July 28, 2017 -Bill White- ADDICTION RECOVERY IN THE ISLAMIC REPUBLIC OF IRAN


Like the United States, the Islamic Republic of Iran has faced critical challenges from rising opioid addiction. And like the U.S., Iran has experimented with a wide variety of remedial responses, ranging from supply reduction efforts and harsh punishment of users to expansion of harm reduction, treatment, and recovery support services. The latter include the explosive growth of Narcotics Anonymous meetings, which now constitutes 28% of all NA meetings worldwide, and the growth of other indigenous recovery communities, such as Congress 60.
Congress 60 was founded by Mr. Hossein Dezhakam in 1998 and has since grown to 38 branches across Iran with more than 50,000 members. Over the past decade, I have had the privilege of regularly communicating with Mr. Dezhakam and members of Congress 60. Several aspects of Congress 60 commend it to international readers interested in addiction treatment and recovery, including:

A theory of addiction (the X theory) that parallels much of what is being learned within modern studies of the neurobiology of addiction,
A theory of recovery as a sustained process of physical, mental, emotional, and spiritual (worldview) rejuvenation and self-discovery,
Decelerating doses of reparative medicine (opium tincture) through the first eleven months of recovery initiation and stabilization,
Sustained and saturated involvement in a vibrant recovery community, with its own recovery-focused language, literature, values, symbols, and rituals,
Intense involvement of members in competitive sports, music, the arts, and community service activities,
Integration of smoking (tobacco) cessation within the larger rubric of addiction recovery, and
Sustained involvement of family members in the treatment and recovery processes.
Medication-assisted and psychosocial approaches to addiction treatment have historically existed as isolated, competing, and often mutually antagonist silos in the United States. Discussions have begun about the potential value of uniquely combining and sequencing these approaches across the stages of long-term addiction recovery. With programs like Hazelden Betty Ford taking the lead in such explorations, it would be of value for us to also look beyond the borders of the United States for models of such integration. Congress 60 offers one such approach that should be closely examined for potential replication and adaptation across cultural contexts. Congress 60 integrates theoretical constructs and practices from both approaches and adds elements not found in either.Like the United States, the Islamic Republic of Iran has faced critical challenges from rising opioid addiction. And like the U.S., Iran has experimented with a wide variety of remedial responses, ranging from supply reduction efforts and harsh punishment of users to expansion of harm reduction, treatment, and recovery support services. The latter include the explosive growth of Narcotics Anonymous meetings, which now constitutes 28% of all NA meetings worldwide, and the growth of other indigenous recovery communities, such as Congress 60.
Congress 60 was founded by Mr. Hossein Dezhakam in 1998 and has since grown to 38 branches across Iran with more than 50,000 members. Over the past decade, I have had the privilege of regularly communicating with Mr. Dezhakam and members of Congress 60. Several aspects of Congress 60 commend it to international readers interested in addiction treatment and recovery, including:

A theory of addiction (the X theory) that parallels much of what is being learned within modern studies of the neurobiology of addiction,
A theory of recovery as a sustained process of physical, mental, emotional, and spiritual (worldview) rejuvenation and self-discovery,
Decelerating doses of reparative medicine (opium tincture) through the first eleven months of recovery initiation and stabilization,
Sustained and saturated involvement in a vibrant recovery community, with its own recovery-focused language, literature, values, symbols, and rituals,
Intense involvement of members in competitive sports, music, the arts, and community service activities,
Integration of smoking (tobacco) cessation within the larger rubric of addiction recovery, and
Sustained involvement of family members in the treatment and recovery processes.
Medication-assisted and psychosocial approaches to addiction treatment have historically existed as isolated, competing, and often mutually antagonist silos in the United States. Discussions have begun about the potential value of uniquely combining and sequencing these approaches across the stages of long-term addiction recovery. With programs like Hazelden Betty Ford taking the lead in such explorations, it would be of value for us to also look beyond the borders of the United States for models of such integration. Congress 60 offers one such approach that should be closely examined for potential replication and adaptation across cultural contexts. Congress 60 integrates theoretical constructs and practices from both approaches and adds elements not found in either.

I recently published a photoessay describing the Congress 60 recovery community. Those interested in learning more about their methods may review this essay HERE. The translated publications of Mr. Hossein Dezhakam and my posted interviews with him are available HERE and HERE.

Post Date July 28, 2017 by Bill White

TALES FROM A JAG-HOUSE-Bill White-July 21, 2017


The affluent alcoholic has always had institutions that catered to his or her needs for periodic detoxification and physical and emotional renewal. When inebriate homes, inebriate asylums and addiction cure institutes collapsed in the opening decades of the 20th century, a new social institution quietly emerged on the American landscape. This new institution was the small, local “drying out” facility that offered discrete care for the affluent alcoholic. These sanatoria and rest homes became known as “dip shops” (a derivative of dipsomania–a medical term for the binge drinking pattern of alcoholism), “jitter-joints,” “Jag-farms,” or “jag-houses.” Operating invisibly throughout the United States during the first half of the 20th century, their presence is revealed primarily via brief references in the autobiographies of American alcoholics. One published work, however, provides a clearer window into the inner operations of the early 20th century jag-house.
In 1909, a most unusual book was published. Authored by C. and J. A. Jones, the book was entitled, Opisthophorus: Or, The Man Who Walked Backwards. The purpose of the book was to better understand “the sufferings and temptations of a drunkard” as well as the “possibilities of his redemption.” It pursued this goal by describing the experiences of “men of fine capabilities who, when sober, are often the most refined of gentlemen” during their stay in a jag-house. Jones’ book provides a unique portrayal of the workings of one such institution.
Two physicians are at the center of Jones’ tale: a Dr. Coin who is personally transported by a friendly judge to Ohio where the doctor is to be treated for his alcoholism by a Dr. Car. The jag-house to which Dr. Coin is taken is a large home encircled with shade trees within which a handful of men are in varying stages of recovery from alcoholism. The house itself consists of private bedrooms on the second floor with a clubhouse, library and kitchen on the first floor. The home is administered by a middle-age couple and an old-maid who served as a cook and who believed that most of the patients were “drunken fools and not worth the powder and shot it would take to kill them.” The medical and psychological care of the residents was provided by Dr. Car, who made twice-daily visits to all the patients. The care consisted of tapered withdrawal via decreasing doses of whiskey, hypodermic injections of undisclosed but sedating content, regular ingestion of medicinal tonics, nourishing food, sober fellowship, and the motivational talks of Dr. Car.
The social attitudes toward alcoholism at the time are revealed in a letter Dr. Coin receives from his father-in-law. The letter castigates Dr. Coin for putting his faith in a quack doctor, admonishes him to be a man and control his drinking, and warns him to not attempt reconciliation with his wife.
Following many weeks of treatment, Dr. Coin and his fellow patients are given a certificate of graduation, admonished to remain forever abstinent from all forms of alcohol, and invited to return each year for a reunion of all the former patients and their families. The book ends with Dr. Coins’ joyous reunification with his family and his resolution to never touch alcohol again.
Dr. Coins tale was replicated by the thousands in small homes and sanatoria across the country where well-to-do alcoholics sought help outside of the hospitals that in that era would not admit them for treatment. The Jones’ text illuminates the jag-house as a little-known milestone in the American treatment of alcoholism.
But one mystery remains: What’s with this strange title? Jones explains that OPISTHOPHORUS is an alcoholic disease characterized by the inability to walk forward. Jones explains: “When the one so afflicted is told to advance, he may use every effort to do so, but can only succeed in going backward. He sees his shopmates and old acquaintances getting on comfortably, but the poor fellow who is taken with Opisthophoria can never keep up with them.” So some among my readers may now choose to proudly declare their status as a recovered or recovering Opisthophoric.
For more stories from this early history, see the new edition of Slaying the Dragon: The History of Addiction Treatment and Recovery in America.

Post Date July 21, 2017 by Bill White

July 15, 2017 -Bill White- TOWARD A “CONSPIRACY OF HOPE” (JASON SCHWARTZ AND BILL WHITE)


So it is not our job to pass judgment on who will and will not recover from mental illness and the spirit breaking effects of poverty, stigma, dehumanization, degradation and learned helplessness. Rather, our job is to participate in a conspiracy of hope. It is our job to form a community of hope which surrounds people with psychiatric disabilities. —Pat Deegan
With those words, Dr. Patricia Deegan, Adjunct Professor at Dartmouth College Geisel School of Medicine and indomitable recovery advocate, introduced two ideas with potentially profound implications for the future of addiction treatment and recovery. Below we offer a few reflections on these ideas.
A conspiracy of hope is an organized movement to inject the optimism of lived recovery experience into an arena historically fixated on addiction-related pathology and its progeny of injuries to individuals, families, and communities. But why is there need for such a conspiracy? Opposition to prevailing conditions often arises within the context of oppression. People suffering from addiction and those seeking recovery face innumerable sources of such oppression.
Addiction itself inflicts a rising cascade of consequences, crushing one’s sense of value and blinding one’s vision beyond the insatiable immediacy of drug hunger. Addiction-related social stigma—fueled by media fixation on the most lurid caricatures of addiction—further damages personal identity, fuels social isolation or entrenchment in subterranean drug cultures, and prevents or slows help-seeking. The resulting addiction-based social network behaves like crabs in a bucket—those trying to escape are repeatedly pulled back in. The paucity of helping resources and their lack of accessibility, affordability, and quality all reinforce the view that reaching out for help would be a waste of time and money. When help is sought, the therapeutic pessimism and paternalism of professional and nonprofessional “helpers” can also reinforce low recovery expectations.
As a result of such conditions, addiction-fueled despair whispers and then shouts that we are not deserving or capable of anything different—that recovery is a myth and that the ever-present threats of incarceration, disability, or death are rightful consequences of our unworthiness. Only an organized conspiracy of hope can challenge the oppressive conditions that stand as major barriers to long-term addiction recovery.
Character of the Conspiracy
But what would such a conspiracy of hope require? It would require the cultural and political mobilization of individuals and families in recovery and their allies. It would require a vanguard of such individuals and families willing to share their recovery stories at a public level. It would require those in recovery to move beyond their own personal stories and their particular recovery pathway to identify themselves as “a people” with a shared history, shared needs, and a shared destiny. In short, it would require a social movement aimed at shifting the governing image of addiction from that of the repeatedly relapsing celebrity to the millions of people living quiet lives of stable, long-term recovery. Shifting the dominant view of addiction from one of pessimism to hope will require the involvement of a broad spectrum of people and professions, but people in recovery will be central to this achievement through their individual and collective storytelling and their leadership within recovery advocacy efforts.
There are whole professions whose members share an extremely pessimistic view of recovery because they repeatedly see only those who fail to recover. The success stories are not visible in their daily professional lives. We need to re-introduce ourselves to the police who arrested us, the attorneys who prosecuted and defended us, the judges who sentenced us, the probation officers who monitored us, the physicians and nurses who cared for us, the teachers and social workers who cared for the problems of our children, the job supervisors who threatened to fire us. We need to find a way to express our gratitude at their efforts to help us, no matter how ill-timed, ill-informed, and inept such interventions may have been. We need to find a way to tell all of them that today we are sane and sober and that we have taken responsibility for our own lives. We need to tell them to be hopeful, that RECOVERY LIVES! Americans see the devastating consequences of addiction every day; it is time they witnessed close up the regenerative power of recovery. (White, A Day is Coming, 2001)
What makes this a conspiracy is the knowledge that through these simple acts of storytelling and advocacy we are part of a chorus of others taking similar strategic steps to achieve larger social gains. Built on the back of earlier recovery advocacy efforts, this conspiracy of hope was officially launched at the 2001 Recovery Summit in St. Paul, Minnesota. Christened the New Recovery Advocacy Movement, it has since spread throughout the U.S. and internationally. But the success of this movement hinges on more than our collective storytelling; in Deegan’s vision, it requires a new form of community-building.
Building Communities of Hope
Communities of hope involve creating the physical, psychological, and social space (recovery landscapes) in local communities and the culture at large in which recovery from addiction can flourish. Assuring such space requires building sustainable institutions through which recovery is supported within every area of community life, e.g., government, business and industry, housing, education, medicine, social services, religion, music, the arts, sports, and leisure. The idea of communities of hope means that people in recovery have opportunities to be supported by and in turn support other people in recovery and that those in recovery have opportunities individually and collectively to participate in the larger life of their communities. It also suggests the presence of safe sanctuaries that can serve as incubation chambers for those early in their recovery. We are now witnessing the spread of such new institutions (e.g., recovery community centers, recovery homes, recovery industries, high school and collegiate recovery programs, recovery cafes, recovery ministries, recovery-focused sports and entertainment venues, and recovery celebration events) that transcend the historical categories of addiction treatment or recovery mutual aid societies.
We are also witnessing the emergence of an ecumenical culture of recovery with language that links the distinctive cultures that have historically evolved within these professional and mutual aid settings. Within the addictions arena, the communities of hope that Deegan refers to are under construction across the U.S. and in other countries. That stands as a notable historical milestone within the history of addiction recovery. It is a trend that will benefit individuals seeking recovery and the service systems designed to serve them, but it will also mark a step in elevating the broader health and quality of communal life. We have followed closely the work of John McKnight, Peter Block, and Bruce Alexander on the value of deliberate welcoming, sharing gifts, and collaborative community building and commend their writings to recovery advocates and addiction professionals.
Implications for Addiction Treatment Programs
What does all this mean for addiction treatment programs? Addiction treatment programs could participate in this conspiracy of hope and recovery community building by taking actions such as the following:
*Elevating resilience and recovery as the central organizing constructs for the design and delivery of all services, e.g., strengths-based assessment protocol, recovery-focused training of all service personnel on the prevalence, processes, pathways, stages, and styles of long-term personal and family recovery. Identification and mobilization of client gifts are essential. Conspiracies of hope and communities of hope are built upon participant’s gifts, not their needs.
* Reconnecting what have become ever-briefer episodes of addiction treatment to the larger and more enduring process of addiction recovery via embracing models of recovery management nested within larger recovery-oriented systems of care, e.g., precovery outreach services, assertive linkage to indigenous recovery support institutions, sustained post-treatment recovery checkups, and support services for families in long-term recovery.
*Assuring the presence, diversity, and visibility of people in long-term recovery within the treatment milieu.
* Actively supporting (without controlling or exploiting) local recovery advocacy and recovery community building activities.
* Using community standing to expand the conspiracy beyond people in recovery and beyond service providers, e.g., engaging employers and faith communities as well as other social institutions to make the community “recovery ready.”
Joining the Conspiracy
The journey from addiction to recovery is as possible and fulfilling as it is challenging. Few things are as spiritually energizing as being part of a “conspiracy of hope” to support those journeys. Such journeys are eased when nested within a community of fellow travelers. Few things are as fulfilling as being part of building such communities. Are you ready to join the conspiracy of hope and nurture the development of communities of hope? What steps could you take today to assert such a commitment?

Post Date July 15, 2017 by Bill White

July 7, 2017 -Bill White- NARRATIVE-BASED ADDICTION MEDICINE IN AN EVIDENCED-BASED WORLD (JONATHAN J. KOPEL AND BILL WHITE)


In 1976, Dr. Thomasina Borkman penned a now-classic paper depicting two ways of knowing: professional knowledge and experiential knowledge. In distinguishing the two, she noted the following: “In contrast to professional information, experiential knowledge is (1) pragmatic rather than theoretical or scientific, (2) oriented to here-and-now action rather than to the long-term development and systematic accumulation of knowledge, and (3) holistic and total rather than segmented.” The tension between these two ways of knowing is evident throughout the history of addiction treatment and recovery and within the relationship between academically trained addiction professionals and helpers credentialed by personal addiction recovery experience. While the categories of professional and experiential knowledge are not mutually exclusive, the tensions between the two have heightened in both primary medicine and addiction medicine.
Within primary health care, evidenced-based medicine (EBM) remains the primary methodology for examining the efficacy of medical treatments. EBM was originally developed to counter the rise in harmful or ineffective treatments being disseminated within the medical field. EBM is based on a rigorous analysis of the risk, costs, and side effects of any proposed treatments through randomized trials and meta-analytic studies. Although EBM has dramatically improved treatment outcomes, it fails to reflect the full spectrum of factors involved in the care and healing of patients. Each patient has a unique personality, culture, ethnicity, history, social standing, and religious background, which EBM cannot analyze quantitatively, but which are critical to providing optimal care and addressing the full spectrum of physical, emotional, and spiritual needs of the patient. In light of EBM’s limitations, many physicians have adopted narrative-based medicine (NBM) within their clinical practice and research.
Unlike EBM, NBM focuses on examining the intertwining narratives found between physician-patient relationships and society. As Ian McWhinney explains, “It is not easy for us to attend to our patients’ experience. To do so requires us to step out of our usual way of attending to a person’s illness. We are trained to see illness as a set of signs and symptoms defining a disease state – as a case of diabetes or peptic ulcer or schizophrenia. The patient, on the other hand, sees illness in terms of its effects on his or her life. The physician therefore must learn to see illness as it is lived through, before it has been categorized and interpreted in scientific terms”. Rather than being viewed as a statistic or disease entity, each patient within the NBM is understood and encountered through the lens of their personal journey and narrative. In the framework of NBM, the physician aims to utilize the narratives of themselves and their patients to address the relational and psychological dimensions involved in both treatment and healing.
Similar trends are evident in addiction medicine and the larger arena of addiction treatment. There is, on the one hand, a growing emphasis on evidence-based practices and competency-based training of addiction treatment practitioners. On the other hand, there is a growing recovery advocacy movement that seeks to reconnect acute care models of addiction treatment to the larger and more enduring lived experience of personal and family recovery. The latter is being supported, in part, by the re-integration of people with lived experience of recovery as “wounded healers” within the clinical world of addiction treatment. The result is an effort to identify and replicate scientifically-validated methods of treatment that have measurable effects on recovery outcomes and parallel efforts to help patients weave such supports into larger narratives that have personal and cultural salience.
What is occurring in primary health care and addiction treatment is a blending of professional knowledge and experiential knowledge. Such a synthesis can counter the limitations of each way of knowing and holds great promise within the future of both primary medicine and addiction medicine. This shift will require shifting the service relationship from an expert model to a sustained recovery partnership.
About the Authors: Jonathan Kopel is an M.D./Ph.D. student at the Texas Tech University Health Sciences Center (TTUHSC); Bill White is author of Slaying the Dragon: The History of Addiction Treatment and Recovery in America.
References
Borkman, T. (1976). Experiential knowledge: A new concept for the analysis of self-help groups. Social Service Review, 50(3), 445-456.
McWhinney, I. (1997). A Textbook of Family Medicine. 2 ed. New York: Oxford Univeristy Press.

Post Date July 7, 2017 by Bill White

June 30, 2017 -Bill White- SPEAKING TRUTH IN SILENCE

Addiction is often accompanied by mutations in character (e.g., lying, deceit, manipulation, aggression) that in turn spark breaches of trust within one’s family, personal, and professional relationships. It is thus not surprising that addiction constitutes one of the few health conditions in which reconstruction of character is posited as an essential dimension of the recovery process.
Addiction-spawned changes within the brain contribute to these mutations via the prioritization of sustained drug use above all other human needs and values. Such aberrations also constitute defensive gambits to avoid drug-related consequences and the emotional toll of guilt, shame, self-hatred, and fear of insanity. Whatever their source, affected parents, siblings, children, intimate partners, extended family members, friends, employers, business associates, creditors, and professionals seeking to offer help all bear the brunt of the resulting breaches of trust.
So for one on the brink of entrance into recovery, key questions become: “How can trust, once lost, be again restored? How do I get people to listen, who, for their own sanity and survival, no longer believe my words?” I have been asked such questions for nearly half a century by people beginning their recovery journeys. There are several things I have learned from these prolonged consultations. Trust can be strained, broken, or shattered, and only the latter is impossible to repair. Trust being healed is fragile and easily re-broken. Restoring trust takes time. Trust-building is best nested within a larger reconstruction of personal identity and values. But most importantly, trust is rarely, if ever, initially restored by words.
Words of manipulation play such an important role in addiction maintenance. If one were asked, “How could you maintain addiction for so long?” the answer might well be, “It was all done with words.” But the verbal proficiency of active addiction is a double-edged sword. While helping preserve the intimate drug relationship, it erodes all other relationships and, in that process, destroys any value our words may have once possessed. The lies, the deflections, and the failed promises and resolutions all become part of the mask of addiction that others come to distrust.
So where does that leave the man or woman standing on the threshold of recovery wanting to retrieve the remnants of personal integrity? The answer quite simply is that, like reestablishing a lost credit rating, you must act your way into recovery until your words again have value. If you seek trust from others, then seek first to be trustworthy by being reliable and responsible, humble and helpful, forgiving and grateful.
We are most eloquent, and most trustworthy, when we speak silently through our actions. Only our actions can restore the integrity of our words. And that is a time-dependent process for which we and we alone are responsible. So, when posed with the trust questions, I offer quite simple guidance. Show up and keep showing up. Be there for people and keep being there. Be of service to others and keep serving. When no one is surprised by our consistent presence, then we can speak fresh words of truth from a now sobered heart.

Post Date June 30, 2017 by Bill White