Bill White-TOWARD A TECHNOLOGY OF HOPE-September 21, 2018


Andy: Remember Red, hope is a good thing, maybe the best of things, and no good thing ever dies.

Red: Hope is a dangerous thing my friend, it can kill a man.

–The Shawshank Redemption

In earlier blogs, we explored the curse of low recovery expectations expressed in policy, professional, and public contexts and how those who work in addiction treatment and other recovery support roles can counter addiction-related stigma in their public and professional interactions. The present blog addresses how those working in such roles can ignite hope among addicted people and their families who may themselves have internalized the socially and professionally pervasive pessimism about the prospects of long-term addiction recovery.

Recovery from severe addictions has long been framed as a pain quotient: Recovery becomes possible when the pain of addiction gets greater than its experienced rewards (e.g., when people “hit bottom”). Belief in this equation has two unfortunate consequences. First, it provides the historical rationale for heaping untold pain (shame, social shunning, arrest, incarceration, and invasive and humiliating “treatments”) on those addicted with little awareness that such interventions may actually thrust the individual deeper into addiction. Second, it ignores the critical role hope plays in recovery initiation. Escalating pain in the absence of hope is an invitation to, at best, accelerated drug use, or, at worst, suicide.

The pain of addiction-related consequences serves as a catalyst of recovery only in the presence of hope. The natural history of addiction will provide sufficient quantities of pain to incite recovery readiness, but what and where are the sources of hope essential for recovery initiation? And what roles can addiction professionals and peer recovery support specialists play in nurturing such hope? Below are some prescriptive actions that addiction professionals and those providing recovery support services can use to elicit hope in the face of addiction-fueled despair.

    Practice a Ministry of Presence
    Addiction is a disorder of disconnection with hope for recovery most often rising in the context of relationships—relationships marked by empathy, compassion, respect, and encouragement. The first gift we give those in need of recovery is our time and attention. Practicing this ministry of peaceful presence requires quieting the roar of our own pressing needs to be fully present, to listen, and to experience another’s story. It is helpful to recall people in our own lives who gifted us with such hopeful presence. The first acts of help and hope? Listen, Listen, Listen.

    Capitalize on Crisis Most people seeking our help will arrive in crisis, and the crises will keep unfolding well into recovery–the legacy baggage of addiction. Some of those we serve will be as addicted to such crises as they were to the drugs in their lives. Each crisis is a window of potential opportunity—a turning point, a teachable moment, a developmental window of opportunity, a crossroads—to help those we serve see the larger picture of their lives, understand how such crises are created, learn how they can be shed, and, most importantly, how they can be prevented. Rather than simply rescuing, crises are opportunities to teach critical thinking and problem-solving skills. Hope rises exponentially with the expansion and application of such competencies.

    Normalize Ambivalence Addiction and early recovery are each marked by extreme ambivalence. What the individual wants to do more than anything is to maintain the drug relationship—the very definition of addiction. What the individual wants to do more than anything is to sever the drug relationship—the essential requirement for recovery initiation. It is helpful to acknowledge this ambivalence. The scales of such ambivalence can often be tipped towards recovery by periodically conducting a pro-con analysis of drug use and the rewards each person hopes to gain from recovery. This first involves reviewing what drugs did for (+) the person and what drugs did to (-) the person. The second involves envisioning the promised of recovery.

    Express Confidence in Their Capacity to Recover Let those you are helping know that recovery is the norm rather than the exception and that, with concerted effort, they can join millions of people who have achieved long-term recovery and its gifts. That confidence can best be expressed by hanging in with them in the face of setbacks after which they have been historically abandoned by others in anger and disgust. Let those we serve know that those seeking recovery can achieve together what each was unable to achieve alone. Let them know that previously hidden powers within and beyond themselves can be mobilized to speed this journey. Conduct a formal inventory of each person’s assets (recovery capital) and acknowledge incremental changes as a way to stoke confidence and sustain the momentum for change.

    Offer Living Proof of Recovery Share your own story of recovery and/or your witness of the recovery of others over the course of your career and expose the newcomer in recovery to as many people in long-term recovery as possible, particularly people with whom they may experience strong mutual identification. Make sure such exposure includes recovery carriers—people in recovery who make recovery contagious based on their infectious personalities, character traits, and their service activities. Offer living proof that people whose lives were diminished by destructive addictions now experience purpose-driven lives day after day, year after year, without the need for chemical anesthesia. Expose them to the laughter of recovery—that raucous, joyous expression of relief, release, and gratitude.

    Acknowledge the Varieties of Recovery Experience Convey to those seeking recovery that there are many pathways and styles of recovery and share descriptions of such variations, e.g., with and without treatment, through varied treatment methods, with and without medication, with and without recovery mutual aid participation, through a variety of mutual aid choices, etc. Choice of recovery goals and methods incentivizes recovery initiation and enriches quality of life in recovery.

    Share Iconic Stories Expose those you are helping to the stories of earlier recovery pioneers with whom they can identify. Good storytellers are among the most effective professional helpers. Collect stories that inspire and elevate those you serve. Use stories to convey catalytic words, phrases, and metaphors that are personally and culturally meaningful. For members of marginalized groups, link the personal story to the larger story of recovery of a people, e.g., drugs as a tool of oppression and recovery as an act of personal/cultural/political resistance.

    Facilitate Story Reconstruction and Storytelling Help the person seeking recovery make sense of the chaos they are experiencing via their own story: 1) Who was I before I began using? 2) Who and what did I become as a result of my use? 3) Why me? How do I explain what happened? 4) What led to my decision to change? 5) Who and what am I now? 6) Where am I going and what do I need to do to get there? Exploring these questions activates the push and pull forces of recovery and opens the further question, “Recovery to do what?”—a self-questioning that in some cases involves the retrieval of childhood dreams and aspirations.

    Provide Exposure to the Culture of Recovery Guide those seeking recovery into relationships with people, places, and things that support recovery. Help them discover recovery-friendly people and places within their local community. Provide exposure to the language, symbols, rituals, literature, music, film, theatre, and art of recovery. Articulate recovery values. Note the growing number of recovery support institutions. Introduce those you serve to others in recovery with shared backgrounds, vocations, avocations, and aspirations. Social support is the glue that binds elements of a recovery lifestyle.

    Provide Systems Navigation Those with the most severe and greatest number of problems who you serve may need resources across multiple systems to initiate and sustain their recovery. Navigating the ever-complex helping systems can be extremely frustrating and lead to pessimism about one’s prospects for change. Providing a map and tour guide through these systems can minimize such frustration and allow clearer visualization of a later life in recovery.

    Convey The Promises of Recovery Let those you are helping know that recovery is more than the deletion of problems from an otherwise unchanged life. Let them know that recovery brings with it an unlimited range of possibilities to not just get well, but to get better than well. Let them know that recovery comes with the potential for a new life of meaning and purpose.

    Recovery opens a doorway to a new life. In this rebirthing process, hope is a glowing new skin. The above are among the actions I have found that stimulate hope in the recovery process. What actions would you add to this list?

    Before closing, a final note of warning from Red is warranted. Hope has restored and transformed untold number of lives, but there is also a risky side of hope. Elevating hope without the necessary resources to fulfill that hope risks fueling endless despair and self-destruction. When we offer hope, we must have the capacity to deliver on the promises of recovery. Achieving “recovery by any means necessary under any circumstances” doesn’t require perfect resources, but it does require that we fulfill our commitment of continued recovery support over time—again, that ministry of presence.

    Post Date September 21, 2018 by Bill White

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Bill White-VARIATIONS IN RECOVERY IDENTITY ADOPTION-September 14, 2018

A significant portion of people who resolve alcohol and other drug (AOD) problems do not embrace a recovery identity—do not see themselves as recovered, recovering, or in recovery. I first suggested this in Pathways from the Culture of Addiction to the Culture Recovery (1990) and later in a co-authored essay on the varieties of recovery experience (White & Kurtz, 2006), but had nothing but years of observation and anecdotal stories to support it. When I was asked about the prevalence of adoption or non-adoption of a recovery identity among people who had resolved AOD problems, no data were available to inform that question. Thanks to a just-published study by Dr. John Kelly and colleagues of the Recovery Research Institute, there is now data that addresses that and related questions.

The Kelly-led research team surveyed a representative U.S. population sample of people who had resolved a significant AOD problem during their lifetime and determined the extent to which such individuals adopted a recovery identity and whether such identification had changed over time. Here are some of their major findings.

*Of the 45.1% of people who had resolved an AOD self-identified as “in recovery”, 39.5% had never seen themselves as being “in recovery”, and 15.4% once identified as being “in recovery” but no longer embraced a recovery identity. Of all people with recovery identification at some point in their lives, 25% no longer embrace a recovery identity.

*People who had resolved an AOD problem and who also currently embraced a recovery identity were more likely to have been diagnosed with a substance use disorder (SUD), diagnosed with a mental health disorder, treated for a SUD, and more likely to have been involved with a recovery mutual aid group—all potential proxies for greater problem severity and complexity.

*People who had resolved an AOD problem who never saw or presently do not see themselves “in recovery” offered several reasons for not embracing a recovery identity: 1) self-perceived lower problem severity, 2) self-perceived ability to function in spite of AOD problems, 3) ability to stop AOD use without peer or professional help or, for some, success in decelerating use to escape AOD-related problems, 4) seeing AOD problem resolution as a past chapter of their life—a past decision—and not a present struggle, and 5) a desire to avoid the “sickness” label.

*Quality of life indicators did not differ across the three groups (current recovery identity, rejection of recovery identity, once embraced but now reject recovery identity).

The Kelly group study confirms the variations in recovery identity among people who have resolved a significant AOD problem. It appears that people with lower problem severity may resolve AOD problems without embracing a recovery identity, while people with greater problem severity may find it helpful to embrace such an identity as a mechanism of stable recovery maintenance. Also of note is the portion of people who evolve out of a recovery identity over time. These include people who may have once been involved with a recovery mutual aid group but who have sustained problem remission after cessation of such active participation. I have discussed these populations in earlier blogs HERE and HERE.

What is becoming apparent and confirmed in multiple studies is that AOD problems exist of a broad spectrum of problem severity with quite different lifetime trajectories—from risky use, binge use, sustained heavy use, and compulsive use. Problem resolution strategies and personal styles vary greatly across this spectrum. The question facing addiction treatment as a social institution and recovery community organizations is this: Do we seek cultural ownership of all AOD problems or only the most severe and complex of such problems?

If the treatment field embraces responsibility for all AOD problems, then our knowledge base, our change and support technologies, and our public messaging must be dramatically broadened and become far more nuanced. If the field restricts itself to the most sever and complex AOD problems, then we need to clearly define the boundaries of our expertise, practice only within those boundaries, and make it clear that other social institutions are responsible for AOD problems marked by lower severity, complexity, and chronicity. Unintended harm can come from indiscriminately applying models of care and support designed for high problem severity and low recovery capital typical of late state SUDs to people with low problem severity and high levels of recovery capital—and vice versa!

The Kelly recovery identity study also has important implications for how we communicate to the public and policymakers about AOD problems. As the Kelly research team suggests, “AOD public health communication efforts may need to consider additional concepts and terminology beyond recovery (e.g., “problem resolution”) to meet a broader range of preferences, perspectives, and experiences.”

Are the addiction treatment and recovery support fields capable of reaching people within this broader spectrum of AOD problems? Are they ready to embrace broader pathways and styles of AOD problem resolution? The fact that less than half of people who have resolved a significant AOD problem see themselves as “in recovery” is a striking finding. Are we ready to introduce ourselves to the other half and face the challenges such contact will inevitably bring to prevailing ideas and service practices? What do you think?

References

Kelly, J. F., Abry, A. W., Milligan, C. M., Bergman, B. G., & Hoeppner, B. B. (2018). On being “in recovery”: A national study of prevalence and correlates of adopting or not adopting a recovery identity among individuals resolving drug and alcohol problems. Psychology of Addictive Behaviors, August. doi: 10.1037/adb0000386

Kelly, J. F., Bergman, B., Hoeppner, B., Vilsaint, C., & White, W. L. (2017). Prevalence, pathways, and predictors of recovery from drug and alcohol problems in the United States Population: Implications for practice, research, and policy. Drug and Alcohol Dependence, 181, 162-169.

Post Date September 14, 2018 by Bill White

Bill White-THE FUTURE OF RECOVERY SCHOLARSHIP-August 5, 2016

Is it possible we are seeing the rise of a new generation of scholar activists who combine the experiential knowledge of addiction recovery, academic excellence, and a desire to give back through recovery-focused research, writing, teaching, and advocacy activities?

Over the past decade, I have interviewed many of the pioneers who made major contributions to the modern scientific and historical study of addiction recovery. All of these pioneers brought impeccable academic credentials to their work, but many withheld their personal or family recovery status or only disclosed that status late in their careers when they felt such disclosure would not damage their career opportunities or professional reputations. (See HERE and HERE for examples of the latter). Such secrecy or delays in disclosure were the result of the social stigma attached to addiction. Major efforts to reduce recovery-related stigma may make it easier for a new generation of scholars to pursue the study of the personal and family recovery experience while living openly as people in long-term addiction recovery.

Six factors will influence this future. First, the levels of education of people in recovery is increasing due both to the number of people with advanced education who are seeking recovery and the number of people in recovery choosing to pursue continued education as part of their recovery process. As examples, nearly 20% of AA members work as professionals, health professionals, or educators; 41% of surveyed NA members report having a college or graduate degree; and 47% of SMART Recovery members report having a college or graduate degree. Second, resources have expanded via the growing network of collegiate recovery programs through which people in recovery can pursue advanced education in a recovery-supportive academic and social environment. Third, there are now more than 280 colleges and universities offering formal addiction studies programs that academically prepare people to work within such areas as policy, administration, research, harm reduction, prevention, treatment, and recovery support services (Click HERE for a full list of such programs). The number of recovery-focused studies within Master’s theses and doctoral dissertations is increasing exponentially. Fourth, people are entering recovery at younger ages, with a growing contingent of politically aware and articulate young recovery advocates, some of whom are being drawn to academically prepare themselves for a career in the addictions field. Fifth, this emerging generation of recovery advocates has a seasoned vanguard of recovery role models working as addiction professionals, including at the highest levels of policy development and service delivery, as well as strong associations representing addiction medicine specialists and other addiction professionals. Sixth, recovery mutual aid organizations are themselves getting more involved in historical research and in collaborating with academic and private research organizations in the conduct of recovery research. Collectively, these forces are motivating people in recovery to further their education and extend their avocation of volunteer service work into a vocation within the addictions field.

This is all a way of saying there are ways that those who have been part of the problem can be part of the solution and that this influence can be exerted locally, nationally, and globally. Perhaps this invitation is being written for you. Perhaps you have changed your own life for a purpose that remains unclear to you. Perhaps that purpose is to help change the world—to help us understand the personal and family recovery processes in new ways, to elevate the quality of addiction treatment, to widen the doorways of entry into recovery, or to help find ways to break intergenerational cycles of addiction. Yes, such contributions will take a profound commitment, sustained preparation, and tenaciousness that will test you beyond measure. But from one who has followed this path, I invite you to accept the torch extended to you from my aging generation of scholar activists. Combining recovery-grounded experiential knowledge with the most rigorous historical and scientific methods of inquiry might indeed reshape the future of addiction and addiction recovery. Is that vision something that calls to you? Is it time to begin or take the next step in your preparation for this calling?

Post Date August 5, 2016 by Bill White