Sunday, May 24th, 2015 Focus: By being a witness to my thoughts, I become master of my mind.

We must do more than simply change the way we think; we must change our relationship with thought. We must become its ever-present witness to avoid being its ever-suffering accomplice. Helpful one moment and devious the next, thought is like a petulant child requiring our constant attention.

As thought’s witness, we are its master. We can summon it if we wish to bake a cake or split an atom, and dismiss it when it shows up uninvited. But for this cozy relationship with thought to last, we must keep it permanently in our sights. This will take every ounce of energy we have, and at first even that won’t be enough. We have been thought’s servant for so long that we often continue to obey it by sheer habit.

But in time our tolerance for suffering at the hands of thought will lessen. The pleasure will no longer seem worth the pain. And those isolated moments when we glimpse the chains and pulleys driving our thought process will begin to connect like stars in a constellation. As we step further and further back from the realm of thought, we will see it in its entirety and know that we exist beyond its borders.

Excerpted from the article:

Stepping Toward Peace by Changing Our Relationship With Thought
Written by John Ptacek.

Read more of this article…

RECOMMENDED BOOK OF THE DAY

Stillness Speaks by Eckhart Tolle.
Stillness Speaks
by Eckhart Tolle.

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BLOG & NEW POSTINGS May 22, 2015Bill White STIGMA REDUCTION THROUGH CONTACT STRATEGIES (BILL WHITE AND TOM HILL)

“We can be convinced logically of the need for intervention and change. But it is the story of one individual that ultimately makes the difference—by offering living proof.” ― John Capecci and Timothy Cage
Eighty-year old Supreme Court Justice Ruth Bader Ginsburg recently commented on the changing American attitudes toward gay people: “The change in people’s attitudes on that issue has been enormous. In recent years, people have said, ‘This is the way I am.’ And others looked around, and we discovered it’s our next-door neighbor — we’re very fond of them. Or it’s our child’s best friend, or even our child. I think that as more and more people came out and said that ‘this is who I am,’ the rest of us recognized that they are one of us….Having people close to us who say who they are — that made the attitude change in this country.” Justice Ginsburg’s observation offers observed testimony to the power of contact strategies—public disclosure of personal stories by individuals who share a concealable stigma for purposes of changing social attitudes and social policies.
But does such contact REALLY change such attitudes? A new study led by Emma McGinty and published in the journal Social Science & Medicine suggests that it does. In a randomized national sample of more than 3,900 U.S. adults, McGinty and her colleagues compared responses to vignettes portraying untreated and successfully treated addiction and the extent to which these responses indicated a desire for social distance, belief in the effectiveness of treatment, and willingness to discriminate. Study findings suggest 3 major conclusions.
Silence PosterFirst, “concealment, which is driven by stigma, also likely perpetuates stigma by preventing second-hand experience of successful treatment by family members, friends, and acquaintances” (p. 80). This confirms the proclamation of recovery advocates that, “By our silence, we let others define us.” While the wide range of motivations for concealment may be understandable, the broader social consequences of such concealment are becoming increasingly clear.
Second, the over-telling of addiction-related pathologies and the biological roots of addiction without reference to recovery prevalence, at best, may have little effect on desired social distance, perceived effectiveness of addiction treatment, or willingness to discriminate, and, at worst, may inadvertently increase stigma and discrimination.
Third, exposure to successful stories of addiction recovery result in “less desire for social distance, greater belief in the effectiveness of treatment, and less willingness to discriminate against persons with these conditions” (p. 73). Findings from this study confirm the power of contact strategies in reducing the stigma attached to addiction recovery.
There are clear and simple messages that permeate my writings on this subject over the past 15 years. Nearly everyone in America knows someone in long-term addiction recovery, but most are not aware of the recovery status of these acquaintances, colleagues, friends, and even family members because the person in recovery has carefully concealed this status. Attitudes toward addiction, addiction treatment, and addiction recovery will not change in this country until we reach a critical mass of people who are aware of the recovery experience among their family, social, and professional network. That is unlikely to occur until a vanguard of people in long-term recovery disclose their recovery status and stories at a public level. That is what the new recovery advocacy movement is bringing to America and to other countries that is fundamentally new.
In 2001 Recovery Summit in St. Paul, Minnesota that launched this new movement, the first author shared the following:
“We cannot confront stigma in the outside world until we discover how stigma works within us and our relationships with the world. The internal consequences of such stigma must be excised before one experiences the worthiness and the power to confront its external source. We must excise that stigma so that we can move beyond our own healing to find our indignation, our outrage, and our sorrow that people who could be recovering are instead dying. We have to move beyond our own serenity and retrieve the fading memories of our own days of pain and desperation. Before that day, we need leaders who will jar us from our complacency and challenge us to hear the cry of the still suffering. Stigma is real, but we need to confront the fact that our own silence has contributed to that stigma. Listen to the words of Senator Harold Hughes who before he died proclaimed:
Senator Harold HughesBy hiding our recovery we have sustained the most harmful myth about addiction disease–that it is hopeless. And without the example of recovering people it is easy for the public to continue to think that victims of addiction disease are moral degenerates–that those who recover are the morally enlightened exceptions….We are the lucky ones, the ones who got well. And it is our responsibility to change the terms of the debate for the sake of those who still suffer.
“How can addicted people experience hope when the legions of recovering people in this culture are not seen or heard? Where is the proof that permanent recovery from addiction is possible? We need a vanguard of recovering people to send an unequivocal message to those still drug-enslaved that they can be free. We need a vanguard willing to stand as the LIVING PROOF of that proposition….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 for 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.”
Those words were shared in 2001 in the belief that contact strategies, even more than education and protest strategies, would be crucial to dismantling the stigma attached to addiction recovery. We still believe that, and, needless to say, we are delighted to see research confirming the power of recovery disclosure as a strategy for social change. What would be the state of LGBT quality of life in the U.S. if all members of that community had remained hidden in the closet these past decades? In decades to come, we can hopefully ask this same question in reference to the recovery community.

References on the Power of Contact Strategies to Reduce Stigma and Discrimination
Corrigan, P.W., Kuwabara, S.A., & O’Shaughnessy, J. (2009). The public stigma of mental illness and drug addiction: Findings from a stratified random sample. Journal of Social Work, 9(2), 139-147.
Corrigan, P.W., Morris, S.B., Michales, P.J., Rafacz, J.D., Rusch, N. (2012). Challenging the public stigma of mental illness: A meta-analysis of outcome studies. Psychiatric Services, 63(10), 963-973.
Corrigan, P.W., River, L.P., Lundin, R.K., Penn, D.L., Uphoff-Wasowski, K., Campion, J., et al. (2001). Three strategies for changing attributions about severe mental illness. Schizophrenia Bulletin, 27, 187-195.
Couture, S.M., & Penn, D.L. (2003). Interpersonal contact and the stigma of mental illness: A review of the literature. Journal of Mental Health, 12, 291-305.
Keys, K.M., Hatzenbuehler, M.L., McLaughlin, K.A., Link, B., Offson, M., Grant, B.F. & Hasin, D. (2010). Stigma and treatment for alcohol disorders in the United States, American Journal of Epidemiology, 172(12), 1364-1372.
Lavack, A. (2007). Using social marketing to de-stigmatize addictions: A review. Addiction Research and Theory, 15(5), 479-492.
Livingston, J.D., Milne, T., Fang, M.L. & Amari, E. (2011). The effectiveness of interventions for reducing stigma related to substance use disorders: A systematic review. Addiction, 107, 39-50.
McGinty, E.A., Goldman, H.H., Pescosolido, B. & Barry, C.L. (2015). Portraying mental illness and addiction as treatable health conditions: Effects of a randomized experiment on stigma and discrimination. Social Science & Medicine, 126, 73-85.
White, W. (2014). Waiting for Breaking Good: The media and addiction recovery. Counselor, 15(6), 54-59.
White, W.L., Evans, A.C. & Lamb, R. (2009). Reducing addiction-related social stigma. Counselor, 10(6), 52-58.

BLOG & NEW POSTINGS May 20, 2015 – Bill White TRIBUTE TO A RECOVERY MANAGEMENT PIONEER

In 1997, Michael Boyle, the CEO of Fayette Companies, the primary behavioral health provider in Peoria, Illinois had a visionary idea: redesign addiction treatment based on models of chronic disease management that are emerging within primary health care. In collaboration with Russ Hagen, the CEO of Chestnut Health Systems in Bloomington, Illinois, Mike procured funding in 1998 from the Illinois Legislature to create a think tank to pilot innovations within such an approach. The result was the Behavioral Health Recovery Management project.
For the following eight years, I had the privilege of working with Mike on this project, conceptually developing frameworks that were nationally promoted under the rubrics of recovery management and recovery-oriented systems of care (RM & ROSC). It was a most interesting collaboration—me with my fascination with the details of the history of addiction treatment, and Mike with his visionary thinking about the future of treatment. Where I mined the lessons of the past, Mike was forever thinking about new possibilities for the future. Between us, we developed an admittedly grandiose vision of changing how addiction treatment was conceptualized and practiced in the United States. Working with Mike on that project exerted an enormous influence on my professional life, as it did on the field we had worked within for most of our lives.
Mike’s work was widely recognized in the U.S. by other advocates of RM & ROSC and he exerted an international influence through his advocacy of RM & ROSC in various UN-sponsored projects. In recent years, Mike retired from Fayette Companies and relocated to Florida with his wife, Laura. During this time, he remained involved in further development of RM and ROSC models through his work as a research associate at the University of Wisconsin-Madison. His most recent interests included the potential of new recovery support technologies (e.g., smart phones) to enhance long-term recovery outcomes.
The role of CEO within behavioral health organizations has taken on an increasingly business orientation as these organizations evolved from small service programs in the 1960s and 1970s to what have often become multi-million dollar corporations. What most intrigued me about Mike was that in his CEO role, he never lost his focus on the client and the quality of frontline service practices. I don’t know any CEO in the country who maintained such an intense focus on clinical philosophy, frontline service practices, and long-term recovery outcomes. Mike was a very successful CEO by contemporary business standards, but he was also successful as an innovative clinical thinker and a champion of evidence-based treatment practices.
Mike and I worked on several papers together over the years of our collaboration. Here are links to two of his favorites:
White, W., Boyle, M., & Loveland, D. (2003). Addiction as chronic disease: From rhetoric to clinical application. Alcoholism Treatment Quarterly, 3/4, 107-130.
White, W., Scott, C., Dennis, M., & Boyle, M. (2005) It’s time to stop kicking people out of addiction treatment. Counselor, 6(2), 12-25.
My 2007 interview with Mike Boyle is posted at http://www.glattc.org/Interview%20With%20Michael%20Boyle.pdf
Michael Boyle died suddenly on May 7, 2015 at the age of 68. He left a deep imprint on the field and on the lives of those of us who were blessed to have worked with him and counted him as a valued colleague and friend.
Thanks Mike. We live in a better world because of the work you did on behalf of its citizens.

BLOG & NEW POSTINGS May 15, 2015-Bill White – RECENT LIFE-IN-RECOVERY SURVEYS

“…in recovery, people lead full, productive and healthy lives.” Laudet, 2013, Life In Recovery Survey
Life in Recovery SurveyScientific knowledge about addiction recovery has been based historically on short-term treatment follow-up studies, point-in-time membership surveys of recovery mutual aid fellowships, and small qualitative studies of the recovery experience. The value of these early studies was limited by the uncertainty to which their findings could be applied to the larger pool of people who have resolved alcohol and other drug (AOD) problems. A new generation of in-depth surveys based on large community samples is broadening our understanding of the prevalence, pathways and styles of long-term addiction recovery.
First, a series of rigorous epidemiological studies reported remission rates for AOD-related problems (those once meeting but no longer meeting diagnostic criteria for a substance use disorder). These studies revealed a substantial U.S. population in remission from a substance use disorder and underscored differences in AOD problems between clinical and community populations.
Then, surveys were conducted of how the general public perceived “recovery” from severe alcohol and other drug problems. A 2004 Faces and Voices of Recovery public survey conducted by Hart Research and Coldwater Corporation (See 2004 Recovery Survey) revealed that the majority of the U.S. public understood “recovery” to mean that a person with a history of AOD problems was “trying to stop using alcohol and drugs”, with only 22% understanding “recovery” to mean that the person was now “free from addiction.” Pessimism toward recovery was also revealed in the 50% who thought people seeking treatment for addiction would be unable to achieve life-long recovery. A similar 2008 SAMHSA survey of the U.S. population revealed a slightly more optimistic view, with approximately three-quarters of those surveyed believing recovery was possible for those experiencing problems with alcohol, cannabis or prescription drugs, but only 58% believing recovery was possible for problems related to the use of heroin, cocaine, and methamphetamines.
Most recently, researchers conducted population-based surveys of people in recovery to determine the characteristics of those in recovery and to profile the commonalities and varieties of recovery experiences. These studies include:
2002: Pathways to long-term recovery survey of the Connecticut Community of Addiction Recovery (Laudet, Savage, & Mahmood)
2007: New York City meaning of “recovery” survey (Laudet)
2013: U.S. Faces & Voices of Recovery Life in Recovery Survey (Laudet)
2014: U.S. What is Recovery survey (Kaskutas, Borkman, Laudet, et al.; Witbrodt, Kaskutas & Grella)
2015: Australian Life in Recovery Survey (Best & Savic)
2015: U.S. survey of students in collegiate recovery programs (Laudet, Kimball, Winters, & Moberg)
2015: UK Life in Recovery Survey (in process)
Below are 20 tentative conclusions that can be drawn from these studies.
1. Between 25-40 million Americans once experienced but no longer experience significant alcohol and other drug-related problems.
2. People in recovery are quite diverse in terms of age, gender, race, ethnicity, living environment (urban, suburban, rural), education, employment, and history of military service.
3. There is considerable variation in personal understandings of the meaning of “recovery” among people self-reporting recovery status. While the majority of persons surveyed define recovery in terms of abstinence, a minority (12% of the Kaskutas et al. 2015 study subjects) view moderated use as consistent with their understanding of recovery.
4. Moderated strategies of problem resolution are associated with less severe AOD problems. Abstinence-based strategies are associated with greater problem severity, complexity and chronicity, and with prior failed attempts at moderation.
5. Abstinence as a preferred recovery strategy increases with age and duration of recovery, adding weight to earlier studies noting that abstinence is a more stable pattern of long-term remission than moderated use (See Ilgen et al. 2008; Dawson, et al. 2007) and may produce greater long-term benefits (see Kline-Simon, et al, 2013).
6. There is considerable variation in how people describe the change in their AOD use, e.g., recovered, recovering, in recovery, medication-assisted recovery, or used to have a problem but don’t anymore.
7. The longer people are in recovery and the more 12-Step meetings they have attended, the more likely they are to view no use of tobacco as part of their recovery definition—an important historical shift within American communities of recovery.
8. Self-identified people in recovery report substantial recovery duration, with 67% in the U.S survey respondents reporting 5 or more years of stable recovery at the time of the survey and 32% reporting 20+ years in recovery.
9. People in recovery report considerable variation in type of recovery support resources. In the 2013 U.S. survey, 71% had received professional treatment, 18% reported the use of medication to support recovery, 95% reported 12-Step participation and 22% reported participation in a non-12-Step recovery support group. Combining multiple sources of recovery support is common.
10. People in “natural recovery” (without aid of professional treatment or recovery mutual aid participation) are under-represented in recovery surveys (only 4% of the Kaskutas et al. 2014 Survey participants), perhaps because “recovery” is often not central to their personal identity.
11. People in “natural recovery” are less likely to self-define themselves using recovery language (recovered, recovering, in recovery) and more likely to see themselves as once having, but no longer having, an AOD problem.
12. Most self-identified people in recovery view recovery as a lifelong process, while a minority view addiction/recovery as a past chapter of their lives that they have now transcended.
13. Most self-identified people in recovery view recovery as far more than altered patterns of AOD use. Such broader dimensions of recovery include enhancements in global (physical, emotional, relational) health, repair of the person-community relationship (e.g., citizenship), and enhanced life meaning and purpose. Recovery definitions of people in recovery also often include dimensions of character and lifestyle (e.g., honesty, balance, positive coping, helping others).
14. The majority (57%) of people participating in the life in recovery surveys in the U.S. report a history of both alcohol and other drug use, with 29% reporting alcohol use only and 13% reporting only drugs other than alcohol.
15. Nearly all (98% in Kaskutas et al. 2014 study) people participating in Life in Recovery surveys meet DSM-IV criteria for alcohol or drug dependence—a much higher rate than that reported in the epidemiological studies reviewed by White (2012).
16. Most self-identified people in recovery report prolonged years of AOD use and addiction prior to recovery initiation, e.g., 18 years of prior addiction in the U.S. survey and 12.5 years of prior addiction in the Australian survey.
17. Most self-identified people in recovery have experienced significant consequences related to their AOD use, e.g., physical/emotional/occupational/financial/family/legal problems, etc.
18. Most people in recovery in the U.S. report dramatic improvements in quality of life (QOL), with QOL ratings of good (22%), very good (43%), or excellent (28%).
19. Physical/emotional/relational health and quality of life improve with the duration of recovery.
20. Recovery reaps substantial social rewards, e.g., enhancement of housing stability, improvements in family engagement and support, educational/occupational achievement, debt resolution, and community participation and contribution, as well as dramatic reductions in domestic disturbance, arrests/imprisonment, and health care costs.
A recovery advocacy movement was launched in the late 1990s in the U.S. whose kinetic ideas included the following three propositions: 1) Recovery is a reality (in the lives of millions of individuals and families), 2) There are multiple pathways of recovery, and 3) Recovery can give back much of what addiction has taken from individuals, families, and communities. Modern epidemiological studies and recent life in recovery surveys are offering empirical support to these declarations in what is a most interesting intersection of experiential knowledge and scientific knowledge.
References
Best, D. & Savic, M. (2015) The Australian life in recovery survey. Turning Point.
Dawson, D. A., Goldstein, R. B., & Grant, B. F. (2007). Rates and correlates of relapse among individuals in remission from DSM-IV alcohol dependence: A 3-year follow-up. Alcoholism: Clinical and Experimental Research, 31(12), 2036-2045.
Faces & Voices of Recovery. (2001). The road to recovery: A landmark national study on the public perceptions of alcoholism and barriers to treatment. San Francisco, CA: Peter D. Hart Research Associates, Inc./The Recovery Institute.
Ilgen, M.A., Wilbourne, P.L., Moos, B.S., & Moos, R.H. (2008). Problem-free drinking over 16 years among individuals with alcohol use disorders. Drug and Alcohol Dependence, 92, 116-122.
Kaskutas L.A., Borkman, T., Laudet, A., Ritter, L.A., Witbrodt, J., Subbaraman, M., Stunz, A., & Bond, J. (2014). Elements that define addiction recovery: the experiential perspective. Journal of Studies on Alcohol and Drugs, 75, 999-1010.
Kaskutas, L. A. & L. Ritter (2015). Consistency between beliefs and behavior regarding use of substances in recovery.” International Journal of Self Help and Self Care, January-March. 1-10.
Kline-Simon, A. H., Falk, D. E., Litten, R. Z.,Mertens, J. R., Fertig, J., Ryan,M., &Weisner, C.M. (2013). Posttreatment low-risk drinking as a predictor of future drinking and problem outcomes among individuals with alcohol use disorders. Alcoholism, Clinical and Experimental Research, 37(S1), E373–E380.
Laudet, A. (2013). Life in recovery: Report on the survey findings. Washington, D.C.: Faces & Voices of Recovery.
Laudet, A. B. (2007). What does recovery mean to you? Lessons from the recovery experience for research and practice. Journal of Substance Abuse Treatment, 33, 243-256.
Laudet, A., Harris, K., Kimball, T., Winters, K.C., & Moberg, D.P. (2015). Characteristics of students participating in collegiate recovery programs: A national survey. Journal of Substance Abuse Treatment, 51, 38-46.
Laudet, A., Savage, R., & Mahmood, D. (2002). Pathways to long-term recovery: A preliminary investigation. Journal of Psychoactive Drugs, 34, 305−311.
Office of Communications (2008). Summary Report CARAVAN Survey for SAMHSA on Addictions and Recovery. Rockville, MD: Office of Communications, Substance Abuse and Mental Health Services Administration.
Subbaraman, M. S. & J. Witbrodt (2014). Differences between abstinent and non-abstinent recovery from alcohol use disorders. Addictive Behaviors, 39(12), 1730-1735.
White, W.L. (2012). Recovery/Remission from Substance Use Disorders: An Analysis of Reported Outcomes in 415 Scientific Studies, 1868-2011. Great Lakes Addiction Technology Transfer Center, Philadelphia Department of Behavioral Health and Intellectual disAbility Services Mental Retardation Services and Northeast Addiction Technology Transfer Center.
Witbrodt, J., Kaskutas, L.A., & Grella, C.E. (2015). How do recovery definitions distinguish recovering individuals? Five typologies. Drug and Alcohol Dependence, 148, 109-117.

BLOG & NEW POSTINGS May 8, 2015 – Bill White – A DIFFERENT KIND OF INVENTORY

The death of a person undergoing medical treatment is cause for serious reflection on the part of caregivers. Historically, procedures have been developed to help understand the circumstances of such deaths. These procedures range from a focus on the person (e.g., such as a medical status review and/or psychological autopsy of the deceased patient) to a broader focus on the caregiving environment and caregiving procedures (e.g., mortality review committees). Such procedures have become routine within hospitals and other health care organizations and have expanded to encompass a broad spectrum of agencies, including organizations addressing issues of child welfare and family violence. The expectations of such reviews have been extended to accredited addiction treatment organizations, but such reviews in my experience have focused primarily on patients’ deaths that occur during detoxification or during inpatient or residential treatment. More common and less addressed is the death of a patient in the days, weeks, or months after primary inpatient or outpatient treatment has been completed.
Families who have lost a family member to addiction following one or more episodes of addiction treatment are beginning to move beyond their own grief and guilt to ask questions about the quality of addiction treatment their family member received and how treatment assumptions and procedure could be improved to prevent such tragedies for other families. Bill Williams is one such family member who is turning his grief into advocacy. The post below is one worthy of serious reflection by addiction professionals and treatment administrators. It suggests two obvious first steps: 1) every person entering addiction treatment (regardless of subsequent discharge status) should receive assertive recovery check-ups for at least one year (and preferably for five years), and 2) the death of any patient within one year of discharge following addiction treatment should be rigorously reviewed with a focus on identifying any changes in service practices that could potentially prevent such deaths.
March 26, 2015 Post by Bill Williams (posted with permission)
Discussions about Substance Use Disorder in its various guises often include ideas about “Rock Bottom”. The notion being that sooner or later the afflicted have to experience a life altering event — overdose, incarceration, getting kicked out of school, losing a job, getting kicked out of home, to name a few — that shocks them into lasting change. Our family, too, heard this advice from multiple sources while our son, William, struggled with his use of heroin and we struggled to cope and understand.
The problem is this. The rocks at the bottom are strewn with dead bodies, including that of my son. Death is rock bottom. Anything else is just a serendipitous, albeit uncomfortable, landing on an outcropping on the way down. It may be a tough climb back. There may be other falls. But it’s not death.
I have recently come up with the idea of writing a letter to everyone who helped treat William along the tortuous descent to his rocky demise. I want to ask them whether his death has given them any cause to reflect upon his treatment. If so, what have they learned? Big ideas or tiny changes in practice? What change might they like to bring about so that others might not only avoid his fate, but actually entertain a productive lifelong recovery?
My suspicion is that very few, if any, have reflected much on William and his treatment. Given a lack of time or effort devoted to reflection, I suspect precious little, if anything, has been learned. I am talking about good, well-intentioned people who have dedicated their lives to important work. But is it work so trapped in orthodoxy of practice, work so mired in bureaucracy, that it leaves little time for introspection? How much are those who treat substance use disorder just like those they hope to cure, repeating the same behavior over and over? We ask addicts to look at what they do. We need to ask treatment providers to take a harder look at what they do. Or how about, just a look.
Recovery is like a pinball machine. Up at the top somewhere, protected by bumpers and barriers is a target, prolonged recovery, hit sometimes by good luck, sometimes by good management. Your ball may land in a hole temporarily and then get spit back into play again. That’s Emergency Rooms or the court system. Points off for the court system. You might get lucky and hit a treatment gizmo that puts two balls in play — one for substance use and one for mental health issues. Your ball may just get swallowed up for a while before reappearing somewhere by surprise. That’s insurance coverage. Or relapse. Points off. The ball may disappear down a hole until it pops up in the starting mechanism. You pull back, let go and start over. Inpatient or outpatient. Or relapse. Points deducted. Up toward the top are some flippers to keep you in play. Methadone. Suboxone. Side bumpers bounce you repeatedly into the center of the game. 12 Steps. DO NOT TILT! The lights flash, the bells go off and you do your best to tune out the frenzy in a game slanted downhill. Over time too many balls roll through that last set of flippers and disappear. Rock Bottom. Game Over.
So why don’t we tilt the table? Why don’t we take the whole game and flip it on its end so that all the balls roll toward WINNER!
I can hear someone calling me a bitter, unrepentant enabler right about now. Unwittingly, or even knowingly, maintaining the status quo. I’m tilting the table. Family members are hardly the only enablers, however quickly blame may come our way. When physicians, medical schools, therapists, Twelve Step programs, insurance companies, pharmaceutical companies, inpatient and outpatient treatment providers, politicians, judges, drug courts, police, schools and colleges take a good hard look at themselves and ask how they enable addiction, how their actions and ignorance perpetuate it, then we’ll have taken a step toward a solution. We can’t expect answers and solutions when we resist even asking the questions necessary to solve the problem. I’M FLIPPING THE GAME! Who’s joining me?

Updates from William L. White | Blog Blog & New Postings In the 05/01/2015 edition: Defining Recovery-oriented Systems of Care By Bill White on May 01, 2015 07:33 am

Defining Recovery-oriented Systems of Care
By Bill White on May 01, 2015 07:33 am

Federal, state, and local behavioral health authorities have continued to embrace Recovery Management (RM) and Recovery-oriented Systems of Care (ROSC) as new organizing paradigms for addressing substance use and mental health disorders at clinical and community levels.  Much of my work over the past two decades has focused on assisting such efforts through my research, writing, training, and consultation activities. A crucial aspect of this work involved collaborations with Dr. Arthur Evans, Jr. and others in what has been depicted as the “recovery revolution in Philadelphia.” The innumerable requests to share the details of the recovery-focused systems transformation process in Philadelphia led to a series of papers and monographs that captured many of the lessons learned from this effort. In those earliest papers, we set forth definitions of RM and ROSC as follows:Â

Recovery management is a philosophy of organizing addiction treatment and recovery support services to enhance pre-recovery engagement, recovery initiation, long-term recovery maintenance, and the quality of personal/family life in long-term recovery.

The phrase recovery-oriented systems of care refers to the complete network of indigenous and professional services and relationships that can support the long-term recovery of individuals and families and the creation of values and policies in the larger cultural and policy environment that are supportive of these recovery processes.

In 2013, Dr. Evans and I drafted a brief statement on the definition of Recovery-oriented Systems of Care. That statement is reproduced below in response to a recent increase in requests for such clarification.     Â

Since the late 1990s, the authors have been involved in numerous efforts to transform acute and palliative care models of addiction and mental health treatment into models of sustained recovery management (RM) nested within larger recovery-oriented systems of care (ROSC). Through that process, “RM” and “ROSC” have become code for a wide variety of behavioral health system transformation efforts. In this short essay, we would like to share with our readers what we mean when we talk about ROSC as an organizing concept for behavioral health care.  Â

RecoveryÂ

For us, recovery has three potential meanings. The first is the movement from a state of illness and isolation to a state of health and connectedness. In the addictions arena, this end state has been recently defined in terms of sobriety, improvement in global health, and citizenship. In the mental health arena, recovery has been described in terms of medical/clinical recovery (no longer meeting diagnostic criteria of active illness) and functional recovery (a socially connected and meaningful life in the community). Many people who have suffered severe behavioral health disorders achieve such full remission, with “recovery” depicting the process through which hope and health have been initiated and sustained.Â

A second meaning of recovery is the process through which one actively manages and transcends the symptoms of persistent illness to achieve improved quality of life and functioning. This means that some symptoms of the illness may continue to ebb and flow (e.g., cravings, obsessive thoughts, emotional distress), but they cease being the controlling center of one’s personal, family, and social life.

For historically traumatized and oppressed populations, recovery may also involve drawing upon the historical resilience of a people and the assertion of personal and family health as an act of political resistance or cultural survival.Â

We see in these patterns of recovery quite different styles of personal relationship to illness: escaping illness, making peace with illness, and doing battle with illness. When recovery advocacy leaders proclaim that “there are multiple pathways of long-term recovery and all are cause for celebration,” they widen the ROSC tent to include all styles of personal recovery management and commit ROSC resources to support these myriad styles of recovery.Â

Recovery-oriented

“Recovery-oriented” within the context of ROSC means that system resources are strategically allocated toward this vision of recovery and whole health. It means that the principles embedded within the care process are drawn from the lived experience of personal and family recovery and that people in recovery have visibility and voice throughout the system. It means that the core knowledge driving service system design is based on the study of resilience and recovery rather than solely on the study of pathology or clinical interventions. It means that the benchmarks used to measure the performance of roles, organizations, and systems all have a direct or indirect nexus to personal and family recovery. It means that measures of traditional systems health (e.g., number of people served, number of units of service, number of organizational staff, organizational budgets) have virtually no meaning and value unless linked to measurable, sustainable long-term recovery outcomes. Â

 System(s)

The “system” in ROSC is first and foremost not a treatment provider or even a network of formal treatment providers. Instead, the “system” is a larger mobilization of recovery supports within a neighborhood, community, state, or nation. RM is a philosophical framework for organizing behavioral healthcare services; ROSC is a framework for creating the physical, psychological, and social space in the larger community ecosystem where recovery can flourish. While treatment providers can serve as a catalyst in mobilizing a ROSC, they cannot themselves be a ROSC. The ultimate goal of a ROSC is not an ever-expanding professional services system. While professional services are an important component of any ROSC, such services do not in and of themselves constitute an ROSC. A purported ROSC consisting only of recovery support available within funded agencies would violate the very meaning of a ROSC.    Â

Of Care

The “care” in ROSC has multiple meanings. First, it reflects but transforms the concepts of “level of care” and “continuum of care.” These latter phrases traditionally refer to the intensities and elements of formal health and human services. Care as services in ROSC shift from a focus on intensity of services to a vision of extensity of services. Recovery-oriented care means that the focus of support spans all stages of long-term recovery and not just the stage of recovery initiation and stabilization. ROSC resources are also directed to support pre-recovery priming, the transition from recovery initiation to recovery maintenance, enhanced quality of personal and family life in long-term recovery, and efforts to break intergenerational cycles of problem transmission. It is in extending its focus across these stages that the ROSC concept theoretically and in practice connects professional treatment and recovery support to indigenous recovery support systems and to the arenas of primary prevention, early intervention, and broader public health initiatives, including harm reduction.

Second, the meaning of care is extended beyond professional services to the creation of a healing community. Professionally directed services that aid the recovery process may be important components of this experience of community, but they are seen as secondary to the long-term importance of connection to community within the recovery experience. ROSC extends the acute care focus on an individual’s thoughts, feelings, and behaviors to create a family and social milieu in which recovery can be ignited and sustained. The caring actor thus shifts from that of a paid professional to the family, extended family, community, and culture.

Third, the “care” in ROSC is a relational construct. “Care” becomes, in addition to a range of services and supports,

1. an expression of empathy and compassion (“We share with you the experience of personal aspirations in the face of limitation and struggle.”),

2. a communication of invitation and acceptance (“Please join us. You are part of our communal family and our fates are inextricably linked.”),

3. a communication of value and affection (“We care about you and your future.”),

4. a communication of commitment (“We are committed to sustaining support to you in the days, months, and years to come.”), and

5. an expectation of responsibility and service (“Join us in this helping process: you now have a responsibility to ‘pass it on’–help others and to help the community.”). Â

Collectively, these communications serve to break the traditions of contempt, condemnation, and punishment that have so often plagued relationships between communities (and their representatives, e.g., service professionals) and persons with severe behavioral health disorders. A ROSC is as much a change of emotional affect within a community and culture as it is a change in professional service design and delivery.Â

Summary

Creating recovery-oriented systems of care involves a radical re-orientation of approaches to the long-term resolution of mental health and substance use disorders. The ROSC vision is more focused on personal possibilities than pathologies and more focused on continuity of long-term support in natural community relationships than the intensity of short-term professional interventions. Professional interventions can play crucial roles as aids to personal and family recovery, but such services are not a substitute for community relationships that are natural, continually accessible, reciprocal, enduring, and non-commercialized. ROSC is an approach to expanding and integrating these diverse forms of helping. The ultimate measure of ROSC is not the size and scope of professional services but a community’s capacity for compassion, support, and inclusion.

About the Authors:  Dr. Arthur C. Evans, Jr., is Commissioner, Philadelphia Department of Behavioral Health and Intellectual disAbility Services. William White is Emeritus Senior Research Consultant, Chestnut Health Systems.  Â