BLOG & NEW POSTINGS May 22, 2015Bill White STIGMA REDUCTION THROUGH CONTACT STRATEGIES (BILL WHITE AND TOM HILL)


“We can be convinced logically of the need for intervention and change. But it is the story of one individual that ultimately makes the difference—by offering living proof.” ― John Capecci and Timothy Cage
Eighty-year old Supreme Court Justice Ruth Bader Ginsburg recently commented on the changing American attitudes toward gay people: “The change in people’s attitudes on that issue has been enormous. In recent years, people have said, ‘This is the way I am.’ And others looked around, and we discovered it’s our next-door neighbor — we’re very fond of them. Or it’s our child’s best friend, or even our child. I think that as more and more people came out and said that ‘this is who I am,’ the rest of us recognized that they are one of us….Having people close to us who say who they are — that made the attitude change in this country.” Justice Ginsburg’s observation offers observed testimony to the power of contact strategies—public disclosure of personal stories by individuals who share a concealable stigma for purposes of changing social attitudes and social policies.
But does such contact REALLY change such attitudes? A new study led by Emma McGinty and published in the journal Social Science & Medicine suggests that it does. In a randomized national sample of more than 3,900 U.S. adults, McGinty and her colleagues compared responses to vignettes portraying untreated and successfully treated addiction and the extent to which these responses indicated a desire for social distance, belief in the effectiveness of treatment, and willingness to discriminate. Study findings suggest 3 major conclusions.
Silence PosterFirst, “concealment, which is driven by stigma, also likely perpetuates stigma by preventing second-hand experience of successful treatment by family members, friends, and acquaintances” (p. 80). This confirms the proclamation of recovery advocates that, “By our silence, we let others define us.” While the wide range of motivations for concealment may be understandable, the broader social consequences of such concealment are becoming increasingly clear.
Second, the over-telling of addiction-related pathologies and the biological roots of addiction without reference to recovery prevalence, at best, may have little effect on desired social distance, perceived effectiveness of addiction treatment, or willingness to discriminate, and, at worst, may inadvertently increase stigma and discrimination.
Third, exposure to successful stories of addiction recovery result in “less desire for social distance, greater belief in the effectiveness of treatment, and less willingness to discriminate against persons with these conditions” (p. 73). Findings from this study confirm the power of contact strategies in reducing the stigma attached to addiction recovery.
There are clear and simple messages that permeate my writings on this subject over the past 15 years. Nearly everyone in America knows someone in long-term addiction recovery, but most are not aware of the recovery status of these acquaintances, colleagues, friends, and even family members because the person in recovery has carefully concealed this status. Attitudes toward addiction, addiction treatment, and addiction recovery will not change in this country until we reach a critical mass of people who are aware of the recovery experience among their family, social, and professional network. That is unlikely to occur until a vanguard of people in long-term recovery disclose their recovery status and stories at a public level. That is what the new recovery advocacy movement is bringing to America and to other countries that is fundamentally new.
In 2001 Recovery Summit in St. Paul, Minnesota that launched this new movement, the first author shared the following:
“We cannot confront stigma in the outside world until we discover how stigma works within us and our relationships with the world. The internal consequences of such stigma must be excised before one experiences the worthiness and the power to confront its external source. We must excise that stigma so that we can move beyond our own healing to find our indignation, our outrage, and our sorrow that people who could be recovering are instead dying. We have to move beyond our own serenity and retrieve the fading memories of our own days of pain and desperation. Before that day, we need leaders who will jar us from our complacency and challenge us to hear the cry of the still suffering. Stigma is real, but we need to confront the fact that our own silence has contributed to that stigma. Listen to the words of Senator Harold Hughes who before he died proclaimed:
Senator Harold HughesBy hiding our recovery we have sustained the most harmful myth about addiction disease–that it is hopeless. And without the example of recovering people it is easy for the public to continue to think that victims of addiction disease are moral degenerates–that those who recover are the morally enlightened exceptions….We are the lucky ones, the ones who got well. And it is our responsibility to change the terms of the debate for the sake of those who still suffer.
“How can addicted people experience hope when the legions of recovering people in this culture are not seen or heard? Where is the proof that permanent recovery from addiction is possible? We need a vanguard of recovering people to send an unequivocal message to those still drug-enslaved that they can be free. We need a vanguard willing to stand as the LIVING PROOF of that proposition….There are whole professions whose members share an extremely pessimistic view of recovery because they repeatedly see only those who fail to recover. The success stories are not visible in their daily professional lives. We need to re-introduce ourselves to the police who arrested us, the attorneys who prosecuted and defended us, the judges who sentenced us, the probation officers who monitored us, the physicians and nurses who cared for us, the teachers and social workers who cared for the problems of our children, and the job supervisors who threatened to fire us. We need to find a way to express our gratitude for their efforts to help us, no matter how ill-timed, ill-informed, and inept such interventions may have been. We need to find a way to tell all of them that today we are sane and sober and that we have taken responsibility for our own lives. We need to tell them to be hopeful, that RECOVERY LIVES! Americans see the devastating consequences of addiction every day; it is time they witnessed close up the regenerative power of recovery.”
Those words were shared in 2001 in the belief that contact strategies, even more than education and protest strategies, would be crucial to dismantling the stigma attached to addiction recovery. We still believe that, and, needless to say, we are delighted to see research confirming the power of recovery disclosure as a strategy for social change. What would be the state of LGBT quality of life in the U.S. if all members of that community had remained hidden in the closet these past decades? In decades to come, we can hopefully ask this same question in reference to the recovery community.

References on the Power of Contact Strategies to Reduce Stigma and Discrimination
Corrigan, P.W., Kuwabara, S.A., & O’Shaughnessy, J. (2009). The public stigma of mental illness and drug addiction: Findings from a stratified random sample. Journal of Social Work, 9(2), 139-147.
Corrigan, P.W., Morris, S.B., Michales, P.J., Rafacz, J.D., Rusch, N. (2012). Challenging the public stigma of mental illness: A meta-analysis of outcome studies. Psychiatric Services, 63(10), 963-973.
Corrigan, P.W., River, L.P., Lundin, R.K., Penn, D.L., Uphoff-Wasowski, K., Campion, J., et al. (2001). Three strategies for changing attributions about severe mental illness. Schizophrenia Bulletin, 27, 187-195.
Couture, S.M., & Penn, D.L. (2003). Interpersonal contact and the stigma of mental illness: A review of the literature. Journal of Mental Health, 12, 291-305.
Keys, K.M., Hatzenbuehler, M.L., McLaughlin, K.A., Link, B., Offson, M., Grant, B.F. & Hasin, D. (2010). Stigma and treatment for alcohol disorders in the United States, American Journal of Epidemiology, 172(12), 1364-1372.
Lavack, A. (2007). Using social marketing to de-stigmatize addictions: A review. Addiction Research and Theory, 15(5), 479-492.
Livingston, J.D., Milne, T., Fang, M.L. & Amari, E. (2011). The effectiveness of interventions for reducing stigma related to substance use disorders: A systematic review. Addiction, 107, 39-50.
McGinty, E.A., Goldman, H.H., Pescosolido, B. & Barry, C.L. (2015). Portraying mental illness and addiction as treatable health conditions: Effects of a randomized experiment on stigma and discrimination. Social Science & Medicine, 126, 73-85.
White, W. (2014). Waiting for Breaking Good: The media and addiction recovery. Counselor, 15(6), 54-59.
White, W.L., Evans, A.C. & Lamb, R. (2009). Reducing addiction-related social stigma. Counselor, 10(6), 52-58.

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‘A Personal Tribute: Ernie Kurtz, 1935 – 2015′ by Bill White Posted: 01 Feb 2015 02:50 PM PST


Ernest Kurtz, who made landmark contributions to the study of addiction recovery, died January 19, 2015 of pancreatic cancer. Following publication of Not-God:Â A History of Alcoholics Anonymous in 1979, Kurtz focused his studies on the growing varieties of recovery experience, the healing of shame and guilt, and the role of spirituality in addiction recovery.

Ernest Kurtz was born in Rochester, New York, September 9, 1935 – only two months after the meeting of two desperate alcoholics in Akron, Ohio marked the birth of Alcoholics Anonymous. Kurtz attended St. Bernard’s Seminary and College and was then ordained as a Catholic Priest in 1961.

Following five years of parish work, he began his graduate studies at Harvard University where he completed an M.A. in philosophy and a Ph.D. in the history of American civilization. His Ph.D dissertation on the history of A.A. marked a turning point in the scholarly study of A.A. and the larger arenas of addiction recovery and recovery mutual aid societies, both legitimizing such studies and setting a benchmark by which future studies would be evaluated.

Kurtz subsequently taught at the university level (University of Georgia, Loyola University of Chicago), served as Director of Research at Guest House – an addiction treatment program for Catholic clergy, and served as a research associate at the University of Michigan Center for Self-help Research. He trained generations of modern addiction professionals through his perpetual presence at Rutgers Summer School of Alcohol and Drug Studies and other prominent training venues.

He leaves a series of seminal publications and books that followed on the heels of Not-God, including The Spirituality of Imperfection (with Katherine Ketcham), Shame and Guilt, The Collected Ernie Kurtz, and the recently released Experiencing Spirituality (with Katherine Ketcham).

In the early 1990s, I contacted Ernie, as did legions of people before and after me, requesting help with a project. I was writing a book on the history of addiction treatment and recovery in the United States and sought Ernie’s review and comment on the chapters on A.A.

I was quite intimidated by approaching him and did not know at that time that Ernie loved up-and-coming historians of both academic and amateur standing. He welcomed me as he did so many others. I had no inkling at the time that this initial consultation would morph into a sustained mentorship and friendship that would endure for more than twenty-five years and produce the most significant collaborations of my professional career.

Before critiquing my A.A. chapters, Ernie insisted that I had to master the basics of researching and writing history. He created a stack of “must read” history books, including the works of Barbara Tuchman, who he suggested I emulate. As that initial consultation expanded into a broader mentorship of all my historical research and writings, I began to make note of the guidelines within Ernie’s repeated admonitions. He challenged me to:

1) Tell the story chronologically (do not confuse your reader but give them hints on what is coming),
2) Tell the story in context (let your reader know what else is going on around the event you are profiling),
3) Present and document the historical evidence – ALL of the evidence,
4) Separate statements of fact from conjecture and opinion,
5) Tell the story from multiple perspectives,
6) Localize and personalize the story, and
7) Stay connected to my readers – keep them wanting to turn the page to find out what happens next.

Ernie also talked a good deal about the ethics of historical research and disclosed his own past dilemmas as a teaching tool, e.g., his response to a request by an A.A. General Service Board trustee not to include the account of Bill Wilson’s LSD use in Not-God.

I recently published an in-depth profile of Ernie’s life and work in Alcoholism Treatment Quarterly, which I would commend to the readers. What I would offer here for readers is a personal glimpse into Ernie’s mentorship and why so many aspiring and accomplished historians have held him in such high regard and why so many now mourn his passing.

In his mentorship of others, Ernie, like A.A. itself, expressed far more interested in alcoholics than the disorder of alcoholism. He found within the recovery experience of the alcoholic something of great universal value – the acceptance of human limitation – one’s not-Godness, what he often characterized as the spirituality of imperfection. He felt such acceptance was a powerful and essential antidote to many of the ills plaguing individuals, families, communities, and countries.

Causes and consequences of alcoholism captured far less of his attention than the paradoxes that existed within the experience of alcoholism recovery.

He found something relevant to all that hidden gifts could be found within the curse of illness, that strength could rise from the acknowledgement of weakness, that wholeness could rise from brokenness, that authentic connection and community could rise from the most severe forms of estrangement and isolation, that envy and resentment could give way to forgiveness and gratitude, that grandiosity and self- hatred could both give way to self-acceptance and humility, and that injury to others could give way to service to others.

These poignant lessons he found within his observations of men and women recovering from alcoholism. In his mentorship of others, Ernie was far more interested in calling our attention to the possibilities that could flow from recovery from alcoholism – and what those possibilities revealed about the human condition and human potential – than in the pathologies that alcoholism continued to wreak in the absence of recovery.

Ernie knew stuff, and he knew people. What he did for me and so many others, including legions of M.A. and Ph.D. students, was connect us to information and sources that escaped the usual search methods. He was a walking encyclopedia of the subjects he held most dear and freely shared those resources.

So many people’s research had crossed Ernie’s path that he served as a crossroads continually connecting people with shared interests. Ernie loved connecting people and he played a key role in forging a community of A.A. historians in collaborations with Brown University, A.A. Archivists, A.A. History Lovers, and other such groups. Many of the stories I was able to share through my writings were made possible by Ernie opening doors to people whose names would never have been revealed in a search of the published literature.

Mentoring under Ernie’s guidance was not for the faint of heart. I ended many a session with a piece of work bruised or battered, but always believing I could and would do better. Faint praise was not Ernie’s style.

Those seeking a warm and fuzzy father figure and blind adoration of their capabilities were quickly dismissed of any such expectations. He had very high expectations, and he didn’t brook fools. His feedback was extremely pointed, lacking any attempt at sugar coating, but, when he saw potential, his challenges to elevate the quality of one’s research, thinking, and writing were quite inspiring.

My mentorship by Ernie evolved into later collaborations on numerous formal studies, monographs, and articles. That experience also taught me a style of collaboration that I found effective and professionally fulfilling.

When Ernie and I found a topic we wanted to mutually explore, we would divide and share the research; brainstorm the central ideas and our potential approach; determine which of us would take the lead writing responsibility; create, discuss, and repeatedly revise a detailed outline; prepare a first draft; and repeatedly revise it – sometimes with input from external reviewers before taking it through a formal peer review process.

When working on papers using this process, I often learned as much from what we did not include in the papers as from what was included. The frontier issues, often lacking sufficient evidence to then include, were left on the editing floor to be later gathered for further investigation and discussion.

Ernie was a lover of stories and had a profound belief in the healing power of personal story reconstruction and storytelling. With so much to explore within the history of A.A., he repeatedly came back to the personal narratives forged in A.A. and what happened when these stories were exchanged among A.A. members.

In that same vein, he believed that history was a form of collective storytelling and that wisdom and healing could flow from this form of sensemaking. He believed that the study of history could make a difference in present and future decision-making. And Ernie loved the ideas that flowed from his study of history. Few things energized him more over the years I knew him than his intellectual exchanges with the likes of Robin Room, Ron Roizen, Bill Miller, Alan Marlatt, and innumerable others.

Ernie often said that if he were to do another book on A.A., it would be titled Varieties of A.A. Experience. He was particularly interested in the growth of secular spirituality within A.A., as represented by such groups as Atheists and Agnostics in A.A. (Quad A) and A.A. Agnostica, and he had a deep interest in the growth of secular and religious alternatives to A.A.

He led the effort by Faces and Voices of Recovery to create a Guide to Recovery Mutual Aid Resources that catalogued secular, spiritual, and religious mutual aid groups in the United States. Ernie was one of the few people who commanded wide relationships and respect across these boundaries.

When Ernie reflected on these diverse pathways of recovery, he saw more similarities than differences. He saw recovery across these pathways as an escape from self-entrapment – an achievement of beyond and between (connection with resources and relationships beyond the self) – manifested in six core experiences: release, gratitude, humility, tolerance, forgiveness, and being-at-home (Kurtz and White, in press, Religions).

These past months, Ernie and I were acutely aware his days were limited. Two things struck me about our final months of working together. First, he was primarily concerned with the burdens his illness and death would impose on his wife (Ernie had left the priesthood and later married Linda Farris); he spoke rarely of any other concern about the process of dying.

Second, he was concerned that the final fruits of his work be completed, not as a tribute to himself, but as a resource for future historians he hoped would carry his work forward. Toward that end, we spent the closing weeks of his life creating a Kurtz section of my website that contains his collected papers, interviews, and links to his books, and we completed the final revisions of our last co-authored paper four days before his death – a paper he thought of as a final testimony of his work and thought.

The fact that people representing diverse and sometimes warring constituencies today mourn the passing of Ernie Kurtz is itself a remarkable tribute to the man and his contributions. My heart weighs heavy in the face of Ernie’s absence, but I draw great comfort from the memories of our work together and the many gifts he left us all.’

Bill, thank you for this insightful and beautifully written obituary of a remarkable man.

BLOG & NEW POSTINGS November 21, 2014Bill White PREDICTING ADDICTION/RECOVERY TRAJECTORIES

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It has become fashionable by commentators in the addictions arena to point to research studies confirming three linked findings: 1) the course of alcohol and other drug (AOD) problems are highly variable rather than inevitably progressive, 2) the majority of people experiencing substance use disorders and broader patterns of AOD-related problems resolve these challenges without specialized professional care or mutual aid assistance, and 3) the majority of such resolutions occur through deceleration of the frequency and intensity of use rather than through complete and sustained abstinence. Those findings, drawn from studies of community populations, have been used to buttress attacks on addiction treatment, Alcoholics Anonymous and other abstinence-based mutual aid organizations, the conceptualization of addiction as a disease, and the characterization of addiction as a “chronic” disorder. There is within these critiques an implied underlying tone of moral indictment: “If such large numbers of people resolve AOD problems without the need for abstinence and professional assistance, then why can’t you?” The tone of moral superiority in which this question is posed suggests that such problems could be resolved if one would just “Suck it up and deal with it!”
The idea that some people can resolve alcohol problems on their own via an exertion of will is not a new one and is outlined clearly in the basic text of A.A.–authored before most contemporary critics were born. Such self-will and moderated approaches had not worked for early AA members, but AA made no effort to deny that option to others. In fact, AA took quite the opposite position.
Then we have a certain type of hard drinker. He may have the habit badly enough to gradually impair him physically and mentally. It may cause him to di a few years before his time. If a sufficiently strong reason-ill health, falling in love, change of environment, or the warning of a doctor-becomes operative, this man can also stop or moderate, although he may find it difficult and troublesome and may even need medical attention. (Alcoholics Anonymous, 1939, p. 31)
If anyone, who is showing inability to control his drinking, can do the right-about-face and drink like a gentleman, our hats are off to him. Heaven knows we have tried hard enough and long enough to drink like other people! (Alcoholics Anonymous, 1939, p. 42)
AA literature makes no claim that the collective experience of AA members constitutes a universal truth applicable to the broader universe of all alcohol problems. By distinguishing themselves (“real alcoholics”) from problem drinkers, early AA members defined their own recoveries in terms of abstinence and mutual support because that is what had been successful in their experience.
So if there are potentially two worlds of AOD problems reflected in the divergent conclusions of epidemiologists and clinicians, what separates those who naturally mature out of AOD problems without professional or peer support and those for whom AOD problems become prolonged, life-threatening medical disorders? Having closely observed both patterns for nearly half a century, I believe there exists a “clinical cluster” that predictively distinguishes those whose AOD problems are most likely to become the most severe, complex and enduring and that are less amenable to natural recovery and moderated resolution. This cluster includes the following elements:
* Family history of AOD-related problems
* Early age of onset of AOD use
* Euphoric recall of first AOD use
* Atypically high or low drug tolerance from onset of use
* Historical or developmental trauma: cumulative adverse experiences with traumagenic factors (e.g., early onset, long duration, multiple perpetrators, perpetrators from within family or social network, disbelief or blame following disclosure)–without neutralizing healing opportunities
* Adjustment problems in adolescence that contribute to adult transition problems, e.g., instability in education, employment, housing, and intimate and social relationships
* Multiple drug use
* High risk methods of drug ingestion (e.g., injection)
* Co-occurring physical/psychiatric challenges
* Enmeshment in excessive AOD-using family and social environments, and
* Low levels of recovery capital (internal and external assets that can be mobilized to initiate and sustain recovery).
Each of these factors constitutes a risk factor for the development of severe and prolonged AOD problems, but such risks are dramatically amplified when combined. Not everyone sharing such risk factors will develop severe and chronic addiction, and some lacking such factors will still experience prolonged addictions. Some in the former group will also resolve their AOD-related problems without professional or formal peer assistance. But addiction is a disorder of odds, and one’s odds of escaping addiction and achieving recovery without help from others decline in tandem with the accumulation of risk factors and the absence of factors that protect and promote resiliency.
In my professional experience, the prospects of natural recovery and problem resolution via moderation decline in tandem with the increased number and intensity of the above factors. The “apples and oranges” comparison problems can be minimized, if not transcended, if we realize that findings from studies of the resolution of AOD problems among persons without these risk factors cannot be indiscriminately applied to those who possess such characteristics, and vice versa!