“How does it feel to be a problem…It is a peculiar sensation, this double consciousness, this sense of always looking at one’s self through the eyes of others, of measuring one’s soul by the tape of the world that looks on in amused contempt and pity.” –W.E.B. Du Bois, The Souls of Black Folks
“I am invisible, understand, simply because people refuse to see me. Like the bodiless heads you see sometimes in circus sideshows, it is as though I have been surrounded by mirrors of hard, distorting glass. When they approach me they see only my surroundings, themselves or figments of their imagination, indeed, everything and anything except me.” ― Ralph Ellison, Invisible Man
W.E.B. Du Bois and Ralph Ellison introduced three concepts of considerable import to recovery advocates. Du Bois’ notions of the veil and double consciousness were brilliantly conceived with profound implications for the future of race relations and efforts to escape the personal effects of racism—or similar processes related to people affected by prolonged historical trauma and contemporary social stigma and discrimination.
Du BoisIn the addictions context, the veil is a metaphor for the artificial lens through which people in addiction recovery are socially viewed and through which they simultaneously view the larger social world in which they are nested. As Howard Winant has observed, “The veil not only divides the individual self; it also fissures the community, nation, and society as whole (and ultimately, world society in its entirety.).” The veil contains objectified images and caricatures that distort how one is seen and how one sees oneself and others. Self-talk and communication with others are hampered and distorted through the veil’s influence. The veil creates a deep sense of alienation, disconnection, and utter sense of aloneness. As Richard Wright’s Bigger Thomas declares in Native Son: “Half the time I feel like I’m on the outside of the world peeping in through a knothole in the fence.”
Du Bois double consciousness depicts a related split produced by the introjection of addiction-related social stigma (a stained self) and the resulting defensive projection of a false self. Over time, these processes of double consciousness make claiming one’s “real self” increasingly difficult. As a result of this prolonged mask-making, one’s greatest fear is not that one’s inner evilness will be revealed, but that one’s utter emptiness and status as an imposter will be fully exposed to self and others.
Ralph EllisonEllison’s concept of invisibility suggests a potential threefold loss of self: 1) being seen only as an objectified caricature if one’s recovery identity is revealed, 2) a profound sense of imposterhood as one’s stigmatized status is hidden behind layers of masks, and 3) the inability to feel and hold to one’s own true self. That sense of invisibility-even to oneself–is amplified by the depersonalization experienced in late stages of addiction. Social invisibility, whether buried within a subterranean drug culture or hidden behind a carefully but fragilely crafted mask of normalcy, is an inevitable dimension of the addiction experience.
While addicted, we are invisible until acts of degradation and desperation (or our untimely death) briefly thrusts us into the public spotlight. In recovery, we also remain invisible until we come to see ourselves as a “people” and respond to prophetic call to collectively step from hiding to declare our existence. Other illnesses once bore a moral stain (e.g., tuberculosis, epilepsy, schizophrenia, cancer) and social invisibility, but campaigns to destigmatize some of these disorders (most particularly, cancer) have fundamentally altered their social perception and their professional treatment.
When we all step out of our cloistered sanctuaries and look around, we realize a profound lesson: we are all wounded in some way and all reaching for healing and wholeness. When the veils fall, the need for double consciousness diminishes and invisibility and transparency give way to a new sense of personhood. When the veil is lifted, we can escape entrapment within the label “substance abuser” and emerge as a free person of substance. When the veil of shame is lifted, we will find to our great surprise that what lies beneath is not our personal inferiority, but shared pain, unquenchable hope, and our common humanity—what Ernie Kurtz and Katherine Ketcham christened The Spirituality of Imperfection. It is time the veil, the double consciousness, and the invisibility that pervades addiction recovery were relegated to the dustbin of history. Only a recovery advocacy movement sustained across generations will achieve that goal.

Post Date May 20, 2016 by Bill White


The extension of acute care (AC) models of addiction treatment to models of sustained recovery management (RM) models of sustained recovery management (RM) for people with severe, complex, and chronic substance use disorders requires a fundamental redesign of what we have known as the continuum of care. A newly conceived continuum of care would span the stages ofprerocovery, recovery initiation and stabilization, recovery maintenance, enhanced quality of personal and family life in long-term recovery, and efforts to break intergenerational cycles of alcohol- and other drug-related problems. A striking hole within that continuum of care at present is what happens to individuals and families following discharge from addiction treatment. Aftercare remains an afterthought despite rhetoric to the contrary, and the cost of such neglect is the repeated recycling of people through acute care models of addiction treatment, with the accompanying demoralization of patients, families, and caregivers, to say nothing of the related costs. One of the promising innovations in post-treatment recovery management is that of recovery management checkups. recovery management checkups.
For more than a decade, Dr. Christy Scott, Dr. Michael Dennis, and their colleagues have refined a model of recovery management checkups (RMC) aimed at enhancing long-term addiction recovery process and influencing tandem behavioral risks (e.g., illegal activity and HIV risk behavior). The RMC model includes regular post-treatment monitoring, recovery encouragement, assertive linkage to treatment other recovery support resources as needed (including transportation for re-assessment), and an HIV risk reduction intervention. In a 2013 summary of three RMC clinical trials, Scott and colleagues summarized the study outcomes and implications as follows.
“RMC (recovery management checkups) clinical trials provide evidence that ongoing monitoring, feedback, and early reintervention can be effective methods of managing recovery over time. Ideally, such services would be paid for and become a requirement for treatment program licensure, accreditation, and funding. Those requirements would be best linked to a larger strategy of reorienting addiction treatment from a predominantly acute care model of intervention to a service model that provides services ranging from a brief intervention to long-term recovery management. However, the implications of shifting to a chronic care model are significant. That shift will require a radical redefinition of the continuum of care, new service philosophies, new service delivery technologies, and a fundamental rethinking of systems of reimbursement for addiction treatment and recovery support services…. Experience to date also suggests the need for a substantial investment in articulating the ethics and etiquette of conducting RMC across diverse clinical populations and cultural contexts.” (p. 272)
Questions remain on key dimensions of the RMC model. What roles and organizational settings are best suited to conduct RMCs, e.g., the treatment organization, a recovery community organization, a research team, and managed care organization? Do RMC outcomes vary by key characteristics of the person performing the RMC, e.g., education, level of training and supervision, gender or ethnicity matches, recovery status, paid versus volunteer? Does RMC effectiveness vary by clinical subpopulation or by cultural context? What is the ideal duration of RMCs following recovery initiation? Could current patient-focused RMC formats be modified to focus on the recovery process of the whole family?
What is not in question is the need for continued systems of recovery support for those with severe substance use disorders and the potential value of the RMC as an integral component of such assertive continuing care. Are RMCs being utilized within your local treatment programs and recovery support organizations? If not, why not?
Recent RMC Studies/Reviews
Dennis, M.L., Scott, C.K. & Laudet, A. (2014). Beyond bricks and mortar: Recent research on substance use disorder recovery management. Current Psychiatry Reports, 16, 442.
Garner, B. R., Godley, M. D., Passetti, L. L., Funk, R. R., & White, W. L. (2014). Recovery Support for adolescents with substance use disorders: The impact of recovery support telephone calls provided by pre-professional volunteers. Journal of Substance Abuse and Alcoholism. 2(2), 1010.
McCollister, K.E., French, M.T., Freitas, D.M., Dennis, M.L., Scott, C.K., & Funk, R.R. (2013). Cost-Effectiveness analysis of Recovery Management Checkups (RMC) for adults with chronic substance use disorders: evidence from a four-year randomized trial, Addiction, 108, 2166-2174.
Scott, C.K., Dennis, M.L., Willis, B., & Nicholson, L. (2013). A decade of research on recovery management checkups. In: Interventions for addiction: Comprehensive addictive behaviors and disorders. Elsevier Inc., San Diego: Academic Press, pp. 267–273.

Post Date May 13, 2016 by Bill White


Addiction recovery is a highly intrapersonal process, but it also can and often does involve a journey between two physical and cultural worlds. Some years ago, I explored the implications of this suggestion in the book, Pathways from the Culture of Addiction to the Culture of Recovery. Here are some key points from that book.
Elaborate cultures–with their own tribal organization, roles, rules, core daily activities, relationship etiquette, language, values, symbols, rituals, music, literature, and art–have evolved to provide sanctuary for people with severe and prolonged alcohol and other drug problems. Such cultures can play important roles in the initiation and maintenance of addiction, and they can constitute a major obstacle to successful addiction recovery. People can become as addicted to a culture of addiction as they are to the central sacraments of that culture. The wide range of needs met within that culture can be as powerful a pull back to addiction as the brain’s adaptation to the presence (euphoria, self-comfort) or absence (craving, anxiety) of drugs.
Recovery involves radically altering the person-drug relationship, but it also involves changes in one’s relationship to the culture (people, places, and things) that has supported the person-drug relationship. The addiction experience varies to the extent one is isolated from the culture of addiction (acultural style), is involved in both the mainstream and addiction cultures (bicultural style), or lives one’s life almost exclusively within the culture of addiction (enmeshed style). For those with significant involvement within the culture of addiction, recovery requires discovery of new ways to meet a vast array of needs once met within the culture of addiction. Failing that, addiction recurrence is as much a return to the culture of addiction as a return to the drug.
People who have escaped the addiction experience have organized parallel cultures of recovery to serve as havens for those with these shared experiences and aspirations. The culture of recovery also has its own tribal organization, roles, rules, core daily activities, relationship etiquette, language, values, symbols, rituals, music, literature, and art. This culture offers an alternative set of people, places, and things that support recovery initiation, recovery maintenance, and enhanced quality of personal and family life in long-term recovery. The recovery experience varies to the extent one is isolated from the culture of recovery (acultural style), is involved in both the mainstream and recovery cultures (bicultural style), or lives one’s life almost exclusively within the culture of recovery (enmeshed style). As with addiction, these styles of cultural affiliation can vary across the stages of recovery.
People with enmeshed styles of addiction may need a period of decompression and parallel enmeshment within a culture of recovery to achieve successful recovery stabilization and maintenance. They may need guides to assist them on this journey, e.g., the peer assistance found within recovery mutual aid societies, culturally competent addiction professionals, or within new recovery support roles (e.g., recovery coaches). What has changed since first writing Pathways is the exponential development of the culture of recovery in the United States. Recent history has witnessed the growth and diversification of the culture of recovery via the growth of secular, spiritual, and religious recovery mutual aid societies; a new addiction recovery advocacy movement culturally and politically mobilizing people in recovery and their allies; new recovery support institutions (recovery community centers, homes, schools, industries, ministries, cafes, and sports venues); development of new recovery-focused language, art, music, literature, theatre, and film; and the growth of technology-based recovery support via the Internet. The culture of recovery in the U.S. has never been more fully evolved, diverse, family-inclusive, geographically accessible, and financially affordable.
In an era that continues to be dominated by acute care models of addiction treatment, treatment that focuses almost exclusively on neurobiological stabilization (e.g., short-term detoxification, medication with minimal if any sustained psychosocial support), and treatment that views recovery as a primarily physical and psychological process, it is helpful to again remind ourselves of the role of culture in the processes of addiction and recovery. If recovery is for many a journey between two worlds, then there is a need for a fully developed culture of recovery available across geographical and cultural contexts. That development is one of the major stories of recent decades. Also needed are roles filled by persons with a profound depth of knowledge of the cultures of addiction and recovery to serve as guides in this transcultural process. That has yet to be achieved, and the rise of new services and support roles aimed at speeding recovery initiation (shortening addiction careers) and supporting long-term personal and family recovery is in part an attempt to fill this void.
In writing Pathways from the Culture of Addiction to the Culture of Recovery, I tried to provide a travel guide through which addiction professionals and recovery support specialists could serve as effective guides in this cultural journey from addiction to recovery. Since then, both cultures have undergone profound changes. I hope others will carry forward this work of cultural exploration and its service and recovery support implications. Addiction treatment and peer recovery support outcomes may be determined as much by the presence and vitality of healing communities (cultures of recovery) as by the vulnerabilities and assets of individuals in need of such healing. Many have written eloquently about the role of culture and community in recovery, but perhaps none more eloquently than that found in the words of Joseph Campbell.
“We have not even to risk the adventure alone; for the heroes of all time have gone before us; the labyrinth is thoroughly known; we have only to follow the thread of the hero-path. And where we had thought to find an abomination, we shall find god; where we had thought to slay another, we shall slay ourselves; where we had thought to travel outward, we shall come to the center of our existence; where we had thought to be alone, we shall be with all the world.” –from The Hero with a Thousand Faces
Post Date May 6, 2016 by Bill White


The history of addiction treatment includes a pervasive and cautionary thread: the potential to do great harm in the name of help. The technical term for such injury, iatrogenesis (physician-caused or treatment-caused illness), spans a broad range of professional actions that with the best of intentions resulted in harm to individuals and families seeking assistance. My recounting of such insults within the history of addiction treatment (see here, here, and here) also includes the observation that such harms are easy to identify retrospectively in earlier eras, but very difficult to see within one’s own era, within one’s own treatment program, and within one’s own clinical practices.
The challenges for each of us who work in this special service ministry and for the specialized industry of addiction treatment include conducting a regular inventory of clinical and administrative policies and practices to identify areas of inadvertent harm, altering conditions linked to such harm, making amends for such injuries, and developing mechanisms to prevent such injuries in the future. In my own professional life, many of the projects in my later career were products of such an inventory and served as a form of amends for actions I took or failed to take in my early career due to lack of awareness or courage. (See here and here for two vivid examples.)
There have also been times I have taken the larger field to task for practices I deemed harmful. I have suggested at times that what were perceived as personal failures to achieve lasting recovery could be more aptly characterized as system failures (See here). I have suggested at times that the field was becoming addicted to professional power and money and that the field itself was in need of a recovery process that should include processes of rigorous self-inventory, public confession, and amends (See here and here).
The shift from acute care models of addiction treatment to models of sustained recovery management (RM) and recovery-oriented systems of care (ROSC) involves dramatic changes in clinical practices, including a shift in the basic relationship between the service provider and service recipient. The service relationship within the RM/ROSC models shifts from one dominated and controlled by the professional expert to a sustained recovery support partnership, with the provider serving primarily as a consultant to the service recipient’s own recovery self-management efforts. Those who have made this relational shift inevitably look back on areas of potential harm that emerged from the expert relational model they once practiced. And then the question inevitably arises, “How does one make amends for past harm in the name of help within the context of addiction counseling?”
Chris Budnick, an addictions professional in North Carolina and founding Board Chair for Recovery Communities of North Carolina, Inc. (RCNC), recently responded to that question by preparing a formal letter of amends to the individuals, families, and communities he has served. Below is the text of that letter, which was presented at the North Carolina Recovery Advocacy Alliance Summit, February 24, 2016. (The link to the video is:
My name is Chris Budnick and I am a Licensed Clinical Addiction Specialist. I first began working in the addiction treatment and recovery field in 1993.
There are many components involved in the broad issue of substance use disorders and recovery. Employers, first responders, the criminal justice system, policy makers, politicians, companies, advertisers, treatment providers, addiction professionals, the recovery community, families, and the individual with the substance use disorder. Of all these components, individuals with substance use disorders face the greatest scrutiny, stigma, discrimination and blame. For too long they have stood alone bearing the full brunt of this responsibility while systems of care and policies impacting housing, education, and employment have largely conspired to undermine any chance of sustaining recovery.
Last week I found myself approaching a police department to apologize for failing them. When they reached out to us in the middle of the night seeking services for a young woman we told them “no.” “We can’t help her tonight.” She was killed within hours of this decision leaving behind a 2-year-old daughter. I told the officer that we pledge to do better.
This experience has nudged me to put to paper ideas that I’ve articulated and ideas I’ve only contemplated. I feel compelled as an addiction professional to make amends and pledge to do better.
While I have changed my attitudes and practices over the years, I have not spoken up to say I’m sorry. So here are the things I want to make amends for:
I’m sorry for all the barriers you confront when trying to access help.
I’m sorry for contradictory “sobriety” and “active use” requirements you encounter when trying to access services.
I’m sorry for the harm that has come to you, your family, your unborn children, and your community when you have not been provided services on demand.
I apologize for expecting that you will provide all the motivation to initiate recovery when I have assumed no responsibility for enhancing your readiness for recovery.
I am sorry for creating unrealistic expectations of you.
I’m sorry for provider success statistics that have misled you and your family.
I’m sorry that I have discharged you from treatment for becoming symptomatic. I’m even more sorry, though, for abandoning you at your time of greatest vulnerability. And I am sorry for how this failure has contributed to the heartbreak of your loved ones.
I am sorry for abandoning you when you have left treatment, either successfully or unsuccessfully.
I am sorry for the irritation in my voice when you have returned following a set-back because you didn’t do everything that I told you to do.
I am sorry for my arrogance when I’ve assumed that I am the expert of your life.
I am sorry for privately finding satisfaction in your failure because it reinforces the fallacy that I know best and if you just do as I say, you’ll recover.
I am sorry for not celebrating as enthusiastically your successes when you have achieved them through a different pathway or style then me.
I am sorry for being a silent co-conspirator for the stigma that has resulted in systems of punishment and discriminatory policies and practices.
I’m sorry for turning you away from treatment because you’ve “been here too many times.”
I’m sorry for not referring you to different services when you have not responded to the services I offer.
I am sorry for allowing you to take the blame when treatment did not work instead of defending you because you received an inadequate dose and duration of care.
I am sorry for reaping the benefits of recovery yet failing to do everything I can to make sure those benefits are available to anyone, regardless of privilege, socio-economic status, education, employability, and criminal history.
I’m sorry for being an addiction professional who has not provided you with the recovery supports needed to sustain recovery. More importantly, I apologize for conspiring through silence and inaction with a system that ill prepares you to achieve success.
I’m sorry for not calling to check on you when you don’t show up for treatment. I’m sorry for not calling to support you after you leave treatment.
I’m sorry for letting society maintain the belief that you used again because you chose to.
I’m sorry for not fighting for adequate treatment and recovery support services. All persons with substance use disorders should be entitled to a minimum of five years of monitoring and recovery support services.
I’m sorry for not advocating for you to have opportunities to gain safe and supportive housing and non-exploitive employment.
I am sorry for being so self-centered that I only think about you in the context of treatment while failing to fully understand the environmental and social realities of your life and how they will impact your ability to initiate and sustain recovery.
I am deeply sorry to your loved ones who have been robbed of chances to have a healthy member of their family. I am deeply sorry to your community, who has been robbed of the gifts that your recovery could have brought them.
I’m sorry that systems of control and punishment has been the response to communities of color during drug epidemics.
I am sorry that through my silence and inaction that I have contributed to belief that persons with substance use disorders are criminals and should be punished.
I am sorry for not speaking as a Recovery Ally to families, friends, neighbors, colleagues, policy makers, and public officials about why I support recovery.
I’m sorry for all the things that I have left off this list because I’ve failed to regularly solicit your feedback about how effective I have been in supporting you in your recovery.
This sorrow is the foundation of my commitment to improve the accessibility, affordability, and quality of addiction treatment and recovery support services and to create the community space in which long-term personal and family recovery can flourish.
Chris Budnick
Licensed Clinical Addiction Specialist
This is a remarkable statement worthy of emulation. I look forward to the day when leaders prepare such a statement of amends to individuals, families, and communities on behalf of American addiction treatment institutions. I look forward to the day when clinical humility becomes a foundational ethic guiding the practice of addiction counseling.
Post Date April 29, 2016 by Bill White


Until recently, the public faces of addiction recovery in the United States have been those of privileged white men and women. When I began to reconstruct the history of recovery on America more than four decades ago, I was struck by the absence in the historical literature of accounts of recovery within communities of color. I vowed early in my own historical research to help fill this void. Through my collaborations with Don Coyhis and Mark Sanders and the contributions of other advocates and scholars, progress has been made in reconstructing the history of recovery within Native American and African American communities. These contributions include a newly posted paper acknowledging African Americans who have made significant contributions within the history of addiction treatment and recovery in the United States. (See here). Needed research on the history of recovery in other ethnic communities remains at its infancy.
To the extent that existing findings from Native American and African American research can be extended to all communities of color, several conclusions are worthy of note.
Historically, portrayals of the etiology of alcohol and other drug (AOD) problems within communities of color have been rooted in allegations of genetic inferiority (e.g., “firewater myths” portraying Native Americans as inherently vulnerable to alcoholism), psychopathy (sin/evilness), and cultural inferiority (e.g. community disorganization). Such portrayals have been part of the larger ideological rubric supporting the decimation and colonization of these communities. The cultural legacies of such portrayals include generations of stigma (e.g., the “drunken Indian” stereotype), racial shame, and a fundamental misconstruction of the sources of, and solutions to, alcohol and other drug problems in communities of color.
Communities of color have not been passive victims in the face of alcohol and other drug (AOD) problems; there are long histories of indigenous resistance and recovery movements within these communities.
Indigenous resistance and recovery movements within communities of color have been most often led by people in recovery who linked addiction to broader issues of oppression and linked their own personal recovery to the broader cultural, political, and economic liberation of their people.
Within communities of color, the healing of the individual, the family, and the community are inseparable.
The ultimate solutions to AOD problems within communities of color lie within these communities and within larger processes of cultural renewal and community revitalization.
Addiction treatment and recovery support services within communities of color are best framed within a broader concern for the global health of these communities, rather than within a singular focus on AOD-related problems.
Addiction treatment is at its best when it aligns itself with culturally indigenous pathways of recovery and indigenous healing rituals.
The history of resistance and recovery within communities of color stands as testimony to the cultural forces of prevention and healing that remain powerful, but underutilized, antidotes to AOD problems.
It is time that both addiction and recovery were presented in a rainbow of colors. Below is a partial chronological listing with links to some of the published work to date resulting from these collaborations.
Coyhis, D. & White, W. (2002) Addiction and recovery in Native America: Lost history, enduring lessons. Counselor 3(5):16-20.
White, W. & Sanders, M. (2002) Addiction and recovery among African Americans before 1900. Counselor, 3(6):64-66.
Coyhis, D. & White, W. (2003) Alcohol problems in Native America: Changing paradigms and clinical practices. Alcoholism Treatment Quarterly, 3/4:157-165.
White, W. (2003). Native American resistance to alcohol problems since first contact. Well Nations Magazine, 4(23) & 4(24). Posted at
Coyhis, D. & White, W. (2006) Alcohol problems in Native America: A new and provocative history. Counselor, 7(4), 54-56.
Coyhis, D. & White, W. (2006). Alcohol Problems in Native America: The Untold Story of Resistance and Recovery-The Truth about the Lie. Colorado Springs, CO: White Bison, Inc.
Sanders, T., Sanders, M. & White, W. (2006). “When I Get Low, I Get High”: The portrayal of addiction and recovery in African American music, Counselor, 7(6), 30-35.
White, W., Sanders, M. & Sanders, T. (2006). Addiction in the African American community: The recovery legacies of Frederick Douglass and Malcolm X. Counselor, 7(5), 53-58.
White, W. (2008) The Native American Wellbriety Movement: An Interview with Don Coyhis. Wellbriety Magazine, 9(10), 2-10.
White, W., & Sanders, M. (2008). Recovery management and people of color: Redesigning addiction treatment for historically disempowered communities. Alcoholism Treatment Quarterly, 26(3), 365-395.
Evans, A.C., Achara, I., Lamb, R.& White, W. (2012). Ethnic-specific support systems as a method for sustaining long-term addiction recovery. Journal of Groups in Addiction and Recovery. 7(2-4), 171-188.
Sanders, M. & White, W. (2016). African Americans who made (and are making) a difference in promoting resistance to and recovery from alcohol and other drug problems. Posted at

Post Date April 22, 2016 by Bill White


Essentially, it is thought that the negative effects emanating from group trauma experiences are not only transferred across generations, but that these effects accumulate, such that events occurring at different points in history are part of a single traumatic trajectory.—Amy Bombay, Kimberly Matheson, and Hymie Anisman Wakiksuyapi, those carrying the historical trauma, can transcend trauma through a collective survivor identity and a commitment to traditionally oriented values and healing. Maria Yellow Horse Brave Heart
Historical trauma and historical unresolved grief (as that experienced in the Jewish Holocaust, in the genocidal and cultural wars against the Indigenous tribes of North America, and in the historical enslavement of African peoples) are recently introduced concepts that convey the enduring effects of mass disconnection from culture, family, and self (Brave Heart, 2000).
Historical adversity, such as that currently underway in Syria, involves the simultaneous experience of mass deaths, loss of homeland, dislocation and dispersion, economic hardship and exploitation, abandonment by the world community, and the resulting destruction of family/cultural ties and identity-shaping stories. Such trauma involves a colonization of homeland and culture and can also involve a colonization of the mind.
Research on historical trauma underscores the potential intergenerational effects of such adversity upon individuals, families, and cultures, particularly when remnants of institutional violence and oppression remain in the emerging social, political, and economic environment. Recent studies of survivors of the Jewish holocaust and survivors of Indian Boarding Schools vividly reveal how the effects of historical trauma can amplify the effects of contemporary stressors across generations and be manifested through increased rates of guilt, depression, suicidality, substance use disorders, aggression, pessimism, apathy, sleep disorders, and interpersonal conflicts.
The mechanisms of such intergenerational transmission have been extensively catalogued and span multiple dimensions. Physiological mechanisms include the transmission of trauma and stress vulnerability via epigenetic inheritance. Psychological mechanisms include the collective memory of and preoccupation with traumatizing events or a shared “conspiracy of silence” related to such events, amplification of responses to current injustices, survivor guilt, self-blame, increased risk for personal trauma, low self-esteem, internalized aggression, and enhanced risks from self-medication. Social mechanisms of transmission include the disruption of family, extended family, and kinship networks; loss of positive cultural identity; suppression of cultural coping styles and rituals; lack of parental role models; impaired parenting across generations; and potential enmeshment in subcultures (e.g., drug, criminal) that undermine personal hardiness. Religious mechanisms include the loss of religious traditions and healing rituals and vulnerability to charismatic cults. Political and economic mechanisms include political and economic marginalization and the loss of personal and tribal agency.
Collectively, these factors can create a snowball effect of stress proliferation and impaired coping capacities across generations, including the intergenerational transmission of alcohol and other drug problems and their progeny of related problems. But history does not dictate personal or collective destiny. Recent research on historical trauma reveals the capacity to transcend such effects through open acknowledgement of the traumatizing events, restorative justice (cultural acts of apology and restitution), forgiving the unforgivable, rituals of inter-group healing, and intra-cultural strategies aimed at intergenerational resistance, resilience, and recovery. The story of historical trauma is incomplete and is itself wounding if it fails to include the elements of survival, strength, and the potential for healing and health in spite of prolonged adversity. This brief essay will focus on these healing processes that tend to unfold in four overlapping stages.
Intergenerational recognition is a breakthrough of awareness of the links between the past, present, and future. Recognition involves full admission and acceptance of prevailing problems and their interconnection, a new vision of solutions, and discovery of the laws of change that govern the journey from problems to solutions. Recognition involves the discovery that solutions lie both within the self, family, community, and culture and in the mobilization of resources between and beyond these realms. Resistance, resilience, and recovery begin with processes of truth-seeking and truth-telling across the generations.
Intergenerational resistance is a culturally-, politically-, economically-, and religiously-aware refusal to continue family and tribal legacies of alcohol and other drug problems. It is a refusal to expose oneself to that risk. It is a personal declaration, “Here it stops!” Addictive disorders result from a collision of vulnerability and exposure. Resistance is the conscious refusal to be exposed.
Intergenerational resilience is a refusal to develop a severe alcohol or other drug problem following alcohol or other drug use exposure. It is an assertion of health in the face of adversity and risk, e.g., a drug-saturated family and social environment. It is the embrace of alternative styles of coping and an alternative identity. It is the conscious mobilization of internal and external resources to neutralize the mechanisms through which intergenerational alcohol and other drug problems are transmitted. It is the advent of new personal and family traditions of coping and health. Intergenerational resilience is the process of aborting alcohol and other drug problems before they have an opportunity to fully develop.
Intergenerational recovery involves initiating or sustaining a family history of recovery to break intergenerational cycles of alcohol and drug and related problems. It is the unequivocal admission of one’s own problems within a larger historical context and a sustained commitment to enhance intergenerational health and positive connection to community. It is a personal declaration that this new tradition starts with me!
In the face of historical trauma and historical unresolved grief, manifested in generations of alcohol and other drug related problems, we have observed seven steps essential to promoting intergenerational recognition, resistance, resilience, and recovery for individuals, families, and communities.

Awakening and Collective Commitment There is a period of consciousness-raising through which new stories (oral histories) arise that acknowledge prolonged AOD problems and place them in their larger historical trajectory. New and renewed leaders voice unspeakable truths framed in a message of hope for the future and a vision of how to create such a future. The healing vision of the future extends to the seventh generation. “I stories” of injury and healing (personal narratives) are reframed through a new and larger “we story” of injury and healing (collective story of a people). Anger, guilt, shame, and fear are openly acknowledged. Personal and collective survival are extolled and rendered heroic—tapping new strength within and beyond personal and tribal identities. In light of these truths, drinking and drug use are framed as forms of personal and cultural capitulation/suicide; sobriety is framed as an act of personal, family, and cultural resistance and a strategy of survival and protection of oneself, one’s family, and one’s culture. The personal healing of historical trauma requires escaping one’s own encapsulation and standing with others in a cultural circle.

Mass Mobilization There is a call to action that reaches the hearts of the people, first in small numbers and then in every-increasing waves. Personal self-consciousness gives way to a new collective consciousness and commitment to action. The expansion of resources for healing self and family are extended to visions of a healed community and a healed history. A revitalized culture is birthed via history, language, symbols, art, literature, music, and ritual. Collective identity solidifies into awareness that new activities constitute a potentially historic movement. Personal and family identities are strengthened by this renewed cultural identity.
Personal and Collective Mourning The past is mourned so that a future can be forged. Tears must wet the early trail of new beginnings. The sites of past trauma are revisited. Rituals of personal and collective grief are created and repeated so the unspeakable past is never forgotten. Injuries of the past are linked to continued injuries in the present, as well as awareness that inherited styles of coping may not fit new realities. The wounds of men, women, and children are distinctive, creating the need for them to heal separately before they can heal together.
Forgiving the Unforgivable To move beyond the enduring wounds of the unspeakable past and its contemporary legacies, ways must be found to forgive the unforgivable. Self-destructive rage over past injury must give way to healing across the boundaries of victim grief and perpetrator guilt. (We become what we carry!) The heart of the perpetrator must be found within the heart of the victim; the heart of the victim must be found within the heart of the perpetrator. Forgiveness of others begins with forgiveness of self.
Achieving a New Harmony. Historical balance between the peoples is achieved through acts of restitution and new rituals of reconciliation. Mechanisms of restorative justice are explored and acted upon. Without acts of, and the experience of, justice; replicating cycles of the past cannot give way to new forms of relationships. We-they polarizations give way to a larger understanding of the human family. Interpersonal contacts between cultures increase exponentially and are ritualized and harmonized.
Wellbriety2Acts of Empowerment, Service, and Advocacy There is a mass transformation of helpees into helpers. The wounded are rechristened as healers and charged with the responsibility of sharing their resilience and recovery (experience, strength, and hope) stories with others. Personal dependence (isolation and victim-stance) gives way to mutual dependence (restoration of an ethic of collaboration and community service). Mutual help through the sharing of stories is an act of service, but also assures cultural continuity—a ritual that is as much cultural communion as communication. Collective action, in the form of political advocacy, becomes a ritual of personal and cultural empowerment—a positive antidote to internalized anger and apathy.
Cultural Revitalization Cultural development begun in the stage of mass mobilization takes on increased attention and depth, including expansion of historical research; language reclamation and purging of stigma-laden words and images; embrace of ancestral and new rituals; adoption of ancestral forms of self-presentation via hair, dress, jewelry; culture-laden art, theatre, and film; and expressive styles of music and dance. A stage of community building is evident in new and revitalized institutions, emboldened by sober leadership, that support the health of individuals, families, and the community. Collectively, this revitalized culture and these support institutions constitute a healing forest that mends the wounds of the people and frees their capabilities.
Acts of Celebration Ancestral community ceremonies (gatherings, memorials, communal rituals, power songs, dances) are renewed and new ceremonies are birthed that celebrate cultural survival and vitality. Kinship bonds are strengthened. Cultural values of survival are elevated and extolled through acts of storytelling. Stories of suffering are transformed through a process of cultural alchemy into stories of heroic survival and strength. Connections between youth and elders are strengthened by the transmission of historical memory and through mutual identification. Problem visibility is replaced by celebration of personal, family, and community solutions. The public nature of these celebrations also progressively alters how communities view those who have experienced historical trauma. A new empowering narrative revealed in these events alters perception of self and one’s own culture and also alters how one and one’s community are perceived by others, shedding legacies of stereotypes, stigma, discrimination, and personal shame.
Red Road to Wellbriety

The seven processes above are critical to the promotion of intergenerational recognition, resistance, resilience, and recovery across diverse communities and cultural contexts. Such processes are a reaffirmation of the inextricable link between personal and community health as set forth in The Red Road to Wellbriety: “…the individual, family, and community are not separate; they are one. To injure one is to injure all; to heal one is to heal all.”


We had this vision of empowering young people, of carrying a message of hope, not proposing we have the best way to recover, not endorsing a certain kind of recovery, but just lifting up all these great things that we’d experienced and heard about…Our really big vision is a world where all young people in or seeking recovery can achieve their potential in life….We wanted to be supportive of any way a young person could find recovery. –Justin Luke Riley, 2014, Counselor

Recovery advocacy is not new. The roots of such advocacy reach into the nineteenth century and, since the mid-twentieth century, the National Council on Alcoholism and Drug Dependence (NCADD) and other organizations have worked tirelessly to alter addiction-related public perceptions and public policies. Those efforts culminated in the rise of a new recovery advocacy movement in the opening years of the twenty-first century with new grassroots recovery community organizations networked through the leadership of Faces and Voices of Recovery. What does stand as fundamentally new is the cultural and political mobilization of the largest cohort of young people in recovery in history—mobilization best exemplified in the activities of Young People in Recovery (YPR). in 2011, YPR’s mission is to create recovery-ready communities through policy advocacy and the development of recovery support resources in employment, housing, and education. That mission is achieved through the activities of its 120 chapters in 37 states that are supported by a 20-member governance board, 10 full-time and 15 part-time team members, and an annual budget of $2 million. YPR work is amplified through key affiliation agreements with the Association of Recovery Schools, a consortium of recovery highs school programs; R5 / Value Up School Climate System, a school-based substance use prevention and anti-bullying program; and Rise Together, a recovery advocacy initiative for young people.
YPR activities are guided by five foundational ideas drawn from the experience of its members and local chapters. 1) Young people can and are achieving long-term recovery from alcohol and other drug problems. 2) There are multiple pathways of recovery for young people, and ALL are cause for celebration. 3) Young people and their families must recovery together. 4) Young people in recovery and affected families are joining together for mutual recovery support to advocate for pro-recovery social policies and expansion of recovery support resources. 5) The recovery advocacy movement is for everyone: people in recovery, family members, allies, and supporters.
These foundational ideas are expressed through YPR national and chapter program and activities that include the following:
Policy advocacy (e.g., congressional testimony), including sustained support for parity legislation and passage of the Comprehensive Addiction and Recovery Act (CARA),
Rise Together, a school-based prevention curriculum and recovery advocacy program,
Project AMP, a collaborative project with Center for Social Innovation funded by the Conrad N. Hilton Foundation that provides mentoring-focused prevention and early intervention services,
Project PHI, an adolescent preventive health initiative,
Bridges Project, funded by the Colorado Office of Behavioral Health, provides community resource linkage services in two counties to transition-age youth who are aging out of the child services system,
EPIC program, a peer delivered curriculum consisting of housing, education, and employment workshops designed for young people during and following addiction treatment,
Project Catalyst, a transitional-aged youth and young adult peer recovery support specialist training program, offered in collaboration with the Association of Persons’ Affected by Addiction to young recovery leaders in Texas,
PUSH program, a collaborative recovery support project with United Healthcare that serves transition-age youth in Wichita, Kansas,
Choice in Recovery – Many Pathways Initiative, a community education project hosting forums on local recovery support options,
Phoenix, an educational and peer recovery support program for criminal justice-involved youth,
Lynx, a community education and recovery support linkage project for youth seeking or in higher education, and
EDGE, for exploring diversity, and gender equality.
All of these projects provide resources to equip and empower youth in or seeking recovery. In 2014, YPR was privileged to receive the Emerging Young Leaders Award from the National Association of Drug & Alcohol Addiction Counselors (NADAAC).
There was a time in the not so distant past that a young newcomer entering the rooms of recovery mutual aid fellowships was likely to receive a cool welcome from a crusty oldtimer proudly boasting that he had spilled more booze on his tie than the youngster had ever drank (or an equivalent comment for drugs other than alcohol). The message conveyed was a jarring suspicion that the young person simply had not earned the right of admission. In the face of such attitudes, both addiction and recovery statuses were too often withheld or begrudgingly granted to the young person seeking help.
That era is rapidly fading as the largest generation of recovering young people in history rise to shape the future of recovery (and of addiction treatment) in America. YPR stands at the forefront of this movement. Far too many people have entered recovery with only limited years remaining in their lives to clean out the addiction debris, forge a new life, and share their experience, strength, and hope with others in need. Today, young people entering recovery will have decades of life, service, and advocacy ahead of them. What a difference this is making for them, their families, and the world!
Those wishing to support the work of YPR can do so by clicking here:
Of Related Interest
White, W. (2013). Young people in recovery: An interview with Justin Luke Riley. Posted at
White, W. (2013). A passion for youth recovery: An interview with Stacie Mathewson. Posted at
White, W. (2014). Young people in the new recovery advocacy movement. Counselor, 15(2), 64-69.