My personal experience with addiction ~ my journey into recovery from drugs and alcohol guide me and my team.

I would like to think that other treatment providers and those in this industry have their clients best interest in mind when treating, housing and advising people in early recovery. In the 10 years that I have spent preparing for this day, I have seen myself and others in the field of addiction recovery grow and find that we are not in control. Not in control of anything but ourselves.

The person sitting in front of you is at an impasse that is not always fully recognizable to many ‘providers’. It has always been a hard thing to witness when the person sitting in front of you is sitting in front of you. We tend to rationalize and internalize that which is obvious to people suffering from SUD. What I am trying to say is that most of us want to help, but are truly not listening and understanding the client. Put yourself in their shoes, live and learn from the person instead of wanting to jump in and swim without knowing why you are swimming.

Here’s a good way of stating this-What is it that stops a person from wanting a better life? What is a better life and why are we wanting to make it better for the person weeping in your office.

The best advice I could give a provider, an addict or anyone is open your to truly open your ears, open your mind, and open your heart. Once you have dropped all of the bullshit and stigmas we all have, we can begin to paint with broader, more defined strokes.

~The Effects of Covid-19 while opening a new recovery house~

We at El Rancho De La Vida are doing our very best as we try attract new clients to our new beautiful facility in central Maine. We are here to offer a safe place to get well and to recover from addictions with grace and dignity. That being said, we are all coming out of a 2 month quarantine while addictions never sleep…

It has truly been a mind bending couple of months for us at the ranch-as we have been working very hard to furnish and design our recovery house. While we implement policy and procedure, stock food and assemble all of the working parts. There is no written manual for what we are trying to do, while remaining true to our values, vision and mission.

~To say nothing of how inept banks, lenders, politicians and others which hold power over money have treated us. We have not been persuaded to give up and we will never give up, but at times it has been impossibly and indescribably challenging these past 2 months has been for all of us at the ranch~

We are starting to see daylight now as the SBA loans have started to trickle in while we have now onboarded our first couple. Great things are happening in this little corner of the world and we are moving towards the light.

Have faith and things will get better-Peace

June 20, 2019- Bill White RECOVERY ATTEMPTS: NEW DATA AND THEIR IMPLICATIONS (BILL WHITE AND JOHN KELLY)

What is the number of serious attempts required to achieve stable resolution of a significant alcohol or other drug (AOD) problem? Previous studies of addiction treatment populations suggest prolonged addiction careers, and a substantial proportion (over half) of people in the United States admitted to addiction treatment indicate one or more prior treatment admissions. These reports stand as justification for the characterization of addiction as a “chronic relapsing” disorder. Such clinical studies, however, may not be representative of the larger pool of people experiencing AOD-related problems.

Convenience studies of community populations of “people in recovery” reveal a different profile. A recent Canadian study found that more than half of those surveyed reported no problem recurrence after the first initial recovery attempt, and that only 15% of those surveyed required six or more attempts prior to achieve stable recovery. But it has been unclear whether such convenience samples accurately represent the experience of all people who have resolved AOD problems, including those who do not embrace a recovery identity.

Having normative information about recovery attempts prior to successful AOD problem resolution is critically important to the individuals and families affected by such problems, to the multiple professionals and institutions seeking to help such individuals and families, and to drug and health care policy makers. A newly published study by Dr. John Kelly and colleagues provides the first available data on recovery attempts based on a national representative sample of people who have resolved a significant AOD problem. Findings and implications of this landmark study include the following.

In contrast to public and professional perception, the number of recovery attempts to achieve stable resolution of an AOD problem is actually surprisingly low, with most people surveyed achieving resolution within the range of 1-2 attempts. The range of time in recovery within the study sample was from a few months to 40+ years and it may be likely – particularly for those in the early phases of recovery – that there could be further AOD problem recurrence and thus additional recovery attempts made that could add to the estimated tally of serious recovery attempts. The researchers found that those with more stable recovery (5+yrs) were no different than those in the first 5 years of recovery – for both groups of individuals the median number remained at 2 and the mean was still just over 5.
A greater number of recovery attempts is associated with greater problem severity and complexity, to include a history of mood and anxiety disorders, past history of treatment services and mutual help group participation, greater social isolation, and/or higher levels of current psychological distress. While this pattern of high problem severity, complexity, and chronicity is seen as the norm, most people with AOD problems do not experience this pattern.
Interestingly, the number of recovery attempts to resolve AOD problems is far lower than the number of attempts required to successfully stop smoking—the latter ranging from 6-30 attempts depending on the study methodology (Chaiton, et al., 2016).
The difference between the mean (average) recovery attempts (5.35 attempts) and the median (2 recovery attempts) indicates wide divergence in characteristics of those experiencing AOD problems and the presence of outliers with high problem severity and low recovery capital that require a much higher number of recovery attempts prior to successful problem resolution. Reporting average recovery attempts produces a distorted representation of the intractability of AOD problems, whereas reporting the median conveys more positive expectations for problem resolution.
“…a treatment system designed around the mean clinical profile would have 2 unforeseen consequences: overtreating those persons with lower severity patterns and high recovery capital and undertreating those with high problem severity patterns but minimal recovery capital.” (Kelly, et al., 2019)
The characterization of all AOD problems as a “chronically relapsing disease” erroneously conveys an image of endless recovery attempts with limited likelihood of success when, in fact, successful recovery with a low number of attempts may well be the norm with the pattern of prolonged “chronic relapse” the exception to this more positive general rule.
Data from the Kelly study should spur optimism among people seeking resolution of low to moderate AOD problems, their families, and their service providers. The study also encourages persistence and possibility among those with the most severe and complex problems. Recovery is possible in both circumstances though with varying levels of effort.

Future reports on recovery attempts and reported treatment history should report both the mean and median of such episodes to assure that the prospects of problem resolution are not over or under estimated. AOD problems are not a single clinical entity and representing them as such may do great disservice to both those with the lowest and highest levels of problem severity.

References

Chaiton, M., Diemert, L., Cohen, J. E., Bondy, S. J., Selby, P., Philipneri, A., & Schwartz, R. (2016). Estimating the number of quit attempts it takes to quit smoking successfully in a longitudinal cohort of smokers. BMJ Open, 6:e011045.

Kelly, J. F., Greene, M. C., Bergman, B. G., White, W. L., & Hoeppner, R. B. (2019). How many recovery attempts does it take to successfully resolve a drug or alcohol problem? Estimates and correlates from a national representatives study of recovering U.S. adults. Alcoholism: Clinical & Experimental Research. May 15. doi: 10.1111/acer.14067. [Epub ahead of print]

Post Date June 20, 2019 by Bill White

RADICAL HOPE AND RECOVERY INITIATION-April 5, 2019 -Bill White

Radical hope—a radiant vision of new possibilities in the face of personal or collective devastation—is the catalytic ingredient at the heart of personal transformations and successful social movements. Such hope has been spread contagiously by charismatic figures like Handsome Lake, Frederick Douglass, Susan B. Anthony, Mahatma Gandhi, Rosa Parks, Martin Luther King, Jr., Malcolm X, and Cesar Chavez, to name a few. Radical hope, at a personal level, allows one to rise from the ashes of addiction-related collapse and step into an unknown recovery future.

Psychoanalyst and philosopher Jonathan Lear, in his 2008 book Radical Hope: Ethics in the Face of Cultural Devastation recounts the story of the great Crow Chief, Plenty Coups, who guided the Crow nation through an era of utter cultural devastation. In the wake of cataclysmic loss—mass slaughter of the buffalo, epidemic disease, and White intrusion into Crow hunting grounds, all amidst the larger physical and cultural assault on Native tribes, Plenty Coups faced the question of how the Crow people could go on without the values and traditions that had made life meaningful throughout their tribal history. Plenty Coups drew upon an apocalyptic dream to lead the Crow nation into a completely unknown and questionable future. His dream suggested that the Crow would have a future only by emulating the Chickadee figure of Crow mythology whose distinguishing trait was the ability to listen and learn from others. According to Lear, it was this focused capacity to observe, listen, and learn that allowed construction of a new and meaningful life for the Crow people.

Addiction tests our capacity for suffering and our fear that life has no meaning beyond pain and insatiable desire. For many at the brink of extinction—the exhaustion of our personal history and the near-complete destruction of all that we had been and hoped to be, a life without drugs and a life in recovery seemed completely inconceivable. Only a radical form of hope—a hope powerful enough to challenge the formidable objective evidence of a hopeless future—could propel us through the early days and weeks of recovery. That transition often required death of the old self to form the ashes from which a new self can rise. Radical hope, as opposed to false optimism or outright delusion, provided the courage to let go of the past, the momentum to step forward, and the endurance to fully commit to this turbulent journey of personal resurrection. What made this hope radical was its leap into a future beyond one’s capacity to see and understand.

Recovery tests our capacity for healing and forces us to face the fear that a life without our elixir will be filled only with nothingness. Facing that fear requires radical hope bolstered only by the knowledge that others have made this journey before us. Like the Chickadee figure in Crow mythology, what will guide us is the ability to observe, listen, and learn as we move forward into this unknown world of recovery. Through others who have made this journey, we can learn the words, ideas, rituals, and relationships that guide the reconstruction of personal character, personal identity, and daily lifestyle. Some will draw on hidden resources within the self while others draw on powers beyond the self, but rarely is the journey of recovery made in isolation.

The Chickadee figure suggests a “middle ground” between two worlds where one can, through the acts of listening and learning, forge a new way of thinking and being. Various cultures of recovery may provide such a middle ground. Within such a milieu we can construct a new story of our lives—one describing what life was like before one’s metamorphosis, and what life is like now (who and what we are becoming). Central to that new way of life is commitment to a lifelong process of character reconstruction based on a new set of ideals (e.g., honesty, humility, gratitude, forgiveness, tolerance, harmony, and service). Recovery moves beyond removing intoxicants from one’s life to changing one’s identity at a most fundamental level. Embracing the need to do both may be possible only in the presence of radical hope.

Lear suggests that when the Crow people were at their lowest point of impotent grief and rage as a nation, what they most needed was a new poet who could reinterpret Crow beliefs of the past to forge “vibrant new ways for the Crow to live and to be.” Plenty Coups served this role and in doing so opened a path of radical hope for the future. The lowest points of addiction provide similar opportunities, and the collective stories forged across secular, spiritual, and religious pathways of recovery provide both the radical hope and the building blocks through which new ways to live and be become possible.

So what advise does this offer the person at the doorway to recovery? Welcome and embrace radical hope no matter how imperfect its messenger and emulate the Chickadee virtues of observing, listening, and learning from the successes and failures of those around you. As experienced by so many who have gone before you, radical hope can enable your survival and open new ways of living and being.

Post Date April 5, 2019 by Bill White

Bill White-YOUR RECOVERY QUOTIENT? TOWARD RECOVERY FLUENCY-October 19, 2018

In 2012, I experimented with the creation of a recovery knowledge exam (See What is Your Recovery Quotient? Toward Recovery-focused Education of Addiction Professionals and Recovery Support Specialists). The 100-item test was intended to illustrate the training emphasis on drug trends, psychopharmacology, and addiction-related pathologies in marked contrast to the scant attention paid to the prevalence, pathways, styles, and stages of long-term addiction recovery. (For details on such limited attention, click HERE)
We live in a world where people experiencing significant alcohol and other drug (AOD) problems call upon diverse iconic historical and contemporary figures, catalytic ideas, words, slogans, metaphors, and quite varied identity and story styles to resolve these problems. The challenge for addiction treatment and recovery community organizations and their service providers is to create environments and service menus within which all of these organizing motifs and languages are available. Achieving such broad recovery fluency among addiction treatment and recovery support specialists requires mastery of the history of addiction recovery and a basic understanding of what is being learned about recovery through rigorous scientific studies.

For addiction professionals and recovery support specialists, this calls for basic fluency in the language of secular, spiritual, and religious pathways of recovery and their related mutual aid societies; knowledgeable about assisted and unassisted styles of problem resolution; and knowledge of a broad spectrum of prevention, harm reduction, treatment, and recovery support technologies. Embracing such a menu is predicated on the belief that people use diverse ways to avoid and escape AOD problems and that such success is enhanced through informed choice and respectful guidance.

So exactly what would such fluency mean at its most practical level? Which of the following statements would you support?

*Educational media within addiction treatment and recovery support programs should be available in multiple languages, particularly the most prominent languages within a program’s geographical catchment area.

*Organizations providing addiction treatment and non-clinical recovery support services, regardless of their primary orientation (secular, spiritual, or religious; abstinence-based or pharmacotherapy-focused; etc.), should provide everyone screened and served with information on alternative approaches.

*Organizations providing addiction treatment and non-clinical recovery support services should shift from stand-alone, single-modality/philosophy service organizations to multimodality service centers offering a broad menu of evidence-based, experience-informed services.

*Any person being served by an addiction treatment or recovery support organization who fails to respond via measurable positive effects or who experiences clinical deterioration during the course of service should be informed of alternative approaches and assertively linked to such services.

*People in recovery working in professional or peer service roles and people who are academically credentialed without experiential knowledge of recovery should be provided orientation and training on and exposure to alternative pathways of recovery and how to present treatment and recovery support options in an objective manner.

*Addiction treatment and recovery support specialists should have a working knowledge of the history, organization, primary mechanisms of change, core literature, meeting and communication rituals, and assertive referral procedures for the major recovery mutual aid organizations and other indigenous recovery support institutions.

*Addiction professionals and recovery support specialists should be knowledgeable about local ethnic/cultural communities and indigenous healing roles and healing practices that may be engaged as sources of recovery support.

If you would like to assess your recovery quotient and fluency, click HERE. I look forward to updating this test in the future to incorporate recent historical developments and recovery research published since 2012.

We have learned so much about addiction-related pathologies and the mechanics of biopsychosocial stabilization (acute treatment); it is past time we learned about the prevalence, pathways, and processes through which individuals and families resolve such problems and the diverse communities in which such healing occurs.

Post Date October 19, 2018 by Bill White

Bill White-EXPERIENCING RELEASE IN RECOVERY-October 12, 2018

In their classic 1992 text, The Spirituality of Imperfection, Ernie Kurtz and Katherine Ketcham described six dimensions of spirituality at the core of the recovery experience: release, gratitude, humility, tolerance, forgiveness, and being-at-home. In my prolonged mentorship by and collaborations with Ernie, we often returned to those central themes.

The essence of the addiction experience is being confined and bound by something once highly prized that subsequently mutated into a monster over which one had minimal if any control. It is then not surprising that within numerous varieties of recovery experience, there is a shared thread of letting go, of breaking free. This experience of release goes by many names and descriptors—escape (from physical craving and mental obsession), deliverance, liberation, pardon, regeneration, serenity, tranquility, harmony, and balance. This release is both breaking free from an enslaved past—a freedom from the insatiable demands of the drug and the guilt, shame, fear of insanity, and self-pity that are so integral to the addiction experience—and a freedom to move forward to a life of higher meaning and purpose. This sense of being liberated, when fully realized, elicits an emotional intensity impossible to comprehend by those suggesting that addiction is a choice.

Kurtz and Ketcham describe a paradox embedded within this release opportunity.

“Letting go” involves a breaking down of the resistance to reality, a surrender to the demand for certitude; it can be pictured as a letting fall of fetters, a shucking of bonds of fear and possessiveness now experienced as no longer binding. We ‘wake up” to discover that the locks and chains have been removed, and realizing this, we lift our arms and let the chains drop away. But—the chains cannot drop if we have become so attached to them that we fear being without them. While the chains may no longer be attached to us, we may still be attached to them. The deeper release, then, is of our attachment to the chains that bind us (Kurtz and Ketcham, 1992, p. 170).

In our discussions, Ernie often suggested that self-centeredness and self-deception were the major obstacles to this act of letting go so central to the initiation of recovery, but he left open the question of whether such self-entrapment was a cause or consequence of addiction. In contrast to traditional psychotherapies, Ernie thought that recovery for many involved a process of getting out of themselves rather than deeper into themselves.

Release in recovery is a complex experience. It has physical dimensions, particularly the diminishment or complete loss of the insatiable cravings (i.e. the cellular hunger for the drug). It is marked by cognitive and perceptual changes—escape from the mental preoccupations that crowded out all else and the loss of attentional bias toward drug cues that leaves one the sense of truly seeing the world for the first time. There are, of course, psychological and emotional dimensions to release—the expiation of long-suppressed emotions and what is sometimes experienced as a simultaneous and paradoxical escape from self and acceptance of self—the essence of Kurtz and Ketcham’s spirituality of imperfection. Spiritual dimensions of release include awakening to the reality that one has been gifted (graced) with a new sense of freedom and hope—a rebirth—midwifed by some greater force in the universe or the fruit of an ultimate life decision. Release can also have relational aspects in the severing of toxic, drug-linked relationships and the expansion of one’s social world.

To those who are yet seeking such a release, know that it is an immeasurable gift buried within the heart of the recovery experience. Know that you will not likely be in control of when and how it arrives. For some, this sense of being set free arrives early in recovery while for others it arrives unannounced months or years into recovery at a time its expectation has been forsaken. For some, release will come in a lighting strike—the legacy of a transformational change experience that is unplanned, positive, and permanent; for others, it slowly seeps into one’s experience until the day arrives when one suddenly realizes that destructive desires and obsessions are gone.

For many, the release experience remains a mystery, but a mystery worth embracing with deep humility and gratitude.

Post Date October 12, 2018 by Bill White

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

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

Bill White -STIGMA-BUSTING: SHARING THE GOOD NEWS OF RECOVERY AT A PROFESSIONAL LEVEL-July 27, 2018

Stigma has many targets. It reaches beyond people addicted to various drugs to affect family members and those providing addiction treatment and recovery support services. Such secondary stigma, for example, is the source of the peculiar pecking order within the addictions field through which status (or stigma) is bestowed across varied settings based on one’s recovery status or lack of recovery experience. It also is the source of coded conversations between those working in the addictions field and members of the larger community. As a result, addiction professionals and recovery support specialists may find their legitimacy, their value, and even their sanity challenged by professional peers and by members of the larger culture. The ways in which we respond within such conversations can mark an appeasement (passivity in the face of insult or aggression) or a challenge to addiction-related stigma.

Below are some frequently heard comments (and their coded meanings when combined with certain voice tones and facial expressions) that people working in addiction treatment or recovery support roles hear when they disclose their life’s work to acquaintances outside the worlds of addiction treatment and recovery. It is tempting for some of us in these social situations to hide one’s occupation, quickly divert to other topics, flee and avoid such future encounters, or escape into a social network made up almost exclusively of others working in the field. But such encounters with the larger community hold great opportunity. They provide a means of challenging the imbedded myths and stereotypes that feed addiction- and recovery-related stigma and its harmful progeny.

Below are some stigma-busting responses to such comments.

Comment: “That must be very difficult [or distasteful/depressing/dangerous] work.” (Code for: “Alcoholics and addicts, as bad people doing bad things, are morally disreputable and dangerous.”)

Response: Actually, working with individuals and families affected by alcohol and other drug problems is very rewarding. Many of the people I work with are bright, attractive, and engaging. They represent people from very diverse backgrounds and life stories. I enjoy guiding and observing people regain health and happiness. I also like working within a team of very competent and committed service professionals. Many of those I work with have suffered multiple and quite severe problems, but I continue to be in awe of their persistence and resilience in rebuilding their lives. I could make more money and have more professional status doing other things, but I don’t think I would love doing them as much as what I do now. I would not trade what I do for anything. The most difficult part of what I do is not the people I work with but the community resource limitations and the paperwork and other administrative red tape that can demand so much of my time.

Comment: “But what about all the treatment failures and deaths I read about?” (Code for: “Why would you work in an area in which success is so rare?”)

Response: Such losses are horrible and personally painful, but they are an inevitable part of working within any sector of healthcare. But most importantly, addiction-related deaths among those I work with are the exception. Far more common are individuals and families who positively transform their lives and express their gratitude for the help that we have been able to provide them. And what we do through our harm reduction, treatment, and recovery support activities reduces the incidence of such deaths. The deaths that do occur provide an opportunity to recommit myself to improving the accessibility and quality of the services we as a field are able to provide, particularly services that help keep people alive until they achieve stable recovery.

Comment: “I guess what you do would be valuable even if you only help one person.” (Again code for: Recovery is the exception to the rule—a miracle; “once an addict, always an addict.”)

Response: If only one person was helped by my organization, we would have to seriously re-evaluate our treatment approaches. There are more than 23 million Americans who once experienced alcohol or other drug problems who have resolved these issues. In treatment, we deal primarily with the most severe and complex of these problems, but the vast majority of people seeking our help will recover, sometimes after multiple efforts. It is a great feeling to be a critical link within this healing process. And we have the opportunity in addiction treatment to see very sick individuals and families get well and go on to achieve significant levels of social contribution. Many of the men and women I work with get better than well.

Comment: “It must take a very special person to work with THOSE people; I don’t think I could do that.” (Code for, “You must be insane to choose to spend your life trying to help alcoholics and addicts! Who in their right mind would want to that?”)

Response: Thank you. It’s true that not everyone is suited to work effectively in addiction treatment and recovery support roles. It requires education, training, and supervised work experience, and it also requires particular values and traits of character such as compassion and empathy. Addiction treatment and recovery support remain frontier areas of healthcare so working in them also requires constant learning. Have you ever been in a situation where you were asked to help someone who was experiencing a difficult or life-threatening problem? I find there are common values within the long-term addiction recovery experience that are very attractive—values such as honesty, gratitude, humility, humor, simplicity, tolerance, forgiveness, gratitude, and service. Working with people in recovery provides daily reminders of these important values.

Comment: “How did you happen to get in that kind of work?” (Code for, “Were you an addict?” “Could you not find another job?”)

Response: I had known people who recovered from addiction and went on to make considerable contributions within their professions and communities. It seemed to me that helping people overcome such conditions would be a personally fulfilling way to spend one’s life. That has proved to be true. I was equally motivated by seeing so many communities that had so few high-quality addiction treatment and recovery support resources. (Optional: I also thought lessons I drawn from my own personal/family recovery experiences might be of benefit to others facing similar challenges.)

Comment: “I have been reading about the arrest of people in addiction treatment for fraud and exploitation of patients.” (Code for: “Addiction treatment is a scam—the modern equivalent of the snake oil salesman. Are you such a person?”)

Response: There are unethical or incompetent people within any service industry who seek to exploit it for their own profit. In the addictions field, we have tried to minimize such exploitation through program accreditation and licensing standards and codes of professional ethics. We try to hold organizations and individuals ethically and legally accountable for breaches of these standards, but some still occur, as they do in all industries. Such breaches do great harm to those needing help and to reputable organizations and service professionals. Unfortunately, the day in and day out delivery of effective and ethical addiction treatment does not make headlines.

Closing Reflection

The comments noted above rarely spring from maliciousness; they are rarely intended to consciously disparage or shame us and those with whom we work, and some are intended as genuine compliments. The issue is that such comments, when accompanied by repugnant voice tones and facial expressions, are drawn from the core ideas that buttress social stigma and misrepresent the sources of and solutions to alcohol and other drug problems. Such ideas are best changed not from direct confrontation but through personal encounters that provide an alternative way of viewing these problems and solutions. We can be the change agents within this process.

It is easy to cave into the stigma. But silence or weak responses leave stigma and stereotypes intact. As the advocacy slogan declares, “By our silence, we let others define us.” Challenging stigma and stereotypes require a much different response. In 2001, I posed the following challenge to people in recovery:

“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, and 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.”

Today, I am challenging those of us who work within this special ministry to be more assertive in sharing the transformative power of recovery with all those we encounter socially and professionally and to share the privilege we have experienced as a guide and witness to such transformations. The public is constantly bombarded with addiction’s bad news; it’s time we shared with them the good news of recovery. Each time we introduce ourselves and what we do to a new acquaintance stands as a potential community and cultural intervention. We too are the faces and voices of recovery–regardless of our recovery status.

Acknowledgement: I would like to thank the following members of the Recovery Rising Book Club whose recent discussion inspired this blog: Brian Coon (Pavillon – Mill Spring, NC), Matt Statman (University of Michigan – Ann Arbor, MI), Jason Schwartz (Dawn Farm – Ypsilanti, MI), Ken Schuesselin (NC DHHS, Division of Mental Health, Developmental Disabilities, and Substance Abuse Services – Raleigh, NC), Scott Luetgenau (SouthLight Healthcare – Raleigh, NC), Brandon Robinson (Fellowship Health Resources – Raleigh, NC), Amanda Blue (Healing Transitions – Raleigh, NC), Shane Phillips (Duke University Medical Center – Durham, NC), and Chris Budnick (Healing Transitions – Raleigh, NC).

Post Date July 27, 2018 by Bill White