William L White

The Wounded Healer

 

 

Here is a video of Ernie Kurtz, academic historian on the subject of recovery, principally 12 step recovery, being interviewed by William White. They discuss shame and how 12 step recovery helps treat the shame that often drives addictive behaviour.

Below is also a link to Ernie Kurtz’s book on “Shame and Guilt” which is freely available online at Ernie Kurtz’s behest.

Shame and Guilt

 

Kurtz is interesting in asserting that some of the 12 steps principally deal with guilt whereas others help deal with the ongoing struggle with shame.

Guilt seems to be about events and specific actions whereas shame is a process of healing, of coping with and challenging a negative self schema inherited from childhood and sometimes reinforced since then.

 

Can you be Sober and in Recovery while on Medication?

 

In a recent blog from the Recovery Research Institute http://www.recoveryanswers.org/blog/12-step-mutual-help-and-medication-assisted-treatment/

by  Brandon G. Bergman, Ph.D. 

It was suggested that a survey of almost 300 long-term AA members (average time in recovery 13 years), more than half felt medication to resist alcohol cravings/urges was or might be a good idea, and 17% did not think it was a good idea, but were “OK with it”.

Obviously if these AA members have a respect for the Traditions of AA they would have been responding to the survey as individuals in recovery? As Tradition 10 of Alcoholics Anonymous states:-

“Alcoholics Anonymous has no opinion on outside issues; hence the A.A. name ought never be drawn into public controversy.”

This is a very important point. I do not write this blog as an AA member but as a researcher and recovering alcoholic/addict who seeks to combine  neuro-psychological research with the experiential insights I have been given as the result of recovery, albeit with 12 step recovery. I do not speak for AA nor would I wish to. I believe the traditions can be incorporated in our daily recovery like the 12 steps. The traditions are there to protect us from ourselves and gives us guidelines for interacting with the wider world.

Being drawn into public controversy is not good I believe for the health of AA or the recovering individual within AA.

I mention this also because in this article, the author appears to suggest that AA’s  membership has an  official position on Medication-assisted treatment (MAT), including opioid agonists (e.g., Suboxone) and antagonists (e.g., Naltrexone and its monthly depot formulation Vivitrol).

Is this actually the case or is this statement misleading?

I will leave you to decide that? The   official position on MAT is that of the AA pamphlet The A.A. Member — Medications and Other Drugs – which this author suggests “appears to be one of skeptical tolerance”.

Personally I have read through the pamphlet and see no mention of MAT whatsoever.

The pamphlet appears to be alerting AA members to the reality that certain members “must take prescribed medication for serious medical problems. However, it is generally accepted that the misuse of prescription medication and other drugs can threaten the achievement and maintenance of sobriety”.

Among some suggestion listed in this pamphlet are

“• No A.A. member should “play doctor”; all medical advice and treatment should come from a qualified physician. • Active participation in the A.A. program of recovery is a major safeguard against alcoholic relapse. • Be completely honest with your doctor and yourself about the way you take your medicine. Let your doctor know if you skip doses or take more medicine than prescribed. • Explain to your doctor that you no longer drink alcohol and you are trying a new way of life in recovery….”

The pamphlet proceeds to warn

“From the earliest days of Alcoholics Anonymous it has been clear that many alcoholics have a tendency to become dependent on drugs other than alcohol. There have been tragic  incidents of alcoholics who have struggled to achieve sobriety only to develop a serious problem with a different drug. Time and time again, A.A. members have described frightening and sobriety-threatening episodes that could be related to the misuse of medication or other drugs.”

Experience suggests that while some prescribed medications may be safe for most nonalcoholics when taken according to a doctor’s instructions, it is possible that they may affect the alcoholic in a different way. It is often true that these substances create dependence as devastating as dependence on alcohol.

I can not see a “skeptical tolerance” or even a mention here of MAT.

The author then suggests that “broader anti-medication messages may be pervasive” within AA membership.

Although he slightly contradicts this by citing a survey “of almost 300 long-term AA members (average time in recovery 13 years), more than half felt medication to resist alcohol cravings/urges was or might be a good idea, and 17% did not think it was a good idea, but were “OK with it”. That would be a majority are “ok with it”?

The actual study concluded that “it did not find strong, widespread negative attitudes toward medication for preventing relapse among AA members. Nevertheless, some discouragement of medication use does occur in AA. Though most AA members apparently resist pressure to stop a medication, when medication is prescribed a need exists to integrate it within the philosophy of 12-step treatment programs.”

So why say it anti-medication views are pervasive based on this study?

However, one could say they are indeed pervasive based on the next study.

The author then states, “However, in a follow-up survey  with about 130 participants from Project MATCH 10 years after they began the clinical research study, only 16% agreed that 12-step members say it is acceptable to take medications to address drinking problems.”

I found this passage a little confusing so looked at the original survey abstract which states “In general, client perceptions were not favorable about the use of such medications.”

The author then proceeds to mention NA’s  official position “on individuals receiving MAT is welcoming on the one hand, while on the other, is explicitly restrictive and conveys a clear divide between members who are “clean” (i.e., “in recovery”) and those who are “on drug replacement therapy” (i.e., attending meetings but are not “in recovery”).”

NA’s “official position” is outlined in the pamphlet – NA groups and Medication

Drug Replacement

By definition, drug replacement is used for a different reason than prescribed medications for mental or physical health. This distinction makes drug replacement a separate issue for us in NA. When it comes to those who participate in drug replacement, it is helpful to remember that our Third Tradition clearly states that membership in NA is established when someone has a desire to stop using or when they choose to become a member, not when they are clean. No matter what the issue, groups are still charged with the goal of welcoming each person who walks into a meeting.

Some NA members are confused or even intolerant of those on drug replacement due to what they see as a contradiction between drug replacement and the NA principle of complete abstinence.

Some of us are fearful when those on drug replacement want to share or speak on behalf of NA. It may be helpful for all of us to remember that many addicts on drug replacement eventually do get clean, stay clean, and find a way of life they thought was unobtainable before coming to NA. This process doesn’t always occur when an addict attends his or her first meeting—getting and staying clean is often a decision that’s made after attending many meetings over a period of time.

Because NA a is program of complete abstinence, groups do sometimes limit the participation of members on drug replacement to ensure the clarity of the NA message. Yet, we must balance this limited participation with the idea that membership in NA comes with a desire to stop using, not abstinence.

As the Tradition Three essay in It Works: How and Why, reminds us, “Desire is not a measurable commodity. It lives in the heart of each member. Because we can’t judge the sole requirement for membership, we are encouraged to open wide the doors of our meetings to any addict who wishes to join.”

Opening our doors to these members means that groups take the time to discuss this issue and find ways to make everyone feel welcome. Each group is autonomous, and a group’s conscience will ultimately determine the level of participation of those on drug replacement.

Some groups may decide to encourage those on drug replacement to serve as coffee or tea makers, or as a clean-up person, instead of holding leadership positions. These commitments may encourage a desire for complete abstinence through allowing these members to feel a part of NA.

The reality is that some groups already permit those on drug replacement to share and lead meetings, while others do not. Although we may not endorse this level of participation, we can simply acknowledge what exists and consider ways to encourage every member to get clean and find the hope and recovery that are possible in NA. The real question groups are left with is how to honor the NA philosophy of complete abstinence and still welcome addicts in our groups and meetings.

What is most important is that we don’t let our fears get in the way of our group’s ability to carry the NA message of hope and freedom. The only requirement for membership is a desire to stop using. Tradition Three One of the most challenging aspects of this issue is that while an NA group is free to ask those who have used that day to refrain from sharing in the meeting, groups don’t decide what “using” means for an individual member. The use of medication is an issue that many members have strong personal feelings about, but a group is not there to enforce, endorse, or oppose members’ personal opinions.

Any member—those who take medication and those who feel taking medication is inappropriate—has a responsibility to not represent their personal feelings and opinions as the opinions of Narcotics Anonymous as a whole. In NA, we purposely attract people who are ill, unstable, and in need of help. Our challenge is to continue to practice tolerance, patience, and love, so that we create an atmosphere in which those who want to recover can do so.

Many of us have watched as NA meetings become weighed down by disruptions, controversy, and negativity around this issue. Yet, when these challenges are addressed through incorporating the spiritual principles of our program, groups often become stronger and more focused as a result. Recovery is often a demanding process with many ups and downs, and NA groups tend to experience similar challenges. Yet, it is these struggles that allow us to grow as individuals and as groups.

Narcotics Anonymous is here to help addicts find a new way of life, and joining NA means becoming a part of a lively and diverse fellowship. As our First Tradition reminds us, “Our relationships with one another are more important than any issue that may arise to divide us.” Keeping this in mind allows our groups to best serve all addicts seeking recovery in NA.”

However, as the author notes in reference to William White’s observations , “there are no empirical studies of how MAT patients engage with NA or, in parallel, NA members’ perceptions and attitudes toward MAT. In an informal qualitative assessment of MAT-focused online discussion forums (e.g., suboxforum.com), however, he found that some individuals receiving MAT have had positive, live-saving experiences in NA, though the majority experience was one of feeling rejected, confused, or angry, sometimes leading individuals to seek support elsewhere.”

The author concludes that “the medication-skeptical culture in professional 12-step-oriented treatment programs and systems appears to be in transition. Cutting-edge, front-line organizations like Hazelden Betty Ford recognize the power, and evidence, in both linking individuals to MHO-based recovery supports, as well as the need to address opioid use disorders with a comprehensive biopsychosocial approach.”

“They are currently studying pilot outcomes of this new integrated treatment that uses MAT to help patients get into recovery emphasizing 12-step MHO engagement, with an eventual gradual taper once long-term, stable recovery is achieved. It is unclear whether this type of attitudinal shift is also taking place within the community-based 12-step MHO groups themselves.

In the meantime, the limited available data suggests individuals receiving MAT are likely to encounter concerns or outright opposition from 12-step MHO members (with greater anti-medication attitudes in NA). They and their providers and family/friends should be prepared for this. The field would benefit from research studies of MAT patients’ quality of life recovery outcomes, MAT patients’ attitudes about NA, NA members’ attitudes about MAT, and whether and how MAT patients can successfully navigate anti-medication sentiment during their 12-step MHO participation. Also, specific research questions around different opinions about agonists versus antagonists would have important implications on clinical practice. Finally, there are a host of non-12-step MHOs that the field knows far less about from an empirical perspective, like SMART recovery, which, for example, officially supports legally prescribed, evidence-based MAT.”

It is worth noting that AA also has no opinion on treatment centres either. What happens at HalezdenBettyFord is not the concern of AA.

The results of their study or prospective studies do not necessarily have any bearing on 12 step groups either.

There are a number of hugely important issues raised in this article, which is indeed timely.

In part 2 of the is blog I will attend to these points and another article recently posted in the After the Party Magazine.

In order to get to the bottom of this debate we have to ask ourselves some serious questions such as

What is that I suffer from as an addict (what are the underlying conditions)?

How are these underlying mechanism “treated”by 12 step recovery processes? What is recovery?

How would this treatment or recovery be helped or hindered by continued use of MAT – i.e. when is short term use ok and long term not (how do we draw he line between recovery and choosing an easier softer way which does not arrest our condition but may contribute to it’s continued trajectory?)

There may be no hard and fast answer to the last question.

I am not sure we have arrived at a comprehensive theory of addiction which links the cognitive affective mechanisms which mediate the impaired neurobiology of addiction.

As such we seem to rely on neurobiological accounts which have a focus on paradigms such as craving and cue reactivity etc when these are always mediated by factors such as stress and emotion dysregulation?

To conclude we need to ultimately consider recovery tools which address the emotion and stress dysregulation which maintain this disorder and prompts carving and relapse.

Whether MAT straightjackets or facilitates this process to wellness is ultimately the question.

My craving dissipated with full acceptance of my addictive disorder.

Ultimately it is a very personal question too!?

This is often for individuals, and their sponsors and home groups to decide not by “official positions” – to decide for themselves what is in the best interest of recovery within individual groups at a micro level not the macro levels that researchers want 12 step groups to comment on.

Researchers may also consider that it is not always fear that prompts anti medication debates but real concern that certain individuals are engaged in a recovery process. Not to be engaged in a recovery process or reluctant to be has obvious consequences also.

AA and other 12 step groups are ingenious in their structures  that flow from from the 12 steps, to the 12 traditions to the 12 concepts for World Service to help what is essentially group of, at times, fear based control freaks to live properly together, to recover, together. They achieve in that  human terms is the equivalent of learning how to  herd cats!

They are truly remarkable. They are also there to protect us from the however well meaning opinions of others, or otherwise, in the outside world!

The outside world often has not got a clear idea of how these structures protect our recoveries. AA is a network of indepedent groups, a federation in the true sense, of emotionally vulnerable people who only want to help others like them.  This is in fact how these fellowships  grow and recovery

Within these structures we try not take other people’s inventories but only our own. We try not judge but be tolerant of. Groups take their own inventories but not other groups’. in an ideal scenario anyway!

If individuals do not feel welcome in these meetings there are often other groups where they will.

I am stating this because there is an idea of 12 step groups as a monolith when the opposite is true. The liberties of 12 step groups far exceeds any other groups I have ever known. No one is in charge of AA or other groups and it is enshrined in our concepts, traditions and steps that we all,  AA and other 12 step groups included, have the right to be wrong.

It is via our own individual and group consciousness that the best direction that most suits others in need is sought.

We recover by helping others recover.

But ultimately we all have to consider as NA states ” What is most important is that we don’t let our fears get in the way of our group’s ability to carry the NA message of hope and freedom.

We do this I believe by “love and tolerance”  and by showing 12 step recovery to those who may not yet have it.

All our efforts thus must be to facilitate this for others, even if that is facilitated by a group conscience that seems at odds with the acceptance of MAT but hopefully not with our traditions of service.

 

 

 

 

 

 

 

Healing Communities via Recovery

Recovery is healing. From the personal to the communal. Here is a great example of recovering in recovery communities. It illustrates how recovery is a gradual move from isolation from,  to commune with other people.

We recover via communal contact and interaction with others. It is the new “secure attachment” with others which helps heal and also repair the neurobiology impaired by addictive behaviours.  It helps heal not only us but also our families and the communities we belong to. Love is the drug for me (and us).

The Healing Power of Recovery – Connecticut  Community of Recovery – how community recovery also helps individuals overcome feeling stigmatised by their condition and can feel more encouraged to seek treatment for their addictive behaviours.  So in a sense we can see recovery communities are passing the message of recovery on to others by putting a “face on recovery” acting as role models of recovery. Attraction and promotion.

For me this recovery community is showing the world “how it works” in a sense, the collective wisdom of recovery we often share among ourselves in recovery meetings but now share this with the wider society; this is what we got and what you can have.   We will help you get it too if you want it. This is how we all get better, recovering together.

 

Recovery is Contagious

In our final blogs on the invaluable insights into the Recovery process given by the research and experience of William White we finish by looking at the rise of recovery communities in the US in particular and discuss whether this “New Recovery Advocacy Movement” is the future of recovery (treatment) which is much more long term recovery orientated rather than simply treating this chronic condition of addiction as an acute disorder which is generally what treatment centres do.

We may have to move away from a narrow neurobiology of addiction (disease model) to a wider neurobiology of recovery (recovery model). We may have to make it more plain to the world that recovery happens all the time and that millions upon millions around the world are in long term recovery, and have a very high chance of remaining so.

That is not to say we should not continue to look within the brains of addicts to learn which neural and affective mechanisms propel this disorder forward but that research into addiction needs to be much less lopsided and negative. It needs to look at vulnerability and the progression of this condition but it also needs to more fully address the recovery stage too. It is like reading a page turning novel only to find the riveting denouncement has pretty much been omitted. Research needs to move from diagnosis of the problem to prognosis of the solution, i.e. recovery.

The shares of a 12 step meeting are some of the greatest stories of redemption you are likely to hear. The outside world needs to know how these stories are created, yes, but also how they are resolved via recovery. The outside world needs to hear the story does not end with recovery, in some ways this is where the story really gets interesting. The spiritual voyage of recovery is a story those suffering from addictive behaviour need to hear. Otherwise, research demoralises, rather than encourages. It perpetuates a unnecessarily negative view and a false picture about the reality of long term recovery for many millions of people, their families and communities.

Clinical neuroscience, in particular, needs to show the images to go with these stories otherwise it is falling down on it’s obligations to society and the greater world.

Science has not sufficiently shown us how the brain is altered in a positive, adaptive, healthy manner by behavioural changes associated with long term recovery. The major role of science is to predict behaviour. It needs to start demonstrating and confirming that if an addict starts doing certain behaviours, certain positive outcomes will follow. It needs to illustrate the neuroplasticity so that suffering people can clearly chart, in a rational manner, the course of wellness ahead.

I remember seeing the Jellinek Curve in treatment and was re-assured that this was a disease that one could clearly recover from and within a defined trajectory. It showed me rationally how others had done this recovery thing and how I could and would if I wanted to achieve what they had achieved.

Rather than the constant search for a “magic pill” should we not be celebrating in research this wonderful success story called long term recovery. Isn’t this one of the greatest stories out there?

Anyway, back to William White and his powerful advocacy of recovery communities which as he suggests may make students of us all when some of use thought we were teachers.

The story moves on, becoming more enriching and inspiring.

There is a movement towards the management of long term recovery from an acute treatment model. There have been new developments like recovery coaches which show an increasing focus on long term recovery.

There is also an emergence of a recovery movement that has not historically existed before. “Recovery is everywhere” campaigns organised not by treatment centres but by local, grass-root, recovery community organisations. They are not mutual aid or treatment based. They have never had a category to put them in until now.

We are seeing the mobilisation of people in recovery. We are seeing a number of New Recovery Support Institutions such as Recovery Community Centres, offering non clinical recovery support services for individuals and families in long term recovery, Recovery Homes, Recovery Schools movement, Collegiate recovery programs, recovery industries who realise that people in recovery make the best and most hard working employees, recovery ministries, religious base recovery communities like including Celebrate Recovery which is attached to over 10,000 churches throughout the US, Recovery Cafes, and an ever increasingly elaborate interconnection of recovery resources.

William White ends with an intriguing suggestion that we may, via these increase recovery support organisation and via our own long term recovery be able to break the chain of dependence in our own children.

This way seem somewhat far fetched to some but equally it may be possible to identify the ways genes are expressed by certain behaviours in certain environments and for these to be altered by a change in these behaviours as the result of recovery and for environments to be changed too.

If, as we have suggested, addiction is at heart an emotion processing and regulation disorder, we could intervene to shore up these skills in those vulnerable to alter addiction by teaching sharing emotions, identifying and labeling of emotions, verbalisng of emotions etc, because we are attacking the pathomechanism of addiction, the mechanism by which addiction is propelled.

In doing so we may have a fighting chance of altering the course of possible addiction. So what has always been seen as inevitable (drunks beget drunkards) may for the first time in history not be so straight forward, so inevitable. This pathomechanism may be malleable and be susceptible to us changing the course of a likely disorder. In doing so, it will affect the chain of genetic inheritance from one generation to the next?

Fanciful or possible?

We discuss our ideas and William White’s ideas on this in another blog.

Let’s be Friendly with our Friends?

Cross fertilisation among Recovery Fellowships

I have unfortunately heard sometimes not very complimentary remarks about different recovery groups and fellowships which I have never found particularly helpful or useful in attracting the alcoholic or addict who is still suffering. The simple reality is that people recover from alcoholism and addiction by a wide variety of means, and recovery regimes.

My father recovered via the Catholic Church and was probably not even aware of 12 step or other recovery groups?

People seem to recover in a myriad of ways – unassisted, via religious, spiritual and secular means.

The Big Book says we (AA) have no monopoly on God – I would add we have no monopoly on recovery or treatment either, however widely and prolifically used 12 step programs have become internationally.  We may benefit more from a position of love and tolerance and understanding of the reality we are in recovery from a potentially fatal malady and support each other however we can, no matter what our recovery affiliation is.

It may be that each and every group have many useful recovery knowledge and skills to learn from each other. Showing a united front as a greater recovery community may have a profound effect on attracting suffers of addictive behaviours to recovery.

In this video, William White explains how co-attendance between different fellowships is becoming much more common, as recovering individuals stray over to check out other recovery groups and fellowships. For example for woman for sobriety to attend woman’s groups in AA, perhaps brought to together by a general  “woman in recovery” generality.

It is not unusual for secular groups in recovery to also attend AA meetings especially atheist and agnostic groups with AA. Again a commonality in a more  non theist approach may be a commonality here, especially as there is  rise of agnostic and atheist  approaches within recovery, and especially 12 step groups, such as AA Agnostica. In fact, the Ernie Kurtz and William White have researched this rising trend in much detail.

 

In fact William White writes about this in his website – in the blog “Further reflection on Dual Citizenship” by himself and John Kelly, another leading researcher into recovery.

The Dual Citizenship Phenomenon

“Dr. Tom Horvath recently posted a blog on the “dual citizenship phenomenon”–individuals who concurrently participate in SMART Recovery and AA or other 12-step meetings.

Dr. Horvath’s interest in this phenomenon was sparked by recovering people simultaneously being involved in secular, spiritual and religious recovery support groups–groups whose core ideas and practices would on the surface seem to be incongruous.

The degree of dual citizenship in recovery is revealed in the membership survey of various recovery mutual aid groups.  In Gerard Connors and Kurt Dermen’s survey of Secular Organizations for Sobriety (SOS) members, 30% of (SOS) respondents reported concurrent AA attendance with an average of more than 50 A.A. meetings attended in the past year.

Lee Ann Kaskutas’ study of Women for Sobriety (WFS) revealed that about one-third of WFS members also concurrently attend AA meetings. 

In the LifeRing Secular Recovery Survey, 35% of LSR members surveyed reported co-attendance in another recovery support program–57% of those reporting attending AA. 

The most recent survey of SMART Recovery membersrevealed that 32.4% of SMART Recovery members also attend AA, NA or another 12-step program, 13.8% attend meetings of another secular recovery support program, and 10.5% participate in a faith/religious/spiritually-based program.

(Typically these dual citizens report that “I attend AA for the fellowship and community, and SMART Recovery for the tools.” These individuals, I suspect, would not attend AA if SMART Recovery were as large and had the same depth of community – certain individuals who seem equally committed to both organizations and both approaches –  these individuals are the true dual citizens.)

Such surveys reveal considerable eclecticism in recovery support participation across what are often portrayed as quite distinct frameworks of addiction recovery support.”

 

More recovering individuals are looking at themselves as members of a greater recovery community rather than simply identifying themselves within the confines of fellowship membership.

My own recovery has hugely enhanced by researching the neuropsychology of addiction and recovery over the last 5-6 years, in fact, on occasion this research has saved my life from probable relapse. My blogs seek to embrace aspects of DBT, CBT, psychological and psycho-analytic theories of addiction etc.

I have come to an understanding of my own addictive behaviours as being driven by an inherent emotional dysfunction mainly via academic research. For me the spiritual malady of AA can also be explained in terms of emotional dysregulation as can the processes of positive behavioural change prompted by working the 12 steps.  These views are not opposing but complementary, mutually supporting views.

I have a “critical” head which is not at odds with 12 step spirituality. I have not given up on self, but chosen to exercise self under the direction of my Higher Power, a HP that does not act via fear. My critical head has helped me explore my spirituality.  I do not leave my reasoning brain at the door when I enter the rooms of AA and I don’t suggest any one else does either.

In fact my initial understanding of myself as an alcoholic is primarily based on the perceived wisdom of AA members in their lived experiences  as recovering alcoholics –  I believe AA is as much about this shared recovery experience as it is the contents of the Big Book.

The “traditions” of AA are also borne out of the lived experience of recovery, compiled and organised by Bill Wilson from the lessons learnt in a multitude of recovery settings and recovery group experiences throughout the US and beyond over a number of years.

The Big Book described this illness in one way nearly 80 years ago and this way is still valid today but it should never preclude us from adding to this sum of knowledge, from explaining this illness given the understandings which have been developed in that 80-year time frame. We now know a huge amount about this condition and increasingly about recovery.

Bill Wilson himself commented that he feared the Big Book would become “frozen in time”. As someone who looked at different possible supplements to recovery, such as vitamin therapies, one can be sure that he were alive today he would be absolutely fascinated with  developments in our knowledge base about this condition and it’s recovery.

He may even have some pride that he helped in no small part, by  prompting such inquiry. Bill Wilson was fascinated and intrigued by alcoholism and his fellow alcoholics. For him anything that alleviated  the suffering of alcoholics would be considered helpful. He after all asked us to be “friendly with our friends”?

Isn’t that we are all trying to achieve, a greater understanding of the underlying mechanisms of this emotional disorder, this spiritual malady? A greater awareness of the recovery process and possible outcomes of recovery? For ourselves and our families and communities.

Isn’t this a wonderful journey that we can all share?

The Family Afterwards…

Today we listen to the research wisdom of William White in relation to family recovery, especially long term.

Family recovery is much overlooked and not adequately supported long term in terms of “after care” which is incredible when one considers that interpersonal factors such as family relationships contribute in a major way to  relapse?

Instead of spending millions upon millions on cue reactivity and attentional bias studies which look at how recovering people are supposedly constantly drawn to alcohol and substance cues in the environment like lemmings to a cliff (when this does not seem particularly evident in the literature, particularly in relation to being relapse factors) or on anti-craving medication when me and scores of other alcoholics and addicts in recovery rarely have these once they have ultimately accepted in our innermost selves that they are alcoholic/addict (and if we do, we can deal with them via our support networks), why does research funding via various funding bodies and various universities not look at the efficacy of supporting families in long term recovery, certainly to around the 3-5 year mark, at the very least?

I suspect one would find that support of family recovery long term, possibly in extended recovery communities, may be the most potent way to assist long term recovery?

Why doesn’t research address what works, and why it works rather than trying to develop the next miracle pill? 

Craving is also a symptom of an underlying condition, it is this condition that recovery should be treating?

We have the solution already? Why not support it to increase it’s efficacy long term?  We, via research and funding, could very possibly increase long term recovery, period.

Just a couple of ideas to put out there?

Back to William White and …

The Ecology of Recovery –  there appears to be a historical shift in recovery away from intrapersonal dynamics to a more interpersonal dynamic. From a recovery within with self, looking at the self,   to a fuller recovery involving others in one’s recovery life such as families and recovery communities.

Family Recovery – if we attend to families at all in recovery, it is brief and very short term. Unfortunately,   research suggests that recovery is actually “horribly destabilising” for families. 

The Trauma of Recovery

Families are at a high risk of disintegrating in the early stages of recovery. So we need to build “support scaffolding” for these families. Recovery  does little to prepare or support families in recovery. Stephanie Brown refers to this as the “trauma of recovery”!  We still do not know the extent of what that means or the extent of our roles in recovery in guiding families, according to William White.

Please also click to this link to watch a series of videos on family recovery by SAMHSA which are very illuminating about the process of recovery and describe a process of recovery I have gone through myself with both my  wife, nuclear and extended families.

Recovered?

When does sobriety for today predict sobriety for a life time?

When does the risk of relapse plummet?

How long do you have to be in recovery before this risk falls below 15% which is a figure used with other diseases?

According to William White it is constantly demonstrated to be between four and five years recovery! For opioid dependence it is a little longer. Even at 5 years there still appears to be a 25% relapse rate in this group.

The 5 year mark for durable recovery is the same as with other major disease states such as cancer. Unlike cancer there is really never any effective follow up with those in recovery although there is after care with, say, cancer. Why should this be the case?

Why are recovery people not monitored and followed routinely for 5 years?

In other words, why do recovering people, recovering from the devastating consequences of addiction not get the same medical care?

Recovering My Identity

We continue to mine the research wisdom of William L White on the next few blogs. William White is one of a growing number of researchers looking into recovery. This is an oft neglected part of research although we are beginning to see  research into the neurobiology of recovery as we have discussed in various other blogs.

William White takes a more qualitative approach than our previous research blogs. It is important to marry quantitative and qualitative research moving forward. For example, William White makes an important point in his research writing about durability of recover, i.e. at what point (or how long does it take for) recovery to be considered durable?

Is there a period at which we can say these individuals in recovery will most likely continue to stay in recovery long term?

From a quantitative perspective it would be illuminating to image the brain of these individuals at say 5 years and compare to early recovery brain images to show what functions of the brain improve, what neurobiology is replenished (balanced) which neural networks are connected or reconnected via altered behaviour-based neuroplasticity etc.

Everyone should have access to information on the processes involved in  getting well, what this wellness looks like and how to get there. If you went to your doctor about any other illness or condition you would expect some information about treatment, likely chances of treatment success, likely outcomes of treatment and how you are likely to be in the long term. So why not have this information available in relation to addictive behaviour recovery?

Anyway on with next video on the experience of recovery.

Recovery Identity

There appear to be three types of recovery identity according to William White’s research

Positive – extremely enthusiastic about being in recovery and want everyone to know that they are in recovery!! I can relate to this I’m afraid. Especially int he earlier months of recovery when I was converting the world to the 12 step world of spiritual awakening!! The preaching phase of my recovery.

Neutral

Negative – In recovery but deeply ashamed about being in recovery because of the social stigma related to having the disease of addiction.

Interpersonal Styles of Recovery

Acultural – individuals who initiate and sustain  recovery without relationships with other people in recovery.

Bi cultural – can move within distinct cultures of recovery but can also function quite comfortably with “normies”or “earthlings” i.e. normal people at large in society.

Culturally enmeshed – deeply enmeshed within the culture of recovery. They live within the culture of recovery so much  and so exclusively that they have almost no contact with the mainstream culture. This is not unusual in early recovery but may not be encouraged in much later recovery.

At some point we all should be encouraged to, as William White states, “get a life” which is to leave to comfort blanket of exclusively 12 step life to start walking across that bridge to normal living. I know from my own recovery that suddenly, after 18 months, having to start working in a school with troublesome boys and kids with learning differences improved my recovery immeasurably.  Although I did not want to do it initially and was half terrified of doing so.

The best recovery is often in the world of people, this connectedness to others helps the recovery process no end. All recovery seems to most effective in a social setting. It helps test our so-called spirituality no end. We can only be sages in an AA meeting but in real life we really find out how spiritual we really are!!? 

It also helps with self esteem and self confidence in our own abilities. I have found in recovery, that I am recovering a person I have never known or met before. Recovery is an adventure in a sense. We continually disprove our over critical heads which is constantly telling us we can’t when we can.

I leave it to my higher power, which I call God, to reveal the me He wants me to be. 

Drugs were never this exciting!

 

Recovery: can you feel “Better than Well!”?

Degrees of Recovery?

Better than Well – I love this concept and reality and relate to it myself. This is a reality for many recovery people who feel they had an amplified recovery or in simple terms, people who got better than well!

This people did not simply have the pathology of addiction extracted from their lives. These people did not only go on to recover but went on to live incredibly rich lives in terms of the quality of their lives and the service to their communities.

These are people who talk about addiction and recovery as a blessing! These are individuals who suggest that what they achieved after recovery was not in spite of their recovery but because of the strength they drew out from their addiction recovery.

Their fulfillment of life was greater perhaps than if they had never been addicted and suffered from addiction. Their recovery from addiction gave them a meaning that they may not have had, if they had not been addicts.

I believe I am 25% smarter in recovery (can be proved in terms of exam grades), I understand people now in recovery, I am a more empathetic human being in recovery. My life is immeasurably better than it was before. I have a contentment unknown to me previously. A peace of mind I thought impossible.

My roots grasp a new soil! I feel like I have been reborn.

This kinda fits in also with Bill White’s description of recovery as a method of transcending the self or “getting out of self”. This idea and reality relates to various previous blogs on why we need to live “outside” self regulation” systems of the brain as these appear to have been hijacked by the effects of drug and behavioural addiction.

One way of doing this is by using our self in a different way, to use self to serve others. This way we can use our stories to help others in recovery and improve our own self regulation as it strengthens areas of the brain like the ventromedial pre frontal cortex used in self referential information and emotional regulation.

We can get reward not from drugs or behaviour but by helping others which supplants the depleted dopamine, natural opioids, oxytocin of increased attachment and bonding and the serotonin of well being. It improves our orbitofrontal cortex as we become more empathetic, begin to become emotional literate, reading emotional expression in other’s faces.  It reduces stress and distress. Lowers glutamate and increases GABA. We become less fearful and more serene.

Helping others helps us so profoundly.  It changes the neurobiology and hence neuroplasticity of our brains.

The video ends with a brief look at the “hot flash” spiritual awakening of recovery a la Bill Wilson and  the slower more incremental or “educational” variety of spiritual awakening. For me, spiritual awakening can mean emotional catharsis, sometimes so dramatic that it immediately changes how we think and feel about the world and our place in it or the more experiential, where our views and attitudes to the world gradually change. Each leads to the same goal of long term recovery. The latter being, by far, the most common.

 

Recovery – a need for change?

A need for change?

Addiction is a chronic condition but is treated as if it was an acute disorder. Treatment has become disconnected from the longer processes of recovery. Hence is there a need to redesign “treatment” to address the reality that recovery is a long process, not something that can be treated in weeks or months? Should there be a greater focus on interpersonal and family relationships, especially as they are demonstrated to be a major reason for relapse.

Toward a new Recovery Paradigm?

What do we know about this thing called recovery?

First we have to define recovery, so let’s start with “What is recovery?”  Do we need to move from a pathology and treatment paradigm to a recovery paradigm? Although it is feasible that these paradigms could be interlinking? Or at least considered more than at present.

At present we focus almost exclusively on what is wrong with addicts not how they get better via recovery and the ways in which they get better too? We need more research to evaluate the processes in recovery, the different types of recovery, we need research into the success of recovery, i.e. how many people actually recover, the durability of recovery etc.

We need to clearly say where we are headed and what we can hope for by coming into recovery!

We could fill libraries with what we know about the neurobiology of addiction but barely a library shelf with what we know about recovery from addiction.

 What exactly do we know about the neurobiology of recovery?

In recovery are there any ways recovering persons can help with altering vulnerabilities, such as developing the verbalising of emotion, to help with emotion processing and regulation which we know have a aetiological influence of the risk of later addiction?

In short can we affect the epigenetics of addiction (how genes are expressed in environments) by recovery? Can we reduce the stress that potentiates dopamine and reward and acts as a vulnerability to adolescent drinking which in itself is linked to later alcoholism? Can we counter the child maltreatment and insecure attachment that propels addiction?

So many questions remain unanswered. Can the people who suffer addiction, in recovery, be the most potent agents in actually affect vulnerability to later addiction? Can certain, seemingly unavoidable eventualities be addressed and changed?

Can our recoveries help our at risk children? Can we modify the effects of genetic inheritance? Is it inevitable that addiction occurs, can it not be “treated” in early childhood. Can we intervene to disrupt or alter the course of addiction?

This is the research question of the next decade?