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After watching "The Cultures of Recovery" you will have many questions such as:
You can ask these questions and more as part of a "live" online discussion with William L. White, addiction expert, author, and senior research consultant at Chestnut Health Systems, on Wednesday, July 16, 2003, from 3 to 4 p.m., E.S.T. Be a part of this lively exchange; mark your calendar today and post your questions in advance. Chat Transcript MODERATOR: The Web chat will begin in 5 minutes. Welcome to the Recovery Month 2003 Web chat. Our host today is William L. White, addiction expert, author, and senior research consultant at Chestnut Health Systems. Our topic today is The Cultures of Addiction. This online discussion will highlight what communities can do to support and encourage individuals with substance use disorders as they begin the recovery process and as they reclaim their lives. Please note that the views and opinions expressed by non-CSAT staff members in the Web chats and Webcasts should not be interpreted as official CSAT policy, but, as the views and opinions of the individuals participating in these events. Now we are ready for the first question. This question was previously submitted. How can the community of people in recovery help make long-term recovery more attainable? William White: The first thing people in recovery can do to make recovery available is to participate in the service venues that they are involved in. This can range from 12-step work in NA or CA or AA or service work through alternative 12-step groups, such as faith-based ministries. Another way they can expand the accessibility of recovery is to participate in the new recovery advocacy organizations that are springing up around the US. These organizations are very active, hoping to expand recovery support services and resources and to educate local communities about the resources. The final way that some are choosing to expand recovery is by making a decision go public related to their personal story of family members in recovery. The goal of this is to put a positive face and voice on recovery and reduce the stigma that continues to attach to addiction. merl: What are the needs of people in recovery? William White: The needs of people in recovery vary tremendously across the boundaries of age, gender, ethnicity, and drug choice. They also vary considerably based on developmental stages of recovery. Needs of people the first year of recovery are dramatically different than the needs of individuals that have been in recovery for more than 5 years. In the early stages of recovery, tremendous effort is required to detoxify from both the drug and the drug cultures that one was often meshed with and begin to repair all the damage that accrued during the years of addiction. Once recovery is initiated and stabilized during early months and sometimes years, there is often what might be called the mid-life crisis in recovery. One wakes up one morning and suddenly it is not enough to not drink or use drugs. This mid-life crisis must be resolved or individuals are at high risk for relapse, and even with some recovery behind them. But what many of us are trying to do now is maintain a continuum of treatment and support services that address changing needs across these developmental stages of recovery. betty: What can I, as a parent, do to support my children throughout the recovery process? William White: There are several things parents can do that differ somewhat, based on the ages of the children seeking recovery. Or parents of adolescents seeking recovery. It is very important for parents to support recovery by educating themselves about addiction and recovery, by helping to eliminate obstacles through recovery (such as access to recovery support meetings), and to participate in a family recovery program such as through attendance at Alanon or Families Anonymous meetings. The other thing parents can do, and all family members can do, is recognize that there are developmental stages to family recovery just as there are to personal recovery and that families often need outside support to sustain themselves individually through the early months, and sometimes years, of recovery. Families who don't seek such support even though they remain intact during the years of active addiction are vulnerable for increased conflict in the worse case, disintegration in facing the tremendous changes that recovery brings. MODERATOR: This question was previously submitted. What can help motivate an 18-year-old going into college to make the transition? Particularly since drinking has been such a large part of his social life up to the point where it became destructive? William White: For an 18-year-old who has been involved in heavy drinking, transition to a college and university environment pose significant risks. Such an individual is at considerable risk to migrate toward heavy drinking subcultures within the college and university environment. Under these circumstances, the drinking of some college students accelerates along with the problems associated with it. For the 18-year-old who is in recovery and leaving for the college or university environment, the challenge is to be able to develop recovery support systems within his or her college or university environment similar to those that sustained them in their home community. The good news on this is that there are a growing number of colleges and universities that contain vibrant cultures of recovery within them. Some colleges and universities, such as Texas Tech University and Augsburg College in Minnesota, provide special recovery support programs for students in recovery. These campuses are noteworthy for the vibrancy of the recovery support groups that meet regularly on their campuses, the low relapse rates for students involved in these programs, and the high degree of academic excellence that these students achieve. Guest2: What are the developmental stages to family recovery? William White: Unfortunately, we have very little research on the stages of family recovery. The work of Stephanie Brown and Virginia Lewis is a noteworthy exception. What they found in their study of alcoholic families in recovery was that much of the pain and chaos within the addicted family often continues for months, and actually a number of years, into the recovery process. They actually refer to the "Trauma of Recovery" to convey that the highly disturbed pattern of family relationships during addiction must collapse before individual family members and their relationships can be repaired. Unfortunately, we have almost no information related to developmental stages of recovery for families if a family member was addicted to drugs other than alcohol. On the positive side, as we are having more family members step forward to become part of the new recovery advocacy movement, their stories are filled with an incredible degree of hope about the prospects of family recovery and healing. What their stories convey individually and collectively is that the curse of addiction can become transformed into a blessing of recovery that not only resolves problems in the family, but strengthens the family far beyond any pre-existing level. The only other thing I would add about developmental stages of recovery is that, like individuals, family members and the family as a whole may need some excessive and somewhat brittle defense mechanisms to get through the early weeks and months of recovery. This means, for example, that family members for a period of time need to be as obsessed with recovery as they previously were with the experience of addiction. These brittle patterns often fade for individuals and the family as a whole as recovery time accumulates. Guest4: Can you comment on the apparent dominance of the "12 step" paradigm in the recovering community? And doesn't this rather dogmatic devotion to the teachings of "Bill and Bob" as the only true path to successful recovery limit, rather than expand, our opportunity to reach all individuals whose lives are negatively impacted by alcohol and drugs? First, Alcoholics Anonymous and the other 12-step derivatives (AA, CA) have earned the right to be the standard by which all other methods of recovery are evaluated based on their longevity, membership size, geographical dispersion, and influence on professionally-directed treatment. What are remarkable in recent decades are the growing varieties of experience within Alcoholics Anonymous and other 12-step groups and the growing number of adjuncts and alternatives to 12-step programs. These alternatives include such things as Native American cultural revitalization movements; secular framework of recovery, such as life-ring secular recovery and secular organization for sobriety; gender-based frameworks of recovery, such as Women for Sobriety; and a wide variety of faith-based recovery support structures. While some members of 12-step groups and advocates of 12-step-based treatment exhibit such dogmatism and argue that AA is the only legitimate pathway of recovery, the AA founders and AA literature have consistently suggested that AA's "Roads to Recovery are Many." What is occurring within the recovery community and the professional community is a growing recognition that there are multiple etiological pathways into alcohol and other drug problems, that these pathways unfold into diverse patterns potentially requiring very different treatment, and that there are many diverse pathways and patterns of long-term recovery. It is time we all began to celebrate the tremendous variety in the ways individuals and families are initiating and sustaining recovery from alcohol and other drug addiction. MODERATOR: This question was previously submitted. Bill…lot of activity since we met in St. Paul in November '01. Our group, SOFAR, Speak Out for Addictions Recovery, remains very active telling Tucson and Arizona that recovery is all around us and it pays to recognize, accept, treat as a medical problem, and support recovery efforts in order to keep addicts growing and contributing to the community. My question: Is there a regularly updated, non-clinical central fountain of information about the success of treatment and recovery? Ex. 80 percent of employees treated for alcoholism stay with the employer and is promoted. 71 percent of treated addicts become volunteers for programs helping other addicts and prevention. Sure, this is fantasy, or is it? William White: First, congratulations on your perseverance initiating and sustaining recovery advocacy/anti-stigma campaigns. It is a very difficult challenge. [This is] primarily because the evidence of failed treatment is highly visible; whereas, the successes of treatment become virtually invisible within this culture. You are part of a larger movement that is challenging a vanguard of recovering people to step forward and announce their presence within their culture. Attitudes about cancer in America were not changed until we reached a critical mass of people who knew someone who survived this devastating disease. [The] same will be true of addiction, and it is time we brought the message of successful recovery to the very heart of the American consciousness. As to a central repository of information, the faces and voices of recovery campaign is hopefully going to be helping both assemble and disseminate some of this prorecovery research. As for treatment outcome research, NIDA and CSAT continue to increase their efforts to convey the findings of their latest studies to the public at large. There are also projects, such as the behavioral health recovery management project (www.bhrm.org), that are trying to move treatment for those with the most severe alcohol and other drug problems. A model: A crisis-oriented episode of brief intervention to a process of sustained recovery management. The BHRM Web site provides some of the latest evidence-based clinical guidelines as well as a number of key papers on recovery support services and recovery advocacy. While there is a growing body of literature that evaluates treatment, what we desperately need is research that really documents the styles and patterns and prevalence of long-term recovery. Building such a research base and disseminating that research to the professional and lay communities would help offset the growing demedicalization, restigmatization, and recriminalization of addiction in America. Elizabeth Jones: What can community- and faith-based organizations do to support the culture of recovery? William White: A grassroots recovery and faith-based organization can play a critical role by creating physical, psychological, and social space where recovery flourishes. There is a growing movement to expand recovery ministries within American churches. The best of these ministries are creating alternatives to professionally directed treatment for some, and adjunct to professional treatment for others. Most importantly, many of these ministries are providing personally and culturally-relevant, long-term, sobriety-based support structures. The other thing these organizations can do is to confront conditions in the larger community that promote excessive alcohol and drug consumption, advocate for prorecovery policies, heighten the responsiveness of local treatment agencies and needs of particular ethnic communities, and create sanctuaries to support individuals whose recoveries would otherwise be unsustainable. Bill: What are the barriers that prevent individuals from finding recovery? William White: Most barriers to recovery exist at multiple levels. There is, first of all, [the] power of the drug and [the] drug's relationship to one's body. Many people addicted to alcohol and other drugs also develop chronic self-defeating styles of interacting with others that make getting help for alcohol and drug problems very difficult. There are also barriers for those individuals who are enmeshed in family and social environments that are saturated with alcohol and other drugs. Beyond the families and the immediate neighborhoods, we also have the barriers of inadequate treatment and post treatment recovery support services. Far too many people reach a crisis in their relationship with alcohol and other drugs and reach out only to find, and be confronted with, unconditionally long waiting lists to access addiction treatment. A major goal of the new recovery advocacy movement is to assure that such people will find both role models of recovery and assistance of recovery on the day they are ready to reach out for help. betty: You have authored eight books. Which is your favorite and why? William White: I think my favorite book would have to be "Slaying the Dragon: The History of Addiction Treatment and Recovery in America," simply because the research and writing of that book consumed so much of my life and [it] was such a work of love. What I found in that book that has so inspired me is that through the cycles of despair and hope that permeate the history of alcohol and other drug problems, whenever conditions look their bleakest, recovering people, their families, and visionary professionals always come together to rebirth [a] new or renewed framework of hope for long-term recovery. That particular book also has continued to fascinate me in terms of the deep historical roots of addiction treatment and recovery in this country. If there is a legacy that I will leave in writing to this field, my guess is that it will be that book. Lilo: What impact does stigma have on cultures of recovery? William White: What stigma does is suppress cultures of recovery and force people in recovery to live a life of invisibility, either in isolation or in subterranean subcultures. Stigma is one of the things, perhaps the primary thing, that makes recovery from addiction so invisible within this country. It is because those individuals and families who step forward to tell their own stories of recovery pay a price for such courage and candor. That stigma is on the rise and has triggered a new generation of recovery advocacy organizations and a renewal of advocacy activities within such organizations as NCADD. What this new recovery advocacy movement tends to do is offer living proof that recovery is a reality in the lives of hundreds of thousands of individuals, families, and communities. That movement is also attempting to address the structural aspects of stigma that are reflected in diminishing treatment resources (at least in some areas) as well as the various forms of discrimination that people in visible recovery regularly encounter. MODERATOR: Our guest will now make some concluding remarks... William White: There are elaborate cultures of addiction that exist in most American communities. Most cultures have their own language, symbols, rituals, etc., and there are individuals who are as addicted to those cultures as in the drugs in their lives. Disengaging from these cultures is extremely difficult and often contributes to a high relapse rate found in the treatment of addiction. What many of us are attempting to do is to build vibrant cultures of recovery in local communities throughout the US that can provide pathways of exit from these cultures of addiction. MODERATOR: Our hour has concluded. For more information, visit CSAT's Recovery Month Web Site at http://www.recoverymonth.gov. Visit the multimedia area (http://www.recoverymonth.gov/2003/multimedia/) to see a list of upcoming Web chats and Webcasts on various topics. You can also watch the archived version of the Webcast that complements this Web chat at http://www.recoverymonth.gov/2003/multimedia/w.aspx?ID=210. Join us next month on August 20 from 3-4 p.m. EST for our next Web chat. The topic is "Finding and Paying for Addiction Treatment in Your Community." We would like to thank our host, William White, addiction expert, author, and senior research consultant at Chestnut Health Systems for his participation in this online event. [We also would like to] thank our participants for their questions. This transcript will be available shortly so that others may benefit from the dialogue. The chat has now officially ended. Books by William L. White:Pathways from the Culture of Addiction to the Culture of Recovery: A Travel Guide for Addiction Professionals Slaying the Dragon: The History of Addiction Treatment and Recovery in America Related Publications:HEP-CATS, NARCS, AND PIPE DREAMS: A History of America's Romance with Illegal Drugs A Call to Action: Changing the Culture of Drinking at U.S. Colleges Center for Media Literacy Bibliography Flier for Webcast on 7/2/03 and Web chat on 7/16/03: The Cultures of Recovery | ||||||||||||||||||||||||
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