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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New Recovery Advocacy Movement Basics
Definition- The New Recovery Advocacy Movement (NRAM) is a social movement led by people in addiction recovery and their allies aimed at altering public and professional attitudes toward addiction recovery, promulgating recovery-focused policies and programs, and supporting efforts to break intergenerational cycles of addiction and related problems.
Historical Context- The NRAM rose in the late 1990s in reaction to the increased demedicalization, restigmatization, and criminalization of alcohol and other drug (AOD) problems and the resulting cultural pessimism about the prospects of long-term addiction recovery. New grassroots recovery community organizations (RCOs) across the U.S. were aided by seed grants from the Center for Substance Abuse Treatment’s (CSAT) Recovery Community Support Program (RCSP). The RCSP meetings served as an incubator for the gathering of local RCOs and recognition of the need for a national recovery advocacy movement. The Alliance Project of the Johnson Institute hosted an October 2001 Recovery Summit that marked the creation of Faces and Voices of Recovery and the formalization of a national infrastructure for the NRAM. The subsequent cultural and political mobilization of people in recovery and people personally affected by addiction was enhanced by a the growth and diversification of recovery mutual aid groups, a new generation of recovery advocacy literature (Let’s Go Make Some History: Chronicles of the Addiction Recovery Advocacy Movement; Alcohol Problems in Native America: The Untold Story of Resistance and Recovery; Many Faces One Voice), a landmark documentary film (The Anonymous People), and a national recovery rally in Washington D.C. (Unite to Face Addiction).
Why “New”?- References to a “new” recovery advocacy movement pay homage to earlier advocacy movements, particularly the past work of the National Council on Alcoholism and Drug Dependence (NCADD) and the Society of Americans for Recovery (SOAR), and signal the rise of new ideas and strategies that distinguished the NRAM from earlier movements aimed at addressing alcohol and other drug problems in the United States.
NRAM Organization- The heart of the NRAM is the more than 100 grassroots RCOs operating in local U.S. communities. The national infrastructure, from its beginnings, has been a collaborative one. Key partners in this collaboration have included Faces and Voices of Recovery, National Council on Alcoholism and Drug Dependence, Young People in Recovery, Unite to Face Addiction, and Legal Action Center. People in medication-assisted recovery have been represented by The National Alliance for Medication Assisted Recovery, Advocates for Recovery through Medicine (ARM), the National Alliance of Advocates for Buprenorphine Treatment (NAABT), and Stop Stigma Now. Local RCOs are now represented by theAssociation of Recovery Community Organizations. New recovery support institutions—a key product of this movement—are represented and supported by such organizations as the National Alliance of Recovery Residences, the Association of Recovery Schools, and the Association of Recovery in Higher Education.
NRAM Funding Organizations- Within the national recovery advocacy movement are funded by a mix of governmental and foundation grants and the private philanthropy of people in recovery and their allies. Local recovery community organizations are funded by a mix of federal, state, and private grants and contracts (mostly for the delivery of recovery-related professional and public education and peer-based recovery support services) as well as through the private philanthropy of local citizens. The work of the NRAM is also supported by a new generation of private advocacy organizations and foundations organized by persons blessed by recovery or who have lost family members to addiction.
Movement Goals-The founding goals of the new recovery advocacy movement were to: 1) portray alcoholism and addictions as problems for which there are viable and varied recovery solutions, 2) provide “living proof” of the diversity of those recovery solutions, 3) counter any actions that dehumanize, objectify, and demonize those with or recovering from AOD problems, 4) enhance the variety, availability, and quality of local/regional treatment and recovery support services, and 5) remove environmental barriers to recovery by promoting laws and social policies that reduce AOD problems and support long-term individual and family recovery.
Kinetic Ideas- The core and evolving messages of the NRAM include the following:
Addiction recovery is a living reality for individuals, families, and communities.
There are many (religious, spiritual, secular) pathways to recovery, and ALL are cause for celebration.
Recovery flourishes in supportive communities.
Recovery is a voluntary process.
Recovering and recovered people are part of the solution: recovery gives back what addiction has taken from individuals, families, and communities.
Recovery is contagious and can be spread in local communities by increasing the density of recovery carriers and expanding recovery landscapes (physical, psychological, social, and cultural spaces) supportive of addiction recovery.
Movement Strategies- The major strategies of the NRAM include:
Building strong, grassroots recovery community organizations (RCOs) and linking these RCOs into a national movement to develop recovery leaders, offer opportunities for the recovery community—people in recovery, family members, friends, and allies—to express their collective voice on issues of common concern, respond to community-identified recovery support needs, and provide a forum for recovery-focused community service.
Advocating for meaningful representation and voice for people in recovery and their families at local, state, and federal policy levels on issues that affect their lives.
Assessing and responding to national and local needs related to the adequacy and quality of local treatment and recovery support services.
Educating the public, policymakers, and service providers about the prevalence, pathways, and styles of long-term addiction recovery.
Developing human and fiscal resources by expanding philanthropic and public support for addiction treatment, recovery support services, and recovery advocacy and by cultivating volunteerism within local communities of recovery.
Creating recovery community centers that make recovery visible on Main Street and provide a setting for the delivery of non-clinical, peer-based recovery support services, supports, and activities.
Celebrating recovery from addiction through public recovery celebration events (e.g., marches, rallies, concerts) that offer living proof of the transformative power of recovery.
Supporting research that illuminates the pathways, processes, stages, and styles of long-term personal/family recovery.
Accomplishments- The major achievements of the NRAM as of 2015 include:
Mass Mobilization: A national recovery advocacy constituency has been mobilized through creation of more than 100 local RCOs, recovery-focused social media outlets, recovery messaging training, multiple recovery summits, and the ritualization of local and national recovery celebration events with ever-increasing numbers of participants. Particularly distinctive has been the leadership roles that women, people of color, members of the LGBT and other historically marginalized communities, and members of diverse recovery communities have played in assuring the cultural inclusiveness of the NRAM. Scientific surveys have been conducted on public attitudes toward addiction recovery and on the demographics, experiences, and opinions of U.S. citizens in recovery.
Policy Victories: Policy advocacy efforts have contributed to a) passage of Mental Health Parity and Addiction Equity Act and the Affordable Care Act, b) mobilization of bipartisan support for Comprehensive Addiction and Recovery Act of 2015 (CARA), c) removal of key discriminatory laws and regulations affecting people in addiction recovery, d) elevation of recovery as a new organizing paradigm at ONDCP and SAMHSA/CSAT and within state planning/funding authorities, and e) the first inclusion of recovery within the National Drug Strategy.
Professional Influence: Major developments include a) increased recovery representation within AOD-related policymaking and governance bodies; b) professional consensus conferences on the definition of recovery and on extending the benefits of addiction treatment via recovery support services, c) progress in purging stigmatizing language (e.g., abuse, clean/dirty, alcoholic/addict) from the addiction field’s language of professional discourse, d) sustained pressure to extend acute care models of addiction treatment to models of sustained recovery management (RM) nested within larger recovery-oriented systems of care (ROSC), e) legitimization of recovery as an important arena for scientific investigation, to include an increase in scientists specializing in recovery research (e.g., Best, Davidson, Dennis, Galanter, Godley (M), Godley (S), Humphreys, Jason, Kaskutas, Kelly, Laudet, McKay, Mericle, Pagano, Polcin, Scott, and Tonigan), f) increased recovery focus within peer-reviewed scientific journals (e.g., special issues of Journal of Substance Abuse Treatment, Alcoholism Treatment Quarterly, Journal of Groups in Addiction and Recovery), g) expansion of funding streams to integrate pre-treatment, in-treatment, and post-treatment recovery support services (e.g., outreach, recovery coaching, ongoing recovery check-ups) within clinical models of addiction treatment, and h) progress in the tri-directional integration of harm reduction services, clinically-directed addiction treatment, and recovery support services.
Expansion of Recovery Support Institutions: Expansion of a) RCOs, b) recovery community centers, c) recovery residences, recovery high schools and collegiate recovery programs, d) recovery industries, e) recovery ministries, and f) recovery cafes and other social venues.
Expansion of Culture of Recovery: Promulgation of recovery-focused language, symbols, rituals, art, film, theatre, music, and social media.
NRAM as International Movement-The international spread of the recovery advocacy movement is evident in the rise of recovery advocacy movements and organizations in Canada, the UK, South America (e.g., Brazil), Africa (e.g., South Africa), Asia (e.g., Japan), and Australia.
Movement Challenges- The long-term cultural and professional influence of the NRAM is unclear. The NRAM will face many of the challenges faced by other social and health care transformation movements, including cultural backlash, professionalization and commercialization of indigenous support, and highly publicized episodes of emotional/sexual/financial/ideological exploitation of service recipients prior to development of ethical standards of practice and effective structures for selecting, training, and supervising those providing peer-based recovery support services. That said, the NRAM has the potential to dramatically alter public and professional perceptions of addiction recovery and forge fundamental changes in the design of addiction treatment and the nature and magnitude of recovery support services available to American citizens.
William L. White is an Emeritus Senior Research Consultant at Chestnut Health Systems / Lighthouse Institute and past-chair of the board of Recovery Communities United. Bill has a Master’s degree in Addiction Studies and has worked full time in the addictions field since 1969 as a streetworker, counselor, clinical director, researcher and well-traveled trainer and consultant. He has authored or co-authored more than 400 articles, monographs, research reports and book chapters and 18 books. Bill’s sustained contributions to the field have been acknowledged by awards from the National Association of Addiction Treatment Providers, the National Council on Alcoholism and Drug Dependence, NAADAC: The Association of Addiction Professionals, the American Society of Addiction Medicine, and the Native American Wellbriety Movement. Bill’s widely read papers on recovery advocacy have been published by the Johnson Institute in a book entitled Let’s Go Make Some History: Chronicles of the New Addiction Recovery Advocacy Movement.
Addiction is a deadly epidemic affecting every community across our great nation. According to the Centers for Disease Control (CDC), more Americans die each year from drug overdoses than in car crashes. While Faces & Voices of Recovery leads the way in raising the profile of the recovery community by demonstrating and celebrating long-term recovery, we are also compelled to tell the stories of lost loved ones, to put a public face on addiction.
2015 has also been a year of change at Faces & Voices of Recovery. While the organization has made considerable strides in strengthening our structure and governance, we also suffered a terrible setback by the sudden death of our beloved friend and Director of Operations, Jerry L. Gillen.
Jerry died of an accidental drug overdose within days after our phenomenal annual awards gala, America Honors Recovery, in July. Although those close to him knew some of the details, none of us knew the official cause of his death until just recently after his family had been informed by the medical examiner: a lethal combination of heroin and methamphetamine.
I am sharing this with you, our members, with a very heavy heart. While we debated about whether we would share this sensitive information publicly, in the end, the importance of the work and our mission was the deciding factor. We must not allow the shame and stigma that has historically kept our friends and families shrouded in a cloak of secrecy to regain any traction. We are a recovery movement founded on the value of sharing our stories to help the public better understand addiction and recovery. We work hard to eliminate negative public perception and to reduce the discrimination that keeps people from seeking recovery or moving on to better lives once they achieve it. We are reminded how precious life and recovery are and of the reality of relapse in the chronic nature of addiction.
Jerry Gillen found a better life in recovery. We will remember him as a tireless recovery advocate, a compassionate friend and a dedicated, loyal and skilled professional. Jerry had a natural ability to make everyone feel welcome, whether on the phone or at a Faces & Voices event. He was an incredible event coordinator and a trusted colleague; he was a fast-talker and he had an uncanny sense of humor. Jerry made us all laugh; he loved his Potbelly milkshakes and his Dr. Pepper; his favorite source of self-care was shopping at DSW to buy more shoes! Jerry was deeply committed to the mission of Faces & Voices of Recovery; he was like family to so many of us who knew him well.
When tragedy hits home we MUST do more to make long-term recovery possible for even more individuals and families. We MUST continue to mobilize and organize to raise the profile of the organized recovery community and help more people find recovery by demonstrating that over 23 million Americans from all walks of life have found recovery. We MUST continue to promote widespread understanding that long-term recovery is a reality and a process that takes time and support.
Faces & Voices of Recovery is dedicating 2016 to Jerry Gillen as the “Year of Recovery.” It will be a year of celebration of our history and for all of our leaders, staff, board members and supporters who have touched Faces & Voices of Recovery over the years. It will be a year of new friendships and new faces emerging within the organization and within the recovery advocacy movement.
Best wishes for a happy and healthy new year!
Yours in recovery,
Growing up, I was taught that I shouldn’t use drugs. Even though others in my family had experienced problems with substance use, it didn’t spark the kind of two-way discussion that would have allowed for an open dialogue. Today, things are different; my family and I talk openly about this important health issue. In fact, I have 6 nieces and nephews, and as each one reaches an appropriate age, I share my recovery story and make them aware of the dangers of drug use, the history of addiction in our family, and the importance of making healthy choices. I encourage you to do the same.
Talking with your family about substance use can be awkward and uncomfortable. But, parents play a critical role in their children’s decisions to experiment with substances. In fact, research shows that kids who learn about the risks of drugs from their parents are up to 50 percent less likely to use drugs and drink alcohol. So mark your calendar for the National Night of Conversation on November 19.
Ready to get started? There are a number of resources available to help you prepare for this pivotal conversation. Today, United States Surgeon General, Vice Admiral Vivek H. Murthy, M.D., M.B.A., appeared on the Dr. Oz show to talk about the need for the National Night of Conversation. In preparation for November 19, Dr. Oz released a discussion guide to help break the ice and establish trust as you kick off your dinnertime conversation. Additionally, SAMHSA’s parent resources can help you plan for a conversation that will make a big impression.
Leading up November 19, let others know that you will be having this important conversation with your family and inspire them to do the same. Post a picture of an empty dinner plate with the hashtag #NightOfConversation on your social media sites. Let’s all come together to speak openly and honestly about substance use.
National surveys have given us with valuable information about rates of alcohol and other drug use, abuse and dependence (SAMHSA, 2013). 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. (SAMHSA, 2013). 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 for alcohol, genetic factors (those passed down from parent to child through DNA), account for about half of the risk for developing an Alcohol Use Disorder (AUD). 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 AUD, 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 AUD 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 AUD 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 is hoping to undertake the same type of study focused on individuals with addiction. Our goal is to better understand genetic and environmental influences in Alcohol Use Disorders and our first objective is to determine if such a study is even feasible. That is, can we recruit 30,000 individuals with a history of AUD who are willing to complete a brief survey and provide a DNA sample which is central to such research? We think so, but need the pilot data to make our case.
This is an exciting time in the field of addiction, and if our pilot data are promising, 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 AUD; either now or in the past. If you would like to see if you qualify for the GAP pilot study, please click on the link below. If you have questions, you can contact GAPonline@vcu.edu.
We hope that you will join us in this effort to learn more about AUD, 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
Dawson, D. A., Stinson, F. S., Chou, S. P., & Grant, B. F. (2008). Three-year changes in adult risk drinking behavior in relation to the course of alcohol use disorders. Journal of Studies of Alcohol and Drugs, 69, 866- 77.
Laudet, A. (2013) “Life in Recovery” Report on the Survey Findings. Faces and Voices of Recovery.
Levinson, D.F ; Shi, J., Wang, K., Oh, S., Riley, B., Pulver, A.E., Wildenauer, D.B., Laurent, C., Mowry, B.J., Gejman, P.V., Owen, M.J., Kendler, K.S., et al. (2012). Genome-wide association study of multiplex schizophrenia pedigrees. The American Journal of Psychiatry, 169, 963-73.
Substance Abuse and Mental Health Services Administration. (2013). Results from the 2013 National Survey on Drug Use and Health: National Findings (Office of Applied Studies, NSDUH, HHS) Publication No. SMA14-4863 Rockville, MD
White, W.L., Malinowski Weingartner, R., Levine, M., Evans, A.C., & Lamb, R. (2013). Recovery Prevalence and Health Profile of People in Recovery: Results of a Southeastern Pennsylvania Survey on the Resolution of Alcohol and Other Drug Problems. Published in abridged form in Journal of Psychoactive Drugs, 45, 287-296.
White, L. W., (2012) Recovery/ Remission from Substance Use Disorders: An Analysis of Reported Outcomes in 415 Scientific Reports, 1868-2011:
Over several years, I served as Board Chair of Faces and Voices of Recovery. During many retreats and meetings we talked about someday bringing about a great assembly in D.C. My caution always was, when we are truly ready. We got ready. Unfortunately, When the Unite to Face Addiction event happened and recovery celebrants gathered on the 4th, other commitments kept me away. I was certainly there in spirit. Thanks to the Legal Action Center for the live streaming. Thanks to the planning and executing team that made this happen. I saw and felt the energy and joy of that great recovery community. I also heard the echoes of all the recovery rallies held across the nation in September. Though the event dodged the rain, I suspect there were few dry eyes during much of the event.
Significant also was the 600 or more constituents of consequence visiting congressional leaders the following day. We face addiction everyday but we want to beat addiction, overcome addition, and diminish and eliminate addiction. Beat, overcome, diminish, and eliminate. Those are action words. Faces to be seen. Voices to be heard. Action to be taken.
The Comprehensive Addiction Recovery Act (CARA) 2015 is the most expansive federal, bipartisan legislation to date for recovery support services, designating up to $80 million toward advancing treatment and recovery support services in state and local communities across the country. The call across the country is to Take Action in support of this legislation. It takes positive action to produce positive outcomes. May I suggest that sometimes even hope needs help?
Through the UnitE event and the growing recovery movement, a significant constituency of consequence is now a recognized reality. We can be a powerful, political, presence if we take action to preserve and promote it. Please pardon the alliteration. Carry the message in your own words but Carry the Message.
“I pray to feel my feelings,” the veteran AA told me, “knowing that I will not be abandoned by myself or god.” What a prayer! Stopped me in my tracks. Over the years, I’ve passed it on. Reports are that others find it helpful. We all agree that it’s a challenge.
Do we addicts really want to feel our feelings? The experts tell us that all feelings fit into just four categories: happy, sad, angry, scared. You read that right. Fully three-quarters of these categories are painful.
And happy? One of the severn dwarfs, maybe, but not a known hallmark of active addiction. I’m not sure we believe in it.
Ever defiant, I rejected this schema when it was presented to me at rehab. (Sorry, Howland!) I simply would not accept that our feelings so unambiguously incline to the negative. Where’s the good news of sobriety? Why can’t I be promised continuous happiness in recovery? That might get my addict attention.
Because . . . life’s not like that!
For addicts, relief from feeling (especially those majority painful ones) is the pay off. “Dear Substance-of-Choice, Let me put my feelings on hold.” Yes, it’s a Faustian bargain and we lose: substances stop working before we do, we get sober, feelings come back.
Hence, the feelings prayer.
Back in the 1990s, a British tv movie, The Grass Arena told the story of homeless alcoholics. (Wonderful Mark Rylance – television’s Thomas Cromwell – starred as the true-life protagonist.) There’s a harrowing scene depicting their experience of antabuse, clearly intended as a deterrent. Of course, my filmic fellows drank the whiskey (wouldn’t you?), notwithstanding the inevitable violent illness to come. Still active, I nonetheless recognized the futility of this therapeutic strategm. “Addicts know all about pain, any pain” I told anyone who’d listen. “We’ve figured a way to live with it. With drink. Drink is the priority.”
Carl Jung put it more elegantly: “All neurosis [read: addiction] is the avoidance of necessary pain.” To the alcoholics of television drama, drinking poison with unavoidable and dreadful consequences is preferable to the (necessary) pain we suspect awaits us in sobering up.
When first struggling to come to consciousness, I asserted to my therapist that I hadn’t lost anything through addiction. She put me straight, and quick. “You lost your hopes and dreams.” Oh, that.
Then there was the inventory I set myself: listing the funerals I’ve attended over the years to assess whether I thought addiction was implicated in these deaths. It will come as no surprise that over 95% tested positive. Material for a towering grief.
(Best have another drink, my once-upon-a-time strategy.)
I come from a culture where acknowledging grief is discouraged: Don’t be self-indulgent. That’s just self-pity. Don’t think about that now. She wasn’t a member of your family, why do you care? Leave him alone – he’s just crying in his beer.
And that most damaging injunction to “honor thy father and thy mother” (no grief allowed for the compromised childhood of addiction). If all else fails, the three-fold iron rule of our dysfunctional training: don’t talk; don’t feel; don’t trust. Well, that’s it then.
We now know that our feelings don’t go away. Try as we might, repressed feelings will manifest, just not in healthy ways. If our bodies remember our pain, as they do, so too does our subconscious. There are repercussions. What more universal manifestion of unresolved grief than active addiction?
To complicate matters, I believe from experience that addicts know ahead of time that we’re in for an emotional ride if we’re so foolhardy as to get sober. I read Judith Herman’s book on trauma while I was still drinking – just because we’re addicts doesn’t mean we’re stupid. My takewaway? I would have to walk through my pain to recover. I didn’t think so. Jungian integration could be left to stronger souls; the first time around for all that grief was quite enough for me.
And then . . . you guessed it – alcohol abandoned me. I was devastated. Where now to find relief?
“Get in the middle of the group of drunks and stay there,” I was advised. “You may disappear in the crowd, but you won’t get lost.” “Let us love you until you can love yourself,” is – unbelievably! – a trustworthy invitation. I’ve come to believe that community is the genius of recovery, the community that doesn’t fail us.
I don’t evangelize on behalf of 12 Step fellowships. (For one, it’s against the traditions!) But I do champion the efficacy of their core way of doing business – that is, in group. The great psychodramatist, JL Moreno, essentially founded group work as a forum for mutual healing. He built a life’s work on the premise that, in groups, we co-create the therapeutic environment, we heal each other. Thus, the mechanism of 12 Steps meetings: self-selected individuals united in a common healing purpose. A power greater than any one person in the room. Together, we welcome and manage feelings and the challenges they raise.
As I write, I’m mindful that it’s the 70th birthday of my friend, Irish visual artist Donal O’Sullivan. He didn’t live to see the milestone. Rather, he reached the jumping off point of which Bill Wilson writes. Literally. Unable to live with or without alcohol, he threw himself into the River Liffey more than twenty years ago. There isn’t a day I don’t miss him. I felt (re)orphaned by his loss. Our lives had partly diverged some time previously; my grief is not generally considered legitimate. But I’ve learned that, as a sober woman, the opinion of others is (blessedly!) no longer any of my business.
I acknowledge my grief; I honor my loss. In community.
With the grace of recovery, I accept life on life’s terms, even when I don’t like it. I share my griefs as they arise. I accept that I’m never going to have had a happy childhood. (Apparently, this is a measure of mental health.) I accept that there’s been enough love to bear my losses this far, that there’s always enough love to carry me forward, that there will be new love to delight.
I don’t abandon myself to addiction today. One day at a time.
This blog post was provided by Ruth Riddick, a woman in long-term recovery since 2003, she is the Founding Director of Sobriety Together™ – Peer Education & Recovery Coaching Services.
Years ago, while sitting around the table at a regular 12-Step meeting that I used to regularly attend, I would inwardly cringe when one person in particular at that meeting was called upon to speak: “Hi, my name is Bart and I’ve got a Ph.D… I’m a Poor Helpless Drunk!” I think “Bart” was trying to be clever. Some of the members would laugh a little or chuckle, but even way back then I would wonder how his introduction might have made a newcomer feel. At the time, Bart was sober for quite a few years.
For those of us “In the Rooms”, we sometimes use “in-house” language as a means of self-disparaging humor: “My name is John, and I’m a drunk!” I’ve heard (and made) comments such as this for countless years. Some may refer to their Higher Power as GOD (Group Of Drunks). We sit around the rooms talking about getting “Clean & Sober”. No big deal… everyone does it. As an “Insider”, I can easily get away with using language in such a fashion. I remember while still in rehab hearing a fellow patient jokingly proclaim that a result of the education he received while in treatment: “This place got me a promotion… when I came in here I was just a drunk – now I’m an alcoholic!” We all laughed.
Some of us may use such language with a fair degree of conscious awareness and intentionally poke fun at ourselves: we know we’ve made progress when we learn to laugh at ourselves. For some others – they may not have sufficiently recovered to be aware of the subtle self-deprecating language they still use that reinforces their lingering guilt and shame. “My name is Tymeka and I’m a drunk”, or, ”I’m Michael and I’m an addict.”
However, with the advent of the new recovery movement, the language we use with relative mutual acceptance “in-house” becomes a whole new animal when we take it “out-house”- out to John Q. Public: to the schools, the legislators, the judges, funders, higher education, the media, and elsewhere. It’s one thing to call ourselves an “addict” in the rooms, but when we do this in public settings, it simply reinforces the very stigmatizing concept that we’re now working so hard to reverse. Language DOES matter. I don’t know that we can say this enough – or in enough different ways.
Until we do, we’ll have a very difficult time changing THEIR attitudes, views, and beliefs until we change our own.
This blog post was provided by John Winslow, Program Director, Dorchester Recovery Initiative, a Charter Member of the Association of Recovery Community Organizations (ARCO).
Corresponding to the ten-year rise of a powerful grassroots recovery advocacy lobby, we’re also seeing a growing nationwide network of recovery community centers providing practical and vocational services in an environment characterized by activist Tom Hill as “recovery nurturing.” Meeting identified service gaps, these centers are responding with increased efficacy and sophistication to the acknowledged inadequacy of “treating a chronic disease as if a crisis intervention would be enough.”
Recovery community centers are also pioneering the concept that recovering people ourselves are well placed to provide ongoing support as recovery peer advocates and coaches. Peer service providers, in the language of the centers, work to help remove personal and external obstacles to recovery by making recovery community linkages and serving as personal guide and mentors in the management of individual and family recovery (Connecticut Community for Addiction Recovery). In offering peer-staffed support, the centers provide both continuity of care before and after treatment, and a companion service to twelve-step programs.
In promulgating this non-clinical recovery oriented systems of care model (ROSC), the recovery community centers return us to the experiential roots of successful recovery support at the same time as they add value through the expertise of trained peer service providers. These providers, in turn, are building an emerging and evolving credentialed profession bound by formal Codes of Conduct and disciplinary procedures.
As early as the 1990s, George Mason University’s Thomasina Borkman developed a definition of qualifications appropriate to the special responsibiities of this non-clinical model. She writes that people serving as recovery peers “rather than being legitimized through traditionally acquired education credentials, draw their legitimacy from experiential knowledge and experiential expertise.” Experiential knowledge is defined as information acquired about addiction recovery through the process of one’s own recovery or being with others through the recovery process; experiential expertise requires the additional ability to transform this knowledge into the skill of helping others achieve and sustain recovery.
Specialized trainings and certifications offered nationwide prepare peers for voluntary or entry-level employment as recovery peer support providers in their communities. Formal credentialing, requiring further education and supervised work experience, creates additional opportunity for peer vocational development.
As an experienced trainer of the CCAR Recovery Coach Academy, I can attest to the depth and value of the training curricula, not only for the aspiring professional but for anyone seeking to deepen an understanding of the peer services model. Much of the material common to most recovery coach training is based on the work of Harvard emeritus, William L. White, an intellectual leader of the recovery movement, whom we – affectionately! – remember in class as “white guy, white hair, white goatee.”
For the student versed in the clinical treatment role, ROSC presents the very specific challenge of managing role clarity. “Stay in your lane,” we advise: if you’ve begun a working relationship in your clinical capacity (counselor or therapist), do not switch lanes by behaving as a non-clinical coach or advocate. (If a recoveree could benefit from referral to a compatible service provider with different professional protocols, by all means, let’s make the introduction.) Similarly, netiher coaches or advocates, no more than counselors, perform the work of 12-step sponsorship, notwithstanding that individual providers may also be personally experienced in that role. Protecting role boundary integrity is a key service value in the field.
In my teaching experience, I’ve found the video-vignette, The Birth of a New Movement, to be particularly effective in illustrating the recovery oriented systems of care model. This short piece looks at the emergence and mission of the recovery community centers and the support services they provide. Comments by activists such as Andre Johnson and Michael Askew, together with footage showing community programs as far afield as Detroit and Philadelphia, confirm the adage that “a picture is worth a thousand words” – or any number of power-point slides! And, at a tight six minutes, the video-vignette holds the attention.
“All the video-vignettes in the ManyFaces1Voice library are great for teaching,” says Faces & Voices Executive Director, Patty McCarthy Metcalf. I don’t doubt her. They are a terrific resource and available via Vimeo for use in a wide variety of recovery education settings.
Meanwhile, thanks to the advocacy efforts of the grassroots recovery movement, participation in approved training may be state-funded as a pathway not only to meaningful personal recovery but to professional opportunity. The formal credentialing available at state level –for example, the New York Certification Board’s Peer Recovery Advocate certificate (CPRA) – may also lead to medicaid-funded employment under the ROSC model. As the treatment field evolves, additional peer opportunities may be created under both public funding and expanded private health insurance.
As we see in “The Birth of a New Movement,” the success of the non clinical peer services model is valued beyond the recovery community by public officials such as Arthur Evans Jr. of Philadelphia’s Department of Behavioral Health. Evans goes so far as to support taxpayer funding of services – such as peer advocates and coaches – that can be shown to result in lives which are personally meaningful and socially productive.
It works when we work it, and it’s a particularly exciting and innovative time for the field. Come join us!
This blog post was provided by Ruth Riddick, a woman in long-term recovery since 2003, she is the Founding Director of Sobriety Together™ – Peer Education & Recovery Coaching Services.
Posts from William White
Featured Panelists: Christina Love, Dharma Mirza, and Meghan Hetfield
Christina Love, Advocacy Initiative Specialist, Alaska Network on Domestic Violence & Sexual Assault (ANDVSA)
Dharma Mirza Equity & Justice Fellow at ARHE & Oregon Measure 110 Oversight & Accountability Council Member
Dharma Mirza (she/her) is an artist, activist, policy advocate, and scholar living in Corvallis, OR. Dharma is a Public Health and Gender Studies student at Oregon State University. Dharma focuses her work and research on harm reduction, sexual health, addiction, public health equity, and the intersections of behavioral health and marginalized health populations. Dharma informs her work through intersectional, feminist, and decolonial frameworks and draws on her own experiences in navigating health/harm reduction services as an HIV-positive, queer, biracial transgender woman, Khwaja Sira (Pakistani Third Gender), and former survival sex worker and IV drug user.
Meghan Hetfield, Certified Addiction Recovery Coach and Certified Recovery Peer Advocate
As a Nationally Certified Peer Recovery Support Specialist and a NY State Certified Recovery Peer Advocate and Trainer, Meghan has found purpose in supporting people in their individual pathways of health and wellness. She is a dedicated advocate for Harm Reduction and ending the racist War on Drugs. She believes that radical compassion is needed to heal each other and meet our fellow humxns “where they’re at” without shame or judgement. Meghan is currently working from home in New York’s Catskill Mountains for WEconnect Health Management as a PRSS where she enjoys swimming holes, mushroom club hikes and cooking all her plant & fungi foraging finds.
Description: Recovery belongs to us all. Leading up to the second summit in St. Paul, MN this October 3-6, 2021 – 20 years after the original summit – what do we expect of our future? Three vibrant leaders discuss their perspectives and hopes for the next two decades of the Recovery Community. Through this moderated discussion, we will investigate the need to end gatekeeping and welcome everyone to recovery by lowering barriers to recovery support, creating inclusive spaces and programs, and broadening our understanding of what recovery means for people with different experiences. As we grow in empathy and understanding, we save lives by adding protective factors and building resiliency. Ever reminding us that Recovery is for Everyone: Every Person, Every Family, Every Community.
Moderated by: Keegan Wicks, National Advocacy and Outreach Manager, Faces & Voices of Recovery
This webinar series is sponsored by Alkermes.
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.
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.
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.
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.
Recovery Innovations: The Well-Fed Social Supermarket
Dave Higham, Ged Pickersgill and David Best
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 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.
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.
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.
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 addiction, substance use disorder, or problem with alcohol or other drugs. They similarly differ depending on the resolution language: abstinence, sobriety, recovery, remission, controlled (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.
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 Dependence, 214, 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 Dependence, 181, 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. Addiction, 102(5), 696-703.
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. Seabrook; Drinking 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.”
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.