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

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

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

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

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

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

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

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

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

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

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

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

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

Post Date October 19, 2018 by Bill White

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

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

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

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

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

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

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

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

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

Post Date October 12, 2018 by Bill White

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


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

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

–The Shawshank Redemption

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

    Post Date September 21, 2018 by Bill White

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

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

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

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

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

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

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

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

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

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

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

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

References

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

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

Post Date September 14, 2018 by Bill White

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

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

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

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

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

Post Date August 5, 2016 by Bill White

Bill White – ATTENTIONAL BIAS IN ADDICTION AND RECOVERY-July 6, 2018

People addicted to alcohol and other drugs see the world differently. They SEE the world differently as a result of neurocognitive changes in perception that accelerate in tandem with increased tissue tolerance, increased intensity of cellular hunger (craving), and the resulting obsession with maintaining the drug relationship at all costs. As drug seeking, drug procurement, and drug use rise to the top of one’s motivational priorities, one develops attentional bias toward words, symbols, and images linked to these substances. Perceptual preferences for drug-linked stimuli are an essential element within the neurobiology of addiction. In recovery, this perceptual preference is reframed, giving perceptual priority to words, symbols, and images that reinforce the recovery process.

The journey from addiction to recovery is marked by extreme ambivalence, particularly during the early stages of recovery, and exposure to these contrasting sets of cues can tip the scales toward either addiction recurrence or the transition from recovery initiation to long-term stable recovery. The issue raised in this blog is the ratio of addiction cues versus recovery cues within community environments. The concern is the relative paucity of community-level recovery cues compared to a near-constant bombardment of drug cues.

Recovery folklore is filled with cautions about stimuli (aka “people, places, and things”) that can send a seductive call back to one’s past life in addiction. Imagine the sensory cues a person experiences in their first days of “sobriety sampling” as he or she pursues daily life in the community. Imagine her exposure to alcohol and other drug cues in every communication medium—the product of billions of dollars in alcohol, tobacco, and drug advertising that glamorizes intoxication and links mood-altering products to physical beauty, social popularity, romance, sexual fulfillment, financial success, and freedom from emotional distress. Imagine that even the social and print media she reads that address drug problems are filled with endless images of drug use, drug products, needles, and all manner of other drug paraphernalia. Imagine constant visual encounters with people and places closely linked to her past rituals of drug use. Imagine the sheer volume of drug cues she experiences driving down any U.S. commercial street—encounters with these cues on billboards and in restaurants, gas stations, grocery stores, and recreational venues, as well as through popular movies, magazines, and music.

One of the shared goals of alcohol, tobacco, and drug (ATOD) industries is to increase the physical presence of their products (and their carefully crafted images) within American life. They have been enormously successful over two centuries in achieving that goal. The result is a literal visual assault of drug-inviting words, images, and slogans infused into the very fabric of American life. In contrast, the stigma attached to having experienced problems with these substances has, until quite recently, rendered invisible the people, places, and things associated with addiction recovery. While ATOD icons have been ever-present in American life, words, images, and slogan celebrating the recovery experience have for too long existed only within subterranean subcultures hidden from mainstream community life.

Returning to our topic of attentional bias, one can see the challenge of initiating recovery within a cultural stew saturated with positive drug cues and few if any recovery cues. This imbalance is a personal challenge faced by each person beginning a recovery journey, but it is also a problem at an environmental level. Just as the ATOD industry sought proliferation of their product images, recovery advocates must help forge recovery-friendly communities in which the glamorization of these products are offset by images portraying their risks and by images linked to successful cessation of drug use and the resulting personal and social benefits.

For recovery advocacy organizations, this means two things. First, it means that they must counteract efforts by the alcohol, tobacco, and pharmaceutical industries to glamorize and promote drug consumption, target vulnerable populations, introduce products of ever-heightened potency, create more pleasure-inducing methods of drug administration, and expand the times and places in which the sale or use of such products are acceptable. By serving as a force to inhibit such cues within the community, recovery advocacy organizations can play important roles in ATOD prevention and the promotion of public health, while also reducing the cues people in early recovery are exposed to that could tip the scales toward re-addiction. An example of this is clearly evident in the history of tobacco policy in the U.S. It is far easier for a person to quit smoking today than in the 1960s, in part, because the massive promotion of smoking and the ever-expanding space within which smoking was acceptable has been reversed as a matter of public health policy. Imagine the cues the smoker trying to quit smoking would be exposed to in 1960 compared to today. Our goal as advocates should be to similarly reduce the cues and community spaces within which addiction to other drugs flourishes.

A second strategy of recovery advocacy organizations is to expand the public visibility of people, places, and things (and words, symbols, and images) that cast a recovery beacon within local communities. An ecumenical culture of recovery is rising into the light of community life through new recovery support institutions, recovery education and celebration events, and the increased representation of the recovery experience through art, literature, music, and social media.

Imagine that same young woman in decades to come in her earliest days of recovery. Imagine her ambivalence about addiction and about recovery. Imagine the challenges of attentional bias, but also imagine a community in which drug cues calling her back are counterbalanced by recovery cues calling her forward into a new life. In that new world, she has a much better chance than the chance she has in far too many communities today in which the former are ever-present and the latter are invisible. We must help build a world in which her recovery will be warmly welcomed. Addiction now flourishes on Main Street America; it is time recovery stepped out of the shadows and announced itself on Main Street. Thanks to recovery advocates across the country, that process has now begun.

References

Cox, W. M., Blount, J. P., & Rozak, A. M. (2000). Alcohol abusers’ and nonabusers’ distraction by alcohol and concern-related stimuli. American Journal of Drug and Alcohol Abuse, 26, 489–495.

Cox, W. M., Hogan, L. M., Kristian, M. R., & Race, J. H. (2002). Alcohol attentional bias as a predictor of alcohol abusers’ treatment outcome. Drug and Alcohol Dependence, 68, 237–243.

Field, M., & Cox, W. M. (2008). Attentional bias in addictive behaviors: A review of its development, causes, and consequences. Drug and Alcohol Dependence, 97, 1–20.

Stormark, K. M., Laberg, J. C., Nordby, H., & Hugdahl, K. (2000). Alcoholics’ selective attention to alcohol stimuli: Automated processing? Journal of Studies on Alcohol and Drugs, 61, 18–23.

Post Date July 6, 2018 by Bill White

Bill White – WHO IS BEST QUALIFIED TO PROVIDE RECOVERY SUPPORT SERVICES?-June 22, 2018

The explosive growth of nonclinical recovery support services (RSS) as an adjunct or alternative to professionally-directed addiction treatment and participation in recovery mutual aid societies raises three related questions: 1) What is the ideal organizational placement for the delivery RSS?, 2) What persons are best qualified to provide RSS?, and 3) Are RSS best provided on a paid or volunteer basis?

At present, non-clinical RSS are being provided through and within a wide variety of organizational settings by people with diverse backgrounds in both paid and volunteer roles. While research to date suggests that such services can enhance recovery initiation and long-term recovery maintenance, no studies have addressed the three questions above or the broader issue of the kinds of evidence that should be considered in answering these questions.

I have repeatedly suggested that these questions should be answered by methodologically-rigorous research evaluating whether recovery outcomes differ by variations in delivery setting, attributes of those providing the services, and the medium (paid vs. volunteer) through which such services are provided. There are, however, considerations beyond such outcomes that ought to be considered and factored into decisions on the design and delivery of RSS.

As for organizational setting, I have heard such arguments as follows:

*RSS should be provided by addiction treatment organizations to assure a high level of integration between treatment and post-treatment continuing care.

*RSS should be provided by criminal justice and child welfare agencies to assure the balance between the goals of recovery support, public/child safety, and family reunification.

*RSS should be provided by hospitals and other primary care facilities to assure effective integration of recovery support and primary health care.

*RSS should be provided through public health authorities to assure the integration of prevention, harm reduction, treatment, recovery support, community-level infection control (e.g., HIV, Hep C), and wellness promotion.

*RSS should be provided by behavioral managed care organizations (or insurance companies) to assure coordination and integration of support across levels of care (and potentially multiple service providers) and the effective stewardship of limited financial resources.

*RSS should be provided by private professional recovery coaches who can coordinate support across multiple systems and across the long-term stages of recovery.

RSS are now being piloted through all of the above arrangements, but I think a strong argument can be made for providing RSS through and beyond all of the above settings under the auspices of authentic recovery community organizations (RCOs). Allocating financial resources to deliver RSS through these organizations and to the community at large has the added advantages of: 1) maintaining long-term personal and family recovery as the primary service mission, 2) drawing upon the experiential knowledge within communities of recovery to inform the provision of RSS, 3) contributing to the growth of local recovery space/landscapes (i.e. community recovery capital), 4) financially strengthening the infrastructure of local RCOs, and 5) proving greater peer support to the workers providing RSS.

Similarly, RSS are now being provided by people from diverse experiential and professional backgrounds. I think there are many RSS functions that can be effectively delivered across this diversity of backgrounds, but I think the delivery of these services by people in recovery who have been specifically training for this role offers a number of distinct advantages. Through the delivery of peer-based recovery support services, people in recovery can uniquely offer: 1) recovery hope and modeling (living proof of the reality of long-term recovery), 2) normative information drawn from personal/collective experience on the stages and styles of addiction recovery, and 3) knowledge of and navigation within local indigenous recovery support resources. Such hope, encouragement, and guidance is grounded in more than 200 years of history in which people in recovery (i.e., wounded healers, recovery carriers) have served as guides for other people seeking recovery from severe AOD problems (See Slaying the Dragon, 2014). It offers the further advantage of expanding helping opportunities for people in recovery—creating benefits for both helpee and helper through the helping process. (See discussion of Riesman’s Helper Principle). Some of these advantages are limited, however, when the knowledge of the RSS specialist is drawn from personal experience within only one recovery pathway—thus the importance of combing experiential knowledge with rigorous training and supervision.

If we accept the delivery of RSS through recovery community organizations and by people with lived experience of personal/family recovery from addiction, there still remains the question of whether those directly providing RSS should be in paid or volunteer roles. The most prevalent model of delivering RSS is presently through paid roles, with progressively increasing expectations of education, training, and certification—similar to the modern history of addiction counseling. Paying people in recovery to provide RSS has the advantages of expanding employment opportunities for persons in recovery, acknowledging the value and legitimacy of experiential knowledge and expertise, and potentially creating a more stable RSS workforce. That said, the professionalization and commercialization of the RSS role risks undermining the voluntary service ethic within the recovery community, potentially creating an unfortunate future in which people in recovery would expect financial compensation for all service work.

One option is to provide funding to RCOs for the recruitment, orientation, training, and ongoing supervision of RSS, while relying primarily upon trained volunteers to deliver such services. Only time will tell if this option is a viable and sustainable model for the delivery of high quality RSS. If not, great care will need to be taken to avoid the over-professionalization and over-commercialization of recovery support. Questions related to the design and delivery of RSS should be answered primarily through research on RSS-related recovery outcomes, but such research should also examine broader benefits and the potential for inadvertent harm rising from particular models of RSS.

Post Date June 22, 2018 by Bill White