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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Faces & Voices of Recovery is seeking a dynamic person to assist in building and managing our advocacy strategy for 2021-2022.
Interns must be available to work 10-14 hours per week. We are open to working with your university or college to establish credit. This is not a paid internship at this time.
Tasks and Responsibilities
Advocacy Interns will assist Faces & Voices of Recovery’s Director of Recovery Innovation and the National Advocacy and Outreach Manager in carrying out the organization’s advocacy priorities and legislative agenda.
Position Duties and Responsibilities
- Assist in policy scans, tracking, analysis, evaluation, and communication of relevant federal and state policy issues, legislation and regulations
- Prepare advocacy effort summary reports for sharing with our grassroots and grasstops advocacy networks
- Assist in developing Action Alert content, social media materials, and sign-on letter drafts
- Support Faces & Voices staff in regard to federal, state, and local policy development, communications, and administrative duties as assigned
- Additional responsibilities as assigned by the Advocacy staff
- Excellent organizational, verbal, written, public speaking and interpersonal skills
- Knowledge in computer programs, including excel
- Ability to work under pressure and think quickly on your feet
- Ability to work independently, as well as part of a team
- Experience/interest in engaging and motivating a large group of volunteers a plus
- Familiarity with and interest in substance use disorders, addiction recovery and healthcare issues a plus
- Excellent writing and editing skills, and a keen attention to detail
- Excellent written and oral communication skills; strong technical writing skills in English (Spanish language proficiency would be highly desirable)
- Excellent computer skills; proficient in Microsoft Powerpoint and Word
- Ability to show creative and flexible thinking
- Strong time management skills
- Strong attention to detail and desire to follow procedures
- People with lived experience who have been involved with grassroots campaigns in the behavioral health, harm reduction, justice reform, multi-pathways of recovery, or LGBTQIA+ communities, are encouraged to apply.
- Comfortable with social media advocacy
- Have an introductory or higher understanding of the U.S. legislative system
- Have worked remotely either as a student, volunteer, or employee for over 12 months
- To apply, send letter of interest, current resume/CV and a writing sample between 500 – 1000 words to email@example.com or apply using the link below.
Equal Opportunity Employer
We believe that diversity in experiences, perspectives, knowledge and ideas fuels creativity, broadens knowledge, and helps drive success. That’s why we’re proud to be an equal opportunity employer and strive to treat all employees with honesty, dignity and sensitivity. We welcome all qualified applicants regardless of recovery status, criminal justice history, race, color, national origin, ethnicity, religion, sex, pregnancy, sexual orientation, gender, gender expression or identity, age, disability, veteran status, marital status or any other legally protected class.
Faces & Voices of Recovery would like to acknowledge that, On January 1, 1863, President Abraham Lincoln issued the Emancipation Proclamation, freeing all enslaved people. Nearly two and a half years later, on June 19, 1865, the enslaved residing in Texas received news of their freedom. Juneteenth marks the day when federal troops arrived in Galveston, Texas, to take control of the state and ensure that all enslaved people be freed. On June 17, 2021 President Joseph Biden signed a law making Juneteenth an official federal holiday. Faces & Voices of Recovery recognizes Juneteenth as a national holiday, and we honor it as the day all slaves in America became free.
On this important day, we are proud to release the following document regarding Race Equity. It is the culmination of a year-long examination and thoughtful reflection on our collective role in the recovery community’s pathway toward race equity. We are grateful to our partners in this endeavor for their painstaking work. We also extend an open invitation to any organization who would like to join us in this work.
We believe there is ample opportunity to heal.
The work continues.
Posts from William White
Earlier blogs in this series explored the benefits and limitations of public recovery disclosure, the potential risks to multiple parties involved in such disclosure, and the ethics of recovery disclosure. In this final blog in the series, we explore guidelines for individuals and organizations aimed at minimizing risks related to public recovery disclosure.
The Decision to Disclose
Before disclosing our recovery status or details of our addiction/recovery experiences at a public level, we suggest giving careful thought to such questions as:
*Is this the right time in my recovery to share my recovery story at a public level? Will this strengthen my recovery or would it be a diversion from more critically needed recovery activities?
*Are there any negative effects for myself, my family, my community, and organizations within whom I am associated that could result from sharing my story in public or professional settings?
*Could such story sharing subject me to discrimination in housing, education, employment, health care, or social and business opportunities? Could it have any legal ramifications?
*Do I have a support system that could help me manage any such effects if they should arise?
*Will I be sharing my story alone or alongside other people in recovery?
*Do the potential benefits of public disclosure as a community service outweigh the potential personal risks?
*Who is controlling how my disclosure will be used and is there an explicit right for me to have the final edit on what elements of my disclosure are presented?
Purpose of Public Disclosure
Many people in recovery will have shared their recovery story with family and friends, with medical and treatment professionals, and with other people in recovery before the opportunity for public recovery disclosure arises. Public disclosure is different from any of these preceding situations and involves a different purpose and style of storytelling.
Public recovery storytelling is about service to a larger cause than self. It is the use of self and one’s own story as a catalyst for personal and social change. With each story sharing opportunity, we prepare ourselves by asking key questions. What do I want members of this audience to understand, feel, and do? How can I present my story in a way that will achieve those goals? How can what I do today contribute to the larger goals of the recovery advocacy movement?
It is important that addiction treatment and recovery community organizations provide a process of informed consent when inviting individuals to share their stories in public and professional contexts. This involves a clear statement of the potential benefits and risks of public disclosure and screening out individuals for whom such disclosures present an unacceptable level of risk. Asking individuals currently receiving services to participate in public story sharing or marketing activities is coercive and exploitive.
Many of the risks involved in public recovery story sharing can be avoided with adequate orientation and training. Messaging training has been an effective tool used by Faces and Voices of Recovery and other recovery advocacy organizations to prepare people for this unique service ministry. Messaging training spans both the intent and content of public story sharing and the mechanics of effective story sharing (e.g., language, tone, adaptation for different cultural contexts and audiences, etc.). Pursuing these activities within an established recovery community organization helps assure peer and supervisory support for the “ups and downs” of such sharing experiences.
Public Self-disclosure and 12-Step Anonymity
AA, the precursor of all 12-Step programs, promulgated a tradition of personal anonymity at the level of press as both a protective device for AA and as a spiritual principle. Public disclosure of recovery status and sharing one’s recovery story without reference to affiliation with a particular 12-Step program complies with the letter of 12-Step traditions (See Advocacy with Anonymity), but it may not always meet the spirit of the Traditions. This could occur when advocacy is used as a stage for assertion of self (flowing from ego / narcissism / pride and the desire for personal recognition) rather than as a platform for acts of service flowing from remorse, gratitude, humility, and a commitment to service. For members of 12-Step fellowships, adhering to anonymity traditions (in letter AND spirit) in public recovery story sharing is recommended as a protection both for 12-Step programs and for the protection of the recovery advocate.
Timing of Disclosure
Our capacities (energy, abilities, competing needs and demands) for recovery advocacy ebb and flow over time. It is appropriate to ask ourselves if this is the optimal time for public recovery story sharing, whether this is the first time we have such opportunity or whether we need to take a break from such activities during times of personal distress or competing demands that require our focused attention. Warning signs indicating the latter include losing emotional control over the content of our story sharing (via unplanned expressions of frustration, resentment, anger, sorrow) or experiencing boredom or a loss of energy in our public story sharing. Difficult experiences and emotions can be referenced strategically within our talks (once we have emotional control over them), but public and professional meetings are not the appropriate venues to work out unresolved traumas of the past or present. When we drift across that line, it is time to take a break from this public service role.
Scope and Focus of Disclosure
People in addiction recovery have many stories they can share. There is the life preceding the onset of drug use, one’s addiction career, the turning point of recovery initiation, and the story of one’s personal and family life in and beyond recovery. All of these may be touched on in public recovery story sharing, but the emphasis of this story must be on the recovery story and the lessons drawn from it. Great care is required with the media to maintain this focus. There are dangers that others hijack a recovery story intended to lower stigma in a way that fuels stigma, social marginalization, and the criminalization of addiction. We best serve the advocacy movement and protect ourselves by maintaining a focus on the recovery side of our stories and how we escaped the chaos and drama of addiction.
Depth of Disclosure
There exists a continuum of intimacy defining the degree of risk in public recovery story sharing. There are experiences, feelings, and thoughts known only to ourselves that we have not shared with anyone else. There are experiences, feelings, and thoughts we have shared with only within our most trusted relationships. There are the communications we have expressed only within the context of professional counseling, within a sponsorship relationship, or recovery mutual aid meetings. And there are things about ourselves we have shared widely with those we encounter in our daily lives. Such communications range from high emotional risk to low emotional risk. The question is: Where does sharing our recovery story in professional or public meetings, in media interviews, or on social media fit in this continuum?
All recovery story sharing at a public level involves potential risks to ourselves and other parties, but those risks increase in tandem with the level of detail about our experiences contained within those stories. The category “people in recovery” includes highly armored people who are unable to trust others enough to share their real experiences, feelings, and thoughts. Others in this category enter recovery with no armor and no boundaries to facilitate the nuances of self-disclosure and self-protection in different settings and relationships. People existing on the extremes of this continuum from overly guarded to completely unguarded may need greater time in recovery prior to recovery story sharing at a public level. All people on this continuum need guidance and discipline to manage the depth of public recovery disclosure and the discipline to maintain this boundary over time.
Training and supervision related to public recovery disclosure can provide a safe setting in which we can address such questions as the following:
What is the level of risks (who could experience harm and to what degree?) in the following story sharing venues: a social media post; a radio, television or newspaper interview; speaking at a recovery celebration event; speaking to a professional audience; or speaking to a public audience; writing an article or memoir about our recovery experience?
What parts of my story are not appropriate to share publicly? (We want to break no-talk rules related to addiction/recovery, but we want to avoid disclosures that are so intimate in detail that they pose threats to our own emotional health or repel those who hear our story.)
What aspects of my past or present experience remain too emotionally intense to include in my public recovery story? (These are the boundaries we need to define BEFORE we stand before an audience or sit for an interview! Message training and peer supervision can assist this process.)
Have I avoided referencing other people’s stories who might experience harm or discomfort resulting from my disclosure? (It is best to get permission for inclusion of others within our stories, e.g., spouse, family members.)
Have I fully explored why I am sharing my story and sought feedback from other people who know me to understand the nuances and potential unintended consequences of disclosure?
Facing Criticism of Public Disclosure
As a final note, it is not unusual for individuals disclosing their recovery story at a public level to draw criticism for such activities from expected and unexpected quarters. You may be accused of “grandstanding,” “ripping off the program,” violating program traditions,” or be caught in the crossfires of various ideological debates. Some will comment on what you should have or shouldn’t have included in what you shared. Our advice is to have one or more people you are close to who can help you sort such feedback. And to positively use what you can and disregard the rest. Do know that such criticism is inevitable and can help us refine our message and its delivery—even when the criticism is unfounded and prompted by spurious motives.
We have tried in this series of blogs to explore the purpose, contexts, and risks of sharing our recovery stories at a public level and to explore some of the ethical issues involved in recovery story sharing. It is our hope that these discussions and suggested guidelines will serve as a catalyst for discussion and a tool for the training of recovery advocates who choose to join the vanguard of people who are putting a face and voice to the recovery experience.
Our stories have the power to achieve many things, but we must not embrace total responsibility for eliminating addiction/recovery-related stigma. Those individuals and institutions who spawned and perpetuated stigma and discrimination bear that responsibility. What we can do is offer our stories and our larger advocacy activities to offer hope to wounded individuals, families, and communities and do so in a way that protects our own health and safety.
Ethics involves the application of moral principles to promote good and prevent harm. Ethical decision-making within our service and advocacy activities is an assessment of the ratio of potential benefits to potential harms in any course of action—with a particular emphasis on “first do no harm.”
Such decision-making involves asking ourselves three questions. First, what parties could benefit or experience harm in this situation (and what is the degree and duration of such benefit or harm)? In our advocacy roles, it is helpful to assess such potential benefits and harms related to ourselves, our families, organizations with whom we are associated, the recovery advocacy movement, and the community.
Second, are there any laws, policies, or historical practices that offer guidance in this situation? This question illuminates the complexities between law and ethics: actions may be legal and ethical, unethical and illegal, legal but unethical, or illegal but ethical.
Third, what ethical values are most applicable to this situation and what course of action would these values suggest? Self-disclosure as an ethical issue has been explored in both professional and peer recovery support contexts (See HERE and HERE), but little attention has been focused on ethical concerns related to self-disclosure within the context of public recovery advocacy. Several traditional ethical values inform decisions related to disclosure of our personal recovery stories in public or professional settings.
Beneficence is the ethical command to help others and not exploit the service context. It invites us to share our story as a means of helping individuals and families suffering from addiction and commands us to focus that story on those in need rather than as an act of self-aggrandizement or a means of pursuing our own interests.
Nonmaleficence is the ethical command to do no harm. In the context of public recovery storytelling, it forces us to assess the timing and the intended and unintended consequences of our public disclosures on ourselves and other parties.
Honesty demands that the recovery story be a truthful representation of our experience. Honesty and candor challenge us as advocates to speak truth to power even when lacking confidence in the authority of our own voice.
Fidelity calls upon us to keep our promises. It asks us to remain faithful to pledges we have made to individuals and organizations. It asks us not to make promises that we cannot keep and to adhere to commitments made in the context of our story sharing.
Justice requires that we acknowledge disparities in recovery opportunities and resources and calls on us to seek equity in such opportunities and resources.
Discretion calls upon us to protect our own privacy, the privacy of our family, and the privacy of others in the presentation of our story. Public recovery storytelling is an act of public service; it is not public therapy or a platform for airing personal grievances.
Self-protection calls upon us in our service roles to avoid harm to self, family, and others. It is an acknowledgment of the legitimacy of tending to our own safety and health. It is a recognition that risks of harm to self and others exist within the public storytelling arena.
There are also values deeply imbedded within the history of communities of recovery that can inform recovery storytelling within public and professional arenas.
Humility reminds us of the dangers of ego-inflation and that we speak not for ourselves but for the experiences and needs of all people seeking and in recovery. (See earlier blog on distinction between recovery rock stars and recovery custodians)
Gratitude is a call to give credit where it is due and to express our thanks to individuals and organizations that made our story possible. We offer our own story in thanks for the meaning we drew from the stories of others at a time we were most desperate for the hope they offered.
Respect/Tolerance is a recognition of the spirituality of imperfection—that we are all wounded in some way, that through this shared brokenness and healing, we can experience profound connectedness. It is an extension of humility and empathy—seeing ourselves in the lives of others and respecting multiple pathways and styles of recovery.
Service is the call to carry a message of recovery to all those who continue to suffer from addiction and related problems. We do that as an act of altruism and as a perpetual step in our own self-healing.
There are many decisions involved in public recovery storytelling. Filtering these decisions through a model of ethical decision-making and core values of recovery can help minimize risk to self and other parties.
A central goal of public recovery self-disclosure is to challenge myths and misconceptions about addiction and recovery through the elements of our personal stories. Recovery advocates must avoid contributing to false narratives by having selective parts of our stories appropriated while ignoring the central recovery message.
Addiction/treatment/recovery-related social stigma and its untoward consequences rests on old and new misconceptions regarding the sources and solutions to alcohol and other drug problems. Such key pillars of belief about the nature of addiction, addiction treatment, and addiction recovery constitute the structural supports of addiction-related social stigma. Below are examples of such pillars (in the stigmatized language in which they have been historically conveyed) and how our stories can be hijacked to support these false narratives
Addiction is a product of moral turpitude (badness) that is best prevented and discouraged by public shaming and other forms of punishment. Acts flowing from this premise began with American colonies forcing those convicted of public intoxication to wear the letter D (for “Drunkard”) on their clothing or to be set in stock in the town square under a sign reading “Drunkard.” The moral turpitude pillar continues to feed social shunning, serves as grounds for divorce, and provides a rationale for political disenfranchisement and discrimination in housing, employment, education, and medical benefits. Overemphasizing or exaggerating the “bad people” we were in the addiction portion of our stories inadvertently feeds this view.
Addicts pass on their degeneracy (“bad seed”) to their children. This pillar of belief has resulted in the inclusion of addicted people in mandatory sterilization laws, surgical sterilization without consent during institutionalization, and loss of parental custody and related legal rights. It also feeds false narratives that paint the children of addicted parents with the same brush, e.g., false narratives of “crack babies” as a “biological underclass.”
The addict is an infectious agent who must be closely surveilled and isolated from the community. This pillar of belief provided the rationale for inebriate penal colonies, prolonged institutionalization in psychiatric asylums, prolonged surveillance (addict registries, prolonged probation/parole), and fed the modern era of mass incarceration.
Addicts pose the greatest threat to the community when they associate with each other. This belief undergirded laws banning addict fraternization and probation or parole violations for associating with other addicts. “Loitering addict” laws provided for the arrest of known addicts for simply being in the presence of other individuals identified as addicts. Policies that dissuade recovery networking and the inclusion of recovery voices in matters that affect us may well be rooted in earlier biases against addicts being with each other.
Addiction does not discriminate. Actually, it does! It was with the purest of intentions that the tagline of “addiction does not discriminate” became one of the public education mantras in the wake of the “opioid epidemic.” It was a way of saying, “See…it could happen to anyone… and now you should care.” This narrative sought to normalize (AKA Whiten) addiction by projecting the image of “innocent,” (AKA White), middle-class children and their parents deserving of public resources to support their care. Such care was advocated as an alternative to arrest and incarceration for the “deserving” (AKA White people of means), while addiction in communities of color continued to be stigmatized, de-medicalized, and criminalized.
Stating that alcohol and other drug problems cross boundaries of race and class in the United States obscures the inordinate toll addiction and drug policies have long taken and continues to take on communities of color and other historically marginalized populations. The addiction vulnerability of these communities stems from historical trauma; social, economic, and political marginalization; and related disparities in access to prevention, harm reduction, early intervention, treatment, and recovery support services. An ethical framework of public messaging and education would call for equity of policy application and resource allocation across all affected communities. Ideally, recovery storytelling would include the stories of people from diverse backgrounds and living circumstances. It is important that through our stories we convey the reality of recovery, the varieties of recovery experience, and the challenges of recovery across cultural contexts.
Addiction is untreatable (“Once a junkie, always a junkie.”) This pillar of belief feeds personal, public, and professional pessimism about addiction and provides the rational for prolonged institutionalization/incarceration as well as justification for harmful and potentially lethal treatment experiments. In the U.S., the latter have included brain surgeries, indiscriminate use of chemo- and electroconvulsive therapies, toxic drug withdrawal procedures, and other harmful treatment methods. Portraying the role treatment played within our recovery stories and the nature and positive effects of modern treatment challenges this misconception.
Treatment Works! is a counter misconception in that it suggests the presence of a uniform protocol of addiction treatment in the U.S. that achieves consistently positive clinical outcomes. It also ignores widespread addiction treatments that lack empirical evidence of their effectiveness as well as the presence of treatments more focused on financial profit than long-term recovery outcomes. This central marketing slogan of the treatment industry misrepresents the highly variable outcomes of addiction treatment, which span minimal, moderate, and optimal effects, as well as harmful effects. Addiction is a treatable condition, but recovery outcomes depend upon numerous personal, clinical, and environmental factors. Great care must be taken in how our stories are used by the addiction treatment industry. What we are offering as advocates is living proof of long-term recovery, not an advertisement for a particular proprietary approach to addiction treatment. (See HERE for full critique of this slogan.)
Recovery is not possible until an addicted individual “hits bottom.” Actually, most people recover from addiction long before “hitting bottom” (losing everything). Addiction-related loss and pain in the absence of hope is an invitation for continued self-destruction. Recovery initiation is the fruit of addiction-related consequences interacting with sources of hope for a healthier and more meaningful life. The “hit bottom” premise suggests that recovery responsibility rests solely with the individual—that there is little family or community can do until that point of individual awakening arrives. This constitutes an invitation for family and community abandonment of those suffering from addiction. This premise is untrue, is not applied to other medical conditions, and should be forever discarded within the addictions arena. We must not let our story be twisted to support this supposition even if we were one of those who did hit bottom and lost everything.
Addiction recovery is the exception to the rule. Actually, recovery is the norm; individuals who do not achieve sustainable recovery are the exceptions. Those who struggle with recovery stability are distinguished by higher problem severity, co-occurring problems that make recovery initiation and recovery more difficult, and fewer natural recovery supports in the community. Even people with the most severe addiction problems can and do recover with more intense and prolonged recovery support resources. We must repel any effort to cast our recovery as the heroic “exception to the rule” and convey the consistent message that no one need die of addiction. Recovery is far more than possible; it is the probable long-term outcome for those who experience alcohol- and other drug-related problems.
Addiction recovery is a brief episode that allows one to then get on with their life. For people with mild to moderate levels of addiction severity who possess substantial recovery capital, recovery may be just that. However, for those escaping addictions marked by severity, complexity, and chronicity, recovery is a prolonged process comparable to the assertive and sustained management needed for other chronic medical conditions. It is important in our stories to acknowledge variability of addiction severity and recovery support resources. Our recovery story is just that—our personal story; it is not the whole addiction/recovery story.
Media channels frequently tell the story of addiction recovery only as a personal story rather than a larger story of the role of family and community in addiction and recovery. The prevalence and severity of addiction are profoundly influenced by social, economic, and political contexts. The recovery tipping point has as much to do with family and community resources and capacity for resource mobilization as it does what is going on inside the addicted person. We serve best when we present our journey from addiction to recovery within these larger contexts and extoll the role of family and community in the recovery process.
Addiction recovery is only achieved through a particular type of professional treatment, lifelong affiliation with a recovery mutual aid society, and lifelong abstinence from alcohol and illicit drugs. Actually, people recover from substance use disorders with, and without, treatment, and through diverse approaches to treatment and recovery support. People achieve recovery with and without involvement in recovery mutual aid groups. Professional- and peer-supported pathways of recovery constitute particular styles of recovery, not the only pathways to recovery. Those involved in treatment and recovery mutual aid represent more severe and prolonged patterns of addiction. There are secular, spiritual, and religious pathways to alcohol and other drug (AOD) problem resolution, and AOD problems can be resolved through styles of sustained abstinence or through decelerated patterns of drug use (the latter most viable for individuals with less severe AOD problems and greater social supports). Our personal story illustrates one within many pathways and styles through which people resolve AOD problems. We preface our stories with “In my experience…” and “What I have observed is…” We are sharing our experiential knowledge, not universal truths that have stood the tests of science or application across diverse cultural contexts.
The above pillars of belief (and the degrading caricatures that often accompany them) serve the interests of multiple parties. They aim to socially stigmatize and discourage drug use. They disparage groups with whom the drug is, correctly or incorrectly, associated. They justify surveillance and over-policing of marginalized communities. And they feed institutional profit. Collectively, these pillars define us as a people as outsiders–outcasts for whom doors of entry into the human community should remain closed.
Our goals run counter to these interests. Our intent is to elicit what Isabel Wilkerson has christened “radical empathy”—the ability of listeners to emotionally project themselves into our experience to the point that they move beyond tolerance and compassion to actions that include us within the human community. This requires framing our stories to elicit conscious awareness that addiction is only one of many forms of woundedness that can and do touch all of our lives, and that recovery mirrors the promise of healing that can follow. The challenge we face is to assure that our recovery stories serve this higher purpose and not feed false narratives that are part of the problem.
Supervision is a key component in providing peer recovery support services and should be a relationship that nurtures growth, hones skills, and addresses opportunities for growth that support recovery support core competencies.
A central strategy of the new recovery movement is sharing our stories in public and professional venues to change public perceptions and public policies related to addiction and recovery. Drawing from earlier social movements, we learned that “contact strategies”—increasing personal contact between marginalized and mainstream populations—is one of the most effective means of reducing stigma and discrimination and expanding opportunities for full community participation. Public attitudes toward those recovering from alcohol and other drug problems become more positive when members of the public have positive exposure to people living in long-term recovery with whom they can identify.
We also learned that there were limitations to this approach of public recovery storytelling. Changing personal attitudes of those exposed to our stories left in place much of the institutional machinery (e.g., laws, policies, and historical practices) that negatively affected individuals and families experiencing alcohol and other drug problems. Twenty years into the new recovery advocacy movement, discrimination against us remains pervasive. We must remain vigilant to prevent appropriation of our stories by others to support unrelated agendas. When this happens, we experience further marginalization.
People in recovery face discriminatory barriers in housing, employment, education, professional licensure, health care, and numerous arenas of public participation (such as voting and holding public office). Laws and regulations intended to protect us from discrimination remain unenforced. Addiction treatment remains of uneven quality, often lacking in long-term recovery orientation, and limited in its accessibility and affordability. Too many communities lack long-term recovery support services. And people in recovery continue to be excluded from meaningful representation within alcohol and drug and criminal justice policy discussions and decisions.
It is in this context that we must be clear about what our public recovery storytelling can and cannot achieve, and relatedly, who precisely is responsible for eliminating entrenched policies and practices that have such a direct impact on our lives.
There is a paradox within our anti-stigma efforts. We must challenge oppressive barriers to recovery and full participation in community life. As Frederick Douglass so clearly and eloquently stated, “Power concedes nothing without a demand.” Historical inertia and personal and institutional self-interests sustain structures of oppression until they are challenged. Who will pose such a challenge if not people in recovery? Yet the ultimate responsibility for dismantling discriminatory practices rests upon the shoulders of the systems within which such oppressive machinery continues to operate. The responsibility to eliminate discrimination rests with those who discriminate. By itself, telling the perfect recovery story will not end discriminatory practices.
So where does recovery storytelling fit into all this? Our stories are a means of humanizing addiction and recovery—a means of challenging the myths, misconceptions, and caricatures that have let others objectify and isolate us. Our stories are an invitation for people to reconsider the sources of and solutions to alcohol and other drug problems. Our stories are a means of building relationships that embrace us within the human family—as people who share the dreams and aspirations of others. Our stories, directly or indirectly, also constitute Douglass’ demand to change the structures that have prevented embrace of our humanity and rendered us people to be feared, shunned, or punished. This involves far more than changing people’s perceptions, attitudes, and behaviors toward those with lived experience of addiction and recovery. It involves identifying and eliminating the precise mechanisms (e.g., policies and practices) through which social shunning and discrimination have been institutionalized.
This is not to suggest that people in recovery have no role to play in this change process nor that we should passively embrace a victim status in the face of such systemic challenges. We can take responsibility for our own personal and family recovery, make amends to those we have harmed, and reach out to others still suffering. We can participate in recovery-focused research (to create a science of recovery that can challenge recovery misconceptions), participate in protests and advocacy efforts, offer our recovery stories in public and professional educational venues, and represent our lived experience within policy-making settings. Such actions have contributed to numerous positive changes.
Our stories possess immense power as long as we recognize our stories alone will not create recovery-friendly social institutions or recovery-inclusive communities. We must not allow our stories to stand as superficial window-dressings while discrimination remains pervasive, even among some of the very groups and institutions who on the surface support our storytelling. Our stories must support specific calls for institutional change. We must hold individuals and institutions that discriminate accountable until they eliminate such conditions.
How we craft and communicate our stories for public/professional consumption is an important element of this process of social change. Recovery advocacy organizations have a responsibility to prepare and support the vanguard of individuals who heed the call of this public story-sharing ministry. This includes building a community ethic that protects those who possess the bravery and privilege of sharing their recovery stories in public forums. Collecting our stories without meaningful dialogue about how our stories will be used and the protections we will be afforded is unacceptable.
This is the first in a continuing series of blogs on personal privacy and public recovery advocacy. We hope it will set recovery storytelling within a larger context. The remaining blogs will explore the risks of public recovery storytelling, the ethics of public recovery story sharing, and suggest guidelines on protecting personal privacy and safety within the context of public recovery storytelling. The impetus for this series comes from our knowledge of individuals who have experienced unanticipated harm related to their advocacy efforts.
Health and psychosocial risks associated with COVID-19 fall disproportionately on historically marginalized populations. I recently reviewed published studies on preliminary findings related to COVID-19 among people experiencing or recovering from substance use disorders (SUD). Major findings from this review are summarized below.
*The COVID-19 pandemic is associated with an increase in substance use, SUD prevalence, and drug-related deaths in the U.S. (Dubey et al., 2020; Wardell et al., 2020)
*Self-medication of emotional distress related to COVID-19 and its socioeconomic effects (e.g., social isolation, loss of employment, and threat of housing instability) are linked to new populations of people experiencing alcohol and other drug problems, exacerbation of the severity of those with pre-COVID SUDs, and destabilizing recovery for some individuals with a past history of SUD (Dubey et al., 2020; Enns et al., 2020).
*Adults with a SUD, when compared to those without a SUD, have a greater likelihood of co-occurring health challenges (cardiovascular disease, type 2 diabetes, cancer, obesity, and diseases of the lung, kidney, and liver) (Wang et al., 2020; Melamed, et al., 2020; Mallet et al., 2020).
*Adults with a lifetime or recent SUD are at increased risk for COVID-19 infection, COVID-19 hospitalization, and COVID-19 death compared to people without a SUD history (Wang et al., 2020; Wei et al., 2020; Jemberie et al., 2020).
*COVID-19 infection, hospitalization, and death risks are particularly enhanced among adult African Americans and for adults with recent opioid use disorder (Wang et al., 2020; Schimmel et al., 2020).
*COVID-19 risks for people with a history of SUD are likely linked to three factors: co-occurring health challenges, specific drug effects, and socioeconomic adversity— including disparities in access to health and social services (Wang et al., 2020).
*While some cautions have been suggested regarding the interactions between medications used in the treatment of opioid addiction and medications used in the treatment of COVID-19 (Mansuri et al., 2020), Wang and colleagues (2020) found no differences in COVID-19 risk based on prescription or nonprescription of methadone, buprenorphine, or naltrexone.
All of the above findings are preliminary and subject to change through future investigations. At present we know nothing about the interactions of SUD and COVID-19 among adolescents and other special demographic and clinical populations, and we do not yet have studies on the specific effects of COVID-19 on people in different stages of recovery compared to people with active SUD or people without a SUD history.
- Persons entering addiction treatment and recovery support services should be routinely screened and tested for COVID-19 and educated on their increased risk of COVID-19 infection and prevention strategies.
- Advocacy efforts should begin now to assure that people with a SUD history, as a high COVID-19 risk group, are included among priority populations for a COVID-19 vaccination when it becomes available.
- The increased COVID-19 risk experienced by people of color (and particularly older African Americans with an opioid use disorder) reinforces the need for advocacy efforts to address both the social ecology of COVID-19 and SUDs as well as racial disparities in access to healthcare.
- Studies need to be conducted on the effects of SUD recovery status on COVID-19 infection, hospitalization, and death risk.
- Studies are needed that illuminate the effects of COVID-10 on people involved in addiction treatment and recovery mutual aid organizations as well as the larger effects on these organizations.
There is much to learn on the relationship between COVID-19 and alcohol and other drug problems. We must act on available probationary data and do all we can to protect people impacted by these problems and their families and communities.
Defining people with a SUD history as an at-risk population warranting early access to a COVID-19 vaccination when available will encounter resistance as to whether the SUD population is “morally worthy” of being given priority over people without a history of SUD. That will again provide opportunities for public and professional education about addiction, addiction treatment, and addiction recovery.
Dubey, M. J., Ghosh, R., Chatterjee, S., Biswas, P, Chaterjee, S. et al., (2020). COVID-19 and addiction. Journal of Diabetes and Metabolic Syndrome, 14(5), 817-823).
Enns, A., Pinto, A., Venugopal, J., Grywacheski, V., Gheorghe, M., et al. (2020). Substance use and related harms in context of COVID-19: A conceptual model. Health Promotion and Chronic Disease Prevention in Canada: Research, Policy and Practice, 40(11-12). Doi: 10.24095/hpcdp.40.11/12.03.
Jemberie, W. B., Williams, J. S., Eriksson, M., Grönlund, A-S., Ng, N. et al, (2020). Substance use disorders and COVID-19: Multi-faceted problems which require multi-pronged solutions. Frontiers in Psychiatry, 11, 714.
Mansuri, Z., Shah, B., Trivedi, C., Beg, U., et al, (2020). Opioid use disorder treatment and potential interactions with novel COVID-19 medications. The Primary Care Companion for CNS Disorders, 22(4). https://doi.org/10.4088/PCC.20com02703
Mallet, J., Dubertret, C., & Le Strat, Y. (2020). Addictions in the COVID-19 era: Current evidence, future perspectives, a comprehensive review. Progress in Neuro-Psychopharmacology & Biological Psychiatry, 110070. Online ahead of print. Doi: 10.1016/j.pnpbp.2020.110070.
Melamed, O.C., Hauck, T.S., Buckly, L, Selby, P, & Mulsant, B. H. (2020). COVID-19 and persons with substance use disorders: Inequities and mitigation strategies. Substance Abuse, 41(3), 286-291.
Schimmel, J., & Manini, A. F. (2020). Opioid use disorder and COVID-19: Biological plausibility foir worsened outcomes. Substance Use Misuse, 55(11), 1900-1901.
Wang, Q. Q., Kaelber, D. C., Xu, R., & Volkow, N. D. (2020). COVID-19 risk and outcomes in patients with substance use disorders: Analyses from electronic health records in the United States. Molecular Psychiatry, https://doi.org/10.1038/s41380=020-00880-7.
Wardell, J. D., Kempe, T., Rapinda, K. K., Single, A., Bilevicus, E. et al., (2020). Drinking to cope during COVID-19 pandemic: The role of external and internal factors in coping motive pathways to alcohol use, solitary drinking, and alcohol problems. Alcoholism: Clinical & Experimental Research, online ahead of print. Doi: 10.1111/acer.14425.
Wei, Y., & Shah, R. (2020). Substance use disorder in the COVID-19 pandemic: A systematic review of vulnerabilities and complications. Pharmaceuticals, 13(7), 155. Doi: 10.3390/ph13070155.
The problems men and women of the U.S. military experience upon re-entry to civilian life receive considerable research and media attention. Far less common is information on their resilience to and recovery from such challenges. It is in that context that a landmark study has just been published on the prevalence of recovery from alcohol use disorders among U.S. veterans.
Stefanovics and colleagues surveyed 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. This representative sample of U.S. veterans plotted current drinking patterns across three categories: abstinence, subthreshold (not meeting alcohol use disorder diagnostic criteria), or hazardous (currently meeting criteria for an alcohol use disorder). This research marks one of the most rigorous non-clinical studies of the trajectory of alcohol problems among U.S. veterans. Major study findings include the following:
- More than three-quarters of U.S. veterans surveyed reporting a lifetime alcohol use disorder (AUD) no longer meeting diagnostic criteria for AUD. Twenty-eight percent were abstinent and 48.2 percent reported a drinking pattern below the AUD diagnostic threshold. This represents an AUD remission rate higher than that found in the general population.
- Nearly a quarter (23.8%) of U.S. veterans with a lifetime AUD reported current drinking at a hazardous level.
- AUD remission via abstinence was associated with increased age, less education, greater likelihood of having past concurrent PTSD, drug use disorder (including smoking), greater health problems, less socially engaged, and greater religious orientation.
- AUD remission via subthreshold drinking was associated with higher income, lower concurrence of other drug and tobacco dependence, fewer health challenges, and lower measures of social engagement.
This study has several important implications. First and foremost, findings offer considerable hope for veterans and their families affected by alcohol use disorders. Remission for AUDs is not just possible for veterans; it is the most likely outcome for AUDs.
Second, subthreshold drinking among U.S. veterans with past AUDs is a viable pathway to problem resolution that may be either sustained over time or migrate towards abstinence with increased age. This point suggests the potential for clinical strategies that support choice in treatment goals and the viability of both decelerating drinking and abstinence as pathways to AUD remission. Subthreshold drinking can also be followed by clinical deterioration and sustained AUD-related problems. This finding suggests the need for continued in-treatment and post-treatment monitoring, support, and, when indicated, re-evaluation of treatment goals and methods.
Rather than argue that subthreshold drinking in AUD is impossible, the addictions field would be well served by clearer delineations of those clinical populations that are most and least likely to achieve moderated resolution of AUD and subclinical alcohol problems, e.g., factors such as genetic liability, problem severity, medical/psychiatric co-morbidity, personal/family/community recovery capital, etc.
Hopefully, the Stefanovics’ study marks a shift in veterans research away from a near-singular preoccupation with pathology toward a focus on the prevalence and processes of veteran resilience and recovery.
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
For recent studies on moderated resolution of AUDs, see the following:
Tucker, J. A., Cheong, J., James, T., Jung, S., & Chandler, S. D. (2020) Pre-resolution drinking problem severity profiles associated with stable moderation outcomes of natural recovery attempts. Alcoholism: Clinical and Experimental Research, 44(3), 738-748. DOI:10.1111/acer.14287.
Witkiewitz, K., Heather, N., Falk, D. E., Litten, R. Z., Hasin, D. S., et al. (2020). World Health Organization risk drinking level reductions are associated with improved functioning and are sustained among patients with mild, moderate and severe alcohol dependence in clinical trials in the United States and United Kingdom. Addiction, 115(9), 1668-1680. DOI:10.1111/add.15011.
Witkiewitz, K., Pearson, M. R., Hallgren, K. A., Maisto, S. A., Roos, C. R., Kirouac, M.,…Heather, N. (2017). Who achieves low risk drinking during alcohol treatment? An analysis of patients in three alcohol clinical trials. Addiction, 112, 2112–2121. http://dx.doi.org/10.1111/add .13870
Witkiewitz, K., & Tucker, J. A. (2019). Abstinence not required: Expanding the definition of recovery from alcohol use disorder. Alcoholism Clinical and Experimental Research, 44(1), 36-40. DOI: 10.1111/acer.14235
For more than two decades, advocates with lived experience of addiction recovery have tried to shift the conceptual center of the addictions field from a focus on addiction-related pathology and deficit-focused models of assessment and treatment to a focus on resilience and recovery. A less heralded effort has been to extend the intrapersonal focus on recovery to a broader appreciation of the role of family, community, and culture in long-term addiction recovery. Both agendas have consumed much of my attention, and I recently discovered two papers that may also be of interest to my readers. Below are my takeaways from these two important articles.
In 2012, David Harper and Ewen Speed published a paper in Studies in Social Justice entitled “Uncovering Recovery: The Resistible Rise of Recovery and Resilience.” They make several points worthy of reflection, including the following:
*Behavioral health systems focus almost exclusively on changing how distressed service consumers think, feel, and act. The target of service interventions is the individual.
*The intrapersonal focus of behavioral health systems (i.e., the medicalization of emotional distress) obscures structural causes of distress and structural solutions to behavioral health problems.
*Interventions that encourage embrace of a “recovery identity” as a solution to psychological distress inadvertently enable the invisibility of social, economic, and political conditions that contribute to such distress.
*”…it is only when the collective, structural experiences of inequality and injustice are explicitly linked to process of emotional distress that recovery will be possible.”
*The alternative to this either/or focus is to integrate the personal and the political by combining both personal strategies for problem resolution as well as seeking “institutional remedies for institutional harms.” This will require a simultaneous focus on personal and social change, with the latter reversing historical marginalization based on class, ethnicity, gender, and sexuality.
A 2016 essay by Price-Robertson and colleagues in Advances in Mental Health make many of the same points as Harper and Speed. In describing prevailing models of addiction recovery, they suggest that “the onus of recovery is placed on the individual, while the familial, social, material, educational, economic, and political contexts of mental ill-health are largely obscured.” They contend that individualistic philosophies of recovery miss the complex contexts in which addictive disorders both arise and are resolved. The authors conclude that recovery is best understood and promoted when understood within the contexts of cultural systems of oppression and privilege that constitute many of the social determinants of illness and health.
As concerns related to social justice increase in the United States, it seems an ideal time for us to extend this exploration to the cultural contexts of addiction and addiction recovery. In our current focus on the expansion of peer-based recovery support services, we must not forget the activist and advocacy agendas out of which the modern recovery advocacy movement was birthed.
Harper, D., & Speed, E. (2012). Uncovering recovery: The resistible rise of recovery and resilience. Studies in Social Justice, 6(1), 9-25.
Price-Robertson, R., Obradovic, A., & Morgan, B. (2016). Relational recovery: Beyond individualism in the recovery approach. Advances in Mental Health, September, 108-120.
Never in U.S. history have there existed more choices of support for the resolution of alcohol and other drug (AOD) problems. Today, recovery support groups span secular, spiritual, and religious orientations, with meetings also organized by gender, age, sexual orientation, language preference, profession, and co-occurring conditions, to name just a few. Recent scientific studies and reviews offer a window into these expanding choices and their relative effectiveness.
Individuals who have resolved alcohol and other drug (AOD) problems do so with and without participation in recovery mutual aid groups. Results from the National Recovery Study (Kelly, et al., 2017) found that, of U.S. adults who resolved an AOD problem, 45% did so with the support of a mutual aid organization; 28% did so with the help of professional treatment. Participation in recovery mutual aid and professional treatment is associated with more severe patterns and consequences of substance use.
An updated Cochrane review of the 27 most methodologically rigorous studies of Alcoholics Anonymous and related Twelve-Step Facilitation (TSF) treatment studies concluded: “AA/TSF interventions produce similar benefits to other treatments on all drinking-related outcomes except for continuous abstinence and remission, where AA/TSF is superior.”
White and colleagues (2020), in their review of 158 NA-related studies, concluded: “NA participation is associated with decreased drug use, increased rates of abstinence, improved global (physical, emotional, spiritual) health, enhanced social functioning, increased involvement with mainstream community institutions, and decreased health care costs—effects amplified by intensity and duration of NA participation.”
Kelly and colleagues (2014) examined the comparative responses to Alcoholics Anonymous and Narcotics Anonymous among 279 young adults undergoing treatment for a non-alcohol drug use disorder. The majority of mutual support meetings attended post-treatment were AA rather than NA meetings (due in part to less availability of NA meetings). There were no significant differences in participation rates or positive outcomes achieved between drug dependent patients attending AA or NA. The research team concluded: “contrary to expectations, young adults who identify cannabis, opiates, or stimulants as their preferred substance may, in general, do as well in AA as NA.”
Zemore and colleagues (2018) compared the comparative effectiveness of participation in Women for Sobriety, LifeRing, SMART Recovery, and Twelve-Step groups among individuals with an alcohol use disorder (AUD). “Results tentatively suggest that WFS, LifeRing, and SMART are as effective as 12-step groups for those with AUDs, and that this population has the best odds of success when committing to lifetime total abstinence.”
Tsutsumi and colleagues (2018) compared group retention and transitions in group affiliation among 647 individuals participation in 12-Step, Women for Sobriety, LifeRing, or SMART Recovery groups. Key findings include:
1) changing groups among participants of 12-Step alternatives is common,
2) the most common pattern of change was from a 12-Step alternative to a 12-Step group,
3) those transitioning to a 12-Step group continued to report disliking some aspects of the 12-Step program,
4) changing groups is often a search for greater support rather than a different philosophy of recovery, and
5) changing groups was most common among younger participants and people of color,
The above studies are reflective of a larger body of scientific literature documenting the viability of alternative pathways of long-term addiction recovery. The expansion of pathway choices is worthy of celebration by everyone concerned about the resolution of AOD problems. Collectively, these studies affirm the role recovery mutual aid participation in long-term addiction recovery and inform the growing varieties of recovery experience.
Kelly, J. F., Abry, A., Ferri, M., & Humphreys, K. (2020). Alcoholics Anonymous and 12-Step facilitation treatments for alcohol use disorder: A distillation of a 2020 Cochrane Review for clinicians and policy makers. Alcohol and Alcoholism (Oxford, Oxfordshire), June.
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.
Kelly, J. F., Greene, M. C., & Bergman, B. C. (2014). Do drug-dependent patients attending Alcoholics Anonymous rather than Narcotics Anonymous do as well? A prospective, lagged, matching analysis. Alcohol and Alcoholism, 49(6), 645-653.
Tsutsumi, S., Timko, C., & Zemore, S. E. (2020). Ambivalent attendees: Transitions in group affiliation among those who choose a 12-step alternative for addiction. Addictive Behaviors, 102, 106143. https://doi.org/10.1016/j.addbeh.2019.106143.
White, W., Galanter, M., Humphreys, K., & Kelly, J. (2020) “We do recover”: Scientific Studies on Narcotics Anonymous. Posted at www.williamwhitepapers.com
Readers who have followed this blog series are aware of my sustained interest in the ecology of recovery, particularly the role of recovery space/landscapes within local communities, and the stages of long-term personal and family recovery. A just-published article by Lena Theodoropoulou in the International Journal of Drug Policy offers some intriguing insights into these topics. Below are notes on what I have drawn from the key ideas in her article.
Addiction recovery is an experience of emotional and social connections that prompts a radical renegotiation of the person-drug relationship.
Addiction recovery is far more than an intrapersonal process of change. Recovery is a series of interacting processes that unfold over time in physical, social, and psychological spaces that protectively incubate or suffocate recovery efforts.
These processes most often unfold in fits and spurts over time. Episodes of recovery testing (sampling) often precede the achievement of recovery stability.
Addiction (desire for the drug) and recovery (desire for change) co-exist, and their relative balance dictates both addiction and recovery experiences. Emotional and social connections constitute the push and pull forces of addiction and recovery–the “tipping points” that dictate the final chapters of one’s personal story.
Addiction recurrence is a temporary or sustained breach in the emotional and social connections that initiate and sustain recovery. Addiction recurrence is “the outcome of the interrupted relationship between a subject and a recovery space.”
Brief treatment episodes offer fragile connections capable of inciting hope for recovery. The question is whether brief treatment episodes result in durable connections that can sustain passage from recovery initiation through the later stages of recovery.
Brief episodes of biopsychosocial stabilization without sustained recovery support can leave one “trapped in repetition and broken connections.” (See HERE for my take on this.)
“All encounters between the service and the user matter” as they “constitute components of an ongoing turning point.” Evaluating treatment effectiveness based on a single brief course of service fails to measure the effects of service relationships and activities on the course of long-term recovery.
“By positioning the focus on the connections that become possible within the recovery space, healing becomes a socio-political rather than an individual process, ‘accomplished less through personal therapeutics and processing of painful memories than through small-scale, tentative restoration of trust and support’.”
Recovery must be viewed within the context of time: “There is using time, harm reduction time, recovery time, and accordingly relapse time, all of them part of the recovery assemblage.” The process of moving through these time zones is not always linear.
Recovery must be viewed in the context of space—a transition from using space to recovery space—a deterritorialisation of active addiction, the avoidance of people, places and things that anchor one to the addiction experience.
Unraveling the chronicity of addiction is a sociopolitical problem, not a medical one.
I hope we hear a great deal more from Lena Theodoropoulou. We can learn a lot from her observations on treatment services in the UK and Greece.
Theodoropoulou, L. (2020). Connections built and broke: The ontologies of relapse. International Journal of Drug Policy, https://doi.org/10.1016/j.drugpo.2020,102739.