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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- Open, host, and close virtual training
- Support facilitators by monitoring the chat, managing breakout rooms, uploading documents or links in the chat, and presenting slideshows as needed
- Support participants with any technical difficulties, such as locating Zoom features, renaming, utilizing cameras and microphones, etc.
- Answering questions related to the National Recovery Institute and their services
- Troubleshoot any technical issues on Zoom for participants and facilitators
- Provide excellent customer service via email, phone, Slack, and Zoom
- Advanced knowledge of Zoom platform and computer programs
- Excellent organizational, verbal, written, public speaking, and interpersonal skills
- 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
- Familiarity with and interest in substance use disorders, addiction recovery, and healthcare issues a plus
- Excellent computer skills: proficient in Zoom, Microsoft PowerPoint, Word, and Outlook
- Excellent attention to detail
- Excellent written and oral communication skills
- Ability to show creative and flexible thinking
- Strong time management skills
- Strong ability to follow procedures
- Minimum of 6 months hosting Zoom meetings and/or virtual conferences
- Remote work as a student, volunteer, contractor, or employee for at least 1 year
- Introductory or higher understanding of adult learning
- People with lived experience who have been involved with grassroots campaigns in behavioral health, harm reduction, justice reform, multi-pathways of recovery, or LGBTQIA+ communities, are encouraged to apply
Faces & Voices of Recovery is seeking a Program Assistant for our Training Team.
This is a full-time home-based position with a competitive annual starting salary- based on experience. Faces & Voices of Recovery offers generous leave and health benefits.
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.
A cover letter describing your interest in THIS job and why you’re a good fit is required.
Send resume and cover letter to email@example.com.
The Training Program Assistant provides support for the National Recovery Institute (NRI). The Program Assistant works on multiple projects collaboratively with team members.
Duties and responsibilities
- Schedule trainings for the NRI
- Complete reminder and evaluation emails for all NRI trainings
- Organize and maintain project files in SharePoint and Salesforce
- Create and run evaluation reports for trainings and Adjunct Faculty
- Coordinate technical host coverage for trainings
- Schedule conference calls and meetings
- Prepare meeting materials and record meeting notes
- Coordinate travel and event logistics for the NRI
- Edit and update content for the NRI
- Input content for trainings and initiatives on the NRI page of the website
- Manage the NRI social media pages
- Audit training registrations
- Other duties as assigned
- Administrative experience required
- Advanced knowledge of Zoom platform and computer programs
- Proficient in Salesforce, Microsoft Office applications strongly preferred
- Excellent attention to detail
- Strong editing skills
- Able to communicate effectively with internal and external partners
- Strong ability to collaborate across departments
- Strong aptitude for technology required
- Excellent organizational, verbal, written, public speaking and interpersonal skills
- 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
- Familiarity with and interest in substance use disorders, addiction recovery and healthcare issues a plus
- Ability to establish and maintain effective working relationships with staff and representatives from other agencies, organizations, and the general public.
- Ability to use technology to maintain records.
- Ability to juggle multiple priorities in fast-paced environment
- Ability to facilitate teamwork and work collaboratively across teams
Other characteristics such as personal characteristics
- Ability to think critically, discuss and integrate health equity in terms of diversity, equity, and inclusion (DEI) into training, technical assistance, presentations, and while representing the organization in external activities
- Passionate about Faces & Voices’ mission and able to promote and communicate the mission and values to external and internal stakeholders.
- Values recognizing accomplishments and abilities of other staff
- At least 2 years of progressive experience in a support role
- Experience in remote work and virtual platforms
- Experience with Salesforce preferred. Must be willing to learn Salesforce.
- Travel is anticipated to be 10-20% of time once COVID limitations are reduced
- Commensurate with experience.
Faces & Voices of Recovery employs remote workers who must maintain a home office conducive to optimal work performance and free of distractions. This includes a separate office space and a minimum of 20 Mbps downstream and 5 Mbps upstream for internet service. Some projects may require staff to travel. All staff are required to work and be available during office hours –9:00 am -5:00 pm ET unless otherwise approved by supervisor.
Employee must be able to remain in a stationary position 90% of the time. Constantly operates a computer and other office productivity machinery. The person in this position frequently communicates with other team members and customers who have inquiries. Must be able to exchange accurate information in these situations. Some occasions may call for moving equipment weighing up to 50 pounds to and from venue locations for various events.
“In the early days of the pandemic during lockdown, I lost three people in one month. With that happening and being in the recovery field, sometimes you wonder if you’ve done enough for someone.” – Pete Walker.
2020 was an unprecedented year. Feelings of uncertainty and dread crept over the general public as COVID-19 broke headlines, further spreading and festering into a full-blown pandemic. The whole world seemed to be turned upside down as everything shut down around us. People lost their jobs, their homes, and their loved ones. Yet while this ongoing pandemic continues to dominate headlines, in the United States there has been another, tangential crisis gripping the country and its communities long before COVID – the addiction and overdose epidemic.
The addiction and overdose epidemic has impacted communities across the country for years now. According to the CDC, there have been close to 841,000 people die from a drug overdose over the span of 20 years from 1999 to 2019. Despite research, advocacy efforts, and attempts to partially mobilize the recovery community, no one was quite prepared for the storm that 2020 would bring across the nation.
The convergence of the COVID-19 pandemic and overdose epidemic led to a spike in overdose deaths, with overdoses hitting an all-time high in 2020. Recently, the CDC released new data showing that for the first time ever, during the ongoing pandemic, overdose deaths had exceeded 100,000 during a twelve-month period . According to the Recovery Research Institute, substance overdose deaths increased the most during the first five months of the pandemic . This can be attributed to most states going into lockdown, leaving many stuck in their homes. The isolation and disconnect experienced during this time often intensified existing mental health and substance use disorders.
Abraham “Pete” Walker of Michigan and Florida, owner of Walker Consulting and Recovery Coaching, reflects upon the challenges he experienced during those early months of the pandemic and lockdown.
“I like to say that with my emotions, I am pretty level keeled. I try to be spiritual and do good. But during lockdown I went into a very dark place”, says Pete.
During this time, as Pete worked for his own LLC and some other recovery nonprofits, he lost three individuals to overdose in just one month. The emotional burden that compounded loss places upon a professional working in recovery support services is tremendous. By being a person in recovery as well, Pete directly understands the challenges that the isolation of the pandemic brought on to so many.
“All of this is like a tornado happening. Maybe some that weren’t necessarily going to get caught up in it are getting swept up. Perhaps some of it comes from isolation and boredom, or from the scares and anxiety of the pandemic. We don’t know what happens to some people or what they might be going through – and COVID really intensified emotions and swept more people up into this tornado.”
This metaphor Pete uses to capture the grim reality of what happened in 2020 hits close to home for many communities across the United States, as this ‘tornado’ touched down and wreaked havoc in nearly every corner of the country. At Healing Transitions in Raleigh, North Carolina, Courtni Wheeler leads the Rapid Responder Team. She began this role at the very start of the COVID pandemic, when most overdoses that Courtni and her team responded to were related to heroin or fentanyl use. However, as lockdowns started, the overdose calls they were responding to shifted to cocaine, pressed pills, methamphetamines, and even marijuana.
Overdoses from marijuana were something Courtni described as ‘simply unheard of’. In fact, the majority of calls her team responded to in those early months of the pandemic were overdoses resulting from substances one wouldn’t typically overdose from. In working alongside Emergency Medical Service (EMS) personnel, Courtni became aware of how overloaded they were with calls, with many of them being related to mental health.
“With the world shutting down and people losing their jobs, mental health crises were going up and so was substance use,” Courtni says. “We all know working in this field that mental health and substance use go hand-in-hand.”
In responding to calls during the pandemic and lockdown, Courtni witnessed just how much COVID was impacting her community and those with substance use disorder.
“For a lot of people. . . the only thing they have as a coping skill – to release those emotions and that stress and anxiety – is to use something to make them feel better,” says Courtni. “People who normally don’t suffer from mental health problems, or those that just have generalized anxiety, are now trying to cope with depression and are turning to substance use to do that.”
Tornadoes don’t impact all communities equally. More marginalized communities don’t have as strong of structures to sustain themselves. When a tornado hits, they are more brutally damaged, even in less severe conditions. They have fewer resources to respond to the disaster crisis and scant reserves to fall back on when their communities lose infrastructure. The convergence of the COVID-19 Pandemic and the addiction and overdose epidemic— what is known as a ‘syndemic’ —has not impacted all communities equally. We need to address the long-standing deficits and historic gaps that have been exposed by the crises that have unfolded across all our communities.
The syndemic has also taken its toll on the first responders that millions rely on each day. In many communities across the country, EMS first responders were already answering large volumes of calls related to overdoses. The COVID-19 pandemic just created even more of a burden. Anxieties over getting and spreading COVID to their families, coupled with the stress and increasing number of calls became almost unbearable for most. Many first responders interviewed for this article expressed experiencing compassion fatigue and had an internal conflict of wanting to help, but not feeling that compassion towards individuals who were overdosing. This internal struggle and burnout were something that they each had to cope with and work through, as they navigated through their emotions and the toll of being on the front lines of both crises.
The substance use care system was already deep into what would be considered a severe workforce crisis, simmering for over at least the last two decades. In 2019, the Annapolis Coalition released a report commissioned by SAMHSA on our pre-COVID workforce crisis. It was estimated then that there was a need for 1,103,338 peer support workers and 1,436,228 behavioral health counselors, as part of the 4,486,865 behavioral health workers conservatively anticipated at the time of this report to meet the current need . However, it is even worse now. Recovery support systems have suffered from inconsistent funding and low compensation, and the result has been devastating. A recent occurrence has been individuals all over the country walking out of their jobs in what has been dubbed ‘The Great Resignation of 2021’. We are witnessing some recovery programs with 100% turnover of peer staff. The loss of recovery infrastructure at a time of greatest need is unsustainable. To rebuild, we must create a trauma and recovery-informed substance use disorder service system that is inviting for people to work in, focused on long-term healing and inclusive of the recovery community in all its diversity.
A fundamental facet of how communities successfully respond after a disaster includes meaningful inclusion of all the members of that community in the rebuilding process. The first responder and recovery workforce have been working in this dynamic of assisting communities even as their own support systems have been ravaged. We must address the needs of first responders and peer workers in ways that foster healing at the individual and community level with stable funding at both the federal and state levels. A good start to this would be supporting the ten-percent recovery support set-aside in our federal Substance Abuse Prevention and Treatment Block Grant (SABG).
The Substance Abuse Prevention and Treatment Block Grant (SABG) enables states and jurisdictions to provide prevention, treatment, and recovery support services. This federal funding allows programs to plan, implement, and evaluate activities related to substance use. Grantees are required to spend at least 20% of SABG dollars on primary prevention strategies. Currently, a similar carve-out for recovery support services is in discussion for the federal FY2022 budget. Fondly referred to as the Recovery Set-Aside, this new dedicated funding would require Grantees to spend at least 10% of SABG dollars on recovery services and strategies to strengthening recovery community organizations, collegiate recovery programs, recovery residences, and other peer recovery programs for substance use. Supporting and advocating for the Set-Aside is just one important step towards ensuring states can use these much-needed resources to support grassroots recovery community efforts in a sustainable and inclusive manner. Communities across the country depend on it, including yours.
Faces & Voices of Recovery, a national advocacy organization and staple in the recovery community since 2001, is proud to further the work and dedication of International Recovery Day (IRD). Assuming responsibility of International Recovery Day – formerly International Recovery Day, Inc. – and all its assets, Faces & Voices will now lead and manage the continuation of this incredible event and its movement into the future.
In 2019, John Winslow founded International Recovery Day, Inc. as an organization and event dedicated to promoting all recovery pathways from substance use disorders and educating the public on the value of recovery. Celebrated the 30th of September (Recovery Month), International Recovery Day is an opportunity to celebrate recovery with countries from across the globe! Although International Recovery Day, Inc. will no longer operate, the annual celebration remains. Entering its third year, Faces & Voices will continue this international celebration by working with organizations, entities, and enthusiastic supporters of recovery to illuminate monuments and structures in purple across the world on September 30th.
Founder, and former owner of International Recovery Day, John Winslow, shares his excitement for this transition, “From its earliest inception, I have pondered how best to ensure the continuity and growth of International Recovery Day… I felt an increasing recognition of the need to find and establish a solid home base for this new and tender venture that held the potential to impact millions. I feel confident this transition will ensure continuity of our annual global event and expand addiction recovery awareness and involvement to a much larger scale. It just feels right.” IRD blends seamlessly into Faces & Voices core service – advocacy. Continuing the tradition of International Recovery Day embraces Faces & Voices mission to change the way addiction and recovery are understood and embraced through advocacy, education, and leadership.
Faces & Voices is ecstatic for this opportunity to heighten international awareness for recovery. “International Recovery Day has demonstrated that the global recovery movement has incredible power and provides a vital connection for millions around the world. We’re sincerely grateful for John Winslow’s leadership and vision for IRD. We’re honored to coordinate the annual observance and raise awareness for all recovery pathways from all addictions. We aim to engage individuals in every country around the world as a way to honor those in recovery and provide hope for those still struggling with addiction”, says Patty McCarthy, Chief Executive Officer, Faces & Voices of Recovery.
International Recovery Day demonstrates the immense impact addiction recovery has on the world around us. From Niagara Falls in New York to Google Headquarters in California, and landmarks across the world lit purple on a single day to acknowledge recovery shows the tremendous affect that substance use disorder and recovery has on communities.
International Recovery Day’s website – internationrecoveryday.org also provides space for people across the world to launch virtual fireworks on September 30th, to symbolize the hope and help that is offered through different recovery pathways and allow people to celebrate their own recovery – in a way that’s unique to them – and yet still a small part of a greater whole.
Advancing IRD’s accelerated progress requires a revitalized sense of community from person-to-person gatherings or screen-to-screen hangouts, “around the world, the recovery movement is gaining traction and depth. We are thrilled to continue International Recovery Day and support equitable access to recovery for any human being who wants it. At Faces & Voices, we envision a global recovery movement that knows no bounds, borders, or barriers”, says Phil Rutherford, Chief Operating Officer, Faces & Voices of Recovery.
Whether anyone or any group participate launching virtual fireworks or illuminating landmarks and buildings purple, International Recovery Day reminds us that “Recovery is for Everyone” and engaging and celebrating recovery extends well beyond a single person.
Thank you for supporting us in our efforts and advocacy for a brighter future for all.
Emily Porcelli, Marketing and Communications
Faces & Voices of Recovery
Posts from William White
Harvard-trained historian Ernest Kurtz loved stories. The power of story and the role of storytelling in personal identity and addiction recovery filled his writings on Alcoholics Anonymous (A.A.), and they were central themes in the books he co-authored with Katherine Ketcham: The Spirituality of Imperfection and Experiencing Spirituality.
I apprenticed under Ernie’s guidance for more than two decades in hopes of mastering the art and science of historical research. Sitting across from him in his office, I must have asked Ernie a thousand questions. His most frequent response was to lean forward in his chair, eyes twinkling, arms and hands in motion, to share a story in a voice that would have done Moses justice. Ernie was at heart and above all a spellbinding storyteller.
Ernie was fascinated with how life stories were, by necessity, reconstructed as part of one’s recovery from alcoholism. He often commented on how the A.A. story style helped newcomers construct a new life story from the fragments of their brokenness. The new story helped make sense of experiences that were otherwise inextricable, helped fire hope, salvaged self-esteem, and bolstered the commitment to sobriety.
One of the many themes within Ernie’s historical research was the role of memory in storytelling—writ small (personal identity) and large (collective history). Aware that much of my recounting of the modern history of addiction treatment and recovery flowed from interviews with key players within that history, Ernie cautioned me to think of memory as more construction site than storage drawer. He often discussed the potential loss of objective history due to the filtering of memory through efforts of self-enhancement, institutional interests, and contemporary political and cultural wars. His admonition? Verify everything!
Ernie was equally intrigued by the role of memory as scaffolding for addiction and recovery. He suggested that how we select and attach meaning to events in our life exert a profound effect on our future. The selection and deselection of life events to form a coherent narrative in his view could support either addiction or recovery. An essential feature of the journey between the former to the latter was thus a process of story reconstruction and storytelling. Ernie suggested: change the story, change the life—a process aided by both skilled clinical intervention and participation in a community of recovering people with whom one could identify.
Ernie also explored how recovery stories changed over time, marking a prolonged process of healing and reconstruction of personal character and values. In The Spirituality of Imperfection, he identified six experiences/traits expressed in these evolving stories—all keys to this long-term reconstruction of self: release, gratitude, humility, tolerance, forgiveness, and being-at-home. As is evident, Ernie understood addiction recovery as a process involving far more than the deletion of drugs from an otherwise unchanged life.
During my last visit with Ernie before his passing, he shared with me a number of private documents. Included was 145 pages of raw notes on story and storytelling. This elaborately coded document contained quotations and summaries from all his related readings as well as many of his own reflections, only some of which appeared in his published work. I have cherished these notes for the past five years and have decided, with permission from Ernie’s wife, Linda Ferris Kurtz, to share some excerpts from these notes. Below are just a few of Ernie’s prized discoveries and reflections on story, memory, and storytelling. I share these as a way of continuing to honor what Ernie meant to so many of us. To review selected excerpts from the Kurtz notes on Story, Memory and Storytelling, click HERE.
SAMHSA’s BRSS TACS releases directory of peer recovery coaching training and certification programs
The Substance Abuse and Mental Health Services Administration’s (SAMHSA) Bringing Recovery Supports to Scale Technical Assistance Center Strategy (BRSS TACS) recently released their State-by-State Directory of Peer Recovery Coaching Training and Certification Programs. The directory provides detailed information about certification processes for peer recovery coaches, including training requirements, curricula, exam criteria, fees, and program descriptions. The directory also identifies recovery coach supervisor training requirements and supervisor training courses.
Social anxiety/phobia, often mischaracterized as extreme shyness, constitutes a potential pathway into addiction and a major obstacle to addiction treatment and recovery.
Robert and Kaisha could not be more different at a quick glance, but they shared the curse of what others perceived as extreme shyness. Robert and Kaisha dreaded any social situation filled with strangers, the expectation of conversation, or any undue focus upon themselves. Just the thought of entering such a situation induced a trembling voice, a racing heart, sweaty hands, a blushing face, dizziness, nausea, extreme self-consciousness, and fears of embarrassment and humiliation. In social situations that could not be escaped, they sought invisibility, shunning as much contact as possible, avoiding eye contact, speaking very little or not at all, and spending inordinate time afterwards harshly judging their social performance.
Robert and Kaisha found something of a solution for their social anxiety. They discovered magic elixirs that lessened or dissolved their fears and loosened their tongues. The problems only came when their increasing dependence on ever-increasing dosages and frequencies of these elixirs created all manner of other problems in their lives. When these escalating problems forced them to seek help, imagine their mortification to hear that their “treatment” would involve group therapy and participating in recovery mutual support groups in their local community.
The situation faced by Robert and Kaisha is by no means rare. A study by Book and colleagues found that 37% of people entering addiction treatment also experienced clinically significant social anxiety. The 37% figure would extrapolate to more than 740,000 individuals entering addiction treatment each year. The Book study raises several important questions.
Of 21.7 million Americans in need of help for a substance use disorder in the past year, only 2.3 million received specialized SUD treatment. What portion of those not receiving treatment were dissuaded from seeking help due to social anxiety and the group-orientation of addiction treatment and recovery mutual aid?
Since 1999, more than 770,000 Americans have died from drug overdoses. What portion of those lost lives chose not to seek help due to social anxiety and the group-orientation of addiction treatment and recovery mutual aid?
Since 1999, nearly one million individuals died from alcohol-related causes. What portion of those lost lives chose not to seek help due to social anxiety and the group-orientation of addiction treatment and recovery mutual aid?
There are an estimated 1.4 million suicide attempts and more than 47,000 deaths by suicide in the United States each year. What portion of these people suffer from a substance use disorder and fail to seek help due to social anxiety and the group-orientation of addiction treatment and recovery mutual aid?
The situation faced by people who need help for a substance use disorder but who shun such help due to social anxiety could be improved if:
*Addiction professionals assessed the presence and degree of social anxiety of every person seeking help for a substance-related problem.
*Integrated addiction and mental health services existed that could concurrently treat SUDs and anxiety disorders via potential combinations of psychosocial support and medication.
*Treatment adjuncts/techniques potentially helpful to those with social anxiety (e.g., thought-stopping, reframing, biofeedback, systematic desensitization, situation rehearsal, progressive relaxation, breath training) were routinely available in addiction treatment programs.
*Outpatient individual counseling was universally available as an alternative to the dominant group-oriented intensive outpatient and residential models of addiction treatment.
*Prescriptive bibliotherapy and self-guided manuals were more widely available as adjuncts and alternatives to addiction treatment.
*E-therapy and e-recovery support services, including online recovery support chat rooms and online meetings (e.g., In the Rooms) were assertively promoted to people with social anxiety.
*Each person with social anxiety was assigned a recovery coach as a personal travel guide into the social worlds of addiction recovery.
*People with social anxiety were phased in to recovery-focused social contact, beginning with orientation to program literature and rituals, one-on-one contact, and large speaker meetings where there is no expectation for participation prior to exposure to smaller closed meetings.
Social anxiety constitutes a major obstacle to addiction treatment and recovery. Human connection is a key mechanism of change within addiction recovery, but people with social anxiety may need special support to access such connection. Scientific research, careful clinical observation, and personal lived experience may offer such people improved solutions for the future.
Acknowledgement: Thanks to members of the Recovery Rising Book Club for comments on an early draft of this blog.
Book, S. W., Thomas, S. E., Dempsey, J. P., & Randall, P. K. (2009). Social anxiety impacts willingness to participate in addiction treatment. Addictive Behaviors, 34, 474-476.
Substance Abuse and Mental Health Services Administration, (2019). Treatment Episode Data Set (TEDS): 2017. Rockville, MD: Substance Abuse and Mental Health Services Administration.
White, A. M., Castle, I-J., P., Hingson, R. W. & Powell, P. A. (2020). Using death certificates to explore changes in alcohol-related mortality in the United States, 1999-2017. Alcoholism: Clinical & Experimental Research. 44(1). 178-187.
I believe we live in the greatest era of snake oil salesmen in the history of mankind. —Michael Crichton, Next, 2006
The addictions treatment field has grossly oversold the effectiveness of a single episode of brief clinical intervention. For more than two decades, calls have increased for a radical redesign of addiction treatment and related recovery support services—a shift from acute care models of intervention to models of sustained recovery management (RM) nested within larger recovery-oriented systems of care (ROSC).
Defining Acute Care: Acute care (AC) models of addiction treatment encompass service interventions that intervene at a late stage of problem development via services focused on brief biopsychosocial stabilization that lack sustained support across the stages of long-term personal and family recovery. AC models of intervention that have dominated specialized addiction treatment since its inception in the mid-nineteenth century share distinct characteristics:
*Services are delivered “programmatically” in a uniform series of encapsulated activities (screen, admit, single point-in-time assessment, minimally individualized treatment, discharge, brief “aftercare” as an afterthought, termination of the service relationship).
*Clinical intervention is focused on symptom elimination for a single primary problem.
*Professional experts direct and dominate the assessment, treatment planning, and service delivery decision-making.
*Services transpire over a short (and historically ever-shorter) period of time—usually as a function of a prearranged, time-limited insurance payment designed specifically for addiction disorders and “carved out” from general medical insurance.
*The individual/family/community is given the impression at discharge (“graduation”) that “cure has occurred”: long-term recovery is viewed as personally self-sustainable without ongoing professional assistance.
*The intervention is evaluated at a short-term, single-point-in-time follow-up that compares pretreatment status with discharge status and short-point-in-time post-treatment status.
*Post-treatment symptom recurrence and needed readmission are viewed as failure of the client rather than flaws in the design or execution of the treatment protocol. Treatment in subsequent admissions is essentially the same as that of the first admission.
Why Acute Care? The modern addictions treatment field migrated toward an acute care model in the 1970s and early 1980s. The model reflected a bid for professional credibility of an emerging field, a needed response to the surge in public funding for addiction treatment, and a strategy to acquire private insurance reimbursement for such treatment. The resulting scheme of treatment and related funding policies resembled the acute care hospital, with duration of treatment becoming ever briefer following the advent of aggressive systems of managed behavioral healthcare. Detoxification programs were modeled on the hospital emergency room, inpatient and residential programs were modeled on acute care wards of the general hospital, and outpatient programs were modeled on the outpatient medical clinic. The resulting model prescribed a series of clinical steps all compressed in as little time as possible.
Potential Value of Acute Care: AC models of SUD intervention are very appropriate for people with low to moderate substance use disorders (SUDs) who also possess substantial recovery capital. Millions of people fitting this profile are today in long-term stable recovery who express unending gratitude for the AC treatment they received. For people with more severe SUDs, acute care is one critical stage in what needs to be a multi-staged process of sustained recovery support.
Unintended Consequences of AC Model: Failure to meet SUD severity criteria denies access to care for many people with mild to moderate substance-related problems and substantial recovery capital. People with the most severe, complex, and chronic SUDs are being repeatedly recycled through AC models of care whose low intensity and duration of services offer little hope of sustainable SUD recovery. (58% of people now admitted to addiction treatment in the U.S. have one or more prior treatment episodes, TEDS Data). I have regularly compared AC models of addiction treatment to providing inadequate dosages or duration of antibiotics in the treatment of bacterial infections. In both cases, treatment leads to temporary suppression of the symptoms but inadvertently leads to resurgence of the condition in a more intractable condition.
Cost-ineffectiveness of AC Model
Millions if not billions of dollars allocated to AC treatment is wasted due to the lack of earlier intervention into alcohol and other drug problems and the lack of long-term post-AC recovery support services. Service utilization and related profits within inpatient and residential treatment programs would plummet if improved recovery rates dramatically reduced multiple treatment admissions. Knowledge of that fact is a major obstacle to needed systems transformation within the addiction treatment industry. Ideally, dollars now allocated almost exclusively to AC treatment of addiction in the U.S. would be reapportioned across the stages of long-term personal and family recovery.
Ethics of Acute Care: Acute care models of addiction treatment that lack assertive outreach to shorten addiction careers and recovery support services across the stages of long-term recovery should be called out for what they are: clinical incompetence and financial exploitation, by consequence if not intent. The practice of recycling people with severe, complex and chronic SUDs repeatedly through AC-limited services is more money machine than “treatment “ and should be professionally and publicly exposed as such.
Alternative to AC Models of Care:
The alternative to the AC model that leaders in the addictions field are exploring is a model of recovery management nested within larger recovery-oriented systems of care.
Recovery management (RM) is a philosophical framework for organizing addiction treatment services to provide pre-recovery identification and engagement, recovery initiation and stabilization, long-term recovery maintenance, and quality-of-life enhancement for individuals and families affected by severe substance use disorders.
Recovery-oriented systems of care (ROSC) are networks of formal and informal services developed and mobilized to sustain long-term recovery for individuals and families impacted by severe substance use disorders. The system in ROSC is not a local, state, or federal treatment agency but a macro-level organization of a community, a state, or a nation. ROSC initiatives provide the physical, psychological, cultural, and social space within local communities in which personal and family recovery can flourish.
Distinctive Features of RM and ROSC
The emerging RM & ROSC vision calls for:
*strengthening the infrastructure of addiction treatment to ensure sustained continuity of support and accountability to the individuals, families, and communities served by addiction treatment institutions;
*more proactive systems of identifying, engaging, and ensuring service access for individuals and families at the earliest possible stage of AOD-related problem development;
*individual, family, and community needs-assessment protocols that are comprehensive, strengths-based, and ongoing;
*the utilization of multidisciplinary and multi-agency service models for supporting long-term recovery for those individuals, families, and neighborhoods experiencing severe, complex, and enduring AOD problems;
*the reconstruction of the service relationship from an expert model to a partnership model involving a long-term recovery support alliance;
*expanding the service menu, with an emphasis on evidence-based and recovery-linked service practices;
*ensuring each client and family an adequate dose and duration of pre-treatment, in-treatment, and post-treatment clinical and recovery support services;
*exerting a greater influence on the post-treatment recovery environment by shortening the physical and cultural distance between the treatment institution and the natural environments of those served, and by intervening directly to increase family and community recovery capital;
*assertive linkage of clients and families to recovery mutual aid groups and other indigenous recovery support institutions;
*post-treatment monitoring (recovery check-ups for up to five years following discharge from primary treatment), ongoing stage-appropriate recovery education, sustained recovery coaching, and, when needed, early re-intervention; and
*the systematic and system-wide collection and reporting of long-term post-treatment recovery outcomes for all individuals and families admitted to addiction treatment.
RM and ROSC system redesign would integrate the now isolated siloes of primary prevention, harm reduction, early intervention, treatment, and recovery support services.
People in personal/family recovery and a vanguard of addiction professionals are working diligently across the country to make this vision a reality. If I had another lifetime to devote to the elevation of the quality of addiction treatment in the United States, this is what I would be trying to achieve.
Substance Abuse and Mental Health Services Administration, Treatment Episode Data Set (TEDS) Discharges, 2015. Rockville, MD: Substance Abuse and Mental Health Services Administration, 2018. Accessed February 13, 2020 at https://wwwdasis.samhsa.gov/dasis2/teds_pubs/TEDS/Discharges/TED_D_2015/teds_d_2015_codebook.pdf
Kelly, J. & White, W. (Eds., 2010). Addiction recovery management: Theory, science and practice. New York: Springer Science
White, W. (2008). Recovery management and recovery-oriented systems of care: Scientific rationale and promising practices. Pittsburgh, PA: Northeast Addiction Technology Transfer Center, Great Lakes Addiction Technology Transfer Center, Philadelphia Department of Behavioral Health & Mental Retardation Services
Until the lion learns how to write, every story will glorify the hunter. –African Proverb
From Lin-Manuel Miranda, Hamilton: “Why do you write like you’re running out of time?”
Me: “Because I am.”
In the late 1990s, I experienced an epiphany of sorts—a sudden awareness that the addiction field had acquired a massive body of scientific and professional knowledge about alcohol and other drug problems and their clinical treatment but possessed little knowledge of the prevalence, pathways, styles, and stages of long-term personal and family recovery. Being over fifty seemed a strange time to plot a new career direction, but that is what I did. My decision was clear: whatever remaining time I had would be devoted to the scientific study of recovery and pushing the addiction field’s organizing center from a focus on pathology and the nuances of clinical intervention to a focus on the lived experience of long-term recovery. Fortunately, I was not alone in either this awareness or that commitment. The subsequent years witnessed the rise of recovery-focused research scientists and a new generation of recovery advocates. Today, recovery journalism–from the scientific journals to the growing legion of recovery blogs–is coming of age.
When I entered the addictions field in the 1960s, there were two distinct classes of workers: “professionals” (doctors, nurses, psychologists, and social workers) and “paraprofessionals” (people with lived experience of addiction and recovery). There was little consideration that one could be both a professional AND a person in long-term recovery: you were one or the other. If you had a foot in each world, your legitimacy could be and often was questioned within each—seen as too broken in the professional world and not broken enough in the recovery world. Over time, people in recovery working in the field were extruded as addiction counseling became more professionalized and as those in recovery, as an act of self-protection, hid their recovery identity behind a smokescreen of increasing credentials.
Now for a present story. A lively discussion recently ensued among a group of people in recovery when the name of a prominent recovery advocate came up. The discussion entailed back and forth arguments over whether the person was a “real addict” [in recovery] or an “academic.” Again, notice the binary choice here—a remaining shadow of the past.
Historically disenfranchised people face the stigmatizing judgement of others in ways that limit the vision of their own potential as individuals and as a people. Black children who excel academically are castigated by some of their peers as “acting White” in oppressed, wounded worlds where Blackness and academic achievement are perceived as incongruent. In a similarly distorted worldview, a person with an advanced degree could not be a “real addict” or a “person in recovery.” In that view, academic achievement and eloquent writing are incompatible with the status of addiction recovery. The good news is that such warped views of self and the world are breaking down.
Under the influence of a vibrant recovery advocacy movement and new recovery support institutions (e.g., recovery high schools, collegiate recovery programs, recovery-focused academic mentoring), legions of people in recovery are pursuing college, university, and graduate training, and they are doing so as visible people in recovery. The result is an explosion in recovery-focused writing that spans memoirs, scientific studies, professional papers, popular journal articles, and social media posts. The perception that academic excellence and exemplary writing are incompatible with recovery status is fading among people in recovery, in the professional world of addiction treatment, and among the public. That is a remarkable achievement of historical significance.
I am part of a community of physicians, nurses, pharmacologists, psychologists, social workers, research scientists, historians, authors, educators, addiction professionals, and community activists. AND we are all people in long-term addiction recovery. If you are a person in recovery, you can be anything you want to be—and still be a person in recovery. Recovery is a launching pad, not a restrictive cage. Don’t let anyone foist you into such a cage.
At the very heart of addiction lies the search for power, control, comfort, relief, and pleasure. At first, the drug is a secret superpower that heals, emboldens, and frees us, but as it feeds on us, it becomes stronger and we become progressively weaker. In the end, we worship the drug at the exclusion of all else as we become one with the drug. We are in its power, feeling more possessed that master of our fate. It is thus little wonder that the issue of personal power is at the center of multiple pathways of addiction recovery.
Mainstream 12-Step recovery, drawn from the experience of first-generation, predominately White male AA members who had lost their personal and cultural empowerment due to alcoholism and the Depression, rests on a deep acceptance of one’s powerlessness. Complete surrender to this state of powerlessness is the beginning and very crux of recovery within the 12-Step program. Later frameworks of recovery, drawn primarily from the collective experience of addicted women, people of color, young people, members of the LGBTQ community, and other historically disenfranchised populations, proffered the assertion of power and control as the central recovery catalyst. These later frameworks also emphasized much greater reliance on discovering power within oneself rather than sole reliance on power beyond the self. (For full discussion, see White and Chaney Metaphors of Transformation.)
Twelve-Step critics, drawn primarily from alternative recovery mutual aid societies and from the professional disciplines of psychology and psychiatry, allege that the core concepts and practices of 12-Step programs are disempowering at personal, cultural, and political levels. On the surface, it would seem that the effect of embracing powerlessness and extolling surrender would result in a lost sense of personal power, but early 12-Step members discovered a remarkable paradox. In the act of openly admitting their powerlessness over a drug (alcohol in A.A.) or a process (addiction in N.A.), they mysteriously acquired an unprecedented level of power and control over their lives. Early 12-Step literature speaks to this: “Such is the paradox of A.A. regeneration: strength arising out of complete defeat and weakness, the loss of one’s old life as a condition for finding a new one.”
Long-tenured members of AA, NA, and other 12-Step fellowships suggest that there is something quite liberating to peel away one’s drug dependence and shed the related monetary extortion and corruption of personal character. In their experience, freedom lies in the clarity that one has not been, is not, and can never be in control of the drug relationship. They argue that the only way to be free of Sisyphean attempts to control the drug relationship is to sever that relationship completely and irrevocably. They also note a sense of exhilaration in the full realization that all they can ever hope to be and do—both duration and quality of life—hinges on one single issue and related daily priority.
While different perspectives on power and powerlessness exist across religious, spiritual, and secular recovery mutual aid organizations, I am most interested in the contrast on these issues that exist between professional service organizations and recovery mutual aid organizations (and more specifically 12-Step organizations). There would seem to be some value in comparing what “empowering” alternatives 12-Step critics have to offer as a solution to severe substance-related problems. In short, what are the major differences in “power” across professional and peer support contexts? I would argue that the peer support context offers considerably more power and freedom than that found in the professional service relationship.
Twelve-Step members control the pace of emotional intimacy through their choice of meeting styles, meeting frequency, degree of socializing outside of meetings, and choice to have or not have a sponsorship relationship and with whom. In the professional context, the service professional prescribes the frequency and intensity of contact. Twelve-Step programs are accessible around the clock, including evenings, weekends, and holidays—something unheard of in the professional context. Twelve-Step programs are geographically accessible even when traveling the world; historically, the professional service relationship is rooted to a single location. There are no fees attached to 12-Step participation—only small volunteer contributions to support maintenance of the group. In contrast, professional recovery support can involve tens of thousands and potentially hundreds of thousands of dollars. Twelve-Step programs maintain no record of one’s support activities; professionals maintain extensive records that are not in control of the “patient.” Peer relationships within 12-Step programs rest on a foundation of reciprocity of support and equality of power; professional relationships are hierarchical with greater power placed in the role of the professional. Twelve-Step relationships are potentially enduring; professional relationships are almost universally time-limited and ever-briefer within the current service funding environment. Where 12-Step programs limit invasiveness and levels of personal disclosure (via discouragement of crosstalk and discouragement of taking other people’s inventories), professional treatment often involves pressure for a heightened degree of personal disclosure.
I do not intend to contrast 12-Step and other mutual aid groups and professional interventions into a binary either/or choice or in a contrasting superiority/inferiority judgment. Both have value as mechanisms of recovery support. I am simply pointing out that people have far more personal power in the recovery mutual aid context than in the professional context. Moreover, it is hypocritical for professionals to castigate 12-Step groups as “disempowering” only to offer an alternative in which individuals have far fewer choices and find themselves at the bottom of a hierarchical service relationship characterized by substantial fees, limited accessibility, and short duration of support followed by what many may experience as “clinical abandonment.”