained in addiction medicine to consult in your overall treatment and to provide ongoing guidance following treatment discharge. It is recommended that such a physician be affiliated with the American Society of Addiction Medicine or the American Academy of Addiction Psychiatry. Addiction medicine specialists in your area can be identified by contacting these organizations.

Beyond these two suggestions, it is critical that anyone seeking addiction treatment become an informed consumer. This requires seeking both experiential knowledge and empirical knowledge about addiction and recovery. The former can be obtained by talking to individuals and families who have successfully resolved alcohol and other drug problems. The latter can be obtained by reading the latest research findings about the critical ingredients of addiction treatment and recovery—research findings that have recently been translated for public consumption by the Recovery Research Institute, a nonprofit arm of Massachusetts General Hospital and Harvard Medical School.

Each person in recovery must own his or her own recovery process. A wide variety of professional and peer support services may be helpful along this journey, but it is the person in recovery who must direct this process, assembling diverse consultants who can inform and assist this effort. Physicians and psychiatrists knowledgeable about addiction recovery and experienced in offering guidance through the recovery process can be important and even crucial resources within the recovery process. The challenge for America is to expand the number of physicians and psychiatrists who possess such knowledge and expertise. The challenge for organizations that make up the addiction treatment industry is to assure their staffing patterns match their rhetoric of addiction as a treatable medical disorder.

Post Date April 19, 2018 by Bill White

THE FUTURE OF RECOVERY SUPPORT PART II (BILL WHITE AND MIKE COLLINS) April 6, 2018 By-Bill White

“Disruptive innovation, a term coined by Clayton Christensen, describes a process by which a product or service takes root initially in simple applications at the bottom of a market and then relentlessly moves up market, eventually displacing established competitors.”
The worlds of addiction treatment and recovery mutual aid are on the brink of being radically disrupted and transformed. New recovery support institutions and bold innovations in how, when, and where recovery supports are delivered will pose unprecedented threats and opportunities for established players within the treatment and mutual aid arenas.
In our last blog, we offered five predictions about the future of recovery support in the United States.

1. Transformative innovations in recovery support will encompass high and low tech platforms and a dramatically broadened menu of products, services, and support activities.

2. An ecumenical culture of recovery will spread through new recovery support institutions.

3. Addiction treatment as a professional and business endeavor will face intensified challenges to its legitimacy as a cultural institution, due in great part to its own excesses.

4. Responding to this crisis, addiction treatment institutions will attempt to colonize new recovery support competitors and will pioneer new service menus and new technologies of service delivery.

5. Formal membership in 12-Step groups (as measured by membership surveys) will slowly decline but rate of attrition in groups such as AA will be offset by attraction of new members through non-traditional routes of entrance and the growing secular and religious wings of AA.

Below we will discuss five additional predictions and sample some of the websites, social media accounts, apps, and online mutual aid societies that point to this emerging future.

6. The definition of a valid or sanctioned recovery support “meeting” will be increasingly fuzzy, and the roles of the “meeting” and canonic literature will remain but diminish in their import to recovery initiation, recovery maintenance, and enhancement of quality of life in long-term recovery.

“Meetings” will be extended to a growing catalogue of phone- and internet-based recovery support platforms providing continuous discussions (e.g., continual teleconferences) and social activities that one can enter and exit any day and any time of day. Literature will be transformed to instantaneously-accessible audio and video formats that will provide topical guidance on managing an infinite menu of challenges and opportunities before, during, or after such encounters. This transition could be thought of as the moving from “in the rooms” to “beyond the rooms.”

Historically, recovery mutual aid focused on three delivery mechanisms: 1) “friendly visitors” (recovery sponsorship or mentorship in modern language); 2) scheduled membership meetings for story sharing, problem solving, and recovery celebration; and 3) the written literature of a particular mutual aid society. Tomorrow, such friendly visitors will arrive at one’s wrist and often include people we have never met face-to-face.

It’s not that formal recovery support meetings will cease; it is that such meetings will become a smaller part of a much larger menu of recovery support activities that one can combine and sequence according to personal needs and interests over the course of long-term recovery. A day is rapidly approaching when more people will use telephone and online recovery support than those participating in formal face-to-face (F2F) recovery support meetings. The former will dramatically widen the doorways of entry to recovery for people who cannot access or do not feel comfortable/safe within F2F meetings, e.g., women, youth, high-status professionals, people in communities lacking F2F meetings, people whose physical limitations preclude access to F2F meetings, and people who experience social anxiety, to name a few.

7. Phone-based and web-based information and screening tools will facilitate self-diagnosis of substance-related problems and dramatically expand the pool of people seeking recovery support. Service and support options will increase for people experiencing low to moderate AOD problem severity who are now rarely seen in or retained within specialized addiction treatment institutions or traditional recovery mutual aid meetings.

This population of non-dependent help seekers will spark a parallel growth in models of problem resolution that include support for the moderated resolution of alcohol and other (AOD) problems. The “abstinence only” goal of treatment and recovery support is sustainable only as long as providers of such assistance remain closed ideological systems serving only those with the most severe, complex, and chronic substance use disorders while denying the existence of the much broader spectrum of AOD-related problems. Broader population-based technologies aimed at the full spectrum of AOD problems will allow us to shift beyond clinical interventions with the most severely affected individuals to interventions with whole populations that will reduce the prevalence of this broader spectrum of AOD problems at a cultural level.

8. Geographical boundaries of recovery support, including international boundaries, will progressively dissolve as online addiction treatment and peer recovery supports expand and include simultaneous language translations among people from all over the world.

The beginnings of a global recovery community are already evident. Ironically, this emerging global recovery community may provide the connecting tissue to counter the escalating political, religious, and economic divides that threaten the very future of the world.

9. The exponential growth of recovery support will be fueled by two phenomena: positive network effects and open source recovery support.

Put simply, positive network effects suggest that the more people who use a particular recovery support mechanism, the greater its value and long-term viability as a social institution. For examples, the effects of an online recovery support service increases in tandem with the number of members using such services, the effects of participating in a recovery celebration event increase in tandem with the number of people participating in such events, etc.

The idea of open source, drawn from the history of software development, is that recovery support resources (ideas, information, techniques, helping platforms, literature, art, film, etc.) are a product of peer production: products developed within a community and shared at minimal or no cost. Examples of peer production include all the service activities (e.g., 12-Step calls, sponsorship, literature authorship, and other service work) delivered through recovery mutual aid groups by members without compensation or the free exchange of ideas and materials between recovery advocacy organizations.

Peer production is the antithesis of proprietary, fee-based, profit-driven services and products. Open source recovery resources will grow exponentially in the coming decades and survive the threats of professionalization and commercialization. The very essence of the recovery movement (“You can’t keep it unless you give it away”) is a revolutionary concept when freed beyond the bounds of a particular recovery fellowship and freed through new technologies beyond the limitations of face-to-face contact. The future of recovery support will be marked by accessibility, affordability, convenience, portability, flexibility (to one’s personal needs/values/culture), and inclusiveness. It will also be marked by a balance or shift between an expert relational model and a mutual partnership relational model.

10. New innovations in recovery support will engage both dissatisfied portions of existing recovery support markets as well as open new markets that have not been reached through the dominant systems of service provision.

We are witnessing a detonation point that will forever alter the history of recovery. And what is this defining moment? It is twofold: freeing recovery from the bounds of recovery mutual aid meetings and professionally-directed addiction treatment (via new recovery support institutions) and the extension of recovery support beyond the boundaries of space and time (via the explosion of digital recovery support platforms and content). The recovery revolution is here and we do not yet see and grasp its full implications. As William Gibson—the man who coined the term cyberspace—suggests, “The future is here. It’s just not evenly distributed.”

A small sampling of websites, social media accounts, apps, and online mutual aid societies that point to this brave new future include the following:

https://www.reddit.com/r/stop drinking/ 94,776 readers at press time.

https://www.intherooms.com/ 491,114 members. Ever-expanding menu of online secular, spiritual, and religious recovery support meetings and related services. Total member recovery Time: 2,029,267 YEARS! Year

https://recovery2point0.com/ 250,000 person online recovery community embracing a holistic approach to recovery from addiction.

https://sobermovement.com/ These guys have moved all flavors of recovery to Instagram (https://www.instagram.com/sobermovement/?hl=en) 56,300 followers.

http://www.viralrecovery.com/ Chronicling all types of online recovery websites, social media, and apps.

https://geniusrecovery.com/ Watch for big things from this group.

https://www.facebook.com/groups/AddictionUnscriptedSupport/?ref=br_rs 63,000+ members.

Samples of Recovery Bloggers

http://soberseniorita.com

https://www.miraclesarebrewing.com/the-bloom-club/

https://www.recoveryelevator.com/about/

http://www.hipsobriety.com/

http://sobermoxie.com/

http://www.tiredofthinkingaboutdrinking.com/

http://sherecovers.co/blog/

https://iloverecovery.com/

http://livingwithoutalcohol.blogspot.com/

http://sincerightnow.com/contact

http://guineveregetssober.com/

https://www.hellosundaymorning.org/

https://www.facingaddiction.org/ (Just merged with the the National Council on Alcoholism and Drug Dependence, NCADD).

https://facesandvoicesofrecovery.org/

https://soberworx.com/

http://www.thesobrietycollective.com/link-love/

http://sober.gotop100.com/

http://soberblogs.gotop100.com/

http://annadavid.com/

http://ericaspiegelman.com/

https://thisnakedmind.com/

http://www.iamnotanonymous.org/

http://www.theroomsproject.org/

https://theherrenproject.org/

http://y12sr.com/

http://youngpeopleinrecovery.org/

https://www.facebook.com/groups/friends.billw/

Sample Apps

http://meetnomo.com/index.html

https://www.sobergrid.com/

http://www.sobertool.com/

Post Date April 6, 2018 by Bill White

COUPLE RECOVERY (ROBERT NAVARRA, PSYD, LMFT, MAC AND BILL WHITE)-March 22, 2018 By Bill White

If you have spent any significant time in the worlds of addiction treatment and recovery, you have witnessed couples who survived everything addiction inflicted on their relationship only to have that relationship disintegrate during the recovery process. What is going on here?

Recovery from addiction can answer long-proffered prayers, but, without transitional support, recovery can also threaten the stability and future of intimate and family relationships. That provocative conclusion, drawn from the original research of Drs. Stephanie Brown and Virginia Lewis, has profound implications for the design and delivery of addiction treatment and recovery support services. A long-term perspective on intimate relationships is critical to the provision of family-focused addiction recovery support services, as is awareness that missteps in the provision of such support can undermine relationship viability.

Knowledge of the effects of addiction on the family and brief family-focused treatment services have grown exponentially in recent decades, but far less attention has been given to sustained support needs of couples through the course of recovery. This brief essay explores the groundbreaking work of couple recovery as an emerging model for treatment based on the Couple Recovery Development Approach (CRDA) as developed by Dr. Robert Navarra and the Sound Relationship House model developed by Drs. John and Julie Gottman.

Severe alcohol and other drug problems provoke dramatic changes in family roles, rules, rituals, and relationships. These progressive adaptations permeate all aspects of family life (e.g., individual health, couple health, parent-child relationships, and sibling relationships) as well as the frequency and quality of family interactions with extended kinship and social networks. While disruptive of long-term personal and family health and an impediment to addiction recovery, these adaptations are essential for the maintenance of family stability and the short-term emotional and safety needs of family members. Recovery brings another level of disruption, and oft-times trauma, to couple and family life. A family system organized around a substance use or a behavioral disorder often struggles to navigate the arduous path from active addiction to recovery.

To date, adaptations in addiction treatment to address the needs of addiction-affected families include family night/week educational formats, brief addiction-specific family therapies, psychoeducational programs for affected children, and linkage to such family support groups as Al-Anon and Alateen. Couples-focused recovery support has yet to be mainstreamed within addiction treatment. Only one couples-focused recovery mutual aid group presently exists (Recovering Couples Anonymous) with only limited availability. And the expansion of peer-based recovery support services has yet to include focused support for couples.

The lead author has developed a relational model of recovery support. The model is premised on the belief that couple recovery simultaneously involves intrapersonal and interpersonal recovery processes, e.g., the personal recoveries of each partner and a separate recovery process for the couple relationship. The essential tasks of couple recovery are viewed as Shifting, Intergenerational Reworking, and Attending, which in turn require: a) restructuring relationship roles, b) redefining relationship boundaries, c) addressing family of origin issues related to attachment, d) increasing relational stress tolerance and coping abilities, and e) observing and managing the evolving stages of personal and relationship recovery. Collectively, these tasks result in forging new personal identities (with focus on increased autonomy and personal growth) and a new identity as a couple.

Several important conclusions can be drawn from this work to date.

1) The beliefs that work on intimate relationships is a later stage recovery task and that beginning such work in early recovery could destabilize recovery initiation have been challenged by scientific research and cumulative clinical experience.

2) Couples can be successfully engaged in ongoing support beyond the stage of recovery initiation and stabilization.

3) Couple recovery supports ideally span the functions of screening, clinical assessment, treatment and recovery planning, service delivery, post-treatment recovery support (e.g., recovery checkups), service evaluation, and couples-focused recovery education and advocacy at professional and public levels.

4) Personal recoveries of the intimate partners and couple recovery are reciprocal processes, with each feeding and amplifying the other. Providing personal recovery support without providing couple recovery support risks the subsequent destabilization and termination of the intimate relationship.

5) In spite of long-standing empirical support for couples therapy within the context of addiction treatment (when its effects have been studied), couples-focused research remains sparse compared to the voluminous body of person-focused research studies. Many questions related to the ideal ingredients and timing of couples recovery support remain unanswered, but pioneering work on couple recovery support is proceeding in both clinical and peer-support settings.

For the past 15 years, the lead author (Navarra) has trained addiction therapists in a model of supporting couple recovery that can be integrated within existing inpatient and outpatient settings. Information related to these concepts, clinical blueprints, clinical tools, and techniques/exercises can be found HERE.

A one-day training, Couple Addiction Recovery, provides treatment professionals a blueprint and 14 clinical interventions to help support and guide “couple recovery.” A two-day workshop for recovering couples, Roadmap for the Journey, has also been successfully offered in partnership with treatment programs. Combining the one-day training and couples workshop provides a comprehensive program curriculum for couple treatment. (For info, email Katie Reynolds katie@gottman.com or Dr. Navarra drbobnavarra@gmail.com.)

We hope for a day when a relational model of recovery support will be the norm in the delivery of all addiction treatment and recovery support services. You could play a part in this next leap forward within the future of addiction recovery.

About the Authors: Dr. Navarra is a Master Certified Gottman Therapist, trainer, and researcher, and teaches graduate classes on the treatment of addictive disorders at Santa Clara University. William White is Emeritus Senior Research Consultant at Chestnut Health Systems.

Post Date March 22, 2018 by Bill White

THE POWER OF PURPOSE IN RECOVERY-March 16, 2018- By Bill White-


To journey without being changed is to be a nomad. To change without journeying is to be a chameleon. To journey and be transformed by the journey is to be a pilgrim. –Mark Nepo

You should never take more than you give…In the circle of life. –Elton John / Tim Rice Circle of Life

One of the existential turning points within the recovery experience is marked by the diminishment of backward sense making (What happened to me?) and the increased urgency regarding one’s post-sobriety future (Okay, what do I do now?). All manner of emotions feed this transition: release, relief, gratitude, unworthiness (survival guilt), remorse (guilt over past transgressions), a gnawing sense of emptiness, and, not uncommonly, a passion to help others similarly afflicted. Many forces coalesce to push people out of addiction, but finding a higher purpose in one’s life is a potentially powerful pull force within the process of long-term recovery. For many, that purpose is found in service to others.

For decades, I have observed this passion for service fulfilled through numerous outlets and I have guided many people into service roles within the addiction treatment and recovery support arenas. What I have discovered is that answering the “Recover to do what?” question is a very complex one that continues even once an arena of purposeful activity is discovered. There are always tensions and continual changes that challenge staying within what is often a narrow zone of peak performance, peak contribution, and peak personal fulfillment.

We all search for meaning in what we choose to do with our lives, but many things can take us far from such a purpose. Material necessities of family and the socially-fueled drive for material wealth and professional status can lead us far astray by forcing us into jobs that limit our time and energy for more fulfilling activities. What we find meaningful and fulfilling can change over time creating tension-filled mismatches between our needs and our current roles and activities. We can find ourselves in toxic work environments that undermine our ability to stay within that zone of meaning and purpose. And events outside our control can deny or abort such opportunities.

In my addiction recovery support and research activities, I was blessed to find something more akin to calling than professional career. At any point my activities began to feel more like “work” than service, I made adjustments to again find that sweet spot of meaningful service and personal satisfaction. That sweet spot was not always a perfect match with what I wanted for my own pleasure, but it was a perfect match between what my immediate world needed and what I could uniquely contribute to that need. It was not about doing my own thing; it was about doing my part in a much larger unfolding drama. By staying centered in that zone of intersection between personal pleasure and social purpose (or rediscovering it as quickly as possible), I have never had to worry about money, even when following that sweet spot demanded decisions that resulted in a reduction in income. The result was hardly what could be called a career ladder. Instead it was something much more akin to improvisational jazz. I am aware that this may not be possible for everyone, but this brief message is a retrospective affirmation that achieving a higher purpose in recovery is possible. There are few more powerful motivators than clarity of purpose. It is the source of the fierce determination and the unquenchable urgency that sparks and sustains successful advocacy movements—and lives of meaningful service.

So where does that leave us? Don’t be afraid to dream. Don’t be afraid to turn the turmoil of your past life into a higher purpose. That can be done! To thrive, we must first survive. But don’t ever doubt that thriving in recovery is possible and happening every day. What is your recovery mission?

Post Date March 16, 2018 by Bill White

ADDICTION AS A BRAIN DISEASE (PERSPECTIVES FROM THE ISLAMIC REPUBLIC OF IRAN) -March 9, 2018 -Bill White

The understanding of addiction as a brain disease has been a central organizing principle within the research agendas of the National Institute on Drug Abuse and the National Institute on Alcohol Abuse and Alcoholism. Promotion of the brain disease paradigm stirred controversies over its scientific legitimacy and contentions and counter-contentions over its effects on addiction-related stigma, but it exerted unquestioned influence on public and professional conceptions of addiction and approaches to the treatment of addiction in the United States. Interesting variations in the conceptualization of addiction as a brain disease occurred contemporaneously in other countries. The challenge across cultural contexts has been to integrate recent research on the neurobiology of addiction to create more dynamic biopsychosocial models of treatment and recovery support.

One of the most innovative examples of such integration can be found within the Islamic Republic of Iran’s Congress 60 recovery community. Encompassing more than 57,000 active members across 58 branches in Iran, Congress 60 combines a medication-assisted transition into recovery with an extensive menu of psychosocial supports. The rationale for medication support and the unique scheme of such support (the DST method) has been outlined by Congress 60 Founder Hossein Dezhakam in what he christened the X Theory.

I recently had the opportunity to interview Mr. Dezhakam about the X Theory and the DST method and how they are integrated within the larger culture of support within the Congress 60 recovery community. This interview is highly recommended for those exploring such integration in diverse cultural settings, including in the United States, and for those interested in variations in the clinical application of the brain disease model of addiction in non-Western countries.

For decades in the U.S., addiction treatments, with and without medication support, have existed as warring factions fueled by debates producing far more heat than light. Such either/or polarization defies the fact that many people in medication-assisted treatment could greatly benefit from an expanded menu of long-term recovery support services and that recovery outcomes within traditional “abstinence-based” programs could be elevated by recognition of the potential role medications can play for some patients in recovery initiation and/or maintenance. Congress 60 provides a template of how medication support and psychosocial support can be fully integrated within a vibrant recovery culture.

Post Date March 9, 2018 by Bill White