September 29, 2017 -Bill White- RECOVERY MILESTONES OF THE EARLY 21ST CENTURY


One of the most difficult challenges facing the historian is evaluating a series of linked events while they are still unfolding and while their long-term import remains unclear. That is a challenge I regularly face in recounting recent threads within the evolving fabric of addiction treatment and recovery in the United States. This brief essay risks identifying emerging trends I believe to be of enduring historical significance. Here are 12 advancements within the history of addiction recovery that mark the opening years of the 21st century.

1) The international growth and philosophical diversification (secular, spiritual, religious) of addiction recovery mutual aid societies. This trend is expanding recovery support choices and stirring calls for researchers to formally map the multiple pathways, styles, and stages of long-term addiction recovery.

2) Scientific research confirming the widespread phenomena of natural recovery (people resolving alcohol and other drug problems without the aid of professional intervention or participation in recovery mutual aid groups), particularly among people with lower problem severity/complexity/chronicity and higher recovery capital. The prevalence of natural recovery is spurring discussion about how this style of recovery could be professionally and publicly legitimized, promoted, and supported.

3) The explosive growth of virtual recovery communities and technology-based recovery support resources that are dramatically increasing accessibility of recovery support. The potential import of this technological revolution within the history of recovery support is incalculable.

4)The political and cultural mobilization of people in personal/family recovery and their allies via a new recovery advocacy movement. This movement has exerted, and continues to exert, a profound influence on drug policy, the level of social stigma attached to addiction and addiction recovery, and the status and design of addiction treatment and recovery support services.

5) Emergence of recovery as a new organizing paradigm within the alcohol and drug problems arena, including federal, state, and local agencies granted cultural ownership of alcohol and other drug problems. This marks a shift in focus from pathology (etiology, course, and consequences) and intervention (methods of brief biopsychosocial stabilization) to a focus on lessons drawn from the lived experience of long-term personal/family recovery.

6) Challenges to extend acute and palliative care models of addiction treatment to models of assertive and sustained recovery management (RM) (across the stages of personal and family recovery) that are ideally nested within larger recovery oriented systems of care (ROSC). Most debates about the relative merits of various addiction treatments for the past two centuries have addressed issues within the acute care model; RM and ROSC constitute fundamental challenges to the historical design of addiction treatment.

7) Promising experiments in conceptual and practice integration across ideological divides within the addictions field, including efforts to integrate prevention, harm reduction, early intervention, treatment, and recovery support services (e.g., the integration of medication assisted and psychosocial approaches to addiction treatment). Particularly promising are strategies that integrate time-sustained clinical and mutual aid models of intervention with environmentally-focused public health models.

8) Recovery-focused service integration initiatives between addiction treatment and allied systems (e.g., primary medicine, psychiatry, child welfare, criminal justice, etc.). Of these, efforts toward the tri-directional integration of primary medicine, psychiatry, and addiction treatment are of profound significance in supporting early recovery initiation and long-term recovery maintenance.

9) The development of new recovery support institutions (e.g., recovery centers, homes, schools, industries, ministries, cafes, etc.) and new recovery support roles (e.g., recovery coaches) that fall outside the historical rubrics of recovery mutual aid groups, addiction treatment, and traditional helping roles. These new institutions and roles stem from an understanding of the ecology of recovery—the belief that the tipping point of recovery is determined as much by community recovery capital (the physical, psychological, and social space within which recovery can flourish) as by intrapersonal factors.

10)The growth of an ecumenical culture of recovery that transcends one’s identification with a particular treatment or recovery mutual aid enterprise, resulting in people in recovery seeing themselves as “a people” whose collective stories are expressed through recovery-infused history, language, values, symbols, rituals, music, literature, art, cinema, theatre, and sport. This blossoming culture of recovery is particularly valuable to those who have been enmeshed in the culture of addiction. The culture of recovery provides a world in which sustainable recovery can be physically and socially nested.

11) The recognition that recovery can be socially contagious. This is spawning systematic efforts to reduce environmental obstacles to recovery and increase the density of recovery carriers within local communities via assertive community outreach and recovery-focused professional and public education. (Recovery carriers are people whose quality of life and character—genuineness, hopefulness, and helpfulness) attract others to the recovery lifestyle.

12) Recovery research advancements, including research scientists and clinical leaders focusing their research portfolios on the experience, prevalence, and processes of addiction recovery. Particularly noteworthy is a new generation of MA and PhD students focusing their theses, dissertations, and future research plans on the study of addiction recovery.

Some years ago, I addressed my professional colleagues with the following observation:
What we know about alcohol and drugs, addiction, and the short-term treatment of addiction fills libraries, and this knowledge has helped many people start their recovery journey. But what we know as a professional field about long-term personal and family recovery from addiction from the standpoint of science and clinical practice could at best barely fill a few scant shelves within such libraries….As communities of people in long-term recovery turn to addiction scientists and clinicians in search of guidance on such issues, we find little recognition of our existence and little guidance. So we turn to each other and wonder collectively why, after decades of addiction research, our most basic questions about recovery remain unanswered.
That world is changing, based on the recent trends noted above. The 21st century might well become the century of recovery—yes, for the addictions field, but more importantly for individuals, families, and communities across the globe. Perhaps this will also be the century when the world begins to heal itself. Each of us has a potential role to play in this healing process.
Post Date September 29, 2017 by Bill White

Advertisements

September 22, 2017 -Bill White- RECOVERY HISTORY AND THE NEW RECOVERY CONSCIOUSNESS

Advocacy movements require transforming highly personal stories into the collective narrative of “a people.” Merging the individual stories into a larger collective mosaic allows people with shared characteristics and experiences to see their past and future as part of a larger drama. As Marcus Garvey suggests, individuals become a people only when connected to their shared historical roots.
So when did Americans in addiction recovery first begin to see themselves as “a people” with a shared heritage and destiny? The roots of such consciousness begin in the late 1700s within abstinence-based religious and cultural revitalization movements among Native American tribes, arise anew within the early American temperance societies, and extend into groups formed exclusively for the purpose of recovery mutual aid—the Washingtonians, recovery-focused fraternal temperance societies, the ribbon reform clubs, and groups links to the earliest addiction treatment programs (e.g., the Ollapod Club, Godwin Association, Keeley Leagues). Dozens of such groups predate the founding of Alcoholics Anonymous, other 12-Step groups, and their modern religious and secular alternatives.
Much of this history is recounted in three books: Slaying the Dragon: The History of Addiction Treatment and Recovery in America, Alcohol Problems in Native America: The Untold Story of Resistance and Recovery (with Don Coyhis), and The History of Addiction Counseling in the United States. Summations of the history of addiction recovery have also appeared in a series of authored and co-authored articles that are available for free download on my website. For readers interested in this history, I commend the following articles:
Addiction and Recovery in Native America: Lost History, Enduring Lessons (With Don Coyhis)
The History of Recovered People as Wounded Healers: I. From Native America to the Rise of the Modern Alcoholism Movement
The History of Recovered People as Wounded Healers: II. The Era of Professionalization and Specialization
Listening To Lazarus: The Voices of America’s first “Reformed Drunkards”
The Role of Recovering Physicians in 19th Century Addiction Medicine: An Organizational Case Study
Addiction and recovery among African Americans before 1900 (with Mark Sanders).
Addiction in the African American Community: The Recovery Legacies of Frederick Douglass and Malcolm X (with Mark Sanders)Pre-AA Recovery Mutual Aid Societies

Twelve Defining Moments in the History of Alcoholics Anonymous (with Ernie Kurtz).
Faith-based Recovery (with David Whiters)
Styles of Secular Recovery (with Martin Nicolaus)
Early recovery biographies, interviews with recovery advocacy leaders, and key documents related to the history of secular, spiritual, and religious recovery mutual aid groups are available by clicking HERE, HERE, and HERE.
One of the most significant historical trends within the history of addiction recovery is people in recovery beginning to see themselves as “a people” apart from affiliation with a particular treatment or recovery mutual aid enterprise. This rising ecumenical culture of recovery is marked by a new language of self-identification and expression; political mobilization; economic development; new recovery support institutions; and creative innovations in the arenas of music, art, literature, cinema, theatre, and new rituals of celebration and protest. Unraveling and extolling the history of recovery are part of this new recovery consciousness, which is itself a historical milestone. Researching and mining the lessons of history are legitimate forms of recovery activism. How might you help capture or pass on the stories that make up the history of addiction recovery?
Post Date September 22, 2017 by Bill White

September 18, 2017 -Bill White- RECOVERY RISING: A RETROSPECTIVE OF ADDICTION TREATMENT AND RECOVERY ADVOCACY

I am soliciting your assistance in announcing the publication of my latest book, Recovery Rising A Retrospective of Addiction Treatment and Recovery Advocacy.
I have worked in the arenas of addiction treatment, recovery research, and recovery advocacy for nearly half a century and been blessed with opportunities to work with some of the leading policymakers, research scientists, clinicians, and recovery advocates of my generation. At this late stage of my life, it seemed a worthy effort to try to pass on some of the hard-earned lessons I have drawn from this work. Such was the inspiration for turning decades of professional journaling into a book of stories that highlight, through my own experiences, some of the major milestones in the modern history of addiction treatment and recovery.
Recovery Rising contains more than 350 vignettes with accompanying reflective questions that allow readers to explore their own thoughts and experiences related to the most challenging issues within the front lines of addiction treatment and recovery support. Recovery Rising is a sweeping story that readers may wander (and wonder) through at their leisure, pausing to reflect on the personal meanings that can be drawn from each vignette. I have tried to create the book I wish my professional elders had placed in my hands when I began this special service ministry. I hope you and others will find your life’s work affirmed in these pages and that a younger generation of addiction professionals and recovery advocates will feel the passing of a torch.
Recovery Rising is available through Amazon in e-book ($9.99) format and may be ordered by clicking Amazon or Amazon UK. A paperback format is coming soon.
Any help you can provide in letting others know about the release of the book via your professional network or social media will be deeply appreciated. A portion of the proceeds from each book will be donated to grassroots recovery advocacy organizations.
Bill White

September 1, 2017 -Bill White- MECHANISMS OF CHANGE IN ADDICTION RECOVERY

High degrees of variability in the pathways and styles of addiction recovery obscure shared mechanisms of change across such healing processes.
The alcohol and drug problems arena is filled with professional claims and counterclaims, excessive marketing hype, and riveting personal testimonies of how such problems can be best resolved. The central stakeholders in these debates commonly assert that their particular ideas and methods constitute THE TRUTH, and wrap these claims in the mantle of science or personal/clinical experience. The resulting noise can leave listeners understandably bewildered about the nature of such problems and their ultimate solution.
People recover with and without the ever-expanding menu of professional treatment; with and without medication support; with and without involvement in the growing networks of religious, spiritual, and secular recovery mutual aid groups; and with and without involvement in new recovery support institutions (from recovery homes and collegiate recovery communities to recovery cafes and recovery ministries). Some find culturally indigenous pathways of resistance and recovery (e.g., The Red Road, Wellbriety Movement). For some, recovery is a transformative conversion experience, while for others it is a long-term process of incremental change. Some take on new recovery identities and recovery-based social networks, while others do not. For some, problem resolution involves a deceleration of drug use, while for others it involves complete and enduring abstinence. For some, recovery involves a complete reconstruction of one’s life; for others, changes in alcohol and drug use occur within an otherwise unchanged life. And on and on the varieties continue. So what does one make of such varieties?
As a person in long-term recovery, a treatment practitioner, a recovery historian, and a recovery research scientist, I have conducted a sustained meditation on the recovery process across diverse populations and cultural contexts for nearly half a century. Here are some of the conclusions I have drawn at this late stage of my life.
*The resolution of alcohol and other drug (AOD) problems is marked by multiple pathways and styles. All should be cause for affirmation and celebration.
*The question, “Which pathway of recovery is best or most effective?” is unanswerable without reference to “For whom?”, “At what point in time within that person’s addiction/recovery life cycle?”, and “Within what environmental and cultural context?”.
*Addiction recovery involves processes of destruction, retrieval, and creation. Destruction entails breaking entrenched patterns of acting, thinking, feeling, and relating. Retrieval involves the reacquisition of lost assets. Creation requires new recovery-nourishing daily rituals, character traits, relationships, and reformulating life meaning and purpose. These recovery processes can be thought of in terms of subtraction, addition, and multiplication.
*Secular, spiritual, and religious pathways of addiction recovery address the need to address addiction-spawned debris/baggage (i.e., harm to self and others) via such processes as acceptance, commitment, self-inventory, confession, acts of restitution, and acts of service.
*Seemingly contradictory metaphors of change (e.g., powerlessness and empowerment) may be simultaneously or sequentially integrated within the recovery process. This can be seen in patterns of dual citizenship in recovery (i.e., individuals who concurrently participate in Alcoholics Anonymous and SMART Recovery or Women for Sobriety).
*Distinct pathways of recovery (e.g., secular versus spiritual and religious, assisted versus unassisted) often share common mechanisms of change.
*While many factors (e.g., age, gender, sexual orientation, gender identity, ethnicity, etc.) may influence the saliency of particular mechanisms of change, the two most powerful of such influences appear to be problem severity/complexity/duration and personal/family/community recovery capital. Recovery pathways and styles differ markedly across these two dimensions.
*Mechanisms of change and related recovery support strategies that are effective for those with low problem severity/complexity/duration and moderate to high recovery capital cannot be indiscriminately applied to those with high problem severity/complexity/duration and low recovery capital. And vice versa!
*Mechanisms of change common across recovery pathways include breakthroughs of self-perception, mutual identification, trust, the creation and maintenance of hope (to move beyond pain of the past and forge a better life), self-efficacy (confidence in ability to adhere to AOD-related change in the face of high-risk social situations and positive/negative emotions), coping skills, termination of pro-drug relationships, acquisition of pro-recovery relationships, helping others, and spirituality. These mechanisms work simultaneously and synergistically, and combinations may vary across individuals, stages of recovery, and cultural settings.
*Recovery can be initiated at any stage in the progression of AOD problem development. Mechanisms of change and their catalytic metaphors may differ significantly by the stage of problem severity at which recovery is initiated. Some mechanisms (e.g., spirituality) are likely to have greater salience among those with greater problem severity and fewer social supports. Mild to moderate AOD problems are commonly resolved through acts of self-assertion (drawing on strength within the self) where the resolution of the most severe, complex, and chronic AOD problems are marked by a process of self-transcendence (reliance on strength outside the self).
*The factors required to sustain recovery may be different than those required to initiate recovery. While particular mechanisms of change may differ across individuals and within the same individual across the stages of recovery, some mechanisms of change seem to span stages of recovery. A change in status within any of these mechanisms may influence both quality of life in recovery and the risk of addiction recurrence.
*Combining/integrating mechanisms of change may have a catalytic effect in recovery initiation or enhancing quality of life in recovery beyond what could be predicted from the effects of the single ingredients.
*Historically, there has been more focus on conflict than commonalities within AOD problem resolution strategies. Quite promising are recent studies by Dr. John Kelly and others on shared mechanisms of change within what on the surface appear to be different recovery processes.
The mechanisms of change in addiction recovery are often nested within two very different processes: story construction and storytelling. Those experiencing addiction, affected family members and friends, and those seeking to offer help all have a need for sense-making. All, including myself, develop theories about the sources and solutions to addiction and weave these into personal and professional narratives that may or may not have anything to do with the actual processes through which such change occurs. The ultimate truth (and the best news) is that such change is possible and increasingly common.

Post Date September 1, 2017 by Bill White