August 11, 2017 -Bill White- STAGES AND STYLES OF ADDICTION RECOVERY

Dr. Ernie Kurtz and I, during the last years of his life, spent considerable time exploring the varieties of addiction recovery experience, including variations in the stages and styles of addiction recovery. For me, this exploration of stages and styles began in 1974 when I heard John Wallace present a paper at the Alcohol and Drug Problems Association meeting in Minnesota. The presentation stunned me with its clarity and potential clinical import. Wallace first stated that alcoholics frequently develop a preferred defense structure (PDS) (e.g., denial, minimization, projection of blame, intellectualization, etc.) to sustain excessive drinking and escape its growing consequences.
That starting position was not a new idea to most of us in the audience, but Wallace went on to say that the same PDS that supports drinking may be used as strategic coping mechanisms through the early stages of recovery and that prematurely confronting this brittle, recovery-sustaining PDS could trigger a resumption of drinking. That denial and minimization (of the problems facing the just-sobered), black-white thinking (e.g., “all of my problems are related to my drinking; all I have to do is not drink and everything else in my life will be fine”), and other defense mechanisms could be allies in the recovery process was a striking concept and one pregnant with implications for clinical practice—practices which at the time consisted primarily of verbally confronting such defensive gambits.
But then Wallace laid out the third paradox of recovery: the same PDS that supported alcoholism and that could be reframed to support early recovery must be eventually abandoned in later stages of recovery. In Wallace’s view, the latter transition was crucial to fully stabilize recovery, as well as enhance maturity and quality of life in long-term recovery.
I have been closely observing the addiction recovery process for half a century. I have been struck by two extremes: people whose fragile recovery is forever frozen at a primitive stage of development, and people who go through metamorphic changes that transform their character, values, and the quality of their interpersonal relationships. In the former, drug use has ceased or radically decelerated in frequency, intensity, and consequences, but this change remains nested within the same self-centeredness, resentfulness, dishonesty, and intolerance that often characterizes active addiction. This former pattern has been referred to as the “dry drunk” syndrome. In the latter style, the radically altered person-drug relationship is accompanied by dramatic enhancements in global health and functioning, as well as changes in character and identity—changes AA co-founder Bill Wilson characterized as “emotional sobriety.”
It is easy to cast these widely varying styles of recovery into the boxes of bad and good, but time and experience have softened that view for many of us as we have come to see how each style can exist within the same persons (and within ourselves) at different stages of the long-term recovery process. Also of note is that the executive brain functions of some people may have been severely and even permanently damaged from addiction, precluding tolerance of the ambiguity and more complex decision-making of the transformative style of recovery.
Today’s guiding mantra is “whatever it takes—recovery by any means necessary under any circumstances.” While we can deeply admire those in recovery who have used the recovery experience as a catalyst for personal transformation (via humility, gratitude, tolerance, service, etc.), we can also admire those who must tenaciously cling to those crude early defenses as a way to “keep the plug in the jug.” Both are deserving of respect and admiration.
Post Date August 11, 2017 by Bill White

August 8, 2017 -Bill White- MULTIPLE PATHWAYS OF RECOVERY CONFERENCE


The Connecticut Community of Addiction Recovery (CCAR) hosted its first Multiple Pathways of Recovery Conference in May of 2016. Due to travel limitations, my presentation for that conference was presented by video. (See presentation outline and video.)
The second of CCAR’s Multiple Pathways of Recovery Conference will be held in Punta Gorda, Florida October 23-26, 2017. Due to its proximity to my home, I will be able to join many of you to participate in this conference. I will do a book signing on the opening day and Don Coyhis and I will be doing a Q & A session at the conference on Wednesday, October 25. I look forward to spending time with recovery advocates from across the country and listening to the many scheduled presentations.
There are many recent and noteworthy milestones in the history of addiction recovery in the U.S.—the growth and diversification of recovery mutual aid societies; maturation of the recovery advocacy movement; exponential growth of virtual recovery communities; landmark recovery research studies such as the life in recovery surveys; the proliferation of new recovery support institutions (community centers, residences, industries, schools, ministries, cafes, etc.); integration of peer recovery support services within a growing spectrum of service organizations; and the rise of an ecumenical culture of recovery with its own language, symbols, literature, art, music, theatre, sport venues, and rituals of celebration. Key to all of these developments has been a foundational proposition: There are many pathways and styles of addiction recovery and ALL are cause for celebration.
CCAR’s Multiple Pathways of Recovery Conferences represent grassroots efforts to map recovery pathways in an environment of mutual learning and respect. I look forward to seeing you at the Conference in October. Those who wish more information about the conference and registration details may click HERE.
Between now and the conference, I will focus some of my weekly blogs on the growing varieties of recovery experience.

August 8, 2017 by Bill White

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