BLOG & NEW POSTINGS September 25, 2015 – Bill White – RECOVERY’S FINAL CHAPTERS

Long-term addiction recovery has a beginning (or many beginnings), a middle, and an end. Nearly all our national resources allocated to addiction are devoted to the first of these stages, even as efforts of the past 15 years have pushed a vision of support into the mid-life of personal and family recovery. All of these are noble efforts, but they leave unanswered the questions generations have faced in the final chapters of their lives. After living a life in recovery, how does one face death in recovery? Recovery must be managed in this last context or be lost after being hard-earned and so carefully sustained and protected.
There is some attention paid to the addiction vulnerabilities of older adults, but one can find few scientific studies and little experiential knowledge captured within mutual aid literature about the final stages of one’s life as a person in recovery. This is regrettable in that these final stages offer threats to, but opportunities within, the recovery process.
Aging poses all manner of challenges that can destabilize recovery: innumerable indignities, acute and chronic pain from illness and injury, the progressive erosion and loss of functions long taken for granted, disengagement from personally fulfilling roles and activities, the loss of loved ones and other important people, strain as family and friendship are subsequently reconstituted, and even the loss of those who guided one’s own recovery initiation–all combined with a growing awareness of the shortness of time. And for those who enter recovery but who face the threat of a life cut short by addiction-related disease, there is the haunting self-accusation that that one has thrown one’s life away and, given that, the question of whether going out in a blaze of self-destruction is preferable to end-of-life recovery.
It should not be surprising in these contexts that recovery can be weakened to a breaking point. Sadly, the very support structures that played such an important role in early recovery initiation and in recovery maintenance may have eroded by the time a person needs them most during these final chapters of recovery. Even when stability is sustained, the meaning within and beyond recovery may need to redefined during these final chapters of recovery.
And yet there is potential richness in this last edition of the “what we are like now” part of our personal stories. There is often a shedding of trivialities, embracing a quietness of spirit, the deep pleasure of having cheated “the beast,” and a valuing of one’s legacy. The “searching and fearless moral inventory” conducted by many in early recovery may have far deeper meaning when such accounting is done toward the end of one’s life. Such final accounting can be a source of deepening spirituality (meaning and purpose) and service.
If there is a final legacy of recovery—and a final opportunity, it may well be in the more complete healing of our families and the deepening recovery of others touched by our words of hope and guidance. There can be a very real sense that those so touched will extend our own lives in unseen ways into the future. If we have done this well and been very blessed, we will see generations coming behind us who will start a new cycle free of the burdens we have carried. Then new personal, family, and community futures begin. The slightest glimmer of such futures can bring a final smile. That’s a smile worth our efforts to earn and make possible for others. The goal is the ability to take a sober last breath, not with regret, but with gratitude and release.
This blog is an invitation to reflection for those interested in addiction recovery. It’s an invitation for research scientists, addiction professionals, recovery support specialists, mutual aid leaders, and family members to explore how we can best help people write these final chapters of recovery.

Post Date September 25, 2015 by Bill White

BLOG & NEW POSTINGS September 11, 2015- Bill White KICKING PEOPLE OUT OF ADDICTION TREATMENT: AN UPDATE AND COMMENTARY (IZAAK WILLIAMS AND WILLIAM WHITE)

The practice of administratively discharging people from addiction treatment, primarily for confirming their diagnosis (via continued alcohol or other drug use) or violating rules with little nexus to addiction recovery, has a long history within modern addiction treatment. The authors’ calls to examine and alter this practice began a decade ago and have continued to the present (See suggested reading list below). This brief report outlines the conclusions drawn from our latest analysis of data regarding administrative discharges from addiction treatment in the United States.
Data on discharge status from addiction treatment in the United States is limited, but is available for the years 2002-2011 within the Substance Abuse and Mental Health Services Administration’s Treatment Episode Data Set (TEDS). The number of states and jurisdictions reporting within the TEDS database has grown through these years from 23 to 49, with the number of patient records increasing from 792,513 to 1,922,385. In analyzing the TEDS discharge status data for 2002-2011, several clinically important findings are evident.
Trends in Treatment Completion Rates: The majority of people admitted to addiction treatment in the U.S. do not successfully complete treatment. The addiction treatment completion rate (discharge with staff approval) was 40.6% in 2002, reached its peak of 47.5% in 2006, and was 43.7% in 2011.
Trends in Treatment Non-completion: Those not completing treatment fall into seven categories: dropped out, terminated by the facility (administrative discharge, AD), transferred, incarcerated, death, other, and unknown. Between 2002 and 2011, drop-out rates showed little change with an average of 24.4% between 2002-2011, with a high of 26.6% and a low of 22.2%. Transfer rates increased from 8.6% in 2002 to 15.2% in 2011–reflecting greater levels of care available and a trend toward “stepped care”—assertive linkage between multiple levels of care in response to changing needs of the patient. While death and other categories have remained stable from 2002 to 2011, terminations due to incarceration have slowly risen over this time span to 2.4% of all discharges.
Trends in Administrative Discharge (AD) Rates: AD rates have ranged from 15.9% the first reporting year (2002), dropped to 8.2% in 2003, and have ranged in all subsequent years between a low of 6.3% (2008) and a high of 7.9% (2005), with a most recent (2011) reported level of 7.3%. The classification of discharge status and reporting may be administratively influenced, as indicated by states with very large treatment systems (e.g., California) that report no ADs or seemingly underreport AD data (e.g., in 2010 Arizona reported 6 terminations out of 17,452 discharges).
AD by Treatment Modality: AD rates vary considerable across service modalities, with AD rates lowest in the briefest service interventions (detoxification and hospital residential) and highest in those involving sustained care (long-term residential, opioid replacement therapy, and outpatient). It appears the longer the service relationship, the greater the probability of being administratively discharged from addiction treatment.
Demographic Characteristics: ADs are not evenly distributed across patient identifiers. When service type at time of discharge is considered, AD appears most starkly gender slanted toward men in long-term residential treatment and hospital inpatient treatment. At the aggregate level, across all service modalities, women and men are at roughly equal risk of AD irrespective of referral source; however, in controlling for age, the most pronounced gender difference in AD is seen in patients under the age of 20, with male patients at considerably higher risk for AD. Patients aged 18-29 have a higher risk for AD than all other age groups. African Americans are at significantly higher risk of AD than are other racial groups entering addiction treatment. A lower level of educational achievement—less than a high school diploma or its equivalent—a socioeconomic class indicator–significantly increase one’s likelihood of AD, as does the status of no income.
AD Discharge and Number of Prior Treatment Episodes: The probability of an AD discharge decreases in tandem with an increase in prior treatment episodes until the fifth prior treatment episode, at which the risk of termination via AD increases—a trend suggesting that AD in this group may serve as a proxy for problem severity, complexity (co-occurring psychiatric illness), and chronicity. The probability of AD also increases in tandem with increased frequency of drug use in the 30 days prior to admission—another indicator that those with the most severe, complex and chronic problems are overrepresented within such discharges.
Three major conclusions can be drawn from this brief data summary.
That more than half of people admitted to addiction treatment do not complete treatment is highly disturbing, particularly given efforts during the years reviewed to expand choice in addiction treatment and enhance therapeutic engagement via greater use of staged change models and widespread training in motivational interviewing.
In spite of some agitation for reform, the AD rate from addiction treatment has not substantially declined in the U.S. According to the TEDS data, 1,071,091 patients admitted to addiction treatment between 2002 and 2011 were administratively discharged—more than 126,000 in the last available reporting year (including patients who were admitted multiple times in the same reporting year). This is disturbing for several reasons.
First, the use of administrative discharge as punishment (e.g., extruding patients from care for exhibiting symptoms of the disorder for which they are being treated or for rule violations unrelated to the treatment of that condition) are unprecedented in the larger health care system.
Second, there is no scientific evidence that ADs, or so-called therapeutic discharges—have any therapeutic value as a motivational fulcrum for recovery-related behavioral change. In fact, we would suggest that practice contributes to further clinical deterioration (e.g., escalation of problematic drug use, criminal offending, incarceration, etc.) and re-enmeshment in drug and criminal subcultures at the exact time the patient is in greatest need of a recovery-enriched social environment. Reports from families of overdose deaths immediately following administrative discharge of their family member suggest the potential increased risk of mortality linked to ADs.
Third, the fact that AD decisions may inordinately target African Americans and persons of low socioeconomic standing, as well as those persons in greatest need of treatment—those with highest problem severity, complexity and chronicity and the lowest recovery capital—is particularly disturbing. The existing rate of failure to complete addiction treatment, in general, and the AD rate, in particular, is an indicator of inadequate assessment and level of care placement, weak therapeutic alliance, problems of countertransference, and racial and social class conflicts that exist across addiction treatment modalities and programs. The AD rate remains unchanged, in part, because accrediting and regulatory authorities have also failed to hold programs accountable for this critical benchmark of quality.
Any addiction treatment systems reform effort must address the low treatment completion and high AD rates. Given the relationships between treatment duration, adult discharge status, and long-term recovery outcomes, enhancing treatment engagement and completion rates must become one of our highest priorities within the addiction treatment field. A wide spectrum of changes in clinical practices will be required to achieve that goal.
Further Reading
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. See http://www.williamwhitepapers.com/pr/2005StopKickingPeopleOutofAddictionTreatment.pdf
White, W. (2014). Stop Kicking People out of Addiction Treatment. Posted April 4, 2014, http://www.williamwhitepapers.com/blog/2014/04/stop-kicking-people-out-of-addiction-treatment.html
Williams, I. L. (in press). Moving clinical deliberations on administrative discharge beyond moral rhetoric to empirical ethics: A call for research. Journal of Clinical Ethics.
Williams, I. L. (in press). Is administrative discharge an archaic or synchronic program practice? The empirical side of the debate. The Online Journal of Health Ethics.
Williams, I.L. & Taleff, M.J. (in press). Key arguments in unilateral termination from addiction treatment: A discourse of ethical issues, clinical reasoning, and moral judgments. Journal of Ethics in Mental Health.
William, I.L. & Taleff, M.J. (2015). Sex, romance, and dating in treatment recovery: Ethical reflections and clinical deliberations on challenging addiction decision making. Ethics in Mental Health, Open Volume, (1), 1-7.

Tuesday, September 8th, 2015 Focus: The only limits I have are those that I encourage with my beliefs.

It is a simple procedure to calculate the number of seeds in an apple. But who among us can ever say how many apples are in a seed? No one—and the reason is that the answer is infinite. Endless! That is what the abundance principle is all about: endlessness.

It seems a paradox, because we as human forms seem to begin and end at a specified time, and so endlessness is not a part of our experience in form. But it is difficult to imagine that the universe has any boundaries, or that it simply ends someplace. If it does, what’s at the end, and what’s on the other side of what’s at the end? And so I suggest there is no end to the universe, and there is no end to what you can have for yourself when this principle is part of your life.

Consequently, abundance, with its absence of limits and boundaries, is the very watchword of the universe. It applies to us as much as it does to everything else in the One song. We should be conscious of abundance and prosperity and not make scarcity the cornerstone of our lives. The only limits we have are those that we encourage with our belief in those limits.

Excerpted from the article:

You Can Allow Yourself to Have It All
Written by Dr. Wayne Dyer.

Read more of this article…

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You’ll See It When You Believe It by Wayne Dyer.
You’ll See It When You Believe It: The Way to Your Personal Transformation
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BLOG & NEW POSTINGS September 4, 2015 – Bill White – LGBT AND RECOVERY ADVOCACY MOVEMENTS (TOM HILL AND BILL WHITE)

There is much that the recovery advocacy movement can learn from the LGBT rights movement of recent decades. The latter movement is one of the most successful social movements in history as judged by the speed at which it has elicited broad changes in cultural attitudes and policies of import to the LGBT community. We have just completed a draft of a paper on lessons drawn from the LGBT rights movement that we feel have great relevance to the recovery advocacy in the U.S. and internationally. We invite you to read and provide us with your comments and suggestions on this paper. The paper can be accessed by clicking here, and you may provide us feedback at the following email addresses: Tom.Hill@altarum.org
If the recovery advocacy movement continues to culturally and politically mobilize people in recovery and their families and allies and to draw upon the experience of other social movements, we are likely to see the following in the coming years:
A more conscious effort on the part of recovery advocates to extract lessons from the civil rights, women’s liberation, disability rights, LGBT rights, and other successful social reform movements.
The expansion of symbolic firsts in recovery beyond the arenas of music, entertainment, and sports to such arenas as government, business, science, medicine, and religion.
The mass mobilization of families affected by addiction/recovery, including families who have lost a family member to addiction (e.g., public story elicitation).
The increased portrayal of recovery as a family achievement that produces profound effects on family relationships and family health.
Continued growth in local and national recovery celebration and recovery advocacy events.
Legislative milestones that mark a shift from punitive to public health responses to alcohol and other drug problems, including the dismantling of legal barriers to full community participation of people in recovery, e.g., in such arenas as housing, employment, education, health care, voting, and other areas of civic participation.
The continued growth of local recovery support institutions (beyond addiction treatment and recovery mutual aid fellowships) and growth of recovery advocacy organizations addressing specialty issues related to housing, education, employment, leisure, and social networking.
The growth of recovery social clubs (beyond 12-step clubhouses) and the emergence of “recovery neighborhoods” within large urban communities.
Growing regional networks of recovery community centers as social, service, and organizing hubs.
The proliferation of micro-businesses created by and for recovering people that will afford marginalized people in recovery opportunities to acquire new skills and participate in the licit economy.
More fully developed portrayals of people in recovery within the popular media (film, television, theatre, and literature), including the portrayal of the diversity of people living in long-term recovery and the varieties and styles of long-term recovery.
Growing interest in the history of the recovery advocacy movement via new historical treatises, memoirs, and documentary films.
Growing sophistication in advocacy/activism, issue articulation, and mobilization strategies.
Tensions within the recovery advocacy movement on the boundaries of movement inclusion (e.g., range of inclusion of people recovering from other compulsive behaviors) and definitions of recovery.
The abandonment of professionally stigmatizing language within healthcare and specialty sector addiction treatment (e.g., abuse/abuser, alcoholic/addict, and clean/dirty) as a result of successful recovery advocacy efforts.
The establishment of recovery as a legitimate research and clinical specialty within the alcohol and other drug problems arena.
Development of sophisticated strategies to fund recovery advocacy efforts, including expanded donor base (large and small gifts) from recovery community members, corporations, and foundations.
Advanced awareness of factors that impact recovery organizing and outreach, such as gender, sexuality, culture, race, class, and histories of trauma and incarceration.
Continued capacity-building and infrastructure development in recovery community organizations, institutions, cultures, and the networks that connect them.
We look forward to hearing your thoughts and suggestions on this latest paper. A final version of this paper will be posted that incorporates this feedback.
Appreciatively, Tom and Bill