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The FIRST STEP Act was recently passed and was signed by the President. This was historical.  Federal passage of the FIRST STEP Act provides action on criminal justice reform. Ultimately, the FIRST STEP Act is one step in the right direction for reducing mass incarceration in the United States. The Second Chance Act reauthorization was recently included in the FIRST STEP Act. The changes will reduce incarceration for a number of lesser offenses, many involving drugs.

Addiction recovery is far more than the removal of drugs from an otherwise unchanged life. Recent definitions of recovery transcend radical changes in the person-drug relationship and encompass enhanced global health and social functioning. The authors have carried on a decades-long interest in what has been christened full recovery or amplified recovery—a state of enhanced quality of life and personal character in long-term recovery. We each know individuals we believe have achieved such status and have asked ourselves what unique characteristics distinguish such persons. Here are some of our initial reflections on this question, offered here as an expression of gratitude to such people who have enriched our own lives.      

Radical hope—a radiant vision of new possibilities in the face of personal or collective devastation—is the catalytic ingredient at the heart of personal transformations and successful social movements. Such hope has been spread contagiously by charismatic figures like Handsome Lake, Frederick Douglass, Susan B. Anthony, Mahatma Gandhi, Rosa Parks, Martin Luther King, Jr., Malcolm X, and Cesar Chavez, to name a few. Radical hope, at a personal level, allows one to rise from the ashes of addiction-related collapse and step into an unknown recovery future.

I have been closely observing the addiction recovery process for half a century. I have been struck by two extremes: people whose fragile recovery is forever frozen at a primitive stage of development, and people who go through metamorphic changes that transform their character, values, and the quality of their interpersonal relationships. In the former, drug use has ceased or radically decelerated in frequency, intensity, and consequences, but this change remains nested within the same self-centeredness, resentfulness, dishonesty, and intolerance that often characterizes active addiction. This former pattern has been referred to as the “dry drunk” syndrome. In the latter style, the radically altered person-drug relationship is accompanied by dramatic enhancements in global health and functioning, as well as changes in character and identity—changes AA co-founder Bill Wilson characterized as “emotional sobriety.”

Efforts by professionals to “treat” alcoholism and other addictions have a long and colorful history. Alcoholics have been forced to drink their own urine and forced to drink wine in which an eel had been suffocated. They have been surreptitiously dosed with everything from mole blood to sparrow dung and subjected to the “Swedish treatment” in which everything they consumed and even their clothes and bedding were saturated with whiskey. They have been prescribed dietary treatments that included the apple, salt, grape, banana, onion, and watermelon cures. They have been fed gold, iron, and bark to quell their appetite for alcohol.

High degrees of variability in the pathways and styles of addiction recovery obscure shared mechanisms of change across such healing processes.

The American Society of Addiction Medicine (ASAM) recently released Standards of Care: For the Addiction Specialist Physician.  The Standards outline the responsibilities of addiction medicine specialists in the areas of assessment and diagnosis, withdrawal management, treatment planning, treatment management, care transitions and care coordination, and continuing care management.  There is one sentence in the Standards that deserves particular acknowledgement:  “Recovery check-ups by addiction specialist physicians, just as those by primary care physicians or other providers, may promote sustained recovery and prevent relapse” (p. 13).

Stigma Reduction Through Contact Strategies
Justice Ginsburg’s observation offers observed testimony to the power of contact strategies—public disclosure of personal stories by individuals who share a concealable stigma for purposes of changing social attitudes and social policies.

The threats to health that occur during active addiction have been widely communicated in the popular media and in the scientific literature, but the health profile of  people in long-term recovery from substance use disorders remains something of a mystery.  While one might assume that physical and emotional health rapidly improves following recovery initiation and stabilization, a health survey of Philadelphia and surrounding counties just published in the Journal of Psychoactive Drugs reveals a more complex and ominous picture.