August 4, 2017 -Bill White- THE ECOLOGY OF ADDICTION RECOVERY

Addiction and addiction recovery are most often portrayed in the form of highly personal stories, but vulnerability to addiction and efforts to recover unfold within life-transforming or life-ending contexts. I have tried through many of my writings to illuminate these environmental influences and was struck in my recent interview with Dr. Phoebus Zafiridis his articulation of how physical, political, economic, cultural, and professional environments influence addiction and addiction recovery. For those readers unfamiliar with the work of Dr. Phoebus Zafiridis, he is a social psychiatrist and founder of the therapeutic community “ITHAKI” and the Self-Help Promotion Program of the Department of Psychology at the Aristotle University of Thessaloniki (2000) in Greece.
Below are three excerpts from my interview with Dr. Zafiridis.
“I believe that policy makers over the last decades, in collaboration with the dominant scientific trend, have been trying in every possible way to avoid any association of growing psychosocial problems with the socioeconomic environment. The reasons are obvious. Such a correlation would imply a demand for political and social change. Therefore, manipulation of research in the specific scientific field is an essential condition for the maintenance of the status quo. The research in psychology and psychiatry that is unaffected by political or economic interests can illustrate the importance of transparency, social justice, social coherence, and decreasing inequality to the mental health of citizens.”
“I do believe that psychotherapeutic procedures would make more sense if they related people’s personal psychological problems to the prevailing social conditions and promoted personal as well as social change. For it is self-awareness and the understanding of one’s environment that make citizens claim their right to participation in political decisions that determine the quality of their lives. That is mature political action. This is the emancipatory version of psychotherapy, as opposed to the dominant manipulative version, which is content with appeasement and temporary relief of the symptom. This symptom is considered to be a very personal experience in modern societies. It is treated as a problem of separate individuals and most of the time is classified as a new disorder by a “neutral” scientific community, supported by the pharmaceutical industry. This is why psychology and psychiatry should investigate and address the social and cultural dimensions of personal problems, instead of covering them up.”
“…dominant Psychology and Psychiatry today support the people in power. They conceal facts that would help citizens realize the true nature of their problems and urge them to fight for social change. This is not only achieved by constructing diagnoses and nosological theories to explain people’s misery and suffering. It is achieved by the “psychologization” of everyday life, with the support of the television, popular media and multiple pop psychology publications. I have had enough of listening to personal dramas that center around a lack of meaning and emptiness; failed friendships, romances and relationships; financial and professional failures; deep sorrow caused by a pet’s psychological problems; and problematic parental relationships, which are used by 40 or 50 year-old people as excuses for their misery, or even for the family drama caused by the inability to afford a summer house, etc….And all this, at a time when our politicians are piling refugees from Syria into tents and unheated buildings, and people right next door can’t have enough food to survive the day. We avoid looking at what’s going on right next to us, ignoring the suffering that exists around the world. The more we focus exclusively on ourselves, the more we ignore other people’s problems, and hence, the greater our misery seems. This is the price to pay for egoistic behavior.”
Those wishing to read the full interview may click HERE.

Post Date August 4, 2017 by Bill White

July 28, 2017 -Bill White- ADDICTION RECOVERY IN THE ISLAMIC REPUBLIC OF IRAN


Like the United States, the Islamic Republic of Iran has faced critical challenges from rising opioid addiction. And like the U.S., Iran has experimented with a wide variety of remedial responses, ranging from supply reduction efforts and harsh punishment of users to expansion of harm reduction, treatment, and recovery support services. The latter include the explosive growth of Narcotics Anonymous meetings, which now constitutes 28% of all NA meetings worldwide, and the growth of other indigenous recovery communities, such as Congress 60.
Congress 60 was founded by Mr. Hossein Dezhakam in 1998 and has since grown to 38 branches across Iran with more than 50,000 members. Over the past decade, I have had the privilege of regularly communicating with Mr. Dezhakam and members of Congress 60. Several aspects of Congress 60 commend it to international readers interested in addiction treatment and recovery, including:

A theory of addiction (the X theory) that parallels much of what is being learned within modern studies of the neurobiology of addiction,
A theory of recovery as a sustained process of physical, mental, emotional, and spiritual (worldview) rejuvenation and self-discovery,
Decelerating doses of reparative medicine (opium tincture) through the first eleven months of recovery initiation and stabilization,
Sustained and saturated involvement in a vibrant recovery community, with its own recovery-focused language, literature, values, symbols, and rituals,
Intense involvement of members in competitive sports, music, the arts, and community service activities,
Integration of smoking (tobacco) cessation within the larger rubric of addiction recovery, and
Sustained involvement of family members in the treatment and recovery processes.
Medication-assisted and psychosocial approaches to addiction treatment have historically existed as isolated, competing, and often mutually antagonist silos in the United States. Discussions have begun about the potential value of uniquely combining and sequencing these approaches across the stages of long-term addiction recovery. With programs like Hazelden Betty Ford taking the lead in such explorations, it would be of value for us to also look beyond the borders of the United States for models of such integration. Congress 60 offers one such approach that should be closely examined for potential replication and adaptation across cultural contexts. Congress 60 integrates theoretical constructs and practices from both approaches and adds elements not found in either.Like the United States, the Islamic Republic of Iran has faced critical challenges from rising opioid addiction. And like the U.S., Iran has experimented with a wide variety of remedial responses, ranging from supply reduction efforts and harsh punishment of users to expansion of harm reduction, treatment, and recovery support services. The latter include the explosive growth of Narcotics Anonymous meetings, which now constitutes 28% of all NA meetings worldwide, and the growth of other indigenous recovery communities, such as Congress 60.
Congress 60 was founded by Mr. Hossein Dezhakam in 1998 and has since grown to 38 branches across Iran with more than 50,000 members. Over the past decade, I have had the privilege of regularly communicating with Mr. Dezhakam and members of Congress 60. Several aspects of Congress 60 commend it to international readers interested in addiction treatment and recovery, including:

A theory of addiction (the X theory) that parallels much of what is being learned within modern studies of the neurobiology of addiction,
A theory of recovery as a sustained process of physical, mental, emotional, and spiritual (worldview) rejuvenation and self-discovery,
Decelerating doses of reparative medicine (opium tincture) through the first eleven months of recovery initiation and stabilization,
Sustained and saturated involvement in a vibrant recovery community, with its own recovery-focused language, literature, values, symbols, and rituals,
Intense involvement of members in competitive sports, music, the arts, and community service activities,
Integration of smoking (tobacco) cessation within the larger rubric of addiction recovery, and
Sustained involvement of family members in the treatment and recovery processes.
Medication-assisted and psychosocial approaches to addiction treatment have historically existed as isolated, competing, and often mutually antagonist silos in the United States. Discussions have begun about the potential value of uniquely combining and sequencing these approaches across the stages of long-term addiction recovery. With programs like Hazelden Betty Ford taking the lead in such explorations, it would be of value for us to also look beyond the borders of the United States for models of such integration. Congress 60 offers one such approach that should be closely examined for potential replication and adaptation across cultural contexts. Congress 60 integrates theoretical constructs and practices from both approaches and adds elements not found in either.

I recently published a photoessay describing the Congress 60 recovery community. Those interested in learning more about their methods may review this essay HERE. The translated publications of Mr. Hossein Dezhakam and my posted interviews with him are available HERE and HERE.

Post Date July 28, 2017 by Bill White

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

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

Post Date June 9, 2017 by Bill White

May 26, 2017 -Bill White- LIFE IN RECOVERY FROM ADDICTION IN CANADA

A 2015 review of Life in Recovery surveys in the United States, the United Kingdom, and Australia highlighted 20 conclusions of these surveys and related epidemiologic studies on remission from substance use disorders. The profiled studies confirm substantial recovery prevalence within the general populations, the diversity of people in recovery, the diversity of pathways of recovery initiation and maintenance, and the substantial improvements in health and quality of life that accrue with time in recovery.
The Canadian Centre on Substance Abuse has just released Life in Recovery from Addiction in Canada, confirming and amplifying many of the findings from the earlier studies. Here are a few highlights from this report.
Self-identified Canadians in Recovery report substantial past problem severity, with more than 70% having experienced each of six major diagnostic criteria for addiction. Most began substance use by their mid-teens and reported onset of addiction between the ages of 15-25. The most frequently reported primary drug choices in order of prevalence were alcohol, cocaine, cannabis, heroin, prescription opioids, and methamphetamine.
Most (52.4%) Canadians in recovery define recovery in terms of abstinence (with a minority of less than 1% reporting controlled use) combined with enhancement of global health and functioning.
Canadians in addiction recovery report substantial gains in health, quality of life, and social functioning.
–70.6% report overall quality of life as excellent, very good, or good.
–80.0% report their physical health as excellent, very good, or good
–In comparing addiction time to recovery time:
* regular exercise increased from 16.5% to 68.7%
* regular medical checkups increased from 33.7% to 82.8%
* healthy eating habits increased from 14.5% to 82.1%
* use of tobacco products decreased from 80.1% to 34.2%
–84.3% report their mental health as excellent, very good, or good.
–78.9% of Canadians in recovery are employed, 11.3% are retired or semi-retired, and 6.5% are students.
–Comparing addiction time to recovery time, reported arrests dropped from 42.3% to 2.3%; jail or prison time dropped from 13.9% to 1.4%; and driving under the influence dropped from 80.2% to 3.5%.
Canadians in recovery report substantial shifts in family and community involvement in comparing time in addiction and time in recovery.
–Participation in family activities increased from 31% to 90.3%
–Rates of reported family violence and lost custody of children all dropped precipitously following recovery initiation,
–Volunteering with a community or civic group increased from 14.4% to 66.8%
–Rates of paying bills, paying current and back taxes, all substantially increased after recovery initiation.
Canadians in recovery report using a wide variety of resources to help initiate and maintain their recovery, including 12-Step mutual support groups, professionally-directed addiction treatment, psychiatric or psychological therapy, recovery housing, non-12 Step mutual support groups, and medication-assisted treatment. More than 50% of respondents also reported using such supports as family and friends, religious or meditative practices, reading recovery literature, pets, exercise, nutrition, recovery websites or social media, and cultural values and traditions.
A significant portion of Canadians in recovery report current use of a prescription drug to treat a co-occurring physical (37.2%) or mental (35.2%) condition, but only 1.8% report current use of a medication for the management of addiction. 20.2% of survey respondents report having used medication-assisted treatment to help initiate their recovery.
More than half (51.2%) of Canadians in recovery report no subsequent experience of relapse following recovery initiation.
More than half (53.4%) of Canadians in recovery report more than five years of time in recovery, with 20.7% reporting more than 20 years in recovery from addiction.
The Life in Recovery from Addiction in Canada report is the latest investigation confirming the possibility of sustained recovery from addiction through a diversity of recovery pathways. It affirms the value of communities creating the physical, psychological, and social space within which personal/family recovery from addictions can flourish. For the full report, click HERE.

Post Date May 26, 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 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