RecoveryBlog

recoveryblog: a blog for recovery advocates!

Our recovery advocacy blog is produced by individuals in recovery!  Here you will find commentary and personal discussions on different aspects of addiction recovery and advocacy.

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LGBTQ+ Recovery Resources

August 16, 2019

LGBTQ+ Recovery Resources

According to the Recovery Research Institute, it is estimated that 30 percent of LGBTQ+ individuals face some form of addiction, compared with 9 percent of the general population. However, there is a lack of LGBTQ+ recovery resources.
LGBTQ+ Recovery Resources

Photo by Jasmin Sessler on Unsplash

Despite substance use disorders disproportionately affecting larger numbers of the LGBTQ+ community, recovery looks largely heteronormative. Both mutual aid meetings and online recovery communities are geared more to cisgendered and heterosexual individuals, making these spaces feel exclusive to many in the LGBTQ+ community. However, LGBTQ+ people represent 12 percent of Americans who have found recovery. Recovery activist Brooke Feldman often raises the important issue of heterosexism within the addiction recovery community.  “With the risk of developing a substance use disorder as much as 20-30 percent higher for individuals who identify as LGBTQ+, it is baffling to me that heterosexism still pervades large pockets of the recovery communities,” she says “Heterosexual individuals are often unaware of the privilege they hold and what life is like for those without it,” Feldman says. “While for many folks, the idea of suggesting that ‘men stick with the men and women stick with the women’ seems to be sound advice, this suggestion totally discounts the reality of gender identity being far more than a binary of male or female.  It also ignores the fact that sexual orientation actually exists on a vast and fluid spectrum that includes so much more than just a firm heterosexual.”

Why does substance use disorder affect more LGBTQ+ people?

People who identify as lesbian, bisexual, gay, trans, queer, intersex, or asexual and a myriad of other communities (LGBTQ+) are at a statistically higher risk of addiction because they face increased stigma, discrimination, and other challenges on a regular basis — such as healthcare inequalities, exclusionary governmental policies, social rejection, hate crimes, harassment, violence, and barriers to accessing quality housing, healthcare, and employment. Facing these daily inequalities, prejudices, and homophobic behaviors can lead to coping with substances, while having less access to healthcare.  Socialization is a big factor, too. Many events within the community are largely focused around bars as a primary social outlet. Plus, alcohol advertising is geared toward the LGBTQ+ community, with the rainbow flag often used on popular alcohol branding. 

Key facts:

According to the National Institute of Drug Abuse and the Recovery Research Institute
  • Gay, lesbian, and bisexual individuals are 18 percent more likely to have alcohol use disorder and 20 percent more likely to have substance use disorder. 
  • 77 percent of lesbian/gay/bisexual people and just 57 percent of those who identify as transgendered have access to healthcare.
  • LGBTQ+ individuals are more likely to start drinking earlier and they have a greater likelihood of experiencing substance use disorder in their lifetime. 
  • There is  a higher risk of co-occurring mental disorders such as depression, and higher chances of poor physical health, activity limitations, chronic conditions, obesity, smoking, and binge drinking in the LGBTQ+ community due to their adverse experiences and healthcare status. 
  • Transgender youth experience higher levels of depression, suicidality, self-harm, and eating disorders.
  • Gay men are three times more likely as straight men to have an eating disorder, and lesbian and bisexual women are twice as likely as straight women to suffer with binge eating.
  • People with co-occurring disorders are at a higher risk of fatal opioid overdose: this is 3 times higher for those with depression and six times higher for those with serious mental illness. 
LGBTQ+ Recovery Resources

Photo by Jean Sabeth on Unsplash

LGBTQ+ recovery resources

Given the unique characteristics and disparities that individuals face within the LGBTQ+ community, it is essential that we continue to expand queer-specific resources and be more accommodating in all recovery spaces. Below, we have listed specific resources for LGBTQ+ individuals as well as tips on how to be more inclusive in your recovery spaces. 

LGBTQ+ specific resources

Across the nation, there are an increasing number of resources for people in the LGBTQ+ community. Many of them are city-specific. We have listed a range of online communities, social accounts to follow, gatherings and events, social spaces, and meetings that are available nationally.  While there are multiple pathways of recovery, each person will need an individual approach that deals with their unique needs.  Online communities: LGBTteetotalers, Queers Without Beers Social media accounts to follow: Queer Introverts, The Temper, Tawny Lara, Liv’s Recovery Kitchen, Murphthejerk, Josh Hersh, Served Up Sober, Sober Hipster, Queer Sober Atlanta, SobrieteaParty Queer gatherings and events: Gay & Sober, Queeret, Queer Soup Night, Queer Kentucky’s Monthly Meetup, Sober Queer Mixer Sober spaces: There are many alcohol-free safe spaces for the LGBTQ+ community. Here are a few: Framingham GLASS in Massachusetts, Bookstore Giovanni’s Room in Philadelphia,  Wicked Ground Kink Cafe and Boutique in San Francisco, Q Center and Grindhouse Coffee in Portland OR, Cuties in LA, Odd Fox Coffee in Brooklyn, Rainbow Bakery in Indiana, Squirrel Chops in Seattle, Mutiny Information Coffee in Denver, Comic Girl Coffee in North Carolina, Firestore in Asheville, and Lakeview Rewired Cafe in Chicago Publications: The Temper Meetings: Gay & Sober, LGBTQ Recovery Group (online), Gay and Lesbians in Alcoholics Anonymous. There are also numerous meetings in cities across the nation, just search for your city and “LGBTQ+ friendly recovery meeting.” Podcasts: Queer Mental Condition, Breaking Free: Your Recovery. Your Way. Served Up Sober, and Recovery Rocks.

Inclusive spaces

Mutual-aid meetings are the most widely available free resource for those seeking recovery. However, given the language used and the sometimes limited awareness of the issues the LGBTQ+ community face, we have a way to go to provide a more inclusive space.

Tips for making your recovery space more LGBTQ+-inclusive 

  1. Don’t assume an individual’s sexuality or their gender. State your own pronouns when you introduce yourself and encourage other group members to do the same, especially if they are cisgendered. For example: “I’m Liv. My pronouns are she, her, hers.”
  2. Don’t use heteronormative cliches like “men stick with the men and women with women.”
  3. Consider reviewing literature and change any gendered pronouns to neutral “they/them/theirs.”
  4. Be conscious of your privilege around access to healthcare, housing, and other facilities and resources. Don’t assume that everyone has the same opportunities.
  5. Advertise your group on the meeting schedule as LGBTQ+-affirming and don’t share images that are heteronormative or clearly gendered. Try to represent equity and inclusion in choosing images.
  6. Consider renaming bathrooms to be gender neutral.
  7. Don’t silence an individual’s experience relating to their sexuality and be mindful that they may have experienced prejudice and other harms as a result. These types of stressors are just as valid as any other. 
  8. Educate yourself about trauma and practice holding a trauma-informed space.
    1. When holding meditations, give people the option of keeping their eyes open and moving around. 
    2. Announce at the beginning of the meeting where the exits are, and make it clear that if anyone feels uncomfortable at any time they are free to take a time out and leave the room.
    3. Ask members to be conscious about sharing traumatic events and that they may be triggering for others. 
    4. Consider holding a specific time during the meeting for people who find it hard to share.
Sources NIDA (2017). Substance Use and SUDs in LGBT Populations. The Recovery Research Institute: LGBTQ+ & Recovery Them: Sober Queer Spaces Are Giving LGBTQ+ People a Place to Just Be Huffpost (2016) Brooke M Feldman, “Men Stick with the Men, Women Stick with the Women,” Hererosexism in the Addiction Recovery Communities.” The Temper (2019) Tracy Murphy, “Josh Hersh is Creating Sober Spaces For Queer Introverts.

The recovery advocacy movement & how to get involved

August 9, 2019

The landscape of recovery has changed dramatically over the past few decades, and we have the recovery advocacy movement to thank for that. While there’s still a long way to go to help more people find recovery and improve public and professional perception of substance use disorder, we’ve made huge strides in this political and social and cultural movement. Together we’ve put a face to people in recovery, fought stigma, improved policy and the rights of our people, and demanded greater resources to help people find the treatment they need. 

History of recovery advocacy

Photo by Oleg Laptev on Unsplash

The recovery advocacy movement

Researcher Bill White summarizes the progression of our movement beautifully. 

“As I entered the world of addiction treatment and recovery in the late 1960s, I witnessed the end of a very dark era in our country — an era in which those with alcohol and other drug problems festered in the drunk tanks of local jails and the back wards of aging state psychiatric hospitals or died alone bereft of hope.”

He continues, “Few resources existed in most communities outside the rooms of mutual-aid fellowships. It would have been unthinkable in those early days that I would live to see a national network of addiction treatment and recovery support resources and the rising cultural and political mobilization of people in recovery. I could not have conceived of a day when I would witness more than 100,000 people in recovery marching publicly as far as the eyes could see or that I would one day stand before leaders of new recovery advocacy organizations from all over the United States. And yet we all witnessed the unprecedented numbers in recent Recovery Month celebration events, and I am here today living out the second of those unthinkable visions.”

Our major accomplishments as a movement have included a mass mobilization of people getting involved in recovery advocacy, policy victories, professional influence, expansion of recovery support institutions, and the expansion of a culture of recovery. 

The social movements have gained momentum over the years largely because they have been led by people in recovery and their allies. “We’ve come a long way since we launched the first ever Recovery Bill of Rights, in 2008 and hosted a National Call-In Day for Paul Wellstone Mental Health and Addiction Equity Act in 2008,” says Executive Director of Faces & Voices of Recovery Patty McCarthy. “These, and many more campaigns and activities, have mobilized the recovery community to have a unified voice in advocacy efforts in their own communities across the nation.”. 

Recovery advocacy movement

Photo by Melany Rochester on Unsplash

Local grassroots recovery advocacy

Now tens of thousands of recovery advocates engage in campaigns on a local grassroots level with over 100 recovery community organizations (RCOs). 

“RCOs bring the recovery community together it is easy to coalesce around a single mission,” says Tony Vezina, executive director of 4D, an RCO for young people in Oregon. 

He believes that RCOs play a critical role in the recovery advocacy movement because they employ peers — people with lived experience. “This workforce cares deeply about ‘their people’ tackling issues from finding recovery to equal pay. Advocating for increased services translates into fulfilling their need to help their community while advocating for their needs,”  he says.

“RCOs like 4D that are Recovery Community Centers (RCC), with peer services and a diversity of recovery support mutual-aid groups, are well-positioned to be epicenters of the recovery reformation movement. RCCs bring the diversity of the recovery community center together under the same roof and the peers are educated in honoring multiple pathways to recovery.”

At a local level, these organizations make a huge difference to the lives of people in recovery, and those seeking it. Together, however, we have witnessed the emergence of a much more powerful movement. 

National recovery advocacy success

The greater power in our movement has been through these organizations working collaboratively: RCOs are represented by the Association of Recovery Community Organizations, and other support institutions have formed the National Alliance of Recovery Residences, the Association of Recovery Schools, and the Association of Recovery in Higher Education. Together these organizations have addressed public policy to reduce the discrimination that keeps people from seeking recovery — or moving on to better lives once they achieve it — and have supported recovery-oriented policies and programs. 

Faces & Voices of Recovery has been a national leader in the recovery advocacy movement. We have helped pass legislation including the Comprehensive Addiction and Recovery Act (CARA) and the 21st Century CURES Act, and we have fought to protect our right to privacy by maintaining the federal confidentiality law, 42CFR Part 2. 

Our campaign Recovery Voices Count has made it possible for even more of our friends, neighbors and family members to experience long-term recovery from addiction by building a powerful recovery movement that recognizes the recovery community as a constituency of consequence. 

Through nonpartisan civic engagement at local, state, and national levels, our goal is to support local recovery organizations develop an organized voice of people in recovery who are educated on key issues. We believe that together will have an even greater impact on the lives of people who still need help with their addiction, people in long-term recovery, and family members.

Take action!

We believe that investing in recovery support services will have great economic benefits for long-term recovery, reduce the burden on criminal justice and welfare systems, and get people the housing, employment, and education services they need. 

Our priorities for 2019 are to:

  1. Secure and expand substantial new federal funding for Recovery Support Services
  2. Protect patient privacy rights
  3. Enforce the Mental Health Parity and Addiction Equity Act of 2008
  4. Restore voting rights for individuals with felony drug convictions
  5. Support federal and state policy reform efforts to eliminate discriminatory policies and practices that create barriers to employment, housing, education, healthcare and civic engagement

How can you help continue to further the work of our recovery advocacy movement?

  • Download the linked list of priorities and share on social networks
  • Sign up for alerts that tell you how to take action
  • Advocate for policies that support the recovery community by getting involved with local recovery community organizations in your area
  • Get involved with Recovery Voices Count
  • Become a member of Faces and Voices of Recovery
  • Share your recovery story
  • Make a donation

 

 

 

 

Language Matters in the Recovery Movement

August 1, 2019

Language matters. The words we use to describe substance use disorder, people using drugs, and people in recovery has the potential to cause a significantly detrimental impact in a number of ways, such as access to treatment and recovery outcomes. 

Language matters in addiction and recovery

Photo by Brett Jordan on Unsplash

Our language can influence whether people view substance use disorder as a moral issue, requiring punishment rather than treatment like any other medical condition. This is at the heart of stigma, which is defined as “an attribute, behavior, or condition that is socially discrediting.”

Faces & Voices of Recovery’s Work to Reduce Stigma

Through our advocacy over the years, Faces & Voices of Recovery has helped to end stigma for those seeking recovery. By encouraging tens of thousands of people across the nation to share their stories through our program Our Stories Have Power, we have helped further that mission. We believe in giving people in recovery and their family members the messaging and the language that they can use to talk about their recovery. 

The recovery community is speaking out to educate friends, neighbors, policymakers and the media about the reality of recovery so that others can get the help they need.

Recovery Science on the Importance of Language

Research conducted by recovery scientists proves that the language we use:

  • can increase stigma, which already acts as a major barrier to accessing care
  • can negatively influence the care we receive
  • can influence recovery outcomes
  • can have a detrimental impact on attitudes towards people in recovery and those who use substances

Stigmatizing substance use and recovery means that substance use disorder is still seen as a moral, criminal, or social issue. In a study conducted by the Recovery Research Institute, participants were asked how they felt about two people using drugs and alcohol.

Recovery Research Institute on stigma

Source: Recovery Research Institute

The study found that when participants considered a person described as a “substance abuser,” they thought of that person as:

  • Less likely to benefit from treatment
  • More likely to benefit from punishment
  • More likely to be socially threatening
  • More likely to be blamed for their substance related difficulties and less likely that their problem was the result of an innate dysfunction over which they had no control
  • More able to control their substance use without help.

Recent research by scientists Robert Ashford, Austin Brown, and Dr. Brenda Curtis builds upon this existing research by measuring the bias elicited when certain common phrases and words are used when referring to people with substance use disorder and those using drugs. 

They found that phrases like “relapse,” “addict,” “alcoholic,” and “substance abuser” are strongly associated with negative bias among the general public, behavioral health professionals, and medical professionals — leading ultimately to explicit discrimination. 

Given that each year 25 percent of people with acute substance use disorder don’t seek treatment because they believe they will be stigmatized by friends, neighbors, or employers, it is essential that we continue to change our language. 

The study showed that using person-centered and medical language elicited more positive responses. Overall, the study concluded by recommending that we stop using stigmatizing terms like “alcoholic” and “addict” in public.  The research does not suggest, however, that we cease using these terms in the privacy of mutual-aid meetings. 

So when we’re not in a meeting, what language should we use?

Quick reference guide for suggested recovery terms 

The following infographic is a helpful reference guide to use when referring to people who have a substance use disorder, who use drugs and alcohol, who have returned to drug use, and who take medication as a pathway of recovery. 

Recovery dialects

Source: Drug and Alcohol Dependence, volume 189 (August 2018). Ashford, R.D., Brown, A.M., & Curtis, B. (2018) Substance use, recovery, and linguistics.

We encourage you to think about the impact of your words and consider informing others when you hear them using these stigmatizing terms. Language matters!

Become a member of the global recovery advocacy movement. Together we will eliminate the stigma of addiction and recovery. Apply today. 

Mama’s in Recovery: Alannah’s Story

June 13, 2019

Meet Alannah, our November “Mama’s in Recovery” feature story.  Alannah took the time to sit down with Faces & Voices of Recovery to share a bit of her recovery journey.

Alannah Gout is the mother of a 3-year-old daughter, Finnleigh and a 6-month-old son, “Tripp” and a woman in long-term recovery.  Her addiction began around the age of 14 and by the time she was a sophomore in high school, it was running rapid.  Alannah’s recovery journey began at the age of 19 after finding out that she was pregnant with her daughter.  In her early pregnancy, she just thought that she was having morning sickness but realized later that she was going through withdrawal.  At the time she didn’t connect the dots and surely didn’t think she had an issue with addiction.  It wasn’t until Finnleigh was born that she started to open up to the reality that she had a problem with drugs and alcohol.  Alannah didn’t actively use when she was pregnant, but her family knew there was an issue and soon, Alannah did too.

After giving birth to Finnleigh, Alannah was set on finding a network that wasn’t using drugs or alcohol.  Taking a closer look at her life, she felt it was unmanageable.  Reflection became a key point for her.  Alannah knew that she had plenty of opportunities to grow.  She coped in ways that had a negative impact on her life – acting out on, sex, spending money, and self-sabotaging behavior.  She attended a few fellowship meetings here and there but, “didn’t do anything they suggested”.  Nonetheless, Alannah saw something attractive about the fellowship and the recovery lifestyle.  During the early stages of her recovery, Alannah ran in to an old friend, Tony.  Tony was “living the dream” of recovery in Alannah’s eyes and soon he became a guiding force in her recovery.  Alannah found something else attractive, and that was her old friend, Tony.  Yet, Alannah knew that she had to focus on her recovery and they decided to take it slow as friends.  Alannah, took some time to herself and began dating outside of the fellowship of recovery only to find herself back in the realm of addiction, picking up that drink during dinner.  According to Alannah, “I think I could have controlled it for a while…I had no consequences but emotionally, I felt so guilty.  I felt like I was right back where I started when I was using.”  Alannah stated that, “the desire to use my drug of choice was scarier than anything so I came back to the fellowship and dove in”.  After about 7 months of recovery, Tony and Alannah dated exclusively and not long after the love blossomed, baby “Tripp” arrived.

Alannah still has a few personal struggles, but she has found a true connection to the “Mama’s in Recovery” and recently celebrated 2 years of recovery!  She is grateful for the mom’s, “it’s my outlet, I can talk to them at three in the morning.  We talk about balance, raising kids, and having a relationship.”  For Alannah, it can be difficult getting to meetings but, “being able to talk to the girls makes me feel like I’m doing something for my recovery everyday”.  As a stay at home mom, Alannah is learning to tend house and says that, “there is no other job I’d rather do, I love staying home with them”.  She has come a long way in her recovery and, while at first, she focused on recovery because of Tony and her daughter, Finnleigh, she has now built a foundation, “now it’s about me…I realize that I’m worth it and I deserve the life of recovery”.  We support you Alannah!  Faces & Voice of Recovery is honored that Alannah welcomed us as a part of her network and look forward to seeing where her journey takes her!  You deserve it!  Your village is cheering for you!

A Rendezvous with Hope

June 12, 2019

Original Blog Date:  May 30, 2014

Vern Johnson then came along and convinced us we could raise the bottom through a process he called intervention.  Staging such interventions within families and the workplace was something of a revolution that brought large numbers of culturally empowered people into recovery, including a former First Lady.  All of these early philosophies and technologies relied on pain as a catalyst of addiction recovery, and that was the view I brought to my work as an evaluator of an innovative network of women’s treatment programs in the 1980s called Project SAFE.

Client engagement in Project SAFE relied on an extremely assertive approach to community outreach that often involved many home visits before a woman entered formal treatment services.  When interviewing one of the outreach workers, I could tell she was becoming frustrated with my questions about how clients entered treatment and particularly my attempts to isolate the painful crisis that had propelled the decision to enter treatment.  The outreach worker finally turned to me and said the following:

Bill, you’re not getting it!  My clients don’t hit bottom; my clients live on the bottom.  Their capacities for physical and emotional pain are beyond your comprehension.  If we wait for them to hit bottom, they will die!  The issue of engaging them is not an absence of pain, it is an absence of HOPE!

As the evaluator of Project SAFE, I had the opportunity to interview woman many months and years after they had completed addiction treatment.  More specifically, I had the opportunity to interview women in long-term recovery who at the point of initial contact with Project SAFE had a very poor prognosis for recovery.  They presented with a massive number of severe and complex problems, involvement in very toxic intimate and family relationships, and innumerable personal and environmental obstacles to recovery.  As I faced these amazingly resilient women, I asked each of them to tell me about the sparks that had ignited their recovery journey.  Each of them talked about the role their outreach worker had played in their lives.  The following comments were typical.

I couldn’t get rid of that women.  She came and just kept coming back–even tried talking to me through the locked door of a crack house.  She wore me down. She followed me into Hell and brought me back.

(Describing the first day she went to treatment–after eight weeks of outreach contacts)  It was like a thousand other days.  My babies had been taken and I was out there in the life.  I’d stopped by my place to pick up some clothes and there was a knock on the door. And here was this crazy lady one more time, looking like she was happy to see me.  I looked at her and said, Don’t say a word; Let’s go (for an assessment at the treatment center).  She saw something in me that I didn’t see in myself, so I finally just took her word for it and gave this thing (recovery) a try.

And she kept sending me those mushy notes–you know the kind I’m talking about.  (Actually, I had no idea what she was talking about.)  You know, the kind that say, “Hope you’re having a good day, I’m thinking about you, hope you are doing well” and all that stuff.  I treated her pretty bad the first time she came, but she hung in there and wouldn’t give up on me.  I can’t imagine where I would be today if she hadn’t kept coming back. She hung in with me through all the ups and downs of treatment and getting my kids back.

What I learned from these remarkable women was that, for the disempowered, the spark of recovery is a synergy of pain and hope experienced in the context of a catalytic relationship.  Life and their addictions had delivered to these women more than enough pain; what was needed was an unrelenting source of hope delivered to them by a cadre of recovering women who lacked much by way of professional credentials and polish, but who brought an inextinguishable and contagious faith in the transformative power of recovery.  These outreach workers knew recovery was possible.  They were themselves the living proof of that proposition.  And they spread the germ of recovery to women who initially caught it rather than chose it.

The assertive outreach that was the hallmark of Project SAFE continues today in cities like Philadelphia.

Our vision is to expand low threshold services that at the same time elevate peoples’ sense of what is possible for them.  We do this by exposing them to living proof that recovery is possible even under the most difficult of circumstances, confirming that there are people who will walk this path with them, and offering stage-appropriate services to support people in their journeys from addiction to recovery.–Dr. Arthur C. Evans, Jr.

As Dr. Evans suggests, we need to move beyond treating those who are ready for treatment to priming recovery motivation in those who are not yet ready.  As the outreach worker so eloquently scolded me, “If we wait for them to hit bottom, they will die.”

William L. White

Emeritus Senior Research Consultant

Chestnut Health Systems

Punta Gorda, Florida

William (“Bill”) White
Emeritus Senior Research Consultant at Chestnut Health System
Recovery Historian

Read all of Bill White’s Blog Posts on his website here www.williamwhitepapers.com

In Others’ Words

June 12, 2019

In previous blogs I have suggested that when I’m at a loss for words— doesn’t happen often— I use the words of others. The act of messaging is quite satisfying. I am reading a book by friend and mentor, Johnny Allem, titled Say The Second Thing—That Comes Into Your Mind. This book is a “tool box” that supports the work and joy of recovery.  I know that recovery support for self and others is not a job but requires work. In describing his early days, Johnny writes about the tools of work. “In high school I learned to repair radios and appliances … my habit of respecting tools and keeping them in assigned places became very useful.” Ironically, my father also repaired radios and household appliances and had appropriate tools for the task. He wired houses during the depression and made all the electrical connections without the benefit of power tools.  I still have some of those tools, now 90 years old.  Johnny writes, “On my journey, I have come to realize that we are hard wired to belong to each other, to connect with each other and share a common spiritual calling.” I agree that we may be hard wired, but it is now a wireless world. Our wireless platform may well be fellowship.

Though I am sensitive to political correctness, my “PCs” of today are to pursue connections, preserve connections, and protect connections.  “Cs” the day with action through Contact, Connection, Conversation, Communication, and Community—with Courage. In Johnny’s tool book, he has a chapter titled “Today Matters.” He writes, “Today is game day. It is the only time to put points on the board. When the measure of our lives is totaled, it will be our actions that count. Not our wishes, not our opinions, not our intentions.”

I was privileged to be with Johnny Allem and Bill White in St Paul, Minnesota in 2001 when we and almost 200 others made a commitment to faces and voices proclaiming the reality of recovery. Bill White wrote and reflected on that occasion with a question: “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….”

Bill wrote in a more recent blog, “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?”  Early in the life of Faces and Voices of Recovery, a now large and growing recovery movement, I spoke to an audience at a reunion of alumni of a treatment center. Many were in recovery, along with family members. I spoke of the courage of those in the LBGT community who came out and came up to overcome stigma and discrimination and gained the power of purpose and presence for millions. Afterwards, a woman approached me and with a passionate plea asked. “Mr. Karst, when do we have our own ribbon? “ Symbols are great but nothing beats the power of story.  As I referenced earlier, Bill White spoke of the importance of a “contact strategy” and we have learned, though not related to athleticism, recovery support is certainly a contact sport.

Johnny Allem was the 2016 recipient of the William L. White Lifetime Achievement Award of Faces & Voices of Recovery. He pioneered Recovery Ambassadorship. His book should be sought at local bookstores and is available on the Faces & Voices webstore HERE . Bill White is a well-known author of a multitude of papers and several books. He is a regular contributor to the Faces & Voices of Recovery blog site. I’m grateful for the words from these significant others for the messages.

Merlyn Karst

Recovery Advocate, Denver, Colorado

Founding Board Member, Faces & Voices of Recovery

Relax and Recognize Stress Awareness Month

June 12, 2019

Whether it’s positive or negative, stress has a profound way of seeping into our lives. While a little bit of stress might not make a huge impact, constant stress over a long period of time can have a significant effect on your health. In fact, stress has been linked to a wide range of health issues, including mood, sleep, appetite and even heart disease.

According to BioIQ, 77% of Americans experience physical symptoms as a result of stress. Additionally, 33% state they are living with extreme stress, while 48% blame stress for negatively impacting their personal and professional lives. No matter how you look at it, stress plays a major role in our lives.

Because of this, the month of April has been recognized as National Stress Awareness Month since 1992. This month aims to increase awareness about stress, its negative effects and how to relieve it. If you’re experiencing stress, keep these ideas in mind for how to relax.

1. Meditate. This might seem confusing, but it doesn’t have to be. Meditation simply refers to the practice of slowing down and breathing deeply from your stomach. Take a short amount of time every day to calm your body and clear your mind. Focus on centering your thoughts on your breathing. Meditation has enormous benefits for reducing stress, and has even been linked to lessening the risk of heart disease. If sitting still is difficult, try including yoga or walking in your meditation practice.

2. Unplug. Nowadays, it’s practically impossible to get away from the constant stream of information, advertisements and media impacting our brains. All of this input can significantly affect our stress levels. Perhaps you feel overwhelmed by negative news, or feel the need to immediately respond to work emails or want to compare yourself to others on social media. Instead, take at least 10 to 15 minutes per day to unplug and be away from technology. Your stress levels will vastly reduce.

3. Sleep. There’s a reason sleep deprivation is considered a form of torture. A lack of sleep can increase anxiety and depression, making it difficult to deal stressful situations. If you feel continually stressed, check your sleeping schedule. Chances are things are pretty irregular. To establish a healthy sleeping routine, turn off all of your electronics at least 30 minutes before bed. Then, review your nighttime ritual, such as reading or meditating. This signals your brain that it’s time to relax and prepare for a restful night of sleep.

4. Exercise. Not only is exercise good for your physical health, but it can also benefit your mental health. Exercising gives you an outlet to relieve stress through. Rhythmic exercises such as walking, jogging and swimming have proven to be especially effective at reducing stress levels. To avoid stress from the beginning, aim for about 30 minutes of moderate activity per day, five days a week.

5. Eat. Even your diet can impact how your body absorbs and responds to stressful situations. Eating fresh, whole foods can keep your body energized and well-fueled, so you can respond to stress naturally. On the other hand, stimulants like caffeine, alcohol and nicotine tend to amplify stress, interfere with sleep and worse the effects on your body. If you want to reduce stress in your life, investigate the foods and drinks you consume.

6. Ask. Ultimately, if you find yourself constantly stressed without any apparent solution, don’t be afraid to ask for help. Lots of people experience stress, so there is no shame in recognizing a need for support. Talk with your friends and family about your experiences, or seek out guidance from a professional counselor. Not only will he or she provide a listening ear, but they will also have personal insight to help you better combat stress.

At one point or another, all of us experience stress. This is why the April was dedicated as Stress Awareness Month. This month, take time to focus on any stress you experience and consider how best to reduce it. Not only will you feel healthier mentally and physically, but your life will be impacted for the better.

Research Opportunity Alcohol Use Disorder

June 12, 2019

Introduction. National surveys have given us with valuable information about rates of alcohol and other drug use, abuse and dependence. Much of what we know about addiction, however, has come from information obtained from men and women entering inpatient or outpatient treatment for their substance use problems. While such information is important, it represents only one segment of the much larger group of people with addictions. Many such individuals have never been admitted to a substance abuse treatment program nor have they participated in any kind of addiction recovery support group (White et al., 2013).

In research, this restricted focus on the substance abuse treatment community has been accompanied by an equally narrow definition of treatment “success”, which in many cases has been measured solely by whether a person has relapsed to drinking/drug use or they have remained abstinent. Similarly, epidemiological studies of substance use disorders (SUD) have looked predominantly at remission, examining how many individuals with a lifetime diagnosis of SUD do not meet those criteria for the past year (White et al., 2013). For alcohol use disorders (AUDs) in adults, such remission rates have ranged from 5.3% to 12.9% (Dawson at al. 2008, as cited in White, 2011, p.26)

A recent national survey by the Partnership at Drugfree.org and the New York State Office of Alcoholism and Substance Abuse Services (OASAS) estimates that >24 million adults in the USA are in recovery from SUDs (White et al., 2013). Their study affirmed how little is known about the demographic, medical and psychosocial characteristics of this larger population of people with addictions.

Faces & Voices of Recovery recognizes there are many paths to recovery, ranging from self-help to formal treatment and it has embraced people with all types of recovery experiences (Laudet, 2011). The organization has been instrumental in spearheading change in how the general public views people with addiction and what constitutes recovery. Their efforts have also had an impact on the research community, with greater recognition of how important it is to include this broader recovery group in future studies.

Our research team at Virginia Commonwealth University (VCU) in Richmond, VA, hopes to contribute to this effort by making sure members of Faces & Voices of Recovery and the larger community can, if interested, participate in our study of “Genes, Addiction and Personality” (GAP). The study seeks to better understand genetic and environmental influences in individuals with alcohol and other drug use disorders.

Background. As you probably know, alcohol and drug addiction tend to “run in families”. Researchers, including members of our VCU team, have tried for decades to better understand why this happens. This is difficult, because families share both common genes and common environmental experiences that can contribute to familial clustering. To tease them apart, we have used such strategies as twin and adoption studies. Taken together, such studies have found that genetic factors (those passed down from parent to child through DNA) account for up to about half of the risk for developing a problem with addiction. Environmental circumstances, both within and outside the family, account for the remaining risk.

More recently, with advances in human genetics, researchers have undertaken projects aimed at identifying which genes influence risk. This has been no small task, because for alcohol and other substance use disorders, we know that hundreds or even thousands of genetic variants are likely to play a role in the risk for developing the disorder. Each of these variants contributes only incrementally to risk, with the environment also playing a key role in the process. Environmental factors can not only increase the chances people NOT at high genetic risk might develop SUD, it can also be protective among those who ARE at high genetic risk. For example, if an individual is never exposed to alcohol due to local laws prohibiting its purchase, they will not develop problems with alcohol, even if they have many of the genetic risk variants.

To complicate things further, the symptoms of addiction differ a lot across individuals with the disorder. The new DSM-5 diagnosis of SUD describes 11 symptoms that range from craving to loss of control to problems at work/school to physical withdrawal. Two people can receive a diagnosis of SUD with no overlap in their symptoms. This variability and diversity has been a focus of more recent research: might genetic factors impact which symptoms a person exhibits? More importantly, if there are such genetic differences, what can we learn about them that might improve prevention, intervention, and treatment?

The impetus for the GAP study came from recent schizophrenia research. Schizophrenia is another condition that is influenced by many genetic variants of small effect (Levinson et al., 2011). Recent research has provided valuable insight for researchers trying to understand the genetic basis of schizophrenia. This research only became possible after survey data and saliva samples for DNA analysis were obtained from over 30,000 people with schizophrenia. With this large sample, the results have been promising, with scientists reporting they had identified over 100 genomic regions that impact risk for schizophrenia.  Many researchers believe data from this research is likely to inform the field about new ways to assess for schizophrenia risk as well as develop novel and more effective treatment options.

Our research team at VCU received funding from the National Institutes of Health (NIH) to undertake the same type of study focused on individuals with addiction. Our goal is to better understand genetic and environmental influences in Substance Use Disorders. Based on pilot data we collected over the past 2-3 years, we hope to recruit 12,000 individuals with a history of SUD who are willing to complete a brief survey and provide a DNA sample which is central to such research.

We wrote this blog because we think it is very important to have the broader recovery community participating in the research from the very beginning. To help us meet this goal, Faces & Voices of Recovery has agreed to post several links to the GAP study. Those clicking on the link will be taken to a site where they can get additional information about the project. If they qualify for the study, they can then decide if they want to participate. Participation involves completing a 15-20 minute on-line survey and then providing a saliva sample (kit sent through the mail) for DNA. Once the survey and saliva samples are received, participants will receive a $5 gift card for their time and effort. No identifying information will be linked to the data, but with your permission we will maintain your contact information in case you are interested in participating in future studies.

This is an exciting time in the field of addiction, and the VCU research team is committed to conducting the study. But we can’t make progress without the involvement of individuals entering treatment and members of the recovery community who have struggled with SUD; either now or in the past. If you would like to see if you qualify for the GAP study, please click on the link below. This will take you through a short series of questions to see if you are eligible for the study. If you are, you’ll be given additional information about the research before starting the survey. This link is active for data collection starting on April 12, 2019. If you have previously participated in the GAP study, please do not take the survey again. If you have questions, you can contact GAP2online@vcu.edu.

https://redcap.vcu.edu/surveys/?s=MJNA4FLD9X

We hope that you will join us in this effort to learn more about SUD, with a common goal of improving the lives of those impacted by the disorder and their family members. We also hope the project will provide information helpful to Faces & Voices of Recovery and other organizations committed to advocating and educating federal agencies, policy makers and clinicians as well as the lay public about people with addictions and their long-term recovery.

Dace Svikis, PhD, and Kenneth Kendler, MD

Principal Investigators of the GAP Online Survey

 

CHAOS, ADDICTION RECOVERY, AND THE POWER OF SYNERGY

June 12, 2019

“What’s the point of a spark of light if it stands alone? The key is, and will always be, synergy.” ― Suzy Kassem

People seeking help for the resolution of alcohol and other drug (AOD) problems in the United States encounter not comprehensive systems of care but silos of care based on single pathway models of addiction with narrow menus of derived services, each highly critical of competing silos. Far too often, people with the most severe, complex, and enduring AOD problems traverse multiple silos without finding a sustainable recovery solution. Below are some reflections on why these single pathway approaches to addiction and recovery are so troublesome and a few thoughts on how we may escape entrapment in such ideological prisons.

Future advancements in addiction recovery are more likely to come from personally and culturally potent and carefully sequenced service combinations delivered across the life cycle in expansive environmental venues than from any new single element added to existing addiction treatment or recovery support services. I recently reviewed a paper that provided an elegant explanation for why this proposition might hold considerable promise for the future of addiction recovery. Drawing inspiration from “Embracing Chaos and Complexity: A Quantum Change for Public Health” authored by Drs. Kenneth Resnicow and Scott Page, I suggest the following propositions.

Addiction and addiction recovery most often occur, not through a single source of vulnerability or resilience, but from a collision (“perfect storm”) of multiple personal and environmental factors. The synergy of risk factors that produces addiction differs widely across individuals and cultural contexts resulting in highly varied patterns of drug use, a broad spectrum of problem severity and complexity, and a wide divergence in long-term drug use trajectories and outcomes. Recovery is similarly influenced by a synergy of multiple factors that defies easy identification and replication. To say that addiction is solely the product of this (genetics or neurochemistry) or that (trauma) or something else (social disconnection) is to fail to understand the power of clustered risk factors and the variety of ways they interact. Similar failures occur when attributing recovery initiation to a single factor.

In short, addiction is rarely “one thing,” and addiction recovery rarely springs from a single pathway of influence. Like the best gumbo, addiction and recovery can only be fully understood and appreciated by going beyond their key ingredients to the sequence in which ingredients are combined within a particular time and space to create something fundamentally new. Master gumbo chefs would scoff at the idea that their gumbo could be understood or replicated solely by discovering its most visible ingredients. (The whole really is greater than the sum of its parts.) Addiction treatment and recovery support specialists would do well to mirror this understanding.

Synergies of vulnerability and resilience and dimensions of space and time can be capitalized upon to disentangle the roots of addiction and enhance personal, micro, and macro level strategies of recovery support.

If there are innumerable ways catalytic recovery ingredients can be combined and sequenced and if such catalytic clusters differ from individual to individual and across cultural contexts, then wide divergence of pathways into recovery and variations of styles of recovery within these pathways should be expected and celebrated.

Ingredients that have person-specific affinity for one another, when properly combined and sequenced at receptive points of time and space, cluster together to create a cascade (a dramatic and unprecedented surge) in recovery motivation and progression.

Receptivity to recovery catalysts may differ within various environments, with increased receptivity noted when people have a sense they are within “sacred space”—spaces that heighten perception of self and the self-world relationship, e.g., religious sanctuary, sweat lodge, or nature. There is value in presenting varied clusters of recovery catalysts within varied physical/cultural spaces and atmospheres and at different points within an individual’s addiction career.

Recovery initiation and stabilization can result from rational self-assessment (pro-con analysis of continued drug use) and cumulative efforts (e.g., additive effects of multiple treatments or other recovery initiation attempts), but can also be a product of quantum change that is unplanned, positive, and permanent. “Quantum change” (or “transformational change”) is a sudden motivational cascade that reaches a “tipping point” of recovery initiation and stabilization. Such catalytic moments can rise suddenly within a prolonged history of failed recovery initiation efforts.

Motivational storms of recovery initiation or progression rise from an infinite number of potential recovery catalysts that are potent only in certain combinations and sequences and remain potent only within narrow windows of time and space. Ingredients that failed to initiate recovery in isolation may gain heightened potency and, like a combination lock, may “work” only when properly sequenced.

Unique service combinations that are transformative for one individual may exert no effects, minimal effects, or even harmful effects on others. This proposition affirms the need for expansive menus of recovery support elements (as opposed to a fixed “program”) and rapid adaptations in such offerings based on individual responses to services over time. It also suggests that any single pathway model of addiction and recovery will only result in sustained recovery for a limited subset of the total population of AOD-affected individuals and that those outside that subset could be injured when subjected to mismatched interventions. In medicine, such injuries are referred to as iatrogenic illnesses (e.g., treatment-caused harm).

Changes, even minor changes, within the context of active addiction or early recovery can result in later leaps of recovery initiation, recovery stabilization, and enhanced quality of life in recovery. The potential for such “butterfly effects” suggest the need to continue to inject novel ingredients into addiction treatment and recovery support milieus in hopes of igniting such recovery cascades.

Catalytic ingredients that have been successfully combined and sequenced to initiate recovery often require alteration during the transitions into later stages of recovery. This suggests the need for ongoing recovery consultations and supports through such transitions—supports that can be provided through professional and peer venues.

Suggesting such complex interactions within the recovery process is not an invitation to therapeutic nihilism or abandonment of science, e.g., the suggestion that all treatment and recovery frameworks are worthy and only need their elements combined. (Some may be ineffective or harmful.) It is instead an invitation to bring ALL of  evidence-based, practice-informed ingredients into our service and support milieus, mixing and matching them as we draw from the experiential knowledge of people in recovery, while closely monitoring and adapting personal responses to various service clusters that are chosen. It further calls for a heightened level of professional humility and personal awe that unseen forces may be at work in providing a detonation point for these combustible ingredients.

Our best strategy as caregivers is to keep as many influences (recovery push and pull factors) in play as long as possible and join with those we serve to “not give up before the miracle happens.” At personal and population levels, the odds of recovery initiation, stabilization, and enhanced quality of personal and family life in recovery increase in tandem with the number of such factors we can activate within the self and the environment.

A day is coming when no one need feel self-conscious that their recovery gumbo is so markedly different than that of their peers: Recovery by any means necessary under any circumstances.

Reference: Resnicow, K. & Page, S.E. (2008). Embracing chaos and complexity: A quantum change for public health. American Journal of Public Health, 98(8), 1382-1389.

Acknowledgement: Thanks to Matt Statman and Jason Schwartz for calling my attention to the Resnicow and Page article.

Father’s Day Gift Ideas That Give Back

June 10, 2019

It’s that time of year again. With the summer sun beating down and the fresh scent of aftershave in the air, Father’s Day is right around the corner. This weekend, we celebrate the men in our lives who have been with us from the very beginning. Whether he’s your biological father, grandfather or someone who fills the role of father in your life, this is the perfect time to show him how much he means to you.

Altruism can seep into every avenue of your lifestyle, such as shopping for the special man in your life. In fact, there are always ways to give back to others around you, even including the presents you buy. Here are some ideas for Father’s Day gifts that give back.

Reusable Water Bottle
If you want to love your dad and love the environment at the same time this Father’s Day, then consider gifting him a reusable water bottle. Not only is this the perfect present for the outdoorsy, athletic or nature-loving father, but it’s a great way to care for the environment at the same time. Research companies to find the ideal water bottle for your father. Some, like Love Bottle, provide reusable glass water bottles that are even made in the United States. Find a water bottle he would like and surprise him with it.

Socks for a Cause
For the fashion-forward (or backward) dad, consider giving socks for a cause. For example, Society B is an online marketplace of products that give back and are fair trade. They even donate 10% of their sales to various charities. Their website showcases various charitable socks, such as those that help fund education, fight hunger and give clean water. Search online for other charitable sock organizations. Pick out a pair that matches your dad’s favorite outfit, or surprise him with something silly and generous to wear.

One for One
If you’re not sure what to buy, but know you want to give back, then consider researching one for one companies near you or nationally. A one for one company refers to a specific business model, in which a corporation gives away one needed item for each item purchased. For example, if you buy a pair of shoes from TOMS for your dad, they will give another pair to a person in need. One for one companies are the perfect way to make sure to give back, even if you’re not quite sure what your dad wants. Explore some options and find something he would love.

Honorable Donation
Maybe your dad feels very strongly about a certain cause, charity or nonprofit organization in your area. Why not use Father’s Day as an opportunity to give to a foundation in his name? Make a contribution to someone or something in need, then be sure to credit him for the gift. On Father’s Day itself, you can even make a cute little coupon, card or video, sharing the special news of how you donated in his name. Give it a try to really celebrate him by celebrating others on Father’s Day.

With Father’s Day just around the corner, it’s time to step up and find the best gift possible, which truly personifies the father figure in your life. If you strive to live an altruistic lifestyle, keep these ideas in mind for Father’s Day gift ideas that give back. Then, have a wonderful day this weekend celebrating the man who means so much to you.

Posts from William White

Ethics Tip Sheet

April 6, 2021

Peer recovery support service (PRSS) programs require an ethical framework for service delivery. In most cases, simply “importing” a professional code of ethics is not effective. There is a difference between the professional-client relationship and the relationship of the peer leader and the peer being served that warrants an ethical framework specifically tailored to PRSS.

We Have Been (Addiction Lament & Recovery Celebration)

February 25, 2021

Understanding oneself is incomplete when divorced from the history of one’s people. Those with lived experience of addiction and recovery share such a larger history. Over the course of centuries and across the globe, we have been:

Abandoned  Arrested   Berated   Caned   Castigated   Coerced   Confronted   Condemned   Conned   Defamed  Defrocked   Divorced   Deported   Denied Probation   Denied Pardon   Denied Parenthood   Executed   Electrocuted   Electroshocked   Evicted   Expelled   Exploited   Exiled   Feared   Fired   Forsaken   Hated   Humiliated   Incarcerated   Incapacitated   Kidnapped   Kicked Out   Quarantined   Restrained  Ridiculed   Sedated  Seduced  Shunned   Shamed   Surveilled   Tough Loved   Criticized   Colonized   Commercialized   Criminalized   Delegitimized   Demonized   Depersonalized   Deprioritized   Disenfranchised   Eulogized   Euthanized   Glamorized   Homogenized   Hypnotized   Institutionalized   Lobotomized   Marginalized   Memorialized   Miscategorized   Mischaracterized   Monetized   Mythologized   Objectified  Ostracized   Patronized   Politicized   Proselytized   Publicized   Sensationalized   Stigmatized   Scandalized   Sensualized   Sterilized   Terrorized   Theologized   Traumatized   Tranquilized  Trivialized

More recently, through the efforts of recovery advocates and professional and public allies, we are being:

Applauded   Awakened   Celebrated   Defined   Educated   Elevated   Encouraged   Helped   Healed   Enfranchised   Hired   Informed   Inspired   Motivated  Profiled   Reconstructed   Recruited   Redeemed   Rekindled   Renewed   Restored   Represented   Reunited   Supported   Surveyed   Transformed   Uplifted  Utilized  Valued Vindicated   Actualized   Baptized   Decriminalized   Destigmatized   Diversified   Enfranchised   Hypothesized   Idealized   Legitimized  Medicalized   Mobilized   Organized   Prioritized   Professionalized   Radicalized   Randomized   Recognized   Reconceptualized   Revitalized   Secularized   Sympathized Theorized

Through our shared journeys, recovery is gifting us with:

Accountability   Acceptability   Adaptability   Authenticity   Clarity   Collegiality   Community   Dignity   Employability   Fidelity   Flexibility   Honesty   Humility   Integrity   Longevity   Maturity   Opportunity   Possibility   Predictability   Productivity   Prosperity   Respectability  Responsibility  Sanity   Serenity   Sobriety   Spirituality   Stability  Survivability   Tranquility   Visibility   Wellbriety

Is it any wonder given the complexity of these experiences that we struggle in recovery to answer, “Who am I?” We cannot fully understand the “me story” without the “we story.”  Our personal stories nest within the hands of this larger multigenerational and multinational story. Our present circumstances, our shared needs, our individual aspirations, and our future destinies are inextricably linked to this complex, collective past. We can draw upon that past for resolve and inspiration at the same time we rise above it. Personally and collectively, we have fallen, yet like Lazarus, we rise anew.  Personally and collectively, we are moving from pain to purpose.

 

National Standards of Best Practices for RCOs

February 24, 2021

To ensure fidelity to the recovery community organization model, Faces & Voices of Recovery, RCOs across the nation, and stakeholders have identified the following as national best practices for recovery community organizations.

Recovery Innovations: The Well-Fed Social Supermarket

February 18, 2021

I recently discovered a UK-based project that I found so exciting that I solicited the below blog to share with my readers. To me, the Well-Fed Social Supermarket signals a next stage in the evolution of recovery support services: programs that serve those seeking and in recovery while simultaneously benefiting the larger community. For generations, “service work” in the recovery community has reflected the support we provide each other, our mutual aid organizations, and individuals and families seeking recovery. Perhaps the day has arrived when that service ethic will be extended in new and dramatic ways to larger communities and cultures.

–Bill White

 

Recovery Innovations: The Well-Fed Social Supermarket

Dave Higham, Ged Pickersgill and David Best

Background

Recovery is a process that is characterised through the acronym CHIME – standing for Connectedness (the importance of social engagement); Hope; Identity (the growth of positive personal and social identities); Meaning (engaging in activities that give value to each day) and Empowerment (often experienced as positive self-esteem and self-efficacy).

For recovery community organisations, supporting people to achieve sustainable recovery is often about finding ways to promote CHIME that are personalised to individual aspirations and goals, and the stage of a person’s recovery. This means creating access to positive social and community resources that can nurture recovery capital.

In the UK, there have been a glut of recovery cafes, some of which have succeeded and others failed, but an increasing quest for diverse programmes and social enterprises that can both bolster recovery experiences while also contributing to the growth and wellbeing of the local community. This article provides a brief overview of the Well and then will focus on its innovative contribution to recovery pathways and community wellbeing.

The Well

The Well is a not-for-profit, community interest company (CIC) formed by ex-offender Dave Higham in 2012. Dave left prison for the last time in 2007 having spent over 25 years in addiction and in that time spent more time in prison than he did in the community. Since leaving prison in 2007 he has dedicated his life to supporting others with drug and alcohol addiction through both voluntary and paid employment. Dave set up The Well with his own money and with no blueprint to follow. Instead, he used his experience, vision and determination to create what has now become a leading provider of recovery services in the region.

Dave set up The Well when he recognised a gap in the provision of services during  off-hours and weekends for those people who wanted to achieve or maintain abstinence. The first hub was launched in Lancaster in 2012, and a further four sites quickly followed in Lancashire and Cumbria (in the North-West of England).The majority of staff at The Well have lived experience of substance misuse and offending histories.

The Well has always been shaped, designed and delivered by the people it serves and supplemented by the assumption that both the person and their family need to recover and are thus welcomed. The Well is also open to people with prescription drug histories, mental health issues and trauma, and nearly all the people served have experienced CPTSD (Complex Post Traumatic Stress Disorder). The Well is based on the assumption that ‘Where we serve our community, we become active citizens in the community’.

The Social Supermarket

A Social Supermarket has been designed as a positive way of supporting those on low incomes, tackling poor diet and overcoming health inequalities, through the provision of surplus stock sold at heavily subsidised prices.

Since store’s opening in November 2019, Wellfed Social Supermarket has had a footfall of over 5,000 people and has also resulted in 279 referrals into The Well Communities through various mechanisms of support.  The social supermarket has also facilitated (including but not limited to ) delivery of over 1500 hot meals to marginalised families, issued over 150 food bank vouchers, issued 17 free flu vaccination vouchers, delivered 37 emergency food parcels, delivered 242 sets of ingredients and recipes, and assisted families with welfare signposting in respect of white goods.

Well Fed social supermarket secures high-quality short dated food from retail and manufacture supply chains that would otherwise be sent as waste to landfill but is fit for human consumption. We sell this food to customers at reduced prices, typically an average of one-third of normal retail prices. Marketing is carefully targeted at residents on the lowest incomes and thus at greatest risk of experiencing food poverty and related health issues.

The social supermarket model innovates further by working with local agencies to provide a range of on-site support services. These are tailored to members’ needs and help them overcome multiple barriers to getting out of poverty. On-site support, signposting and assertive linkage may include money advice, debt counselling, and courses on healthy eating and cooking on a budget, as well as employability and vocational skills training. The Well-Fed Social Supermarket is a non-profit organisation with all monies re-invested back into the local community.

The Well Communities Social Supermarket is a model which enables residents in Barrow in Furness to access the retail aspect of the social supermarket and our Fairshare Model Food clubs and to be included in The Well Communities  Building Better Opportunities (BBO) Project  which helps members benefit from the employment and business opportunities that are arising in Barrow in Furness both now and through the longer term delivery of the BBO programme.

This is linked to the Well-fed Food Clubs which provide a sustainable alternative to free food distribution and foodbanks. Through a £3 per week payment, members receive approximately £10 to £15 worth of food each week while reducing food waste by working closely with fareshare North West by collecting the food from the regional Hub in Preston. The Well has built up a very strong membership of marginalised families; most of the postcode areas we serve are listed in the indicies of multiple deprivation. Over 30 tonnes of surplus food has been distributed to date.

The whole model is based on looking upstream and looking behind the actual need for discounted food. Each family has difficulties which mean they need to obtain goods due to some form of financial hardship; the intention is to determine such reasons and help in some way to alleviate these problems. These are then linked to in-house support mechanisms which Include assertive linkage to local statutory and third sector organisations.

Building Recovery and Community Capital                                                                     

The Well identifies people’s recovery capital, identifies their  passions, and works with them to create enterprises. They have had several successful enterprise ideas, the first being The Well itself, but they have also had some failures or learning that were not so successful. To get to the successful Social Supermarket idea we went through a process of ideas and attempts, the first being a catering trailer business, where the Well bought and renovated a trailer and employed a member of our community as he had experience as a chef, got a pitch for the trailer, but the marketing strategy of announcing that we were recovering addicts and alcoholics was the wrong thing to do as in the first year the project  was working at a loss. The lesson was that the most important factor about a food trailer is the pitch, and let this business go but kept the company name Well-Fed and started up foodbanks.

The other successful business, “Well maintained” used the employment capital and experience within the Well membership, including carpenters, electricians, plasterers and so on, and renovated our Dolton Road Hub which is now the location for The Social Supermarket.

Conclusion

There were false first steps on the road to creating the Social Supermarket, but the commitment to the principles of peer empowerment, community engagement and CHIME have resulted in a number of successes that contribute to the growth, wellbeing and inclusiveness of the recovery community as an active and vibrant part of the local, lived community. Not all of these enterprises will succeed, but the skill base, dedication and creativity of the recovery community will ensure a net gain and a positive contribution to individual recovery journeys, family inclusion and community connections and growth.

Mechanisms of Change in Addiction Recovery Revisited

February 11, 2021

In an earlier blog posted in 2017, I offered some preliminary observations on mechanisms of change in recovery and the variation in such mechanisms across pathways of recovery, stages of recovery, clinical populations, and cultural contexts. A recent collaboration with Dr. Marc Galanter in designing a study to investigate such mechanisms of change among members of Narcotics Anonymous has stimulated further thinking about the precise catalytic elements that contribute to addiction recovery.

Mechanisms of change involve precise behaviors that when performed over time elicit radical changes in personal character and identity, personal lifestyle, and interpersonal relationships. They involve decisions, actions, and rituals that strengthen motivation for recovery, serve as building blocks of a recovery-centered lifestyle, and elevate the quality of personal and family life in long-term recovery.

Recovery-focused behavioral mechanisms (repeated actions) lead to intermediate processes that enhance recovery stability and the progressive movement towards global health and social functioning. Such intermediate effects include increased hope for recovery, increased self-confidence in achieving recovery, improved decision-making and coping skills, increased family and social support, and spiritual awakening (sudden epiphanies and turning points; clarification of values and life goals; increased life meaning and purpose).

In my earlier blog, I noted the following: “Addiction recovery involves processes of destruction, retrieval, and creation. Destruction entails breaking entrenched patterns of acting, thinking, feeling, and relating. Retrieval involves the reacquisition of lost assets. Creation requires new recovery-nourishing daily rituals, character traits, relationships, and reformulating life meaning and purpose. These recovery processes can be thought of in terms of subtraction, addition, and multiplication.”

Understanding the mechanisms of change in addiction recovery requires 1) identifying a menu of potential actions, 2) investigating which precise actions or combinations/sequences of mechanisms have the greatest potency and 3) determining how the use of these mechanisms varies across the stages of recovery initiation, recovery maintenance, and enhanced the quality and meaningfulness of one’s life in long-term recovery. A menu of potential change mechanisms could include such actions as the following:

  • Altering the frequency, intensity, or circumstances of drug use
  • Stopping all drug use
  • Seeking specialized addiction treatment
  • Seeking other counseling
  • Seeking treatment for other health conditions
  • Using prescribed medication to facilitate withdrawal and to reduce craving and drug-seeking
  • Using medication as prescribed to treat conditions that contribute to drug use, e.g., anxiety, depression, pain, etc.
  • Participating in face-to-face recovery support meetings
  • Choosing a home group / meeting for regular attendance
  • Participating in online recovery support meetings
  • Attending other recovery-focused events
  • Sharing my recovery story
  • Celebrating anniversaries of being drug free
  • Participating in the service structure of a recovery mutual aid fellowship
  • Reducing or ceasing contact with drug-involved friends and family members
  • Severing unhealthy, addiction-supportive relationships
  • Reconnecting with weakened or lost family and social relationships
  • Socializing with other people in recovery and people supportive of recovery
  • Reading recovery-focused literature
  • Reading other change-inspiring literature
  • Choosing and meeting regularly with a recovery sponsor / mentor / coach
  • Serving as a recovery sponsor / mentor / coach for others
  • “Working” recovery program Steps/principles
  • Working to improve coping and communication skills
  • Centering activities, e.g., praying, meditating, reflecting, journaling
  • Participating in recovery community center activities
  • Participation in religious services and practices
  • Participating in recovery advocacy and peer recovery support activities
  • Pursuing further education or training
  • Resuming old pastimes or cultivating new interests, hobbies, and pastimes
  • Helping others / acts of volunteer community service
  • Improving physical health (e.g., increased exercise, improved nutrition, regular sleeping schedule, smoking cessation)
  • Changing living environment
  • Relocating to safer and more recovery-supportive environment
  • Changing occupation or employment setting

Important research related to such mechanisms of change is progressing. Below are my predictions on what we will ultimately discover from these studies.

Mechanisms of change in addiction recovery include a core of essential mechanisms (without which recovery for most people is not possible) and a larger set of secondary and complementary mechanisms.

Such common factors are widely shared among people with diverse recovery stories, with some differences shaped by age of recovery initiation, gender, ethnicity, sexual orientation, primary drug choice, degree of problem severity, levels of recovery capital, and degree of religious orientation.

Mechanisms of change differ across stages of recovery, with some having greater salience in recovery initiation and others coming into greater play in the transition to recovery maintenance or enhancing quality of life in recovery. We will likely find variations in such effects across cultural contexts, where personal recovery must be integrated into a larger rubric of cultural values and rituals. Differences may also exist in these mechanisms across secular, spiritual, and religious pathways of recovery.

Particular combinations and sequences of actions will be identified that are particularly catalytic in recovery initiation or facilitating the transition from one stage of recovery to another.

The mechanisms of change (actions) in addiction recovery are woven together within two very different processes: story construction and storytelling. Those experiencing addiction, affected family members and friends, and those seeking to offer help all have a need for sense-making. There are numerous theories about the sources and solutions to addiction that become woven into personal and professional narratives that may or may not have anything to do with the actual processes through which such change occurs. The ultimate truth and the best news is that such change is possible and increasingly common. Behavioral prescriptions for recovery initiation, maintenance, and enhancement will become increasingly clear in future research on mechanisms of change. That is cause for considerable optimism and anticipation.

Addiction Recovery Prevalence in the United States: Latest Data

February 4, 2021

For decades, the United States has meticulously measured the prevalence of alcohol and other drug (AOD) use and related problems. The question of how many U.S. adults have resolved such problems has received far less attention until recently. In 2012, I reviewed published studies of clinical and community populations in the U.S. that reported rates of recovery from such problems, and two recent landmark studies provide the best data yet on recovery prevalence in the U.S.

Answering the basic question, “How many people are in addiction recovery in the United States?” is complicated because of differences in definitions of the problem and the solution. Reported outcomes differ depending on the language used in the surveys. Survey responses vary when questions include references to addictionsubstance use disorder, or problem with alcohol or other drugs. They similarly differ depending on the resolution language: abstinencesobrietyrecoveryremissioncontrolled (moderate) use, or once had but no longer have an AOD problem. Recovery prevalence estimates expand and contract based on expansive or restrictive problem and solution definitions. In spite of such challenges, a series of important studies reveal a surprisingly high prevalence of lifetime AOD problem resolution that challenge the notion that “recovery is the exception to the rule.”

My 2012 review of recent studies concluded that 5.3% to 15.3% of the U.S. adult population are in remission from significant alcohol or other drug problems—a conservative estimate of 25 million people (not including those in remission from nicotine dependence alone). The reviewed surveys included the Epidemiologic Catchment Area Study, National Comorbidity Survey, National Health Interview, National Longitudinal Alcohol Epidemiologic Survey, and the National Epidemiologic Survey on Alcohol and Related Conditions. In community studies published since 2000, 54% of people who met lifetime criteria for a substance use disorder no longer met such criteria at the time of follow-up. Problem resolution strategies spanned complete AOD abstinence and deceleration of AOD use.

In 2017, Kelly and colleagues published the results from the National Recovery Study—a U.S. survey of the course of AOD problems in the adult population. Survey findings revealed that 9.1% (22.35 million) U.S. adults responded in the affirmative to the question, “Did you used to have a problem with drugs or alcohol, but no longer do?” Of those who had resolved an AOD problem, 46% self-identified as being “in recovery.”

In 2020, Jones and colleagues published an analysis of recovery data from the 2018 National Survey on Drug Use and Health. Of the 27.5 million U.S. adults reporting ever having an AOD problem (11% of the adult population), 75% (more than 20.5 million) reported no longer experiencing such problems. Both the Kelly and Jones surveys found both supported and unsupported pathways of recovery, including a substantial portion of people who had achieved recovery without participation in formal treatment or recovery mutual aid groups.

In 2020, Stefanovics and colleagues published a survey of more than 1,200 veterans who had experienced an alcohol use disorder during their lifetimes as part of the National Health and Resilience in Veterans Study. More than three-quarters of U.S. veterans surveyed who reported a lifetime alcohol use disorder (AUD) no longer met diagnostic criteria for AUD at the time of the survey.

In 2001, recovery advocates from across the United States participated in a summit in St. Paul, Minnesota that formally launched a new addiction recovery advocacy movement in the U.S. The kinetic ideas at the core of this movement included: 1) Addiction recovery is a reality in the lives of millions of individuals and families, and 2) There are many pathways to recovery and ALL are cause for celebration. Those core propositions, grounded in the experiential knowledge of people in recovery across the U.S., now have substantial scientific support. Recovery is not just a possible outcome for AOD problems; it is the probable and likely outcome when people have access to formal and informal recovery support resources.

References

Jones, C. M., Noonan, R. K., Compton, W. M. (2020). Prevalence and correlates of ever having a substance use problem and substance use recovery status among adults in the United States, 2018 [Epub ahead of print]. Drug and Alcohol Dependence214, 108169. doi: 10.1016/j.drugalcdep.2020.108169

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 Dependence181, 162-169.

Stefanovics, E. A., Gavriel-Fried, B., Potenza, M. N., & Pietrzak, R. H. (2020). Current drinking patterns in US veterans with a lifetime history of alcohol use disorder: Results from the National Health and Resilience in Veterans Study. The American Journal of Drug and Alcohol Abuse, September. DOI: 10.1080/00952990.2020.1803893

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.

White, W. L. (2007). The new recovery advocacy movement in America. Addiction102(5), 696-703.

 

The Portrayal of Addiction Recovery in American Comic Books & Graphic Novels – Part 2

January 22, 2021

This final blog in our five-part series concludes our exploration of the portrayal of addiction recovery within 35 American comic books and 9 graphic novels.

The Role of Recovery Mutual Aid Groups

The supportive role of recovery mutual aid groups was limited exclusively to Twelve-Step groups (Alcoholics Anonymous) within American comic books and graphic novels that contained addiction storylines.

Characters seeking recovery through AA include Tony Stark, Carol Danvers, Katina (“Katchoo”) Choovanski, and five characters in the graphic novel Sobriety. Tony Stark and Carol Danvers even go to the same AA meetings in multiple issues. In Iron Man: Resolutions #313, Tony spends New Year’s Eve at an AA meeting reflecting on his early exposure to alcohol as a pre-teen and current struggles with alcoholism. The role of an AA sponsor is portrayed through the character of Dr. Black, who serves as Ruben’s (Buzzkill) sponsor:

“The rest [beyond admitting you have a problem] is going to be tough, but I’ll be here to guide you. I’ve been through this before. It’s not impossible, Man.”

All five characters in the graphic novel Sobriety were involved in a Twelve-Step program. Larry noted his early perceptions of rehab and AA: “Look at rehabs: They’re invested on getting reimbursement from health insurance companies—the very same companies that require a medical treatment. It seems to me that the Twelve Steps are about something else; it’s like a cult!”

Several characters report getting sober through the help of other AA members. The character Matt (Sobriety) describes how the Twelve-Step program works:

“The problem is easy: we have a disease of the body that causes us to lose control when we drink or drug, and an obsession of the mind that causes us to drink and drug.  That’s the powerlessness that step one describes…The solution to that irreconcilable dilemma is that the other steps give us a way to restore purpose and meaning to our lives.”

Resistance to Twelve-Step programs was portrayed via the character of Matthew Parker in Larceny in My Blood. At one of his parole hearings, Parker declares: “Well, I’ll tell you what I won’t do. I won’t go to NA meetings, or AA meetings, or any of that other crap.” (He was then paroled based on his honesty). In speaking of a later parole hearing, he recalls: ”I told them what I really thought of their rehabilitation policies and 12-Step programs in particular. I just think it’s all bullshit.”

There were no references to secular, spiritual, or religious recovery mutual aid alternatives to Twelve-Step programs in the comic books and graphic novels we reviewed. Given the national and international growth and diversification of alternative groups such as Women for Sobriety, SMART Recovery, LifeRing Secular Recovery, Celebrate Recovery, and numerous others, it is somewhat surprising that they have yet to appear within comic book and graphic novel addiction storylines.

Portrayal of Addiction Treatment

The representation of addiction treatment in American comic books is limited. Natural recovery is far more common than professional treatment, and comic book storylines offer few details related to the actual nature of treatment beyond medical withdrawal. In spite of the portrayal of opioid addiction in numerous storylines, there is little portrayal of the pharmacotherapy of opioid addiction. Recovery most often involved heroic rescue or was portrayed as an isolated episode that when shaken off allows other storylines to proceed without continued references to a recovery process. Below are the few treatment references we located.

In the Batman series, there are references to Doctor Leslie Thompkins and Tiffany Fox operating addiction treatment programs without reference to what such treatment involved. The DC Fandom Wiki explains, “Doctor Thompkins ran the free Thomas Wayne Memorial Clinic for criminals and drug addicts in Gotham City. While the majority of her patients were repeat offenders, she continued to do her job with great perseverance and determination.” Dr. Thompson later ceased her helping role and became a vigilante.

There are numerous examples over multiple decades of Tony Stark seeking treatment for alcoholism, however they rarely show details of what that treatment entailed. In Iron Man: Deliverance #182, Tony is admitted to a hospital for detoxification and later shown attending AA meetings.

In Vengeance of Bane, the psychiatrist Dr. Flanders, who Bane saw while in prison, is portrayed as empathic and skilled

The character Leslie in Hey Kiddo references going to a clinic after her release from prison and getting involved with another patient there: “He’s getting treatment, just like me….Miguel and I are on this road to recovery together.” She relapses and later dies of a heroin overdose.

Alex (Sobriety) entered a government-sponsored rehab for four weeks following an overdose. He warmly describes his counselor, who introduces him to the Twelve Steps: “David was a guy who listened—really listened—to me. He was in recovery himself. And he let me see the truth of my life: that it had spun out of control and was insane.”

The most detailed of addiction treatment appears in The Abominable Mr. Seabrook.

William Seabrook’s physician admitted him to Doctors Hospital, dried him out with the aid of “prescription booze”, and then discharged him as cured.  The images of this episode show Seabrook looking through bars. Following his discharge from Doctors Hospital, he immediately returned to heavy drinking and was subsequently committed to the Bloomingdale Insane Asylum. Seabrook was a challenging patient, often objecting to various rules of the institution. Treatment at Bloomingdale consisted of “cold turkey” withdrawal from alcohol, hydrotherapy (baths and wetpacks), and psychotherapy to address his “addictive personality” and his sexual perversions. Seabrook was discharged after seven months and later detailed his experience there in his book Asylum. At the end of Asylum, he proclaimed himself cured, that he could now drink without excesses of the past and that he had conquered his writer’s block. “I’m now able to take a drink or two without desiring another and I seem to be cured of drunkenness.”

Seabrook’s drinking again raged out of control.

Matthew Parker provides the most detailed account of treatment resistance in his graphic memoir, Larceny in my Blood.  Parker describes being ordered into a halfway house by a judge: “I was allowed to go to work and report back to the rehab each night, which made it easy to maintain my habit.” When arrested for failing a drug test, he “played the contrite junkie.” At a later 28-day rehab, he sarcastically describes his superficial compliance: “Oh, yes, I’ve seen the light. Hit rock bottom. I’m powerless over my addiction. I have to give it away to keep it.” Then released to Maverick House, he described feeling like he was “being conned.”

On Addiction Recurrence

Addiction recurrence following a period of recovery is described in several comic book and graphic novel storylines. Carol Danvers experienced a recurrence of drinking at a time she is struggling with writer’s block. Another time, she follows the Avengers into a bar on a mission commenting that she will need to stay vigilant to avoid another recurrence. Tony Stark experienced multiple relapses across his many storylines.  Below is scene from Ironman: Demon in the Bottle that offers a typical depiction of the tensions that often precede a recurrence:

“For days, the stalemate rages—until at long last, emotional blocks begin to crack, then crumble—and Tony Stark spills his pent-up pain like milk from a spilt pail. He sighs, he shudders…and he shakes.” The purge helps and he returns to work. He apologizes to Jarvis saying he has “a handle on it now,” and Jarvis responds, “You have an illness. I quite understand.” While he’s at the Avenger’s mansion, Tony knows there’s a bottle in his room but says, “I don’t need the booze…I can handle this on my own without any counterfeit courage at all.” Later back at the mansion, Tony starts to pour a drink and Beth stops him. His face is sweating, eyes are down, he’s frowning, his hands are shaking. It’s described as the “hardest battle of his life.” Beth reminds him of his life’s dream, and shaking he recaps the bottle.

The self-talk that feeds addiction recurrence is vividly displayed in The Abominable Mr. Seabrook. Following treatment and a period of sobriety, Seabrook tires of the sober life and proclaims: “I’m tired of being a cripple. From now on, I’m going to prove that I can take a drink or leave it alone, like any other man.” After losing control over his drinking again, he would pledge sobriety anew but soon became bored and commence his drinking binges. His repeated refrain when talking to himself in the mirror:  What do drunkards do? They drink themselves to death.” At a later stage of his story, Seabrook’s lover and third wife-to-be plunged his hands in boiling water to scald the skin so that he would be unable to pick up a drink. Seabrook continues drinking from a liquor bottle using a straw. He was committed to the Hudson State Hospital in mid-1945. A few months later and after his release, Seabrook committed suicide with sleeping pills and whiskey on September 20, 1945.

Brandon Novak (The Brandon Novak Chronicles) re-experienced heroin addiction after publishing his book, Dreamseller, in which he recounted losing his career as a professional skater due to his heroin addiction. In his graphic memoir, he describes coming back from his “insatiable appetite for heroin.”

Addiction, Recovery, and the Family

An area of scant attention in the addictions storylines of American comic books and graphic novels is the effect of addiction upon the family or the involvement of affected families in family support groups or addiction treatment. The few conclusions that can be drawn related to family include the following.

Addiction inflicts repeated episodes of humiliation, helplessness, worry, guilt, anger, and loss on the family (The Abominable Mr. SeabrookDrinking at the Movies, Hey Kiddo).

Addiction can become so imbedded within the marital relationship that recovery may pose more of a threat to the relationship than continued addiction. Willie Seabrook’s second wife reveals, “I confess, Willie had handled the teetotaling better than I did.”

Sustained family support can play a crucial role in addiction recovery. Jarrett’s grandfather (Hey Kiddo) purchases a house for Leslie when she finishes the release program to support her new sobriety. Matthew Parker in Larceny in my Blood recounts such support:

“But as pissed as she [his mother] was, I always had a place to live. She was too kind and I used her…. At 41 years old and on my fifth trip to prison, she [mother] saw no reason for hope…But my mom never gave up on me—I think because our shared struggles showed how bad it could get….We were still family, not despite but because of all that we had lost.”

Sustained recovery brings indescribable relief to the family. Again, Matthew Parker reflects:

“She [mother] was not convinced of my commitment to kick heroin until a year after my release, during my second semester at SCC….I think that was the first time in 40 years that my mom could relax.”

Closing Reflection

The portrayal of the role of recovery mutual aid organizations in the process of addiction recovery is limited within the storylines of American comic books and graphic novels to Twelve-Step fellowships. In spite of their recent growth in the U.S. and internationally, the existence of secular, spiritual, and religious mutual aid alternatives have yet to be portrayed. Addiction treatment is briefly referenced within the addiction storylines of American comic books and graphic novels without substantial details related to the nature of such treatment or its degree of effectiveness. Addiction recurrence following an initial recovery attempt is common within the addiction storylines, with trajectories ranging from death to a final re-stabilization of recovery. American comic books and graphic novels have yet to fully portray the effects of addiction on the family and the processes, stages, and long-term effects of family recovery from addiction.

We anticipate a future in which collaborations between addiction professionals, recovery advocates, and the writers and illustrators will produce a new generation of addiction storylines within American comic books and graphic novels that more accurately portray the prevalence, pathways, stages, and styles of long-term addiction recovery.

 

 

About the Authors: Alisha White, PhD, is an associate professor of English Education at Western Illinois University. Her research focuses on representations of disability and mental health in young adult literature and teaching with arts-based practices.  William White, M.A., is Emeritus Senior Research Consultant at Chestnut Health Systems. His research focuses on the history, prevalence, pathways, stages, and styles of long-term addiction recovery.

The Portrayal of Addiction Recovery in American Comic Books and Graphic Novels – Part 1

January 15, 2021

Earlier blogs in this series have explored how a sample of 35 American comic books and 9 graphic novels portrayed drug use, the causes of addiction, and addiction-related consequences on individuals and families. The present blog explores dominant themes related to the portrayal of addiction recovery.

Limited Portrayal of the Recovery Experience

While addiction is a central thread within many American comic book and graphic novel storylines, the addiction recovery process receives scant attention. For example, Julia Wertz’s graphic memoir, Drinking at the Movies, portrays the evolution of her drinking throughout the book, but devotes only one page at the end to her decision to stop drinking. Hey Kiddo shows Jarrett visiting Leslie in the halfway house, but it isn’t until much later that Leslie describes her recovery to him. There is within the brief recovery storylines a sense of being free and an awakening of previously unrecognized inner strength. Bane, for example, declares, “I am free of Venom. I am truly free for the first time in my life….I didn’t need Venom then. I don’t need it now.”

Recovery as an Incremental Process

American comic books and graphic novels portray addiction recovery as a difficult process often involving multiple efforts before recovery is sustainable. This pattern of repeated recovery attempts is present in the character storylines of Tony Stark(Ironman) , Roy Harper (Green Arrow), Bane, Bruce Wayne (Batman), Katina “Katchoo” Choovanski (Strangers in Paradise), Carol Danvers (Avengers, Ironman), Allan Quartermain (The League of Extraordinary Gentlemen), and Rose Wilson (Teen Titans). Comic book storylines often portray stable recovery preceded by failed promises and resolutions to stop drug use (Matthew Parker) and by experiments in drug substitution. Matthew Parker (Larceny in My Blood) laments, “I’m bent on substituting the slobbering inebriation of alcohol for the nihilism of heroin” before relapsing once again to heroin addiction.

The transition between active addiction and recovery initiation is preceded by elaborate defenses to sustain drug use, e.g., denial, minimization, rationalization, projection of blame, and anger/aggression. These are elaborately detailed over three years (1998-2000) in the sustained storyline of Carol Danvers crossing over from Avengers to Quicksilver and Ironman and eventually ends with Carol going to AA with Tony. Comic book storylines portray the movement towards recovery as a tortured effort to see oneself and the world as they really are. Regarding the distortions that commonly precede recovery, Willie Seabrook’s second wife Marjorie Worthington described Willie’s repetitive lies in his written work and in his life: “Willie always told the truth: His truth.”

Motivation for Recovery

Momentum for addiction recovery as portrayed in American comic books and graphic novels rises in tandem with the erosion of drug effects, escalating consequences, and experiences within active addiction that serve as a catalyst of recovery. Brandon Novak (The Brandon Novak Chronicles) describes the diminishment of drug effects: “But there is one law that every drug fiend is incapable of breaking: The law of diminished returns.”

Other push forces toward recovery include fear of loss of one’s powers (Dr. Cecilia Reyes) and fear of death if they don’t stop and if they do. Willie Seabrook, his drinking at its worst, prophetically writes his publisher, “I think I’ll die if I don’t stop drinking.” Carol Danvers (Iron Man) and Rose Wilson (Teen Titans) are both told by doctors that continued drug or alcohol use will lead to their deaths. Rose Wilson is told, “…You don’t lay off the epinephrine, you’ll be dead” because of the damage to her heart. She’s warned of the effects from prolonged epinephrine use including “migraines, tremors, blurred vision. Oxygen deprivation. Heart failure.”

Comic books and graphic novels also note positive forces within the addiction experience itself that can serve as push factors toward recovery.

“As devious as we have become, junkies are still capable of emotion, compassion, generosity, and charity. And sometimes we depend on each other to extend kindness, and through this selfless act our humanity can be restored, even if only for a few hours.” (The Brandon Novak Chronicles)

There are references in comic books and graphic novels to what today would be called “interventions” (e.g., Batman’s role in the recovery of Martian Manhunter), there is a surprising lack of references to institutions of control that play such a prominent role in the lives of addicted men and women (e.g., law enforcement, courts, prison, and the child welfare system). In one example we noted (Hey Kiddo), Leslie’s sobriety is implicitly tied to her time in prison. When she is released on probation and gets a job, her family worries that if she does not stay clean and keep her job she will return to prison. In another example, Carol Danvers (Avengers) is court martialed after making serious mistakes due to excessive drinking during a mission. The court martial scene is drawn like an intervention with each Avenger giving a statement about the impact her alcohol use has had, but she quits Avengers before they can demote her.

Styles of Recovery Initiation

There are varied styles of recovery initiation portrayed in American comic books and graphic novels. Recovery for most is portrayed as an incremental, stage-dependent process—a progressive accumulation of drug-related consequences. The turning point is often depicted as a “hitting bottom“ experience. The alcoholic character Wilty in the Wash Tubbs comic series proclaims, “I’m through saying I can quit if I have to…I can’t. I don’t drink any more to get a lift, I drink to stay alive….I’m licked.”

An AA member in the graphic novel Sobriety laments, “This is the case for many of us. We don’t want sobriety until it hurts badly enough.” Later, that same AA member notes the varieties of recovery experience: “Different people have different spiritual experiences. A few are sudden and dramatic… A lot of people—in fact, most—have similar experiences [more gradual and prolonged] that come as a result of working the steps.”

Comic book and graphic novel storylines where the change process was portrayed as unplanned, positive, and permanent include the character of Bane.  While imprisoned in solitary confinement, Bane reviews the traumas of his life (e.g., in prison since his birth, subjected to experimental drugs, victimized by other prisoners) and experiences a vision conveying the message that he had “the strength of innocence to overcome the poison [Venom].” That vision marked the beginning of his recovery process. There are also examples of altered states of consciousness or sudden epiphanies that marked recovery initiation. Klaus (The Umbrella Academy) experienced a vision of himself in a stark white desert where he hears God commanding, “Stay off the drugs, Klaus.” Julia Wertz (Drinking at the Movies) experienced a sudden realization that she has been drowning in self-pity and blaming everything but herself for her problems. Matthew Parker, who had resisted NA and AA and varied treatments, had an epiphany in jail that marked his recovery initiation:

“I was totally, irrevocably, utterly in their control and had been for the past 13 years….I wasn’t a thorn in the side of The Man, but rather old meat trapped in his intestines….I therefore decided, right then and there, to quit using. To turn my life around.”

Viewed as a whole, recovery initiation in American comic books and graphic novels is portrayed as an intersection of pain and hope.

The Need for Sustained Vigilance

Even successful recovery, as in the case of Tony Stark (The Invincible Iron Man), is accompanied by the need for sustained vigilance against cravings and impulses to use: “It’s always with me…whispering to me.”  Holly Robinson in Catwoman is constantly reminded of her addiction during the early months of her recovery: “…And I just can’t stop seeing these streets in junkie-vision…Or noticing how easy it would be to give in…”.

The need for sustained vigilance against impulses to use are well illustrated in the Wash Tubbs comic series, as Ben (AA member) describes Wilty’s continued vulnerability during the early days of Wilty’s recovery:

“Let’s get that straight…there is no cure. I’m what we call a permanently arrested case….one of perhaps 50,000 in AA who will never take another drink but we’ll always be alcoholics because we’re still allergic to alcohol. However, we can live normal lives! We’ve quit kidding ourselves that we can ever be social drinkers.”

“Gig’s [Wilty’s] chief danger now is a false sense of security, as he gradually loses his urges to drink.  Unless we help him keep his guard up, an emotional upset…fatigue…an impulse to join friends in a “quick one”…or even a sudden piece of good luck could cause a relapse. ”

An AA speaker in the graphic novel Sobriety shares similar sentiments:

“Addiction isn’t just in our heads—it’s in our bodies and our spirits too. ….As an alcoholic I will always “have it”—but it doesn’t have to have me!”

“There’s no cure as yet—It’s a chronic illness that needs to be managed, like diabetes.  But there’s a spiritual solution in the Twelve Steps.”

Recovery Support Resources

Recovery was often achieved in American comic books and graphic novels through reliance on resources and relationships beyond the self. Examples of this include Batman’s rescue and detoxification by his assistant Alfred, Captain America detoxing with the aid of Black Widow, the support Tony Stark received from his girlfriend and butler, Theresa Cassidy’s (X-Force) recovery with the aid of Warpath, Speedy’s cold turkey withdrawal with aid of Black Canary, and Harry Osborn’s rescue by Spider-Man. In the X-Men series, Dr. Cecelia Reyes achieves recovery after being rescued by the X-Men and through the support of Xavier through her drug withdrawal process. After Carol Danvers achieves sobriety with the aid of Tony Stark, she later helps him when he returns to drinking following revelation of his true identity. After Danvers achieves sobriety, she rejoins the Avengers on the condition that she be supervised and continue her AA involvement.

In the Catwoman series, Holly Robinson’s friends Selena and Karon serve as key support to her recovery. Leslie (Hey Kiddo) describes how she and her boyfriend support each other’s recovery, “He’s getting treatment, just like me.” (p. 229) … “Miguel and I are on this road to recovery together.” (p. 230). All five characters in the graphic novel Sobriety are involved in a Twelve-Step program, and one of the characters (Alex) references living in a recovery residence.

While in France, Willie Seabrook asked the famed author Gertrude Stein for guidance on his drinking problem. Her advice was simple: “stop drinking so much and return to writing….You must stop drinking and you must begin to write again.” Following that advice, Willie wrote his publisher in September 1933 asking for help. His publisher responded by making arrangements for Willie to return to America and be admitted to Doctors Hospital under the care of Dr. Alexander Lambert.

Character Transformation in Recovery

Recovery within American comic books and graphic novels provides an opportunity for the acquisition of new powers and altered qualities of character. Following Bane’s recovery from Venom addiction, he uses this period of isolation to strengthen his body through extreme physical exercise and strengthen his mind through meditation. Many American comic book characters who transitioned from addiction to recovery went on to develop a recovery-focused service ethic. Batman, after his own recovery, was involved in supporting the recoveries of three other characters: Arsenal, Speedy, and The Martian Hunter. Arsenal then goes on to become a drug counselor and law enforcement officer. Batman served as a recovery role model and recovery coach for others. Other examples of such service activities after recovery initiation include Dr. Cecilia Reyes’ volunteer activities at a homeless shelter (X-Men) and Karen Page’s operation of a legal clinic in Hell’s Kitchen (Daredevil).

Wilty, in the Wash Tubbs comic series, reflects on the therapeutic effects of helping others as part of one’s own recovery: “I had to call on Ben (AA member) again last night. He took me with him to see a very pathetic case. I think we helped him, but it helped me even more.” Holly Robinson in the Catwoman series worked undercover to take down drug dealers following her recovery from heroin addiction. Reflecting on this work, she explains, “I can use my life experience to my advantage for a change…And that makes me feel stronger…Prouder.”

In the graphic novel Sobriety, Dan and Alex describe their lives in recovery

“I once had a life that was destroyed by drugs and alcohol…But I got life back because of the Twelve Steps. It’s different than it was before. It isn’t perfect…But it’s full of surprises. And it’s worthwhile… Sobriety is more than the definition we find in a dictionary. It’s a new lifestyle that we embrace. It gives us real existence.”

“Now, I’ve left that life. I’m selling fine automobiles in London. And I’m happier than ever.”

Matthew Parker (Larceny in my Blood) described channeling his propensity for excess into his recovery process, using education as a pathway to recovery: “Being an excellent student also makes it easier to stay clean. I now channel my compulsion into more productive activities. Compared to the hard work involved in being a junkie, becoming an honor student is ridiculously easy.” Describing his experience in college and his writing aspirations, Parker describes the irony of his new circumstances: “Credit [to pay for school] is my new heroin, and debt its walls and razor wire.”

Closing Reflection

While limited in the range and depth of storylines, American comic books and graphic novels have portrayed recovery as part of addiction-related storylines, including the motivations for recovery, styles of recovery initiation, and the potential of recovery as a medium of personal transformation and service to others. In our next and final blog, we will highlight the portrayal of recovery mutual aid groups and addiction treatment in American comic books and graphic novels, as well as portrayed risk factors for addiction recurrence and the paucity of attention to family recovery.

About the Authors: Alisha White, PhD, is an associate professor of English Education at Western Illinois University. Her research focuses on representations of disability and mental health in young adult literature and teaching with arts-based practices. William White, M.A., is Emeritus Senior Research Consultant at Chestnut Health Systems. His research focuses on the history, prevalence, pathways, stages, and styles of long-term addiction recovery.

The Portrayal of Addiction Consequences in American Comic Books and Graphic Novels

January 8, 2021

In the first two blogs in this series, we explored the historical portrayal of drug use and addiction in American comic books and graphics novels as well as the factors related to addiction vulnerability. The present blog examines the portrayal of addiction-related effects on global health and social functioning within 35 American comic books and 9 graphic novels that contained an addiction storyline.

Physical Consequences

Physical deterioration was among the most prominent consequences of addiction conveyed within the comic books and graphic novels reviewed. Physical manifestations of addiction included portrayals of hangovers and morning drinking as an attempted cure (Julia Wertz / Drinking at the Movies; Tony Stark / The Invincible Iron Man), memory blackouts (Ruben / Buzzkill), as well as an overall erosion of self-care and personal hygiene. Addiction was graphically portrayed via images of dirty, ashen skin, unshaven faces, and disheveled clothing. Physical emaciation of addicted characters was common as was self-expressed concerns about physical health (Karen Page / Daredevil; William Seabrook / The Abominable Mr. Seabrook). A typical scene has the central character looking in a mirror and reflecting, “My skin’s a bit green and I pissed blood the other morning. But it’s easier said than done, to kill yourself with booze.” (The Abominable Mr. Seabrook). Physical insults from addiction also included physical injury from accidents while intoxicated (William Seabrook / The Abominable Mr. Seabrook; Larry and Alex /Sobriety), painful drug withdrawal (Bane), and alcohol or other drug overdose and hospitalization (Tony Stark / The Invincible Ironman, Carol Danvers / The Invincible Ironman; Rose Wilson / Teen Titans). Drug-related death by overdose or suicide were also represented (Leslie / Hey Kiddo; Larry and Alex / Sobriety; and William Seabrook / The Abominable Mr. Seabrook).

Psychological Consequences

The comic books and graphic novels reviewed detailed early psychological effects of addiction. Such effects included embarrassment from drinking behaviors–drunk calls/texts/emails/social media posts, and Amazon buying in Julia Wertz / Drinking at the Movies), getting into fights while using (Ruben / Buzzkill), sexual encounters while drunk (Jessica Jones / Alias), the diminishment or loss of superpowers (Rose Wilson / Teen Titans), and cognitive impairment (inability to concentrate, impaired decision-making as illustrated by Tony Stark in The Invincible Ironman: Demon in a Bottle. The accumulation of secrets and shame was a common theme. As Ruben (Buzzkill) reflected:

“Every addict or junkie has their own secrets. Things they’ve done or said. People they’ve hurt… We tell ourselves that the meetings and the journaling will help us to deal with these secrets…What it amounts to is baring every nerve, forcing yourself to face the parts of your story that don’t want to be told. Facing them and making them submit. Dragging them, scrabbling and screaming into the light.”

As addiction progressed within the comic book and graphic novel storylines, early psychological effects were followed by two dominant experiences. The first was radical personality changes while using and overall psychological deterioration marked by hallucinations, paranoia and fear of insanity (Marjane Satrapi / Persepolis; Rose Wilson / Teen Titans; Matt / Sobriety), sometimes requiring psychiatric hospitalization (Klaus / The Umbrella Academy). As William Seabrook’s alcoholism progressed, he vacillated between periods of self-loathing and a grandiose sense of self-importance accompanied by a hyper-criticalness of others. In the Amazing Spider-Man series, the character Freak, while addicted to heroin, breaks into a laboratory and injects himself with loaded syringes he believes to be heroin but contain instead animal stems cells that turns him into a monster—a metaphor for the deforming experience of addiction. A Dr. Jekyll / Mr. Hyde portrayal of addicted characters is common in American comic books and graphic novels, with references to “feral anger” and portrayal of characters with a “monkey on their back” as rabid—wild eyes, sneering mouth, clenched muscles (Ironman). Larry, the Alcoholics Anonymous member in the graphic novel Sobriety explains such transformations: “Put a drop of booze or mood-altering chemical in us and we change, we become that which we never thought we would: manipulative, lying, stealing, self-centered people…only headed to jails, institutions, or death.”

The second dominate experience involves loss of volitional control over drug use decisions and complete domination of one’s life by drug seeking and drug use. Several central characters describe such effects.

Bane: “I was driven by Venom…It controlled me, not the other way around…the Venom weakened my judgment and I lost everything.”

Larry (Sobriety): “And that’s the thing about alcohol use: For a while I thought I was managing it. That’s not really the way it was: It was managing me. I would come to learn that my addiction would, in due course, demand priority over everything, even the woman I married.”

Holly Robinson (Catwoman) “And when you’re a junkie that’s all you do—wait to score, wait to shoot up, wait for it to wear off, wait for the guy who gives you more money to score again, do anything he wants to get it, wait to score, wait to shoot up…And, then when you quit, it’s all waiting–to not see the world in junkie-vision, I guess…I wonder when that starts”

Matthew Parker (Larceny in my Blood): “Heroin was the dictator of my higher brain functions at the time…2 + 2 = heroin. The capital of Thailand is opium. I think, therefore, I am a junkie.” ; “I couldn’t conceive of a world without heroin. I loved it that much.”

Brandon Novak (The Brandon Novak Chronicles): When asked if he believed in true love, Novak responds, “I believe I truly love heroin!” When asked if he would eat poop for a million dollars, Novak responds, “I’d do it for free if you dipped it in heroin!”

Effects on Social Functioning

The physical and psychological effects of addiction as represented in American comic books and graphic novels/biographies/memoirs exacerbated multiple areas of social functioning within the affected characters:

  • Dropping out of college: Ruben (Buzzkill)
  • Employment challenges (Julia Wertz / Drinking at the Movies); loss of leadership position (Tony Stark / Avengers); court martial (Carol Danvers / Avengers)
  • Financial distress (The Abominable Mr. Seabrook),
  • Indebtedness (Matthew Parker / Larceny in my Blood),
  • Housing instability and homelessness (Matthew Parker / Larceny in my Blood; Matt / Sobriety; Holly Robinson / Catwoman);
  • Loss of driving privileges (Ruben / Buzzkill), and
  • Drug-related arrests, imprisonment, and revocation of probation or parole (Leslie / Hey Kiddo; Matthew Parker / Larceny in my Blood; Matt and Hannah / Sobriety.)

The addiction-crime link is vividly described in The Brandon Novak Chronicles:

“In the daily life of a Junkie, at any given time there is a crime of the moment….Dope provides the addict with the relentless compulsion to lie, cheat, and steal at every opportunity in order to score, and this transformation robs the dope fiend of his humanity.”

Relationship Effects

American comic books and graphic novels also depict the devastation addiction inflicts on interpersonal relationships. Such effects encompass addiction-related family conflict and family dissolution (Karen Page / Daredevil), intimate and collegial relationship conflict over drug use (Tony Stark / Ironman; Holly Robinson / Catwoman; Jessica Jones / Alias; Carol Danvers / Avengers), parent-child alienation and lost custody of children (Wilty / Wash Tubbs; Debby / SobrietyHey Kiddo), and multiple divorces (William Seabrook / The Abominable Mr. Seabrook). The strain on social and intimate relationships is revealed in the storylines of numerous characters.

Matthew Parker (Larceny in my Blood): “I was crazy about Maria. But I was crazy for narcotics first.”

Ruben (Buzzkill): “None of my friends will talk to me anymore. I understand why. I get it, but it’s just hard.”

Brandon Novak (The Brandon Novak Chronicles): “I am a predator and a tortured soul. She [former girlfriend] is my prey and my savior.”

Closing

American comic books and graphic novels have revealed perceived roots and consequences of addiction within their storylines. The depth and texture of such portrayals could increase through collaboration between addiction professionals, recovery advocates, and the authors and illustrators of comic books and graphic novels.

Coming Next: The Portrayal of Addiction Recovery in American Comic Books and Graphic Novels

About the Authors: Alisha White, PhD, is an associate professor of English Education at Western Illinois University. Her research focuses on representations of disability and mental health in young adult literature and teaching with arts-based practices.  William White, M.A., is Emeritus Senior Research Consultant at Chestnut Health Systems. His research focuses on the history, prevalence, pathways, stages, and styles of long-term addiction recovery.

Participatory Process Tip Sheet

December 30, 2020

Recovery Community Organizations (RCOs) and other peer programs are more productive as a recovery community and more supportive as a recovery space when they strive to meet folks where they’re at. Begin by creating an environment where participation is natural, enthusiastic, non-threatening — a culture where social roles within a community begin to emerge. We have designed this Tip Sheet specifically for you to understand some of the key characteristics of a participatory process and integrate it into your organization.