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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On July 20, The Senate Caucus on International Narcotics Control held a hearing on the state of treatment and recovery in the United States, entitled “The Federal Response to the Drug Overdose Epidemic.” Witnesses included federal officials Regina LaBelle (Acting Director of the Office of National Drug Control Policy) and Tom Coderre (Acting Director of the Substance Abuse Mental Health Services Administration.) The role of recovery support services was a central theme of the testimony.
Tom Coderre shared his personal story of recovery and urged lawmakers to see the positive results it has yielded. “True success with substance use disorder also involves enduring efforts, many of which are through recovery supports,” he stated.
Coderre cited that Recovery Support efforts have been part of SAMHSA’s portfolio since the late 1990s. SAMHSA first launched the Recovery Community Support Program, later the Recovery Community Services Program (RCSP) in 1998. This grant helped launch and supported the development and strengthening of recovery community organizations (RCOs). Their focus has been emphasizing the critical importance of as a bi-directional bridge between communities and formal systems, including SUD treatment, and the criminal justice and child welfare systems. Coderre praised RCOs for being peer-led and managed.
Also receiving attention in the hearing were two newer grant initiatives, the RCSP 5-year grant program and the Treatment, Recovery and Workforce Support Grants (Workforce Support). The 5-year RCSP grants build peer recovery support services capacity through recovery community centers, and the Workforce Support grants enhance employment opportunities for individuals in recovery from SUDs by addressing gaps in services and providing opportunities for veterans, homeless individuals, and those reentering the community after incarceration. Coderre mentioned that also of note, SAMHSA developed the targeted capacity expansion-peer to peer (TCE-PTP) grant portfolio forging the path for the extensive ongoing training of peers towards certification and expanding the workforce. This portfolio has provided state recognition for peer support service providers in the workplace and, in some states where allowable, Medicaid reimbursement for their services.
Since 2017, SAMHSA allocated over 60 million dollars to recovery support initiatives, but Coderre urged the Senate to do more to build out the continuum. Following the lead of President Biden’s FY 2022 Budget, he reiterated his call for a 10 percent set aside for recovery support services in the Substance Abuse Prevention and Treatment Block Grant which would provide states with funding to further invest in building out recovery support services.
Acting Director LaBelle reiterated the priorities of the Biden Administration, including a need to expand access to recovery support services, as well as the advancement of recovery-ready workplaces. She recognized that recovery support services are offered in various institutional and community-based settings and include peer support services and engagement, recovery housing, recovery community centers, and recovery programs in high schools and colleges, and increased capacity and infrastructure of these programs will create strong resource networks to equip communities to support recovery for everyone. The required infrastructure includes a safe, reliable, and affordable means of transportation to access recovery support services. She pledged that ONDCP will work with Federal partners, State, local, and Tribal governments, and recovery housing stakeholders to begin developing sustainability protocols for recovery housing, including certification, payment models, evidence-based practices, and technical assistance.
A Historical Summit
by: Bill White
In 2001, more than 130 recovery advocates from more than 30 states gathered in Saint Paul, Minnesota at the invitation of the Johnson Institute’s Alliance Project and with support of the Center for Substance Abuse Treatment’s (CSAT) Recovery Community Support Program (RCSP). That gathering marked the formal launch of a new recovery advocacy movement in the United States. The vision of culturally and politically mobilizing people in recovery and their families and allies was not a new vison, but those of us in St. Paul during those momentous days had an unmistakable feeling that we were participating in something that could reshape the future of addiction recovery. Now, with 20 years of hindsight, we can acknowledge what was so significant about this event.
The 2001 Recovery Summit marked a clarion call to shift the center of the alcohol and other drug problems arena to a focus on the lived solution for individuals, families, and communities. The shift from pathology/clinical paradigms to a “recovery paradigm” exerted pressure for urgent changes in policy, research, treatment, recovery support practice, and service system evaluation. The emergence or elevation of such concepts as recovery management, recovery-oriented systems of care, recovery coaching, recovery support services, recovery capital, recovery cascade (contagion), culture of recovery, community recovery, etc. would be missing from our current landscape without this paradigm shift, as would many recovery-focused research studies.
The 2001 Recovery Summit marked the passing of the recovery advocacy leadership torch from an earlier generation of advocacy organizations, most notably the National Committee for Education on Alcoholism (1944, later the National Council on Alcoholism and Drug Dependence) and the Society of Americans for Recovery (1991). The founding of Faces and Voices of Recovery as an outcome of the Summit set the stage for subsequent efforts, including Young People in Recovery, Facing Addiction, Shatterproof, the Recovery Advocacy Project, Latino Recovery Advocacy, Black Faces Black Voices, the African American Federation of Recovery Organizations, and other national recovery advocacy efforts. Faces and Voices provided the connecting tissue for RCO leaders to gather, communicate, share resources, and speak with a collective voice. The 2001 Recovery Summit set the foundation for the landmark accomplishments of Faces and Voices of Recovery and other recovery advocacy organizations.
The 2001 Recovery Summit marked the coming of age of a new organizational entity—the grassroots recovery community organization (RCO). The emerging RCO was not a recovery mutual aid fellowship, an alcohol/drug problems council, or a prevention or treatment organization, but rather an organization focused exclusively on recovery community mobilization, recovery advocacy, and recovery-focused community development. Subsequently linked through the Association of Recovery Community Organizations, RCOs have been instrumental in supporting further recovery community institution building, e.g., recovery community centers; recovery residences; occupational/workplace recovery programs; recovery high schools and collegiate recovery programs; recovery ministries; recovery-focused health, sports, and adventure programs; and recovery-focused projects in music, theatre, art, and community service.
The 2001 Recovery Summit marked a milestone in multicultural and multiple pathway recovery advocacy. The 2001 Summit was diverse in its representation of women, communities of color, and the LGBTQ community as well as its representation of diverse pathways of addiction recovery. The Summit was historically noteworthy in bringing affected family members into the advocacy movement on an equal footing with those with lived experience of addiction recovery. The Summit marked a milestone: people representing diverse pathways and styles of recovery seeing themselves collectively as “a people” with shared needs and aspirations. That “peoplehood” inspired subsequent calls for authentic and diverse recovery representation at all levels of decision-making within the AOD problems arena.
The 2001 Recovery Summit marked an early vision—the seed—of the integration of primary prevention, harm reduction, early intervention, treatment, and peer recovery support—a process that continues to this day through efforts to delineate roles and responsibilities as well as efforts of coordination and collaboration across this service and support continuum. Prior to the 2001 Recovery Summit, recovery never appeared on the alcohol and other drug service continuum. The emergence of peer recovery support services as a distinct service entity following the Summit constitutes a significant historical milestone.
What the 2001 Recovery Summit did more than anything was weld the personal commitments of individuals and programs into a national recovery advocacy movement. We had a name; a consensus on vision, goals, and tactics; and, most importantly, we had mutually supportive relationships across the country that bound us together in common cause. I look forward to our gathering this October to revision the future of recovery advocacy in the United States.
An Invitation to Return to Saint Paul
by: Philip Rutherford
Even before my arrival at Faces & Voices, I learned about the rich history and significance of the St. Paul summit that happened on October 5, 2001. While working at a Minnesota RCO, I attended an event put on by The Association of Recovery Community Organizations (ARCO) that was modeled after the original summit. At the time, it was called the ARCO Executive Directors Leadership Academy, and it transformed both my personal understanding of the recovery movement, and ultimately the trajectory of my organization. ARCO’s roots are connected to the powerful movement that arose from the St. Paul summit and that continue to propel the work of countless organizations today.
On October 3, 2021, at the River Centre in St. Paul, Minnesota, we will convene another summit to commemorate the passing of the 20th anniversary of that event. We will examine where we are today and look toward the future. The event will have plenary speakers like Bill White, Dr. Nora Volkow, William Moyers Jr. and Dr. Delphin-Rittmon, and will include six different tracks of learning concentrations around Advocacy, Peer Recovery Support Services, Capacity Building, Diversity, Equity, and Inclusion, Family and Youth, and Leadership Development.
Many things have changed about the recovery movement since 2001. At Faces & Voices, we see this event as an opportunity to celebrate the tireless efforts of those who have come before us, honor those in the trenches right now, and help clear a path for anyone who wants to join the journey. Similarly, some things haven’t changed, and we see this event as an opportunity to have frank and open discussions about where change is required.
If 2020 has taught me anything, it is to expect the unexpected, and as such, I’d be remiss if I didn’t mention COVID-19 and the possibility of rates of infection affecting our plans. The COVID-19 Delta and Lambda variants are influencing how the celebration will take place. We are closely monitoring guidelines and restrictions and will make decisions as the situation unfolds.
Unless restrictions prohibit us from gathering, we plan on hosting the conference in-person. We understand some people may be hesitant to attend, due to safety concerns.
If necessary, we will deliver a webinar-based, hybrid option to accommodate more people, so that we can still be together as a community for this important milestone. We will update you as we can. In addition, the River Centre has taken a number of precautions to ensure your safety.
Thank you for your patience and understanding during this time.
To make it a bit clearer, here are three possible scenarios as examples:
Scenario A– All is well. No mandates or city-wide orders in place regarding COVID
*Summit takes place as scheduled. Proof of Vaccine/Negative test results/mask required (with audit during event). We will stream only keynote events.
Scenario B– Positivity rates increase, moderate concern surrounding transmission. No mandates or city-wide orders in place regarding COVID.
*Summit takes place as scheduled. Proof of Vaccine/Negative test results/mask required (with audit during event). Social distancing rules will be enforced, hybrid conference occurs with streaming of each session.
Scenario C-All is not well, mandates or city-wide orders are in place regarding COVID
Summit takes place entirely in virtual space.
Gate: September 1 decision date
Nationwide positivity of >12% Scenario C
Nationwide positivity of 5-12% Scenario B
Nationwide positivity of <5% Scenario A
Regardless of the eventual format, we extend a warm invitation for you to participate. You can register by clicking HERE. Let’s go make some more history.
UPDATE: On September 1, 2021 Faces & Voices of Recovery made the difficult decision to move the event to a completely virtual setting.
When I remember the thousands who died, many whose stories were never recorded in history, I bow my head. And when my wailing is done, I get up and carry on, not in my name, but in theirs….When you know your history, you know your value. You know the price that has been paid for you to be here. You recognize what those who came before you built and sacrificed for you to inhabit the space in which you dwell. –Cicely Tyson (with Michelle Burford), Just as I am
We have not even to risk the adventure alone; for the heroes of all time have gone before us; the labyrinth is thoroughly known; we have only to follow the thread of the hero-path. And where we had thought to find an abomination, we shall find a god; where we had thought to slay another, we shall slay ourselves; where we had thought to travel outward, we shall come to the center of our existence; where we had thought to be alone, we shall be with all the world. –Joseph Campbell, The Hero with a Thousand Faces
Those seeking and in recovery owe a great debt of gratitude to earlier generations of people whose life discoveries opened and charted pathways to addiction recovery and built the recovery support organizations available to us today. Much of my (BW) past work focuses on excavating and celebrating the lost stories of these recovery pioneers.
The stories of many of our recovery ancestors remain publicly shrouded behind a veil of stigma. For generations, others who sought our control or cure spoke on our behalf while our own faces and voices remained hidden and silent. Actually, those who spoke for us spoke their stories—their perceptions of us and their work on our behalf, but authentic, first-person narratives of addiction and recovery remained obscured and sometimes misrepresented by such accounts.
Today, we are rediscovering lost recovery stories and declaring that we can now speak for ourselves. Every stigmatized and oppressed people must liberate their history and take control of their own stories. As the African proverb suggests, “Until the lion learns how to write, every story will glorify the hunter.”
We as a people can assure that the stories of our recovery ancestors are preserved and called forth at critical times to illuminate our present circumstances. Here are few potential possibilities.
*Designating and training archivists and archival skills within recovery-focused organizations
*Creating formal recovery archives for historical preservation and research
*Digitizing historical materials and creating virtual libraries filled with resources on the history of addiction recovery
*Creating and disseminating histories of recovery, recovery mutual aid and advocacy organizations, and key recovery figures via articles, books, films, plays, and photo exhibits.
*Creating and disseminating the history of recovery among special populations, e.g., women, youth, people of color, LGBTQ, etc.
*Preserving iconic historical sites
*Creating forums for communication between people interested in the history of recovery, e.g. AA History Lovers, NA History Lovers
*Creating oral history projects through which the stories of local recovery elders are recorded and preserved
*Hosting symposia on the history of addiction recovery and related organizations, and
*Ancestor consultations: Consulting with local recovery elders and regularly asking ourselves how recovery ancestors responded to challenges and opportunities similar to those we are currently facing.
Our recovery ancestors have provided a body of historical lessons. They have endowed an intellectual and emotional inheritance on how to best navigate the complexities, challenges, and opportunities within the experience of addiction recovery. They have also forged values and traditions that can best guide our collective life within recovery-missioned organizations. We honor our ancestors by letting their lessons inform our current circumstances. We show up to assert our own needs and aspirations, but we also show up to honor the ancestors that make our survival possible.
You cannot know yourself without knowing the history of your people. We bear the scarred wounds of past recovery generations—the emotional memory of objectification, demonization, maltreatment, and mass incarceration, but we also possess within us the inherited capacity to survive and thrive if we draw upon it.
We must all become students of our history as a people. Once we become students of history, the wisdom of our recovery ancestors lives inside us. We can then elicit the voiced guidance of our ancestors when we most need it. We are but one link in this chain of history. What we as a people achieve today are the fulfilled dreams of our ancestors. What we do today in preparing those who will follow us will shape the future of recovery for generations to come.
We must show up and do our part to prevent a break in this historical chain of personal healing and social progress. We do that for ourselves and in payment for our ancestors’ sacrifices. Our ancestors do not die until we last speak their names. In honor of what they have bequeathed to us and as aide to our own survival and health, we must continue to speak their names.
Posts from William White
The remaining days of 2020 will be difficult and contentious: a raging pandemic, economic aftershocks, social justice protests, and yet unseen global crises—all hyper-illuminated by the inflammatory rhetoric of political campaigns. What is the call to service for recovery advocates in such turbulent times? Yes, we should keep our eyes on the prize: easing the suffering of people affected by addiction, widening pathways of personal and family recovery, strengthening recovery support institutions, and advocating for pro-recovery social policies—as we always do. But is there now a larger call to service within the story of America? Does America itself need a recovery process, and might we play a role in such collective healing? People in recovery have much to offer at this unique juncture of cultural history. We are experts in brokenness, crisis management, and the processes of healing wounds to body and character. Below are a few reflections on what you can expect in the coming months and some examples of what we may be able to offer as a balm to America’s wounds.
You will witness narcissism writ large (“self-will run riot”) from many quarters—grandiosity, arrogance, self-righteousness, and projection of blame. You will see very little of the patience, humility, acceptance of imperfection, embrace of personal responsibility, generosity, gratitude, forgiveness, and unpaid acts of service that have been critical to our own recoveries. We can exemplify these at a time our country is in desperate need of them.
It will be a fearful, noisy, resentful, angry time, with people loudly speaking over and at each other. We can model quiet empathy and our ability to ask questions in search of information rather than as confrontation. We can model compassion, mindful presence, our capacity to listen, and the childhood lesson of “taking turns” as antidotes to vitriolic speechmaking with closed ears and minds.
You will witness frequent examples of dishonesty, factual distortion, and betrayal of past promises. We can model and extol the musty values of honesty, loyalty, and fidelity (promise-keeping) through our daily interactions.
Self-seeking, wannabe leaders will fuel fear and hate to divide us into “we-they” for their own purposes. We can model the values of tolerance, compassion, love, faith, and hope. We can celebrate our shared humanity and shared fate.
You will see the sustained effects of social isolation and alienation—something we know a great deal about. We can share the transformative power of connection to community. We can share how we were able to achieve together what we could not achieve alone, and how connection is possible even in the most difficult of circumstances, that our most desperate moments were also moments of immense opportunity.
You will hear the sounds of pain and anguish—the aftermath of profound loss and life disruption. We can model hope and the possibility of future joy and laughter at times when these seem impossible.
You will see people simply overwhelmed by what feels like unceasing demands and distractions. We can share the value of simplicity, the power of focus, persistence, and the achievements that can ensue from one step at a time, one day at a time.
You will see all manner of excessive behaviors as people become unanchored from personal and social constraints. As a people who know much about such excess, we can model the value of harmony and balance.
You will see a backlash against calls for social justice. We can model the importance of justice and the healing power of self-inventory, acknowledgement of past and present wrongs, making amends, and larger acts of community contribution.
A wounded America is hurting. Desperately needed ingredients within the heart of American life are waning. People in recovery will help each other through these turbulent times, and we can also serve by injecting into the larger culture those critically missing ingredients. We can be agents of cultural healing.
“We Recover and We Vote” is a leading recovery advocacy slogan. This November we can also cast a vote for cultural healing by selecting leaders who most exemplify the values so critical to our own personal recoveries—including the values of honesty, humility, personal accountability, empathy, tolerance, gratitude, justice, forgiveness, and service. There are more than 23 million American citizens in recovery. What would happen if we and our families and allies collectively voted for these values? We’ve recovered; it’s time for our country to recover.
A lot is happening in the world of addiction recovery. The growth and international dispersion of secular, spiritual, and religious recovery mutual aid organizations. The exponential growth of online recovery support resources. The emergence of resistance, resilience, and recovery as alternative organizing concepts for policy, planning, and funding bodies. Increased representation of people in recovery within addiction-focused policy and planning venues. Efforts to shift the design of addiction treatment from models of acute care to models of sustained recovery management nested within larger recovery-oriented systems of care. Expansion of peer recovery support services as adjuncts or alternatives to professional treatment. New recovery support institutions: recovery community organizations, recovery community centers, recovery residences, recovery support within educational settings, recovery industries, recovery ministries, recovery cafes, recovery music festivals, recovery adventure and sports venues. Large public recovery celebration events. Recovery-focused political lobbying. Expanded funding for recovery-focused research studies and an increase in the number of research scientists specializing in recovery research.
These and related innovations are the downstream effects of the cultural and political mobilization of people in recovery and their allies. The emergence of a new recovery advocacy movement and an ecumenical culture of recovery reflects an important historical shift: people from diverse pathways of recovery identifying themselves as “a people” with a distinct history, shared needs, and a linked destiny. As this movement transitions beyond mass mobilization and institution building, it is pushing recovery-friendly policies and practices within law, government, health care, popular and social media, religion, business and industry, entertainment, and education.
Recovery-focused activities are evident in two arenas within institutions of higher education: the growth in collegiate recovery programs and recent calls for the creation of “recovery studies” on par with earlier academic specialties, e.g., Black/minority studies, women’s studies, disability studies, and queer studies.
Collegiate Recovery Programs
Collegiate Recovery Programs (CRPs) are structured supports for students in recovery on college campuses. The Collegiate Recovery Movement began at Brown University in 1977 and was later joined by programs at Rutgers, Texas Tech, and Augsburg. However, by the 2009 founding of the Association of Recovery in Higher Education (ARHE), there were still only a handful of such programs nationally. That has changed dramatically over the past 10 years as there are now more than 150 schools hosting a collegiate recovery program, spurred in part by a large grant program through Transforming Youth Recovery. These programs have evolved and diversified their scope of services: from the original schools whose programs were more formally structured and 12-Step focused, to programs that offer and support many pathways to recovery and provide a range of intensity and formalization of services.
While addiction-related stigma remains a problem among many University administrators and faculty, some schools have embraced CRPs as a part of larger equity and inclusion efforts. Students in recovery on campuses often report feeling marginalized and threatened by what are usually “abstinence-hostile environments”. The creation of recovery spaces, especially physical spaces with dedicated staff, offers students a retreat within the campus environment and serves to validate and support their identities as people in recovery. CRP Students are, on average, significantly older than other college students and thus are often managing additional challenges from being the oldest student in the class, to child care, part or full-time work, heavier familial responsibilities, and other obligations within their recovery community. CRPs seek to not only validate these students but to elevate and celebrate them as they balance school, work, and management of a chronic, and potentially fatal health condition.
Towards Recovery Competence as Cultural Competence
Efforts to grow recovery supports on college campuses are only a part of addressing a University’s responsibility towards people with severe substance use disorders and those in recovery. Far more people in recovery have and continue to navigate the rigors of higher education without CRPs. These students, like many staff and professors on college campuses, separate out their recovery identity from the relationship with the institution. This can create uncomfortable identity conflicts and also robs these institutions of the experience and wisdom that people in recovery have to offer. Creating spaces that encourage and nurture recovery identity enriches the experience of students, faculty, and staff across the university. It is also a moral and ethical imperative for schools that receive tens of millions of dollars in substance-related grant funding to provide recovery support for their own students, staff, and faculty.
Anecdotally speaking, people in recovery are well represented as students and professionals in fields such as substance use counseling, social work, psychology, rehabilitation, and mental health counseling. This is unsurprising given the academic trope “research is me-search”. In many of these classes and professions, students report their experiences being poorly represented or missing entirely in the literature, and worse are often discouraged explicitly or implicitly from sharing their recovery status in their programs or professions. Researchers in recovery frequently hide their recovery status to avoid being labeled as biased or for fear of reprisal within the tenure process. The irony and hypocrisy of the extensive stigma within both the academy and the field perpetuated by many in these “helping professions” demonstrate the necessity for explicit study and celebration of people in recovery through curricular inclusion and expectations of continual development of cultural competence around recovery for professionals.
Universities must learn from the tremendous contributions of Black Studies, Women’s Studies, LGBTQ and Disabilities studies departments who have not only greatly enhanced their own University’s dialogues around these issues but have provided the intellectual bedrock and framework of the most important movements towards equity and justice in our country. These programs have infused subject matter expertise and the voices of people within the communities into the content of teachings throughout the University, while also creating stand-alone fields. In the same way, the serious academic study and teaching of recovery on campuses across the country has the potential to greatly enhance the fields of Psychology, Social Work, Medicine, Counseling, Pharmacy, and Nursing and, in so doing, create a generation of professionals who have cultural competence in recovery, while also highlighting and celebrating recovery voices.
International Programme of Addiction Studies (IPAS)
The International Programme on Addiction Studies (IPAS) is a unique and distinguished academic study program that offers a global understanding of critical issues in the field of addiction. Primarily focused on prevention, treatment, policy, and research, IPAS brings together three of the world’s leading research universities, King’s College, London, the University of Adelaide, and Virginia Commonwealth University. Through distance learning, the Programme offers three graduate options to its students: a Master of Science in Addiction Studies, an Intermediate Graduate Certificate in International Addiction Studies, and an Advanced Graduate Certificate in International Addiction Studies.
Students learn to think critically about issues within the field of addiction science. Although recovery is not the primary focus of the program, students are taught to apply their critical knowledge of the field of addiction science to a variety of settings, including community-based settings addressing recovery supports and services, i.e., peer recovery support services, recovery community organizations, recovery community centers, recovery residences, and education-based recovery support services. The research project required to earn the Master of Science degree addresses key questions in addiction science and assists students in appraising the research literature and translating it into more effective policies and practices.
For many students, this course of study becomes part of the process to earn a PhD. For others it offers a more in depth opportunity to explore and analyze some of the discrepancies, gaps, and issues that exist in the addictions field. Individuals in long-term recovery have graduated from the program, most of whom are seeking to use their passion, lived experience, and knowledge of addiction science to prepare them for work in a variety of settings. One recent graduate has used the skills and knowledge received in the Programme to lead national recovery efforts on behalf of individuals and families in recovery.
More research is needed to advance the field of addiction, and to advance the understanding and field of addiction recovery. As more individuals develop an interest in addiction recovery, research programs like the International Programme on Addiction Studies will emphasize recovery as one of the focus areas of their programs. Until then, it is one of the only programs that requires exceptional students to extend their learning and focus their research projects on facets of recovery. These men and women are among the pioneers of the growing numbers of addiction recovery researchers and practitioners who are paving the way for the next generation and making huge strides in the understanding of and outcomes associated with addiction recovery in all of its phases, stages, and other expressions. Additionally, the multi-country, multi-site, and online nature of the collaboration creates opportunities to study and understand recovery in a variety of cultural contexts and pathways to recovery.
The addiction recovery field has undergone incredible growth over the past several decades. Even though many within the field have embraced a shift from pathology and clinical intervention to a focus on long-term personal and family recovery, many professionals still view and treat addiction as an acute condition.
With the lack of knowledge and expertise about recovery, there is a great need for qualified and trained addiction recovery professionals, including clinicians and researchers within the field. The need for these professionals will only increase over time as more and more people meet the criteria for severe substance use disorder and enter into recovery. Educational programs for mental health providers (e.g., social workers, counselors, marriage and family therapists, etc.) often do not have any classes dedicated to addiction let alone a focus on recovery. In addition to this lack of training, very few doctoral programs train researchers to study addiction and recovery. Thus, although more than 20 million people are in recovery in the United States, we do not know enough about how people enter recovery, navigate recovery, the multiple pathways of recovery (and what works for who), and how individuals and families stay in recovery over a life-time. The recent National Recovery Study indicated that on average it takes more than a decade of recovery for an individual to experience happiness and self-esteem on par with the rest of the population. We know too little about how to enhance the quality and durability of recovery.
Many bright and capable people have written and studied recovery in the past and their work provides a platform that is ripe for clinical improvement and scientific inquiry. Potential elements of recovery studies could include the following: history of addiction recovery, defining and measuring recovery, prevalence of recovery, neuroscience of recovery, multiple pathways of recovery (including harm reduction), stages of recovery, recovery durability (together with recurrence rates and risks), bio-psycho-social nature of addiction and recovery, behavioral addiction and recovery, and family and community recovery (within systems theory). In addition to these, we as professionals in the field need to understand the role and effectiveness of professional treatment and the power of recovery mutual aid organizations including extending recovery support through peer and community-based solutions (e.g., Collegiate Recovery Programs, Community Recovery Centers, etc.). Recovery studies should also include the relationship of recovery to prevention, early intervention, and the current issues and trends of the addiction recovery field.
For those who wish to be good consumers of recovery research or conduct that research, an understanding of the relevant literature and theories of recovery is necessary. Also, students of recovery must delve deeply into advanced research methods, both quantitative and qualitative, including advanced statistics. It is beyond time for the addiction recovery field to elevate ourselves to academic excellence and scientific rigor.
Texas Tech University’s (TTU) Department of Community, Family, and Addiction Sciences (CFAS) offers some insight into how educational programs can integrate recovery studies into their curriculum. In 1986, Texas Tech started a minor in Substance Abuse Studies (SAS), which attracted many students in recovery. These SAS students in recovery were taking classes to meet the educational requirements to become Licensed Chemical Dependency Counselors (LCDC) in the state of Texas. In 1988, Dr. Carl Anderson, a professor in the program and a person in long-term recovery himself, formed the Center for the Study of Addiction, which was one of the first collegiate recovery programs. The Center was later named the Center for the Study of Addiction and Recovery (CSAR 2003-2013) and is currently named the Center for Collegiate Recovery Communities (CCRC) (2013 – current). The name changes of the Center reflect the evolving understanding of addiction recovery and a transitional focus not only on recovery generally but on TTU’s collegiate recovery program specifically.
The SAS minor served and educated numerous students over many years. As the demand for more addiction recovery classes grew in 2007, the Community, Family, and Addiction Sciences (CFAS) department was formed and an undergraduate major in community, family, and addiction recovery was approved and implemented. The CFAS Department also offered programs in human services, addiction and recovery, and couple, marriage, and family therapy—with integrated classes on addiction and recovery. During the formation of the CFAS undergraduate degree, the former SAS minor was updated and underwent a name change to Addiction Disorders and Recovery Studies (ADRS).
Currently, the ADRS minor offers courses in understanding addiction and recovery, family dynamics of addiction and recovery, prevention, relationships, treatment, and research in addiction recovery. The minor continues to meet the educational requirements to become a LCDC in Texas. Presently the CFAS undergraduate major has 65 students and the ADRS minor has 302 students.
In July 2017, after many years of work, the CFAS department gained approval to start perhaps the first PhD. program focused solely on addiction recovery research. Grounded in Family Systems Theory, the ADRS PhD is a timely and unique program with the goal of creating scholars and academicians who have a passion for the science of addiction recovery. These doctoral scholars will have an understanding of addiction recovery, including relevant literature, recovery theories, and research methods and statistics. The students will be prepared to advance the field of addiction recovery with scientifically rigorous research studies from both the qualitative and quantitative traditions. The first cohort of PhD students started their work fall, 2019. Many within this first cohort of PhD students are persons in long-term recovery and products of collegiate recovery programs. With such a wonderful platform of recovery science built for us as a field, the future of addiction recovery knowledge, understanding, and research is bright.
Multiple factors set the stage for the expansion of collegiate recovery programs and the development of recovery studies programs at undergraduate and graduate levels. The former provide a dual emphasis on recovery support and academic excellence; the latter signal the recognition of addiction recovery as an important subject for critical academic inquiry. Historically, experiential knowledge and professional/scientific knowledge exist as two separate worlds within the alcohol and other drug problems arena. Collegiate recovery support programs and recovery studies curricula offer a potential bridge of integration between these two worlds. The future of recovery may rest within that integration.
There is something special about the number 90 in the worlds of addiction treatment and recovery. Recovery mutual aid groups extol the value of 90 meetings in 90 days as a foundation for long-term recovery. The National Institute on Drug Abuse Principles of Drug Addiction Treatment defines 90 days across levels of care as the threshold of clinical support below which recovery outcomes begin to deteriorate. Of all those discharged from addiction treatment who will resume drug use in the following year, most will do so in the first 90 days following discharge. There is a high risk of addiction recurrence and increased risk of overdose death in the 90 days following cessation of methadone maintenance treatment. Abstinence status in the 90 days following discharge from addiction treatment is predictive of long-term recovery outcomes.
The ideal design of addiction treatment and recovery support based on this clear dose effect of recovery support would contain several critical ingredients.
*A minimum of 90 days of professional support across levels of care would be provided to all people seeking treatment for a substance use disorder of high severity, complexity, and chronicity.
*Post-treatment monitoring and support would be provided to ALL clients, not just those successfully completing treatment.
*Responsibility for continued contact would lie with the recovery support staff rather than the person completing primary treatment.
*Saturated support would be provided in the first 90 days following primary treatment.
*Periodic post-treatment “recovery check-ups” would be provided for a minimum of five years using an individualized schedule shaped by client needs and preferences.
As a country, we are a long way from achieving community-based treatment and recovery support systems that contain these critical ingredients, but efforts to shift addiction treatment from an emergency room model of acute biopsychosocial stabilization to a model of sustained recovery management are underway in many states and within many treatment programs. The future of recovery and the future of addiction treatment as a social institution rest on the success or failure of these efforts.
The first 90 days of addiction recovery mark an abrupt ending and a fragile beginning—a death and rebirth. Who would not need intense and sustained support through such transitions? A central mission of recovery advocacy is to assure the universal availability of sustained professional and peer-based recovery support.
Anglin, M. D., Hser, Y. I., & Grella, C. E. (1997). Drug addiction and treatment careers among clients in the Drug Abuse Treatment Outcome Study (DATOS). Psychology of Addictive Behaviors, 11(4), 308–323.
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Dennis, M. L., Foss, M. A., & Scott, C. K. (2007). An eight-year perspective on the relationship between the duration of abstinence and other aspects of recovery. Evaluation Review, 31(6), 585-612.
Hubbard, R.L., Flynn, P. M., Craddock, G., & Fletcher, B. (2001). Relapse after drug abuse treatment. In F. Tims, C. Leukfield & J. Platt (Eds.), Relapse and recovery in addictions (pp. 109-121). New Haven: Yale University Press.
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Ki te mea ka taka te kākano ki te wāhi e tika ana ka tinaku, ā, ka pihi ake he tipu hou
(If a seed falls in the right place it will germinate and a new seedling will sprout)
As William White has argued, recovery is contagious and passes in social networks from one visible ‘carrier’ to another through processes of attraction, engagement, social learning (imitation) and social connection. While this seems like a magical or mystical process, it can be harnessed and applied in treatment settings where there is a commitment to celebrating lived experience and where there are community supports and resources available.
What is described in this paper is how these principles are being used in Auckland, New Zealand, to promote and sustain recovery and to build stronger communities throughout the city.
Odyssey is a not-for-profit organisation supporting New Zealanders with addiction challenges since 1980. Operating in communities, schools, prisons and residential settings, Odyssey works together with tāngata whai ora (people seeking wellness) to help them move forward with their recovery.
The partnership involves Odyssey and a UK university (Derby) who are applying three linked evidence-based techniques to support tāngata whai ora and communities to build all three component parts of recovery capital, each of which maps against one of techniques that we will be using in the project.
Table 1: Recovery capital model and measurement: What it means and how to measure it:
|Type of capital||Definition and examples||Measurement process|
|Level 1: Personal recovery capital||The abilities and skills that the person needs to build to sustain and grow their recovery and wellbeing, e.g. self-esteem, resilience||REC-CAP (Cano et al, 2017): A strengths-based approach to assessing recovery assets and barriers|
|Level 2: Social recovery capital||The social supports the person has and their commitment to them eg family, home group||Social Identity Map (SIM; Best et al, 2016) which is a visualisation of the groups the person belongs to and their commitment to those groups|
|Level 3: Community recovery capital||The resources available in the community that the person can tap into to support their recovery journey||Asset Based Community Engagement Tool (ABCE; Collinson and Best, 2019) which is a way of mapping community assets and the individual’s experiences of engaging with each. Once assets and pathways into such assets have been identified, processes of ‘assertive linkage’ hold great importance to connect individuals into the appropriate resources|
The purpose of the whole model is to develop the Level 1 resources – those skills and capabilities that will protect and support a recovery journey. But we know that this takes time – according to the Betty Ford Institute Consensus Group, ‘stable recovery’ (five years or more of abstinence) takes around five years to achieve.
What our work has shown is that those personal qualities (self-esteem, self-efficacy, communication skills, coping skills and resilience) do not grow by themselves. They are seeds that can blossom into blooming flowers if they are nurtured by social supports and by communities that care and that provide the fuel and nutrients that will allow the flowers to blossom. Supports include therapeutic communities and traditional treatment approaches as well as mutual aid groups, sports and recreation activities, volunteering opportunities, colleges and apprenticeships.
Each person in recovery is different, with a unique set of skills, passions and relationships. The REC-CAP (Level 1) will assess what those strengths and skills are and what barriers there are to building that strengths base and is repeatedly administered (every three months or so) so that the person receiving support can chart their growth in recovery resources, the ultimate metric of how close they are to being ‘self-sufficient’ in their recovery.
The REC-CAP concludes with a recovery care plan, and that is where the Level 2 and Level 3 activities come in.
At Level 2, the Social Identity Map is a visualisation technique that will show the social groups and networks the person belongs to that are pro-recovery (social recovery capital) and that are barriers to their recovery (negative social recovery capital). The map will show how that social world needs to change to allow personal recovery capital to grow, and also the extent to which external supports are needed to actively (assertively) link the person to the recovery resources at Level 3.
The ideal situation is that the person early in their journey has access to supportive groups that they are committed to and who are committed to supporting their recovery. But they will also need their own unique set of resources outside of the social network, and this is where the Level 3 Asset Based Community Engagement process comes in.
For the flower of personal capital to grow, the twin stakes of social and community capital are needed to support the plant until it can stand alone.
And here is the beauty of this model. It is not a zero-sum game. As each recovery flower blooms, so the garden is enriched and enhanced.
To end where we started with William White’s work – he has argued that the soil must be fertile to support recovery growth. Our argument would be that each time a flower blooms in this field, the garden is enriched.
To cite a second academic giant, the Australian criminologist John Braithwaite, social capital is not like financial capital. We all know that when you spend financial capital you end up with less of it. But this is not true of social and community capital. The more of it that is used, the greater the pool that exists.
For every recovery flower that blossoms, so the soil is enriched, and the easier it is for new flowers to grow. As recovery takes hold in a ‘therapeutic landscape’, the community has greater resources, less exclusions and stigma and more resource to support this approach.
The Social Model of Recovery is an attempt to marry the nurturance of the field with the growth of each individual flower to create personalised pathways to stable recovery.
The Problem of Substance Abuse Substance abuse is America’s number one health problem—a problem that touches the life of every American child, family, congregation and community. Contrary to popular perception, America’s substance abuse problem results not only from illegal drugs like crack cocaine, but also from the “recreational” use of so-called “soft” drugs, like marijuana, and the “extra-medical” use of prescription medicines.1 A brief accounting of American’s substance use and its consequences places the issue in perspective.
No culture is neutral about psychoactive drugs. Such substances are placed into four overlapping categories: celebrated (ritualized, promoted, and commercialized), instrumental (regulated as to who, when, where, and how use can occur), tolerated (available but discouraged and socially stigmatized), or prohibited (stigmatized and severely punished). Such designations are subject to rapid change over time. Think, for example, how many of these categories alcohol, tobacco, caffeine, marijuana, cocaine, methamphetamine, and opioids have occupied throughout American history or even within your lifetime.
The social and legal status of psychoactive drugs evolves under powerful political, economic, social, and religious forces. Such cultural designations influence drug availability, the size and characteristics of the user population, product variability and cost, product purity and potency, methods of drug administration, as well as when and where drug use can occur. Historically, licit and illicit drug industries have played a central role in expanding each of these dimensions and religious and public health institutions have served as constraining influences across these dimensions.
At present, there are several historically important trends in the United States regarding the cultural status of psychoactive drugs. Caffeine is achieving unprecedented levels of ritualization and celebration within the culture. Cannabis is being increasingly destigmatized, decriminalized, medicalized, legalized, and commercialized. Tobacco products and the tobacco industry are facing increased stigmatization and control efforts. Opioids are undergoing increased control, and opioid-linked pharmaceutical companies are facing retribution for past profiteering and marketing excesses. Less culturally visible are shifts in alcohol use, a rise in alcohol-related deaths, and the ever-increasing diversification and promotion of alcohol products.
These shifts mark dramatic changes within the culture. Note, for example, that the physical and social spaces in which tobacco products can be purchased and used are shrinking at the same time the parallel spaces for cannabis are expanding. This brief essay is a further exploration of my interest in such spaces and what they mean for people recovering from addiction to various psychoactive drugs (For an earlier essay on this, see HERE).
Several trends are noteworthy related to the expansion of sober spaces in local communities.
First is the expansion of recovery support institutions and activities beyond addiction treatment programs and formal recovery mutual aid organizations such as Alcoholics Anonymous and other 12-Step programs and the growing network of religious and secular recovery mutual aid organizations. These new institutions include recovery community organizations (focused on advocacy, peer recovery support, and harm reduction), recovery homes, recovery high schools, collegiate recovery programs, recovery churches and ministries, recovery cafes, recovery theater groups, recovery-focused sports and adventure venues, recovery book clubs, and recovery music festivals, to name a few. Collectively, these new recovery-focused institutions are expanding the physical, psychological, and social space in which recovery can flourish within local communities. They are creating a drug-free, recovery-friendly social world in which people seeking escape from addiction can live, love, learn, work, worship, and play.
A second trend of note is the “sober-curious” and related movements whose members are seeking a healthier and more enjoyable alternative to alcohol/drug-saturated social activities. These include the rise of wellness clubs, nutrition groups, sober bars, and other health-focused groups who sponsor alcohol and other drug free activities. The sober curious movement includes “Dry January” and other activities that give people an organized way to try on sobriety as a healthy lifestyle. Capitalizing on this movement are a growing network of businesses, that prior to pandemic restrictions, offered alcohol-free drinks (“mocktails”, non-alcoholic beers and wines) within alcohol-free venues.
The above trends suggest that the drug-free space in local communities is expanding for people self-identified as being in addiction recovery as well as for people who have concerns about their alcohol or drug use and want to sample the drug-free lifestyle without the potential stigma attached to addiction treatment or recovery mutual aid involvement. These trends suggest a critically important strategy for recovery advocacy and recovery support organizations: expand local recovery support institutions and recovery spaces within the local communities you serve. This moves our vision beyond that of supporting the personal recovery journeys of individuals and families to creating physical and social worlds that accept and welcome a drug-free lifestyle.
In his most recent book Talking to Strangers, Malcolm Gladwell explores the concept of coupling–the idea that “behaviors are linked to very specific circumstances and conditions.” In this view, addiction is a collision between personal vulnerability, the ever-increasing pharmacological power of psychoactive drugs, and social contexts that encourage drug exposure and amplify the intensity of drug effects. Similarly, recovery is a complex spectrum of ideas, behaviors, sentiments, and relationships elicited and rewarded within particular physical and cultural contexts. Change the contexts and you change the probabilities of both addiction and recovery.
Physical places and sociocultural contexts exert profound effects on human behavior—a reality too often ignored within biological models of addiction. The repertoire of behaviors that constitutes the states of addiction and addiction recovery are far more than an expression of intrapersonal vulnerabilities and strengths—more than a mirrored expression of genes, character, and personality. Personal behavior can reflect the influence of or domination by the ecosystems in which one is nested/trapped. This suggests the need to extend our focus beyond the intrapersonal to the ecology of recovery—creating social contexts that elicit recovery and suppressing contextual factors that increase risk of addiction.
So, do we continue to send fragile recoveries into environments in which only the strongest recoveries survive? Or do we build recovery-friendly communities in which even the most fragile recoveries have a chance of survival? Those are the questions we face as a country and as people working in the addiction/recovery arenas. We must always attend to recovery at a personal level, but we must also think about recovery in its local, regional, national, and global contexts. Both addiction and recovery are a reflection of the ecologies in which they are nested.
The addiction process so empties some of us that we cease being a person. Having lost any semblance of boundaries, hugging us is like trying to hug smoke. Only a masked ghost of our former selves, we exist only as a drug-consumption machine dragging along whatever whisper of our former self that remains. We devolve to a simple organism that has only one function in life—to seek and consume the elixirs that are now the center of our existence. We can no longer assert or protect the self except in service to the drug. The self is empty and its psychological boundaries are now permeable and invisible.
For others, protecting the addiction master requires developing rigid boundaries and impenetrable characterological armor. Hugging us is like trying to hug a porcupine. Completely hidden from others, we become similarly unknown to ourselves. To encounter us is to be repelled. We devolve into little more than mechanisms of defense: pushing people away with machinations of rationalization, intellectualization, overcompensation, projection of blame, black-white thinking, or hostility.
These two patterns share an integrating core: the loss of self and the lost capacity for intimate relationships. The extremes of this experience vary by our pre-addiction lives and by the severity and duration of our addiction careers.
Recovery, depending on our style of adaptation within the addiction experience, involves either forging or loosening boundaries on the journey to reconstructing ourselves. This process of character and identity reconstruction can be an intimidating if not terrifying experience, but the tasks typically unfold slowly across the stages of recovery.
Each stage of recovery entails an unfreezing and refreezing of the personal defense structure that once supported addiction. The critical issue in this change process is that of pacing. If unfreezing is too rapid, we become overwhelmed and the risk for addiction recurrence rises rapidly. If the unfreezing is too slow, we remain rigid and aggressively project our character armor in ways some depict as a “dry drunk” even when we remain free from drug use. In the two styles described above, the former challenge is to develop and assert boundaries and the latter challenge is to relax one’s defenses. Both require careful pacing and are essential to increasing our capacity for healthy intimate relationships.
A community of shared experience and vulnerability can facilitate growth in recovery. If we are diligent but patient, this will unfold over years, long after the cessation of drug use and long after the disengagement of professionals that may have helped us initiate recovery. For some of us, the time of greatest need of professional support may be after recovery initiation and stabilization. At that point, the question is not how to get into recovery. The questions instead are how to fill the “hole in the soul” once filled by drugs and how to relate to others without the filtering balm of such substances.
Perhaps most difficult is restructuring relationships that span addiction and recovery. Dr. Stephanie Brown and colleagues have eloquently described the “trauma of recovery” that families can experience during the transition between these two states. Intimate and family relationships that have absorbed all manner of drug insults during the addiction years but somehow survived are at risk of disintegration during the early recovery years if scaffolding of support is lacking to restructure relationship roles, responsibilities, rules, and rituals. A community of others in recovery and varied helping professionals can provide such scaffolding.
Each of us brings a unique capacity for intimacy—a capacity commonly depleted through the addiction experience. Recovery offers the promise that with time and support such potential can be retrieved and expanded.
One of my favorite authors is Dr. Oliver Sacks, the famed clinical neurologist and author of such works as The Man Who Mistook His Wife for a Hat, Awakenings, and Seeing Voices. Two of Sacks books (Hallucinations and On the Move) and a Sacks biography (And How Are You, Dr. Sacks by Lawrence Weschler) recount Sacks early drug experimentation, his eventual addiction to amphetamines, and his subsequent recovery process.
Sacks’ recovery from addiction began in 1966 as an epiphany about the destructiveness of his accelerating sexual and drug appetites. That breakthrough of self-perception led Sacks to seek help from psychotherapist Dr. Shingold who accepted Sacks as a patient on the condition that Sacks cease his drug use. Through therapy, Sacks developed a deeper understanding of the potential threats his drug use posed to his career and his life, but there was another even more powerful catalyst of his recovery. As Sacks describes:
“…the fact is that through all of those drug experiences, I had been trying to get somewhere, and finally, I did, and what had previously been a febrile incandescence, a sterile awakening, became a fertile awakening. And after that, I didn’t need the drugs anymore” (And How Are You, Dr. Sacks, p. 78).
Looking back later on this process, Sacks reflected, “I would continue to seek satisfaction in drugs, I felt, unless I had satisfying—and hopefully, creative—work. It was crucial for me to find something with meaning, and this, for me, was seeing patients” (On the Move, p. 146)….The joy I got from doing this [recording the experiences of his patients through his writings] was real—infinitely more substantial than the vapid mania of amphetamines—and I never took amphetamines again.” (Hallucinations, p. 1627-1628)
Drug use, like most if not all human behavior, is purposeful. The diverse needs potentially met via drug use reveal differences in the seductiveness of such experiences and the wide variability of addiction vulnerability, severity, and duration. For some people, drugs serve a function so powerful, so central to one’s essence, that they become THE purpose for living.
Dr. Sacks recovery narrative illuminates the distinction between recovering from and recovering to. The former often involves the painful accumulation of drug consequences. While such pain can constitute a powerful push force towards recovery, pain alone is often an invitation for escalating hopelessness and further intensification of drug use. Dr. Sacks experienced such consequences, but his recovery did not become anchored until he found a greater purpose for living—a pull force, which in Sacks case was the meaning found in his work with patients and his writing.
The case of Dr. Oliver Sacks suggests that understanding the twin mysteries of addiction and recovery require discovery of what is being searched for within the drug experience as well as discovery of a more effective, meaningful, and sustainable answer to that search. Those of us involved in helping facilitate the recovery process would be well-served reminding ourselves of the multitude of needs and purposes that feed excessive drug use and the equally diverse range of alternatives through which those same needs can be met.
In the midst of the present coronavirus pandemic, one hears regular reports of people who exhibit no symptoms of COVID-19, but who are capable of spreading the coronavirus infection to others. Asymptomatic (presymptomatic) carriers pose a major obstacle to public health responses to COVID-19—an obstacle underscoring the need for mass testing, tracking, isolation of virus carriers, and quarantine of those exposed to the virus.
Asymptomatic transmission can play a parallel role in surges in substance use and related disorders. This occurs when people in the honeymoon phase of initial drug use who do not exhibit signs of a substance use disorder initiate others into the social world and rituals of drug use.
Those who possess high addiction vulnerability often experience profound euphoria in their earliest drug experiences. This is not just pleasure induced by the drug but a radically new sense of self—one liberated from distress and one imbued with the promise of a new purpose in life. Falling in love or a world suddenly transformed from black and white to technicolor are apt analogies. The desire to share the newfound joy of this magic elixir with others is not surprising.
Drug honeymooners are a key mechanism of drug transmission within local communities. Some will later experience horrendous consequences from their drug use while others will decelerate or cease drug use from boredom, maturation, or discovery of more fulfilling activities. At these later points, members of both groups may discourage drug use to others or cease being addiction carriers, but that does not alter their earlier contagious influence.
Asymptomatic transmission of drug use and addiction has both personal and systems implications.
At a personal level, recovery is a liberation often portrayed via the images of breaking chains and slaying the dragon or demon that possessed one’s soul. This emphasis on freedom misses the subsequent assumption of responsibility for the injuries and harm one’s addiction inflicted upon others. Included within such harms are the seduction of others into the world of intoxicants—some of whom progressed to lives of self-destruction or lost their lives in that world. Asymptomatic transmission encompasses modeling drug use, actively initiating others into drug use, selling or supplying drugs to others, and protecting others from the consequences of their drug use.
This is all a way of saying that addiction can be socially contagious and that addicted people have often served as carriers of this vector. Facing that reality in recovery requires taking responsibility for such actions, making amends via direct expressions of regret, acts of restitution, and acts of service to other individuals and the larger community—all to balance, as much as is possible, the karmic scales.
This is not an easy process. Some of those we influenced with no malicious intent may have later lost their lives to addiction. How does one face having participated, even unconsciously and without harmful intent, in the death of another person? How many lives must one save to balance the life or lives taken by one’s earlier actions or inactions? Fortunately, there are communities of recovery with members whose decades of recovery experience can guide us through such efforts.
At a systems level, surges in drug use and addiction can be prevented and mitigated. This occurs when the cultural density and visibility of addiction and recovery stories match or exceed social interactions that intentionally or inadvertently promote drug use. Responsible decision-making related to psychoactive drug use, including the decision to use no such substances by those for whom such use is contraindicated, is also a socially influenced process.
People in recovery have long reached out individually to others who are suffering from addiction, but in elevating their stories at a public level, a vanguard of people in recovery have the potential to influence people before such suffering begins. In this way, the pool of asymptomatic carriers of addiction shrinks or their voices quieted and the public health of local communities is elevated.
People in recovery have the potential to serve as both wounded healers to those seeking escape from addiction and the potential to serve as agents of prevention at a community level. Recovery communities have longed served the former function; they are now awakening to their potential role as community recovery carriers. It is time national, state, and local drug policy leaders fully capitalized on this potential.