Bill White-YOUR RECOVERY QUOTIENT? TOWARD RECOVERY FLUENCY-October 19, 2018

In 2012, I experimented with the creation of a recovery knowledge exam (See What is Your Recovery Quotient? Toward Recovery-focused Education of Addiction Professionals and Recovery Support Specialists). The 100-item test was intended to illustrate the training emphasis on drug trends, psychopharmacology, and addiction-related pathologies in marked contrast to the scant attention paid to the prevalence, pathways, styles, and stages of long-term addiction recovery. (For details on such limited attention, click HERE)
We live in a world where people experiencing significant alcohol and other drug (AOD) problems call upon diverse iconic historical and contemporary figures, catalytic ideas, words, slogans, metaphors, and quite varied identity and story styles to resolve these problems. The challenge for addiction treatment and recovery community organizations and their service providers is to create environments and service menus within which all of these organizing motifs and languages are available. Achieving such broad recovery fluency among addiction treatment and recovery support specialists requires mastery of the history of addiction recovery and a basic understanding of what is being learned about recovery through rigorous scientific studies.

For addiction professionals and recovery support specialists, this calls for basic fluency in the language of secular, spiritual, and religious pathways of recovery and their related mutual aid societies; knowledgeable about assisted and unassisted styles of problem resolution; and knowledge of a broad spectrum of prevention, harm reduction, treatment, and recovery support technologies. Embracing such a menu is predicated on the belief that people use diverse ways to avoid and escape AOD problems and that such success is enhanced through informed choice and respectful guidance.

So exactly what would such fluency mean at its most practical level? Which of the following statements would you support?

*Educational media within addiction treatment and recovery support programs should be available in multiple languages, particularly the most prominent languages within a program’s geographical catchment area.

*Organizations providing addiction treatment and non-clinical recovery support services, regardless of their primary orientation (secular, spiritual, or religious; abstinence-based or pharmacotherapy-focused; etc.), should provide everyone screened and served with information on alternative approaches.

*Organizations providing addiction treatment and non-clinical recovery support services should shift from stand-alone, single-modality/philosophy service organizations to multimodality service centers offering a broad menu of evidence-based, experience-informed services.

*Any person being served by an addiction treatment or recovery support organization who fails to respond via measurable positive effects or who experiences clinical deterioration during the course of service should be informed of alternative approaches and assertively linked to such services.

*People in recovery working in professional or peer service roles and people who are academically credentialed without experiential knowledge of recovery should be provided orientation and training on and exposure to alternative pathways of recovery and how to present treatment and recovery support options in an objective manner.

*Addiction treatment and recovery support specialists should have a working knowledge of the history, organization, primary mechanisms of change, core literature, meeting and communication rituals, and assertive referral procedures for the major recovery mutual aid organizations and other indigenous recovery support institutions.

*Addiction professionals and recovery support specialists should be knowledgeable about local ethnic/cultural communities and indigenous healing roles and healing practices that may be engaged as sources of recovery support.

If you would like to assess your recovery quotient and fluency, click HERE. I look forward to updating this test in the future to incorporate recent historical developments and recovery research published since 2012.

We have learned so much about addiction-related pathologies and the mechanics of biopsychosocial stabilization (acute treatment); it is past time we learned about the prevalence, pathways, and processes through which individuals and families resolve such problems and the diverse communities in which such healing occurs.

Post Date October 19, 2018 by Bill White

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Bill White-EXPERIENCING RELEASE IN RECOVERY-October 12, 2018

In their classic 1992 text, The Spirituality of Imperfection, Ernie Kurtz and Katherine Ketcham described six dimensions of spirituality at the core of the recovery experience: release, gratitude, humility, tolerance, forgiveness, and being-at-home. In my prolonged mentorship by and collaborations with Ernie, we often returned to those central themes.

The essence of the addiction experience is being confined and bound by something once highly prized that subsequently mutated into a monster over which one had minimal if any control. It is then not surprising that within numerous varieties of recovery experience, there is a shared thread of letting go, of breaking free. This experience of release goes by many names and descriptors—escape (from physical craving and mental obsession), deliverance, liberation, pardon, regeneration, serenity, tranquility, harmony, and balance. This release is both breaking free from an enslaved past—a freedom from the insatiable demands of the drug and the guilt, shame, fear of insanity, and self-pity that are so integral to the addiction experience—and a freedom to move forward to a life of higher meaning and purpose. This sense of being liberated, when fully realized, elicits an emotional intensity impossible to comprehend by those suggesting that addiction is a choice.

Kurtz and Ketcham describe a paradox embedded within this release opportunity.

“Letting go” involves a breaking down of the resistance to reality, a surrender to the demand for certitude; it can be pictured as a letting fall of fetters, a shucking of bonds of fear and possessiveness now experienced as no longer binding. We ‘wake up” to discover that the locks and chains have been removed, and realizing this, we lift our arms and let the chains drop away. But—the chains cannot drop if we have become so attached to them that we fear being without them. While the chains may no longer be attached to us, we may still be attached to them. The deeper release, then, is of our attachment to the chains that bind us (Kurtz and Ketcham, 1992, p. 170).

In our discussions, Ernie often suggested that self-centeredness and self-deception were the major obstacles to this act of letting go so central to the initiation of recovery, but he left open the question of whether such self-entrapment was a cause or consequence of addiction. In contrast to traditional psychotherapies, Ernie thought that recovery for many involved a process of getting out of themselves rather than deeper into themselves.

Release in recovery is a complex experience. It has physical dimensions, particularly the diminishment or complete loss of the insatiable cravings (i.e. the cellular hunger for the drug). It is marked by cognitive and perceptual changes—escape from the mental preoccupations that crowded out all else and the loss of attentional bias toward drug cues that leaves one the sense of truly seeing the world for the first time. There are, of course, psychological and emotional dimensions to release—the expiation of long-suppressed emotions and what is sometimes experienced as a simultaneous and paradoxical escape from self and acceptance of self—the essence of Kurtz and Ketcham’s spirituality of imperfection. Spiritual dimensions of release include awakening to the reality that one has been gifted (graced) with a new sense of freedom and hope—a rebirth—midwifed by some greater force in the universe or the fruit of an ultimate life decision. Release can also have relational aspects in the severing of toxic, drug-linked relationships and the expansion of one’s social world.

To those who are yet seeking such a release, know that it is an immeasurable gift buried within the heart of the recovery experience. Know that you will not likely be in control of when and how it arrives. For some, this sense of being set free arrives early in recovery while for others it arrives unannounced months or years into recovery at a time its expectation has been forsaken. For some, release will come in a lighting strike—the legacy of a transformational change experience that is unplanned, positive, and permanent; for others, it slowly seeps into one’s experience until the day arrives when one suddenly realizes that destructive desires and obsessions are gone.

For many, the release experience remains a mystery, but a mystery worth embracing with deep humility and gratitude.

Post Date October 12, 2018 by Bill White

Bill White-TOWARD A TECHNOLOGY OF HOPE-September 21, 2018


Andy: Remember Red, hope is a good thing, maybe the best of things, and no good thing ever dies.

Red: Hope is a dangerous thing my friend, it can kill a man.

–The Shawshank Redemption

In earlier blogs, we explored the curse of low recovery expectations expressed in policy, professional, and public contexts and how those who work in addiction treatment and other recovery support roles can counter addiction-related stigma in their public and professional interactions. The present blog addresses how those working in such roles can ignite hope among addicted people and their families who may themselves have internalized the socially and professionally pervasive pessimism about the prospects of long-term addiction recovery.

Recovery from severe addictions has long been framed as a pain quotient: Recovery becomes possible when the pain of addiction gets greater than its experienced rewards (e.g., when people “hit bottom”). Belief in this equation has two unfortunate consequences. First, it provides the historical rationale for heaping untold pain (shame, social shunning, arrest, incarceration, and invasive and humiliating “treatments”) on those addicted with little awareness that such interventions may actually thrust the individual deeper into addiction. Second, it ignores the critical role hope plays in recovery initiation. Escalating pain in the absence of hope is an invitation to, at best, accelerated drug use, or, at worst, suicide.

The pain of addiction-related consequences serves as a catalyst of recovery only in the presence of hope. The natural history of addiction will provide sufficient quantities of pain to incite recovery readiness, but what and where are the sources of hope essential for recovery initiation? And what roles can addiction professionals and peer recovery support specialists play in nurturing such hope? Below are some prescriptive actions that addiction professionals and those providing recovery support services can use to elicit hope in the face of addiction-fueled despair.

    Practice a Ministry of Presence
    Addiction is a disorder of disconnection with hope for recovery most often rising in the context of relationships—relationships marked by empathy, compassion, respect, and encouragement. The first gift we give those in need of recovery is our time and attention. Practicing this ministry of peaceful presence requires quieting the roar of our own pressing needs to be fully present, to listen, and to experience another’s story. It is helpful to recall people in our own lives who gifted us with such hopeful presence. The first acts of help and hope? Listen, Listen, Listen.

    Capitalize on Crisis Most people seeking our help will arrive in crisis, and the crises will keep unfolding well into recovery–the legacy baggage of addiction. Some of those we serve will be as addicted to such crises as they were to the drugs in their lives. Each crisis is a window of potential opportunity—a turning point, a teachable moment, a developmental window of opportunity, a crossroads—to help those we serve see the larger picture of their lives, understand how such crises are created, learn how they can be shed, and, most importantly, how they can be prevented. Rather than simply rescuing, crises are opportunities to teach critical thinking and problem-solving skills. Hope rises exponentially with the expansion and application of such competencies.

    Normalize Ambivalence Addiction and early recovery are each marked by extreme ambivalence. What the individual wants to do more than anything is to maintain the drug relationship—the very definition of addiction. What the individual wants to do more than anything is to sever the drug relationship—the essential requirement for recovery initiation. It is helpful to acknowledge this ambivalence. The scales of such ambivalence can often be tipped towards recovery by periodically conducting a pro-con analysis of drug use and the rewards each person hopes to gain from recovery. This first involves reviewing what drugs did for (+) the person and what drugs did to (-) the person. The second involves envisioning the promised of recovery.

    Express Confidence in Their Capacity to Recover Let those you are helping know that recovery is the norm rather than the exception and that, with concerted effort, they can join millions of people who have achieved long-term recovery and its gifts. That confidence can best be expressed by hanging in with them in the face of setbacks after which they have been historically abandoned by others in anger and disgust. Let those we serve know that those seeking recovery can achieve together what each was unable to achieve alone. Let them know that previously hidden powers within and beyond themselves can be mobilized to speed this journey. Conduct a formal inventory of each person’s assets (recovery capital) and acknowledge incremental changes as a way to stoke confidence and sustain the momentum for change.

    Offer Living Proof of Recovery Share your own story of recovery and/or your witness of the recovery of others over the course of your career and expose the newcomer in recovery to as many people in long-term recovery as possible, particularly people with whom they may experience strong mutual identification. Make sure such exposure includes recovery carriers—people in recovery who make recovery contagious based on their infectious personalities, character traits, and their service activities. Offer living proof that people whose lives were diminished by destructive addictions now experience purpose-driven lives day after day, year after year, without the need for chemical anesthesia. Expose them to the laughter of recovery—that raucous, joyous expression of relief, release, and gratitude.

    Acknowledge the Varieties of Recovery Experience Convey to those seeking recovery that there are many pathways and styles of recovery and share descriptions of such variations, e.g., with and without treatment, through varied treatment methods, with and without medication, with and without recovery mutual aid participation, through a variety of mutual aid choices, etc. Choice of recovery goals and methods incentivizes recovery initiation and enriches quality of life in recovery.

    Share Iconic Stories Expose those you are helping to the stories of earlier recovery pioneers with whom they can identify. Good storytellers are among the most effective professional helpers. Collect stories that inspire and elevate those you serve. Use stories to convey catalytic words, phrases, and metaphors that are personally and culturally meaningful. For members of marginalized groups, link the personal story to the larger story of recovery of a people, e.g., drugs as a tool of oppression and recovery as an act of personal/cultural/political resistance.

    Facilitate Story Reconstruction and Storytelling Help the person seeking recovery make sense of the chaos they are experiencing via their own story: 1) Who was I before I began using? 2) Who and what did I become as a result of my use? 3) Why me? How do I explain what happened? 4) What led to my decision to change? 5) Who and what am I now? 6) Where am I going and what do I need to do to get there? Exploring these questions activates the push and pull forces of recovery and opens the further question, “Recovery to do what?”—a self-questioning that in some cases involves the retrieval of childhood dreams and aspirations.

    Provide Exposure to the Culture of Recovery Guide those seeking recovery into relationships with people, places, and things that support recovery. Help them discover recovery-friendly people and places within their local community. Provide exposure to the language, symbols, rituals, literature, music, film, theatre, and art of recovery. Articulate recovery values. Note the growing number of recovery support institutions. Introduce those you serve to others in recovery with shared backgrounds, vocations, avocations, and aspirations. Social support is the glue that binds elements of a recovery lifestyle.

    Provide Systems Navigation Those with the most severe and greatest number of problems who you serve may need resources across multiple systems to initiate and sustain their recovery. Navigating the ever-complex helping systems can be extremely frustrating and lead to pessimism about one’s prospects for change. Providing a map and tour guide through these systems can minimize such frustration and allow clearer visualization of a later life in recovery.

    Convey The Promises of Recovery Let those you are helping know that recovery is more than the deletion of problems from an otherwise unchanged life. Let them know that recovery brings with it an unlimited range of possibilities to not just get well, but to get better than well. Let them know that recovery comes with the potential for a new life of meaning and purpose.

    Recovery opens a doorway to a new life. In this rebirthing process, hope is a glowing new skin. The above are among the actions I have found that stimulate hope in the recovery process. What actions would you add to this list?

    Before closing, a final note of warning from Red is warranted. Hope has restored and transformed untold number of lives, but there is also a risky side of hope. Elevating hope without the necessary resources to fulfill that hope risks fueling endless despair and self-destruction. When we offer hope, we must have the capacity to deliver on the promises of recovery. Achieving “recovery by any means necessary under any circumstances” doesn’t require perfect resources, but it does require that we fulfill our commitment of continued recovery support over time—again, that ministry of presence.

    Post Date September 21, 2018 by Bill White

Bill White-VARIATIONS IN RECOVERY IDENTITY ADOPTION-September 14, 2018

A significant portion of people who resolve alcohol and other drug (AOD) problems do not embrace a recovery identity—do not see themselves as recovered, recovering, or in recovery. I first suggested this in Pathways from the Culture of Addiction to the Culture Recovery (1990) and later in a co-authored essay on the varieties of recovery experience (White & Kurtz, 2006), but had nothing but years of observation and anecdotal stories to support it. When I was asked about the prevalence of adoption or non-adoption of a recovery identity among people who had resolved AOD problems, no data were available to inform that question. Thanks to a just-published study by Dr. John Kelly and colleagues of the Recovery Research Institute, there is now data that addresses that and related questions.

The Kelly-led research team surveyed a representative U.S. population sample of people who had resolved a significant AOD problem during their lifetime and determined the extent to which such individuals adopted a recovery identity and whether such identification had changed over time. Here are some of their major findings.

*Of the 45.1% of people who had resolved an AOD self-identified as “in recovery”, 39.5% had never seen themselves as being “in recovery”, and 15.4% once identified as being “in recovery” but no longer embraced a recovery identity. Of all people with recovery identification at some point in their lives, 25% no longer embrace a recovery identity.

*People who had resolved an AOD problem and who also currently embraced a recovery identity were more likely to have been diagnosed with a substance use disorder (SUD), diagnosed with a mental health disorder, treated for a SUD, and more likely to have been involved with a recovery mutual aid group—all potential proxies for greater problem severity and complexity.

*People who had resolved an AOD problem who never saw or presently do not see themselves “in recovery” offered several reasons for not embracing a recovery identity: 1) self-perceived lower problem severity, 2) self-perceived ability to function in spite of AOD problems, 3) ability to stop AOD use without peer or professional help or, for some, success in decelerating use to escape AOD-related problems, 4) seeing AOD problem resolution as a past chapter of their life—a past decision—and not a present struggle, and 5) a desire to avoid the “sickness” label.

*Quality of life indicators did not differ across the three groups (current recovery identity, rejection of recovery identity, once embraced but now reject recovery identity).

The Kelly group study confirms the variations in recovery identity among people who have resolved a significant AOD problem. It appears that people with lower problem severity may resolve AOD problems without embracing a recovery identity, while people with greater problem severity may find it helpful to embrace such an identity as a mechanism of stable recovery maintenance. Also of note is the portion of people who evolve out of a recovery identity over time. These include people who may have once been involved with a recovery mutual aid group but who have sustained problem remission after cessation of such active participation. I have discussed these populations in earlier blogs HERE and HERE.

What is becoming apparent and confirmed in multiple studies is that AOD problems exist of a broad spectrum of problem severity with quite different lifetime trajectories—from risky use, binge use, sustained heavy use, and compulsive use. Problem resolution strategies and personal styles vary greatly across this spectrum. The question facing addiction treatment as a social institution and recovery community organizations is this: Do we seek cultural ownership of all AOD problems or only the most severe and complex of such problems?

If the treatment field embraces responsibility for all AOD problems, then our knowledge base, our change and support technologies, and our public messaging must be dramatically broadened and become far more nuanced. If the field restricts itself to the most sever and complex AOD problems, then we need to clearly define the boundaries of our expertise, practice only within those boundaries, and make it clear that other social institutions are responsible for AOD problems marked by lower severity, complexity, and chronicity. Unintended harm can come from indiscriminately applying models of care and support designed for high problem severity and low recovery capital typical of late state SUDs to people with low problem severity and high levels of recovery capital—and vice versa!

The Kelly recovery identity study also has important implications for how we communicate to the public and policymakers about AOD problems. As the Kelly research team suggests, “AOD public health communication efforts may need to consider additional concepts and terminology beyond recovery (e.g., “problem resolution”) to meet a broader range of preferences, perspectives, and experiences.”

Are the addiction treatment and recovery support fields capable of reaching people within this broader spectrum of AOD problems? Are they ready to embrace broader pathways and styles of AOD problem resolution? The fact that less than half of people who have resolved a significant AOD problem see themselves as “in recovery” is a striking finding. Are we ready to introduce ourselves to the other half and face the challenges such contact will inevitably bring to prevailing ideas and service practices? What do you think?

References

Kelly, J. F., Abry, A. W., Milligan, C. M., Bergman, B. G., & Hoeppner, B. B. (2018). On being “in recovery”: A national study of prevalence and correlates of adopting or not adopting a recovery identity among individuals resolving drug and alcohol problems. Psychology of Addictive Behaviors, August. doi: 10.1037/adb0000386

Kelly, J. F., Bergman, B., Hoeppner, B., Vilsaint, C., & White, W. L. (2017). Prevalence, pathways, and predictors of recovery from drug and alcohol problems in the United States Population: Implications for practice, research, and policy. Drug and Alcohol Dependence, 181, 162-169.

Post Date September 14, 2018 by Bill White

Bill White-THE FUTURE OF RECOVERY SCHOLARSHIP-August 5, 2016

Is it possible we are seeing the rise of a new generation of scholar activists who combine the experiential knowledge of addiction recovery, academic excellence, and a desire to give back through recovery-focused research, writing, teaching, and advocacy activities?

Over the past decade, I have interviewed many of the pioneers who made major contributions to the modern scientific and historical study of addiction recovery. All of these pioneers brought impeccable academic credentials to their work, but many withheld their personal or family recovery status or only disclosed that status late in their careers when they felt such disclosure would not damage their career opportunities or professional reputations. (See HERE and HERE for examples of the latter). Such secrecy or delays in disclosure were the result of the social stigma attached to addiction. Major efforts to reduce recovery-related stigma may make it easier for a new generation of scholars to pursue the study of the personal and family recovery experience while living openly as people in long-term addiction recovery.

Six factors will influence this future. First, the levels of education of people in recovery is increasing due both to the number of people with advanced education who are seeking recovery and the number of people in recovery choosing to pursue continued education as part of their recovery process. As examples, nearly 20% of AA members work as professionals, health professionals, or educators; 41% of surveyed NA members report having a college or graduate degree; and 47% of SMART Recovery members report having a college or graduate degree. Second, resources have expanded via the growing network of collegiate recovery programs through which people in recovery can pursue advanced education in a recovery-supportive academic and social environment. Third, there are now more than 280 colleges and universities offering formal addiction studies programs that academically prepare people to work within such areas as policy, administration, research, harm reduction, prevention, treatment, and recovery support services (Click HERE for a full list of such programs). The number of recovery-focused studies within Master’s theses and doctoral dissertations is increasing exponentially. Fourth, people are entering recovery at younger ages, with a growing contingent of politically aware and articulate young recovery advocates, some of whom are being drawn to academically prepare themselves for a career in the addictions field. Fifth, this emerging generation of recovery advocates has a seasoned vanguard of recovery role models working as addiction professionals, including at the highest levels of policy development and service delivery, as well as strong associations representing addiction medicine specialists and other addiction professionals. Sixth, recovery mutual aid organizations are themselves getting more involved in historical research and in collaborating with academic and private research organizations in the conduct of recovery research. Collectively, these forces are motivating people in recovery to further their education and extend their avocation of volunteer service work into a vocation within the addictions field.

This is all a way of saying there are ways that those who have been part of the problem can be part of the solution and that this influence can be exerted locally, nationally, and globally. Perhaps this invitation is being written for you. Perhaps you have changed your own life for a purpose that remains unclear to you. Perhaps that purpose is to help change the world—to help us understand the personal and family recovery processes in new ways, to elevate the quality of addiction treatment, to widen the doorways of entry into recovery, or to help find ways to break intergenerational cycles of addiction. Yes, such contributions will take a profound commitment, sustained preparation, and tenaciousness that will test you beyond measure. But from one who has followed this path, I invite you to accept the torch extended to you from my aging generation of scholar activists. Combining recovery-grounded experiential knowledge with the most rigorous historical and scientific methods of inquiry might indeed reshape the future of addiction and addiction recovery. Is that vision something that calls to you? Is it time to begin or take the next step in your preparation for this calling?

Post Date August 5, 2016 by Bill White

Bill White -STIGMA-BUSTING: SHARING THE GOOD NEWS OF RECOVERY AT A PROFESSIONAL LEVEL-July 27, 2018

Stigma has many targets. It reaches beyond people addicted to various drugs to affect family members and those providing addiction treatment and recovery support services. Such secondary stigma, for example, is the source of the peculiar pecking order within the addictions field through which status (or stigma) is bestowed across varied settings based on one’s recovery status or lack of recovery experience. It also is the source of coded conversations between those working in the addictions field and members of the larger community. As a result, addiction professionals and recovery support specialists may find their legitimacy, their value, and even their sanity challenged by professional peers and by members of the larger culture. The ways in which we respond within such conversations can mark an appeasement (passivity in the face of insult or aggression) or a challenge to addiction-related stigma.

Below are some frequently heard comments (and their coded meanings when combined with certain voice tones and facial expressions) that people working in addiction treatment or recovery support roles hear when they disclose their life’s work to acquaintances outside the worlds of addiction treatment and recovery. It is tempting for some of us in these social situations to hide one’s occupation, quickly divert to other topics, flee and avoid such future encounters, or escape into a social network made up almost exclusively of others working in the field. But such encounters with the larger community hold great opportunity. They provide a means of challenging the imbedded myths and stereotypes that feed addiction- and recovery-related stigma and its harmful progeny.

Below are some stigma-busting responses to such comments.

Comment: “That must be very difficult [or distasteful/depressing/dangerous] work.” (Code for: “Alcoholics and addicts, as bad people doing bad things, are morally disreputable and dangerous.”)

Response: Actually, working with individuals and families affected by alcohol and other drug problems is very rewarding. Many of the people I work with are bright, attractive, and engaging. They represent people from very diverse backgrounds and life stories. I enjoy guiding and observing people regain health and happiness. I also like working within a team of very competent and committed service professionals. Many of those I work with have suffered multiple and quite severe problems, but I continue to be in awe of their persistence and resilience in rebuilding their lives. I could make more money and have more professional status doing other things, but I don’t think I would love doing them as much as what I do now. I would not trade what I do for anything. The most difficult part of what I do is not the people I work with but the community resource limitations and the paperwork and other administrative red tape that can demand so much of my time.

Comment: “But what about all the treatment failures and deaths I read about?” (Code for: “Why would you work in an area in which success is so rare?”)

Response: Such losses are horrible and personally painful, but they are an inevitable part of working within any sector of healthcare. But most importantly, addiction-related deaths among those I work with are the exception. Far more common are individuals and families who positively transform their lives and express their gratitude for the help that we have been able to provide them. And what we do through our harm reduction, treatment, and recovery support activities reduces the incidence of such deaths. The deaths that do occur provide an opportunity to recommit myself to improving the accessibility and quality of the services we as a field are able to provide, particularly services that help keep people alive until they achieve stable recovery.

Comment: “I guess what you do would be valuable even if you only help one person.” (Again code for: Recovery is the exception to the rule—a miracle; “once an addict, always an addict.”)

Response: If only one person was helped by my organization, we would have to seriously re-evaluate our treatment approaches. There are more than 23 million Americans who once experienced alcohol or other drug problems who have resolved these issues. In treatment, we deal primarily with the most severe and complex of these problems, but the vast majority of people seeking our help will recover, sometimes after multiple efforts. It is a great feeling to be a critical link within this healing process. And we have the opportunity in addiction treatment to see very sick individuals and families get well and go on to achieve significant levels of social contribution. Many of the men and women I work with get better than well.

Comment: “It must take a very special person to work with THOSE people; I don’t think I could do that.” (Code for, “You must be insane to choose to spend your life trying to help alcoholics and addicts! Who in their right mind would want to that?”)

Response: Thank you. It’s true that not everyone is suited to work effectively in addiction treatment and recovery support roles. It requires education, training, and supervised work experience, and it also requires particular values and traits of character such as compassion and empathy. Addiction treatment and recovery support remain frontier areas of healthcare so working in them also requires constant learning. Have you ever been in a situation where you were asked to help someone who was experiencing a difficult or life-threatening problem? I find there are common values within the long-term addiction recovery experience that are very attractive—values such as honesty, gratitude, humility, humor, simplicity, tolerance, forgiveness, gratitude, and service. Working with people in recovery provides daily reminders of these important values.

Comment: “How did you happen to get in that kind of work?” (Code for, “Were you an addict?” “Could you not find another job?”)

Response: I had known people who recovered from addiction and went on to make considerable contributions within their professions and communities. It seemed to me that helping people overcome such conditions would be a personally fulfilling way to spend one’s life. That has proved to be true. I was equally motivated by seeing so many communities that had so few high-quality addiction treatment and recovery support resources. (Optional: I also thought lessons I drawn from my own personal/family recovery experiences might be of benefit to others facing similar challenges.)

Comment: “I have been reading about the arrest of people in addiction treatment for fraud and exploitation of patients.” (Code for: “Addiction treatment is a scam—the modern equivalent of the snake oil salesman. Are you such a person?”)

Response: There are unethical or incompetent people within any service industry who seek to exploit it for their own profit. In the addictions field, we have tried to minimize such exploitation through program accreditation and licensing standards and codes of professional ethics. We try to hold organizations and individuals ethically and legally accountable for breaches of these standards, but some still occur, as they do in all industries. Such breaches do great harm to those needing help and to reputable organizations and service professionals. Unfortunately, the day in and day out delivery of effective and ethical addiction treatment does not make headlines.

Closing Reflection

The comments noted above rarely spring from maliciousness; they are rarely intended to consciously disparage or shame us and those with whom we work, and some are intended as genuine compliments. The issue is that such comments, when accompanied by repugnant voice tones and facial expressions, are drawn from the core ideas that buttress social stigma and misrepresent the sources of and solutions to alcohol and other drug problems. Such ideas are best changed not from direct confrontation but through personal encounters that provide an alternative way of viewing these problems and solutions. We can be the change agents within this process.

It is easy to cave into the stigma. But silence or weak responses leave stigma and stereotypes intact. As the advocacy slogan declares, “By our silence, we let others define us.” Challenging stigma and stereotypes require a much different response. In 2001, I posed the following challenge to people in recovery:

“There are whole professions whose members share an extremely pessimistic view of recovery because they repeatedly see only those who fail to recover. The success stories are not visible in their daily professional lives. We need to re-introduce ourselves to the police who arrested us, the attorneys who prosecuted and defended us, the judges who sentenced us, the probation officers who monitored us, the physicians and nurses who cared for us, the teachers and social workers who cared for the problems of our children, and the job supervisors who threatened to fire us. We need to find a way to express our gratitude at their efforts to help us, no matter how ill-timed, ill-informed, and inept such interventions may have been. We need to find a way to tell all of them that today we are sane and sober and that we have taken responsibility for our own lives. We need to tell them to be hopeful, that RECOVERY LIVES! Americans see the devastating consequences of addiction every day; it is time they witnessed close up the regenerative power of recovery.”

Today, I am challenging those of us who work within this special ministry to be more assertive in sharing the transformative power of recovery with all those we encounter socially and professionally and to share the privilege we have experienced as a guide and witness to such transformations. The public is constantly bombarded with addiction’s bad news; it’s time we shared with them the good news of recovery. Each time we introduce ourselves and what we do to a new acquaintance stands as a potential community and cultural intervention. We too are the faces and voices of recovery–regardless of our recovery status.

Acknowledgement: I would like to thank the following members of the Recovery Rising Book Club whose recent discussion inspired this blog: Brian Coon (Pavillon – Mill Spring, NC), Matt Statman (University of Michigan – Ann Arbor, MI), Jason Schwartz (Dawn Farm – Ypsilanti, MI), Ken Schuesselin (NC DHHS, Division of Mental Health, Developmental Disabilities, and Substance Abuse Services – Raleigh, NC), Scott Luetgenau (SouthLight Healthcare – Raleigh, NC), Brandon Robinson (Fellowship Health Resources – Raleigh, NC), Amanda Blue (Healing Transitions – Raleigh, NC), Shane Phillips (Duke University Medical Center – Durham, NC), and Chris Budnick (Healing Transitions – Raleigh, NC).

Post Date July 27, 2018 by Bill White

Bill White -THE TIME IS NOW FOR A RADICAL TRANSFORMATION OF ADDICTION TREATMENT BY WILLIAM WHITE, GARY MENDELL, AND SAMANTHA ARSENAULT-July 20, 2018

Countless people have had their lives positively transformed by addiction treatment. But tragically, this is not the norm.

Despite decades of advancements in science, pharmacology, and technology, the continuum of evidence-based addiction treatment services remains largely unavailable to those in need. The addiction treatment system is hindered by fragmentation, outdated treatment philosophies, and a payment system that perpetuates antiquated care models and discourages the adoption of best practices in the field. The historical rise and development of the current addiction treatment system explains the evolution of a broken system, and sheds light on new solutions.

Today, drug policy leaders, frontline addiction professionals, and affected individuals and families are calling for radical changes in the design and delivery of addiction treatment. It’s time for change. It’s time to protect our families.

THE EARLY DAYS OF AMERICAN ADDICTION TREATMENT
Treatment and recovery support for addiction began in the mid-1800s, with the nation’s first temperance and alcoholism recovery mutual aid movements, which subsequently grew into specialized care. In the mid-to-late nineteenth century, addiction treatment was provided by inebriate homes, inebriate asylums, and private addiction cure institutes; faith-based urban rescue missions and rural inebriate colonies; and by aggressively promoted and often fraudulent “home cures.”
An advertisement for Olin Morphine Cure
The early era of addiction treatment in the U.S was riddled with ideological divisions, ineffective and harmful treatment methods, and exposés of fraud. Not surprisingly, this era of unsubstantiated interventions ended with lost cultural faith in the potential for permanent recovery from addiction.

As specialized care collapsed in the early twentieth century, America embarked on a bold social experiment: Let those currently suffering with addiction die off by benign neglect, and prevent future addiction by legally prohibiting the sale of beverage alcohol and by criminalizing the non-medical distribution and possession of opiates, cocaine, and a succession of other intoxicants. During this time, people addicted to alcohol and other drugs were relegated to the “drunk tanks” of local jails, inebriate penal colonies, the “foul” wards of large city hospitals, the “chronic” wards of psychiatric asylums, and, for the rich and famous, exclusive “drying out” sanitaria.
https://www.shatterproof.org/sites/default/files/styles/max_325x325/public/2018-07/08%20New%20York%20State%20Inebriate%20Asylum.jpg?itok=3lkm7QAQThe New York State Inebriate Asylum
In the mid-twentieth century, sporadic efforts to rebirth specialized addiction treatment accelerated. Alcoholics Anonymous (AA, 1935) and the advent of AA-influenced models of treatment (1940s) elevated cultural optimism about recovery, and rising rates of juvenile narcotic addiction in the 1950s spurred new experiments in addiction treatment and recovery support. This resulted in increased availability of replicable treatment models (e.g., outpatient clinics and inpatient/residential alcoholism treatment programs, therapeutic communities, methadone maintenance clinics).

Driven by the emergence of new treatment methods, decades of medical and legal advocacy, rising alarm about heroin use among American soldiers in Vietnam and youth at home, the U.S. reached a cultural tipping point in the early 1970s.
https://www.shatterproof.org/sites/default/files/styles/max_325x325/public/2018-07/OperationUnderstandingGroupPhoto_5-8-1976.jpg?itok=JKzuNMfHOperation Understanding, 1976
The outcome was landmark legislation (Comprehensive Alcoholism Prevention and Treatment Act of 1970 and the Drug Abuse Treatment Act of 1972), providing federal, state, and local funding for prevention and treatment and expanding insurance coverage for addiction treatment, plus a sustained campaign of public education led by people in recovery from alcoholism.

This stimulated rapid growth of addiction treatment from a fledgling therapeutic movement to a multi-billion (currently more than $35 billion) dollar industry. However, this growth was not tied to improvements in quality: The performance of addiction treatment programs was benchmarked by financial metrics such as occupancy rate and budget, rather than measurements of patient outcomes and wellness.

THE WAR ON DRUGS AND THE OPIOID EPIDEMIC
The 1980s and 90s added additional challenges to treatment quality and barriers to access. An intensified “War on Drugs” further criminalized addiction as a moral failing rather than a medical disease. This resulted in increased penalties for drug-related crimes, diversion of addicted individuals from treatment interventions to jails and prisons, and heightened addiction-related stigma. More restrictive insurance coverage for addiction treatment and an aggressive system of managed care led to the closure of many hospital-based addiction treatment units and private residential treatment programs, as well as progressively shorter durations of addiction treatment.

Since 2000, the opioid epidemic has again shifted the treatment landscape. Legislative and regulatory responses now require insurance coverage of addiction treatment at par with other medical conditions (through the Mental Health Parity and Addiction Equity Act and Affordable Care Act), and have expanded treatment, education, and prevention (through the Comprehensive Addiction Recovery Act and Twenty-First Century Cures Act). However, there has been slow progress to integrate addiction treatment with mainstream healthcare and mandate modern best practices. Instead, addiction treatment is still largely delivered with diverse philosophies and methods stemming from its beginnings as a “folk healing art.”

THE DEADLY TOLL OF OUTDATED TREATMENT METHODS
The continued use of outdated treatment methods is harmful to patient health, and, in some cases, it’s even criminal. The treatment system fails to reach people until the latest stages of addiction, and is ill-equipped to provide care for people with low to moderate problem severity. Insurance denials, prior authorization requirements, and admission waiting lists create impossible hurdles. The system is plagued by high early dropout rates (40-60%), high rates of non-completion (more than 50%), and low rates (less than 50%) of successful linkage to long-term recovery support resources.

Families affected by addiction report that they can’t find or judge the quality of treatment services. Gary’s son, Brian, for example, cycled through seven different programs without accessing treatment based on research or attuned to his needs.

THE ONLY PATH FORWARD: A RADICAL TRANSFORMATION
The Surgeon General’s Report on Alcohol, Drugs and Health illuminates how to systemically course-correct the addiction treatment system and improve the quality of care. Shatterproof’s Substance Use Disorder Treatment Task Force, a multi-stakeholder group including leaders in addiction research, treatment, and health policy and payment, is dedicated to making this happen. Drawing upon core concepts from the Report, the Task Force established the National Principles of Care for Substance Use Disorder Treatment, eight core tenants of quality addiction treatment, to guide their work.

Ensuring the addiction treatment system aligns with these principles will take shifts in infrastructure, payment incentives, and treatment philosophies. Shatterproof and the Treatment Task Force are working to create a rating system for addiction treatment programs that will drive these critical changes by bringing new transparency to the quality of care offered at addiction treatment programs. Measuring each program’s use of evidence-based best practices, and making this information available to the public, will allow those seeking treatment to make informed decisions and market forces to incentivize providers to deliver high-quality, evidence-based care.

These steps will not be easy, but they are essential to transforming addiction treatment into a highly-regarded medical specialty, and to ensuring that every American has access to evidence-based medical care.

Gary Mendell is Shatterproof’s founder and CEO. Sam Arsenault is Shatterproof’s Director of National Treatment Quality Initiatives. William White is Emeritus Senior Research Consultant at Chestnut Health Systems and author of “Slaying the Dragon: The History of Addiction Treatment and Recovery in America.”

Photos courtesy of the Illinois Addiction Studies Archives.

Post Date July 20, 2018 by Bill White