BLOG & NEW POSTINGS December 14, 2013 -Bill White- PERSONAL FAILURE OR SYSTEM FAILURE?

In my writings to people seeking recovery from addiction, I have advocated a stance of total personal responsibility: Recovery by any means necessary under any circumstances. That position does not alleviate the accountabilities of addiction treatment as a system of care. Each year, more than 13,000 specialized addiction treatment programs in the United States serve between 1.8 and 2.3 million individuals, many of whom are seeking help under external duress. Those who are the source of such pressure are, as they see it, giving the individual a chance–with potentially grave consequences hanging in the balance.
Accepting the mantra that “Treatment Works,” families, varied treatment referral sources and the treatment industry itself believe that responsibility for any resumption of alcohol and other drug use following service completion rests on the shoulders of the individual and not with the treatment program. This is unique in the annals of medicine. With other medical disorders, continuation or worsening of symptoms is viewed as an indication that the initial treatment is not effective for this particular patient and that changes in the treatment protocol are needed. In contrast, when symptoms continue or worsen following addiction treatment, it is the patient who is blamed and often punished. The stance is, “You had your change and you blew it! You must now suffer the consequences of your actions.” And those consequences are often quite dire, including divorce, loss of children, loss of housing or educational opportunities, termination of employment, discharge from the military under less than honorable conditions, loss of professional licenses, loss of driving privileges, and incarceration, to name just a few. Such punishments are often meted out with an air of righteous indignation in the belief that the person for whom we have done so much has failed this chance we have given them. The question I am raising in this blog is: Was it really a chance?
Put simply, we are routinely placing individuals with high problem severity, complexity and chronicity in treatment modalities whose low intensity and short duration of service offer little realistic hope for successful post-treatment recovery maintenance. By using terms like “graduation” and ending the service relationship following such brief clinical interventions, we convey to patients, to families and to all other interested parties at “discharge” from treatment that recovery is now self-sustainable without continued professional support. And this is true just often enough (but often attributable to factors unrelated to the treatment) that this expectation is maintained for all those treated. For those with the most severe problems and the least recovery capital, I believe this expectation is not a chance, but a set-up for failure with potentially greater consequences than might have naturally accrued.
What we know from primary medicine is that ineffective treatments (via placebo effects) or an inadequate dose of a potentially effective treatment (e.g., as in antibiotic treatment of bacterial infections) may temporarily suppress symptoms. Such treatments create the illusion of resumed health, but these brief symptom respites are often followed by the return of illness–often in a more severe and intractable form. This same principle operates within addiction treatment and recovery support services. Flawed service designs may temporarily suppress symptoms while leaving the primary disorder intact and primed for reactivation. But now the treated individual has three added burdens that further erode recovery capital. First, there is the self-perceived experience of failure and the increased passivity, hopelessness, helplessness, and dependency that flow from it. Second, there are the perceived failure and disgust from others and its accompanying loss of recovery support–losses often accompanied by greater enmeshment in cultures of addiction. Finally, there are the very real other consequences of “failed treatment,” such as incarceration or job loss that inhibit future recovery initiation, community re-integration and quality of life.
The personal and social costs of ineffective treatment are immense. If we as a society and as a profession want to truly give people with severe and complex addictions “a chance,” then we have a responsibility to provide systems of care and continued support that speed and facilitate recovery initiation, buttress ongoing recovery maintenance, enhance quality of personal and family life in long-term recovery, and provide the community space (physical, psychological, social and spiritual) where recovery and sustained health can flourish. Anything less is a set-up for failure.
As addiction professionals, we should always be mindful of the power we wield and its potential effects on people’s lives. That power comes from our professional decisions and actions, but it also flows from the treatment designs within which we operate. If we are going to participate in giving people a chance, then we need to make sure it is a real chance and not a set-up for what is ultimately more a system failure than a personal failure. Self-inventory, inventory disclosure and making amends have been among the essential steps of recovery within AA, NA and other 12-Step groups. Perhaps it is time for leaders of addiction treatment to conduct a similar series of steps. Perhaps addiction treatment as a system of care is itself in need of a recovery process.

Post Date December 14, 2013 by Bill White

BLOG & NEW POSTINGS April 21, 2017 -Bill White- THE REVOLVING DOOR OF ADDICTION TREATMENT

Marvin Ventrell, Executive Director of the National Association of Addiction Treatment Providers (NAATP), recently released the first quarter data from the NAATP Outcomes Pilot Program (OPP). It will be some time before the full results and implications of this study are complete, but there is one striking piece of data worthy of current reflection. Of the 756 people who have been admitted to NAATP study sites to date, 63% reported having received prior treatment for a substance use disorder (SUD). NAATP membership includes a large portion of private addiction treatment organizations, but the NAATP data on prior treatment episodes of those admitted to addiction treatment is similar to previously reported national data.
The Substance Abuse and Mental Health Administration’s Treatment Episode Data Set for the years 2010-2012 reported that of the more than 5 million SUD admissions during those three years, only 37.4% had no prior admissions for addiction treatment, 33.5% had two or more prior admissions, and 11.7% had five or more prior admissions.
In sum, more than 60% of people entering addiction treatment in the United States have one or more prior episodes of such treatment. What are we to make of such a finding? Modern addiction treatment was a social experiment begun, in part, to eliminate the revolving doors of local hospitals and jails through which addicted people repeatedly entered, exited, and reentered. Rather than eliminate this revolving door, we simply moved the door to a new social institution.
In an earlier blog, I suggested that:
“We are routinely placing individuals with high problem severity, complexity, and chronicity in treatment modalities whose low intensity and short duration offer little realistic hope for successful post-treatment recovery maintenance. By using terms like “graduation” and ending the service relationship following such brief clinical interventions, we convey at “discharge” to patients, to families, and to all other interested parties that recovery is now self-sustainable without continued professional support. And this is true just often enough that this expectation is maintained for all those treated. For those with the most severe problems and the least recovery capital, this expectation is not a chance, but a set-up for failure—a systems failure masked as personal failure.”
Addiction professionals sometimes justify this practice of subjecting people to repeated episodes of acute biopsychosocial restabilization by noting the chronic nature of substance use disorders. But portraying severe and complex patterns of addiction as chronic disorders is a call to radically redesign addiction treatment and recovery support services. It is not a justification for repeated cycles of acute care that fail to achieve post-treatment recovery maintenance. Brief episodes of addiction treatment are highly appropriate for those with low to moderate problem severity and moderate to high recovery capital, but such interventions for those with the most severe substance use disorders are more likely to constitute brief respites within a prolonged addiction career than a catalyst for sustainable recovery. Portraying addiction as a “chronic disease” to justify multiple, time-extensive, and expensive treatment episodes constitutes, at best, inappropriate clinical care and, at worst, systematized financial exploitation.
If we as a field really truly believe that severe and complex SUDs are “chronic disorders,” the resources we invest in early screening and intervention and post-treatment recovery maintenance and support would be commensurate with the resources we now repeatedly invest to support recovery initiation/stabilization. There is growing interest in applying to addiction treatment what has been learned from primary medicine about the effective management of chronic disorders like diabetes, hypertension, asthma, and cancer. (In an earlier communication, I described such lessons drawn from my own cancer treatment.)
It is helpful to distinguish five stages of addiction recovery: precovery, recovery initiation and stabilization, recovery maintenance, enhanced quality of personal and family life in long-term recovery, and efforts to break intergenerational cycles of addiction. At present, nearly all recovery support resources are focused on recovery initiation and stabilization, and as a system of care we manage that stage more effectively and more safely than at any time in history. What we don’t achieve as a system is reaching people earlier in the development of addiction and supporting the transition from recovery initiation to long-term recovery maintenance and the subsequent stages of recovery.
There is growing interest in the clinical implications of conceptualizing addiction as a chronic disorder and repeated calls for expanding addiction treatment beyond models of acute care (AC) toward models of sustained recovery management (RM) nested within larger recovery-oriented systems of care (ROSC). But the clock is ticking. The cultural and therapeutic pessimism rising from the revolving door of addiction treatment must end. Treatment leaders must embrace RM/ROSC models of care for those with the most severe and complex substance use disorders and reserve AC interventions for those with mild to moderate problem severity and moderate to high recovery capital. Affected individuals and families and their advocates must demand individualized approaches to care that reflect distinctions in problem severity and recovery capital. Planners and payors of care must re-evaluate funding acute care interventions for the most severe substance use disorders when such care lacks assertive and sustained post-stabilization recovery support services. In the meantime, the revolving door continues to spin.

Post Date April 21, 2017 by Bill White

BLOG & NEW POSTINGS April 14, 2017 -Bill White- RECOVERIES UP IN SMOKE UPDATE

Many people in self-proclaimed addiction recovery experience compromised health and premature death due to a unique form of conceptual blindness—the failure to perceive nicotine dependence on par with the other drug dependencies they have shed from their lives.
On August 23, 2013, I posted a blog noting the following 12 conclusions drawn from available scientific studies of nicotine dependence and its relationship to recovery from other drug addictions.
1.Tobacco use accounts for more sickness and disease than the combined use of alcohol and other drugs.

2. Combining nicotine addiction with another drug addiction amplifies the health risks of both addictions.

3. Between 70-80% of people entering addiction treatment smoke–nearly 4 times the rate for all adults.

4. Between 44-80% of patients admitted to addiction treatment express a desire to stop smoking.

5. People treated for alcohol or drug dependence are more likely to subsequently die from smoking-related diseases than from alcohol- or other drug-related causes.

6. Leading figures within the American history of addiction recovery have died of smoking-related diseases, including Bill Wilson, Dr. Robert Holbrook Smith, Mrs. Marty Mann, Danny C., Jimmy K., Charles Dederich, Dr. Marie Nyswander, and Senator Harold Hughes.

7. Continued smoking among those seeking to initiate or maintain recovery is a risk factor for resumption of alcohol and other drug use.

8. Smoking cessation improves recovery rates of other addiction; rates of smoking cessation rise with length of abstinence from alcohol and other drugs.

9. A growing number of addiction counselors are refusing to model a behavior (smoking) that could take years from their own lives and the lives of those who could be influenced by their example.

10.Some people in recovery are choosing to change their sobriety/clean dates to reflect the date they stopped all addictive drug use–including nicotine use.

11. Addiction professionals are broadening their understanding of “recovery” to encompass smoking cessation.

12. The health benefits of smoking cessation for people in recovery include increased life expectancy, reduced risk of heart disease, heart attacks, strokes, and cancer, as well as a more rapid process of brain recovery from addiction.

Studies published since my first posted summaries (Here and Here) confirm and extend these major findings. The latest study comes from Dr. Andrea H. Weinberger and colleagues who measured the effects of continued smoking or onset of smoking on the recovery outcomes of persons who had previously achieved remission from a substance use disorder. The authors concluded:
…among adults with remitted substance use disorders, those who reported continued smoking 3 years later had increased odds of substance use and relapsing to substance use disorders compare to those who were no longer smoking. (Weinberger et al., 2017, p. e153)
The same risk of increased substance use recurrence was found among nonsmokers who began smoking during the early years of their recovery from other drug dependencies.
The awakening to such realities has progressed in recent years, with many addiction treatment programs now incorporating smoking-related assessment, education, and treatment, as well as encouragement and sustained support for smoking cessation. The National Tobacco Integration Advocacy Committee (NATIAC) is challenging all addiction treatment programs to fully integrate such services through its recently released report A Time to Lead. I encourage all providers of addiction treatment and recovery support services to review and reflect on the NATIAC report. Decisive action on our part can save countless lives and enhance the health and quality of life of people in long-term recovery. Such action could also take us a step closer to correcting the blind spot that has excluded tobacco/nicotine from American drug policies.
Reference
Weinberger, A. H., Platt, J., Esan, H., Galea, S., Erlich, D. & Goodwin, R. D. (2017). Cigarette smoking is associated with increased relapse risk of substance use disorder relapse: A National representative, prospective longitudinal investigation. Journal of Clinical Psychiatry, 78:2.

Post Date April 14, 2017 by Bill White

BLOG & NEW POSTINGS April 12, 2017 -Bill White- GENERATION FOUND: YOUNG PEOPLE AND THE RECOVERY REVOLUTION

In a 2009, I co-authored a paper entitled The Recovery Revolution: Will it include children, adolescents, and transition age youth? At that time, a new recovery advocacy movement was maturing, new recovery support institutions were spreading exponentially, and efforts were underway to extend acute care models of addiction treatment to models of sustained recovery management. But there remained a critical question on the extent to which these developments would affect services for children, adolescents, and young adults as well as the roles these groups would play within these recovery movements. In the years since, Young People in Recovery (founded in 2012) has emerged as a leading recovery advocacy organization and innovative approaches to the delivery of recovery support services for young people are spreading. One of the pockets of such innovation is in Houston, Texas, where people across generations and across systems of care have come together to shape a unique approach to recovery support services.
Pioneering filmmaker Greg Williams, Director of the groundbreaking film The Anonymous People, has co-created a new film, Generation Found, that tells the Houston story, with an emphasis on the role recovery-based education and alternative peer groups can play in the recovery process among young people and their families. The film Generation Found masterfully portrays the story of a youth-focused recovery revolution that could profoundly reshape the future of addiction, addiction treatment, and addiction recovery in the United States. This landmark film will serve as a dynamic catalyst for community education and mobilization. Organizing recovery support systems within high schools and collegiate communities is one of the most important developments within America’s response to alcohol and other drug problems among adolescents and young adults. Generation Found beautifully conveys how such systems of support are transforming one American community.
Screenings of Generation Found have been hosted across the country, but many people have not yet had access to these screenings. The film has just been released for general distribution and is available for order at www.generationfoundfilm.com. I commend this film to everyone concerned about the future of young people in America.
Post Date April 12, 2017 by Bill White

BLOG & NEW POSTINGS April 7, 2017 -Bill White- REDEFINING THE “RECOVERY COMMUNITY”

Over the past half-century, the meaning of “the recovery community” has undergone considerable changes. First used as an umbrella term to embrace local members of AA, the term was gradually extended to embrace members of Al-Anon and Alateen, members of other Twelve-Step fellowships, and then professional and lay allies of AA and related groups. The term was further stretched through the rise and dispersion of secular and religious alternatives to AA and the phenomenon of “dual citizenship in recovery”—individuals concurrently participating in Twelve Step and alternative recovery mutual aid groups.
Growing public and professional recognition that many people achieved recovery from substance use disorders without formal treatment or recovery mutual aid affiliation spurred some in “natural recovery” to claim membership within an expanding concept of “recovery community.” Individuals in recovery from what were christened “process addictions”—codependency, gambling, eating disorders, sexual addictions, etc. also claimed territory within the boundaries of the “recovery community.” A new addiction recovery advocacy movement spawned new recovery support institutions distinct from mutual-aid fellowships and addiction treatment organizations. Harm reduction projects advocating the legitimacy of non-abstinent pathways of addiction recovery further challenged the conceptual boundaries of recovery and recovery community.
A recently published article by Parkman and Lloyd will be of interest to observers of this recovery community building process. According to Parkman and Lloyd, the internet has extended the traditional definition of community that centered on people sharing living space within a defined geographical area. Instead, “imagined recovery communities” now exist whose members reside worlds apart and never meet face-to-face, and “portable recovery communities” afford people from disparate locations who share common experiences and identities opportunities to periodically gather and then disperse. Parkman and Lloyd further note the variability and fluidity with which people in recovery identify or do not identity with this imagined community. The authors conclude: “For those isolated in their addiction, with very little access to social support, access to an imagined recovery community that can provide support could be a valuable beginning to their recovery efforts.”
n reflecting on this evolving recovery community, four overlapping trends are of potential historical import: 1) the growth of an ecumenical “culture of recovery” that respects and blends secular, spiritual, and religious pathways of recovery and transcends geographic, political, economic, religious, racial, and generational barriers, 2) the rise of a new recovery advocacy movement proclaiming there are many pathways to recovery and ALL are cause for celebration, 3) the emergence of new recovery support structures within the arenas of business, law, communications, medicine, religion, education, housing, sports, leisure, and the arts, and 4) the increased linkage of the addiction/recovery experience to other forms of human suffering and healing. Addiction and recovery may become catalytic metaphors aiding broader patterns of personal and cultural transformation, and the broadened experience of recovery community may serve as an incubation chamber for such transformations.
As we witness the progressive splintering of the world’s social fabric into closed ideological camps, the community building rising out of the shared experience of addiction recovery is worthy of broader emulation. The wounded healers within this expanding “recovery community” have much to teach the larger cultures in which they are nested. A day may come when we all embrace our shared “woundedness,” all see ourselves and our communities in a process of recovery, and all join in transforming the world into a healing sanctuary.
Post Date April 7, 2017 by Bill White

BLOG & NEW POSTINGS March 31, 2017 -Bill White- A MOVEMENT OF ONE, A MOVEMENT OF MILLIONS


Carry the message. And if you must, use words.
–Dr. Robert Smith, Co-founder, Alcoholics Anonymous
What can I do to help spur the development of recovery advocacy and new recovery support services within my local community? What can I do to support the larger cultural and political mobilization of people in recovery and their allies? Such questions arrive daily based on my writings on the history of <a href=”http://www.williamwhitepapers.com/papers/topics/recovery_advocacy_articles/”>the New Recovery Advocacy Movement. Below are my most frequently proffered suggestions.
Confront your own Shame (internalized stigma). Social action begins with a change in personal consciousness. You can elevate that consciousness by exploring your own feelings about addiction and recovery. Do you avoid opportunities to share your recovery status or how addiction and recovery have affected your family? Do you find the subject embarrassing? For those who work in addiction treatment, do you find yourself masking your profession in new social situations? How do you react to people’s responses to the disclosure of what you do? Confronting addiction/recovery-related social stigma begins with confronting the stigma we have absorbed into our own being.
Break Silence at Home (within your family and social circle). Moving from shame to self-acceptance requires breaking silence about stigmatized issues. The first (and often hardest) area within which to break silence is to one’s own family and social network. Many recovery advocates can stand in front of a state capital and speak to hundreds or thousands of people about their addiction and recovery but have not shared even the briefest version of that story with their grandparents, aunts and uncles, nieces and nephews, and their friends. Recovery advocacy begins at home.
Educate Yourself (about recovery pathways different than your own). You are not the universe is a needed foundational premise. Learn about pathways and styles of recovery different than your own. Practice humility and tolerance as you encounter others who have experienced alternative ways of healing. “There are many pathways to recovery and all are cause for celebration” is a central mantra of the new recovery advocacy movement. As an advocate, you are not seeking to impose or promote your particular recovery pathway or style of recovery on others. Your task is to validate and celebrate the growing varieties of recovery experience. Achieving that task requires a process of self-education to move beyond the limits of your own experience. Self-education includes learning about recovery within diverse communities and cultures.
Find Kindred Spirits and Organize. Advocacy related to any stigmatized status or condition can be as distressing and exhausting as it is exhilarating. Advocacy is an activity best done through a community of shared experience and commitment. Reach out to others who share your interest and forge an advocacy community—no matter how small the original circle. Link yourself to national (e.g., Faces and Voices of Recovery, Young People in Recovery) and state/local recovery advocacy organizations (See listings at Association of Recovery Community Organizations).
Study the History of the Recovery Advocacy Movement. Social movements are as complex and messy in their execution as they are noble in their intentions. The experiential lessons drawn from the birth and evolution of this movement can guide you through the unfolding stages of your own involvement. Each new generation of recovery advocates pledges anew its commitment to respect, humility, and self-care (the primacy of personal recovery) by becoming a student of this history.
Formulate Your Public Story (about the transformative power of recovery). One’s public recovery story presented in the context of recovery advocacy should be different in content and style from that shared with trusted friends or within the rooms of recovery mutual aid fellowships. The latter often focuses on the details of the addiction and recovery experience where the former focuses on one’s recovery status and the transformative power and fruits of recovery experienced by individuals, families, and communities. Such distinctions, their rationale, and the importance of language and protecting boundaries of privacy can be acquired through the messaging training provided by recovery advocacy organizations.
Offer Public Witness. Recovery stories when publically disclosed provide a form of living proof more powerful than research studies or expert testimony. Such shared stories affirm that individuals and families can and do survive addiction, achieve enhanced global health and functioning, live meaningful lives, and make significant contributions within their communities and the larger society. Of everything you do as an advocate, nothing will be more powerful than sharing your own story and modeling a life lived fully and deeply.
Contribute Time, Skills, and Money. Recovery brings assets that can be returned to others as an act of amends and gratitude. Those assets can be reinvested in widening the doorways of recovery for others on a personal and even social policy level. Invest your time and talents. And invest a portion of the financial resources flowing from your recovery to support organizations that make recovery possible for others. Contribute money to the education and advocacy organizations that confront stigma and discrimination. Contribute money to service organizations that provide treatment and recovery support services. Share your resources with individuals and families who are struggling in early recovery. It makes no sense for recovering people to donate to all manner of other causes and not donate to recovery-focused organizations.
Movement of One For those who aren’t suited for the emotional rigors of involvement in formal social movements or don’t have access to local recovery advocacy organizations, you can function as a movement of one. Tell your recovery story no matter how different that story is from the dominant recovery stories in your community. Even as a single voice, you can convey a motto of the new recovery advocacy movement: Recovery by any means necessary under any circumstances. As Ghandi challenged, we must become the change we wish to see in the world. We can stand with millions of others or stand as a movement of one. But stand we must and shall.
All that is needed to seed recovery advocacy at a local level is a story, a commitment, and a sense or urgency.

Post Date March 31, 2017 by Bill White

BLOG & NEW POSTINGS March 23, 2017 -Bill White- THE HISTORY OF ADDICTION IN AMERICA


If you don’t know history, then you don’t know anything. You are a leaf that doesn’t know it is part of a tree. ― Michael Crichton
History is the ultimate elder, whether her truths are drawn from dusty tomes or passed on by our most revered storytellers. The early history of addiction in America has been well-told, most notably in such classic works as William Rorabaugh’s The Alcoholic Republic, David Musto’s The American Disease, H. Wayne Morgan’s Drugs in America, David Courtwright’s Dark Paradise, and Sarah Tracy’s Alcoholism in America.
I faced a unique challenge in writing Slaying the Dragon: The History of Addiction Treatment and Recovery in America. The original manuscript was more than 1,000 pages—a length too intimidating for most readers. To cut the manuscript by more than half, I deleted all but the briefest of summaries on the history of addiction and focused the book on the history of addiction treatment and addiction recovery. In recent months I have gone through the deleted material and edited it into bite-size stories that capture some of the more interesting chapters within America’s unending love affair with intoxicants of all varieties.
Slaying Cover
Thirty-nine historical vignettes drawn from the first draft of Slaying the Dragon have been added to the new Addiction History Briefs section of my website. The vignettes span drunkenness in Colonial America, the invention of the hypodermic syringe, the role of race in early anti-drug laws, the introduction of heroin in American medicine, the evolution of the American drug culture, and such exotic footnotes as the tale of the psychedelic toad. More will likely be added as time allows, but interested readers may now explore these first excerpted stories by clicking here.

Post Date March 23, 2017 by Bill White
Categories Articles
Tags addiction | history | trends