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

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

Post Date July 21, 2017 by Bill White


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

Post Date July 15, 2017 by Bill White

June 9, 2017 -Bill White- THE DRUNKARD’S CLUB

To many people, the history of alcoholic mutual aid societies begins in 1935 with the founding of Alcoholics Anonymous (A.A.). A.A. history buffs are aware that there was another society, the Washingtonians, that existed almost a century before Bill Wilson and Dr. Robert Smith first met. But few are aware of just how many pre-A.A. alcoholic mutual aid societies existed before 1935. There were early Native American recovery “circles” that date as early as 1750. Numerous recovery-focused fraternal temperance societies, many branches of the ribbon reform clubs, the United Order of Ex-Boozers, and many societies linked to 19th and early 20th century treatment institutions: The Ollapod Club, the Godwin Association, the Dashaways, the Keeley Leagues, and the Jacoby Club, all existed prior to A.A. A.A.’s survival takes on added historical significance in light of the demise of so many of its predecessors.
The fate of one of these pre-A.A. mutual aid societies is detailed in Charles Brace’s 1872 book, The Dangerous Classes of New York. Brace tells the story of Orville “Awful” Gardner, a prize-fighter, known for his drunken binges and his brutality in and outside the ring. (He once bit off a man’s nose.) Gardner experienced a profound religious conversion through which he became sober and experienced a call to help other “hard cases” like himself. Gardner opened a “Coffee and Reading Room” in a ward in New York City notorious for its drunkenness and vice. This small experiment evolved into what became known as “The Drunkard’s Club.” Brace describes:
The rooms are filled with reformed or reforming young men. The great difficulty with a man under vices is to make him believe that change for him is possible. The sight of Gardner always demonstrated this possibility. The place has become a kind of central point for all of those who have become more or less addicted to excessive drinking, and are desirous of escaping from the habit.
According to Brace, more than 700 men were sobered under the influence of the Club. The fate that befell the Drunkard’s Club was not atypical of pre-A.A. mutual aid societies. Gardner’s health began to fail from the “strain of his sins and his reform” and he was forced to retire to a quiet place in the country. Without his leadership, the Drunkard’s Club collapsed.
In an interesting twist of historical continuity, it was this same “Awful” Gardner who inspired the religious conversion of another alcoholic, Jerry McAuley, while both were in Sing Sing Prison. McAuley went on to found the Water Street Mission, the first urban mission that catered its message and services to the late stage alcoholic.
Like the Phoenix rising from the ashes of its own pyre, new addiction recovery mutual aid societies followed the Drunkard’s Club until the first society arrived with the right combination of recovery principles and organizational practices that allowed it to outlive its founding generation.
For more stories from this early history, see the new edition of Slaying the Dragon: The History of Addiction Treatment and Recovery in America.

Post Date June 9, 2017 by Bill White


Post Date May 12, 2017 by Bill White

The most famous and controversial treatment for addiction in the 19th century was Dr. Leslie Keeley’s Bichloride of Gold Cure. Dr. Keeley franchised his cure procedures through more than 120 Keeley Institutes scattered across North America and Europe. These Institutes became the preferred drying out institutions for the rich and famous in the 1890s. But the problem then (as today) was this: Even where there are financial resources to pay for such treatment, how can the afflicted person be convinced to enter such a treatment institution?
There were four general resolutions of this dilemma: self-motivation resulting from the accumulated pain of addiction, company pressure upon an alcohol/drug-impaired employee, pressure from families, and legal commitment of the inebriate (for as long as four years). Family pressure to enter treatment sometimes involved processes similar to what today would be called “intervention,” but these processes did not always go as planned, as is revealed in the following account from Alfred Calhoun’s 1892 book, Is It a Modern Miracle? A Careful Investigation of the Keeley Gold Cure for Drunkenness and the Opium Habit.
As this story unfolds, a family at its wit’s end responds to the chronic drunkenness of one of its members by hosting a meeting of all concerned. The upshot of this meeting is that the young man in question, who we shall call Robert, was to be sent to the Keeley Institute headquarters in Dwight, Illinois, to undergo the Keeley Cure. Seriously doubting Robert’s ability to make this trip on his own, the family enlisted the aid of his uncle to accompany him during the travel to the Keeley Institute in Dwight, Illinois.
On the following day, Robert and his uncle set off for the long trip to Dwight. Robert pleaded with his uncle to stop periodically for alcoholic refreshment on the grounds that this was the only way to stave off the onset of “DTs.” The uncle agreed to such stops, willing to humor his young nephew in any manner that would keep them moving toward Dwight. But the additional catch was that Robert refused to drink such medicinal libation unless his uncle would join him. Although quite an abstemious person, the uncle agreed to imbibe with his nephew as long as they could keep proceeding to Dwight.
So at each stop, which seemed to increase in frequency as the pair neared Dwight, both Robert and his uncle downed various alcoholic concoctions. By the time the now well-oiled pair reached Dwight, both were in a state of considerable intoxication, although they looked quite different. Robert, whose alcohol tolerance was massive, didn’t look too worse for the wear. His uncle, however, whose alcohol tolerance was virtually non-existent, was nearly unconscious by the time they entered the doors of the Keeley Institute.
Upon their arrival, Robert admitted his uncle to the Keeley Institute and absconded with his uncle’s prized car. It took several days to get the uncle sobered up and the nephew located, returned to Dwight, and admitted to treatment. Getting someone in treatment then, as now, was not always easy. But some of the 19th century treatment centers did find ways to keep people in treatment once they were finally admitted: At admission, they took all of their clothes and all of their money!
*For more on the “Keeley Cure” see, the new edition of Slaying the Dragon: The History of Addiction Treatment and Recovery in America.


Recent decades have witnessed calls for the cultural and political mobilization of people in addiction recovery as well as the subsequent rise of a new recovery advocacy movement in the U.S. and internationally. Beyond my efforts to document the history of this movement and to offer broad U.S. policy guidance, I have tried to remain silent on partisan political issues, as the constituencies that make up this movement and my readership span a rainbow of political viewpoints. However, there are limits to such silence.
Today, I am troubled by potential shifts in national drug policy and its effects on individuals and families experiencing and recovering from addiction and its related problems. Troubling are the invisibility (not even a functioning website), lack of leadership, and potential elimination of the White House Office of National Drug Control Policy—all while the opioid epidemic continues to lay bodies at the nation’s doorstep. Troubling are efforts to dismantle the Affordable Care Act, whose provisions facilitated the growing integration of addiction treatment and primary health care in the U.S. Troubling is the appointment of another presidential study commission while virtually ignoring the landmark Surgeon General’s Report on Alcohol, Drugs, and Health prepared by the nation’s leading addiction experts and released by the Surgeon General in 2016 shortly before his dismissal by the new administration. Troubling is a new Attorney General of the United States who seems enamored by the heady drug wars of the 1980s and 1990s that produced the largest wave of mass incarceration of addicts (and people of color) in U.S. history.
These potential concerns, all that may be resolved via future developments, pale in comparison to what has unfolded in communications between the U.S. President Donald Trump and Philippine President Rodrigo Duterte. By way of background, President Duterte has likened himself to Hitler and expressed his desire and intent to “slaughter” his country’s three million drug addicts. To date, his violence-inciting rhetoric and policies are directly responsible for the extrajudicial killing of more than 7,000 “drug personalities” and the related deaths of bystanders (including children) during hundreds off anti-drug raids and attacks by government-sanctioned vigilante groups.

Following a highly criticized initial call between the two presidents, President Duterte reported “He [President Trump] was quite sensitive to our war on drugs and he wishes me well in my campaign and said that we are doing, as he so put it, ‘the right way.’” This past week, President Trump invited President Duterte to visit the White House to discuss the improving relationships between the Philippines and the U.S. Such an invitation should not have been extended, and such a visit should not take place.
The systematic killing of members of any stigmatized group by a government (the very definition of genocide) is morally reprehensible and should be resisted by any and all means necessary. The actions and policies of Philippine President Rodrigo Duterte should be publically condemned by all Americans, and President Duterte should not be welcomed by our leaders to walk the halls of the White House.
Evil incubates in the soil of silence. Even facing sure death, non-violent resistance groups like The White Rose* organized to resist the atrocities of the Nazi regime. Perhaps it is time for formation of The Purple Rose—recovery advocates, their allies, and other Americans of conscience who will not passively and silently witness the abomination of President Rodrigo Duterte being warmly embraced by the President of the United States at the entrance to the White House. There is a time for silent reflection and a time for active resistance. The time for resistance has arrived.
*I wish to acknowledge the Florida Repertory Theatre and playwright David Meyers whose provocative play, We will Not Be Silent, brought the inspiring story of Sophie Scholl and The White Rose to my attention.

Post Date May 1, 2017 by Bill White


Investigations into the effects of participation in 12-Step mutual aid groups on long-term recovery outcomes have grown in number and methodological rigor and have evolved from the question of whether such participation exerts positive effects to the question of the precise mechanisms through which such effects are achieved.
One of the 12-Step mechanisms of change that has been studied in the past decade is sponsorship. In November 2015, I posted a blog outlining the following 10 conclusions drawn from studies of sponsorship.
1.The functions performed by 12-Step fellowship sponsors fall into three broad categories: 1) encouraging participation in core 12-Step activities, 2) providing emotional support and practical recovery guidance, and 3) sharing the sponsor’s story and lived recovery experience with the sponsee (Whelan, et al., 2009).
2.Continuous sobriety increases in tandem with duration of sponsorship (Rynes & Tonigan, 2012; Young, 2013).
3.Factor analysis of assertive models of linkage to 12-Step programs (e.g., MAAEZ) reveal that sponsorship contributes approximately 25% of the positive effects of these models on drinking outcomes (Subbaraman, Kaskutas, & Zemore, 2011).
4.The positive effects of sponsorship occur independent of degree of meeting attendance (Witbrodt, et al., 2012).
5.The rate of sponsorship in A.A. is quite high—82% of members report having a sponsor, as it is in N.A—88.6% report having a sponsor (Galanter, et al., 2013). Currently unsponsored A.A. members are more likely to be older A.A. members with prior sponsor relationships rather than new members who have chosen not to use a sponsor (Young, 2013).
The greatest measurable benefits of sponsorship occur early. In terms of recovery initiation and stabilization, the greatest effects of being sponsored occur in the first year of the sponsorship relationship (Tonigan & Rice, 2010). Half of individuals who reduced sponsorship contact over a seven-year follow-up period maintained complete abstinence (Witbrodt, et al., 2012).
The effects of sponsorship on recovery outcomes vary by sponsor and sponsor-sponsee relationship characteristics—a quality that can be measured via the Sponsor Alliance Inventory with improved sponsor-sponsee alliance associated with enhanced short-term abstinence outcomes (Kelly, et al., 2015).
Surveyed sponsees report trustworthiness, discretion (respecting confidentiality), and integrity as the most important sponsor characteristics (Stevens, 2013).
In a rare study of former injection drug users, having an AA/NA sponsor did not predict improved recovery outcomes, but sponsoring others produced substantially increased odds of abstinence compared to those who were not involved in sponsoring others (Crape, et al., 2002). The study findings by Crape and colleagues are consistent with other studies reporting exceptionally high abstinence rates among those serving as sponsors in A.A. (e.g., 91% abstinent rate in the 10-year follow-up study by Cross and colleagues (1990) and recent studies documenting the power of helping others in enhancing one’s own long-term recovery stability and quality of life in recovery (See Zemore, et al., 2004, 2008, 2013)
Sponsored members of 12-Step fellowships are more likely than those without sponsors to participate in other activities that have been linked to enhanced recovery outcomes, e.g., meeting attendance, home group affiliation, step work, service work, etc. (Young, 2013; Pagano, et al., 2009; Morgenstern, et al., 1996).
A new study of sponsorship conducted by Dennis Wendt and colleagues was recently published in the Journal of Study of Alcohol and Drugs. This multisite, randomized clinical trial examined the effects of 12-Step sponsorship on post-treatment substance use outcomes of people treated for a stimulant use disorder. The investigators drew two primary conclusions from the study data: 1) sponsorship at the end of treatment predicted a higher likelihood of abstinence from stimulant use and having no drug-related problems at follow-up, and 2) sponsorship rates can be improved for those seeking treatment from stimulant use disorders through a short-term TSF [12-Step Facilitation] intervention (Wendt, et al., 2017, p. 287).
Collectively, these studies confirm the value of peer-based mentor relationships within the recovery process and also underscore the value of helping others in enhancing one’s own recovery process. These findings underscore a message that I have tried to convey through much of my advocacy work: Recovery is contagious. Get close to it. Stay close to it. Catch it. Keep catching it. Pass it on.

References and Suggested Reading
Brown, R. E. (1995). The role of sponsorship in the recovery or relapse processes of drug dependency. Alcoholism Treatment Quarterly, 13(1), 69-80. doi: 10.1300/j020v13n01_06
Crape, B. L., Latkin, C. A., Laris, A. S., & Knowlton, A. R. (2002). The effects of sponsorship in 12-Step treatment of injection drug users. Drug and Alcohol Dependence, 65, 291-301.
Cross, G. M., Morgan, C. W., Mooney, A. J., Martin, C. A., & Rafter, J.A. (1990). Alcoholism treatment: A ten-year follow-up study. Alcoholism: Clinical and Experimental Research, 14, 169-173.
Galanter, M., Dermatis, H., Post, S., & Santucci, C. (2013). Abstinence from drugs of abuse in community-based members of Narcotics Anonymous. Journal of Studies on Alcohol and Drugs, 74(2), 349-352.
Gomes, K., & Hart, K. E. (2009). Adherence to recovery practices prescribed by Alcoholics Anonymous: Benefits to sustained abstinence and subjective quality of life. Alcoholism Treatment Quarterly, 27(2), 223-235. doi: 10.1080/07347320902784874
Kelly, J. F., Greene, M. C., Bergman, B., Hoeppner, B. B., & Slaymaker, V. (2015). The sponsor alliance inventory: Assessing the therapeutic bond between 12-step attendees and their sponsors. Alcohol and Alcoholism, (advanced publication, 1-8, doi: 10.1093/alcalc/agv071.
Moos, R. H. (2008). Active ingredients of substance use-focused self-help groups. Addiction, 103(3), 387-396. doi: 10.1111/j.1360-0443.2007.02111.x
Morgenstern, J., Kahler, C. W., Frey, R. M., & Labouvie, E. (1996). Modeling therapeutic response to 12-step treatment: Optimal responders, nonresponders, partial responders. Journal of Substance Abuse, 8(1), 45-59. doi:10.1016/S0899-3289(96)90079-6
Pagano, M. E., Zemore, S. E., Onder, C. C., & Stout, R. L. (2009). Predictors of initial AA-related helping: Findings from project MATCH. Journal of Studies on Alcohol and Drugs, 70(1), 117-125.
Polcin, D. L., & Zemore, S. (2004). Psychiatric severity and spirituality, helping, and participation in Alcoholics Anonymous during recovery. The American Journal of Drug and Alcohol Abuse, 30(3), 577-592. doi: 10.1081/ada-200032297
Rynes, K. N., & Tonigan, J. S. (2011). Do social networks explain 12-step sponsorship effects? A prospective lagged mediation analysis. Psychology of Addictive Behaviors, 432-439 doi: 10.1037/a0025377
Stevens, E. B., & Jason, L. A. (2015). Evaluating Alcoholics Anonymous sponsor attributes using conjoint analysis. Addictive Behaviors, 51, 12-17.
Subbaraman, M. S., Kaskutas, L. A., & Zemore, S. (2011). Sponsorship and service as mediators of the effects of Making Alcoholics Anonymous Easier (MAAEZ), a 12-step facilitation intervention. Drug and Alcohol Dependence, 116(1-3), 117-124. doi: 10.1016/j.drugalcdep.2010.12.008
Stevens, E. (2013). An exploratory investigation of the Alcoholics Anonymous sponsor: Qualities, characteristics, and their perceived importance. (2013). College of Science and Health Theses and Dissertations. Paper 49. Retrieved from http://via.library.depaul.edu/csh_etd/49
Tonigan, J. S., & Rice, S. L. (2010). Is it beneficial to have an alcoholics anonymous sponsor? Psychology of Addictive Behaviors, 24(3), 397-403. doi: 10.1037/a0019013
Wendt, D. C., Hallfren, K. A., Daley, D. C. & Donovan, D. M. (2017). Predictors and outcomes of Twelve-Step sponsorship of stimulant users: Secondary analysis of a multisite randomized clinical trial. Journal of Studies on Alcohol and Drugs, 78, 287-295.
Whelan, P. J. P., Marshall, E. J., Ball, D. M., & Humphreys, K. (2009). The role of AA sponsors: A pilot study. Alcohol and Alcoholism, 44(4), 416-422. doi: 10.1093/alcalc/agp014
Witbrodt, J., Kaskutas, L., Bond, J., & Delucchi, K. (2012). Does sponsorship improve outcomes above Alcoholics Anonymous attendance? A latent class growth curve analysis. Addiction, 107(2), 301-311. doi: 10.1111/j.1360-0443.2011.03570.x
Young, L. B. (2012). Alcoholics Anonymous sponsorship: Characteristics of sponsored and sponsoring members. Alcoholism Treatment Quarterly, 30(1), 52-66. doi: 10.1080/07347324.2012.635553
Young, L. B. (2013). Characteristics and practices of sponsored members of Alcoholics Anonymous. Journal of Groups in Addiction & Recovery, 8, 149-164.
Zemore, S. E., Kaskutas, L. A., & Ammon, L. N. (2004). In 12-step groups, helping helps the helper. Addiction, 99(8), 1015-1023. doi:10.1111/j.1360-0443.2004.00782.x
Zemore, S. E., & Kaskutas, L. A. (2008). 12-Step involvement and peer helping in day hospital and residential programs. Substance Use & Misuse, 43(12/13), 1882-1903.
Zemore, S., Subbaraman, M., & Tonigan, S. (2013). Involvement in 12-step activities and treatment outcomes, Substance Abuse, 34, 1, 60-69.

Post Date April 28, 2017 by Bill White


In my writings to people seeking recovery from addiction, I have advocated a stance of total personal responsibility: Recovery by any means necessary under any circumstances. That position does not alleviate the accountabilities of addiction treatment as a system of care. Each year, more than 13,000 specialized addiction treatment programs in the United States serve between 1.8 and 2.3 million individuals, many of whom are seeking help under external duress. Those who are the source of such pressure are, as they see it, giving the individual a chance–with potentially grave consequences hanging in the balance.
Accepting the mantra that “Treatment Works,” families, varied treatment referral sources and the treatment industry itself believe that responsibility for any resumption of alcohol and other drug use following service completion rests on the shoulders of the individual and not with the treatment program. This is unique in the annals of medicine. With other medical disorders, continuation or worsening of symptoms is viewed as an indication that the initial treatment is not effective for this particular patient and that changes in the treatment protocol are needed. In contrast, when symptoms continue or worsen following addiction treatment, it is the patient who is blamed and often punished. The stance is, “You had your change and you blew it! You must now suffer the consequences of your actions.” And those consequences are often quite dire, including divorce, loss of children, loss of housing or educational opportunities, termination of employment, discharge from the military under less than honorable conditions, loss of professional licenses, loss of driving privileges, and incarceration, to name just a few. Such punishments are often meted out with an air of righteous indignation in the belief that the person for whom we have done so much has failed this chance we have given them. The question I am raising in this blog is: Was it really a chance?
Put simply, we are routinely placing individuals with high problem severity, complexity and chronicity in treatment modalities whose low intensity and short duration of service offer little realistic hope for successful post-treatment recovery maintenance. By using terms like “graduation” and ending the service relationship following such brief clinical interventions, we convey to patients, to families and to all other interested parties at “discharge” from treatment that recovery is now self-sustainable without continued professional support. And this is true just often enough (but often attributable to factors unrelated to the treatment) that this expectation is maintained for all those treated. For those with the most severe problems and the least recovery capital, I believe this expectation is not a chance, but a set-up for failure with potentially greater consequences than might have naturally accrued.
What we know from primary medicine is that ineffective treatments (via placebo effects) or an inadequate dose of a potentially effective treatment (e.g., as in antibiotic treatment of bacterial infections) may temporarily suppress symptoms. Such treatments create the illusion of resumed health, but these brief symptom respites are often followed by the return of illness–often in a more severe and intractable form. This same principle operates within addiction treatment and recovery support services. Flawed service designs may temporarily suppress symptoms while leaving the primary disorder intact and primed for reactivation. But now the treated individual has three added burdens that further erode recovery capital. First, there is the self-perceived experience of failure and the increased passivity, hopelessness, helplessness, and dependency that flow from it. Second, there are the perceived failure and disgust from others and its accompanying loss of recovery support–losses often accompanied by greater enmeshment in cultures of addiction. Finally, there are the very real other consequences of “failed treatment,” such as incarceration or job loss that inhibit future recovery initiation, community re-integration and quality of life.
The personal and social costs of ineffective treatment are immense. If we as a society and as a profession want to truly give people with severe and complex addictions “a chance,” then we have a responsibility to provide systems of care and continued support that speed and facilitate recovery initiation, buttress ongoing recovery maintenance, enhance quality of personal and family life in long-term recovery, and provide the community space (physical, psychological, social and spiritual) where recovery and sustained health can flourish. Anything less is a set-up for failure.
As addiction professionals, we should always be mindful of the power we wield and its potential effects on people’s lives. That power comes from our professional decisions and actions, but it also flows from the treatment designs within which we operate. If we are going to participate in giving people a chance, then we need to make sure it is a real chance and not a set-up for what is ultimately more a system failure than a personal failure. Self-inventory, inventory disclosure and making amends have been among the essential steps of recovery within AA, NA and other 12-Step groups. Perhaps it is time for leaders of addiction treatment to conduct a similar series of steps. Perhaps addiction treatment as a system of care is itself in need of a recovery process.

Post Date December 14, 2013 by Bill White