RecoveryBlog
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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“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.
Washington, DC
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.
For more information, visit internationalrecoveryday.org and www.facesandvoicesofrecovery.org
Emily Porcelli, Marketing and Communications
Faces & Voices of Recovery
202-741-9392
In February of 2020, I began my position with Faces & Voices of Recovery. With experience in grassroots organizing, working with RCOs and state systems, and peer training facilitation and curriculum development, I brought with me a passion to strengthen the national network of Recovery Community Organizations. As a woman in sustained recovery, I personally utilized peer services and had access to local RCOs. This personal experience helped to solidify my understanding of the vital role peers and RCOs have in building a foundation for recovery and across the recovery continuum journey.
I spent my first few months with the organization learning about our ARCO members. I learned from active ARCO members, members who opted to leave ARCO, and organizations who had unsuccessfully applied for membership. I sought a deeper understanding of their challenges and where Faces & Voices of Recovery, the RCO definition, and the 8 Criteria for RCOs and ARCO membership could improve. I grew my knowledge through rich and vulnerable conversations and by listening to understand. After a few short months, I submitted a proposal to complete a programmatic evaluation on our ARCO program with the intent to make changes that were responsive to challenges encountered by RCOs.
As the work on this evaluation began, Faces & Voices of Recovery became aware of how we as an organization, and many others in our national recovery network, failed to equitably represent Black; Indigenous; and people of color in our work to elevate and increase access to recovery. This was something I had already become aware of through the conversations I had been having with RCOs in our national system. The ARCO Programmatic evaluation grew from making responsive changes for developing RCOs into making responsive changes that were culturally congruent to BIPOC community members, LGBTQIA+ community members, People Who Use Drugs (PWUD), and harm reduction efforts that are inequitably welcomed and represented in recovery spaces.
A wise and brutally honest ARCO member expressed to me that Faces & Voices of Recovery, and the recovery movement as a whole, had a history of inequity and whiteness. This member had been a supporter of our organization for many years and continued to do so but was unabashed about his truth and experience as an African American, long-term recovering community member, and recovery advocate. This person committed to helping us do better if I committed to doing the work. You know who you are, and I thank you. It was with passion and empathy, along with support and access to resources to complete the ARCO Programmatic Evaluation from Patty McCarthy; Phillip Rutherford; and Joseph Hogan-Sanchez, that we began our journey to do better.
This report and the work conducted by our ARCO members is a mechanism to reevaluate our systems, embrace dialogue in the spirit of understanding, and challenge what we know to be true. It is a catalyst for change. It has changed our organization and ARCO membership, but more importantly, it has changed me, and I hope that it spurs change for you. Together, we can do better.
We are pleased to present to you the 2021 ARCO Programmatic Evaluation Report which can be accessed for online reading, downloading, and printing here.
Marianna Horowitz
Program Manager, Faces & Voices of Recovery
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Tony Sanchez is a passionate advocate who works tirelessly to enhance and develop recovery-oriented systems of care for all people. As a person in long-term recovery, Tony is continually amazed by the opportunities that have come his way to use his lived experience and knowledge of recovery to serve others. Prior to joining Faces & Voices of Recovery, served as the Director of the Office of Recovery Transformation at Georgia’s Department of Behavioral Health and Developmental Disabilities (DBHDD) from 2016 to 2021. Tony lives in the state of Georgia.
This year marks the 20th Anniversary of Faces & Voices of Recovery. In 20 years, many things have changed in the Recovery Movement, but our dedication to the mission has never wavered.
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Posts from William White
As my long-time readers are aware, I occasionally take breaks from blogging. That time has arrived again. I encourage you to read any blogs you may have missed in this series. Below is a listing and links to recovery blogs that have been posted to date at www.williamwhitepapers.com. Thanks to each of you who have encouraged me to continue this series.
With best regards,
Bill
Private Grief to Public Advocacy (July 5, 2013)
Critics as Benefactors (July 18, 2013)
Myth, Story, and Recovery (July 23, 2013)
Moral Panics, the Limits of Science, and Professional Responsibility (July 25, 2013)
Recovery Durability: The 5-year Set Point (July 31, 2013)
Helping Yourself to Recovery (August 5, 2013)
The Work of Addiction Recovery (August 10, 2013)
Recoveries Up in Smoke (August 23, 2013)
Stigma and Recoveryism (August 28, 2013)
New Era of Recovery Support (August 30, 2013)
Recovery Mobilization in East Africa (August 31, 2013)
Recovery Stories before AA (September 6, 2013)
On Hijacked Brains and Social Stigma (September 13)
A Test of Recovery Management: Or was it? (September 20, 2013)
Recovery for the Health of It (September 27)
NA Comes of Age (October 7, 2013)
Toward a Global Recovery Advocacy Movement (October 11, 2013)
Recovery & Harm Reduction in Philadelphia (October 20, 2013)
Addiction: A Question of Chronicity (October 26, 2013)
Precovery: “And then the Miracle Occurred” (November 1, 2013)
Passing of a Pioneer (November 14, 2014)
On the Shoulders of Giants (November 24, 2013)
In Praise of Patrons (November 28, 2013)
More Varieties of Recovery Experience (November 30, 2013)
Community Recovery (December 7, 2013)
Personal Failure or System Failure? (December 14, 2013)
The Masks of Addiction & Recovery (December 20, 2013)
Recovery in the Wind (December 28, 2013)
Anticipatory Grief and Family Recovery (January 3, 2014)
State of the New Recovery Advocacy Movement (January 11, 2014
Recovery and Justice (January 17, 2014)
Recovery is Contagious Redux (January 24, 2014)
Advocacy for the Lost (February 1, 2014)
Addiction Recurrence after Prolonged Recovery (February 7, 2014)
Amplified Recovery (February 16, 2014)
Language Abuse (February 21, 2014)
Waiting for Breaking Good: The Media and Addiction Recovery (March 1, 2014)
Recovery Landscapes (March 8, 2014)
Recovery Checkups (March 14, 2014)
Shedding Skins in Recovery (March 21, 2014)
No More Graduations (March 28, 2014)
Stop Kicking People out of Addiction Treatment (April 4, 2014)
A Grieving Parent on the Meaning of Parity (April 11, 2014)
Lessons from an Earlier Era (April 18, 2014)
Radical Recovery Revisited (April 26, 2014)
Reflections on AA’s Resilience (With Ernie Kurtz, May 2, 2014)
Brain Surgery as Addiction Treatment? (May 7, 2014)
Experiencing Spirituality (May16, 2014)
Pioneer Voices (May 23, 2014)
A Rendezvous with Hope (May 30, 2014)
The Language of Recovery Advocacy (June 7, 2014)
Volunteerism and Addiction Treatment (June 13, 2014)
Recovery Advocacy and Personal Philanthropy (June 19, 2014)
Year of the Dragon (June 29, 2014)
Addiction Recovery and Intergenerational Resilience (July 11, 2014)
From the Rooms to the Streets (July 18, 2014)
Recovery for a Higher Purpose (July 24, 2014)
AA Agnostica and the Varieties of AA Experience (with Ernie Kurtz, August1, 2014)
Drug Legalization and Recovery Space (August 8, 2014)
Recovery in an Age of Cynicism (August 15, 2014)
The Power of Peers (August 22, 2014)
A Tale of Two Men (Science, Spirit and Recovery) (August 29, 2014)
Personal Reflections on Recovery Month 2014 (September 5, 2014)
Treatment (By Itself) is Not Enough (September 12, 2014)
Stigma and Service Integration (September 19, 2014)
A Milestone for SMART Recovery (September 26, 2014)
Listening across the Stage of Recovery (October 3, 2014)
Stigma Reduction through Recovery Contact (October 10, 2014)
The History of Addiction Counseling in the United States (October 15, 2014)
The Recovery Closet: Reflections on Coming Out Part 1 (October 17)
The Recovery Closet: Reflections on Coming Out Part 2 (October 22)
Further Reflections on “Dual Citizenship” in Recovery (with John Kelly, PhD, October 31, 2014)
Recovery Conversion (November 7, 2014)
The Boundaries of Recovery (November 14)
Predicting Addiction/Recovery Trajectories (November 21)
A Different Kind of Evidence (November 28)
Prison-based Recovery Advocacy (The San Quentin Story) (December 4)
The Roots of Recovery Management (December 13)
Recovery: Principles to Service Practices (December 19)
Testimonies of a Mother and Father (with Margot Head and Bill Williams) (December 26)
Symbolic Firsts in Addiction Recovery (January 2, 2015)
The Recovery Scholarship of Ernest Kurtz (January 9, 2015)
A Person Tribute: Ernie Kurtz (1935-2015) (January 30, 2015)
“Tough Love” Exposed (February 6, 2015)
Day of the Asylum (February 13, 2015)
A Rising Recovery Advocacy Movement in Canada (February 21, 2015)
From Trauma to Transformative Recovery (February 28, 2015)
Community Recovery on the College Campus (with Kitty Harris, April 7, 2015)
Defining Recovery-Oriented Systems of Care (May 1, 2015)
A Different Kind of Inventory (May 7, 2015)
Recent Life-in-Recovery Survey Results (May 15, 2015)
Tribute to a Recovery Management Pioneer (May 20, 2015)
Stigma Reduction through Contact Strategies (with Tom Hill, May 22, 2015)
Recovery behind the Walls (with Chris Budnick & Boyd Pickard, May 29, 2015)
The Comprehensive Addiction and Recovery Act of 2015 (June 5, 2015)
Portraits of Recovery: “Hello, My Name is…” (June 12, 2015)
An 80th Anniversary Tribute to Alcoholics Anonymous (with Ernie Kurtz, June 19, 2015)
The Genesis of Recovery (July 10, 2015)
The Edge of Recovery (July 17, 2015)
Recovery of Social Networks (I Story to We Story) (July 24, 2015)
Recovery Justice (July 31, 2015)
Shortening Addiction “Careers” (August 7, 2015)
The Trajectories of Opioid Addiction (August 14, 2015)
Opioid Addiction: An Open Letter to the 2016 Presidential Candidates (August 20, 2015).
Addiction Neurobiology and Personal Destiny (August 28, 2015)
LGBT and Recovery Advocacy Movements (with Tom Hill, September 4, 2015)
Kicking People Out of Addiction Treatment: An Update and Commentary (with Izaac Williams, September 11, 2015)
The Field that was Ashamed (And Proud) of Itself (September 18, 2015)
Recovery’s Final Chapters (September 25, 2015)
A Day is Coming: Visions of a New Recovery Advocacy Movement (October 2, 2015)
Where Do We Go From Here? (October 9, 2015)
Media and Recovery: A Rare Tip of the Hat (October 16, 2015)
Anonymity and Advocacy (October 23, 2015)
Dr. Vincent Dole (1913-2006) on Methadone Maintenance Treatment (October 30, 2015)
Variability of Recovery Support Outcomes (November 6, 2015)
With Hope of Cultural Recovery (An Apology to Mexico) (November 13, 2015)
All in the Family (Recovery Resource Review) November 20, 2015
The Science of Sponsorship (November 27, 2015)
Is it Time for Person First Language in Addiction Treatment? (with Alisha White, December 4, 2015)
An Anniversary Tribute to Women for Sobriety and Secular Organizations for Sobriety (December 11, 2015)
Rush to Recovery: Rhetoric versus Reality (December 18, 2015)
Pioneers We Have Lost (December 25, 2015)
New Recovery Advocacy Movement Basics (January 1, 2016)
The Future of Addiction Treatment Revisited (January 8, 2016)
Remembering Ernie Kurtz (January 15, 2016)
Toward a Recovery Economy (January 22, 2016)
Remission/Recovery from Cannabis Use Disorders: New Findings (January 29, 2016)
Recovery and Personal Safety (February 5, 2016)
Recovery of the Unaffiliated (February 12, 2016)
Disengaged Styles of Recovery (with Dr. John Kelly, February 19. 2016)
Recovery Research Hall of Fame—February 26, 2016
Who Profits from Addiction/Recovery Stigma? March 4, 2016
Woman Pioneers in Recovery Disclosure (with Dr. Jean Kilbourne. March 11, 2016)
Rethinking the Characterization of Addiction as a “Relapsing Condition” (with Paula Davies Scimeca, March 18, 2016)
The Recovery Monographs (Volumes One and Two) March 25, 2016
Two Iconic Moments in Recovery Disclosure (Operation Understanding and Freedom Fest) (with Beverly Haberle, April 1, 2016
A New Generation of Recovery Advocates (with Justin Luke Riley, April 8, 2016)
Intergenerational Resistance, Resilience, and Recovery (with Don Coyhis, April 15, 2016
The Color of Recovery (April 22, 2016)
A Call for Clinical Humility (with Chris Budnick, April 29, 2016)
Recovery as a Cultural Journey (May 6, 2016)
Time for a Recovery Checkup? (May 13, 2016)
Lifting the Veil of Recovery Invisibility (May 20, 2016)
NA & Recovery from Opioid Addiction (with Dr. Marc Galanter, Dr. Keith Humphreys, and Dr. John Kelly, May 26, 2016)
Recovery Pathways are not always a Pathway (June 3, 2016)
Recovery Coaching: Recent Evidence Reviews (June 10, 2016)
Recovery Coaching: Toward Role Clarity (June 17, 2016)
Nature will find a way; so will recovery (June 24, 2016)
Celebrate Recovery 25th Anniversary (July 1, 2016)
One Dependency for Another? (July 8, 2016)
Calling Attention to Opioid Affected Families and Children (with Dr. Dennis Daley, July 15, 2016)
Addiction Recovery in Japan (July 22, 2016)
Recovery at the Table (July 29, 2016)
The Future of Recovery Scholarship (August 5, 2016)
Beyond Historical Trauma: Apology for Abuses at US Indian Boarding Schools (August 9, 2016)
Art and Recovery Advocacy (with Alastair Roy, and Mark Prest, August 12, 2016
Microaggressions in Recovery (August 19, 2016)
Recovery within Rural and Frontier Communities (August 26, 2016)
African American Recovery Museum (September 2, 2016)
Recovery Support and Connection to Community (September 9, 2016)
Recovery as Heroic Journey (September 16, 2016)
The Boon of Recovery (September 23, 2016)
An Open Letter to Members of Congress (March 18, 2017)
The History of Addiction in America (March 23, 2017)
A Movement of Millions, A Movement of One (March 31, 2017)
Redefining the “Recovery Community” (April 7, 2017)
Generation Found: Young People and the Recovery Revolution (April 12, 2017)
Recoveries Up in Smoke Update (April 14, 2017)
The Revolving Door of Addiction Treatment (April 21, 2017)
Science of Sponsorship Update (April 28, 2017)
Recovery to Resistance (May 1, 2017)
Believe It or Not: Strange Tales from the History of Addiction Treatment (May 5, 2017)
An Intervention Gone Wrong (May 12, 2017)
Troubling New Directions in U.S. Drug Policy (May 16, 2017)
New Resource on Supervision of Peer Recovery Support Services (May 20, 2017)
Life in Recovery from Addiction in Canada (May 26, 2017)
Recovery advocacy is NOT a recovery program (June 2, 2017).
The Drunkard’s Club (June 9, 2017)
Recovery Invisibility (June 15, 2017)
Speaking Truth in Silence (June 30, 2017)
Narrative-Based Addiction Medicine in an Evidenced-Based World (with Jonathan J. Kopel, June 7, 2017)
Toward a “Conspiracy of Hope” (with Jason Schwartz, July 15, 2017)
Tales from a Jag-House (July 20, 2017)
A Noteworthy Anniversary: The Haight-Ashbury Free Medical Clinic (July 24, 2017)
Addiction Recovery in the Islamic Republic of Iran (July 28, 2017)
Best Practices in Recovery Support for Transition Age Youth (August 1, 2017)
The Ecology of Recovery (August 4, 2017).
The Multiple Pathways of Recovery Conference (August 8, 2017)
Stages and Styles of Addiction Recovery (August 11, 2017)
Jimmy K’s Greatest Idea (August 18, 2017)
My Story…NOT the Whole Story (August 25, 2017)
Mechanisms of Change in Addiction Recovery (September 1, 2017)
SMART Recovery 2017 (September 16, 2017)
Recovery Rising: A Retrospective of Addiction Treatment and Recovery (September 18, 2017)
Recovery History and the New Recovery Consciousness (September 22, 2017)
Recovery Milestones of the Early 21st Century (September 29, 2017)
Pathways to Freedom (October 6, 2017).
Denial of Recovery (October 13, 2017)
Recovery and the Eye of History (October 19, 2017)
Mourning to Mass Mobilization (October 27, 2017)
Groundbreaking Survey of Recovery Prevalence and Pathways (November 3, 2017)
Recovery Challenges among Older Adults (with Randall Webber, November 7, 2017)
Addiction/Recovery as a Family Tradition? (November 17)
Relapse Prevention to Recovery Management (November 24, 2017)
Preserving the History of Addiction Treatment and Recovery (November 27, 2017)
The Supervision of Peer Recovery Support Services (December 1, 2017)
The Karma of Recovery (December 8, 2017)
Family Recovery 101 (December 15, 2017)
Continuity of Recovery Support vs. Replication of Abandonment (with Jason Schwartz, December 22, 2017)
A Year-End Note of Gratitude (December 29, 2017)
A Vision of Tobacco-free Recovery Communities (January 5, 2018)
Recovery Support following Overdose or other Medical Emergency (with Rebecca Allen & Phil Valentine)
Love and Addiction Counseling (with Jason Schwartz, January 17, 2018)
The Color and Character of AA (January 26, 2018)
Recovery Support Services in Rural and Frontier Communities (with Darrell Keim, Katie Schmeer, Stacey Rosecranz, & Randy Rosecrans)
Addiction, Recovery, and Personal Character (February 16, 2018)
Recovery Renewal in the Face of Loss (February 23, 2018)
The Secular Wing of AA (March 1, 2018)
Addiction as a Brain Disease (Perspectives from the Islamic Republic of Iran) (March 8, 2018)
The Power of Purpose (March 16, 2018)
Couple Recovery (with Robert Navarro, March 22, 2018)
The Future of Recovery Support Part I (with Mike Collins, March 30, 2018)
The Future of Recovery Support Part II (with Mike Collins, April 6, 2018)
Recovery Wisdom from Africa (April 13, 2018)
The Role of Medicine in Addiction Treatment (April 19, 2018)
Recovery Support for People in Medication Assisted Treatment: The Context (April 27, 2018)
Recovery Support for People in Medication Assisted Treatment: Suggested Strategies (May 4, 2018)
The Curse of Low Recovery Expectations (Part I) (May 11, 2018)
The Curse of Low Recovery Expectations (Part II) (May 18, 2018)
Recovery Management and Old School Social Work (with Mark Sanders, May 24, 2018)
Recovery Porn: A Story of Healers and Hustlers (June 1, 2018)
Recovery as an Act of Cultural/Political Resistance (June 8, 2018)
Quality of Life in Early Recovery and Beyond (June 15, 2018)
Who is Best Qualified to Provide Recovery Support Services? (June 22, 2018)
Changing the Water (June 29, 2018)
Attentional Bias in Addiction and Recovery (July 6, 2018)
The Time Is Now For a Radical Transformation of Addiction Treatment (with Gary Mendell & Samantha Arsenault, July 20, 2018)
Stigma-busting: Sharing the Good News of Recovery at a Professional Level (July 27, 2018)
The Recovery Advocacy Movement in Japan (August 3, 2018)
New York’s Peer Integration and the Stages of Change Toolkit (August 8, 2018)
Life or Death after a Non-fatal Drug Overdose (August 10, 2018)
Remission/Recovery from Cannabis Use Disorders: New Findings (August 16, 2018)
Recovery Advocacy and the Latino Community (with Angelo Lagares and Gaynelle Gosselin, August 24, 2018)
Variations in Recovery Identity Adoption (August 14, 2018)
Toward a Technology of Hope (August 21, 2018)
Recovery Advocacy in the Philippines (August 28, 2018)
A Canadian Perspective on Recovery Advocacy (with Erik Haines, October 5, 2018)
Experiencing Release in Recovery (October 12, 2018)
Recovery Fluency (October 19, 2018)
The Journey through Tolerance to Compassion in Recovery (with Galen Tinder, October 25, 2018)
A Recovery Stigma Case Study (Bill White & Shiv Sharma, November 2, 2018)
The Role of Communities of Recovery in Cultural Healing (November 9, 2018)
Recovery Celebration and Advocacy in Ghana Africa (November 19, 2018)
A Call for Local Recovery Historians (November 23, 2018)
Toward Seven Generations of Recovery Advocacy (with Don Coyhis, November 30, 2018)
Reflections on a Man and a Movement (December 7, 2018)
Radical Hope and Recovery Initiation (April 5, 2019)
Reflections on Long-Term Recovery (Galen Tender and Bill White, April 12, 2019)
Chaos, Addiction Recovery, and the Power of Synergy (April 18, 2019)
Recovery: Children, Adolescents, Transition Age Youth, and Families (April 26, 2019)
Recovery Cascades (Bill White and David Best, May 3, 2019)
Brain Recovery (May 16, 2019)
Recovery Advocacy in Japan (May 23, 2019)
The History of Addiction Recovery (May 30, 2019)
Racism, Moral Panics, and Drug War Casualties: An Update (June 6, 2019)
Self-Disclosure and Recovery Support Services (June 13, 2019)
Recovery Attempts: New Data (Bill White and John Kelly, June 19, 2019).
The Recovery Revolution: Ten Historic Milestones (June 27, 2019)
Recovery Cascade Case Study: NA in the Islamic Republic of Iran (July 4, 2019)
Health Challenges in Addiction Recovery (Bill White and Dr. David Eddie. July 11, 2019)
Beyond Recovery Exceptionalism (July 18, 2019)
Irrationality of Addiction Treatment (July 25, 2019).
Addiction Recovery without Treatment (August 1, 2019)
Parable of Two Programs (August 8, 2019)
Honoring Recovery Ancestors (August 15, 2019)
Partial Recovery (August 21, 2019)
Toward a Recovery Movement 2000 Redux (August 29, 2019)
Recovery Contagion within the Family (September 5, 2019)
A Lesson from Recent Vaping Deaths (September 12, 2019)
A Photographic History of Addiction Recovery in the U.S. (September 19, 2019)
Recovery/remission of Substance Use Disorders: Recent U.S. Data and Reviews (September 26, 2019)
Recovery Community Organization Leadership (Bill White and Mr. Hossein Dezhakam, September 3, 2019).
Prescription Opioid Recovery: New Data (October 10, 2019)
Dragon/Monster/Serpent/Devil Images and Addiction Recovery (October 17, 2019)
The Creation of AA and Its Iconic Text (October 23, 2019)
Further Reflections on Addiction Treatment Medications (October 31, 2019)
The iconic image that pervades pharmacotherapy of opioid addiction is a shadowed face drinking a pale liquid from a plastic medicine cup. The image of a faceless, voiceless person is apt as the historical stigma attached to the use of medications in the treatment of opioid use disorder is so great that few have braved stepping into the light to share their lived experience of medication-assisted recovery. Poised on opposing sides of this image are medication haters and medication advocates, each offering radically different views on the potential value, risks, and limitations of medication support in recovery from opioid addiction. One finds on both sides people who have negative and positive personal and professional experiences in the use of these medications, people grinding innumerable ideological axes, and people whose organizational destinies, personal careers, and financial interests are vested in the outcome of decisions to use or not use medication as an aid to addiction recovery.
For years, I have tried to forge bridges of communication across the polarized, vitriolic debates surrounding the use of medications in the treatment of addiction. I have illuminated the history and current status of medications in the treatment of addiction and reviewed the policies toward medication of major recovery mutual aid societies. I have championed the value of key medications and the legitimacy of medication-assisted recovery. And I have called on medication-centered addiction treatment providers to dramatically expand the scope of their recovery support menus and elevate the quality of their service practices. This latest missive seeks ultimately to lessen the challenges and confusion faced by affected individuals and families as they sort the pro-medication and anti-medication polemics within public, professional, and social media.
I have just posted a paper to help recovery advocates understand some of the complexities and limitations involved in the use of medications and to better understand the positions of some who reject the use of medications as a panacea for opioid and alcohol use disorders. The hope is that recovery advocates can help educate affected individuals and families on the limitations of medications at the same time they assert their potential benefits. There is limited long-term value in replacing a mindless ant-medication bias with an equally mindless pro-medication bias. The challenge for recovery advocates is to forge a source of reliable information between the extremes of “Never” among the rabid medication haters and “Always and Forever” among the most passionate medication advocates. In our efforts to promote the legitimacy of multiple pathways of recovery—including medication-supported recovery, we need far more nuanced discussions of the potential value, the limitations, and the possible contraindications of medications across the stages of recovery.
I invite and encourage all recovery advocates and recovery support specialists to review this latest paper by clicking HERE.
Medications are best viewed as an integral component of the recovery support menu rather than being THE menu, and their value will depend as much on the quality of the milieus in which they are delivered as any innate healing properties they may possess. The “Just get them [medications] out there: Stop the dying!” mantra is understandable in the face of the onslaught of drug overdose deaths but it is not an effective foundation for drug policy. A similar mantra promoted by the pharmaceutical industry–“Just get them [medications] out there: Stop the pain!”–helped create the current crisis. Effective drug policies and personal recovery management strategies must include an understanding of the capabilities AND the limitations of pharmacotherapy in the treatment of addiction and co-occurring disorders. A synergy of influences spawned the current crisis and it will require a synergy of remedies to end it at both personal and public health levels. When communities approach us as experts and ask, “What is the one thing we can do?” our response should be “Don’t do just one thing and rigorously evaluate and elevate the quality of everything you do.”
People seeking recovery from opioid use disorders and their families are in desperate need of science-grounded, experience-informed, and balanced information on treatment and recovery support options—information free from the taint of ideological, institutional, or financial self-interest. In an ideal world, recovery advocates would be a trustworthy source of such information.
Key earlier publications of related interest include the following:
McLellan, A. T., & White, W. L. (2012). Opioid maintenance and Recovery-Oriented Systems of Care: It is time to integrate. Invited commentary on Recovery-oriented drug treatment: An interim report by Professor John Strang, Chair of the Expert Group. (DrugLink, July/August, pp. 12-12). London, England: The National Treatment Agency.
White, W. (2012). Medication-assisted recovery from opioid addiction: Historical and contemporary perspectives, Journal of Addictive Diseases, 31(3), 199-206.
White, W. L. (2011). Narcotics Anonymous and the pharmacotherapeutic treatment of opioid addiction. Chicago, IL: Great Lakes Addiction Technology Transfer Center and Philadelphia Department of Behavioral Health and Intellectual disability Services.
White, W. L. (2007). Addiction recovery: Its definition and conceptual boundaries. Journal of Substance Abuse Treatment, 33(3), 229-241. doi: 10.1016/j.jsat.2007.04.015
White, W. L., & Coon, B. F. (2003). Methadone and the anti-medication bias in addiction treatment. Counselor, 4(5), 58-63.
White, W., Parrino, M., & Ginter, W. (2011). A dialogue on the psychopharmacology in behavioral healthcare: The acceptance of medication-assisted treatment in addictions. Commissioned briefing paper for SAMHSA’s A Dialogue on Psychopharmacology in Behavioral Healthcare meeting, October 11-12, 2011. Posted at www.williamwhitepapers.com
White, W. L., & Torres, L. (2010). Recovery-oriented Methadone Maintenance. Chicago, IL: Great Lakes Addiction Technology Transfer Center, Philadelphia Department of Behavioral Health and Mental Retardation Services, and Northeast Addiction Technology Transfer Center.
Considerable research has been done on the birth and early evolution of A.A. since Not-God: A History of Alcoholics Anonymous by Harvard-trained historian Ernie Kurtz was published in 1979. Ernie was subsequently encouraged and enthralled by each new historical discovery about A.A. but remained in the final years of his life disappointed that no one had since published a scholarly update of A.A.’s birth and continued evolution. If Ernie was still with us, he would be the first to congratulate William H. Schaberg on the publication of Writing the Big Book: The Creation of A.A.
Recent decades have witnessed growing interest in the history of Alcoholics Anonymous, with both professionals and amateurs (e.g., members of AA History Lovers) making important discoveries. Numerous biographical works on early A.A. figures include Bill Wilson, Lois Wilson, Dr. Bob, Anne Smith, Dr. William Silkworth, Clarence Snyder, Marty Mann, Sister Ignatia, Nell Wing, and Fr. Ed Dowling. Equally important works on the history and experience of particular groups within A.A. have been published, most notably Glen C.’s Heroes of Early Black AA, Jolene Sanders’ Women in Alcoholics Anonymous, Roger C.’s A History of Agnostics in AA, and Audrey Borden’s The History of Gay People in Alcoholics Anonymous. But until publication of Writing the Big Book, there has been no scholarly history of early AA with the academic rigor or quality of storytelling found in Not-God.
Comparisons between Writing the Big Book and Not-God are apt as Schaberg follows the major admonitions Ernie Kurtz shared with so many of us about how to do exemplary historical research and writing. Schaberg tells the story of early AA chronologically so that we as readers retain a clear sense of sequence and how each event flowed from what preceded it and influenced what followed, and he identifies crucial events and decisions that defy such orderly sequence. He tells the story in context so that we as readers understand the cultural and organizational atmosphere in which key decisions were made. Like Kurtz, Schaberg provides us with all the evidentiary sources that help separate fact from widely-promulgated myths about A.A.’s birth and early evolution. His liberal use of excerpts from primary sources is crucial as many of the contemporary documents challenge popular origin myths about A.A. Schaberg tells the A.A. story from multiple personal and localized (e.g., Akron, New York, and Cleveland) perspectives, clearly identifying what we know and the mysteries that remain pending the discovery of new evidence. Finally, Schaberg defies the “history is boring” trope by detailing a most fascinating story that keeps the reader—even the informed reader—wanting to keep turning pages to find out what happens next. There are some surprises in these pages!
The early history of A.A. as first outlined in 1979 in Not-God has now been skillfully and eloquently updated. What remains is a new scholarly history that documents the ongoing evolution of A.A. over the last five decades—a history every bit as complex and engaging as A.A.’s birth and early years, but a story that remains untold. Researching more recent decades and A.A.’s history as it is now unfolding is as great a challenge as that faced by Kurtz and Shaberg. Perhaps someone reading Writing the Big Book will have the commitment, skill, and persistence to research and share this still-unfolding story. I hope so, as the future of A.A. may well rest with understanding these later years of A.A. William H. Schaberg has performed a great service by placing Writing the Big Book—The Creation of A.A. in our hands. The remaining question is how A.A. has adapted and evolved since its founding decades. It will be up to future historians to reveal the continuing history of A.A. and the larger history of addiction recovery.
Writing of the Big Book: The Creation of A.A. will be released on November 5, 2019.
Do not meddle in the affairs of dragons for you are crunchy and taste good with ketchup.—Suzanne McMinn
For more than two centuries, autobiographical accounts of addiction and recovery have portrayed the enormous struggle for self-preservation within both experiences. This struggle is sometimes characterized as an internal battle between twin sides of the self—a Dr. Jekyll / Mr. Hype duality in which the addicted self is pitted against the “true/sober” self. At other times, this struggle is portrayed as a battle between oneself and an external power—the latter often depicted in frightening images of dragons, monsters, serpents, or the devil. A common theme within the addiction narratives and images is the sense of being devoured or possessed by something beyond one’s control, and recovery narratives are filled with struggles for power and control or escape from such struggles.
It is thus interesting that one of the modern addiction tropes is the image of the hijacked brain. The once monstrous or devilish hijacker has now been reduced to the quirks of brain chemistry, the hijacked self now reduced to a series of brain slides. And thus the debate continues on whether addiction is a matter of choice or chemistry, with one side tending to convey that you are the master of your own fate and the other side suggesting implicitly that biology is destiny.
For addiction professionals and recovery support specialists who daily witness this struggle between freedom and possession, we should never forget that addiction and recovery are measured not in the absolutes of either/or but in devolving and evolving degrees of lost and regained freedom. For those professional helpers who have never experienced such loss of control and for those whose recovery duration has weakened memory of such experiences, it is good to regularly remind ourselves the wrenching fear of impending insanity that such loss of control brings. The images below, spanning the 19th century intemperance memoirs and the latest social media postings, offer such stark reminders.
A recent study led by Dr. Roger Weiss provides optimism about recovery from prescription opioid addiction. Weiss and colleagues followed 375 patients admitted to buprenorphine-naloxone treatment with different intensities of counseling. Patients were formally evaluated at 18, 30, and 42 months following admission as part of the Prescription Opioid Addiction Treatment Study funded by the National Institute on Drug Abuse. At month, 42, 80% of those who remained in opioid agonist treatment reported opioid abstinence and 50% of those not in agonist treatment reported opioid abstinence. Participants with any history of past heroin use were less likely to be abstinent at follow-up.
Two factors were associated with opioid abstinence: opioid agonist treatment with buprenorphine or methadone and participation in recovery mutual aid groups. Interestingly, those patients who were currently in agonist treatment were more likely to also be involved in recovery mutual aid groups. Outpatient counseling at time of follow-up was not associated with opioid abstinence.
Now here is a key point in their findings: “while receipt of agonist treatment and attendance at mutual-help meetings were both helpful, neither detracted from nor enhanced the abstinence effect of the other. Rather, the benefits were independent and additive.” This finding challenges my previous assertions on the potential multiplication (synergism) effects of combining medication and recovery mutual aid involvement, but it does support my advocacy in combining both interventions. Here is the authors’ final conclusion in the study report:
“While opioid agonist treatment was most strongly associated with opioid abstinence among patients with prescription opioid dependence over time, mutual-help group attendance was independently associated with opioid abstinence. Clinicians should consider recommending both of these interventions to patients with opioid use disorder.” (page e1)
Reference
Weiss, R. D., Griffin, M. L., Marcovitz, D. E., Hilton, B. T., Fitzmaurice, G. M., McHugh, R. K., & Carroll, K. M. (2019). Correlates of opioid abstinence in a 42-month posttreatment naturalistic follow-up study of prescription opioid dependence. The Journal of Clinical Psychiatry, 80(2). doi: 10.4088/JCP.18m12292
Mr. Hossein Dezhakam Addressing the 2017 International Addiction Science Symposium
For more than a decade, I have regularly corresponded with Mr. Hossein Dezhakam (HD), founder of the Congress 60 recovery community within the Islamic Republic of Iran, on the subject of addiction recovery and the challenges faced by leaders of recovery community organizations (RCOs). A recent increase in questions posed to me about RCO leadership has prompted me to review my past communications with Mr. Dezhakam (HD) and my earlier writings on this subject. Below are excerpts from these communications (used with permission) and my own writings (WW) that I hope will be of interest to my readers.
On Unique Leadership demands of RCOs
A leader in other organizations leads through thoughts; however, a recovery leader must rule the hearts. In other words, management of other organizations can make changes by issuing edicts, raising salaries, or through discipline, but a recovery leader must communicate with affection within and without. Such a leader must be able to turn enemies into friends. A wise person is constantly changing enemies into friends and an ignorant person is in the business of making enemies. (HD)
Mr. Dezhakam’s observation about leading from the heart reminded me of the following observation of Van Jones in his book Beyond the Messy Truth: “You can’t lead people you don’t love. You can’t rally people you don’t respect.”
Messiness of Movements; Leadership Vulnerability
Movements, including recovery movements, are about struggle, which means they are not for the faint of heart. Movements are turbulent, messy, unpredictable and, at times, very primitive. Movements can magnify the best and worst in us. We went through such messiness in the early days of the new recovery advocacy movement—rampant paranoia about which person and organization would lead the movement, underground gossip rather than direct communication, fears of secret deals being made, and the scapegoating of early leaders. I think these processes are endemic to all important social movements, but they can get magnified in a community of recovering people or in other historically disempowered groups. It’s a form of historical trauma that gets acted out in our intragroup relations. That’s why nearly all of the recovery mutual aid organizations before AA self-destructed, as did many of their leaders. It wasn’t from the lack of a personal recovery program; it was their failure to find principles that could rein in these destructive group processes. (WW)
Vulnerability of Recovery Advocacy Leaders
Such [leadership] roles can bring deep fulfillment, but they also come with hidden risks. Vulnerability may be an aspect of all leadership roles, but this may be particularly pronounced in organizations organized by and on behalf of persons from historically disempowered groups. I recall one of my friends once noting of the civil rights organizations in which he was involved, “We don’t elect leaders; we elect victims.” He was referring to the tendency of these organizations to scapegoat their leaders while the leaders are living only to later reify them–often after their deaths. Within any stigmatized group, we want our leaders to excel—to model the best of what we can be. And yet the shadows of shame and inferiority buried inside us get projected onto our leaders in the form of doubt, criticism and attack. (WW)
It is the awareness that standing by the hundreds and thousands reduces the enormous vulnerability that comes from standing in isolation to confront stigma and its multiple manifestations. Put simply, it is not safe for us to stand alone. Attention can make the most stable recovery tremble. The glare of the camera and the beckoning microphone can be as intoxicating as any drug. Like Icarus flying too close to the sun, we are doomed in the face of such self-absorption—whether from overwhelming feelings of unworthiness or, perhaps worse, from the feeling that we are the most worthy. It is only when we speak from a position of WE that safety and protection of the larger cause is assured. When asked, “Who is your leader?” we should declare that we are without leaders or that we are all leaders. (WW)
The risk is the virus which can penetrate the recovery leader. This virus is deviation from the original recovery path. What I am trying to convey, is that a leader must have proper capabilities and capacity. Avery poor person who receives a huge amount of money in an instant may lack the capacity to adapt to that money or fame and can be easily destroyed. This is exactly why AA and NA recovery leaders warned the next generations that they must avoid some issues to be safe. I have known recovery leaders who were so kind, humble, and spiritual. They were always with their people but once they became famous, they changed! People couldn’t meet them easily anymore, they hired secretaries and it wasn’t easy to have meetings with them. They asked a lot of money for their time, and at last they hurt their group. They steered their group to darkness. (HD)
RCO Leadership Qualities
Leaders must have minimal defects of character so that they can be duplicated. A flawed leader will only duplicate bad models. Worldview [personal values and philosophy] must be the strong suit of recovery leaders so that they can identify and fix their defects. They must sustain their health and be on sound financial footing. (HD)
Working within recovery service roles does not require complete perfection. If it did, none of us would qualify. But it does require reasonable congruity between the message and the life of the messenger. The leader must by definition be a recovery carrier—a person who makes recovery contagious by the quality of their character, relationships and service. (WW)
Leaders of a recovery community must model the service ethic or belief that is at the heart of such communities. It is a prevailing belief within Congress 60 that: Others planted and we ate; we must plant so others could be fed. This is a figure of speech of course and it means that others helped us to gain our health and we must serve others on a voluntary basis too. That begins with the actions of the leader. (HD)
A leader must have a long-term vision. A wise man once said: if you are looking to get results within three months, then plant greens, tomato, or watermelon. if you are looking for results in one year, then grow sheep. If you are looking to get results within 10 years, then plant a tree. However, if you are planning to educate a human, then plan for a 100 years. Therefore, our jobs requires a long time and is continuous. We will hit challenges and obstacles along the way for sure. But eventually success will embrace us in the end. (HD)
Ethical Leadership
Recovery leaders must be spiritual leaders as well. Thus, ethics play a unique role in a recovery leader. In my opinion, a recovery leader must not hunger! A hungry ego is incorrigible. A person could be poor but not hunger (desiring more and more) at the same time. Beware of those whom hungry eyes! They will never get satisfied! They have eaten all the foods and they are dying of fullness! Still they are looking for more to eat! They are like someone who has stopped smoking heroin 20 years ago, but for the past 20 years their thoughts and eyes have been fixed on heroin. After 20 years of sobriety they still dream about Heroin! They suffer from a hungry ego. (HD)
On Value and Dangers of Charisma
Charismatic leadership functions in a way that people listen to the leader out of deep trust. This type of leadership can lead to a faster pace in terms of getting jobs done. It can prevent debates and divisions, and people will give up many things upon the request of the leader. As for the risks, if people chose the leader wisely this type of leadership will produce great results, however, if a bad person with charisma is chose then the results will be devastating and destructive. We can see this type of bad choosing in non-governmental organizations (NGOs) or companies or even countries, take Adolf Hitler for instance. (HD)
Charisma is a blessing and a curse to recovery mutual aid and recovery advocacy movements. It is something of a paradox that such movements often cannot survive their infancy without charismatic leaders, but cannot reach maturity without transcending charismatic styles of leadership. Alternatives to cult-like leaders require concerted leadership development efforts and the progressive decentralization of decision-making throughout the organization. This does not mean that we have to challenge and extrude our charismatic figures to achieve maturity, but it does mean that we have to help such figures redefine their roles and relationships—in short, to join the movement as members. When that doesn’t happen, the organization/movement moves towards incestuous closure and the risk of eventual implosion (WW).
RCO Leadership Development
A recovery leader is often one who never thought about becoming a leader when he started the work, but he ends leading. Recovery leaders must gurgle like a spring. They must contemplate deeply while taking benefit of consulting with others. They must utilize elders for legislation, just like Congress 60’s watchman which consists of 14 elders. Then the leader must take an approach in which all the members get familiar with these elders and respect them. In return, the elders must treat people with affection and honesty. Therefore, in absence of leader (illness or even death) this counsel can take control. The leader also can choose an individual out of this counsel to take the leadership role in case of his absence. (HD)
I believe a non-governmental organization (NGO) must be planned somehow to engage all members in related activities. It should not be up to few people to plan and execute everything. That’s why all members of Congress 60 are active in a special group, and these groups are called legions. For instance: treatment legions, musical legions, tree planting legions, Marzban legions, cleaning legions, cyber legions, and financial legions. (HD)
On Financial Sustainability
In each branch, those who are financially gifted (travelers or companions) can take part in financial legions with payment annually. Their task will be to plan for receiving donations from members of that very branch. The members of each financial legion are 10 to 50 members for each branch. The gathered donations will be allocated as below: 80 % of it will be allocated to the same branch and the rest will be sent to central office in Tehran (just like Federal system), and this 20% will be allocated to research or helping other branches. As you can see, in our system it is not only up to me or few others to think about financial status. We have hundreds of other members whose job is to fix the budget of branches. We have many members within Congress 60 with more than 15 years of recovery, many have achieved financial status and therefore they are helping Congress 60. (HD)
On Leadership Transition
Perhaps the greatest of such challenges is the transition in leadership between the founders of recovery advocacy organizations and the second generation. That is always a litmus test of viability, just as it is in recovery mutual aid societies. Organizations and larger movements that are successful find ways to decentralize leadership through structures that provide for leadership development and rituals that facilitate regular succession. Even under the best circumstances, these transitions can be difficult for the organization and for the individuals involved….The movement itself is best conceptualized as a marathon run as a relay—people engaging and disengaging as needed over a prolonged period of time. Many people will come and go or return at particular times in the life of the movement, while others will be part of the daily struggles of the movement for the duration. That’s just the way social movements are; this is not to say one style is superior to another. I am a great admirer of endurance and tenacity, but movements also need those who help in short bursts. (WW)
On Recovery Community Organization Sustainability
A.A. found creative solutions to the forces that had limited or destroyed its predecessors. Through the principles imbedded in its Twelve Traditions, A.A. forged solutions to the pitfalls of charismatic and centralized leadership, mission diversion, colonization by other organizations, ideological extremism and schisms, professionalization, commercialization, and relationships with other organizations and the media. A.A. created a historically unique organizational structure (a blend of anarchy and radical democracy relying on rotating leadership, group conscience, intentional corporate poverty, etc.) that even its most devoted early professional allies believed could not work. That structure and those principles have protected A.A. and offer a case study in organizational resilience. (WW)
On Non-affiliation
Supporting other political or religious groups is a devastating mistake which is like an earthquake for a recovery organization. For instance: if the leader of recovery organization is in favor of blue color then the fans of red color will be against him and vice versa. We need to be friends with blue and red or in other words with all regardless of political or religious views or other ways humans divide themselves. The obligation of a non-governmental organization (NGO) is to help people without taking sides. We have achieved this goal within Congress 60 and it is a source of our strength. All sides and groups respect Congress 60. (HD)
Recovery leaders must maintain balance in all of their communications within and without the recovery organization. Their distance with outside and inside entities must be kept exactly just like the distance between earth and sun. If our planet gets too close to sun, we will burn, and we will freeze to death if the reverse happens. Recovery leader must plan in a way to be independent. They must not be financially dependent to governments or other organizations. (HD)
On Evaluating Effectiveness of Recovery Community Organizations
The prime capital of a business organizations is money. Everything is measured by the amount of money. In a recovery community the capital is in terms of sociality. To measure sociality, we must pay attention to:
A: The increased rate of the NGO members annually! If a recovery community performs well then the rate of members must increase fast. For instance, during last year about 10,000 individuals were added to Congress 60’s members.
B: The occupational, financial, educational and social status of the members.
For instance; when we decide to start a new building for Congress 60, since we have all sorts of people with different occupations within Congress 60, this is what happens.
One person donates bricks, another donates plaster, or girder. One takes care of electricity, and another handles the paper work or the administrative process. The sum of these things constitutes the sociality of a NGO.
C: The popularity of the NGO in social media like newspapers, radio, TV, seminars, universities, public, etc.
D: And last but not the least is the effectiveness of that very NGO in its own field using measurable recovery benchmarks. (HD)
Of Related Interest:
Hill, T. (2005). Commonstrength: Building leaders, transforming recovery. Published by Greenleaf Center for Servant Leadership 2006.
In 2012, I authored a monograph reviewing the results of 415 studies published over more than a century that reported rates of addiction recovery. Major findings of that review included 5.3% to 15.3% (25-40 million adults) of the adult population who reported once having but no longer having an alcohol or other drug (AOD) problem—either through sustained abstinence or reductions in AOD use. Substance use disorder (SUD) remission rates in studies published since 2000 were 53.9% in community samples and 50.3% in clinical samples (follow-up studies of addiction treatment). The wide range of estimates of prevalence and remission rates can be attributed to different problem definitions, different definitions of remission, and duration of follow-up (also see Mellor et al., 2019), but these studies collectively confirm a substantial population of people who reported having resolved an AOD problem in their lifetime.
Two recently published studies led by McCabe (2018) and Kelly (2017, 2018) offer additional data on recovery prevalence in the United States. Major findings from the McCabe study, based on data from the 2012-2013 Epidemiologic Survey on Alcohol and Related Conditions, include the following:
- 25.4% of the adult U.S. population reported meeting criteria for a DSM-5 SUD in their lifetime, with one-fourth of these reporting multiple SUDs.
- Among those with prior SUD, past year status was reported as: abstinence (14.2%), asymptomatic use (36.9%), partial remission (10.9%), and persistent/recurrent SUD (38.1%).
- Persistent/recurrent SUD status was associated with being 18-24 years of age, current tobacco use, higher levels of education and income, never married or divorced/separated, no prior addiction treatment, and stressful life events.
Major findings from the Kelly study, based on a U.S. adult population survey, include the following:
- 9.1% of U.S. adults reported once having but no longer having an AOD problem (Kelly, Bergman et al., 2017)
- At the time surveyed, more than 64.5% reported stable remission of more than five years (Kelly, Bergman et al., 2017)
- 53.9% of those reporting having resolved an AOD problem reported having used either formal addiction treatment, a mutual help group, or recovery support services to aid resolution of their problem. Assisted recovery was associated with greater problem severity and complexity. (Kelly, Bergman et al., 2017)
- Recovery identity status of those reporting once having but no longer having an AOD problem is as follows: 45.1% identify as being in recovery, 39.5% never identified as being in recovery, and 15.4% once identified but no longer identify as being in recovery (Kelly, Abry, et al., 2018).
The McCabe and Kelly studies add further evidence that tens of millions of American have experienced an AOD problem and have found sustainable and varied solutions to that problem. Two key tenets of the recovery advocacy movement are: 1) Recovery is a reality in the lives of individuals, families, and communities, and 2) There are multiple pathways of recovery and ALL are cause for celebration. The latest scientific studies simply add an empirical “Amen” to those declarations.
References
Kelly, J. F., Abry, A. W., Milligan, C. M., Bergman, B. G., & Hoeppner, B. B. (2018). On being “in recovery”: A national study of prevalence and correlates of adopting or not adopting a recovery identity among individuals resolving drug and alcohol problems. Psychology of Addictive Behaviors, 32(6), 595-604. doi: 10.1037/adb0000386.
Kelly, J. F., Bergman, B., Hoeppner, B., Vilsaint, C., & White, W. L. (2017). Prevalence, pathways, and predictors of recovery from drug and alcohol problems in the United States Population: Implications for practice, research, and policy. Drug and Alcohol Dependence, 181, 162-169.
Kelly, J. F., Bergman, B. G., Hoeppner, B., Eddie, D., Vilsaint, C., & Hoffman, L. (2018). Recovery from alcohol and other drug problems in the U.S. population: Prevalence, pathways, and predictors. Journal of Recovery Science, 1(2), c1. https://doi.org/10.31886/jors.12.2018.11
McCabe, S. E., West, B T., Strobbe, S., & Boyd, C. J. (2018). Persistence/recurrence of and remission from DSM-5 substance use disorders in the United States: Substance-specific and substance-aggregated correlates. Journal of Substance Abuse Treatment, 93, 38-48.
Mellor, R., Lancaster, K. & Ritter., A. (2019). Systematic review of untreated remission from alcohol problems: Estimation lies in the eye of the beholder. Journal of Substance Abuse Treatment, March, DOI: 10.1016/j.jsat.2019.04.004
White, W. L. (2012). Recovery/remission from substance use disorders: An analysis of reported outcomes in 415 scientific studies, 1868-2011. Chicago: Great Lakes Addiction Technology Transfer Center; Philadelphia Department of Behavioral Health and Developmental disabilites; Northeast Addiction Technology Transfer Center.
Research Opportunity
[Summary: Individuals with a history of substance use disorder might be eligible to participate in a brief online survey about personality, mental health, and substance use. Those who complete the survey and provide a DNA sample (in the form of saliva) will be compensated for their time and effort.]
National surveys have given us with valuable information about rates of alcohol and other drug use and dependence. Much of what we know about substance use disorders (SUD), however, have come from information obtained from men and women entering inpatient or outpatient treatment for their substance use. While such information is important, it represents only one segment of the much larger group of people with SUD. Many such individuals have never been admitted to a substance use treatment program nor have they participated in any kind of addiction recovery support group (White et al., 2013).
In research, this restricted focus on the substance use treatment community has been accompanied by an equally narrow definition of treatment “success”, which in many cases has been measured solely by whether a person has returned to use or have remained abstinent. Similarly, epidemiological studies of substance use disorders have looked predominantly at remission, examining how many individuals with a lifetime diagnosis of SUD do not meet those criteria for the past year (White et al., 2013). For alcohol use disorders (AUDs) in adults, such remission rates have ranged from 5.3% to 12.9% (Dawson at al. 2008, as cited in White, 2011, p.26)
A recent national survey by the Partnership at Drugfree.org and the New York State Office of Alcoholism and Substance Abuse Services (OASAS) estimates that >24 million adults in the USA are in recovery from SUD (White et al., 2013). Their study affirmed how little is known about the demographic, medical and psychosocial characteristics of this larger population of people with addictions.
Faces & Voices of Recovery recognizes there are many paths to recovery, ranging from mutual-aid groups to formal treatment and it has embraced people with all types of recovery experiences (Laudet, 2011). The organization has been instrumental in spearheading change in how the general public views people with substance use disorders and what constitutes recovery. Their efforts have also had an impact on the research community, with greater recognition of how important it is to include this broader recovery group in future studies.
Our research team at Virginia Commonwealth University (VCU) in Richmond, VA, hopes to contribute to this effort by making sure members of Faces & Voices of Recovery and the larger community can, if interested, participate in our study of “Genes, Addiction and Personality” (GAP). The study seeks to better understand genetic and environmental influences in individuals with substance use disorders.
As you may know, substance use disorders tend to “run in families”. Researchers, including members of our VCU team, have tried for decades to better understand why this happens. This is difficult, because families share both common genes and common environmental experiences that can contribute to familial clustering. To tease them apart, we have used such strategies as twin and adoption studies. Taken together, such studies have found that genetic factors (those passed down from parent to child through DNA) account for up to about half of the risk for developing a problem with addiction. Environmental circumstances, both within and outside the family, account for the remaining risk.
More recently, with advances in human genetics, researchers have undertaken projects aimed at identifying which genes influence risk. This has been no small task, because for alcohol and other substance use disorders, we know that hundreds or even thousands of genetic variants are likely to play a role in the risk for developing the disorder. Each of these variants contributes only incrementally to risk, with the environment also playing a key role in the process. Environmental factors can not only increase the chances people NOT at high genetic risk might develop SUD, it can also be protective among those who ARE at high genetic risk. For example, if an individual is never exposed to alcohol due to local laws prohibiting its purchase, they will not develop problems with alcohol, even if they have many of the genetic risk variants.
To complicate things further, the symptoms of SUD differ a lot across individuals with the disorder. The new DSM-5 diagnosis of SUD describes 11 symptoms that range from craving to loss of control to problems at work/school to physical withdrawal. Two people can receive a diagnosis of SUD with no overlap in their symptoms. This variability and diversity has been a focus of more recent research: might genetic factors impact which symptoms a person exhibits? More importantly, if there are such genetic differences, what can we learn about them that might improve prevention, intervention, and treatment?
The impetus for the GAP study came from recent schizophrenia research. Schizophrenia is another condition that is influenced by many genetic variants of small effect (Levinson et al., 2011). Recent research has provided valuable insight for researchers trying to understand the genetic basis of schizophrenia. This research only became possible after survey data and saliva samples for DNA analysis were obtained from over 30,000 people with schizophrenia. With this large sample, the results have been promising, with scientists reporting they had identified over 100 genomic regions that impact risk for schizophrenia. Many researchers believe data from this research is likely to inform the field about new ways to assess for schizophrenia risk as well as develop novel and more effective treatment options.
Our research team at VCU received funding from the National Institutes of Health (NIH) to undertake the same type of study focused on individuals with addiction. Our goal is to better understand genetic and environmental influences in substance use disorders. Based on pilot data we collected over the past 2-3 years, we hope to recruit 12,000 individuals with a history of SUD who are willing to complete a brief survey and provide a DNA sample which is central to such research.
We think it is very important to have the broader recovery community participating in the research from the very beginning. To help us meet this goal, Faces & Voices of Recovery has agreed to support our efforts in the GAP study. To get involved, click the link at the bottom of our blog, where you will be taken to our research site to obtain additional information about the project. If an individual qualifies for the study, you can then decide if you would like to participate. Participation involves completing a 15-20 minute on-line survey and then providing a saliva sample (kit sent through the mail) for DNA. Once the survey and saliva samples are received, participants will receive a $10 gift card for their time and effort. No identifying information will be linked to the data, but with your permission we will maintain your contact information in case you are interested in participating in future studies.
This is an exciting time in the field of addiction, and the VCU research team is committed to conducting the study. But we can’t make progress without the involvement of individuals entering treatment and members of the recovery community who have struggled with SUD; either now or in the past.
We hope that you will join us in this effort to learn more about SUD, with a common goal of improving the lives of those impacted by the disorder and their family members. We also hope the project will provide information helpful to Faces & Voices of Recovery and other organizations committed to advocating and educating federal agencies, policy makers and clinicians as well as the lay public about people with addictions and their long-term recovery.
CLICK HERE for more information and to participate in our survey. If you have previously participated in the GAP study, please do not take the survey again. If you have questions, you can contact GAP2online@vcu.edu.
Temperance Chip, 1841
Since publication of the second edition of Slaying the Dragon: The History of Addiction Treatment and Recovery in America, many people have expressed their appreciation of the photos included in the new edition. These images put flesh and blood on the lives and key events that make up the history of addiction recovery in the U.S.
In response to those comments, I have devoted much of the last two years on developing a photo gallery on the history of addiction recovery in America. That gallery has now been added to my website and contains topical albums, each containing a visual chapter on the evolution of addiction recovery in the U.S. Many more albums and images will be added as additional photos are located and permission to use them obtained. In the meantime, I encourage you to explore these photographs to gain a deeper appreciation of the men and women whose lives paved the way for the recovery opportunities that touched many of our own lives and that are now available to those seeking and yet to seek recovery from alcohol- and other drug-related problems. The new Photo Gallery is available at The Selected Papers of William White / Photo Gallery Index.