X a new research agenda into recovery

The Family Afterwards…

Posted on by alcoholicsguide

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.

Recovering My Identity

Posted on by alcoholicsguide

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!”?

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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?

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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?