The devastating effects of addiction on physical/emotional health and social functioning have been meticulously catalogued, but far less attention has been given to its toll on character and the role character reconstruction plays in the recovery process. A recent rereading of David Brook’s The Road to Character has spurred this reflection on character and addiction recovery.

All diseases have the potential to distort character—particularly in shrinking one’s world to a state of near-complete self-absorption (as observed by Samuel Johnson in 1783). But addiction is unique within the annals of medical disorders in the extremes to which one’s unique essence is distorted as the disorder progresses. By radically reordering personal priorities, addiction ultimately sacrifices all other personal commitments and aspirations to serve this higher need. It shrinks one’s world and hollows one out, leaving only this insatiable need and the painful consequences of serving it as the center of one’s self.

Addiction medicine—actually all medicine—is ill-equipped to address such pathologies of character and to fill the void once drugs are removed from the center of an addicted patient’s life. The person seeking addiction recovery is left with this same challenge: How does one escape such chemically-induced narcissism within a culture that, not just worships the self, but has itself become a “selfie culture.”

This dilemma is well-illustrated by distinctions between the terms remission and recovery. The former term is used in medicine and clinical research to depict the amelioration of addiction. In short, it says the patient once met, but no longer meets, the diagnostic criteria for a substance use disorder. Remission is further specified by duration of symptom suppression, e.g., early remission (3 months not meeting diagnostic criteria) or sustained remission (more than a year not meeting such criteria). Remission does not necessarily mean that alcohol or other drug (AOD) use has ceased or that all related problems have disappeared, only that any remaining use or problems are now below the threshold of diagnosis. Remission eliminates or reduces AOD problems to subclinical levels but may leave the remitted patient with an overwhelming sense of emptiness and disconnection.

In contrast, the term recovery, used more frequently by those with lived experience of having survived addiction, is often used to suggest a process of change far beyond the removal of alcohol and other drugs from an otherwise unchanged life. It depicts the process of moving through and beyond remission to refill oneself, develop depth of character, and propel one towards relationships and contributions that reach beyond the self. In some recovery circles, remission without “recovery” is even castigated as a shallow level of achievement (e.g. a “dry drunk” lacking “emotional sobriety”). In such circles, remission is viewed as the temporary suppression of symptoms (a process of subtraction) where recovery is viewed as the process through which the surviving person is transformed (processes of addition and multiplication).

Remission can be an act of self-assertion; but recovery, this larger achievement of global health and functioning, often comes through an embrace of one’s limitations and transcendence of self. It involves the acceptance of one’s brokenness (discovering in Kurtz and Ketcham’s language, the spirituality of imperfection); the practice of restraint and moderation in our thoughts, feelings, and actions; and finding a purpose for one’s survival. Recovery in this view requires replacing the “I” language of alienation with the “we” language of human connection—shedding the “selfie culture” and embracing a culture of humility, tolerance, interdependence, and community. It involves, as David Brooks suggests, shifting the focus from the exclusive needs of self to needs of the world, e.g., reframing the question, “What do I want from life?” to “What does life want from me?”

Awareness of imperfection and limitation allows us, through becoming “strong in the weak places,” to use adversities of character to build depth of character. Such depth is about far more than character reconstruction as a monument to self-fulfillment; it is about character in service to the larger needs of the world. To achieve this shift, Brooks suggests the need for “redemptive assistance”—resources beyond the self. The courage to face one’s empty self and the humility to reach out to others are the first steps in seeing ourselves not as the center of the universe and instead discovering how our small story fits into a much larger story. To recognize our brokenness and to heal in this way turns adversity and suffering into a transcendent purpose or sacred calling—finding our place within the arch of history and committing ourselves to “tasks that cannot be completed in a single lifetime” (p. 264).

Such a process requires something quite different than getting “into ourselves” through therapies rife with intrapersonal self-exploration and whose aims are to increase self-knowledge, self-esteem, and self-expression. It may instead require two quite different processes: 1) cultivating self-skepticism, humility, and tolerance; and 2) getting out of ourselves, e.g. seeking resources, relationships, and service activities beyond the self. The former strategy requires recognizing our flawed nature and quieting the roar of our own ego to the extent that we can actually listen to and experience other people—what at its best Brooks calls a “ministry of presence.” The latter strategy involves transforming recovery into a heroic journey that serves a larger purpose, while maintaining distrust of self and avoiding turning even the most righteous cause into a vehicle for self-adulation.

Extreme narcissism, self-will run riot in language of Alcoholics Anonymous, is the essence of addiction regardless of whether one sees this trait as a cause or consequence of addiction, regardless of whether that entrapment in self is manifested in grandiosity and acts of exploitation or in self-hatred and self-harm. It is a paradoxical entrapment that combines self-absorption and self-inflation on the one hand with self-hatred and deteriorating self-care on the other. Escaping these Janus faces of addiction may require the shift from getting deeper into oneself to finally getting out of oneself. That journey from the abyss to the world is what builds character. That journey is the essence of recovery and what distinguishes recovery from remission. We are learning a lot about the prevalence and pathways of remission through advances in addiction research; the processes of recovery have yet to fully arrive as a subject of scientific investigation. Many of our addiction treatments, including an expanding menu of medications, can facilitate remission; few of those treatments offer hope for the long-term process of character reconstruction to achieve recovery. Men and women seeking the latter must look to other contexts for such support.

Post Date February 16, 2018 by Bill White


A Counselor and Patient in Long Term Recovery

A Counselor and Patient in Long Term Recovery
Out of the shadows-By Jamie Lebish BS, CADC, RC
What would life and work be like for a long-term MAR (medication assisted recovery) patient, whom is also a drug and alcohol counselor? Stigma dictates that life would not ever be predictable. Logic dictates that there will always be barriers.
Imagine going through part of your life addicted to opiates, by no choice of your own, but everyone still thinks to themselves differently, perhaps with distaste. ‘You made bad choices’.
Imagine actually getting better, becoming clean and having to use a medication to stay clean. This is called MAT or medication assisted treatment. There are millions of us around the world at this very moment.
Now, imagine that you have made it through almost 10 years of recovery and trying your best to go from methadone (oh no! not methadone) to Suboxone. “Not only have some of you stopped reading, but others still have that uncomfortable pit in your throat”. I know. I am one of you and I am one of them. Long term Suboxone patients that are not able to taper lower than 2mgs. There is science behind this Long Term recovery phenomenon.
I am a person that lives in a divided world. One in which some would say, counselors don’t use Suboxone, and certainly not medical marijuana. But we do exist. Not only exist but thrive, and have a true passion for life and helping others get better. We as counselors in recovery know what it is like to be addicted to opiates, and better yet, we know that you can get better. We believe in you.
There is no road map for life, and there certainly is no road map to recovery from Drugs, alcohol or any other addition. You have to want to get better and you find a path that works for you. That is what I did to get better. Along the way many people in the rooms (AA/NA), and in treatment said that “if you want to recover you have to do X, Y and then Z. Well, real recovery does not happen quite like that. To get right with yourself is the hardest part, because you have already written yourself off. Becoming human and learning to like yourself again.
I have to tell you that recovery is not a secret, and most of us that get better, find a path that works for them. The first thing that I did want was; to not have to take opiates as a medication for pain ever again. I am terrified of opiates, as I was in a horrific auto accident and spent 1 month in hospital (the start of my addiction to opiates), and when I started to get older, pain from arthritis came in. I learned to use every alternative, but take opiates. That is where Medical Marijuana came in. For me, it is a vastly safer and effective as an anti-inflammatory and mild pain reliever, and a very effective anti-anxiety alternative. Certainly, you get that? No?
Ok, so I may have to get some more qualifiers in this text for you to believe me, but in the 19+ years since using any illegal narcotics or alcohol, I can safely say that I am a good human being, and I am a good counselor, and I get it. If you or anyone you know who is struggling with addiction, or the stigma associated with MAR or MMJ, please comment on this blog? Let’s get a conversation going for the rest of us that want to come out of the shadows. I am sick of hiding.
We are effective, high-quality people that deserve to live and work alongside others without hiding, and wondering why some of you think it’s ok to drink and drive, instead of relief through MMJ. That’s a whole other debate. If you want to change the status quo, we need to effect change. Leave your comment and let’s talk?

December 29, 2017 -Bill White- A YEAR-END NOTE OF GRATITUDE

We have covered a lot of territory within the more than 50 communications we have shared in 2017. From concerns about troubling directions in national drug policy to the prevalence, pathways, styles, and stages of personal/family recovery; we have taken time each week to explore critical issues related to addiction recovery.

When this weekly recovery blog debuted in 2013, my hope was that it would provide a forum through which I could continue to communicate with addiction professionals, recovery advocates, and people in recovery. I had just been forced by advancing age and health limitations to end decades of traveling and speaking about addiction treatment and recovery. This recovery blog was one more morphing of my role within this special ministry begun nearly half a century ago. I hoped the blog would provide a platform of continued connection to people across the country and the world. The communications that have flowed from this effort have far exceeded my expectations. Thanks to each of you for taking the time to read my words and reflect on their meaning to your life and service activities. Your presence and expressions of appreciation have warmed an old man’s heart.

I would be remiss if I did not also offer a special thank you to those who emailed or posted notes of appreciation and photos of tagged pages and yellow highlighted passages from my recently-released book, Recovery Rising. This book was quite personal and unlike anything I had attempted before, and I was unsure whether the story/reflection format would find an appreciative audience. The release of a book (or a blog) is like an election; in spite of your hopes and the best predictions of others, you never know the outcome until the votes are in. Thank you to all of you who “voted” for Recovery Rising by reading and talking about it with friends and colleagues.

Most importantly, I want to share my gratitude for those of you who continue to work every day on the front lines of addiction treatment, recovery advocacy, and recovery support. You are my heroes, and it is your compassion and commitment I have tried to honor through my writings. Many years ago, I called on a new generation of activists with the words, “Let’s go make some history.” You/we have indeed done that. The world of recovery today is beyond anything I could have imagined when I began this journey. There is much work yet to be done, but, at this closing of the year, let us pause to reflect with gratitude on all that has been achieved and the lives touched and transformed through that process.

Post Date December 29, 2017 by Bill White

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

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


“What is the best approach to the supervision of peer recovery support service specialists within the addictions field?” is a question that, at present, remains unanswered.
In earlier communications, I have disseminated papers that outlined the history, theory, and science of peer recovery support services; delineated the roles of addiction counselor, Twelve-Step sponsor, and recovery coach; detailed linkage procedures to recovery mutual aid organizations and other recovery community institutions; depicted the value of peers in pre-treatment outreach and engagement; described the integration of peer recovery support within professional treatment settings and recovery community centers; and reported on the integration of peer recovery support services within allied systems of care. Peer recovery support specialists—people credentialed by lived experience and on-the-job training—are now being integrated into a wide variety of settings and are delivering services across the stages of long-term addiction recovery. But questions remain about how such services are best supervised even as work progresses on defining the core competencies of peer supervision. A recent trend has been the requirement that peers be provided “clinical supervision.”
Traditional clinical supervision within the context of addiction treatment has many components, but at its core, and at its best, it provides oversight of the screening, assessment, diagnosis, treatment planning, and treatment delivery process, with a particular focus on the quality of the helping relationship. Modeled from supervision within the fields of psychiatry, psychology, and social work, addiction professionals and the individuals and families they serve have benefited greatly from this clinical supervision process. So why not extend this same clinical supervision to peer recovery support specialists? Here’s why.
Regardless of title (e.g., recovery support specialist, recovery coach, peer specialist, etc.), peer recovery support services are not a “clinical” activity in the sense that they do not involve processes of clinical assessment, diagnosis, treatment planning, or the delivery of professionally-directed treatment services. Any time they drift into this clinical domain, the peer helper is migrating beyond the boundaries of his or her education, training, and experience in ways that could inflict inadvertent harm to those being served. “Clinical supervision” of peer workers threatens to both turn them into wannabe therapists and pull them from activities for which they are best suited and which could have the greatest impact on long-term recovery outcomes.
My personal concern at the moment is that we as a field are not recognizing the difference between clinical supervision and the type of supervision needed for peer recovery support services. As noted, the former has a primarily intrapersonal focus. In contrast, the latter has a much great focus on the ecology of recovery—removing personal and environmental obstacles to recovery, assertive linkage to recovery mutual aid groups and other recovery support institutions, navigation of the larger culture of recovery, providing stage-appropriate recovery education to individuals and families, conducting ongoing recovery check-ups, and offering guidance to improve the quality of personal/family life in long-term recovery. While all helping roles involve emotional support, peer services are best delivered with an interpersonal focus that nests recovery within the context of family and community—including changing environmental conditions to enhance recovery outcomes. Supervision must help peer helpers forge links between personal needs and community needs—bridging personal/family support with advocacy at the community level and beyond.
Given these differences, I think the misapplication of traditional clinical supervision to the delivery of peer recovery support services will destroy the true potential of this role in supporting long-term recovery. What do you think?

Post Date December 1, 2017 by Bill White


When that doctor asked me, ‘Son, how did you get in this condition?’
I said, ‘Hey sawbones, I’m just carrying on an ole family tradition.’
–Hank Williams, Jr., Song Lyric, Family Tradition.
The intergenerational transmission of addiction and related problems has been documented for more than two centuries. Put simply, the children of alcohol and other drug (AOD) dependent parents are at increased risk of developing such problems, even when raised in alternative environments. Risks are amplified when combined with other factors, e.g., adverse childhood experiences, early age of onset of drug use, co-occurring medical or psychiatric disorders, enmeshment in drug-saturated social environments, and limited problem-solving assets.
In earlier publications, my co-authors and I have addressed the sources of such risks as well as potential strategies for breaking intergenerational cycles (e.g., see HERE and HERE). The challenge we faced in proposing potential solutions is linked to a much larger issue. The AOD research establishment has historically focused on illuminating the psychopharmacology of intoxicating substances, cataloguing the pathologies of acute and chronic drug consumption, and describing and evaluating the short-term effects of educational or clinical interventions designed to alter the course of substance use and substance use disorders (SUD). Absent from this research agenda have been rigorous studies to elucidate the prevalence, pathways, styles, and stages of long-term personal and family recovery across cultural contexts. Without such a recovery research agenda, some of the most important questions facing individuals, families, and communities remain both unasked and unanswered.
If, for example, we followed a large community and clinical sample of parents meeting diagnostic criteria for a substance use disorder (SUD) and examined the prevalence of AOD use, risky use, and SUD among their children, what would we discover with regard to the following five questions?
Does recovery of a parent reduce the likelihood of that parent’s children developing a SUD compared to parents who have not achieved recovery?
Does parental recovery increase the likelihood of recovery for any of their children who experience a SUD compared to children of parents who have not achieved remission?
Does parental involvement in professionally-directed addiction treatment or a recovery mutual aid group affect the intergenerational transmission of SUDs and the recovery prognosis of their children?
Does the participation of a child in his or her parent’s addiction treatment or in a family-focused peer recovery support group affect that child’s future vulnerability for experiencing or recovering from a SUD?
For parents who have experienced a SUD, are there parental actions associated with lower SUD risks for their children?
These are not obscure academic questions—the addictionologist’s equivalent of how many brain cells can dance on the head of a pin. They are instead questions of enormous concern to every parent who has experienced an alcohol or other drug problem and to every parent in recovery. It is time, no, past time, for such questions to be answered. If even partial answers to these questions are available, why have they not been widely disseminated to those most directly affected? Is anyone at the National Institute on Drug Abuse and the National Institute on Alcohol Abuse and Alcoholism listening?
Apparently so. McCutcheon and colleagues have just published a NIAAA/NIDA-funded study in the renowned journal, Addiction, that is among the first to explore the questions raised above. The study examined whether the odds of remission from an alcohol use disorder (AUD) increased depending on the existence of relatives in AUD remission. The likelihood of remission was more than three times greater for those related to someone in AUD remission compared to those related to someone with persistent AUD. What remains unclear is whether this remission advantage is a function of heritable traits that increase remission probabilities (i.e., a form of biological recovery capital) or whether this advantage springs from social contagion (e.g., the influence of one family member in recovery upon another family member in need of recovery.) This is the most definitive report to date on the intergenerational transmission of increased odds of recovery from addiction. We have long known that the risk of addiction runs in families; there is now preliminary evidence that this is also true of addiction recovery. Future research may illuminate how the odds of transmitting such resilience may be increased.
Post Date November 17, 2017 by Bill White


Dr. John Kelly and colleagues just published (Drug and Alcohol Dependence, 181, 162-169) a landmark survey that measured the prevalence and pathways of alcohol and other drug problem resolution among adults living in the United States. Major findings from this study include the following.
Recovery Prevalence The just-published Recovery Research Institute (Massachusetts General Hospital) survey found that 9.1% of U.S. adults report they “use to have a problem with alcohol or drugs but no longer do.” This prevalence rate is comparable to earlier epidemiologic studies on rates of remission for alcohol and drug use disorders (See here for a review) and would translate to approximately 22.35 million U.S. adults who have resolved alcohol and other drug (AOD) problems. The rate of remission for substance use disorders in earlier surveys ranges from 5.3% to 15.3% of the adult population—an estimated 25 to 40 million U.S. adults (not including those in remission from nicotine dependence alone).
Variability of Problem Severity Approximately half of those who had resolved an AOD problem reported indicators associated with greater problem severity, e.g., early age of onset of AOD use, multiple drug use, and past arrest.
AOD Problem Resolution and Recovery Identity Of those who reported having resolved an AOD problem, only 46% identify as being “in recovery.” This suggests that people embracing a recovery identity (recovered, recovering, in recovery) are a subset of a much larger pool of people who have resolved AOD problems.
Duration of Problem Resolution Of those who had resolved an AOD problem, 35% reported duration of resolution of 5-15 years, and 29% reported having resolved the problem for more than 15 years. There is a substantial population of American adults in stable, long-term recovery from significant AOD problems.
Assisted versus Unassisted Recovery Of U.S. adults who have resolved AOD problems, 46% resolved these problems without professional treatment or peer recovery support and 54% reported using such supports. Significant differences exist between those with unassisted versus assisted pathways of problem resolution, with the latter associated with greater problem severity, problem complexity (e.g., co-occurring psychiatric diagnosis), and more significant consequences (e.g., criminal justice involvement).
Sources of Assistance The most commonly reported resources used to resolve AOD problems were mutual aid groups (45%) and professional treatment (28%), with 9% reporting use of medication support. While the majority noting use of mutual aid reported participation in Alcoholics Anonymous or Narcotics Anonymous, also evident were other Twelve-Step groups and an increasing variety of secular (women for Sobriety, SMART Recovery, etc.) and religious (e.g., Celebrate Recovery) recovery mutual aid groups. Of those who had resolved AOD problems, 22% reported using new recovery support institutions, e.g., sober residences, recovery community centers, and recovery ministries.
For nearly two decades, recovery advocates have championed two kinetic ideas: 1) Recovery is a reality (for individuals, families, and communities) and 2) There are multiple pathways of recovery and ALL are cause for celebration. The research of Kelly and colleagues offers substantive scientific evidence in support of both propositions.
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.
White, W. L. (2012). Recovery/remission from substance use disorders: An analysis of reported outcomes in 415 scientific studies, 1868-2011. Chicago: Great Lakes Addiction Technology Transfer Center; Philadelphia Department of Behavioral Health and Developmental disAbilites; Northeast Addiction Technology Transfer Center.
Related Reading
Arndt, S., Vélez, M. B., Segre, L., & Clayton, R. (2010). Remission from substance dependence in U.S. Whites, African Americans, and Latinos. Journal of Ethnicity in Substance Abuse, 9(4), 237-248.
Calabria, B., Degenhardt, L., Briegleb, C., Vos, T., Hall, W. Lynskey, M., . . . McLaren, J. (2010). Systematic review of prospective studies investigating “remission” from amphetamine, cannabis, cocaine or opioid dependence. Addictive Behaviors, 35(8), 741-749.
Dawson, D. A., Grant, B. F., Stinson, F. S., Chou, P. S., Huang, B., & Ruan, W. J. (2005). Recovery from DSM-IV alcohol dependence: United States, 2001-2002. Addiction, 100(3), 281-292. doi: 10.1111/j.1360-0443.2004.00964.x
Grella, C. E., & Stein, J. A. (2013). Remission of substance dependence: Differences between individuals in a general population longitudinal survey who do and do not seek help. Drug and Alcohol Dependence, 133(1), 146-153.
Price, R. K., Risk, N. K., & Spitznagel, E. L. (2001). Remission from drug abuse over a 25 year period: Patterns of remission and treatment use. American Journal of Public Health, 91(7), 1107-1113.
Spinelli, C. & Thyer, B. A. (2017). Is recovery from alcoholism without treatment possible? A review of the literature. Alcoholism Treatment Quarterly, DOI: 10.1080/07347324.2017.1355219.
White, W. L., Weingartner, R. M., Levine, M., Evans, A. C., & Lamb, R. (2013). Recovery prevalence and health profile of people in recovery: Results of a Southeastern Pennsylvania survey on the resolution of alcohol and other drug problems. Journal of Psychoactive Drugs, 45(4), 287-296.
Post Date November 3, 2017 by Bill White