In 2013, I penned a tribute in Alcoholism Treatment Quarterly honoring recently deceased leaders who had exerted great influence on the history of addiction treatment and recovery in America. As 2015 comes to a close, it seems a fitting time to add to this list of pioneers we have recently lost. Here is a sampling of these men and women who made a difference in the addictions field through their life’s work.
Michael Boyle (1947-2015) was Chief Executive Officer of Fayette Companies, a behavioral health organization in Peoria, IL. He was a leading champion of evidence-based addiction treatment and the integration of mental health and addiction treatment services. He conceived and led the Behavioral Health Recovery Management Project—a project that exerted a great influence on the emergence of recovery management and recovery-oriented systems of care in the United States.
Audrey Conn Kishline (1956-2014) founded Moderation Management in 1994 to promote a moderation-based approach for non-dependent problem drinkers. Media coverage of her book and presentations, her continuing personal struggles with alcoholism (including the deaths of two people in an alcohol-related crash), and her subsequent tragic death all fueled debates about abstinence versus moderation as approaches to the resolution of alcohol problems.
Donald Edward “Mickey” Evans (1932-2014) was the founder of Dunklin Memorial Camp in rural Florida—a faith-based refuge (recovery colony) for men seeking recovery from addiction. Mickey’s life and service were very influential in the Christian recovery movement and reflect the long history of resources outside the traditional treatment system to help individuals and families affected by addiction.
Jim Gillen (1954-2015) served as Director of Recovery Services at the Providence Center in Providence, Rhode Island. He was a leading figure in the rise of a news recovery advocacy movement and the development of local recovery community centers.
William Glasser, MD (1925-2013) was a psychiatrist whose development of Reality Therapy exerted a profound influence on the treatment of addiction in the mid-twentieth century, particularly treatment within the growing network of therapeutic communities and Minnesota Model alcoholism treatment programs.
Ernie Kurtz, PhD (1935-2015) is best known for his books Not-God: A History of Alcoholics Anonymous, Shame and Guilt: Characteristics of the Dependency Cycle, The Spirituality of Imperfection, and Experiencing Spirituality (the latter two co-authored with Katherine Ketcham). Ernie was the consummate A.A. historian and devoted the later years of his life to exploring the growing varieties of A.A. experience and alternative pathways of addiction recovery.
Nancy K. Mello, PhD (1935 -2013) cofounded the Alcohol and Drug Abuse Research Center at McLean Hospital (1974) and worked for more than 40 years. She and her husband, Dr. Jack H. Mendelson, conducted numerous studies on alcoholism and also published the first (1980) study on the potential use of buprenorphine in the treatment of opioid addiction.
Msg. William O’Brien (1924-2014) co-founded Daytop Village in 1963 and became a leading figure in the movement to develop therapeutic communities for the treatment of drug addiction. He helped establish therapeutic communities in more than 60 countries and was one of the founders of the World Federation of Therapeutic Communities.
Garrett O’Connor, MD (____-2015) served as Medical Director of the Betty Ford Center’s Licensed Professionals Treatment Program, Chief Psychiatrist of the Betty Ford Center, and President of the Betty Ford Institute. He taught in the Departments of Psychiatry at the Johns Hopkins University School of Medicine and at UCLA. He was a champion of addiction training for primary care physicians and psychiatrists and had a deep interest in the cultural roots of alcoholism among the Irish.
David Powell, PhD (1945-2013), at the time of his death, was teaching within the Department of Psychiatry at Yale University School of Medicine. He faithfully served the addictions field for more than four decades and was best known for his pioneering publications and presentations on clinical supervision and for his efforts to train addiction professionals in more than 80 countries. His books include Clinical Supervision in Alcohol and Drug Abuse Counseling.
Beny Primm, MD (1928-2015) was the founder and long-tenured Executive Director of the Addiction Treatment and Research Corporation (Manhattan and Baltimore). He was a forceful public health advocate during the early days of the AIDS epidemic, a highly respected proponent of medication-assisted treatment of opioid addiction, and a longtime leader within the American Association for the Treatment of Opioid Dependence. He also served as Director of the Center for Substance Abuse Treatment under President George Bush.
Max Schneider, MD (1922-2014) was a leading figure in addiction medicine for more than 50 years. He was also well known for his leadership on the boards of the California Society of Addiction Medicine, the American Society of Addiction Medicine, and the National Council on Alcoholism and Drug Dependence as well as for groundbreaking films on addiction that were widely used to educate patients, addiction professionals, and the public.
Ed Senay, MD (1927-2014) was a pioneer in addiction medicine, who, in collaboration with Dr. Jerome Jaffe, championed a multi-modality system of addiction treatment within the Illinois Drug Abuse Program that was widely replicated in the 1960s and 1970s. He mentored generations of aspiring addiction professionals (including myself), published innumerable papers, and four books, including Substance Abuse Disorders in Clinical Practice.
Barry Stimmel, MD (____-2014) was the founder and long-serving director of the Mount Sinai Narcotics Rehabilitation Center and the founding editor of the Journal of Addictive Diseases. He also served as a consultant to the White House Office on National Drug Control Policy. His books included Alcoholism, Drug Addiction, and the Road to Recovery: Life on the Edge.
Doug Talbott, MD (1924-2014) was the founder and first medical director of Talbott Recovery Campus – an Atlanta-based addiction treatment program that specialized in the treatment of impaired physicians and other impaired professionals. Dr. Talbott was a key figure in the early development of the American Society of Addiction Medicine.
Betty Ann Weinstein, PhD (1941-2013) taught at the Catholic School of Social Work and the Rutgers Summer School of Alcohol & Drug Studies. Generations of students benefited from her papers and presentations on new diagnostic tools and the clinical management of denial.
Charles Winick, PhD (1922-2015) was a sociology professor who challenged prevailing views of heroin addiction in the 1960s, with his New York State Narcotics Commission studies concluding that most people addicted to heroin “matured out” of addiction without professional assistance. He also collaborated with Dr. Marie Nyswander on developing a clinic for the treatment of addicted jazz musicians in New York City and served during the 1950s on the board of the National Advisory Council on Narcotics—the umbrella organization of Narcotics Anonymous in New York City.
There is a way that the reach of our lives can be extended through the influence we exert upon others and, if we are fortunate, on the larger unfolding of history. The men and women above are among those who achieved such extended influence. That reach is something to which we can each aspire.
Post Date December 25, 2015 by Bill White
Tags Addiction Treatment Pioneers
Does recovery, as a claimed new organizing paradigm within the addictions field, constitute a positive and fundamental shift in the resolution of alcohol and other drug (AOD) problems in the U.S., or is it an ephemeral “flavor of the month” that simply puts a new rhetorical face on unchanged service philosophies and practices? It has the potential to be either.
Two decades ago, a new generation of recovery advocates and a small group addiction professionals began calling for the addiction field to extend its focus beyond cataloguing the sources and patterns of addiction-related pathologies and the methods of brief interventions into such problems. What they proposed was an intensified focus on long-term personal and family recovery and the lessons that could be drawn from studies of the prevalence, pathways, processes, stages, and styles of such recoveries. A resulting vision emerged of extending acute care models of addiction treatment to models of sustained recovery management nested within larger recovery-oriented systems of care to serve those with the most severe, complex, and chronic substance use disorders. In the ensuing years, the recovery concept emerged as a new policy paradigm, a new recovery advocacy movement was born, new recovery support institutions and roles flourished, recovery research emerged as a specialty among addiction scientists, and recovery, recovery management (RM), and recovery-oriented systems of care (ROSC) became extolled as new organizing frameworks for addiction treatment and the expansion of peer-based recovery support services.
As this shift unfolded at national, state, and local levels, addiction treatment providers and allied health care institutions responded in quite varied ways. Some re-evaluated their treatment protocol and launched a radical redesign of their service philosophies, service practices, and service relationships. Others defensively claimed that they were already recovery-oriented and that there was nothing to this new recovery rhetoric. Still others responded by showcasing a new program as evidence of their recovery orientation—a loosely attached appendage that gave the veneer of recovery orientation while their mainstream services practices remained unchanged. Many programs adopted recovery language in their names and service descriptions—some out of a deep commitment to this new orientation and others out of political or financial expediency. This variability left individuals and families seeking help and purchasers of addiction treatment services in a quandary over how to identify the degree of such recovery orientation as a potential indicator of quality of treatment services.
As one of the early advocates of this recovery-oriented transformation of addiction treatment in the United States, I am frequently asked: “How does one separate recovery orientation in substance from superficial recovery rhetoric?” Here is my answer: An addiction treatment program reflects alignment with RM/ROSC principles if, and only to the extent that, such programs:
Can document authentic recovery representation at all levels of institutional governance, service planning and delivery, and service evaluation;
Assertively identify, engage, and assure service access for individuals and families at the earliest stages in the development of AOD-related problems;
Exemplify multidisciplinary and multi-agency service models focused on supporting long-term recovery for those individuals, families, and neighborhoods experiencing severe, complex, and enduring AOD problems;
Conduct individual, family, and community needs-assessment protocols (including recovery resource mapping of served communities) that are comprehensive, strengths-based, and ongoing;
Shift the core service relationship from an expert model to a partnership model involving a long-term recovery support alliance and extend this partnership model to all system component relationships;
Increase treatment retention rates and adopt policies that prohibit extruding people from treatment (via administrative or “therapeutic” discharge) solely for exhibiting symptoms of the disorder being treated;
Offer an extensive service menu, with an emphasis on evidence-based and promising recovery-linked service practices;
Promote a “philosophy of choice” that recognizes the legitimacy of multiple pathways and styles of long-term addiction recovery;
Ensure each client and family an adequate dose and duration of pre-treatment (recovery priming), in-treatment, and post-treatment clinical and recovery support services;
Exert influence on the post-treatment recovery environment by shortening the physical and cultural distance between the treatment institution and the natural environments of those served and offering services aimed at increasing family and community recovery capital;
Assertively link clients and families to available recovery mutual aid groups and other indigenous recovery support institutions;
Provide post-treatment monitoring (recovery check-ups for up to five years following discharge from primary treatment), stage-appropriate personal/family recovery education, sustained recovery coaching, and, when needed, early re-intervention; and
Systematically collect and publically report long-term post-treatment recovery outcomes for all admitted individuals and families by level of care, discharge status, and key clinical characteristics.
Few, if any programs, currently meet all of the above aspirational criteria of the RM/ROSC model of supporting long-term recovery, but a program claiming a high level of recovery orientation is most disingenuous if it cannot describe the progress it is making in these thirteen areas.
Those interested in evidence-based and promising practices to help programs achieve these critical elements are encouraged to explore the following monographs developed by the Center for Substance Abuse Treatment / Great Lakes Addiction Technology Transfer Center, the Philadelphia Department of Behavioral Health and Developmental disAbilities, and the Institute for Research, Education, and Training in Addictions.
Recovery Management and Recovery-oriented Systems of Care: Scientific Rationale and Promising Practices.
Linking Addiction Treatment and Communities of Recovery: A Primer for Addiction Counselors and Recovery Coaches.
Peer-based Addiction Recovery Support: History, Theory, Practice, and Scientific Evaluation.
Recovery-oriented Methadone Maintenance
Other papers related to recovery management and recovery-oriented systems of care are posted here and here.
Policy leaders, purchasers of care, system administrators, addiction professionals, recovery advocates, and recovery support specialists share the responsibility of building recovery-oriented systems of care that reflect these critical changes in traditional addiction treatment practices.
Post Date December 18, 2015 by Bill White
Women for Sobriety (W.F.S) and Secular Organizations for Sobriety (S.O.S) have, respectively, celebrated their 40th and 30th anniversaries in 2015. Each played an important role in the diversification of addiction recovery support in the United States.
There is a long and rich tradition of addiction recovery support in the United States. Formal recovery mutual aid societies date from 18th century Native American recovery circles and extend into an elaborate network of religious, spiritual, and secular recovery mutual aid societies during the mid-late 19th century. Amidst the early twentieth century drive for alcohol prohibition, these early groups collapsed, as did the network of inebriate homes, inebriate asylums, and private addiction cure institutes. The resulting recovery support vacuum was not filled until the founding of Alcoholics Anonymous in 1935, whose 12-Step approach dominated the recovery mutual aid arena for decades.
While there were early adaptations of A.A. for other addictions (e.g., Addicts Anonymous, 1947; Narcotics Anonymous, 1950/1953) and faith-based adaptation of A.A. (e.g., Alcoholics Victorious, 1948), viable secular and gender-specific alternatives to A.A. did not emerge in the United States until the last quarter of the 20th century. W.F.S and S.O.S. were the earliest of these alternatives.
Women for Sobriety W.F.S. was founded in 1975 by Dr. Jean Kirkpatrick who, based on her own recovery experience, believed there were gender-specific causes of and solutions to alcohol problems. She viewed the former as rooted in damage to self-esteem and outlined 13 Statements of Acceptance as a framework of long-term recovery for women. The Statements reflect Kirkpatrick’s belief that recovery for women was contingent upon an experience of empowerment, positive thinking, positive feelings about self and others, personal responsibility, and personal growth (Fenner & Gifford, 2012). When Rita Chaney and I contrasted the W.F.S. approach to other models of recovery based originally and primarily on experience with men, we found that W.F.S. metaphors of change emphasized: 1) empowerment and self-mastery rather than acceptance of powerlessness. 2) hope (seeing the top) rather than pain (hitting bottom), 3) achievement of personal identity rather than connectedness (pronouns of I, my, myself rather than we, our, ourselves), 4) divided attention (fitting sobriety into multiple role responsibilities) rather than focused attention (sobriety as a singular obsession), 5) the resolution of shame rather than a focus on the resolution of guilt, 6) self-affirmation rather than self-effacement (humility), 7) acts of self-care rather than service to others, 8) the importance of physical and psychological safety, 9) self-acceptance of one’s body, and 10) a greater emphasis on uncovery (exposing aspects of self that have been hidden) and discovery (acquiring that which one never had) than recovery (retrieving what has been lost).
SOSS.O.S. was founded in 1985 by James Christopher. Its secular framework of recovery is outlined in its websites (www.sossobriety.org and http://www.cfiwest.org/sos). There are many things that distinguish the S.O.S. approach to recovery, but one of the most significant involves the role of personal character in addiction recovery. Where 12-Step and religious frameworks of recovery often posit the source of addiction within the self (character) and define recovery as a larger reconstruction of self, S.O.S. views sobriety and personal character as separate issues. As illustrated in my 2012 interview with James Christopher, the S.O.S. view is strikingly different:
Issues that contributed to people becoming addicted may be personally important, but they are not important to the decision to stop drinking and using drugs. Debates over whether addiction is a disease or a behavior rage on, but they are not important to the decision to stop the pain in your life. In SOS, we want people to obey the laws of the land, and we hope that you will and use this time now that you’re no longer pickled to go back to college or go into therapy or whatever you may do to develop yourself, but we see all such decisions as separate from the more primary decision to not drink no matter what….If you’re not drinking, I don’t care how you’ve achieved it. If you used to be a drunk and you’re not drinking but continue to steal hubcaps, I don’t advocate that and I hope people will obey the law, but sobriety is a separate issue from these other decisions in life….It’s nice if people are compassionate and decent in their behavior with their fellow humans, but this is not a requirement for sobriety. Mafia chieftains can stop drinking and continue being mafia chieftains I suppose. I’m not advocating that; I’m just saying it’s a separate issue from recovery.
If there is a new chapter within the contemporary history of addiction recovery in the United States, it is the growing recognition and celebration of multiple pathways and styles of long-term addiction recovery. W.F.S. and S.O.S. deserve our recognition for helping build the foundation for such diversification. My congratulations to both organizations on reaching these organizational milestones.
People evolve a language in order to describe and control their circumstances…[Language] is a political instrument…the most crucial key to identity.—James Baldwin (From James Baldwin: A Biography by David Leeming)
Effective social movements rising within marginalized and stigmatized communities inevitably challenge words and images thrust upon them by the dominant culture to denigrate and denote their inferior social, economic, and political status. The twin challenges such movements face—from the civil rights and women’s movements to the disability rights movement—are to expunge (or repurpose) objectifying, disempowering words and images and replace forge new words and images that convey respect, inspire new possibilities, and invite inclusion. The import of such efforts far transcends matters of superficial political correctness. Changes in language are critical instruments of identity reconstruction and key signposts of broader changes in social policy and social norms. Such changes are also a means through which members of the dominant culture and cultural institutions can make symbolic amends for past misdeeds. This brief essay offers a series of observations about language related to alcohol and other drug problems, with particular reference to use of the terms alcoholic and addict within the popular culture, the professional field of addiction treatment, and within indigenous addiction recovery support institutions.
There is a long history of the cultural use of objectifying labels to designate differentness and implied inferiority—labels that have contributed to social, economic, and political marginalization and even to campaigns of genocide. While the latter reference may seem extreme to open this discussion, the reader should be reminded that people with severe alcohol and other drug problems have been subjected historically and globally to economic marginalization, political disenfranchisement, prolonged penal and medical institutionalization, legally mandated sterilization, unconscionably harmful medical interventions, and campaigns of mass extermination (e.g., within the German Third Reich’s campaign of racial purification).
A major thrust within health and disabilities reform movements has been to purge prejudicial language that dehumanizes and objectifies people. Such language obliterates personhood by reducing the individual to a socially discredited category: diabetic, epileptic, schizophrenic, manic depressive, blind, mentally ill, disabled, handicapped, retarded, Mongoloid, deaf and dumb, the obese. The recent trend within reform movements has been to replace such objectifying “I-It” language with “I-Thou” language—the latter commonly referred to as “people first language,” e.g., person with (or affected by) diabetes, epilepsy, etc. While there have been continued discussions and debates within affected communities regarding the best choice of language (see here and here as examples), person-first language has become the acceptable and preferred choice of language for describing people with varied limitations within common professional, cultural, and legal communication (e.g., see People First Respectful Language Modernization Act of 2006).
Stigmatized persons and communities have limited strategies available to respond personally or collectively to the sting of the pejorative words foisted upon them from the dominant culture. They can try to ignore such insults, but such passive acceptance only deepens the personal and collective wounds of such shaming insults. They can protest the use of such language—a strategy most effective when imbedded within a larger social protest movement. They can also transmute and repurpose the offending language in a way that neutralizes its poison and gives it new meaning within in-group communications. This is historically evident in the ways that communities of color and the LGBT—now LGBTQIA—community have, through a process of subcultural alchemy, incorporated use of historically offensive words within these communities to signal in-group affiliation, status, and pride. By alchemy, we mean the appropriation and transformation of externally imposed language used to express repugnance to something chosen and positively reframed as a symbol of mutual identification and affirmation.
There is a long history of “problem first language” used to morally isolate people with severe AOD problems. Since the early 1900s, persons entering treatment for such problems have been labeled inebriates, dipsomaniacs, habitués, addicts, alcoholics, problem drinkers, and substance abusers. An equally long history of such designations pervades popular culture in the U.S., including such terms as drunkard/drunk, sot, tippler, wino, boozer, alky/alki/alkie, rummie, rumhound, dope fiend, doper, junky, viper, speed freak, crack head, crack whore, meth head, tweeker, and stoner, to name just a few. Recently, suggestions have been made that the addictions field and the larger culture abandon all such terms, and like the larger health care and disabilities fields, embrace person-first language (See here, here, and here).
The rise of a new recovery advocacy movement has stirred a re-examination of the language used within the alcohol and drug problems (AOD) arena (see here, here, here, and here). Much of this focus has been on eliminating the stigmatizing alcohol/drug/substance “abuse” language from popular and professional discourse (see here and here), but there have also been discussions about other potentially stigmatizing language (e.g., clean/dirty designations, lapse/relapse) and how to best refer to people who have AOD problems and people who once experienced, but no longer experience, such problems (See here and here). Debate regarding the latter designation has for the past 150 years produced such adjectives as redeemed, repentant, reformed, dry, former, ex-, arrested, cured, recovered, and recovering. The rather quaint term “sobriate” — perhaps a takeoff on inebriate, has also been used in some quarters, as has the more recent term recoveree.
We have closely followed these developments both within the addictions field and within related social movements. To assist addiction professionals and recovery support specialists prepare for these coming language debates, we would offer the following four predictions.
Use of the terms alcoholic and addict will come under increasing scrutiny, criticism, and disuse within the addictions field and within allied health and social services fields on the grounds that such terms lack clinical precision, objectify those being served, and contribute to the social stigma attached to addiction and addiction recovery.
The terms alcoholic and addict will continue for some time as preferred language of self-identification and mutual identification within some indigenous recovery cultures (e.g., meetings of Alcoholics Anonymous and Narcotics Anonymous). The use of these terms in public communications will continue to contribute to public misunderstandings of the meaning of recovery (e.g., public assumptions that someone identifying themselves as an alcoholic/addict is still actively addicted or has not yet achieved stable recovery). This public confusion will lead some people in recovery to migrate towards the use of such terms of self-identification as “alcoholic/addict in long-term recovery” or “person in long-term recovery.”
This dichotomy between the language of addiction research/policy/treatment and the language of many people in recovery will lead groups of the latter to distinguish between in-group and out-group communications. This is already happening via the messaging training for advocates involved in Faces and Voices of Recovery and many local recovery advocacy organizations. Over time, the terms alcoholic and addict are likely to diminish and then cease in professional and public communications.
In the meantime, the differences between in-group and out-group and professional communications will raise questions regarding who can and cannot use terms like alcoholic and addict. Eventually, these terms will be relegated for proper use only among those who have been experientially privileged to use such language (e.g., those who have directly experienced addiction). This will be analogous to a person with a disability referring to themselves as a “crip,” participating in “crip culture,” and serving as a “crip activist” or performing as a “Krip-Hop” artist, while being offended by outsiders—people or professionals without the lived experience of disability—using this same language.
Changes in language can represent superficial adaptations to external pressure for change or represent fundamental shifts in public attitudes and policies and professional principles and practices. We should never underestimate the power of language. As the sage advice of Don Coyhis, the leading figure in the Native American Wellbriety Movement, suggests: Words are important. If you want to care for something, you call it a “flower”; if you want to kill something, you call it a “weed.”
About the Authors: William L. White, MA, is Emeritus Senior Research Consultant at Chestnut Health Systems; Alisha White, PhD, is Assistant Professor in the English Department (English Education, Dis/ability Studies, Arts-Based Research) at Western Illinois University.
Post Date December 4, 2015 by Bill White