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
“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
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.
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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.
National Institute on Drug Abuse. (1999). Principles of drug addiction treatment (NIH Publication No. 00-4180). Rockville, MD: National Institute on Drug Abuse.
Weisner, C., Ray, G. T., Mertens, J. R., Satre, D. D., & Moore, C. (2003). Short-term alcohol and drug treatment outcomes predict long-term outcome. Drug and Alcohol Dependence, 71, 281-294. 674.
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.