By Rick Kuplinski, SMART Recovery Facilitator

“I need to get well.”

Many of us begin our recovery from addiction with this simple declaration. Perhaps wellness sounds like a modest goal, but it is a huge motivational shift to go from “I don’t have a problem” to “I think I have a problem” to “Maybe I need to do something” to “I need to get well.”  

But consider this: Getting even better than well is possible through SMART Recovery. That’s because we focus on getting well through physical sobriety but also on getting better than well by also making emotional sobriety part of our recovery plans.

Physical sobriety is the actual not drinking/not using/not acting out that we practice every day in recovery. It is mandatory (especially for the biological dimension of addiction), but not sufficient for full emotional sobriety (which is more about dealing with the psychological and social dimensions).

Emotional sobriety is the wisdom, compassion, humility, and grace to handle all aspects of our lives maybe even better than we had before we became addicted. It is learning to recognize the difference between truly traumatic situations from which it is necessary to protect ourselves and the merely challenging ones that we can handle without the coping mechanism of our addictions. Emotional sobriety helps prevent setbacks, aids long-term recovery, and improves our general well-being.

And once we appreciate the difference between physical and emotional sobriety, the points, principles, and tools of SMART Recovery come more sharply into focus. For example . . .

Unconditional Acceptance: (See pages 43 through 45 of the SMART Recovery Handbook.) SMART Recovery teaches us to be more practiced in acceptance of self, of others, and of the world in general. While not abandoning hope and action to make things better, we learn to acknowledge reality, to stop demanding that it not exist; and to keep it in perspective (even when unpleasant) This, in turn, helps us better tolerate what we cannot change so we can avoid unnecessary sadness, depression, guilt, shame, anger, irritation, annoyance, resentment, frustration, anxiety, worry, fear, nervousness, panic, inferiority, inadequacy, loneliness, hopelessness, discouragement . . . Wow! That’s quite a list!

Helpful (Rational) vs. Unhelpful (Irrational) Thinking: (See pages 45 through 48 of the SMART Recovery Handbook.) Even when people are “well” by most all measures, we still sometimes hold on to some beliefs about ourselves or the world that: 1. Aren’t exactly true; 2. Don’t really make sense; and 3. Tend to cause harm when the belief is followed or acted upon. Learning to recognize and dispute unhelpful beliefs is a great way to avoid the physical temptation to repeat our addictive behavior that is fueled by “stinking thinking.” It also helps us be better than well by having stronger emotional balance—even long after coping with urges is a daily concern.  

The ABC Tool: (See pages 39 through 42 and 50 through 53 of the SMART Recovery Handbook.) The ABC Tool is the Swiss Army Knife of SMART Recovery, i.e., one tool with a variety of applications for both physical and emotional sobriety. ABC can be used to cope with urges, to deal with emotional upsets, and to retrace the history of a bad decision to better understand how to make better choices in the future.

Living a Balanced Life: (See pages 58 through 71 of the SMART Recovery Handbook.) Regaining health and creating a satisfying lifestyle is important for getting better than well. In our SMART Recovery meetings, we emphasize three things:

  1. What are the areas of our lives where we want to devote time and energy? How satisfied are we with the focus and effort we are devoting to each? How do we begin creating better balance?
  2. What areas of self-care might we have neglected in addiction? What will be our focus in recovery for taking better care of ourselves?
  3. What are the things we want to be passionate about in recovery—interests or pursuits that the freedom from addiction makes possible for us to do (or do again) with renewed energy and vigor?

Getting even better than well takes motivation, patience, and daily practice in applying what SMART Recovery teaches. And the process plays out differently and at a different pace for all of us individually. But getting there is possible, and it represents The Quantum Shift in recovery. That sounds like something out of the movie The Matrix, but it is just a jazzy way to describe when we come to the realization that without addiction: “Life is better this way. I like me more like this. I am now living a life in which addiction no longer fits. I feel . . . better than well.”

Looking to get getting even better than well from addiction? SMART Recovery is a science- and evidence-based program that provides educational and peer support to those who want to abstain and gain independence from all addictive behaviors, whether or not they involve alcohol or drugs. The program emphasizes building motivation and self-empowerment skills, employing strategies to control urges, managing thoughts at the root of addictive behaviors and living a healthy, balanced life. Go to the “Meetings” tab at to find an in-person or online meeting to attend.

[Guest blog by Carolyn Straub]

As you’ve surely noticed, social networks are powerful tools for fostering community and sharing information. Reddit stands out from other platforms as a vibrant hub where likeminded people discuss with one another in communities called “subreddits.” Unlike other social media platforms which require you to use your real name and likeness, Reddit allows users to engage anonymously. In fact, it’s not just allowed. It’s encouraged! Just make sure to choose your username carefully, otherwise you’ll be stuck as “Low_improvement-18” forever (like me).

Because of its ability to promote deep connection while protecting privacy, Reddit is a fantastic place to build recovery-focused communities. One specifically for “SMARTies” – those interested in the SMART Recovery program — already exists, and it’s thriving! If you enjoy connecting with other recovery-minded people in casual, online settings (and being a bit goofy while doing it), you will fit right in. As the top moderator of the subreddit, I may be biased. So don’t just take my word for it, check it out yourself. This is especially true if you are concerned about bullying. This is a concern that, as a moderator, I take very seriously. To convince yourself of the civility of the subreddit, look at old posts. The level of respect given to others is how you will be treated as well. Viewing the subreddit doesn’t require you to make a Reddit account.

If you do decide to make an account, there are many ways to get involved on the SMART Recovery subreddit. The easiest way is to leave a comment on a check-in post. You can introduce yourself (using your Reddit alias of course), ask questions, and even include an emoji or two to spice things up. I also recommend commenting on the weekly posts where we discuss different elements of the SMART Recovery program and how to apply them to our lives. For example, on “Motivation Monday” posts, members share strategies for supporting the first point of the 4-Point Program®, Building and Maintaining Motivation. But we’re not always so serious! Community members often incorporate their offbeat senses of humor into their content. This usually manifests in silly GIFs, good-natured jokes, and enthusiastic celebrations for member milestones. According to the SMARTie mentality, it’s all part of fourth point – Living a Balanced Life.

Although I did not create the SMART Recovery subreddit myself, I feel a deep responsibility to serve the community. I took ownership of it about a year ago because it was unmoderated, which prevented members from engaging with the subreddit in meaningful ways. Since then, I have cleaned up the community and grown it to nearly 10k members. I am proud to say that it now reflects the spirit and principles of the SMART Recovery organization, despite not being an official platform. There’s nothing I or the community would love more than to welcome you as a member of the SMART Recovery subreddit, if you so desire.

I look forward to learning your (hopefully not embarrassing) Reddit alias soon!

You can find Hey SMARTies subreddit here:

*Please note: this sub is moderated by trained SMART volunteers but is not officially affiliated with SMART Recovery. 

Addiction to nicotine in tobacco remains the most deadly substance use disorder, resulting in more than 480,000 deaths each year from tobacco-related diseases including lung cancer. Lung cancer is the most common cause of cancer death, but it is also one of the most preventable.

Safe and effective pharmacotherapies and behavioral treatments already exist to help people quit smoking. Nicotine replacement therapies are available in several forms, including patches and over-the-counter gum that can ease nicotine craving without cancer-causing smoke. Varenicline and bupropion are prescription medications that can reduce nicotine cravings and withdrawal, and behavioral treatments like contingency management have been found to be effective at helping people quit. Combining behavioral treatments and pharmacotherapies may be most effective. And several promising new treatment approaches are also being studied and developed with NIDA funding.

For example, NIDA is working with Antidote Therapeutics, Inc. to complete preclinical studies of a human monoclonal antibody that binds to nicotine in the blood to prevent it from interacting with nicotinic receptors in the brain. Previous animal studies found that it reduced brain levels of nicotine and nicotine-induced increases in blood pressure.

Current NIDA-funded projects also include studies of noninvasive brain stimulation (transcranial magnetic stimulation, TMS) for tobacco cessation; a trial of the safety and efficacy of an infusion of the dissociative drug ketamine for tobacco use disorder; a multi-site randomized controlled trial of the psychedelic drug psilocybin for tobacco use disorder; and trials of compounds with novel mechanisms of action in the brain, including a compound that interacts with a type of glutamate receptor (mGlu2) to reduce nicotine’s reinforcing effects.

NIDA is also funding studies that could help identify individuals who would most benefit from targeted prevention interventions. They include studies of genetic factors underlying risk for nicotine addiction and other co-morbid mental health disorders, and studies to identify the role of vaping in combustible tobacco initiation. Research is also ongoing to assess how social determinants of health influence risk for smoking behaviors and nicotine addiction.

NIDA is prioritizing research addressing smoking-related health disparities and ways to promote quitting in diverse populations. These include a study of a Quitline texting program to promote smoking cessation among African Americans, a contingency management smoking-cessation intervention for pregnant women from ethnic minority groups, and TMS to promote smoking cessation in people with schizophrenia.

Smoking and its health consequences are most prevalent in American Indian/Alaskan Native (AI/AN) people, so NIDA is funding several projects focused on smoking cessation in AI/AN communities, including a family-based program that uses financial incentives to promote smoking cessation. A culturally tailored intervention called All Nations Breath of Life respects the sacredness of tobacco in AI/AN cultures as a way of discouraging recreational use, and NIDA is supporting research to adapt this intervention to being delivered via telephone.

Research is also needed to develop smoking cessation therapies for youth, since nicotine replacement therapies and bupropion are not approved for people under 18 and varenicline has not been approved for people under 16. The National Cancer Institute and NIDA have issued a funding opportunity announcement for initial studies that could lead to the design and development of behavioral smoking interventions for adolescents between 14 and 20 years old. 

The science of whether vaping nicotine in e-cigarettes is effective in helping people quit smoking cigarettes is still evolving. A recent Cochrane review of 78 studies (with over 22,000 participants) found these devices to be more effective than nicotine replacement therapies in promoting quitting. A previous meta-analysis of real-world observational studies concluded that the use of e-cigarettes was not associated with smoking cessation, but results may have been affected by participants’ intention to quit. 

The NIH, in partnership with the FDA Center for Tobacco Products, is currently funding several projects studying whether e-cigarettes are effective as potential harm reduction tools. NIDA is supporting studies to understand the effects on the body of exposure to e-cigarette vapor, including its effects on the lungs compared to standard cigarettes, and studies to measure other health indicators associated with switching from cigarettes to e-cigarettes, among other topics.

In the United States, smoking continues to decline in most groups. In 2021, just 12% of people were current smokers, down from 21% in 2005. But with one in five deaths each year attributable to smoking, we still have a long way to go. One of the aims of the Cancer Moonshot, launched by Joe Biden in 2016 when he was Vice President, is reducing the burden of preventable cancers, including those caused by tobacco. When the President and First Lady reignited the Cancer Moonshot in February 2022, they announced the bold goal to cut the cancer death rate in half within 25 years. As part of the 2023 State of the Union, the Biden-Harris Administration committed to expand smoking cessation services for Americans who want to access them. Developing new tools for smoking cessation and expanding access to and utilization of evidence-based interventions for nicotine addiction are central to this goal including that access to them is equitable.

Yesterday, the White House convened a Forum on Smoking Cessation, consisting of a diverse group of leaders from government, advocacy groups, and medicine who are well positioned to expand access to evidence-based smoking cessation interventions for all groups who could benefit from them. Participants discussed new initiatives and new ways to collaborate to help meet the President’s goal to eventually make cancer as we know it a thing of the past.

NIDA research will continue to be an important part of this objective, including by identifying ways to advance the reach of existing treatments for smoking cessation and developing new approaches to help people end or reduce their use of tobacco products.

Substance misuse and addiction is perhaps our most significant domestic challenge. In 2022, the U.S. Congress Joint Economic Committee (JEC) found that the opioid epidemic alone cost the United States nearly $1.5 trillion in 2020, or 7 percent of gross domestic product (GDP), an increase of about one-third since the cost was last measured in 2017. If you start calculating in alcohol and other drugs and their impact on lost productivity, healthcare and beyond, it moves well into double digit losses to our nation’s economic health. Beyond the economic impact, its impact has reduced the length and quality of our collective lives. If this was any other issue, we would do everything in our power to normalize seeking help and reducing barriers to care. Yet, it is not any other issue, it is addiction. As a nation we have deep seated negative attitudes about addiction and people like me who experience it. As a result, we end up doing things that isolate and stigmatize anyone suspected of possibly having a problem. New technology will likely make these dynamics much worse.

Last April, I wrote about the Algorithm of Medical Care Discrimination. Software company Bamboo Health uses patient data to determine an overdose risk score. The software, NarxCare deploys an algorithm that far too often label patients as potential drug addicts. As this article notes, NarxCare gathers information like criminal records, sexual abuse history, distance traveled to fill a prescriptions and even pet prescriptions to assign risk scores. BIPOC community members score higher as our criminal justice system has historically targeted them for sanctions at higher rates than whites. Women who have more documented sexual trauma than men also get scored higher.

As noted at, a woman was kicked out of receiving services from her primary care provider. Her dogs were prescribed opioids and benzodiazepines. That gave her a high score for potential addiction. She became a person to be gotten rid of, not helped. She got the drug addict treatment, she was shown the door and terminated from care.

People in the crosshairs of this software far too often get treated like pariahs by medical professionals, not offered help but kicked to the curb and treated like societal outcasts. This is the norm for people with SUDs. Two weeks ago a citizens petition was filed with the FDA to take NarxCare off the market. The CUSP FDA Citizen Petition to Protect Patients was filed by the Center for US Policy. The petition asks the FDA to issue a warning letter to Bamboo Health, initiate a mandatory recall, and inform healthcare providers not to use the NarxCare risk scores. It should come off the market.  

The problem is much bigger than NarxCare. The data gathering and AI tools that are increasingly used to sift through information and assist clinical care are ripe with flaws. As noted recently by the Washington Post, denials of health-insurance claims are rising — and getting weirder and include things like an automated system, called PXDX, which “reviews” medical records at a rate of 50 charts in 10 seconds and lead to increased denials for things like substance misuse and addiction.

The book, Weapons of Math Destruction by Cathy O’Neil on the societal impact of algorithms explores how big data is increasingly used in ways that reinforce preexisting inequality. One of the themes of the book is machine learning (ML) bias. Essentially, all the hidden and not so hidden biases ever held in human history is baked into all the data. AI uses the internet and all the information on it like a huge library. It all happens in ways we cannot see, and we tend to falsely believe that these are objective tools. They are not.

Some ML models, like supervised learning, learn by examining previous cases and understanding how data is labelled. AI bias: exploring discriminatory algorithmic decision-making models and the application of possible machine-centric solutions adapted from the pharmaceutical industry noted that: 

“The process of data mining, one of the ways algorithms collect and analyze data, can already be discriminatory as a start, because it decides which data are of value, which is of no value and its weight—how valuable it is. The decision process tends to rely on previous data, its outcomes and the initial weight given by the programmer. One example can be when the word woman was penalized, by being given a negative or a lower weight, on a CV selection process based on the data of an industry traditionally dominated by men like the tech industry. The outcome ended discriminating women in the selection process.”

Training data that are biased can lead to discriminatory ML models. It can happen in at least two ways:

  1. A set of prejudicial examples from which the model learns or in the case of under-represented groups which receives an incorrect or unfair valuation.
  2. The training data are non-existent or incomplete.

Both of these dynamics are in play in respect to SUD. There is significant bias against people with substance use disorders in our healthcare system. Something we explored in, OPPORTUNITIES FOR CHANGE – An analysis of drug use and recovery stigma in the U.S. healthcare system. Stigma is prevalent, but the majority of people with lived experience with SUDs did not need our paper to tell them that, it is in our common experience. The attitudes are abysmal. We are seen as subhuman. We get “treated and streeted.” Labels are openly attached to us like GOMERS (Get Out of My ER) and “frequent flyers.” AI weaponizes these biases, and there are no business or influential stakeholder groups to shape guardrails to protect us from these harms, even as the vitality of our nation continues to erode, a true tragedy of the commons.

AI, addiction, and invasive commercial surveillance

The selling of addictive drugs is highly lucrative. What we have historically done in America is allow these industries (both illicit and legitimate) to flourish and only address the fallout when the scope of the problem becomes too large to ignore. The “opioid crisis” is actually decades in the making and more than just opioids. It only got attention when it reached the magnitude in which it started reducing our overall life expectancy in the US. Remedial efforts have been anemic and not equitably available, leading to more devastation in marginalized communities. These dynamics have been shortsighted, but entirely consistent historically with how we address substance misuse and addiction half-heartedly, even as the devastation is sapping the very vitality and welfare of our nation.

While such technology is always touted as improving care, because of the deep stigma, lack of stakeholder inclusion and money to be made selling addictive drugs, it is much more likely these tools will be used to identify “abusers” and sanctioning them, to deny employment, housing, or educational opportunities. Profit off of selling drugs, then blame the user when they develop a problem and sideline then. Most often in ways that render the impacted person powerless.

Consider the woman I referenced above denied pain killers because her dog was on benzos. If similar software was in use when she applies for a job, or apply for entrance into a university, or rent an apartment, she would never know that she was being redlined because her dog has anxiety. The odds are no one would ever even know or do anything about it. For those of a certain age, it is reminiscent a dark dystopian mid-80s comedy Brazil in which the main character has his life ruined because of over-reliance on poorly maintained machines, but this is no longer science fiction.

When being treated like a drug addict means that people are treated just like everyone else, we will be where we need to be. We have a long way to go to reach that destination. AI is not going to be good for persons with addictions or those of us in recovery in particular. We have not even fully understood the ways people with substance use conditions face discriminatory barriers in the dawn of the age of AI. This is one plane we should not be flying as we are building it, but this is exactly what is happening.

Senior Microsoft executives suggest we should wait for “Meaningful harm” from AI necessary before regulation. What would the threshold of harm be in respect to ferreting our persons with addictions and those of us in recovery and who would determine it? Who is even looking? Those harmed rarely come forward as it sets them up for further sanctions, economically benefits those who discriminate against us. The longer we wait, the higher the hurdles set up by those with vested interests in ferreting out people who experience a substance use disorder. The greater the cost to our entire society. It is time to set up some guardrails before we proceed any farther. NarxCare is a perfect example of software intended to help in respect to prescription drug management that in the quest for beneficence led us down the road of debasement of persons suspected of substance misuse.

Setting up structures to reduce harm of AI for marginalized communities.

These emergent technologies are operating in a wild west environment and may not be containable in ways that have worked historically. Recently, a computer hired a human to defeat the technology we put in place to ensure that the system was interacting with a human rather than a computer. The computer faked a human voice and lied to the human when asked if it was a computer to get access to the data it wanted. This is a world no human has experienced before, and the marginalized are the ones at greatest risk for maleficence.   We should be pumping the brakes on moving forward with AI and related technologies until we initiate ethical limits in its use. Given the scope of our addiction problem and the market forces in play, AI will undermine healing and recovery efforts in a myriad of ways that will exacerbate what is already one of our most profound challenges. It will continue to erode our GDP while reducing US life expectancy as we sit by the sidelines. The only way we will get ahead of this curve is with intention and focus.

There is little evidence we have either.

A colleague in the field (a professional addiction counselor of 30+ years) sent me an email and suggested I respond here on Recovery Review. It’s a great topic with good questions. I’ll place the questions in quotation marks as they were written and reply to each.

The field of Substance Use Disorders and becoming a Substance Use Disorder provider is a “craft” all of its own. Question… Does obtaining a “Master’s” degree in Substance Use Disorder counseling make a person a “Master Craftsman?” I’d be interested in hearing the feedback on that one. What do you think?

To answer this question, first I’ll take the question literally about that exact degree.

I’ll say this…in my 35 years of clinical work in our field I have known less than 5 people who had a terminal master’s degree in Addiction Counseling. Such degrees do exist – as do master’s degrees in mental health counseling, clinical psychology, social work, etc.. But the master’s in Addiction Counseling is a specialty degree. I would hesitate to answer because I have so few to base my answer on. I can say, however, my experience is that such people seem no more or less effective than any other counselor with any other level or type of degree(s).

With that part of my reply out of the way, I’ll be less literal and answer more broadly. And to do that I’ll modify the question a little bit and phrase it as follows: “Does obtaining a Master’s degree that is academically and clinically relevant to providing addiction counseling make a person a “Master Craftsman”?

In my experience the level and kind of degree one has seems unrelated to the primary factor(s) that drive effectiveness in professional addiction counseling. The factors that seem primary to me include inherent personal attributes. These include the capacity for attunement, for not taking things personally, and for compassion in all circumstances. I’d like to emphasize that I literally mean inherent personal attributes, rather than only meaning behaviors one can demonstrate.

Upon the base of those qualities, it seems to me that some addiction counselors also build a particular kind of framework. I think I’ve noticed the best among us have formed a personal framework that consists of at least 3 things.

1. Being emotionally and behaviorally nimble, yet non-reactive.

2. Holding mindfulness of the illness, general and individualized recovery, and the big picture of the entire clinical portion of the patient’s journey, in view.

3. Emphasizing partnering as a working process over almost any other consideration (e.g. even while providing clinical opportunities or challenges).

If such a thing as a “master craftsman” in addiction counseling exits, and I think it does, then I’ll say some addiction counselors with those inherent personal attributes I listed, and who build such a framework, also commit themselves to relatively constant personal and professional growth and improvement. And that they especially do so through the three channels of patient feedback, results/outcomes, and clinical supervision (aside from their own work on their own person). What I am describing are the counselors that commit themselves to this craft, and the improvement of their work, through those three channels, for the lifetime of their work.

Were you a “Master Craftsman” upon Graduation? I’m pretty sure I know what your “personal” answer would be. It would be very interesting to hear from the rest of the field. At “all” levels of “years of experience.”

I will say, “No, I was not.”

Another question to present would be. Has your opinion “changed” over time and if so why.

I think my answer has changed from what I would have said in my first several years. Back then I probably would have said that the “Master Craftsman” must have the required knowledge and skills, and really develop those. And that one must really ask oneself if one is effective, efficient, and holds the knowledge and skills that are necessary and sufficient.

But at this stage in my career, I would disagree with the idea that “effective/efficient/necessary/sufficient” are in fact primary. Now, I would claim that more key than those are the combination of:

  1. the inherent personal qualities, and
  2. the personal clinical framework one builds upon those inherent qualities.

as I described above.

And I would also claim the combination of those is the essential base within or upon which feedback and development can really be maximized over the long haul. I have met some counselors in my career who are like that.

Remember to fan the flames of your recovery, as a fire left untended will go out!

We are taught in recovery that it is dangerous to believe what we did yesterday will be enough to keep us sober tomorrow. Recovered alcoholics and addicts throughout history have demonstrated that the foundation of long-term sobriety is living purposefully One Day at a Time. Yet, complacency creeps in with stale routines, old ideas, failed actions, forgotten promises, dangerous contentment, and a loss of desperation. Oldtimers have referred to this deception as our built in “forgetters!” When achievements and a life of ease seem to come without much difficulty, the very gift of our sobriety can be taken for granted.

GOOD NEWS! There is a SOLUTION. Before the bedevilments on AA page 52 begin to emerge again in our lives and relationships, we must renew a decision to put “work” back into our recovery program. A decision followed by ACTION. Below is a checklist of 25 Tools presented by Angela McClung at a recent workshop session entitled “How to Avoid Complacency.” Remember to fan the flames of your recovery as a fire left untended will go out!

1. Start every day from scratch. New routines. Open mind. Open heart.
2. Surround yourself with friends that hold you accountable. Reengage with the “WE.”
3. Focus on process, not outcomes.
4. Seek out recovery tools in the literature. These tools can be used for all negative emotions and character defects (Pride, Lust, Gluttony, Fear, Jealousy); for example, AA pages 66-67: “This was our course. We realized that the people who wronged us were perhaps spiritually sick. Though we did not like their symptoms and the way these disturbed us, they, like ourselves, were sick too. We asked God to help us show them the same tolerance, pity, and patience we would cheerfully grant a sick friend. When a person was offended we said to ourselves, ‘this is a sick man. How can I be helpful to him? God save me from being angry. Thy will be done.’”
5. Daily readings and prayer first in the day.
6. Pray on knees morning and night.
7. Working the steps in order! Ongoing process! Not “one and done.”
8. Recommit to regularly CALLING Your SPONSOR!
9. Reach out to others! Especially, someone that you don’t always reach out to or a newcomer.
10. SLOGANS! Use them in day-to-day life and pass them onto others.
11. PAUSE! AA page 87: “pause when agitated or doubtful, ask for the right thought or action”
12. CHANGE up meetings! Take notes in meetings.
13. Chair a meeting for a month.
14. Share in meetings.
15. Sit in different locations (we tend to be creatures of habit…sometimes just sitting in a different place in the room gives us fresh perspective).
16. Do 90 meetings in 90 days: Annually or anytime a major change occurs …move, relationship, etc.
17. Ask for a meeting list and numbers: Especially, once in recovery longer (we tend to stop adding numbers to our phones).
18. Get a new Big Book, 12/12, or NA textbook to use in meetings. Don’t rely on old notes or highlights!
19. Read BB with highlighters (Doctor’s Opinion – 164 pages…Pink for promises, Blue for prayers, Yellow for instructions, Orange for caution).
20. Make a service commitment of any kind.
21. VISIT out of town meetings on vacation!
22. Focus on Unity/Service/Recovery (the 3 sides of the triangle). What am I doing for each?
23. Seek ways to be healthy – physically, mentally, and spiritually! (3-fold disease-3-fold recovery).
24. Listen to recovery speakers. You can find them at
25. Explore recovery apps and online resources at

The post Avoiding Complacency appeared first on Fellowship Hall.

This blog was also published on

Nearly 42 years ago, the Centers for Disease Control and Prevention (CDC) reported a rare pneumonia in five gay men, marking the recognized start of the HIV/AIDS epidemic. While we often hear about those men’s sexuality, we hear less often about their substance use. As the 1981 report notes, one of those five men injected drugs, and all five used drugs.

The history of HIV has long been entwined with substance use. In the United States today, more than 30,000 people acquire HIV every year while the drug overdose crisis cost the lives of nearly 107,000 people in 2021. Research shows people with HIV are more vulnerable to drug overdose than are those without HIV.

Because substance use plays such a significant role in HIV transmission and in health outcomes for people living with HIV, the National Institute on Drug Abuse (NIDA) is one of the largest funders of HIV research at the National Institutes of Health (NIH). We highlight the stories behind this essential research in the video series, “At the Intersection: Stories of Research, Compassion, and HIV Services for People Who Use Drugs.”

What is a syndemic?

Syndemics happen when two or more diseases interact to amplify each other—leading to an excess burden of disease and perpetuating health disparities. In a syndemic, environmental and social factors, like lack of quality healthcare, can make people more likely to be exposed to and experience worse outcomes from diseases. Having one health condition can also make people biologically or behaviorally more likely to acquire another illness.  However, science shows that when we address syndemic diseases together, outcomes for both can improve—especially when we integrate a variety of medical and social services with community support programs.

Approaching HIV, substance use, and other health issues through this lens can identify new opportunities to intervene that are invisible when we look at each issue alone.

Methamphetamine use, HIV, and mental health issues

A 2020 NIDA-supported study showed that as many as one in three new HIV transmissions among sexual and gender minorities who have sex with men were in people who regularly use methamphetamine. Many participants reported using methamphetamine to enhance sexual experiences, sometimes called “partying and playing.” Other NIDA-funded research shows that individuals who use methamphetamine are more likely to have sex without HIV prevention; to have mental health issues like depression, anxiety, or bipolar disorder; and are more likely to have detectable HIV viral loads and less likely to take HIV treatment and prevention medication. Fortunately, approaches that emphasize compassion and flexibility over judgement show promise in helping people who use meth achieve their health goals, take medication, and reduce their drug use or stay safer when they are using.

Substance use, HIV, and syringe sharing

Since 2014, there have been at least nine HIV outbreaks associated with the sharing and reusing of syringes in communities of people who inject drugs. CDC- and NIDA-funded researchers have identified factors associated with such outbreaks, including higher rates of hepatitis C and drug overdose, poverty, and lower levels of education. Fortunately, decades of research show that syringe services programs are safe, effective ways to reduce syringe sharing—and with it, the risk of acquiring HIV. Today, many syringe services programs also offer the overdose antidote naloxone and medications for opioid use disorder (MOUD), as well as HIV testing, prevention tools and treatment.

Substance use, HIV, and stigma, criminalization, and violence

People with HIV and substance use disorder (SUD) struggle to access quality, evidence-based healthcare. Racism, homophobia, transphobia, and HIV- and SUD-related stigma in healthcare are serious problems. Policies that punish drug use and criminalize HIV status can lead to time in jails and prisons, where access to HIV and SUD services may be limited. Immediately after incarceration, people are at greater risk of overdose and of leaving HIV care.

These factors—plus high rates of intimate-partner violence (especially among transgender and cisgender women living with HIV), childhood abuse, and other trauma—mean many people face intersectional factors leading to poor HIV and substance use outcomes. But NIDA-funded research shows promising ways forward, including integrated care that addresses the totality of people’s lives. For example, “one-stop” clinics—like the mobile health units in the NIDA-supported INTEGRA trial—test the impact of offering comprehensive services delivered by trained peer navigators who can connect with participants’ diverse experiences.

Bottom Line

Meeting people where they are to provide harm reduction and healthcare without stigma and treating the totality of people’s lives offers hope. And that hope is essential to ending the HIV epidemic.

I assume the reader has heard the term “Recovery Oriented Systems of Care” and of the related clinical practices organized around what is called “Recovery Management.” Regardless, by way of review: 

Lately I seem to notice a trend among addiction professionals and recovery advocates. What trend do I seem to notice? It seems to me that a significant portion of addiction professionals and advocates are tipping toward privileging using over abstinence. 

It has been pointed out that historically, the primary mental health sector has had a strong partial recovery concept and a less robust full recovery concept, while the SUD sector has had a strong full recovery concept and less robust partial recovery concept.

While that is true, it is my opinion that for those with severe, chronic, and complex addiction illness, a framework centered in a goal of continuing using is fraught with peril.

I’ll go further and say that it seems to me that both the Recovery Advocacy Movement and the Recovery Orientation revolution for clinical services I personally witnessed spring up in the late 1990’s have now been shifted and repurposed by some into a: 

Among other things, I seem to notice the four ingredients of Addiction, Treatment, Sobriety/Abstinence, and Recovery are now thought of by some as producing a kind of Using Violation Effect – whereby those four ingredients are considered to add harms.  

In this new world view I consider some additional concepts and practices. I’ve listed some below. 

  1. Using for the sake of recovery 
  2. Abstinence for the sake of using 
  3. Recovery for the sake of using 
  4. Abstinence is relieved by using 
  5. Abstinence for the sake of recovery is relieved by using
  6. Recovery is relieved by using
  7. Recovery for the sake of recovery is relieved by using 
  8. Recurrence of abstinence is a prequel of using
  9. Recurrence of use is relieved by using.
  10. Recurrence of recovery is relieved by using. 

A background in ROSC and RM 

The reader might ask, “What were ROSC and RM?” 

These concepts and related practices were largely birthed and developed within the Behavioral Health Recovery Management (BHRM) Project. That project was begun and operated across a 10 year period within my previous workplace (Fayette Companies/Human Service Center). I served on the steering committee of the BHRM project for the entire ten years of its existence (roughly 1997-2007). The BHRM project was operated across all of our agency’s programs, and we became a living laboratory. As a result of this effort, various concepts and practices were innovated and developed within our agency during the BHRM project. “Recovery Coaching” is one example; for those that are interested, here’s our original Recovery Coaching manual.

And concerning Recovery Coaching itself you might have noticed it has seemingly been replaced by “Peer Support”. And in some current versions of Harm Reduction, one Peer Support method is the Peer Support worker using with the peer they are supporting while the peer is using. 

What concerns me most in all of this is that it seems a Recovery Orientation for clinical services (study recovery and have those lessons inform treatment) is being replaced by a using orientation. That is, rather than adding an orientation and having an expanded menu of options, recovery orientation seems like it’s in danger of becoming obsolete. 

For those that would like more about original…

…I can make a few reading recommendations. 

BHRM Statement of Principles This is a short read listing and describing the central BHRM concepts and practices.

Frontline Implementation of Recovery Management Principles This is a read of several pages. It’s an interview of our CEO who chaired our BHRM steering committee and includes the history and lessons learned inside our project.

Addiction Recovery Management: Theory, Research, and Practice. This is a book published by Springer. The two editors centered the book around Recovery Orientation, ROSC, and RM. The chapters are written by various authors from different backgrounds, settings, and service organizations.

Here are a few posts of my own that reflect my time in the BHRM project to a relatively greater degree than my other posts:

Planes, Car Repair Shops, and Dentists. This short read brings in lessons from outside the field.

Addiction and the Stages of Healing. This is a link to an entire series proposing a long-term research agenda and a unified model of thinking and clinical care.

The Four Pests: recovery, sobriety/abstinence, addiction illness, and treatment. Not a short read, but a relatively straightforward one noting some cautions from a project of the past outside of our field.

Recovery Orphans. Not a long read, but a challenging one. It consists of four separate short essays on the same topic. Each essay is a blend of philosophy and science. The essays become increasingly ambiguous and challenge the reader to reflect.

Study Betel Nut Before You Finalize Your Public Health or Harm Reduction Policy.

Peer Support, or Harm Reduction, or Recovery Coaching? This straightforward read presents a framework that blends these three practices within a Recovery Orientation perspective and a Recovery Oriented System of Care framework, while retaining Recovery Management purposes.

[This post will be updated with additional FAQ’s as they are developed]

The recently announced closure of the SMART Recovery OnLine platform (SROL) has caused some concern in the community, which is understandable. At the time that it was developed, SROL was a community ahead of its time, allowing individuals to come together with one another online as they worked to overcome problematic behaviors. It has served as an important source of support for many over the past decades.

The technology underlying the SROL platform is out of date and unsupported by vendors. Social media and interactive technologies have advanced while SROL has not. The world has moved on to hosted technology solutions that are maintained as a service for multiple organizations rather than costly homegrown software like SROL that is built and maintained for one organization. The decision to gradually close the platform in a controlled manner over the course of six weeks was determined to be a more responsible decision than allowing the platform to just fail at some point in the future.

The most important thing is that all SROL meetings have the opportunity to be be migrated to either National or Local online meetings in the SMARTfinder meeting management system, depending on the preferences of the meeting facilitators. That work is already underway with our Meetings and Volunteers Team. There are certain requirements for National meetings, including a requirement that the meetings stay focused on SMART Recovery rather than other topics. Best practices for National meetings have been refined over the last several months, and support will be provided to all facilitators to help them get their meetings transitioned effectively.

Those who use the message boards and chat in SROL are encouraged to explore other platforms to stay connected. Active SMART Recovery communities exist on Reddit, Facebook, and other platforms. Individuals could also choose to start their own communities with others they’ve become connected with through SROL. Please note that SMART Recovery cannot be responsible for what takes place in third-party spaces, but we do expect that they NOT be used in a way that impairs the confidentiality of any SMART Recovery meetings.

We understand that changes like this can be hard. However, it’s important to keep innovating as an organization so that we can continue meeting the needs of future generations of individuals looking to build balanced lives free of problematic behaviors.

The opposite of addiction is connection” – Johann Hari

Every addiction starts with pain and ends with pain” – Eckhart Tolle

Not why the addiction but why the pain.” – Gabor Maté

One more simple concept introduced on September 14, 1986, that oriented the thinking and framework of addiction policy in a different era:

Say yes to your life. And when it comes to drugs and alcohol just say no.” – Nancy Reagan

Easily recognizable and often referenced quotes that illuminate important facets of addiction in a simple way.  Pain is a huge driver of addiction. Not using drugs prevents addiction. Here is one more quote, this one about simple solutions:

For every complex problem, there’s a solution that is simple, neat, and wrong.” – H.L. Mencken

Of course, that fourth one by First Lady Nancy Reagan escalated the war on drugs in America to new heights (or lows) and in hindsight did a lot of damage. A war on drugs ends up being a war on families, mostly black and brown ones.

In respect to the quotes by Tolle, Hari and Maté, their work has greatly influenced our thinking. They illuminated important truths about addiction and pain. They helped us understand the relationship between trauma, pain and addiction in invaluable ways. Trauma and emotional pain are huge facets that influence substance use that for many people can lead to addiction. These things are true, but not the full truth.

But do we really think that trauma and pain underpin 100% of all substance misuse and addiction? I don’t. If you read their work, they do not see things in such simplistic term either. But generally, society does not like to consider multifaceted issues, preferring soundbite solutions. Hence, the quotes resonate with people who then act as if addressing the issues from this one perspective will solve everything.

In our current era, there is a great emphasis on trauma as that thing that people can focus on addressing as a panacea. Trauma is everywhere, nearly everything in the healing narrative is being relabeled or reconceptualized as trauma or trauma informed. 

Some Broad Questions I will not even attempt to answer:

If we could eliminate all suffering, we may well also eliminate all the growth that comes from experiencing hardships. Humans are wired to overcome challenge. We evolved to do so. Accomplishing hard things is deeply satisfying. We are built to be resilient. I am not suggesting ignoring trauma and pain. Efforts to improve the way we understand and address trauma are vital. There are social determinants of health we must focus on to improve the lives of all of our citizens, particularly members of our society who are exposed to corrosive levels of trauma that sap their wellbeing and vitality. But we are not going to end trauma and addiction anytime soon.

Seeing everything related to addiction as related to trauma is risky. A parallel I am thinking about is the pursuit of pleasure. The American dream, focusing on the good life. Materialism and maximizing experiences that make us feel happy. The best vacation, the nicest clothes, a cool car and an ideal home in the best community. The data shows there is a paradox in the pursuit of pleasure known as the Hedonic Paradox. Some evidence suggests that the more people value happiness, the less happy they are. Long term happiness is actually more strongly associated with pursuing things which are purposeful, which are often hard and may even include experiencing trauma and pain along the way. That is what makes this a paradox!

Ironically, we live in an era in which people feel like they have less purpose than ever. Bored people use drugs too. They also gamble more, use social media more and engage in buying more things. Stuff that gives us a burst of feel-good chemicals in ways that were not as available in any other age. Would it make more sense to focus on connecting people to things that they find meaning and purpose in their lives than it would be to attempt to eliminate all trauma? It may be a worth focus. It is important to note that purposeful people also experience addiction. I offer no simple solutions here, that is my point.

What do we lose when we frame complex conditions as being associated with one factor?  That is probably the thing that the Nancy Reagan quote above can reveal to us most effectively and also why it is important to understand addiction and recovery history when considering how we improve things moving forward. We can look back at the war on drugs and wonder what these people were thinking. They thought they could punish people to the point people would just say no to drugs. By the way, they really did think so, in part because they did not factor in what addiction does to executive function. But the concept of a war was one people understood, so a war we had!

One more quote, “If the only tool you have is a hammer, you tend to see every problem as a nail.” This is a famous quote by Abraham Maslow which refers to a concept commonly known as the “law of instrument” or Maslow’s Hammer. We see what we see because we know what we know. If one comes from the school that sees trauma as the central causative factor in addiction, you will invariably experience confirmation bias, just as other schools do.

While I am not suggesting that the current focus on trauma is equivalent to the war on drugs in potential harms, I do think that conceptualizing the complexities of drug use and addiction as only related to trauma and pain will miss the boat. Drug misuse and addiction also include genetic risk factors and probably also relate to societal trends.

We increasingly lack hope, purpose, and connection due to rapid changes that in our society that started with the age of industrialization, picked up in pace through the information age and may well get worse in a world driven by artificial intelligence. A world with less creativity and effort. A world in which we are redundant. One is which selling addictive substances to sooth pain and boredom is highly lucrative. One in which we may find ourselves in a petri dish primed for suffering and drug addiction.

If we want to latch on to a quote about substance misuse and addiction that would be more helpful, perhaps it is this one: 

If stopping substance misuse and addiction was easy, we would have done it already” – Author Unknown.

Copyright © 2024 Recovery Alliance Initiative
linkedin facebook pinterest youtube rss twitter instagram facebook-blank rss-blank linkedin-blank pinterest youtube twitter instagram