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

BLOG & NEW POSTINGS May 12, 2017 -Bill White- AN INTERVENTION GONE WRONG

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.

BLOG & NEW POSTINGS May 1, 2017-Bill White- RECOVERY TO RESISTANCE

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

BLOG & NEW POSTINGS April 28, 2017-Bill White- SCIENCE OF SPONSORSHIP UPDATE


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

BLOG & NEW POSTINGS December 14, 2013 -Bill White- PERSONAL FAILURE OR SYSTEM FAILURE?

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

BLOG & NEW POSTINGS April 21, 2017 -Bill White- THE REVOLVING DOOR OF ADDICTION TREATMENT

Marvin Ventrell, Executive Director of the National Association of Addiction Treatment Providers (NAATP), recently released the first quarter data from the NAATP Outcomes Pilot Program (OPP). It will be some time before the full results and implications of this study are complete, but there is one striking piece of data worthy of current reflection. Of the 756 people who have been admitted to NAATP study sites to date, 63% reported having received prior treatment for a substance use disorder (SUD). NAATP membership includes a large portion of private addiction treatment organizations, but the NAATP data on prior treatment episodes of those admitted to addiction treatment is similar to previously reported national data.
The Substance Abuse and Mental Health Administration’s Treatment Episode Data Set for the years 2010-2012 reported that of the more than 5 million SUD admissions during those three years, only 37.4% had no prior admissions for addiction treatment, 33.5% had two or more prior admissions, and 11.7% had five or more prior admissions.
In sum, more than 60% of people entering addiction treatment in the United States have one or more prior episodes of such treatment. What are we to make of such a finding? Modern addiction treatment was a social experiment begun, in part, to eliminate the revolving doors of local hospitals and jails through which addicted people repeatedly entered, exited, and reentered. Rather than eliminate this revolving door, we simply moved the door to a new social institution.
In an earlier blog, I suggested that:
“We are routinely placing individuals with high problem severity, complexity, and chronicity in treatment modalities whose low intensity and short duration 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 at “discharge” to patients, to families, and to all other interested parties that recovery is now self-sustainable without continued professional support. And this is true just often enough that this expectation is maintained for all those treated. For those with the most severe problems and the least recovery capital, this expectation is not a chance, but a set-up for failure—a systems failure masked as personal failure.”
Addiction professionals sometimes justify this practice of subjecting people to repeated episodes of acute biopsychosocial restabilization by noting the chronic nature of substance use disorders. But portraying severe and complex patterns of addiction as chronic disorders is a call to radically redesign addiction treatment and recovery support services. It is not a justification for repeated cycles of acute care that fail to achieve post-treatment recovery maintenance. Brief episodes of addiction treatment are highly appropriate for those with low to moderate problem severity and moderate to high recovery capital, but such interventions for those with the most severe substance use disorders are more likely to constitute brief respites within a prolonged addiction career than a catalyst for sustainable recovery. Portraying addiction as a “chronic disease” to justify multiple, time-extensive, and expensive treatment episodes constitutes, at best, inappropriate clinical care and, at worst, systematized financial exploitation.
If we as a field really truly believe that severe and complex SUDs are “chronic disorders,” the resources we invest in early screening and intervention and post-treatment recovery maintenance and support would be commensurate with the resources we now repeatedly invest to support recovery initiation/stabilization. There is growing interest in applying to addiction treatment what has been learned from primary medicine about the effective management of chronic disorders like diabetes, hypertension, asthma, and cancer. (In an earlier communication, I described such lessons drawn from my own cancer treatment.)
It is helpful to distinguish five stages of addiction recovery: precovery, recovery initiation and stabilization, recovery maintenance, enhanced quality of personal and family life in long-term recovery, and efforts to break intergenerational cycles of addiction. At present, nearly all recovery support resources are focused on recovery initiation and stabilization, and as a system of care we manage that stage more effectively and more safely than at any time in history. What we don’t achieve as a system is reaching people earlier in the development of addiction and supporting the transition from recovery initiation to long-term recovery maintenance and the subsequent stages of recovery.
There is growing interest in the clinical implications of conceptualizing addiction as a chronic disorder and repeated calls for expanding addiction treatment beyond models of acute care (AC) toward models of sustained recovery management (RM) nested within larger recovery-oriented systems of care (ROSC). But the clock is ticking. The cultural and therapeutic pessimism rising from the revolving door of addiction treatment must end. Treatment leaders must embrace RM/ROSC models of care for those with the most severe and complex substance use disorders and reserve AC interventions for those with mild to moderate problem severity and moderate to high recovery capital. Affected individuals and families and their advocates must demand individualized approaches to care that reflect distinctions in problem severity and recovery capital. Planners and payors of care must re-evaluate funding acute care interventions for the most severe substance use disorders when such care lacks assertive and sustained post-stabilization recovery support services. In the meantime, the revolving door continues to spin.

Post Date April 21, 2017 by Bill White

BLOG & NEW POSTINGS April 14, 2017 -Bill White- RECOVERIES UP IN SMOKE UPDATE

Many people in self-proclaimed addiction recovery experience compromised health and premature death due to a unique form of conceptual blindness—the failure to perceive nicotine dependence on par with the other drug dependencies they have shed from their lives.
On August 23, 2013, I posted a blog noting the following 12 conclusions drawn from available scientific studies of nicotine dependence and its relationship to recovery from other drug addictions.
1.Tobacco use accounts for more sickness and disease than the combined use of alcohol and other drugs.

2. Combining nicotine addiction with another drug addiction amplifies the health risks of both addictions.

3. Between 70-80% of people entering addiction treatment smoke–nearly 4 times the rate for all adults.

4. Between 44-80% of patients admitted to addiction treatment express a desire to stop smoking.

5. People treated for alcohol or drug dependence are more likely to subsequently die from smoking-related diseases than from alcohol- or other drug-related causes.

6. Leading figures within the American history of addiction recovery have died of smoking-related diseases, including Bill Wilson, Dr. Robert Holbrook Smith, Mrs. Marty Mann, Danny C., Jimmy K., Charles Dederich, Dr. Marie Nyswander, and Senator Harold Hughes.

7. Continued smoking among those seeking to initiate or maintain recovery is a risk factor for resumption of alcohol and other drug use.

8. Smoking cessation improves recovery rates of other addiction; rates of smoking cessation rise with length of abstinence from alcohol and other drugs.

9. A growing number of addiction counselors are refusing to model a behavior (smoking) that could take years from their own lives and the lives of those who could be influenced by their example.

10.Some people in recovery are choosing to change their sobriety/clean dates to reflect the date they stopped all addictive drug use–including nicotine use.

11. Addiction professionals are broadening their understanding of “recovery” to encompass smoking cessation.

12. The health benefits of smoking cessation for people in recovery include increased life expectancy, reduced risk of heart disease, heart attacks, strokes, and cancer, as well as a more rapid process of brain recovery from addiction.

Studies published since my first posted summaries (Here and Here) confirm and extend these major findings. The latest study comes from Dr. Andrea H. Weinberger and colleagues who measured the effects of continued smoking or onset of smoking on the recovery outcomes of persons who had previously achieved remission from a substance use disorder. The authors concluded:
…among adults with remitted substance use disorders, those who reported continued smoking 3 years later had increased odds of substance use and relapsing to substance use disorders compare to those who were no longer smoking. (Weinberger et al., 2017, p. e153)
The same risk of increased substance use recurrence was found among nonsmokers who began smoking during the early years of their recovery from other drug dependencies.
The awakening to such realities has progressed in recent years, with many addiction treatment programs now incorporating smoking-related assessment, education, and treatment, as well as encouragement and sustained support for smoking cessation. The National Tobacco Integration Advocacy Committee (NATIAC) is challenging all addiction treatment programs to fully integrate such services through its recently released report A Time to Lead. I encourage all providers of addiction treatment and recovery support services to review and reflect on the NATIAC report. Decisive action on our part can save countless lives and enhance the health and quality of life of people in long-term recovery. Such action could also take us a step closer to correcting the blind spot that has excluded tobacco/nicotine from American drug policies.
Reference
Weinberger, A. H., Platt, J., Esan, H., Galea, S., Erlich, D. & Goodwin, R. D. (2017). Cigarette smoking is associated with increased relapse risk of substance use disorder relapse: A National representative, prospective longitudinal investigation. Journal of Clinical Psychiatry, 78:2.

Post Date April 14, 2017 by Bill White