“What’s the point of a spark of light if it stands alone? The key is, and will always be, synergy.” ― Suzy Kassem
People seeking help for the resolution of alcohol and other drug (AOD) problems in the United States encounter not comprehensive systems of care but silos of care based on single pathway models of addiction with narrow menus of derived services, each highly critical of competing silos. Far too often, people with the most severe, complex, and enduring AOD problems traverse multiple silos without finding a sustainable recovery solution. Below are some reflections on why these single pathway approaches to addiction and recovery are so troublesome and a few thoughts on how we may escape entrapment in such ideological prisons.
Future advancements in addiction recovery are more likely to come from personally and culturally potent and carefully sequenced service combinations delivered across the life cycle in expansive environmental venues than from any new single element added to existing addiction treatment or recovery support services. I recently reviewed a paper that provided an elegant explanation for why this proposition might hold considerable promise for the future of addiction recovery. Drawing inspiration from “Embracing Chaos and Complexity: A Quantum Change for Public Health” authored by Drs. Kenneth Resnicow and Scott Page, I suggest the following propositions.
Addiction and addiction recovery most often occur, not through a single source of vulnerability or resilience, but from a collision (“perfect storm”) of multiple personal and environmental factors. The synergy of risk factors that produces addiction differs widely across individuals and cultural contexts resulting in highly varied patterns of drug use, a broad spectrum of problem severity and complexity, and a wide divergence in long-term drug use trajectories and outcomes. Recovery is similarly influenced by a synergy of multiple factors that defies easy identification and replication. To say that addiction is solely the product of this (genetics or neurochemistry) or that (trauma) or something else (social disconnection) is to fail to understand the power of clustered risk factors and the variety of ways they interact. Similar failures occur when attributing recovery initiation to a single factor.
In short, addiction is rarely “one thing,” and addiction recovery rarely springs from a single pathway of influence. Like the best gumbo, addiction and recovery can only be fully understood and appreciated by going beyond their key ingredients to the sequence in which ingredients are combined within a particular time and space to create something fundamentally new. Master gumbo chefs would scoff at the idea that their gumbo could be understood or replicated solely by discovering its most visible ingredients. (The whole really is greater than the sum of its parts.) Addiction treatment and recovery support specialists would do well to mirror this understanding.
Synergies of vulnerability and resilience and dimensions of space and time can be capitalized upon to disentangle the roots of addiction and enhance personal, micro, and macro level strategies of recovery support.
If there are innumerable ways catalytic recovery ingredients can be combined and sequenced and if such catalytic clusters differ from individual to individual and across cultural contexts, then wide divergence of pathways into recovery and variations of styles of recovery within these pathways should be expected and celebrated.
Ingredients that have person-specific affinity for one another, when properly combined and sequenced at receptive points of time and space, cluster together to create a cascade (a dramatic and unprecedented surge) in recovery motivation and progression.
Receptivity to recovery catalysts may differ within various environments, with increased receptivity noted when people have a sense they are within “sacred space”—spaces that heighten perception of self and the self-world relationship, e.g., religious sanctuary, sweat lodge, or nature. There is value in presenting varied clusters of recovery catalysts within varied physical/cultural spaces and atmospheres and at different points within an individual’s addiction career.
Recovery initiation and stabilization can result from rational self-assessment (pro-con analysis of continued drug use) and cumulative efforts (e.g., additive effects of multiple treatments or other recovery initiation attempts), but can also be a product of quantum change that is unplanned, positive, and permanent. “Quantum change” (or “transformational change”) is a sudden motivational cascade that reaches a “tipping point” of recovery initiation and stabilization. Such catalytic moments can rise suddenly within a prolonged history of failed recovery initiation efforts.
Motivational storms of recovery initiation or progression rise from an infinite number of potential recovery catalysts that are potent only in certain combinations and sequences and remain potent only within narrow windows of time and space. Ingredients that failed to initiate recovery in isolation may gain heightened potency and, like a combination lock, may “work” only when properly sequenced.
Unique service combinations that are transformative for one individual may exert no effects, minimal effects, or even harmful effects on others. This proposition affirms the need for expansive menus of recovery support elements (as opposed to a fixed “program”) and rapid adaptations in such offerings based on individual responses to services over time. It also suggests that any single pathway model of addiction and recovery will only result in sustained recovery for a limited subset of the total population of AOD-affected individuals and that those outside that subset could be injured when subjected to mismatched interventions. In medicine, such injuries are referred to as iatrogenic illnesses (e.g., treatment-caused harm).
Changes, even minor changes, within the context of active addiction or early recovery can result in later leaps of recovery initiation, recovery stabilization, and enhanced quality of life in recovery. The potential for such “butterfly effects” suggest the need to continue to inject novel ingredients into addiction treatment and recovery support milieus in hopes of igniting such recovery cascades.
Catalytic ingredients that have been successfully combined and sequenced to initiate recovery often require alteration during the transitions into later stages of recovery. This suggests the need for ongoing recovery consultations and supports through such transitions—supports that can be provided through professional and peer venues.
Suggesting such complex interactions within the recovery process is not an invitation to therapeutic nihilism or abandonment of science, e.g., the suggestion that all treatment and recovery frameworks are worthy and only need their elements combined. (Some may be ineffective or harmful.) It is instead an invitation to bring ALL of evidence-based, practice-informed ingredients into our service and support milieus, mixing and matching them as we draw from the experiential knowledge of people in recovery, while closely monitoring and adapting personal responses to various service clusters that are chosen. It further calls for a heightened level of professional humility and personal awe that unseen forces may be at work in providing a detonation point for these combustible ingredients.
Our best strategy as caregivers is to keep as many influences (recovery push and pull factors) in play as long as possible and join with those we serve to “not give up before the miracle happens.” At personal and population levels, the odds of recovery initiation, stabilization, and enhanced quality of personal and family life in recovery increase in tandem with the number of such factors we can activate within the self and the environment.
A day is coming when no one need feel self-conscious that their recovery gumbo is so markedly different than that of their peers: Recovery by any means necessary under any circumstances.
Reference: Resnicow, K. & Page, S.E. (2008). Embracing chaos and complexity: A quantum change for public health. American Journal of Public Health, 98(8), 1382-1389.
Acknowledgement: Thanks to Matt Statman and Jason Schwartz for calling my attention to the Resnicow and Page article.