ADDICTION AS A BRAIN DISEASE (PERSPECTIVES FROM THE ISLAMIC REPUBLIC OF IRAN) -March 9, 2018 -Bill White

The understanding of addiction as a brain disease has been a central organizing principle within the research agendas of the National Institute on Drug Abuse and the National Institute on Alcohol Abuse and Alcoholism. Promotion of the brain disease paradigm stirred controversies over its scientific legitimacy and contentions and counter-contentions over its effects on addiction-related stigma, but it exerted unquestioned influence on public and professional conceptions of addiction and approaches to the treatment of addiction in the United States. Interesting variations in the conceptualization of addiction as a brain disease occurred contemporaneously in other countries. The challenge across cultural contexts has been to integrate recent research on the neurobiology of addiction to create more dynamic biopsychosocial models of treatment and recovery support.

One of the most innovative examples of such integration can be found within the Islamic Republic of Iran’s Congress 60 recovery community. Encompassing more than 57,000 active members across 58 branches in Iran, Congress 60 combines a medication-assisted transition into recovery with an extensive menu of psychosocial supports. The rationale for medication support and the unique scheme of such support (the DST method) has been outlined by Congress 60 Founder Hossein Dezhakam in what he christened the X Theory.

I recently had the opportunity to interview Mr. Dezhakam about the X Theory and the DST method and how they are integrated within the larger culture of support within the Congress 60 recovery community. This interview is highly recommended for those exploring such integration in diverse cultural settings, including in the United States, and for those interested in variations in the clinical application of the brain disease model of addiction in non-Western countries.

For decades in the U.S., addiction treatments, with and without medication support, have existed as warring factions fueled by debates producing far more heat than light. Such either/or polarization defies the fact that many people in medication-assisted treatment could greatly benefit from an expanded menu of long-term recovery support services and that recovery outcomes within traditional “abstinence-based” programs could be elevated by recognition of the potential role medications can play for some patients in recovery initiation and/or maintenance. Congress 60 provides a template of how medication support and psychosocial support can be fully integrated within a vibrant recovery culture.

Post Date March 9, 2018 by Bill White

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THE SECULAR WING OF AA- March 2, 2018 -Bill White-

A.A. is so decentralized that in a very real sense, there really is no such single entity as “Alcoholics Anonymous”—only A.A. members and local A.A. groups that reflect a broad and ever increasing variety of A.A. experience. To suggest that Alcoholics Anonymous represents a “one size fits all approach” to alcoholism recovery, as some critics are prone to do, ignores the actual rich diversity of A.A. experience in local A.A. groups and the diverse cultural, religious, and political contexts in which A.A. is flourishing internationally. (Kurtz & White, 2015)

All are self-identified alcoholics and go by many other names: agnostics, atheists, nonbelievers, skeptics, cynics, rebels, freethinkers, humanists, secularists, and rationalists. What they share in common beyond the experience of alcoholism is need for a personal program of recovery not dependent upon belief in any religious deity. Such needs have propelled the growth of secular alternatives to Alcoholics Anonymous (AA) and a growing secular wing within AA. The existence of the latter challenges AA critics who argue that those without religious faith cannot find a home within AA.

The growth of a secular wing of AA is evident in many quarters. The number of registered secular AA meetings in the U.S. has grown from a few dozen in the early 2000s to more than 400, and two international conventions of atheist and agnostic AA members have been held to date. Online secular recovery support resources for AA members (such as Secular AA, AA Agnostica, and AA Beyond Belief) have grown in tandem with the increase in face-to-face meetings. An October 2016 special issue of the AA Grapevine was dedicated to “Atheist and Agnostic Members,” and there is a planned Grapevine book containing previously published stories of atheist and agnostic AA members. Also of note are the increased number of books on secular recovery within AA (see below) and the increased national media coverage of secular AA meetings.

Chronology of Secular AA & Related Recovery Literature

1991 Martha Cleveland and Arlys G. The Alternative 12 Steps: A Secular Guide to Recovery

2010 My Name is Lillian and I am and Alcoholic (And an Atheist)

2011 Marya Hornbacher Waiting: A Non-Believerʼs Higher Power

2011 Vince Hawkins An Atheists Unofficial Guide to A.A.

2012 Joe C. Beyond Belief: Agnostic Musings for 12 Step Life

2013 Archer Voxx The Five Keys: 12 Step Recovery Without A God

2013 Roger C. The Little Book: A Collection of Alternative 12 Steps

2014 John Lauritsen A Freethinker in Alcoholics Anonymous

2015 Adam N. Common Sense Recovery: An Atheist’s Guide to Alcoholics Anonymous

2015 Roger C. Do Tell: Stories by Atheists and Agnostics in AA

2017 Thomas B. Each Breath a Gift: A Story of Continuing Recovery

Two recent books by Roger C. provide a fascinating window into the world of secular AA. Published in 2014, Don’t Tell: Stories and Essays by Agnostics and Atheists in AA is a potpourri of secular recovery stories, alternative wordings and interpretations of AA’s 12 Steps, book reviews, snippets from the early history of atheists and agnostics in AA, description of a secular AA convention, and discussions of some of the controversies triggered by the growth of secular AA. Published in 2017, A History of Agnostics in AA provides engaging accounts of early secular groups within AA in the U.S. and Canada. Together, these books provide insight into the challenges and triumphs of achieving recovery without religiosity within AA. They are above all a celebration of the “multiple pathways of recovery” mantra that has gained such prominence in recent years.

Anyone wishing to learn more about the secular wing of AA and secular styles of recovery may do so be exploring the rich collection of stories, articles, and other publications posted at AA Agnostica and related websites or by reviewing the growing body of secular AA literature.

The secular wing of AA and the growth of secular recovery mutual aid groups beyond 12-Step groups are both cause for celebration. As the new mantra goes, “Recovery by any means necessary under any circumstances.”

Post Date March 2, 2018 by Bill White

December 8, 2017 -By Bill White- THE KARMA OF RECOVERY


The concept of karma holds that one’s fate in this life or future lives is not a random roll of the dice, but a direct product of one’s thoughts and actions. Rooted in many of the great religions and a central motif within Hinduism, Buddhism, and Jainism, karma is mistakenly confused in popular culture with the idea of good or bad luck. In contrast, karma suggests the presence of a universal principle of justice–that the decisions one makes or the actions one takes or fails to take have inevitable consequences. This principle can be found in many popular aphorisms:
You reap what you sow.
Violence begets violence.
They that sow the wind shall reap the whirlwind.
What goes around comes around.
Chickens come home to roost.
You get what you give.
Those who live by the sword die by the sword.
The principle of karma poses an interesting dilemma for people initiating recovery from addiction: How does one atone for the injuries one’s addiction-shaped actions and inactions inflicted upon others and the community at large? How does one balance the karmic scales to escape the whirlwind?
Most enter recovery with a karmic burden. Harm to others is a near-inevitable and -universal dimension of addiction—a progressive process of relational disconnection and self-absorption. Addiction, by definition, involves a prioritization of the drug relationship above all other aspirations, needs, commitments, and responsibilities. It is thus little wonder that the person at the doorway of recovery is haunted by ghosts of past harmful acts of commission or omission. The oppressive weight of guilt (I have done bad things) and shame (I am a bad person) can lead to self-sabotage for those who feel unworthy of the gifts of recovery. Such baggage must be shed to achieve sustained recovery and a reasonably fulfilled life.
It is common for people on the threshold of recovery to face resentment or rage from shredded promises; confront disappointment, distrust, and disdain in the eyes of others; and fear a backlog of consequences that could come at any time—all while experiencing cellular screams for anesthesia or stimulation. The question then becomes, “How does one step out of such quicksand into sustainable recovery, restore personal sanity, and repair relational trust?” Early Native American recovery circles, the Washingtonians, Fraternal Temperance Societies, Ribbon Reform Clubs, institutional support groups (e.g., Godwin Association, Keeley Leagues), Alcoholics Anonymous and other 12-Step programs, and the growing menu of secular and explicitly religious recovery mutual aid groups have all addressed this question.
Where some groups focused solely on achieving sobriety, on the assumption that with continued sobriety these broader concerns would take care of themselves, most recovery mutual aid groups, particularly those embracing religious and spiritual frameworks of recovery, emphasize the need for character reconstruction and restorative actions within the recovery process. Looking across such frameworks over a span of two centuries, one finds a consistent menu of suggested remedial steps aimed at balancing the karmic scales:
1) unflinching identification of harmful thoughts, feelings, actions, and inactions (self-inventory, humility);
2) private or public ownership of such harm (contrition, confession, self-forgiveness);
3) making amends to those harmed (restorative justice); and
4) unpaid acts of service to others and the community (generic restitution, gratitude, compassion, generosity, story reconstruction, and storytelling).
Accompanying such recommended actions have been admonitions that such actions be taken slowly, deliberately, repeatedly, and with the support of a community of shared experiences and aspirations. The message across generations is: The lived testimonies of millions of people in recovery suggest that positive changes in character and the quality of one’s relationships are both possible and common within the recovery process. The karmic baggage of active addiction can be progressively shed in recovery and replaced by a different kind of karma—one bearing the promises and gifts of long-term recovery. When the latter is achieved, people who were once part of the problem emerge as a vibrant part of the solution by balancing the karmic scales and becoming wounded healers and recovery carriers. Recovery pathways are also pathways of reconciliation.
Post Date December 8, 2017 by Bill White

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

August 11, 2017 -Bill White- STAGES AND STYLES OF ADDICTION RECOVERY

Dr. Ernie Kurtz and I, during the last years of his life, spent considerable time exploring the varieties of addiction recovery experience, including variations in the stages and styles of addiction recovery. For me, this exploration of stages and styles began in 1974 when I heard John Wallace present a paper at the Alcohol and Drug Problems Association meeting in Minnesota. The presentation stunned me with its clarity and potential clinical import. Wallace first stated that alcoholics frequently develop a preferred defense structure (PDS) (e.g., denial, minimization, projection of blame, intellectualization, etc.) to sustain excessive drinking and escape its growing consequences.
That starting position was not a new idea to most of us in the audience, but Wallace went on to say that the same PDS that supports drinking may be used as strategic coping mechanisms through the early stages of recovery and that prematurely confronting this brittle, recovery-sustaining PDS could trigger a resumption of drinking. That denial and minimization (of the problems facing the just-sobered), black-white thinking (e.g., “all of my problems are related to my drinking; all I have to do is not drink and everything else in my life will be fine”), and other defense mechanisms could be allies in the recovery process was a striking concept and one pregnant with implications for clinical practice—practices which at the time consisted primarily of verbally confronting such defensive gambits.
But then Wallace laid out the third paradox of recovery: the same PDS that supported alcoholism and that could be reframed to support early recovery must be eventually abandoned in later stages of recovery. In Wallace’s view, the latter transition was crucial to fully stabilize recovery, as well as enhance maturity and quality of life in long-term recovery.
I have been closely observing the addiction recovery process for half a century. I have been struck by two extremes: people whose fragile recovery is forever frozen at a primitive stage of development, and people who go through metamorphic changes that transform their character, values, and the quality of their interpersonal relationships. In the former, drug use has ceased or radically decelerated in frequency, intensity, and consequences, but this change remains nested within the same self-centeredness, resentfulness, dishonesty, and intolerance that often characterizes active addiction. This former pattern has been referred to as the “dry drunk” syndrome. In the latter style, the radically altered person-drug relationship is accompanied by dramatic enhancements in global health and functioning, as well as changes in character and identity—changes AA co-founder Bill Wilson characterized as “emotional sobriety.”
It is easy to cast these widely varying styles of recovery into the boxes of bad and good, but time and experience have softened that view for many of us as we have come to see how each style can exist within the same persons (and within ourselves) at different stages of the long-term recovery process. Also of note is that the executive brain functions of some people may have been severely and even permanently damaged from addiction, precluding tolerance of the ambiguity and more complex decision-making of the transformative style of recovery.
Today’s guiding mantra is “whatever it takes—recovery by any means necessary under any circumstances.” While we can deeply admire those in recovery who have used the recovery experience as a catalyst for personal transformation (via humility, gratitude, tolerance, service, etc.), we can also admire those who must tenaciously cling to those crude early defenses as a way to “keep the plug in the jug.” Both are deserving of respect and admiration.
Post Date August 11, 2017 by Bill White