BLOG & NEW POSTINGS March 25, 2016 – Bill White -THE RECOVERY MONOGRAPHS (VOLUMES ONE AND TWO)

By the late 1990s, tremendous strides had been achieved in elevating the accessibility and quality of addiction treatment in the U.S., yet leaders in the field were beginning to suggest the need for a radical redesign of addiction treatment—a shift from acute and palliative care models of intervention to models of assertive and sustained recovery management (RM) nested within larger recovery-oriented systems of care (ROSC). In 1998, I began work with Michael Boyle on the Illinois-based Behavioral Health Recovery Management (BHRM) project—a project specifically charged with exploring the potential of adapting chronic care models drawn from primary medicine to enhance the quality of addiction treatment. The papers on RM emanating from the Illinois project garnered considerable attention and led to early consultations with the State of Connecticut and the City of Philadelphia–early pioneers in RM-focused systems transformation processes. The early BHRM work also led to an invitation from the Center for Substance Abuse Treatment’s (CSAT) Great Lakes Addiction Technology Transfer Center (ATTC) to author and co-author a series of monographs on RM & ROSC. I could not be more delighted that the most central of these monographs have now been assembled into a two-volume set of books (available in hardcopy and as e-books) through support from the Center for Substance Abuse Treatment’s ATTC Coordinating Network. Also of note is that all royalties from these books will be paid directly to support the work of Faces and Voices of Recovery.
The first monograph, Recovery Management, was published in 2006 and contained four essays. Recovery: The Next Frontier, originally published in Counselor in 2004, described the emergence of recovery as a new organizing paradigm for addiction treatment and non-clinical recovery support services. The Varieties of Recovery Experience, co-authored with Dr. Ernest Kurtz and published in abridged form in the International Journal of Self Help and Self Care, summarized what could be gleaned from history and science about the pathways, stages, and styles of long-term addiction recovery. Recovery Management: What if we Really Believed Addiction was a Chronic Disorder? was a preliminary attempt to outline the changes in service practices implicit within RM models of care. And Recovery Management and People of Color, co-authored with Mark Sanders and originally published in Alcoholism Treatment Quarterly, was a first attempt to explore application of the RM/ROSC model to historically disempowered communities.
Wide dissemination of the first Great Lakes ATTC monograph on recovery management generated considerable interest from the field and led to two follow-up monographs in 2006 and 2007. Recovery: Linking Addiction Treatment and Communities of Recovery, co-authored with Dr. Ernest Kurtz, offered concrete suggestions for addiction counselors and recovery coaches on how to best link those they served with recovery mutual aid societies and other indigenous recovery support institutions. The third monograph, Perspectives on Systems Transformation: How Visionary Leaders are Shifting Addiction Treatment Toward a Recovery-Oriented System of Care, focused on the RM/ROSC implementation process through a collection of interviews offering national (Dr. H. Westley Clark), State (Dr. Thomas Kirk), municipal (Dr. Arthur Evans, Jr.), program (Michael Boyle), recovery community (Phil Valentine), and ATTC (Lonnetta Albright) perspectives on the implementation of RM/ROSC principles.
These first three monographs can be ordered by clicking Recovery Monographs, Volume I.
One central question loomed as RM/ROSC language and approaches spread through the field: What is the evidence-base for this proposed redesign of addiction treatment? The fourth monograph, Recovery Management and Recovery-Oriented Systems of Care: Scientific Rationale and Promising Practices, was released in 2008 to answer that question. It describes promising practices in such critical treatment performance areas as attraction, access, screening/assessment, engagement/retention, team composition, service relationship, service dose/scope/quality, locus of service delivery, linkage to recovery communities, and post-treatment monitoring and support.

If there was a single area within RM/ROSC proposals that captivated the field’s attention and often emerged as the most visible element of RM/ROSC transformation efforts, it was the reintegration of people in recovery into the addiction treatment arena in both volunteer and paid roles at all levels of the system. Such integration generated mountains of emails and calls about how to achieve such integration and the evidence-based approaches to such efforts. In response, the fifth monograph, Peer-based Addiction Recovery Support: History, Theory, Practice, and Scientific Evaluation, was published in 2009. This monograph achieved two goals. It addressed what was known at that time about peer-based recovery support services from the standpoint of history and science, and it described in considerable detail how peer-based recovery support services were being implemented within addiction treatment and recovery community organizations across the United States.
In 2010, a major question arose about the implications of RM/ROSC for medication-assisted treatment. This question prompted collaboration with Lisa Mojer-Torres (the “Rosa Parks of Medication-Assisted Treatment”) in co-authoring the sixth monograph, Recovery-oriented Methadone Maintenance (ROMM). The ROMM monograph was widely disseminated and led to numerous follow-up presentations and papers. Two other monographs and a book (Addiction Recovery Management coedited with Dr. John Kelly) followed this first series, but I will always think of these first six monographs as my foundational writings on RM/ROSC.
Monographs four through six can be ordered by clicking Recovery Monographs, Volume II.
The RM/ROSC monograph series was done in tandem with numerous other efforts to enhance long-term recovery outcomes in the U.S. Of particular note is the now iconic paper on addiction as a chronic disorder led by Tom McLellan that was published in the Journal of the American Medical Association in 2000. There were also CSAT monographs and monographs from other ATTCs during these same years that played an important role in promoting RM/ROSC system transformation efforts And the increased focus on long-term recovery would not have been possible without the research studies of Michael Dennis, Mark Godley, Susan Godley, James McKay, Christy Scott, and others focused on extending the effects of addiction treatment through assertive approaches to post-treatment continuing care.
There are many people to thank for their support of this monograph series, but none more important than Dr. Westley Clark, Lonnetta Albright, Dr. Michael Flaherty, and Dr. Arthur Evans, Jr. whose leadership and support were beyond what words can adequately express. RM/ROSC offered a new vision and new service technologies that promised to transform addiction treatment from an almost singular focus on recovery initiation to a system capable of supporting enhanced stability and quality of personal and family life in long-term addiction recovery. It will be up to future generations to judge how close we as a field came to fulfilling that vision.
William L. White
Emeritus Senior Research Consultant
Chestnut Health Systems
Punta Gorda, Florida
March 2016

BLOG & NEW POSTINGS March 18, 2016Bill White RETHINKING THE CHARACTERIZATION OF ADDICTION AS A “RELAPSING CONDITION” (BILL WHITE AND PAULA DAVIES SCIMECA)

https://www.drugabuse.gov/publications/media-guide/science-drug-abuse-addiction-basics
http://www.csam-asam.org/sites/default/files/pdf/misc/chronicdiseaseplndp.pdf
Defining addiction as a “chronically relapsing” condition, in spite of its advocacy by leading organizations in the addictions field (see top link, 2nd link),has generated unintended but harmful consequences. Such language should be abandoned and replaced with words that more accurately depict the variable course of substance use disorders (SUDs) and that are more personally and professional empowering.
Our hearts go out in compassion, respect, support, and admiration for people who share their struggles with cancer, heart disease, diabetes, and other medical conditions that require prolonged if not lifelong monitoring and active management. Because a personally positive attitude and family and social support can play crucial roles in bolstering recovery, health professionals do everything in their power to provide optimal hope and encouragement for recovery from these medical conditions. Even when it is statistically unlikely that a patient will be able to survive or return to previous levels of health and functioning, she or he is given words and images of hope. Less than fifty years ago, a diagnosis of cancer was so threatening that those six letters were left unspoken in many households and were socially taboo. Today, society has begun to automatically pair the word “cancer” with “cancer survivor.” It is now commonplace for people to live, and live well, transcending diagnoses of cancer, heart disease, diabetes, asthma, and numerous other complex and life-threatening health conditions. The expectation of surviving and thriving in the face of such conditions has blossomed into a something of a cultural phenomenon.
Unfortunately, when the medical illness is a substance use disorder (SUD), affected individuals and families are often not afforded such optimistic language and images of hope. Until the recent rise of a new addiction recovery advocacy movement, the public faces and voices of “addiction survivors” were rare in the United States, due primarily to the social and moral stigma attached to addiction. The language that accompanied a SUD diagnosis often conveyed the overwhelming expectation–inferred, and often voiced–that recovery from addiction was the rare exception to the rule. Nowhere is such pessimism more evident than in the characterization of addiction as a “chronically relapsing” condition. We offer the following objections to such language.
The lapse/relapse language within this phrase is historically rooted in morality and religion, not health and medicine, and comes with considerable historical baggage (See related blog). The lapse/relapse language in the alcohol and drug problems arena emerged during the temperance movement and was linked in the public mind to lying, deceit, and low moral character—a product of sin rather than sickness. The application of the lapse/relapse language to other medical conditions once linked to personal culpability, such as tuberculosis, cancer, epilepsy, and schizophrenia dissipated as more objective and morally neutral language (e.g., recurrence) was embraced and the etiology and course of these disorders became more clearly understood. Hopefully, the same will be true with SUDs.
The phrase “chronically relapsing” applied to SUDs misrepresents the natural course of SUDS by misapplying findings from clinical research populations and clinical experience with the most severe, complex, and chronic SUDS to the larger pool of SUDs found in the community. Recovery, not prolonged disability and death, is the norm for the long-term course of most substance use disorders. (See here for a review of more than 400 scientific studies confirming that conclusion.) More than 23 million Americans have achieved remission from substance use disorders, and surveys of people in recovery reveal dramatically improved health, functioning, and quality of life. Such findings are cause for personal, public, and professional optimism—not the pessimism conveyed by the “chronically relapsing” language. Recognizing that vulnerability for recurrence is a common dimension of substance use disorders marked by high severity, complexity, and chronicity does not mean that such conditions warrant hope-suffocating language. Such individuals can and do achieve long-term recovery without further episodes of recurrence or with only a few brief episodes of such recurrence.
The characterization of all SUDs as “chronically relapsing,” by inadvertently portraying a SUD as a hopeless condition, is personally disempowering, serves to lower personal expectations of sustainable recovery, and fails to convey how an individual’s daily decisions and lifestyle management can lower the risk of future SUD recurrence. Our concern is that the christening of a SUD as “chronically relapsing” and categorizing individuals as “chronic relapsers” by medical authorities becomes, not an inherent condition of a SUD, but a self-fulfilling prophecy when embraced by professional provider and patient. As with many other health conditions, recovery from a SUD requires assertive and continued management, and resources to support such long-term recovery management are increasingly available. It is time the definitional language of “chronic relapsing disease/condition” was abandoned and replaced with language that conveyed the reality of recovery without repeated activation of addiction, and that there are personal actions that dramatically reduce the risk of recurrence. It is time those in recovery from addiction joined the family of other “survivors” recovering from health conditions that positively respond to assertive and ongoing recovery management.
The “chronically relapsing” characterization of SUDs obscures the large population of individuals who achieve remission from such disorders with no experience of repeated reactivation of the disorder. (Sustained monitoring programs for airline pilots, physicians, and nurses often find 80%+ of them initiating and sustaining recovery from addiction without continued episodes of alcohol or drug use and its consequences.) The “chronically relapsing” language also obscures the high levels of social functioning and social contribution achieved by individuals in long-term recovery. It instead conveys, at best, the image of people in SUD recovery as inherently fragile, “white knuckling” their way through life, on the brink of resumed alcohol and drug use at every moment. Such a caricature may find some truth for those in the earliest days of SUD recovery, but is challenged by the majority of people who live quite comfortably in long-term SUD recovery, many achieving productive and purposeful lives of social contribution.
The characterization of SUDs as “chronically relapsing” contributes to social stigma, discrimination, and the social abandonment of people experiencing such disorders. If the commonly expected outcome of a SUD is not recovery, but repeated and prolonged acute episodes, then persons with a SUD become less viable candidates as intimate partners, parents, friends, employees, college applicants, loan applicants, renters, applicants for health and life insurance, or recipients of government benefits. Characterizing individuals with a SUD as “chronically relapsing”—socially interpreted to mean biologically or psychologically inferior/damaged, provides justification for addiction-related social stigma, sequestration of persons with a SUD from community life, and, at the historical extreme, campaigns of extermination, e.g., inclusion in mandatory sterilization laws, prolonged incarceration, or campaigns of genocide against people with SUDs (as occurred in Nazi Germany).
The “chronically relapsing” language fuels therapeutic pessimism among providers of SUD treatment and serves as a smokescreen for ineffective and financially exploitive approaches to addiction treatment. Professionalized addiction treatment has become disconnected from the larger and more enduring process of addiction recovery, disconnected from indigenous recovery community organizations, and disconnected from regular contact with legions of individuals and affected family members in long-term recovery. With an ever-briefer model of addiction treatment, such professionals are prone to see a core of individuals with histories of multiple treatments as a norm confirming the “chronically relapsing” declaration. Addiction treatment organizations whose owners view persons with SUDs as a crop to be harvested for financial profit can provide inert, ineffective, and even harmful treatments multiple times to the same individuals while masking their ineffectiveness and profiteering behind the “chronically relapsing” depiction of the disorder. Under such circumstances, people with severe and complex SUDs and little recovery capital can repeatedly undergo treatments that have little evidence of producing sustainable recovery while being personally blamed for such outcomes (i.e., “not working the program correctly”). The “chronically relapsing” and “chronic relapser” monikers perpetuate ineffective and exploitive treatment by miscasting flaws in treatment philosophy, design, and execution (system failures) as problems stemming from the condition (“It’s the disease, not our treatment approach.”), and problems of patient compliance (personal failures).
The “chronic relapsing” portrayal of SUDs also exerts its effects on policy and public resource allocation. Why would politicians or the public allocate their limited resources to people perceived as having so little hope of achieving recovery? People experiencing and recovering from SUDs and their families will never be a political constituency of consequence as long as they are pictured as permanent burdens on community resources rather than as people who can and do achieve stable health, work productively, pay taxes, vote, and voluntarily serve the communities that have supported them. The addiction treatment advancements made to date have flowed from Mrs. Mary Mann’s declarations in 1944 that people with such health conditions can be helped and are worthy of help—a portrayal far different than that conveyed by the “chronic relapsing”/”chronic relapser” labels.
The recognitions that severe substance use disorders mimic characteristics of other chronic health conditions and could benefit from sustained recovery management rather than serial episodes of acute stabilization have been critical milestones in the advancement of modern history of addiction treatment. But such sustained care and support is at its best when it is hope-infused and stripped of language that adds to the burden of stigma facing individuals and families in recovery. While care must be taken in the characterization of SUDs as a potentially “chronic” condition for some persons (for some of the same above reasons–see such concerns expressed here, here, and here), it is time “relapsing condition” and such pejorative, objectifying labels as “chronic relapser” were forever deleted from the lexicon of addiction medicine and addiction treatment.
Post Date-March 18, 2016 by Bill White

A personal entry from Jamie and My band; Lebish And Grinnell Music to Thank The Akademia Music Awards for winning Best Hard Rock Song

Dear Lebish And Grinnell,

We wanted to take this opportunity to formally congratulate you on winning The Akademia Music Award for Best Hard Rock Song for ‘Final Approach’ in the March 2016 Akademia Music Awards! The results are now available and public at:

http://www.theakademia.com/home1 This page includes the general announcement and some artist features.

http://www.theakademia.com/winners1 This page lists all of the March 2016 winners in your review group.

http://www.theakademia.com/march2016_bestsong_hardrock1.html This page is your permanent award certificate page.

Be sure to share your achievement with family, friends and fans. You’ve worked hard and you deserve it. Your award certificate page will remain active for years to come and may be shared easily via email, Facebook, Twitter and other sites by copying and pasting the URL page link.

Winning an Akademia Award is a rare career distinction. It also means you are now inside the gates of an organization that can significantly advance your career as an artist. We will be in touch with you shortly regarding the next campaign steps. In the meantime, please be sure to like and follow us at the following portals, as we’ll also be promoting award winners through these portals in the coming weeks.

http://www.facebook.com/TheAkademiaMusicAwards

http://www.twitter.com/AkademiaAwards

http://www.youtube.com/AkademiaAwards

Please accept our warmest congratulations from The Akademia team on your outstanding achievement in the field of music. We look forward to working closely with you to advance your music career.

Kind regards,

The Akademia

BLOG & NEW POSTINGS March 11, 2016 – Bill White; WOMEN PIONEERS IN PUBLIC RECOVERY DISCLOSURE (WILLIAM WHITE AND DR. JEAN KILBOURNE)


Today, women in addiction recovery are visibly leading and supporting recovery advocacy organizations, and they are speaking at and participating in national and local public recovery celebration events. Such actions rest on the legacy of the first women who challenged the discrediting images linked to addicted women. This brief photo-essay begins with the story of eight women who publically disclosed their recovery from addiction and then explores the stigma-laden cultural contexts in which these disclosures occurred.
Lillian Roth (1910-1980) was an early film star who graced popular films of the late 1920s and 1930s. Following the 1953 public disclosure of her recovery from alcoholism in the TV series This Is Your Life, she received tens of thousands of letters of praise and requests for advice. The following year, she elaborated on her recovery story in her New York Times best-selling autobiography I’ll Cry Tomorrow (1954) with an accompanying Hollywood biopic (1955) starring Susan Hayward. This was followed in 1958 by an expanded biography entitled Beyond my Worth. Lillian Roth returned to stage and screen in the 1960s, finishing a most illustrious career.
Mercedes McCambridge (1916-2004) appeared in innumerable films and television shows between 1949 and 1986, winning an Academy Award for Best Supporting Actress in 1949 for her role in All the Kings Men. She publically disclosed her recovery from alcoholism in numerous venues, including in her 1981 autobiography The Quality of Mercy. She used her status as an award-winning actress and her personal recovery story to advocate for the treatment of alcoholism as a medical condition. She offered influential Senate testimony in 1969 in support of legislation that a year later laid the foundation for modern community-based alcoholism treatment.
Marty Mann (1904-1980), one of the first women to achieve prolonged sobriety within Alcoholics Anonymous, founded the National Committee for Education on Alcoholism in 1944—forerunner of today’s National Council on Alcoholism and Drug Dependence (NCADD). Her writings and speeches almost single-handedly laid the groundwork for modern alcoholism education and alcoholism treatment. Everywhere she shared her own story—even in the face of harsh criticisms of such disclosure, women came out of the closet to seek help for alcoholism. Her books included Marty Mann’s Primer on Alcoholism (1950) and Marty Mann Answers your Questions about Alcohol and Alcoholism (1970). After decades serving as a public policy advocate, she worked as an alcoholism counselor at Silver Hill Hospital in New Canaan, Connecticut.
LeClair Bissell, MD (1928-2008), a pioneer in the modern history of addiction medicine, disclosed professionally and publically her status as a lesbian physician in long-term recovery from alcoholism. Dr. Bissell was quite influential in pioneering assistance programs for physicians and other professionals and advocating for improved access and quality of addiction treatment in the United States. Her books included Alcoholism in the Professions (1984), A Woman Like You: Life Stories of Women Recovering from Alcoholism and Addiction (1985), Ethics for Addiction Professionals (1987), and a children’s book entitled The Cat Who Drank Too Much (1982).

Susan B. Anthony II, PhD (1916-1991), grandniece of the famed feminist and civil rights activist, was a women’s rights and peace advocate who was quite open about her recovery from alcoholism—a recovery process she attributed to an encounter with Marty Mann. She shared her recovery story in her 1971 autobiography The Ghost in My Life and in numerous speeches. In the 1970s, she became a vocal advocate for expanding services for the treatment of alcoholism and later co-founded Wayside House, a treatment center for addicted women in Delray Beach, Florida.
Jean Kirkpatrick, PhD (1923-2000) founded Women for Sobriety (WFS) in 1975. She was a sociologist by professional training, but founded the WFS “New Life” program based on her own personal recovery from alcoholism. She spoke throughout the country sharing her recovery story and detailing the WFS program in a series of books that included Turnabout: New Help for the Woman Alcoholic (1977) and Goodbye Hangovers, Hello Life (1986). The founding of WFS marked the beginning of modern gender-specific and secular mutual aid alternatives to Alcoholics Anonymous and other 12-Step programs.
Betty Ford (1918-2011) and former President Gerald Ford courageously declared to the American public in the spring of 1978 that Mrs. Ford had been treated for, and was recovering from, dependence on alcohol and prescription drugs. She became the driving force behind creation of the Betty Ford Center in 1982, continued to share her story publicly, and testified numerous times before Congress on the subject of addiction treatment. Her powerful personal testimony inspired the recoveries of innumerable women.
Ann Richards (1933-2006), former Governor of Texas, lived openly as a person in long-term recovery from alcoholism after announcing in 1980 that she was seeking treatment for dependence on alcohol. She presented a quite memorable keynote address at the 1988 Democratic Convention and, a year later, published her autobiography Straight from the Heart: My Life in Politics and Other Places. As Governor, she championed the expansion of alcoholism treatment services in Texas.

The women profiled above are distinctive in garnering national attention. Women of color in recovery also publically shared their stories within their local communities, but would not garner national attention until media coverage of people of color and communities of color increased in the late Twentieth Century. Recovery stories of women of color remain rarely told in the national media, leaving the stigma attached to addicted and recovering women of color deeply entrenched within these communities and the larger culture. A new generation of women of color is challenging such stigmatized images, most notably within African American and Native American communities.
The groundbreaking role that the eight women profiled above played within the history of addiction treatment and recovery in America is difficult to adequately convey, as is the courage required for them to go public with their personal recovery stories. The latter can be understood only by understanding the conflicting historical and cultural forces these and other women of their eras faced regarding their relationship with alcohol and other drugs. Those forces were twofold: 1) the aggressive marketing of alcohol and other drugs to American women, and 2) highly sexualized and stigmatized images of women addicted to alcohol and other drugs. Vestiges of both remain within the contemporary cultural stew.

Virtue_TemptationThe alcohol industry, always interested in increasing the consumption of alcohol and thus its profits, has targeted women for a long time. Initially, alcohol was offered to women as a way to find romance and be more attractive to men. More recently, women have been encouraged to use alcohol to assert their independence and to be more overtly sexual. Since there is still a powerful double standard about sex, women are placed in an impossible double bind. They are supposed to be sexy but innocent, experienced but virginal. Alcohol marketers encourage young women to use alcohol to resolve this dilemma and to unleash their sexuality. Of course, they still are blamed if they are sexually assaulted while under the influence (as many are).

At the same time, alcohol marketing often objectifies and insults women. Even more insidiously, it sometimes trivializes sexual assault and even seems to encourage men to use alcohol as a “date rape drug.” A 2015 ad in a Bloomingdale’s catalogue pictured a man eying an unsuspecting young women with the headline, “Spike your best friend’s eggnog when they’re not looking.” And a recent Budweiser campaign labeled the bottle “The perfect beer for removing ‘No’ from Your Vocabulary for the Night.” Such messages normalize dangerous attitudes and contribute to the ongoing false stereotype of the female alcoholic as promiscuous and immoral.
The association of alcohol or drug use by women as an aid to glamour, popularity, and personal tranquility lie in stark contrast to the images of addicted women emerging in this same era. The latter images portray women as immoral, deranged, “pitiful creatures.” These stigmatized images and characterizations reached their extremes in the newspapers, tabloids, and pulp fiction of the mid-twentieth century and were most evident in conveying women addicted to illicit drugs—a fact contributing to far fewer women publicly disclosing recovery from illicit drug addiction. Little narrative is needed to explicate the themes conveyed by these images. The promotional lines on the book covers say it all:
“Drink turned her into a sex-crazed animal!”
“Cheap and evil girl sets a hopped-up killer against a city.”
“How should he handle his alcoholic wife? Beat her? Cater to her inflamed desires? Overlook her drunken intimacies with other men? Desert her for his seductive mistress?”
“You had to pity this woman…Each time she fell into the bottle, she sought solace in sordid love.”
“She lusted in sin orgies and reefer brawls.”
“The intimate story of a girl degraded by drugs.”
“Women need men. Junkies need dope. I needed both.”
“She loved men, money and marijuana.”
“She traded her body for drugs and kicks.”
“She rode the needle to depravity’s depth.”
“Pitilessly exposes the depravity of the true addict, who takes lovers without number, performs every heinous vice, in order to embrace her one true love…the needle!”


Even accounts of women seeking support for recovery from addiction and sharing their stories to help other women perpetuated some of these same themes as they were framed by the popular media of the time.
NoBooze-Babes1


The eight recovering women profiled in this short essay shattered those images and did so at great personal cost. Today, women with a substance use disorder can seek and maintain their recoveries in a much safer cultural climate because of the courageous acts of these pioneers. There is still much progress needed to address gender-specific dimensions of the social stigma attached to addiction and addiction recovery, but all continued progress will flow from a debt of gratitude to the pioneering recovery advocates profiled above. Their names and their courage should not be forgotten.
Acknowledgement: Special thanks to Robert Gregory for his assistance with preparation of the photos included within this essay. Photos of alcohol ads are courtesy of Jean Kilbourne; all other photos courtesy of Illinois Addiction Studies Archives.
About the Authors: William White, M.A., is Emeritus Senior Research Consultant at Chestnut Health Systems and author of Slaying the Dragon: The History of Addiction Treatment and Recovery in America. Jean Kilbourne, Ed.D., is a noted advocate, speaker, author, and filmmaker. Her books include So Sexy So Soon: The New Sexualized Childhood and What Parents Can Do to Protect Their Kids and Can’t Buy My Love: How Advertising Changes the Way We Think and Feel. Her films include Killing Us Softly: Advertising’s Image of Women (and the remakes Still Killing Us Softly and Killing Us Softly 3); Deadly Persuasion: The Advertising of Alcohol & Tobacco; Spin the Bottle: Sex, Lies & Alcohol; and Slim Hopes: Advertising & the Obsession with Thinness, Pack of Lies; and Calling the Shots.
Also of Potential Interest:
White, W. (2015). Book Review: Jolene M. Sanders. Women in Narcotics Anonymous: Overcoming Shame and Stigma. Alcoholism Treatment Quarterly, 33(1), 138-140.
White, W. (2015). Gender-specific addiction treatment and recovery support: An Interview with Dr. Stephanie Covington. Counselor, 16(4), 57-61.
White, W. (2009). Tribute to a pioneer: Dr. LeClair Bissell. Counselor, 10(3), 52-56.
Iliff, B, Siatkowski, C., Waite-O’Brien, N., & White, W. (2007) The treatment of addicted women: Modern perspectives from the Betty Ford Center, Caron Treatment Centers and Hazelden. Counselor, 8(3), 42-48
White, W. (2007). An anniversary tribute to a First Lady. Addiction Professional, 5(7), 10-13.
White, W., & Kilbourne, J. (2006). American women and addiction: A cultural double bind. Counselor, 7(3), 46-51.
White, W. (2004). Women who made (and are making) a difference. Counselor, 5(5), 25-29.
White, W. (2002) Women, addiction, and recovery: A historical review. Counselor 3(4):52-54.
White, W., & Chaney, R. (1992). Metaphors of Transformation: Feminine and Masculine. Bloomington, IL: Chestnut Health Systems.
Other women who as public figures disclosed their recovery status include: Drew Barrymore, Mary J. Blige, Naomi Campbell, Susan Cheever, Natalie Cole, Judy Collins, Tara Connor, Jamie Lee Curtis, Kristin Davis, Laurie Dhue, Linda Ellerbee, Carrie Fisher, Sharon Gless, Whoopi Goldberg, Kristen Johnston, Heather King, Lindsay Lohan, Jane Lynch, Mary Tyler Moore, Kate Moss, Stevie Nicks, Mackenzie Phillips, Lucille O’Neal, Kelly Osborne, Bonnie Raitt, Nicole Richie, Susan Rook, Diana Ross, Grace Slick, Jada Pinkett-Smith, Elizabeth Taylor, Elizabeth Vargas.
Post Date March 11, 2016 by Bill White
Categories Articles
Tags addiction | alcoholism | Anne Richards | Betty Ford | Jean Kirkpatrick | Lillian Roth | Marty Mann | Mercedes McCambridge | stigma | Susan B. Anthony II

BLOG & NEW POSTINGS March 4, 2016Bill White WHO PROFITS FROM ADDICTION/RECOVERY STIGMA?

who-profits-from-stigma

The social stigma attached to addiction is most often portrayed as an attitudinal problem rooted in the lack of knowledge about alcohol, tobacco, and other drug (ATOD) problems and the prevalence and methods through which they are effectively resolved. The resulting antidotes thus become focused on public/professional education and changing attitudes through increased public contact with those who have experienced sustained recovery from such problems.

There is, however, another far more penetrating analysis that asked three provocative questions: 1) Who profits from the social stigma attached to ATOD problems? 2) What strategies and tactics are utilized to create, sustain, and intensify ATOD-related social stigma? 3) How could such stigma-promoting forces be reduced as part of the broader effort to humanize these problems and replace systems of ATOD coercion and control with systems of public compassion, professional care, and peer recovery support?

Answering the question of who profits from addiction/recovery-related stigma requires attending the mantra, “Follow the Money!” It is important to identify those individuals and institutions whose interests are served by ATOD-related stigma.  There are five social institutions that directly or indirectly benefit from the stigma attached to addiction and addiction recovery.

The Media  For nearly two centuries, American media outlets have fueled moral panics surrounding drug addiction.  To garner the maximum amount of attention, media campaigns have demonized illicit drugs, illicit drug users, and illicit drug sellers—all while serving as the primary advertising vehicle for licit drugs.  Eight themes permeate these cyclical, media-generated moral panics:

  1. The drug is associated with a hated subgroup of the society or a foreign enemy.
  2. The drug is identified as solely responsible for many problems in the culture, i.e., crime, violence, insanity.
  3. The survival of the culture is pictured as being dependent on the prohibition of the drug.
  4. The concept of “controlled” usage is destroyed and replaced by a “domino theory” of chemical progression.
  5. The drug is associated with corruption of young children, particularly their sexual corruption.
  6. Both the user and supplier of the drug are defined as fiends, always in search of new victims; usage of the drug is considered “contagious.”
  7. Policy options are presented as total prohibition or total access.
  8. Anyone questioning any of the above assumptions is bitterly attacked and characterized as part of the problem that needs to be eliminated.

By its implicit categorization of “good drugs” and “bad drugs” and defining addiction as a problem of sin (“badness”) rather than “sickness,” the media has served as the primary purveyor of the social stigma attached to addiction. By using the most emotionally alarming language and the most lurid and fear-evoking images, media institutions have used addiction stories to serve their primary purpose, which is not to inform, but to garner public attention in order to promote and sell products to in turn sustain their own institutional profit and power. The American media has functioned as a stigma pimp, profiting on the prolonged emotional manipulation of the citizenry it claims to serve.  Reducing addiction-related stigma does not serve its institutional interests; promoting and intensifying alarm through such stigma does.

The Criminal Justice Industrial Complex (CJIC) How alcohol and other drug problems are defined dictates problem ownership and who will receive the cultural resources allocated to address these problems. In short, the fate of professional careers, professional fields, and whole community economies hinge on such definitions.  Any change in problem ownership poses significant threats to individuals, professions, and industrial economies.  The twentieth century stigmatization, demedicalization, and intensified criminalization of drug problems created the largest expansion of the criminal justice system in American and world history.  Once created, these ever-expanding social institutions—law enforcement, courts, jails and prisons, probation and parole services—and all the businesses relying upon these institutions become addicted to a set of stigma-imbedded beliefs and attitudes about drugs, drug users, and drug addiction.  Any suggestion that drug users deserve compassion and care rather than punishment and control threatens to transfer billions of dollars in cultural resources to other social institutions—a move that those with vested interests in the status quo must aggressively resist to protect their own personal and institutional interests.  Drug users—particularly poor men of color–are the raw materials that have fueled the expansion of the CJIC and economically rescued many rural white communities now supported by prison-based economies. The American criminal justice industrial complex and the community economies fed by this complex have profited handsomely from addiction-related stigma and can be expected to resist efforts to destigmatize, decriminalize, medicalize, and humanize addiction-related problems and to lobby for increased drug penalties, mandatory minimum sentencing, three-strike laws, limited parole opportunities, and ease of parole revocation.  Any reform efforts must actively manage such forces of resistance.

The Child Welfare System  The moral panic surrounding prenatal cocaine exposure—and all the misinformation upon which it was based—led to the largest expansion of the child welfare system in the history of the United States.  This and subsequent moral panics (e.g., methamphetamine, prescription opioids) led criminal justice and child welfare authorities to emerge as occupying armies within poor communities of color and in poor white communities.   Once in this role, vested interests have prevented the dismantling of the beliefs upon which such institutional expansion was based.  The child welfare system in the U.S. has yet to fully and publically acknowledge the harm it did to the children and families in response to the cocaine-focused moral panic of the 1980s.  There has been no official apology or restitution effort from the leading institutions within the child welfare field. Nor has there been an acknowledgement that the child welfare system and those who worked in this system profited institutionally, professionally, and personally in the face of the harm to those they were pledged to serve.

The Alcohol, Tobacco, and Pharmaceutical (ATP) Industries.  The licit drug industries in the United States have profited greatly from the stigma attached to licit and illicit drug addiction.  Concepts, words, slogans, and images that portray addiction as a product of moral/character weakness or the biological vulnerability of a small subset of ATP consumers and portray America’s drug problem in terms of illicit drugs and illicit drug markets draw attention from the harmfulness of ATP products and the exploitive marketing practices of the ATP industries.  Moral panics over illicit drug use and caricatured images of addicted persons serve these industries well by hiding America’s real addicts and obscuring her real drug pushers.  The ATP industries have been well-served by caricatured images that bear little similarity to the mass of people whose lives have been severely harmed by the use of alcohol, tobacco, and licit drugs.  The illicit drug industry also profits from social stigma. The foundation of its existence and its inordinate profits rests on the stigma attached to illicit drugs, the legal prohibition of these substances, and the resulting inflated drug prices and profits.

Specialty Sector Addiction Treatment   It would seem on the surface that addiction treatment programs would be among the most vocal advocates for the destigmatization of addiction, addiction treatment, and addiction recovery.  After all, stigma inhibits and slows help seeking and poses a major obstacle to community inclusion and quality of personal/family life in long-term addiction recovery.  But in some ways, specialty sector addiction treatment owes its very existence to stigma.  It exists because mainstream health and human service agencies historically viewed people with alcohol and other drug problems with contempt and as not morally worthy of compassion and care. The failure of these other systems to adequately respond to alcohol and other drug problems became the rationale for a specialized field of addiction treatment.

If ATOD problems, even the most severe, complex, and chronic of such problems, were truly destigmatized, it is quite likely that the treatment of these disorders would be fully integrated into the larger health care system–eroding the very foundation of specialty sector addiction treatment. We are currently witnessing the opening salvos in the tri-directional integration  of addiction treatment, mental health treatment, and primary health care in the U.S.   The resistance of specialty sector addiction treatment leaders to service integration could be based on legitimate concerns about the capacities of these other systems to effectively treat addiction, but it could also be based on the threats to personal, professional, and institutional interests that such integration poses.

If substance use disorders were to be fully destigmatized, one of the unexpected outcomes of that shift could be the dissipation of specialty sector addiction treatment in the United States and the resulting effects on institutional profits and professional careers. Any analysis of the role the addiction treatment field has played in promoting or exploiting stigma would also have to include a review of how addiction-related moral panics (and its stigma producing effects) have historically contributed to increased public and private funding for addiction treatment and the role treatment programs have played in fueling such moral panics.

Others Who May Profit from Stigma  Social stigma attributed to one factor (e.g., addiction) may serve to mask or hide other attitudes that are no longer socially acceptable to publically express (e.g., racism, homophobia).  I have closely watched many of the NIMBY (Not in My Backyard) battles rising over the proposed location of a new treatment center facility or recovery home.  I have witnessed groups of advocates of the new facility faced off against vocal neighborhood representatives opposing the location of the new facility.  On numerous occasions, I have been struck by the heterogeneity of the former (e.g., racial diversity, diversity of sexual orientation and gender identity, religious diversity) and the homogeneity (e.g., whiteness) of the latter.  To what extent does the expression of addiction-related stigma now serve as a proxy for, or a mask to hide, other forms of less socially acceptable prejudice?

Counterstrategies Effective efforts to address the social stigma attached to addiction and recovery must move beyond educational strategies aimed at changing personal attitudes of the public.  They must include strategies that:

  • Expose and document the extent to which individuals, organizations, business sectors, and community economies profit from the perpetuation of stigma,
  • Mobilize grassroots and institutional constituencies that can counter such forces (see for example the work of Stop Stigma Now),
  • Create financial and institutional incentives (via preferential patronage, public praise) for “getting it right” and disincentives for getting it wrong (via boycotts, public condemnation, and legal redress), and
  • Support alternative strategies of economic development for professional guilds and local communities that have profited from stigma-fueled industries.

Those of us committed to ameliorating the social stigma attached to addiction and addiction recovery must engage in serious explorations of these three critical questions: 1) Who profits from the social stigma attached to ATOD problems? 2) What strategies and tactics are utilized to create, sustain, and intensify ATOD-related social stigma? 3) How could such stigma-promoting forces be reduced as part of the broader effort to humanize these problems and replace systems of ATOD coercion and control with systems of public compassion, professional care, and peer recovery support?