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.

More Recent Posts

Advocacy & Outreach Program Assistant

November 21, 2022
Faces & Voices of Recovery is seeking an Advocacy & Outreach Program Assistant. This is a full-time home-based position with a competitive annual starting salary- based on experience. Faces & Voices of Recovery offers generous leave and health benefits. We believe that diversity in experiences, perspectives, knowledge, and ideas fuels creativity, broadens knowledge, and helps drive success. That’s why we’re proud to be an equal opportunity employer and strive to treat all employees with honesty, dignity, and sensitivity. We welcome all qualified applicants regardless of recovery status, criminal justice history, race, color, national origin, ethnicity, religion, sex, pregnancy, sexual orientation, gender, gender expression or identity, age, disability, veteran status, marital status or any other legally protected class. To Apply:  A cover letter describing your interest in THIS job and why you’re a good fit is required.  Send resume and cover letter to Job purpose

The Advocacy & Outreach ProgramAssistant provides support for the Public Affairs department within the organization. The Program Assistant works on advocacy and public policy projects collaboratively with team members on activities such as awareness campaigns, legislative issues, public speaking events, constituent training, national and international outreach.The primary purpose is to provide administrative support to ensure project goals are met efficiently and in a timely manner.

Duties & Responsibilities
  • Answer phone and emails and respond to requests for information and resources
  • Create calendar events in Outlook
  • Maintain project files in Sharepoint
  • Enter data into Salesforce
  • Host virtual meetings through the Zoom platform
  • Schedule conference calls and meetings
  • Prepare meeting materials and record meeting notes
  • Assist with collecting project data and preparing reports
  • Update website as needed
  • Create surveys and collect results
  • Coordinate travel and event logistics
  • Other administrative duties
  • Strong commitment and enthusiasm for recovery advocacy and the people and groups we serve around the country
  • Must be a self-starter with the ability to work independently and as a team.
  • Administrative experience required
  • Strong aptitude for technology required
  • Proficient in Microsoft Office Suite, including SharePoint
  • Experience with Salesforce, WordPress, Survey Monkey, Doodle a plus
  • Superior internet research skills
  • Excellent interpersonal, organizational, and written/oral communication skills
  • Copy editing skills a plus
  • Bachelor’s degree preferred; Associate (AA) or equivalent administrative experience required
  • $40,000 – $45,000 – Commensurate with experience.
Working conditions

Faces & Voices of Recovery employs remote workers, but projects may require staff to travel. All necessary personal arrangements for travel; childcare, house care, etc. should be done on staff personal time. Errands, like shipping and mailing, that pertain to projects can be done during work hours. All staff are required to maintain a suitable home office environment and be working and available to reached during office hours –9-5 ET unless discussed otherwise with supervisor.

Physical requirements Must be able to remain in a stationary position 90% of the time. Constantly operates a computer and other office productivity machinery, such as a calculator, copy machine, and computer printer. The person in this position frequently communicates with customers who have inquiries. Must be able to exchange accurate information in these situations.Some occasions may call for moving equipment weighing up to 50 pounds to and from venue locations for various event’s needs. Direct Reports


Faces & Voices of Recovery Issues Urgent Call to Action

November 17, 2022

Unlocking the Potential of Recovery Community Organizations and Peer Recovery Support Services is an important call to action on the future of addiction recovery in the United States”, says William L. White, Recovery Historian, and author of Slaying the Dragon: The History of Addiction Treatment and Recovery in America. “If its recommendations are heeded, this seminal report could well be a milestone in the future of recovery community organizations and peer recovery support services.”

The white paper, soon to be released publicly by Faces & Voices of Recovery, demonstrates how the current financing models for peer recovery support services present significant barriers to maximizing the role of the peer workforce in addressing the addiction crisis in the United States.  The peer-to-peer relationship impacts health at multiple levels of the socioecological model (i.e., at individual, family, community, and societal levels) and has potential not currently actualized.  The inclusion of peer workers has become a best practice and a number of interventions utilizing them demonstrate compelling outcomes. In this report, the authors lay out the key issues underlying the need for action to bring about broad systems change.

“While we recognize the complexity of policy and financing issues, the peer workforce and recovery community organizations that employ them need a paradigm shift now to sustain their invaluable work in communities across America. This report is a must-read for everyone interested in the future of recovery community organizations and peer recovery support services”, says Patty McCarthy, CEO of Faces & Voices of Recovery.

Authors of the white paper are Kenneth D. Smith, PhD, Assistant Professor of Public Health at the University of Tennessee Knoxville, Robin Peyson, MHSA, Owner & Lead Consultant of RLP Consulting, and Sierra Castedo de Martell, MPH, Doctoral Candidate, UTHealth School of Public Health, Austin Regional Campus.

Join Faces & Voices of Recovery at 3-4:30 pm ET on December 1, 2022, for a webinar with the authors, as well as other nationally recognized leaders in the recovery movement. To learn more or register


Unlocking the Potential of Recovery Community Organizations and Peer Recovery Support Services will be made available on the Faces & Voices of Recovery website at prior to the event.



Director of Public Affairs

November 10, 2022

Faces & Voices of Recovery is seeking a Director of Public Affairs.

This is a full-time home-based position with a competitive annual starting salary- based on experience. Faces & Voices of Recovery offers generous leave and health benefits.

We believe that diversity in experiences, perspectives, knowledge, and ideas fuels creativity, broadens knowledge, and helps drive success. That’s why we’re proud to be an equal opportunity employer and strive to treat all employees with honesty, dignity, and sensitivity. We welcome all qualified applicants regardless of recovery status, criminal justice history, race, color, national origin, ethnicity, religion, sex, pregnancy, sexual orientation, gender, gender expression or identity, age, disability, veteran status, marital status or any other legally protected class.

To Apply: 

A cover letter describing your interest in THIS job and why you’re a good fit is required. 

Send resume and cover letter to

Job purpose

The Director of Public Affairs works closely with the senior management team to develop, advance, and oversee the public affairs activities of Faces & Voices of Recovery, including the organization’s communications, marketing, public relations, government relations, policy, and advocacy strategies.

Focus Area

Special focus of this position includes leveraging the existing initiatives and expertise of the organization to develop a cohesive message and platform for all relevant stakeholders, including members of the recovery advocacy community, government leaders, and the general public. It includes understanding, identifying, and maximizing opportunities to advance public policy issues relevant to the organization and developing and implementing communications strategies. This position requires the ability to swiftly maximize opportunities and mitigate risks, while building positive relationships with stakeholders, the media, and the public. The Director will leverage the expertise of board members, public policy committee and other partners to implement communications and public relations plans to help operationalize the mission and vision of Faces & Voices of Recovery.

Primary Responsibilities

The Director of Public Affairs leads the Public Affairs team and works collaboratively across departments to achieve the following:

  • Develop and implement cohesive national messaging around addiction recovery
  • Develop and implement a process for measuring national impact
  • Identify and leverage opportunities to generate national, regional and local news
  • Develop and implement public relations and communications strategies
  • Oversee implementation of a cross-functional government relations, public policy and advocacy strategy
  • Oversee implementation of a cross-functional marketing strategy for products and services
  • Build, manage, and strengthen relationships with government officials, stakeholders in the recovery advocacy community including Recovery Community Organizations (RCOs), and industry partners at the local, state, and federal levels
  • Generate written content, including press releases, op-eds, articles, keynote speeches, talking points, and other promotional materials for public consumption and internal use
  • Oversee the creation of high-quality briefing materials for political audiences to support public policy strategy and advocacy priorities
  • Ensure the organization’s commitment to justice, diversity, equity, and inclusion (J-DEI) is reflected throughout all communications, publications, materials, and messaging
  • Improve and oversee communications platforms and delivery vehicles, including social media platforms
  • Develop and oversee execution of work plans and project plans to achieve the organization’s public relations, communications, and policy goals and vision
  • Develop a wide range of new opportunities to maximize the impact of the organization.


  • At least 5 years of progressive experience in public affairs related to social justice, healthcare, and/or behavioral healthcare
  • Experience with running grassroots campaigns to engage members and other stakeholders in policy discussions is a plus
  • A strong track record of positioning an organization to achieve tangible outcomes in a competitive communications environment
  • Ability to quickly develop subject matter expertise on a range of issues and translate complex issues and ideas for public consumption
  • Ability to coach, mentor, and support leaders and emerging leaders at all levels of the organizations as public spokespeople, and to function as the organization’s spokesperson when needed and appropriate
  • Expertise in developing messaging strategies
  • Ability to communicate with the public about why we back certain policies and why advocates should make their voices heard to influence government decisions
  • Experience in remote work and virtual platforms a plus
  • Values recognizing accomplishments and abilities of other staff
  • Passionate about Faces & Voices mission and able to promote and communicate the mission and values to external and internal stakeholders


  • A Bachelor’s Degree in public relations, communications, political science, healthcare administration, or another related field, is required for this position
  • Master’s Degree a plus. Relevant experience may be considered as a possible substitution

Specialized Knowledge

  • Demonstrates an understanding of diversity, equity and inclusion (DEI) and a willingness to grow with the team in our DEI journey
  • Thorough understanding of how the internet and social media have transformed grassroots advocacy
  • Understanding of addiction and recovery principles, recovery support services and Recovery Community Organizations


  • Skilled in effective supervision and training of staff
  • Skilled in speaking and writing effectively
  • Skilled in providing public presentations and trainings
  • Proficient in Microsoft Office Suite


  • Ability to establish and maintain effective working relationships with staff and representatives from other agencies, organizations, and the general public
  • Ability to use technology to maintain records
  • Ability to juggle multiple priorities in fast-paced environment
  • Ability to be agile and respond to changing needs and priorities quickly
  • Ability to facilitate teamwork and individualized professional growth among direct reports


  • $80,000 – $90,000 – Commensurate with experience.

Working conditions

Faces & Voices of Recovery employs remote workers who must maintain a home office conducive to optimal work performance and free of distractions. Some projects may require staff to travel. All necessary personal arrangements for travel such as childcare, house care, pet care, etc. should be done on personal time. Local errands, like shipping and mailing, that pertain to work projects should be done during work hours. All staff are required to work and be available during office hours – 9:00 am -5:00 pm ET unless otherwise approved by supervisor.

Physical requirements

Employee must be able to remain in a stationary position 90% of the time. Constantly operates a computer and other office productivity equipment. Some occasions may call for moving equipment weighing up to 50 pounds.

Direct Reports

Marketing and Communications Manager; Advocacy and Outreach Manager

Technical Host

May 13, 2022

Faces & Voices of Recovery is seeking a dynamic person to assist in providing technical support for our training courses starting immediately.  

This is an independent contractor role, up to 20 hours per week, as needed. Technical Hosts must be available to work between 9:00 am – 6:00 pm EST (Eastern Standard Time). 


Tasks and Responsibilities  

Technical Hosts will assist the Faces & Voices of Recovery’s National Recovery Institute by providing technical support for virtual training via the Zoom platform.  

 Position Duties and Responsibilities 

  • 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 

 To Apply 

To apply, send a letter of interest and current resume/CV to 


Equal Opportunity Employer 

We believe that diversity in experiences, perspectives, knowledge, and ideas fuels creativity, broadens knowledge, and helps drive success. That’s why we’re proud to be an equal opportunity employer and strive to treat all employees with honesty, dignity, and sensitivity. We welcome all qualified applicants regardless of recovery status, criminal justice history, race, color, national origin, ethnicity, religion, sex, pregnancy, sexual orientation, gender, gender expression or identity, age, disability, veteran status, marital status, or any other legally protected class. 

Faces & Voices of Recovery’s Statement on Final FY2022 Budget

March 22, 2022

March 22, 2022


President Biden signed the nation’s Fiscal Year 2022 budget into law Tuesday, March 15, 2022. This year’s budget received several increases in areas that directly benefit recovery support services, including:

  • $50 million to Substance Abuse Block Grant (SABG)
  • $25 million to State Opioid Response (SOR) Program
  • $7.3 million Treatment, Recovery, and Workforce Support (SUPPORT Act)
  • $3 million to Building Communities of Recovery (BCOR)

Our advocacy work began last January when the President unveiled his plan to substantially increase dollars available in the Substance Abuse Prevention and Treatment Block Grant (SABG), elevating current levels by over $1 billion. Although the House and Senate included these provisions in their original bills, they unfortunately did not reach the final bill text.

The FY2022 budget was met with primarily flat funding across the board. As a result, our members and community lost several promising provisions– including a 10% set-aside for recovery support services and the re-introduction of text prohibiting federal dollars utilized for safe supplies, like sterile syringes.

“Despite these setbacks,” says David Mineta, Board Chairperson, Faces & Voices of Recovery, “we have made clear strides with Congress, who continue to show overwhelming support for recovery support services. Our work for 2023 has already begun as we repeat the annual cycle for change. We trim last year’s vegetation and nourish the roots that have allowed the Recovery Movement to flower and grow–advocacy by the grassroots.”

Faces & Voices of Recovery has long advocated for Congress to establish a set-aside for recovery. The President’s historical push for a 10% set-aside for recovery support services and an enormous increase to the block grant would dedicate several hundred million dollars for recovery community organizations, including recovery high schools, collegiate recovery programs, recovery residences, and alternative peer groups across the United States.

“Over the last 20 years, our advocacy work has led to substantial increases in federal funding for recovery support services,” says Patty McCarthy, Chief Executive Officer, Faces & Voices of Recovery. “Within the past three years alone, our advocacy efforts have grown the Building Community of Recovery grant program from $5 million to $13 million. These increases in federal funding have allowed our communities to build and strengthen programs where it counts–in community-based settings. Looking to FY 2023, we will continue to work with Congress to ensure that the block grant receives at least a $1.7 billion increase and that 10% of block grant funds are dedicated to recovery.”

The final FY2022 budget may not be the outcome we were anticipating; many advocates did not expect Congress to deny the recommended funding levels during a time when preventable, fatal overdoses are the leading cause of death for people ages 18-45. However, this year’s budget did limit nearly all areas of federal spending. Our staff and partners redouble our efforts to strengthen new and existing programs supportive of recovery services, and we feel confident that the remainder of 2022 will present many opportunities to expand access and funding for recovery support services.

As we execute our federal priorities, we will continue to serve as a national resource to the Administration, Congress, and our community. We encourage all communities to amplify the faces and voices of recovery to ensure that all who seek wellness have equitable access to recovery support. This year onward, our timing and advocacy will be paramount to the future of people who use substances, those with substance use disorder, and their families and loved ones. For these reasons, Faces & Voices of Recovery stands ready to advocate, act, and advance.

We will continue to notify our communities of our progress and calls-to-action to support creating dedicated funding for recovery.

For more information, the FY2022 bill text can be found here.

Faces & Voices of Recovery Supports Safe Supplies for Harm Reduction

February 10, 2022

Board President David Mineta and Chief Operating Officer Philip Rutherford have released the following statement:

Communities across our country face the devastation posed by overdose deaths, now the leading cause of people ages 18-45. As a result, the exponential loss caused by preventable, fatal overdoses has led to an influx of innovative approaches that promote the general health and wellbeing of people that use drugs, including those with addiction.

This crisis continues to overwhelm families and communities through the loss of loved ones and the economic impact that fatal overdoses pose. At a minimum, fatal overdoses cost the United States $1 trillion annually. Alternatively, adequate addiction treatment dramatically reduces law enforcement and healthcare costs, including Medicaid spending, by 700%.

Faces & Voices of Recovery promotes the utilization of services that offer fentanyl test strips, access to HIV and viral hepatitis treatment, sterile syringes, and safe smoking supplies, which reduce the rate of overdose and spread of infectious diseases – minimizing the harmful effects of drug use. Additionally, these strategies promote linkages to care and facilitate services for the health and wellbeing of its participants through motivational interviewing, counseling, and peer support specialists.

Despite continued discussion around the ‘opioid epidemic,’ fatal overdoses are not confined to heroin or opioids, nor are they limited to intravenous drug use. For example, a recent report from the Commission on Combating Synthetic Opioid Trafficking, states that 70 percent of overdose deaths involve heroin or cocaine, and nearly 50 percent involve psychostimulants such as methamphetamines.

We must consider safer consumption for non-intravenous substance use when preventing overdose. Ultimately, dividing the available resources for safer drug consumption perpetuates stigma about different drugs. Historically, we’ve seen the challenges that arise from this mentality through the ‘crack epidemic,’ which led to the inherently flawed and racist practices of mandatory minimum sentencing, the three-strike policy, and ultimately mass incarceration.

These perspectives perpetuate the continued trauma of many Black communities that were and are ignored, untreated, and incarcerated rather than having access to treatment and recovery supportive opportunities. Not only does this further disadvantage communities of color, but it also disadvantages rural communities that may experience higher levels of methamphetamine use and continues the cycle of disproportionate systems and inequitable resources to access addiction recovery.

We encourage all communities to amplify the faces and voices of recovery to ensure that all who seek recovery have equitable access to recovery supports of their choice. Especially policies that eliminate systems, structures, and constructs that marginalize people by race and ethnicity.

Where the Overdose Epidemic & COVID Collide, Peer Coaches & Specialists Face ‘Perfect Storm’

February 7, 2022

“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. 


January 13, 2022

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 – 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 and 


Emily Porcelli, Marketing and Communications 

Faces & Voices of Recovery  


2021 ARCO Programmatic Evaluation Report

January 11, 2022

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

NRI Newsletter – October 2021

October 28, 2021

October 2021
Digital Newsletter

National Recovery Institute

The National Recovery Institute is a peer-run training and technical assistance center. Our mission is to increase the knowledge, capacity, and accountability of recovery support providers throughout the United States and territories.

The National Recovery Institute offers competency and strength-based professional development and leadership training specific to our field.  Our experienced trainers offer training accessible to all learning styles through a combination of information sharing, dialogue, and experiential activities. Through a consultative process, we will build an onsite or online training program specific to your needs.

Please check out our website for more information! We are excited to get your next training scheduled today!

More Info Here!

Mark your Calendars!

Please join us for these FREE upcoming trainings sponsored by the Opioid Response Network

RCO Bootcamp
December 7-9, 2021
10 am – 4pm EST

The RCO Bootcamp is a leadership development program for new and emerging Recovery Community Organization (RCO) directors, program managers, and board members. The Boot Camp covers all the basics to help establish policies and procedures to build the capacity of small non-profit organizations.

CEUs available

Register here!

Recovery Ambassador Training
December 14-16, 2021
10am – 4pm EST

Recovery Ambassador is a training that prepares individuals to advance public understanding and appropriate responses to addiction. The training program consists of a combination of Our Stories Have Power Recovery Messaging, the Science of Addiction & Recovery, and the Recovery Ambassador curriculum.

CEUs available

Register here!
Faces & Voices of Recovery is proud to be a NAADAC Approved Education Provider.
Reduced training rates are available for Faces & Voices Affiliates and for Members of the Association of Recovery Community Organizations (ARCO).
Join Today!

Posts from William White

A Lesson from Recent Vaping Deaths

September 12, 2019

Federal officials have tentatively identified the potential source of recently reported vaping-related respiratory illnesses and deaths. The culprit
appears to be vitamin E acetate, a substance long used as a nutritional supplement and topical skin treatment but whose oily consistency may make it quite toxic when inhaled via vaping. While these findings are preliminary and require confirmation in multiple studies, the unfolding story of vaping-related injuries is pregnant with implications for those on the frontlines of harm reduction, addiction treatment, recovery support, and recovery advocacy.

The vaping illnesses and deaths affirm several principles that can guide our monitoring of emerging drug trends. New technologies that increase the efficiency of drug consumption by altering per episode and lifetime drug dosage, drug purity, or route of drug administration may require a fundamental rethinking of the risks associated with particular drugs.

While the toxic effects of new drugs and new ways of using known drugs are usually identified early in their social emergence, the nightmare scenario would be a Trojan Horse that possessed few if any short term negative effects but devastating effects linked to long-term use. That is precisely the scenario that forced a radical rethinking of the effects of smoking tobacco over the past century. When toxic drug effects become quickly apparent before widespread use, mass public health damage can be minimized. In the case of tobacco smoking, short term studies would not have revealed smoking as the ticking time bomb that it is. We must be vigilant in identifying other drugs and patterns of drug consumption that may share a similar trajectory.

This is the only point I wish to make in this blog. Those at the forefront of dealing with addiction are in a unique position to identify such threats early in their emergence. Through careful listening and observation we may be able to identify new threats to the health of individuals and communities early in the history of their emergence. Seeing such threats, we can communicate what we are observing to public health and community leaders, and by so doing, arouse action to reduce the numbers of people exposed to such threats as well as get people already exposed the help they need as quickly as possible.  Listen. Observe. Help. Advocate.  We are a crucial part of a desperately needed early warning network.

Recovery Contagion within the Family

September 5, 2019

Addiction runs in families, but far less known is the fact that recovery also runs in families. Both of these phenomena have captured my attention in recent decades and been the focus of numerous articles.

Scientific studies are unravelling the factors that combine to elevate risk of intergenerational transmission of addiction and related problems. These mechanisms of transmission include genetic and neurobiological influences, fetal alcohol spectrum disorders, assortative mating (attraction of those exposed to parental addition to individuals who share this family history), co-occurring conditions, temperament, developmental and historical trauma, family dynamics (e.g., parental/sibling modeling and collusion), early age of alcohol and other drug (AOD) exposure, and disruption of family rituals. (See here for review of studies). Rigorous studies have yet to be conducted on the prevalence, patterns, and mechanisms through which addiction recovery of one family member increased the probability of other addicted family members also initiating a recovery process. The purpose of the present blog is to offer some observations on these issues drawn from decades of observation of families impacted by and recovering from severe and persistent AOD problems. The following suggestions should be viewed as hypotheses to be tested via scientific studies and more expansive clinical observations.

  • Innumerable patterns of recovery transmission exist within families. Recovery transmission may occur intergenerationally (e.g., parent to child) and Intragenerationally (between siblings) and reach the extended family and social network. The recovery influence may also be bi-directional, e.g., mother in recovery to addicted child, child in recovery to addicted mother). Recovery transmission, like addiction, can also skip generations.
  • The probability of recovery initiation of an addicted family member increases as the density of recovery within an addiction-affected family network increases. The contagiousness of recovery and the push and pull forces towards recovery increase exponentially as other family members initiate recovery and as overall health of the family system improves.
  • The mechanisms of recovery transmission within affected families include:
    1. infusion into the family of increased knowledge about addiction and recovery by the family member(s) in recovery,
    2. withdrawal of family support for active addiction,
    3. truth-telling about the addicted family member’s behavior and its effects on the family
    4. elicitation of hope,
    5. recovery role modeling,
    6. active engagement and recovery guidance by family member(s) in recovery,
    7. assertive linkage and co-participation in recovery mutual aid and other recovery support institutions,
    8. assistance when needed in accessing professional treatment,
    9. post-treatment monitoring and support, and
    10. adjustments in family life to accommodate recovery support activities for recovering members and family as a whole.

These individual mechanisms achieve heightened power when sequenced and combined over time.

  • Recovery of a family member can spark personal reevaluations of AOD consumption of other family members, resulting in a potential decrease in AOD use and related risk behaviors, even among family members without a substance use disorder. This may constitute a hidden benefit of recovery in lowering addiction-related costs to community and society.
  • The recovery contagion effect on other family members exists even when the recovering family member isolated themselves from the family to protect his or her own recovery stability. The family’s knowledge of the reality of his or her continued recovery and its effects on their health and functioning exerts pressure towards recovery even in absence of direct contact.
  • One of the most complicated forms of recovery contagion is between intimate partners who both experience AOD problems. The recovery of one partner destabilizes the relationship and increases the probability of recovery initiation of the other; addiction recurrence in one partner increases the recurrence risk in the other partner. Recovery stability is greatest when each partner established their own recovery program in tandem with activities to support “couple recovery.”
  • Where conflict exists between a family member in recovery and a family member in active addiction (e.g., a father in recovery and an actively addicted son), the conflict can serve as an obstacle to recovery initiation of the addicted family member. Though recovery initiation may be slowed, recovery prognosis is still increased and the conflicted relationship is often reconciled when both parties are in recovery. When not reconciled, conflict can continue to be played out via different pathways of recovery.

It is rare to escape injury to family within the addiction experience. Such injuries increase progressively within families in which multiple people are experiencing AOD-related problems. For those of us who find ourselves in such circumstances, the greatest gift we can offer our family is our own recovery.

Related Papers of Potential Interest

Evans, A. C., Lamb, R., & White, W. L. (2014). Promoting intergenerational resilience and recovery: Policy, clinical, and recovery support strategies to alter the intergenerational transmission of alcohol, drug, and related problems. Philadelphia: Department of Behavioral Health and Intellectual disAbility Services. Posted at

Navarra, R. & White, W. (2014) Couple recovery. Posted at

White, W. & Savage, B. (2003) All in the Family: Addiction, recovery, advocacy.   Posted at

White, W. (2014) Addiction recovery and intergenerational resilience Posted at

White, W. (2017). Family recovery 101. Posted at

White, W. Addiction/Recovery as a family tradition. Posted at

White, W. (2015) All in the family: Recovery resource review.

White, W. L. & Chaney, R. A. (2008). Intergenerational patterns of resistance and recovery within families with histories of alcohol and other drug problems: What we need to know. Posted at

White, W. L. & White. A. M. (2011).  Tips for recovering parents wishing to break intergenerational cycles of addiction. Posted at:

Toward a New Recovery Advocacy Movement 2000 Redux

August 29, 2019

Senator Wellstone and Representative Ramstads. 2001, Recovery Summit

I was invited in 2000 to do a presentation for the Center for Substance Abuse Treatment Recovery Community Support Program grantees meeting. I chose for my topic “Toward a New Recovery Advocacy Movement” and prepared a paper to share with attendees that constituted one of the first descriptions of the rise of grassroots recovery advocacy organizations at the dawn of the new millennium. That paper included the rationale for a new recovery advocacy movement and offered historical lessons and principles that might guide this fledgling movement. Below are some excerpts from that first paper, delivered almost 20 years ago, that readers may still find of interest.

Call to Action: It is time for a recovery movement.  The central message of this new movement is not that “alcoholism is a disease” or that “treatment works” but rather that permanent recovery from alcohol and other drug-related problems is not only possible but a reality in the lives of hundreds of thousands of individuals and families….In our enduring debate over whether the roots of addiction lie in the medical arena (a problem of susceptibility) or the moral arena (a problem of culpability), we have lost touch with real solutions to addiction, the evidence of which is in the transformed lives of recovering and recovered people across America…. It is time we (the remnants of the existing alcoholism/treatment movements) redirected our energies from an emphasis on pathology to an emphasis on resilience and recovery.

Treatment versus Recovery Interests: Treatment is best considered, not as the first line of response to addiction, but a final safety net to help heal the community’s most incapacitated members.  The first avenue for problem resolution should be structures that are natural, local, non-hierarchical and non-commercialized.  The interests and agendas of the recovery community and the treatment field overlap but are not the same….Professionally-directed treatment services are not the same as the broader umbrella of recovery support services.  Indigenous people who lack professional training should not be involved in the former, while the latter may be best designed and delivered by the recovery community.  Those providing treatment services and those providing recovery support services play different but complementary roles in the long-term recovery process.

Movement Structure: Co-mingling mutual aid and policy advocacy functions usually creates an organization that will either perform both functions poorly or sacrifice one function for the other. It is usually best to separate the service functions of mutual support, professionally-directed treatment, and social policy advocacy into separate agencies (or at least separate organizational units), but there are exceptions to this rule..…For a besieged people (community), personal recovery may be inseparable from the broader issues of social policy advocacy and cultural revitalization.

Kinetic Ideas: To alter public opinion, successful movements condense complex ideas and needs into easily digestible slogans. Once these have achieved broad social acceptance, they may need to be de-constructed for the movement to move toward full maturity.  Where such maxims become concretized and reified, the movement sets itself up for a future ideological backlash.

Multiple Pathways of Recovery: Rather than fight with each other over THE right way to recover, it is time to acknowledge what anyone with any observational skills and common sense has known for a long time: people with myriad patterns and circumstances surrounding their problematic relationships with alcohol and other drugs are finding diverse ways to initiate and sustain their resolution of these problems. It is time we celebrated the growing pluralism of the culture of recovery.

Cost of Recovery: The most important elements of sustained recovery–the commitment of self and the support from family, friends, and other recovering people–come without a price tag, and it is the nurturance and mobilization of those elements that are the primary mission of the new recovery movement.

One People, Many Voices, One Message: The long-term fate of this movement may hinge on its ability to tolerate differences and tolerate boundary ambiguity while forsaking calls to create a closed club whose exclusiveness would leave many suffering people refused entry at its doorway.  Somewhere in this movement’s maturation, a message of unification needs to be extended that psychologically and socially links the growing number of recovery groups and solo flyers into a community of shared experience that can transcend differences and allow it to speak powerfully on one issue: the very real hope for permanent recovery from addiction.  It is crucial that a way be found to transcend the internalized shame that turns members of stigmatized groups upon each other in frenzies of mutual scapegoating.  The most serious battles fought by this movement are best waged, not with each other, but with more formidable forces in the culture that seek to objectify, demonize, and sequester all those with AOD problems.

Changing the Face of Recovery: The faces of barely sober addicts on television screens need to be replaced by the faces of people from all backgrounds who have survived addiction to live full lives.  With no other disorder do we ask people in the earliest days of recovery to speak as if permanent recovery had already been achieved.  It is not that the floundering, newly sober celebrity is not welcome in the culture of recovery; it is that portraying this person as the culture of recovery is a gross misrepresentation of reality.  It is also a fact that thrusting individuals in the earliest stages of recovery into the limelight is to invite disaster for them as well as the movements they represent.

Language of Recovery: One of the challenges of the recovery movement will be how to reduce the stigma attached to a condition and those who suffer from it with a cultural language that is heavily laden with the stigma…. In the addiction recovery arena, two sets of language may be required–one for internal and one for external communications.

Professionalization and Commercialization: The twin threats of professionalization (preoccupation with power/status) and commercialization (preoccupation with money/property) have often proved fatal to advocacy movements. The professionalization of helping systems can inadvertently undermine indigenous supports for recovery, shift the focus of a movement from experienced knowledge to second-hand knowledge, and shift the service relationship from one that is enduring and reciprocal to one that is time-limited, hierarchical, and commercialized.

On Money: It is better to have an unfunded or under-funded movement than to have a well-funded movement whose mission is corrupted by the source or level of that funding. It is better to have the inception of a movement postponed than to have that birth prematurely induced by money that deforms its subsequent development.  Strategies of financial support that work in the short run can sometimes undermine a movement in the long run.  Movements can die from a lack of resources, but they can also die from the turmoil, restrictions, and diversions that resources can bring.  To the new generation of grass roots advocacy organizations I would say: Carefully heed the adage ‘he who pays the piper picks the tune’; find your own voice and sing only your own song. Be aware of seeking funding from any source that changes, no matter how subtly, your thinking, your vocabulary, your mission, or your methods.  Find a way to use money temperately to achieve your mission; money has no value and becomes destructive when it takes your “eyes off the prize.”  If you evolve into funded treatment agencies, you will have failed by professional absorption.

Stewardship: The principle of stewardship demands that we monitor the resources that flow into and out of recovery movement organizations to assure that resources that once passed through the organization into the community, do not begin to remain in the organization.

Risk of Premature Victory: There is danger that movements focusing on reducing stigma prematurely claim victory in the face of a positive media attention or sudden (but often superficial) shifts in public opinion. The fastest way to kill anything in America is to turn it into a superficial fad that dies from distortion and over-exposure…. The most insidious death of the recovery movement could occur if the essence of that movement died while the illusion of its continued existence remained.  This would be an invisible death–a death by value dilution and corruption.

Mission and Methods: Congruity: Social movements often go awry when their emerging methods conflict with their mission and core values. The means used by movements to achieve their mission must be congruent with that mission.  Recovery movements must be, above all, grounded in recovery values: honesty, simplicity, humility, gratitude, and service.

Inclusion/Exclusion: Before the recovery movement can confront stigma in the larger society, it must confront how that same stigma gets acted out as a destructive force inside the movement. Developing an inclusive recovery movement requires skills in cross-cultural communication, conflict resolution processes, and safe sanctuaries where healing and cross-cultural communication and relationship-building can occur….Movements that are created to advocate on behalf of the most disempowered often leave these very individuals behind as the focus of the movement seeks wider social acceptance.

Backlash: Movements that acquire visibility and influence often generate their own counter-movement. Once movements become visible on the cultural horizon, they become a target of those institutions whose interests they threaten.  The degree of success of any movement–the civil rights movement, the environmental movement, the gun control movement–cannot be fully ascertained until that movement has weathered the counter-movement that it generates…. Counter-movements germinate within the soil of a movement’s excesses.

Need for Recovery Research: The future of the recovery movement does not hinge solely on recent or future scientific data on the etiology of alcohol and other drug  problems/addictions.  It hinges on the emergence of a science of recovery extracted from the lives of those who have achieved such recovery.

I will leave it to my readers to judge how these earlies reflections have stood the test of time. The full paper is available HERE.

Partial Recovery

August 22, 2019

Ernie Kurtz and William White

In 2006, Ernie Kurtz and I collaborated on our first paper explicating multiple pathways and styles of addiction recovery. The article was later included in the first recovery management monograph and published in the International Journal of Self Help and Self Care. Included within the paper was a discussion of the variations in depth of addiction recovery, including descriptions of partial, full and enriched recovery.

Partial recovery, which will be described in more detail below, reflects decreased severity and frequency of alcohol and other drug (AOD) problems amidst persistent efforts to achieve recovery stability. Full recovery, while not implying the notions of perfection or completeness and as depicted in the professional literature (See HERE and HERE), most often refers to 1) positive and sustained change in the person-drug relationship (most often measured by sustained abstinence/sobriety or diagnostic remission), 2) improved global health and functioning, and 3) repair of the person-community relationship (sometimes characterized as citizenship). Enriched recovery refers to a state of optimal health, functioning, and community service rising, not in spite of addiction, but because of the strengths of character developed through the addiction recovery process. The latter two states have been elaborated on in subsequent papers and blogs (See HERE and HERE). The present blog seeks amplification of the concept of partial recovery from a substance use disorder (SUD).

Before proceeding, it is important to distinguish between two terms commonly used interchangeably. Remission is a medical term indicating that a person who once met diagnostic criterial for a medical disorder has ceased meeting such criteria for a specified period of time. In the case of SUDs, the American Psychiatric Association designates two categories: early remission—at least 3 but less than 12 months without meeting criteria for a substance use disorder (except craving), and sustained remission—at least 12 months not meeting SUD criteria (except craving). Remission can be characterized as a process of symptom or illness subtraction from what might otherwise be an unchanged life.

Recovery, a term first used to characterize the lived experience of resolving severe and persistent alcohol and other drug problems, is widely described as more than the deceleration or removal of drugs from one’s life. Within the concept of recovery we find the broader three-part definition noted above. It encompasses processes of subtraction (reduction and cessation of drug use) and addition (incremental improvements in physical, emotional, social, and spiritual/ontological (e.g., life meaning and purpose) health. Enriched recovery is distinct in its multiplication effect—dramatic transformations of personal character, identity, and levels of social functioning and community service beyond what would have been likely without strengths drawn from the recovery experience.

The concept of partial recovery is commonly applied to other medical conditions, particularly chronic conditions. This means that the condition has not been permanently cured or its symptoms permanently suppressed but that the severity and frequency of symptom manifestations and their consequences on role functioning and quality of life have been reduced to a more manageable level. The mental health field has long extolled the potential and goal of partial recovery, but until recently denied the probability and even possibility of full recovery from the most severe mental illnesses.  In contrast, the addictions field, has long reified the concept of full recovery but has lacked any functional understanding of the potential for partial recovery as a transitional or terminal achievement and valued outcome of clinical intervention.

Partial SUD recovery can apply to diverse circumstances, including the following:

1. Criteria for SUD continue to be met but at lower levels of severity, e.g., declining frequency, severity, and consequences of AOD use, and related risk behaviors.

2. Substance use has ceased or decelerated to the point of diagnostic remission without evidence of larger improvements in global health and functioning, quality of life, or community integration. (The early months/years of recovery efforts are often marked by continued impairment of physical health and emotional and social functioning–symptoms that continue to improve and remit over the first ten years of recovery for most but not all persons.

3. Patterns of substance use remain unchanged with evidence of improvements in global health, social functioning, quality of life, or community integration (reversing the normally expected sequence).

4. Substance use has ceased or decelerated to the point of diagnostic remission with some but limited improvements in broader areas of health and functioning due to one or more commonly occurring conditions (developmental trauma, psychiatric illness, medical/legal/occupational burdens arising from addiction history) or environmental obstacles to recovery.

Partial recovery is a state of limbo in which addiction has been destabilized (as evidenced by repeated recovery attempts) but recovery has yet to be fully stabilized. Some in this state of limbo are trapped in the space between recovery initiation and recovery maintenance—knowing how to stop use but not yet fully mastering how to avoid restarting use or how to live and cope as a person in recovery. Needed at this point are the right combination and sequence of experiences and supports to serve as a catalyst or tipping point of recovery stability.

Several service implications flow from the concept of partial recovery.

First, partial can constitute a permanent state, a developmental stage of recovery (e.g., precovery), or a time-limited hiatus in drug use with eventual reversion to a previous or greater level of AOD problem severity. Individuals and their families considering addiction treatment and recovery support options should be informed of the spectrum of possible post-service trajectories: 1) no effect (continuation or acceleration of AOD use and its consequences), 2) limited effect (partial recovery), 3) optimal effect (full recovery), and 4) supra-optimal effect (enriched recovery). These same communications should include the factors known to influence these potential outcomes and what the individual and family can do to write the future chapters of their story.

Second, if partial recovery is sustainable without the burden of escalating clinical deterioration and is an individual choice, we should be asking ourselves what we might do by way of service designs to support such achievement given the benefits to self, family, and society that could accrue from problem deceleration. People who are constitutionally incapable of permanent abstinence from AOD use but who may choose or only be able to achieve partial recovery at particular points in their lives have not historically been viewed as legitimate service candidates within the addictions field. The emergence of a separate harm reduction field and calls to integrate harm reduction, clinical treatment, and recovery support services may change that.  The good news to be shared is that recovery, like addiction, exists on a spectrum, and that considerable improvement in health, social functioning, and quality of life can be achieved on the path to full recovery. Each increment of positive change has value in its own right and incubates positive future changes. People achieve partial recovery with or without embracing a recovery identity, with or without recovery mutual aid involvement, and with or without participation in addiction treatment.

Third, alternative service designs are needed for people who achieve time-limited partial recovery but whose periodic escalation in drug use brings them repeatedly through the revolving doors of addiction treatment programs. Recycling these persons through acute care models of addiction treatment offers little more than respite care and needs to be replaced with models of assertive and sustained recovery management and potentially new or clinically adapted recovery support institutions. Recovery mutual aid organizations have long made room for such individuals; adding new sources of support might facilitate the journey from partial to full recovery.

Fourth, we need a clearer understanding of the differences between those who achieve partial versus full SUD recovery. This is both a research and clinical agenda. My observation is that recovery, like addiction, is a spectrum process. This means that just as AOD problems exist on a broad spectrum of problem severity, complexity, and chronicity, recovery similarly exists on a broad spectrum of resolution patterns. A further observation is that those achieving partial recovery often exist within this middle spectrum of problem severity, complexity, and chronicity. They may need recovery support models different than those at the least and most extreme ends of this continuum, and their long-term styles of problem resolution may differ markedly from these other two groups. The needs of those in this middle spectrum constitute a potential zone of future innovations in harm reduction, addiction treatment, and recovery support services.

Photo: Bill White interviewing Ernie Kurtz at his home in Ann Arbor, Michigan, for video series Reflections: Ernie Kurtz on the History of A.A., Spirituality, Shame, and Storytelling. Chicago: Great Lakes Addiction Technology Transfer Center.

References: White, W., & Kurtz, E. (2006). The varieties of recovery experience. International Journal of Self Help and Self Care, 3(1-2), 21-61.

The Power of Story

August 21, 2019

This blog had a prompt. Reading John Steinbeck’s “Grapes of Wrath” is a wonderful experience, to be repeated. The narrative about the Depression, caravans to California, and the description of awfulness those arriving experienced is priceless. It is even relevant in this different time and context. However, one chapter captured my attention as it spoke of storytellers and their importance to some semblance of well being in the camps. He wrote:  And it came about in the camps that the storyteller grew into being, so that the people gathered in the low firelight to hear the gifted ones and the people listened, and their faces were quiet with listening. They listened while the tales were told and their participation made the stories great. The storytellers, gathering attention into their tales, spoke in great rhythms, spoke in great words because the tales were great, and the listeners became great through them. For those reading this, I imagine there have been meetings and events where the “storytellers” have brought about what Steinbeck wrote about.

In the earliest periods of time, Cave drawings educated and as language developed, oral traditions had stories passed along to generations through word of mouth. Storytelling describes the social and cultural activity of sharing stories.  What I have learned is that it is human nature to tell others about our life’s happenings.  Storytelling, with fact mixed with fiction, is a human characteristic. Every culture has its own stories. I also thought of parables. A short definition of parables is a short allegorical story designed to illustrate or teach some truth. Jesus taught with parables. Stories that explained universal truth that used symbolism, simile, and metaphor, to demonstrate the moral lesson. We perhaps know best the stories of the Good Samaritan, the prodigal son, and of the shepherd and the lost sheep in which a shepherd leaves his flock to find a single lost sheep—and upon finding it, he rejoices.Christianity was founded in ritual, fellowship, and storytelling.   Our recovery support groups and communities grow in the same way. In peer support, the storytellers have a lot of “peerness” in their stories.

The Faces & Voices of Recovery web site has a section titled Recovery Stories with the following preamble: Across the country, people in recovery are celebrating their successes and sharing them with others. However, these successes often go unnoticed by the broader population. Sharing and celebrating recovery stories connects community members with one another and empowers those who are still struggling to know they are not alone. It also helps us to eliminate the stigma people in recovery often face and educate the public that recovery is possible.

In a recent blog appearing on the Faces & Voices web-site, titled In Others’ Words, I told of the value to myself and others of finding and giving credit to the words of others to support my views. Here I go again. I have excerpted and combined Bill White’s words from a previous blog. “What is needed within the recovery advocacy movement is not a handful of highly visible charismatic leaders, but thousands of people in recovery stepping together into the light to affirm the reality and transformative power of recovery.” and, “The recovery advocacy movement will have matured when we can ALL stand publicly to represent the diversity of our past brokenness and the extent of our present healing. Every increment of that healing is cause for celebration, even among individuals who would not be the most obvious choice for the face and voice of recovery. If you don’t fit the iconic recovery poster image, you are still the face and voice of recovery, and your time in the sunshine is coming. Prepare yourself for that day.”

Many feel their story is not interesting or worth telling, but it will be. Remember Steinbeck’s word as he describes the listener. They listened while the tales were told and their participation made the stories great. There will be day that provides a special situation and environment when persons in recovery will stand up, stand out, tell their story, and be proud about it. A repeat from Steinbeck: The story tellers, gathering attention into their tales, spoke in great rhythms, spoke in great words because the tales were great and the listeners became great through them.  That is the power of story.

Honoring Recovery Ancestors

August 15, 2019

It is all that we are: history, memory. –Walter Mosely, from John Woman

I have been thinking a good deal more than usual about the history of addiction recovery in the United States. Such ruminations are a reflection of my stage of life, but they have also been stirred by recent events, including the recent demise of the National Council on Alcoholism and Drug Dependence and the passing of a generation of iconic leaders within the addictions field.

Most of my adult life has been dedicated to the collection, preservation, and presentation of the history of addiction treatment and recovery in America. My books, monographs, and collected papers and the creation of the Illinois Addiction Studies Archives collectively constitute a repository of documents and artifacts that chronicle the pathways our addicted citizens have traveled for more than two centuries in their search for freedom. I have earlier penned brief reflections on the import of this history (see HERE and HERE) and now add the following brief nuggets that may be of interest to recovery advocates.

Are People in Recovery a “People?”

What does it take for individuals to define themselves as “a people?” Such peoplehood arises from a common history, collective achievements and continued challenges arising from that history, as well as shared aspirations. These catalytic ingredients lead to embrace of a new identity—a “we-ness” that is often solidified in the face of a common enemy. In the case of recovery, that enemy may be defined as a drug, a process (addiction), exploitive institutions, or cultural norms that have resulted in one’s objectification and demonization. Recognition of oneself as part of a people comes in part because of a history in which one has been treated not as an individual but as a category. Individuals who have been mistreated as a category eventually assert themselves as a category, resist oppressive conditions, and reject the demeaning psychological baggage which has been forced upon them.

The current mobilization of people in addiction recovery is an example of such people-making. We are a people who first turned affliction into a fulcrum of personal transformation and who are now turning our deliverance into sustained cultural awakening and political mobilization. People in recovery are moving beyond their individual stories to discover their collective story—their story as a people—and to take control of the future of that story. To forge a movement, personal suffering must be transformed into a larger story—a dramatic narrative with its past and its own heroes and villains. Such narratives make sense of circumstance that are otherwise inexplicable. They contain the future promise of historical justice—people in recovery becoming active agents in their own liberation and service to others.

Heroic Individuals and Institutions

Historical consciousness helps spark, nurture, and sustain liberation movements. In our case, history is the set of records that document our indebtedness to those who opened the recovery frontier and marked the paths that have informed our own quests for freedom. History is all we have left when voices of the past have been silenced and our collective memories weaken. It thus falls upon us to find ways to keep that history alive. We must never forget days when addicted people in this country were subjected to fraudulent boxed and bottled cures; sequestered for prolonged periods in penal inebriate colonies,  the “foul cells” of public hospitals, and the “back wards” of festering state psychiatric asylums; subjected to prefrontal lobotomies and chemo- and electro-convulsive shock therapies and an endless array of lethal and debilitating drug insults, and faced prolonged incarceration for the status of addiction. People in recovery, their families, and visionary professionals spent decades advocating the end of such practices and to shift people with alcohol and other drug problems from systems of control and punishment to systems of compassion and care. Their stories—their commitment and courage—should be honored and not forgotten. Many of us would not have survived or thrived without the sacrifices of these men and women. Their stories must be regularly drawn upon as a reminder of who we are and how we have survived as individuals and as a people.

The Role of Recovery Advocacy Movement Elders

If we effectively mentor a new generation of leaders, then members of that generation will, out of necessity, need to push us off our pedestal to reach their own destiny. Such processes can be understood and accommodated. Reaching elder status within a social movement requires people once at the pinnacle of history to wholly embrace both their past import and their growing irrelevance. We each have a shelf life of optimal contribution—an expiration date on our most cherished assets and aspirations. When that date has arrived, we must let others we have mentored step forward to fill the space we have occupied. The final act of mentorship is to pass the torch and have faith in where that teaching will lead. It is then that we can become the collective memory and conscience of the movement, reminding those younger of the core values that brought us to this day—and appearing periodically as an admired relic.

Our recovery ancestors and elders of the current recovery advocacy movement were touched by history and stood together in an effort to write a new future. My wish for each of you is to be similarly blessed.

Parable of Two Programs

August 9, 2019

Once upon a time there existed two organizations pledged to offer hope and help to individuals and families affected by alcohol and other drug problems.

The first, which we shall call Hubris, used its massive communications and marketing machinery to assert its claim as the Alpha and Omega of addiction treatment and recovery support. Hubris achieved glowing media accolades. The charisma and eloquence of its leaders were widely acknowledged. Its facilities were beautiful. Its administrative and clinical staff members were professionally polished and engaging. And it boasted a “comprehensive” service menu, an unprecedented “success rate,” and regular surges in its annual budget.

Every service in the community related to alcohol and other drug problems eventually came under Hubris’s administrative umbrella—a feat achieved by undermining or colonizing all potential competitors. The unrelenting message to the community was unequivocal: there is only one professionally-assisted pathway to addiction recovery and it is through the doors of Hubris. In time, as might be expected, Hubris expanded its mission far beyond addiction treatment and recovery support—claiming expertise in an ever-expanding range of community problems and needs. Hubris was by all accounts a highly successful organization.

The second organization, which we will call Humility, never achieved the size or reputation of Hubris. Its leaders sought neither and were the last rather than the first to speak in any community forum. They were far more likely to ask probing questions or praise others than call attention to themselves. Where Hubris prided itself as a successful business enterprise, Humility viewed itself as a service ministry and a small part of a larger recovery-focused social movement. As such, it maintained a singular mission of addiction recovery support and advocacy throughout its years of operation.

Rather than build recovery support services exclusively within Humility, its leaders and staff sought to develop and imbed those services within the wider community. Rather than seeing themselves as THE expert/authority on all addiction/recovery issues, Humility staff and volunteers saw themselves in equal partnership with people in recovery, their families, and their community allies. Where Hubris emphasized service relationships that were professionalized, short term, and commercialized; Humility emphasized the value of recovery support that was natural (voluntary and reciprocal), enduring, and imbedded within a community of shared experience and mutual support. Where Hubris sought to hoard specialized knowledge and services within its own organizational boundaries, Humility sought wide dispersal of recovery support knowledge and activities via recovery-focused professional and public education, personal and policy advocacy, support of local recovery community development, and expansion of community landscapes/spaces in which recovery could thrive.

Humility encouraged and supported the development of recovery supports within the recovery community, allied systems of care, business and industry, religious institutions, and local educational institutions. Its vision was to imbed recovery, not within the walls of a discretely hidden rehab facility, but within the very heart of local community life. Humility took no public credit for this behind the scenes cultural and community development work. Their budget remained comparatively modest, their facilities few and undistinguished, and their staff were more known for their genuineness and passion than their professionalism.

Now as we continue our story and as fate would have it, both organizations ceased to exist after years of operation. I will leave it to the reader to speculate on the sources of these organizational deaths. Hubris might have imploded due to the excesses of its leadership. It might have fallen victim to the capriciousness of funding cuts or been colonized in something akin to a corporate takeover. Or it might have just fallen from grace as the public’s collective experience discredited Hubris’s excessive marketing hype. Humility might have ceased operation due to the passing of its long-time leader, the weakness of its board, or broader disruptions within the local community. Or it might have simply decided to cease existing because its mission of developing natural recovery support resources in the community had been achieved. Our focus is not on how such seemingly successful organizations ceased to exist. It is rather on the state of their respective communities following their closure.

Upon its closing, Hubris’s legacy to its community could be depicted as a pervasive vacuum: few if any remaining addiction recovery support services, weak support for recovery among the community’s leading institutions, little specialized knowledge of addiction and recovery among the community’s mainstream service professionals, and a weak, unaroused recovery community with limited capacity to support its members and advocate on their behalf. Hubris left a legacy of service to its institutional interests and the interests of its leaders, but despite its history of service to individuals, its style of operation did a great disservice to its community. Encouragement and support for recovery once provided by families, extended families, friends, neighbors, co-workers, the recovery community, and other community institutions had over time been strategically absorbed by Hubris. It was in its view good business to do so. At its closing, the community had less internal capacity for recovery support (i.e., community recovery capital) than at the time of Hubris’s founding.

In contrast, the little-heralded Humility left a rich network of recovery support resources, a foundation of public and professional knowledge about addiction recovery, and a mobilized recovery community capable of addressing present, emerging, and future needs. By acting on the premise that it should not do anything alone that could not be done by or in collaboration with the wider community, Humility set the stage for the progressive expansion of indigenous recovery supports sadly missing in the community served by Hubris.

So I leave those among you in leadership positions within addiction treatment or recovery community organizations with two questions: 1) Where would you place your organization on the Hubris to Humility continuum? and 2) What would be the future recovery support capacities of the communities you serve if your organization ceased to exist today?

Moral of the Story: To paraphrase Mark Hyman, the power of community to encourage and support long-term addiction recovery is greater than that offered by any addiction treatment program.

Of Related Interest:

Evans, A. C., Lamb. R. & White, W. L. (2013). The community as patient: Recovery-focused community mobilization in Philadelphia, 2005-2012. Alcoholism Treatment Quarterly, 31(4), 450-465.

White, W. (2009). The mobilization of community resources to support long-term addiction recovery. Journal of Substance Abuse Treatment, 36, 146-58.

White, W. (2003). The road not taken: The lost roots of addiction counseling. Counselor, 4(2), 22-23.

White, W. (2002) A lost vision: Addiction counseling as community organization. Alcoholism Treatment Quarterly,19(4),1-32.

Addiction Recovery Without Treatment

August 2, 2019

A just-published review of the scientific literature on untreated remission from alcohol problems by Richard Mellor and colleagues offers insightful clues about the role of professional treatment and non-treatment resources in the resolution of alcohol problems. Here are some key findings and my take on their implications.

Only a small subset of people with alcohol problems—about 20%–seek treatment related to these problems. This figure is most commonly cited by the treatment industry as justification for increased funding of professionally-directed addiction treatment. That rationale is challenged by data confirming that a significant portion of the 80% of non-treatment-seeking individuals are experiencing problems of lower severity, complexity, and chronicity that will resolve naturally without professional assistance and often without embracing a recovery identity. This process of problem resolution without professional assistance has been variably labeled in the clinical literature as spontaneous remission, autoremission, natural recovery, self-managed change, and quantum change.

Estimates of the prevalence of untreated remission from alcohol problems vary widely—from 2.7% to 98.3% in the 28 studies recently reviewed by Mellor and colleagues. The reasons for such wide variations in findings can be attributed to different definitions and methods of measuring 1) alcohol problems, 2) treatment, and 3) problem resolution. Such wide variation suggests that studies could be cherry picked to support widely varying policy positions, e.g., support and opposition to the need for addiction treatment expansion. Studies of high prevalence of natural recovery could also be isolated to morally castigate those needing professional assistance—adding to the stigma attached to help-seeking for alcohol and other drug problems.

Estimates of the probability of resolving an alcohol problem without treatment decline as alcohol problem severity increases, e.g., when studies are limited to those meeting diagnostic criteria for an alcohol use disorder or a higher number of diagnostic criteria. This underscores the “apples and oranges” dilemma within the alcohol and drug problems arena. Understandings of the cause, course, and resolution processes of mild to moderate alcohol and other drug (AOD) problems cannot be indiscriminately applied to AOD problems of great severity, complexity, and chronicity—or vice versa! The category of “AOD problems” embraces what may be fundamentally different entities, underscoring the importance of differential diagnosis as well as the need for individualized treatment and recovery planning. Failing to recognize such distinctions produces both overtreatment and undertreatment of AOD problems.

Estimates of the probability of resolving an alcohol problem without treatment decrease as the definition of treatment narrows. Definitions of treatment may be restricted to professionally-directed addiction treatment or may encompass a broad spectrum of other professional helpers, e.g., physicians and other medical personnel, psychiatrists, psychologists, social workers, clergy, etc. And definitions of treatment may erroneously include face-to-face and online recovery mutual aid participation as a “treatment.” Estimates of untreated remission should include disclosure of how treatment is being defined.

Estimates of the probability of resolving an alcohol problem without treatment increase when the definition of resolution is expanded beyond abstinence to include non-problematic drinking. Different measures of resolution, remission, and recovery will result in widely varying estimates of the potential to resolve AOD problems without the aid of professional treatment. Such words/phrases as resolution, remission, recovery, and no longer have the problem are often used interchangeably, but may mean very different things when heard by diverse audiences.

Estimates of the probability of resolving an alcohol problem without treatment decline with longer periods of follow-up and number of follow-up points. This finding underscores that some periods of temporary resolution are not stable over time and may be part of the natural course for some patterns of alcohol problems. This raises an essential point: how long does one need to be free of an alcohol problem before that problem can be stably resolved? Research to date suggests 4-5 years of remission stability is required before the risk of future lifetime alcohol problem recurrence drops below 15%. (See HERE). In contrast, most of the studies reviewed by Mellor and colleagues defined remission in terms of 6-12 months.

So, what do we make of all this? Beyond the implications noted above, the Mellor review cautions us to “read the fine print” when such studies are cited and to consider the motives and interest of the persons/institutions citing an estimate of untreated remission from AOD problems. Measuring AOD problems and their resolution is a complex business without consensus on the methodologies through which such estimates are best determined.

Reference: 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, 102, 60-72.

The Irrationality of Addiction Treatment

July 26, 2019

The most cursory review of the history of addiction treatment reveals a long tradition of inadvertent harm in the name of help (iatrogenic illness). Such treatment insults span bleeding, purging, and toxic, mercury-laden medicines in the 18th century. They include the fraudulent boxed and bottled home cures and the use of cocaine to treat morphine addiction in the 19thcentury. And they encompass the oft-lethal withdrawal procedures, prefrontal lobotomies, electro- and chemo-convulsive therapies, prolonged institutionalizations, and the harmful use of stimulants, sedatives, and anti-psychotic medications to treat addiction in the early to mid 20th century.

It is easy to look back with condescension on these and other equally harmful practices and ask in the most self-righteous of tones, “What the hell were they thinking?!” But one must ask what future historians will say of the current era of addiction treatment. Will they find similarly harmful practices? Will they, like us, ask, “What the hell were they thinking back then?” As a historian of addiction treatment, the one thing I can assure you is that such practices are difficult to quickly identify within one’s own era—even in eras in which addiction treatment has wrapped itself in the mantle of science.

Harm can result from deviations in clinical and ethical standards of practice within addiction treatment, but what about irrational, potentially harmful elements within mainstream addiction treatment that we do not see because of their very pervasiveness? The following practices are ones I suspect will be judged harshly by future addiction treatment historians.

Staffing Addiction is one of the few medical disorders treated in settings in which no physicians or other medical personnel are employed or in which those being “treated” only rarely interact with such personnel. Medical personnel make up only 19% of the addiction treatment workforce and even when present, they are rarely and only superficially involved in treatment planning or treatment of co-occurring medical and psychiatric conditions, nor are they the key decision makers in admission and discharge decisions.

Motivational Screening Addiction is one of the few disorders in which one is granted or denied access to care based on the degree of motivation to be treated. In the treatment of other medical disorders requiring lifestyle changes (e.g., diabetes, heart disease, etc.), motivation for change is viewed as an outcome of the service process, not a precondition for admission to care.

Staging of Clinical Interventions If one looks at the clinical ingredients of the dominant models of inpatient/residential rehab of the past half century, two ingredients are striking: 1) daily staff lectures on varying aspects of addiction, treatment, and recovery, and 2) individual and group therapies that require disclosure of highly personal information (e.g., past and present patterns of abandonment, loss, victimization, predation, and a detailed accounting of  emotional distress)–information often elicited in the mid-late 20th century via “therapeutic confrontation”). Didactic lectures (one of the most ineffective teaching methods) assume a level of comprehension, capacity for personal applicability, and memory at the very time most patients are at the peak of addiction-induced deterioration of cognitive functioning. The individual and group therapies assume that such “emotional work” must and can be achieved in the earliest stages of recovery. Ironically, these same activities may have far greater value in later stages of recovery–months or years beyond the involvement of addiction professionals.  The absence of stage-dependent clinical and non-clinical recovery support interventions and the history of confrontation as a clinical tool within addiction treatment will be deeply puzzling to future historians.

Medication Access Addiction treatment is unique in the denial of access to medication that can reduce the risk of premature death on the grounds of treatment philosophy. For example, 28% of treatment admissions in the U.S. are for opioid use disorder, but less than 10% receive medication-assisted opioid therapy. Only a small percentage of addiction treatment programs offer a full spectrum of FDA-approved medications for the treatment of substance use disorders.

Therapeutic Alliance / Retention Of the more than 1.4 million annual addiction treatment admissions, only 43% successfully complete treatment. Treatment adherence is an issue in the treatment of many disorders, but the fact that less than half of people admitted to addiction treatment successfully complete that course of treatment is extremely troubling as is the additional fact that those failing to complete treatment are not routinely provided assertive follow-up after their disengagement from treatment.

Administrative Discharge Addiction treatment is unique in the medical arena for its practice of “kicking” people out of treatment for exhibiting the primary symptom of the disorder for which you have been admitted for care. With other disorders, such symptom expression is confirmation of the diagnosis or a signal that refinements or alternative methods of treatment are needed. People undergoing addiction treatment may also be kicked out of treatment for behavior unrelated to the disorder (e.g., minor rule violations or pursuing a romantic relationship with another patient). More than 100,000 people each year are administratively discharged from addiction treatment—7.1% of all discharges.

Graduation Many addiction treatment programs provide a “graduation” ceremony marking “discharge” from treatment and termination of the service relationship after brief recovery stabilization and at a time of high risk for addiction recurrence. There is no counterpart to this ritual in the treatment of other complex, chronic medical disorders.

Post-treatment Monitoring / Support There is a high risk of resumption of drug use and related problems in the weeks and months following discharge from addiction treatment, and recovery is not fully stabilized until 4-5 years of continuous recovery. Others with medical disorders that have such patterns of vulnerability (e.g., patients treated for cancer, heart disease, diabetes, or asthma) are afforded assertive and sustained post-treatment monitoring, support, and if and when needed, early re-intervention. Such sustained recovery management is not a routine component of addiction treatment in the U.S. although efforts are underway to extend addiction treatment from acute models of care to models of sustained recovery management.

Treatment Recycling Addiction treatment is one of the few areas of medicine in which people are repeatedly recycled through the same treatment regime that previously failed to generate sustainable symptom remission. At present, 58% of people admitted to addiction treatment have one or more prior treatment admissions. In other areas of medicine, symptom recurrence following treatment is indicative of a refinement or alternative method of treatment.

Nicotine Addiction People with substance use disorders present to addiction treatment with high rates of concurrent nicotine addiction, and smoking is a major factor in the disease burden of people in recovery from other addictions. People treated for SUDs are more likely to die following treatment from nicotine-related illnesses than from the drugs for which they were admitted for treatment. Smoking cessation enhances recovery outcomes for other SUDs. (See HERE for review of studies.) In spite of these facts, addiction treatment has not historically viewed smoking within the rubric of addiction or cessation of smoking within the rubric of recovery. The era of enabling nicotine addiction in addiction treatment and the slow pace of integrating smoking cessation as an element of addiction treatment and recovery support will leave historians of the future questioning the sources of this conceptual blindness.

Participation in addiction treatment can elevate recovery outcomes and countless individuals and families owe their very lives to addiction treatment. That fact does not preclude the presence of irrational elements within the design of addiction treatment that will leave future historians asking, “What the hell were they thinking?”

Capacitype Recovery Resource Hub

July 22, 2019

The Recovery Resource Hub is a project of Capacitype & Transforming Youth Recovery dedicated to ending the addiction crisis in our country by providing quick and easy access to information that can transform a struggling life into a thriving life.