News About Addiction, Recovery and Advocacy
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A bill ostensibly intending to reduce opioid overdoses passed the House last month, but rather than cheering it on, drug treatment and recovery advocates are lining up to block it in the Senate.That's because instead of being aimed at reducing overdoses, the bill is actually a means of removing patient privacy protections from some of the most vulnerable people with opioid problems, including people using methadone-assisted therapy to control their addictions.
People addicted to alcohol and other drugs see the world differently. They SEE the world differently as a result of neurocognitive changes in perception that accelerate in tandem with increased tissue tolerance, increased intensity of cellular hunger (craving), and the resulting obsession with maintaining the drug relationship at all costs. As drug seeking, drug procurement, and drug use rise to the top of one’s motivational priorities, one develops attentional bias toward words, symbols, and images linked to these substances. Perceptual preferences for drug-linked stimuli are an essential element within the neurobiology of addiction. In recovery, this perceptual preference is reframed, giving perceptual priority to words, symbols, and images that reinforce the recovery process.
On May 21, 2005, David Foster Wallace opened his commencement address at Kenyon College with the following story.
There are these two young fish swimming along and they happen to meet an older fish swimming the other way, who nods at them and says “Morning, boys. How’s the water?” And the two young fish swim on for a bit, and then eventually one of them looks over at the other and goes “What the hell is water?”
Each of us swims in a near-invisible cultural stew of words, ideas, attitudes, images, and sounds that constitute the personal stage upon which the actions of our daily lives unfold. These near-invisible contextual elements of our lives are so deeply imbedded that they rarely if ever enter our conscious awareness. Yet, they exert a profound influence on how we view ourselves and our relationship with the world. They bestow or deny personal value, convey our degree of safety and vulnerability, and impregnate us with hope or hopelessness.
A Rendezvous with Hope (Lessons from an Outreach Worker)
Through my tenure in the addictions field, the question of readiness for treatment and recovery was thought of as a pain quotient. In the earliest years, we believed that people didn’t enter recovery until they had truly “hit bottom.” If a client didn’t fit that criterion of pain-induced readiness, they were often refused admission to treatment (and if we did admit them, we often threw them out shortly afterward). Then we recognized that the reason it took people so long to hit bottom was that they were protected from the painful consequences of their alcohol and other drug use by a class of people we christened “enablers.” So we then set about teaching enablers to stop rescuing and protecting their beloved alcoholics/addicts. Vern Johnson then came along and convinced us we could raise the bottom through a process he called intervention. Intervention removed the safety net of protection and confronted the alcoholic/addict with the consequences of his or her drug use and promised additional consequences if this behavior continued. Staging such interventions within families and the workplace was something of a revolution—and later an industry—that brought large numbers of culturally empowered people into treatment. But all these philosophies and technologies were about the use of pain as a catalyst of addiction recovery. So, I brought this view to my work as an evaluator of Project SAFE.
The explosive growth of nonclinical recovery support services (RSS) as an adjunct or alternative to professionally-directed addiction treatment and participation in recovery mutual aid societies raises three related questions: 1) What is the ideal organizational placement for the delivery RSS?, 2) What persons are best qualified to provide RSS?, and 3) Are RSS best provided on a paid or volunteer basis?
At present, non-clinical RSS are being provided through and within a wide variety of organizational settings by people with diverse backgrounds in both paid and volunteer roles. While research to date suggests that such services can enhance recovery initiation and long-term recovery maintenance, no studies have addressed the three questions above or the broader issue of the kinds of evidence that should be considered in answering these questions.
A recent blog by Bill White has a picture of a butterfly with one wing in black and white and one in color. In the past I have written about the power of stories of recovery. Many stories are openly and fearlessly shared in the rooms of the alphabet soup of support groups. The rooms are essentially cocoons and metamorphous is gloriously happening. I contend that outside the rooms, too few get to see the butterflies.
Landmark life in recovery surveys have been recently conducted in the United States (Laudet; Kaskutas, Borkman, Laudet, et al.; Witbrodt, Kaskutas, & Grella), Canada (McQuaid, Malik, Moussouini, et al.), Australia (Best & Savic), and the UK (Best, Albertson, Irving, et al.). These surveys provide retrospective confirmation of the improvements in physical/emotional/relational health and quality of life that accrue with duration of addiction recovery. They confirm that increased time in recovery is linked to enhancement of housing stability, improvements in family engagement and support, educational/occupational achievement, debt resolution, and increased community participation and contribution, as well as reductions in domestic disturbance, arrests/imprisonment, and health care costs.
When a slave was drunk, the slave holder had no fear that he would plan an insurrection; no fear that he would escape to the north. It was the sober, thinking slave who was dangerous, and needed the vigilance of his master to keep him a slave. –Frederick Douglass, 1855.
Addiction is influenced by personal vulnerability, but global drug trends and their consequences to individuals and families are also influenced by larger technological, political, economic, and cultural processes. Awareness of such contextual influences and their relationship to personal recovery has been most fully articulated within American communities of color and other historically oppressed and marginalized communities.
The field of addiction treatment is facing a growing cultural backlash that threatens its future as a viable social institution.
Cultural ownership of an intractable problem vacillates over time. Vague but passionate promises of a new approach always garner more hope than the known limitations of current efforts. And any industry that has attracted substantial financial capital will draw a subset of individuals and organizations who will sacrifice public health and safety for personal and corporate profit. When such limitations and abuses are exposed, there exists the risk that a social institution’s probationary status will be revoked and their functions transferred to other institutions within their operating environment. Aware of such risks, most fields develop standards of organizational and professional practice that maximize effectiveness and elevate ethical decision-making. Such protective devises help assure that exposés of industry shortcomings are viewed as the misconduct of particular organizations and individuals and not a reflection on the industry as a whole.
Efforts are well underway to shift addiction treatment from models of ever-briefer acute care to models of sustained recovery management (RM) nested within larger recovery-oriented systems of care (ROSC). This shift involves extending the continuum of recovery support services across the stages of long-term recovery, but it also embraces a more activist stance in shaping community environments in which addiction recovery can flourish. RM and ROSC, through their recognition of the ecology of addiction recovery, force a rethinking of drug policy at national and state levels and place clinical interventions within a larger rubric of local cultural and community revitalization. The roots of such perspectives are many, but some can be traced to the early history of social work in the United States.