Good human relationships and social connections are potent protections against both physical and mental ill health. In an analysis[1] involving hundreds of thousands of people researchers looked to see to what extent social relationships influenced the risk of death. They found that those who had stronger relationships were 50% less likely to die early. Loneliness and social isolation have significant negative impacts. You want to live a long and healthy life? Get loads of friends.

In the same way, being connected to pro-recovery social networks improve outcomes in addiction treatment. For a variety of reasons, not least because of stigma, those suffering from substance use disorders are often relatively socially isolated. Guidelines consistently recommend connections to peer groups like mutual aid and LEROs, though this has historically not been a priority for some services. For recovery from alcohol use disorders, being part of mutual aid has an impact at least as great as evidenced psychological therapies like cognitive behavioural therapy.[2]

“The evidence suggests that 42 % of participants participating in AA would remain completely abstinent one year later, compared to 35% of participants receiving other treatments including CBT.”

Cochrane Review 2020

Researchers from Massachusetts[3] found in a trial of people with alcohol use disorder that the addition of just one person in recovery to their social network resulted in a 27% increased chance of remaining sober in the following year.

“Network support treatment can effect long-term adaptive changes in drinkers’ social networks and that these changes contribute to improved drinking outcomes in the long term.”

Mark Litt and Colleagues 2009

Recovery stigma

There’s little contention in these findings – they are pretty broadly accepted, yet they don’t seem necessarily to have regularly translated into practice, with odd beliefs persisting about mutual aid and a stigma attaching. I have heard some people in influential and powerful positions say some ill-informed and quite dismissive things about mutual aid and peer support, particularly where these interventions abut on treatment. One commentator recently identified recovery organisations as ‘the biggest risk to current drug users’, when the evidence is clear that connection to such groups mitigates risk. Divisive – right? Why should this be?

In the past it was convenient to say that there was no evidence that mutual aid and peer to peer support made any kind of impact but holding that line now would mean you were wilfully evidence-avoidant given the accumulating and emerging research on the topic. 

Perhaps the resistance is because some professionals feel their status is threatened when patients and clients become empowered outside of traditional hierarchical treatment settings. Fear of loss of power or influence can be a potent motivator. Perhaps too many of us go into the caring professions for the gain we get when we get to care for individuals – gain that evaporates when they no longer need us. Perhaps being asked to accept that mutual aid and peer to peer support have a significant role to play in helping people recover will reflect badly on our practice to date, which has been built on the premise that ‘professional knows best’. There may be genuine fears about risk that create reluctance. Perhaps being wedded solely to harm reduction rather than valuing a spectrum of approaches results in cynical views towards anything else not in that fold. Who knows? – perhaps it’s all these things or none of these things. Whatever is behind the resistance, it’s not helpful. However, it does get called out.

Lived experience and professionals

For instance, the author and broadcaster Darren McGarvey has some reflections about the issue in his book, The Social Distance Between Us[4], where in the chapter about addiction he refers to, ‘the complex array of class dynamics, institutional resentments and professional jealousies’ that are relevant, controversially suggesting that someone has ‘as much chance of getting well by following the simple suggestions of other addicts from lower class backgrounds as they do by placing themselves in the care of highly qualified middle class professionals.’ 

Most people do get better from addiction through natural recovery (‘maturing out’ in a variety of ways) and countless others get well in church halls and other meeting rooms via a variety of mutual aid groups, never having to come near treatment services. However, some whose problems seem intractable, complex or life-threatening need more intensive and structured help. I believe such people do best in a partnership where effective treatment is provided in an alliance between the person with the problem and professionals. I believe treatment is likely to be much more effective when underpinned by peer support and when assertive links are made to mutual aid. 

Shared decision making happens when there is a partnership between equals and the person’s goals are understood and prioritised. In more and more treatment settings these days, some of the professionals (like me) have lived experience too. Some of us even come from working class backgrounds! When we eliminate power asymmetries between professionals and service users – accepting that the patient and their family have lived expertise, offer meaningful choice (not only which medication to use), accept that the client’s goals may be different from the clinicians and discuss risks and how to mitigate them, we create a rich and fertile field for growth as well as reducing harms. 

Sadly, this is not everyone’s experience and there are obstacles and barriers to progress for some people which do come out of outmoded delivery models where the priorities of the service are not in sync with those of the service user and their family. Peer support can certainly help here:

Peer recovery support helps to remedy the inequality of power/authority, perceived invasiveness, role passivity, cost, inconvenience, and social stigma associated with professional help for severe alcohol or other drug problems

William White

Hope carriers

In those circumstances, the introduction of peer interventions and mutual aid is a no brainer – introducing hope, role modelling, practical support and vital connections to resources that will build recovery capital and insulate against returning to harmful substance use.

This is not easy. It can take time. John F Kelly, in his paper The Protective Wall of Human Community[5], points out: “It can take up to 8 years and around 4 to 5 treatment/mutual-help participation episodes before adults treated for alcohol or other drug use disorders achieve initially sustained remission.”

Even then, as Kelly says, it can take another roughly five years  of continuous remission before the risk of meeting the criteria for substance use disorder drops to the same level as in the general population. On the surface, this sounds daunting – such a long time – but actually it’s hopeful. Peer recovery workers can help individuals stick with the process and hold out hope over long periods of time.

Practitioners can have low expectations of what their clients can achieve because of the negatively reinforcing experience of seeing people destabilise or come to harm. Michael Gossop called this the treatment fallacy – essentially the belief that people don’t recover because professionals rarely see them recover. Recovered people often move out of services. In my service the place fills up on aftercare days with lots of people in longer term recovery. We get to see positive and enduring changes every week. That makes us hopeful in the same way that, for those of us in recovery, our own recoveries make us hopeful and we transmit that hope to patients.

Sharon Reif and colleagues[6] found, in a 2012 review of peer support impact, that studies ‘demonstrated reduced relapse rates, increased treatment retention, improved relationships with treatment providers and social supports, and increased overall satisfaction with the treatment experience.’ When services have recovering people working in them, then hope becomes integrated and expectations rise. When the practitioner has high expectations, better outcomes ensue and the experience of being in treatment is better. In our service retention in treatment for patients (completion rates) increased significantly in the year following the introduction of a managed peer support programme.

Bridging to better outcomes

In our service, we are about to introduce a Peer Bridging Programme, funded by the local Alcohol and Drug Partnerships and the Scottish Government. One of the drivers for the programme, which aims to improve access, retention and outcomes is the fact that referral rates to rehab can vary significantly between individuals in the same team, between teams and services and geographically.

We want to open the doors as widely as we can and even out those access inconsistencies, but also be as integrated as we can to other services, recognising that recovery journeys are not linear and risks are best managed in integrated systems of care where harm reduction informs all we do, but is not the sum of all we do, particularly where that system includes both peer recovery support and strong and effective links to mutual aid.

We’ll do that by employing people who are experts by experience to act as bridges for patients with substance use disorder to help with journeys into and out of treatment – facilitators for recovery, catalysts for hope and part of a recovery-oriented system of care.

As I say, evidence is accumulating for the value of peer recovery support. One study[7] found that patients who received support from a recovery support navigator were 23% more likely than patients in the services as usual condition to attend treatment within the first 2 weeks post-detox. Engagement and retention in treatment are associated with better outcomes.

We want to know if our Peer Bridging Project will make a difference – to patients, to services and to the peer workers, so we plan to evaluate this and will report our findings. I hope that the evidence we find will help to both support the argument for more lived experience in treatment settings, but also counter those whose voices are raised against such things.

Twitter: DocDavidM
Mastodon: DocDavidM

[1] Holt-Lunstad J, Smith TB, Layton JB. Social relationships and mortality risk: a meta-analytic review. PLoS Med. 2010 Jul 27;7(7):e1000316. doi: 10.1371/journal.pmed.1000316. PMID: 20668659; PMCID: PMC2910600.

[2] Kelly JF, Humphreys K, Ferri M. Alcoholics Anonymous and other 12-step programs for alcohol use disorder. Cochrane Database Syst Rev. 2020 Mar 11;3(3):CD012880. doi: 10.1002/14651858.CD012880.pub2. PMID: 32159228; PMCID: PMC7065341.

[3] Litt MD, Kadden RM, Kabela-Cormier E, Petry NM. Changing network support for drinking: network support project 2-year follow-up. J Consult Clin Psychol. 2009 Apr;77(2):229-42. doi: 10.1037/a0015252. PMID: 19309183; PMCID: PMC2661035.

[4] McGarvey, D, The Social Distance Between Us, Penguin, London, 2022

[5]  Kelly JF. The Protective Wall of Human Community: The New Evidence on the Clinical and Public Health Utility of Twelve-Step Mutual-Help Organizations and Related Treatments. Psychiatr Clin North Am. 2022 Sep;45(3):557-575. doi: 10.1016/j.psc.2022.05.007. Epub 2022 Aug 1. PMID: 36055739.

[6] Reif, S., Braude, L., Lyman, D. R., et al. (2014). Peer recovery support for individuals with substance use disorders: Assessing the evidence. Psychiatric Services (Washington, D.C.), 65(7), 853-861. 

[7] Lee, M. T., Torres, M., Brolin, M., Merrick, E. L., Ritter, G. A., Panas, L., Horgan, C. M., Lane, N., Hopwood, J. C., De Marco, N., & Gewirtz, A. (2020). Impact of recovery support navigators on continuity of care after detoxification. Journal of substance abuse treatment, 112, 10–16. doi: 10.1016/j.jsat.2020.01.019 

On World AIDS Day, December 1, we remember those lost to the HIV epidemic, take stock of how far we have come, and map the way forward. In the past decades, scientific and community leadership have achieved great things in helping people with HIV live long, healthy lives, as well as reducing HIV transmission through prevention. Yet as the United States grapples with the dual epidemics of HIV and drug overdose, people who use drugs continue to be left behind—especially sexual and gender minorities who are disproportionately impacted by HIV.

But even with multiple forms of HIV prevention now available, including pre-exposure prophylaxis (PrEP) pills for people who are HIV-negative and antiretroviral therapy that can help people with HIV maintain an undetectable viral load and thus not transmit the virus, HIV transmission rates remain frustratingly elevated. Increased methamphetamine use over the past decade may play an overlooked role. A 2020 study in the Journal of Acquired Immune Deficiency Syndromes (JAIDS) showed that a third of new HIV transmissions among sexual and gender minorities who have sex with men were in people who regularly use methamphetamine.

Methamphetamine use is more prevalent among gay and bisexual men than among other men, and it often accompanies sex (sometimes called “partying and playing” or “chemsex”). While in previous decades the mixing of methamphetamine and sex was mainly associated with White gay men, Black and Hispanic men who have sex with men are increasingly using methamphetamine too.

The disinhibiting effects of methamphetamine can increase certain sexual behaviors that make transmission of HIV more likely. There is also evidence that methamphetamine may make the body more vulnerable to HIV acquisition and contribute to HIV disease progression. Methamphetamine use can also lead to other serious health concerns, including addiction and fatal overdose.

In a new NIDA video, “Sex, Meth and HIV,” we highlight that to end the HIV epidemic with the effective tools at our disposal requires that we first recognize and respect the complexity and needs of sexual and gender minorities who use drugs. Like other drugs, methamphetamine may help individuals cope with mental health challenges like depression, anxiety, and trauma. Some gay and bisexual men use methamphetamine to enhance sexual experience and sense of connectedness. It can also temporarily boost self-confidence among individuals who may experience stigma and shame surrounding sexuality or other aspects of their lives.

For clinicians working to educate patients about health at the intersection of HIV and drug use, understanding the role that methamphetamine plays in an individual’s life is critical to providing quality care.

As Sarit Golub, a City University of New York (CUNY) Hunter College psychologist researching HIV and stigma, says in a companion video for clinicians, “Trust, Stigma and Patient Care,” telling gay and bisexual men about risks of combining drugs and sex can come across as instilling fear and shame, and may alienate rather than empower. As Dr. Golub notes, such communication can disregard the totality of an individual’s needs—for connection, for pleasure, and for confidence in a world that judges and shames.

Even in healthcare settings, people commonly experience stigma around drug use and sexuality, as well as racism and other forms of discrimination. A history of encountering stigma and discrimination in these settings often leads people to avoid disclosing their substance use and sexual practices with their providers. Clinicians must work with patients to rebuild that lost trust by listening to patients’ concerns rather than imposing their own.

“Meeting people where they are”—that is, providing care regardless of substance use or other behaviors that confer some health risk—has become the guiding philosophy of harm reduction. But it should also apply to prevention and treatment of both HIV and substance use disorders. We cannot hope to reach communities with effective prevention measures such as PrEP without recognizing and accepting the totality of people’s experiences, wants, and needs. Listening and acceptance from others help people take control of their own health. Equally important is to ensure that access and coverage for HIV prevention and treatment are accessible to all who can benefit from them. 

Research to find better ways to reach people who use drugs with HIV prevention tools like PrEP, as well as to guide policymakers and insurance providers in ensuring the coverage of these tools, is a key focus area in NIDA’s 2022-2026 Strategic Plan. Expanding education regarding drugs and HIV, reducing stigma, and overcoming other barriers to care are also crucial. Carrico and CUNY School of Public Health researcher Christian Grov (lead author of the JAIDS study) are currently conducting NIDA-funded research on strategies to increase the use of PrEP among sexual minority men who use stimulants, including use of telehealth and incentives (contingency management) to facilitate adherence.

The new videos are the latest in NIDA’s series, “At the Intersection: Stories of Research, Compassion, and HIV Services for People Who Use Drugs.”

As NIH honors World AIDS Day, we particularly remember the people lost to the dual epidemics of HIV and overdose. For those grieving loved ones, NIDA stands among you. Through scientific advancement, NIDA is committed to saving lives. Recovery and healthy, long lives are possible through the use of evidence-based treatments alongside social support.

Dr. Stanton Peele is a lawyer, professor, psychologist, psychotherapist, and author. Of all of these titles, he’s probably best known as an advocate and pioneer in the addiction and treatment world. His new memoir, A Scientific Life on the Edge: My Lonely Quest to Change How We See Addiction, is his 16th book that tackles addiction issues.  

In this podcast, Stanton talks about:

Additional resources:

Click here to find all of SMART Recovery’s podcasts

PLEASE NOTE BEFORE YOU COMMENT:

SMART Recovery welcomes comments on our blog posts—we enjoy hearing from you! In the interest of maintaining a respectful and safe community atmosphere, we ask that you adhere to the following guidelines when making or responding to others’ comments, regardless of your point of view. Thank you.

If you are interested in addiction recovery support, we encourage you to visit the SMART Recovery website.

IMPORTANT NOTE:

If you or someone you love is in great distress and considering self-harm, please call 911 for immediate help, or reach out to 988 Suicide & Crisis Lifeline @ 988, https://988lifeline.org/

We look forward to you joining the conversation!

*SMART Recovery reserves the right to not publish comments we consider outside our guidelines.*

Chances are, unless you are currently taking it, the medication Spironolactone’s uses are a mystery. In fact, it is used to address heart problems and high blood pressure. But a recent study published in Molecular Psychiatry suggests another use: treating alcohol use disorder (AUD). For the 14.5 million people ages 12 and older who, according to the 2019 National Survey on Drug Use and Health (NSDUH), had AUD, this might be very good news.

The recent study identifying Spironolactone, by researchers at the National Institutes of Health and their colleagues at the Yale School of Medicine, involved mice, rats, and humans. The evidence is said to be significant because it converged across three species and involved different kinds of studies.

At SMART Recovery (SMART), the use of medication for treating AUD is seen as a valid way to seek, as we say, Life Beyond Addiction. It fits right in with our science-based approach, where the latest addiction research keeps us evolving into an even stronger pathway for recovery.

The use of doctor-prescribed medication is called Medication Assisted Treatment, or MAT. There is also a growing trend to call it Medication Assisted Recovery, (MAR), since that is the positive and desirable state for those who seek to address their AUD.

SMART is all for combining different practical approaches to recovery: our mutual support group meetings, tools based on Cognitive Behavioral Therapy (CBT) principles and practices, personal reflection, and MAT.

It’s not that Spironolactone is the first medication identified as a potential help. There are currently three medications approved to treat AUD: Naltrexone, Acamprosate, and Disulfiram.

In simple terms, Naltrexone blocks the brain receptors related to craving alcohol; Acamprosate lessens negative symptoms of prolonged abstinence; Disulfiram causes unpleasant conditions like nausea and flushing of the skin after someone drinks.

What Spironolactone does is work to block mineralocorticoid receptors, which, in higher concentrations, seem to play a part in increased alcohol consumption. Blocking them decreases the “signaling” action of the receptors, lowering their impact.

Since SMART participants are in charge of their own recovery, i.e., self-empowered, choosing to use any of these medications is not frowned upon. Just like SMART doesn’t use labels such as addict or alcoholic, there is no reason for judging or, worse, ostracizing, individuals who are availing themselves of this science-based approach. 

This is also the view of a powerful voice in the recovery community, Dr. Nora Volkow, director of the National Institute on Drug Abuse, “Just like for any other medical condition, people with substance use disorders deserve to have a range of treatment options. In addition, we must address the stigma and other barriers that prevent many people with alcohol use disorder from accessing [treatment].”

With ongoing research into medications like Spironolactone, there is the hope that more people will get treatment. SMART stands ready to help.

PLEASE NOTE BEFORE YOU COMMENT:

SMART Recovery welcomes comments on our blog posts—we enjoy hearing from you! In the interest of maintaining a respectful and safe community atmosphere, we ask that you adhere to the following guidelines when making or responding to others’ comments, regardless of your point of view. Thank you.

If you are interested in addiction recovery support, we encourage you to visit the SMART Recovery website.

IMPORTANT NOTE:

If you or someone you love is in great distress and considering self-harm, please call 911 for immediate help, or reach out to 988 Suicide & Crisis Lifeline @ 988, https://988lifeline.org/

We look forward to you joining the conversation!

*SMART Recovery reserves the right to not publish comments we consider outside our guidelines.*

The major topic of this essay is “hermeneutics” as it applies to addiction counseling.

Definition and aim

What is “hermeneutics”?

“Hermeneutics” can be defined as “the science of interpretation”.   It’s the knowledge about and methods for the task of interpreting. 

Interpretive methods differ across different fields of thought.  Different hermeneutical methods are used to understand various areas of reality, human interest, and life.

As a body of knowledge and as a skill, hermeneutics has specific aims.

Another central aim of hermeneutics is “transparency of apprehension”.   This is contrasted with an opaque kind of apprehending.  When transparent apprehending is happening, you see or hear the thing being represented, rather than the thing doing the representing.  For example, the expert pianist playing Mozart conveys the composer, while the struggling student conveys Mozart plus sounds that are sourced in self. 

World view from the field of hermeneutics

Hermeneutics has a specific way of defining “science”.  It defines “science” as any organized body of knowledge – from physics to theology, and literary criticism.  It does not define science in the more limited sense of merely “natural sciences” such as chemistry and biology.

Hermeneutics seeks to understand methods of interpreting.  For example, we obtain knowledge from science through rather rigidly formulaic methods of interpreting, while we gain truth from art through non-formulaic methods of interpreting.  And as a discipline, hermeneutics puts forward the idea that people gain their most important truths from non-formulaic sources of interpreting. 

People understand the world on its terms.  And they also create their own understanding of their own life on their own terms.  Those are different hermeneutics – different ways of understanding.  For each of us this is complex and life-long.

unsplash.com/photos/1kslaBtXBk8

Further, hermeneutics separates the nomothetic from the ideographic. 

Hermeneutics also understands any human activity as a linguistic gesture and gives us a way of interpreting those gestures.  It views the broader social culture as serving the purpose of collectively progressing away from our individual and permanent alienation.  It does not view our broader social culture as collectively progressing toward an ultimate and positive endpoint. 

An example of applying this aspect of the world view of hermeneutics to our work as addiction counselors is in attempting to understand the person’s personal path of improvement. 

  1. For some, recovery might serve as a project of extrication from the culture of addiction, shedding its trappings and language, and simply forming a new way of understanding.
  2. For some, the use of recovery language, narrative, and culture might only be temporary and serve the goal of moving back into the larger culture of contemporary society and accommodating it.   
  3. For some, the goal might be a return to what one was alienated from, and not include a movement toward an unprecedented and imaginary future.
  4. And some of those we serve might “change teams” as a means of rejoining the larger cultural team. Such a switch would then leave open the question (along with its related anxiety) of whether this change of teams is or should be temporary or permanent and pertain to matters of personal identity or not.   

With that basic background in hermeneutics being established, how does the discipline of hermeneutics understand the work of interpreting?  We will look at interpreting at the level of the little picture, the big picture, and some applications to addiction counseling.

Interpreting at the little-picture level

Each body of knowledge has its own methods of interpreting – its own hermeneutic method.  Different hermeneutic methods are particular to their respective knowledge area or discipline. 

Interpreting at the big-picture level

There is another difficult challenge in the work of interpreting. 

Imagine simultaneously holding different kinds of information that come from very different kinds of sources, and whose disciplines each have very different interpretive methods.  And imagine attempting to blend or assemble all that information into a coherent whole. 

That would require interpreting at the meta-level and would not merely be about deciding which kind of interpretive method wins out over the others.  Rather, it would be like drawing a circle around all that information, each with its own interpretive method, and using a different way to interpret all of it together.  The work of addiction counseling relies on this level of interpretive methodology rather routinely. 

Hermeneutics and addiction counseling

In addiction counseling we encounter information from various sources:  academic, clinical, research, experiential, etc.  And some may also be culturally indigenous, socially bound, and outside our clinical system of understanding and doing. 

How are we doing at switching our interpretive (hermeneutical) methods as we encounter differing types of information?  How are we doing in flexibly using different interpretive methods as we move from the kind of information that requires more strictly objective interpretive methods, to a somewhat less rigidly objective method, and then the kind of interpretative method that is “squishy but still has a form”? And how are we doing at encompassing and interpreting the whole?   

Patients, like us, are people.  We can understand them using these same principles from their own interior position outward.  We can also seek to improve our understanding of them each day through our gaining of a wider access to various frameworks of interpretation across clinical disciplines, domains of life, and culture. 

The addiction counselor is often challenged to grasp the essential discipline-specific information from primary health, nursing, psychiatry, clinical psychology, spiritual care, and mental health counseling as well as culturally bound information from the family system, faith community, recovery community, etc.  And to these, the addiction counselor adds the information and understanding specific to and directly from the discipline of addiction counseling and then builds a case conceptualization. 

Interestingly, the patient is usually working on the same project of building an understanding, at the same time, on their own behalf.  And as the patient moves through time, the addiction counselor helps the patient work on this project of their own as a continuous process.  The addiction counselor helps the patient build a way of understanding over time that holds across person-centered domains (strengths, illness, recovery, illness self-management, recovery management, etc.).  I will point out that many times, helping the patient with this very matter is so natural for the addiction counselor that they might be doing it without precisely realizing it.  (But if we do precisely realize it, we may be able to precisely improve it).

People discover and understand the world on its terms and create their understanding of their life on their own terms. 

With that basic relevance of hermeneutics to addiction counseling in mind, and a partial sense of the improved clarity it can help us gain, what are some dos and don’ts we can consider? 

Hermeneutical methods for understanding people

Do’s:

Don’ts:

Over our clinical careers, addiction counselors should strive to improve their methods of understanding.  With the above dos and don’ts in mind, what are some ways we can go about improving our interpretive methods through a hermeneutic lens?

Getting better at interpreting

Early in our career we rely on others (academic educators, textbooks, articles, and clinical trainers) to provide the results of various kinds of interpretive work for us.  And we also begin to build our methods of interpreting. 

Later in our career we find the world changes around us and around our initial methods of understanding.  Thus, we must incorporate new information and new understandings.  And this includes re-interpretation of our previously gained information and previous understanding over time. 

This is a process not unlike a career-long continuous quality improvement project related to interpretation itself, wherein we keep revising and updating our interpretive methods, and gaining new ones as well. 

From the earliest part of our career, going forward, we can choose to expand or limit the scope of our own development.  And we can choose to improve or limit our understanding of our patients.   

We can: 

Our interior as addiction counselors and clinical supervisors

We do not know and understand and treat the individual patient merely by knowing the science of our profession.  The clinician does not treat the average, hypothetical patient.  The clinician treats the individual person that is actually present.  Put differently, ”Statistics describe everyone and apply to no one”.

Hermeneutics can help us gain awareness of more than just the objective viewed from an external position. Ideas and the representation of ideas are contained in symbol systems.  We find symbol systems in language, science, art, philosophy, and culture.  Hermeneutics applied to addiction counseling would outline a shift in methods of interpreting from:

Further, as a field and as individual clinicians we must find a way to have a shared understanding across disciplines and sectors – various kinds of clinical programming.  We probably assume we do when we in fact don’t. 

The counselor or the treatment program might be one in form, but is it one in interpretation?  And on that basis is it delivering what it should? 

To help us and our systems improve, upstream influences with sufficient competency, lack of countertransference hindrances, and high-information/high-quality supervisory lineage are relevant starting points.  Downstream, in our routine clinical work, do we hear the patient, apprehend transparently, and also interpret without adding our compositional items to the person’s life?

We are all impacted by our cultural traditions.  We should be suspicious, and retain the suspicion, that those traditions may be impacting us.  Language has historically conditioned us and distorts our interpretations. 

We must learn to live inside the constant process and circular operation of forming an expectation, having it thwarted, reforming our interpretation, having that thwarted, and so on.  And to improve our interpretations over time as a result.  

A concluding comment

After my graduate internship, I spent my first 19 years working in a 9-12 month residential therapeutic community addiction treatment program that shared its staff and physical plant with an outpatient methadone maintenance program.  I can assure you that those two types of programs are built on very different ways of understanding.  And because the staff worked across both programs, we all developed the interesting advantage of a 3rd perspective that was outside the circle that could be drawn around those two clinical units. 

For me, growing up simultaneously in those two ways of thinking, and that third way of thinking, has served me over the long haul as a relatively helpful starting point. But a starting point is just a starting point. 

When we addiction counselors seek to learn and understand and honor diverse kinds of clinical programs and recovery pathways, expanding our awareness in an on-going way over the years of our career, we grow in our practical usefulness and our patients are better off. The reasons might be many, but it strikes me that at least part of the reason is found in the aim of hermeneutics as a project: “effective historical consciousness” that produces what is called “common sense”.

Reference

Sugrue, M.  “Gadamer:  Hermeneutics and the Human Sciences.” Lecture given at Princeton University.

Suggested Readings

Gadamer, H-G.  (1960/2013).  Truth and Method.  Bloomsbury Academic.   

Garman, N. B.  (1990).  Theories embedded in the events of clinical supervision: A hermeneutic approach.  Journal of curriculum and supervision, 5(3): 201-213.

Pickering, J.  (1999).  The self is a semiotic process. Journal of consciousness studies, 6(4): 31-45.

Rendon, M.  (1999) Interpretation in the Context of Supervision. International forum of psychoanalysis, 8:3-4: 234-242. DOI: 10.1080/080370699300056275

Rubianes, M., Muñoz, F., Casado, P., Hernández-Gutiérrez, D., Jiménez-Ortega, L., Fondevila, S., Sánchez, J., Martínez-de-Quel, O., & Martín-Loeches, M. (2021). Am I the same person across my life span? An event-related brain potentials study of the temporal perspective in self-identity. Psychophysiology, 58(1), e13692. https://doi.org/10.1111/psyp.13692

Tulleners, T., Taylor, M., & Campbell, C. (2022). Peer group clinical supervision for community health nurses: Perspectives from an interpretive hermeneutic study. Journal of nursing management, 30(3): 684- 693. https://doi.org/10.1111/jonm.13535

Recovery from addiction has two significant facets. For centuries, it is centered on a dynamic that is relatively unique in respect to medical conditions. The power of one person, as part of their own journey of healing helping another to also find their way into recovery. This dynamic has then been repeated over the eons as more people find recovery and then they help others. Recovery communities are thus formed. There have been multiple iterations of this dynamic in America, stretching back before the Washingtonian Movement of the 1840s to Native American peoples, who help form America’s first sobriety-based, mutual aid societies. The second facet it that it is a profoundly stigmatized condition.

Over the years, we have grown to understand how a systemic recovery orientation through an emphasis on mutual support has profound value. This article on studies done a decade ago Case Western Reserve University by Dr Maria Pagano discusses her research to understand service in our community. “When humans help others regardless of a shared condition, they appear to live longer and happier lives. The benefits of helping are significant because the costs of alcoholism and drug addiction to society are so great, in light of recent health care reform, resources which can reduce these costs and suffering are crucial.” She notes that helping others can increase the chances of staying sober by up to 50%. “We’re doing a disservice to patients if we don’t encourage their involvement in service when we know that service is linked to good things (underline added).”  

U.S. Surgeon General Dr. Vivek H. Murthy, in this 2017 interview with the Center for Strategic & International Studies spoke about the need for reducing isolation and supporting purpose as a way to combat addiction and other diseases in America. He noted: “When people ask themselves a question, how can I contribute to help in America? How can in enhance emotional wellbeing in America? Keep in mind, you don’t need a medical degree or a nursing degree to do that. Your ability to help foster and build social connection with the people around you can be one of the most powerful tools that’s used to actually enhance their wellbeing and ultimately their health. And that’s – and that’s important, because if we’re really going to create a more cohesive, connected America, we need to do it with the participation of each and every person. We need to do it with people in communities recognizing that they have the power to heal based on their power to connect, that the outreach that you make to another – whether it’s a stranger or whether it’s somebody you know well – that that is a medicine in and of itself. (Underline added)”

So why, with all of the funding resources that have flowed down from the federal government through the states has there been a paucity of resources that have actually been used to build recovery communities and resiliency efforts to support our recovery communities across America?

I found a series of research articles under the heading of The Ecology of Addiction, Recovery, & Community Recovery in Bill White’s Addiction Recovery: A Selected Bibliography of Professional Publications and Scientific Studies which is a handy tool to find information about addiction recovery research. Including this one, by Dr David Best, Karen Bird, and Lucy Hunton published through Sheffield University in 2015. Recovery as a social phenomenon: what is the role of the community in supporting and enabling recovery? Best Et Al notes that recovery community “is socially constructed in the sense that recovery relies on changes in social identity that are driven by supportive peers and social networks that offer opportunities for social learning and the constraining influences of social control. But these social constructions rest on the availability and accessibility of social networks and role models, who can provide the direction and support that will enable social identity change. This availability will be inversely associated with cultural stigmatization of discrimination towards those in recovery (Underline added).”

Looking down on recovery communities by social and cultural leaders is and age-old phenomenon. On Page 44, of the book A Biography of Mrs. Marty Mann highlights movement division, which may well be a function of what cultural gaslighting by an empowered group on a disempowered community to retain control can look like:

“The Washingtonian Movement swept through America Like wildfire for five years in the 1840s, then abruptly vanished. In large part, the demise was due to a loss of focus on reclaiming the individual alcoholic. The Washingtonians became involved in all kinds of politics, exhibitionism about their recovery, competition with other organizations, and fruitless controversy. Also, the movement offended the social and cultural leaders of the day because it attracted common people, many of the uneducated (underline added).”

I hear this theme often as an undercurrent in respect to addiction recovery community in policy circles in our era too. I have heard policymakers express surprise that our community has life experience beyond addiction. We are also doctors, lawyers, architects, engineers, and artists, not just people lying in the gutter our whole lives like the derogatory stereotype we all know of depicts us. Our systems are biased to see us as immoral and uneducated, even as in addition to our other formal education, we have learned more than most will ever know about the culture of addiction and recovery. No group knows more about how to access and build recovery in our own communities than we do. When there is an acknowledgement of our value, we end up overburdened in regulation and stifling oversight. Vestiges of moral stigma. We cannot be trusted to the same degree as other people. Barriers subtly erected as we are “those people” who did this to themselves. Unworthy of help. I have heard concern for the empowerment of recovery community to be part of our own healing as “turning the asylum over to the inmates.” Clear discrimination.

Why is it so hard to see our value over the long arc of history and into our current times? It can be humbling at best to spend years in school learning about therapy to find out that one of the best interventions you can do is to connect people to others with similar experiences so they can help each other. It is even more difficult as we consider that the majority of our society sees us as less than human. Beings that they do not want to live next to, work with, our assist in any way. Under that lense, it takes an even more profound significance. The unblemished truth is that most Americans do look down on us. The collaborative report that my organization, PRO-A did with RIWI and Elevyst – HOW BAD IS IT, REALLY? Stigma Against Drug Use and Recovery in the United States we distributed in April 2022 explored perceived stigma and found that 71% of Americans believed that society at large considers individuals who use drugs problematically to be outcasts or non-community members. A recent study with a focus on stigma in medical professionals with over 33K respondents from across the US that we are preparing to publish includes similar rates of endorsed stigma.

It is fundamentally true that people and communities alike experiencing difficulties should be active partners in their own healing. A significant body of research shows that when communities experience challenges and are engaged in ways that pull them together, they often experience revitalization and post traumatic growth. We do not apply these lessons to addiction recovery at the community level. This is a direct result of stigma and bias against us.

What should systems consider when engaging recovery communities in being active agents in healing communities:

Make no mistake, we have made significant, positive change in America by sharing our recovery stories. Yet, how much further progress can we make without having very uncomfortable conversations about how stigma against us is so pervasive across America and within the very institutions that decide to fund and support most everything else but communities of recovery?

Millions of families impacted by addiction and especially you and I in recovery have benefitted from what those who came before us did for us. The lesson of the New Recovery Advocacy Movement is that we must come together to do so, despite internal & external forces that threaten to pull us apart. The recovery movement is a fight for freedom from discrimination and to be seen as worthy people, which is what we are.   We are not “those people” we are your people. Your family members, your neighbors, your coworkers, and your community members. We are part of your community, not outcast to be branded and culled from the herd. Treating us as such hurts all of us, including you. It is time for change, but the locus of the change that needs to occur resides with our systems, not just the people and communities impacted by addiction.

The effect on family members of Veterans and First Responders (VFRs) who are suffering from substance use or mental health disorders can be severe.

Military households face the anxiety and strain of having loved ones deployed or assigned. When the individual returns, additional stress within the family can occur as a result of trauma generated by that individual’s service, which may have led to unhealthy habits and disorders. The family dynamic changes and conflict can occur.

Similarly, First Responders face tremendous amounts of stress due to their professional responsibilities. This can make it difficult to balance work experiences with everyday life and negatively impact relationships with their family, partners, and friends. 

Further, these family members and concerned loved ones themselves may also be suffering from acute or post-traumatic stress disorder and social/emotional detachment issues. Unhealthy coping behaviors and a lack of healthy support can set off a downward spiral for all involved. 

As a result of all this, the SMART Veterans and First Responder Community wants to provide direct help to families and concerned loved ones. We are offering a chance for their voices to be heard, so that the process of learning to manage their own self-care and develop new ways to effectively interact with their loved one can begin.

On Saturday November 19th, from 4:00 – 6:00 pm ET, we will be holding a special SMART Family & Friends of Veterans & First Responders support group meeting. Registration for this meeting will be free and open to family members and concerned loved ones of those within the VFR Community who are suffering with substance use or mental health disorders.

Please join us to begin the process of support, understanding and cooperative change!

Registration is open until November 17th at 11:59 p.m. ET

PLEASE NOTE BEFORE YOU COMMENT:

SMART Recovery welcomes comments on our blog posts—we enjoy hearing from you! In the interest of maintaining a respectful and safe community atmosphere, we ask that you adhere to the following guidelines when making or responding to others’ comments, regardless of your point of view. Thank you.

If you are interested in addiction recovery support, we encourage you to visit the SMART Recovery website.

IMPORTANT NOTE:

If you or someone you love is in great distress and considering self-harm, please call 911 for immediate help, or reach out to 988 Suicide & Crisis Lifeline @ 988, https://988lifeline.org/

We look forward to you joining the conversation!

*SMART Recovery reserves the right to not publish comments we consider outside our guidelines.*

 

celebration, holidays and people concept – happy family having tea party at home

In recent years, connecting and spending quality time with those we love has been increasingly difficult due to the COVID-19 pandemic. Thankfully, though, we have adapted and found ways to work alongside the pandemic so that we can remain supported and connected to our recovery networks while we are in early recovery. In 2022, we can finally look forward to a holiday season full of love, laughter, support, and the connection we crave.

Being able to get together again sounds great in theory, but for some people in early recovery, it can set off a panic alarm. What if I’m offered a drink at a party? What will people think when I say no? Will I have to explain my situation to strangers? How comfortable will I be? Know that if you find yourself facing these questions, you are not alone. The holidays can be as stressful as they are joyful. However, with a little confidence, perseverance, and checking in with your support network, you can handle any holiday get-together like a pro. Below are a few common concerns and ideas to help get you out of your head.

First, make sure you are surrounded by people you know and trust. People who understand your situation and support your decisions should be the only kind of people you are spending your time with. Make a plan before the event to make sure you do not find yourself in this situation. For example, notify the wait staff or party host that you’d prefer sparking water instead of alcohol.

 

If you are in an environment surrounded by supportive friends and family, make this request known beforehand. You cannot fully control the decisions of others, but you can create an environment where your request is more likely to be understood and followed. For example, don’t focus on finding big parties hosted by other people. Have your own sober get-together at your own house and keep it lowkey, inviting only those you know, love, and trust. Your house, your rules.

 

Sadly, these feelings are unavoidable – especially if it is holiday time and you are new in your recovery. Remember to connect with your recovery support network in times of struggle, boredom, or craving. Do not feel afraid to leave a party early if you must. FaceTime, text, Zoom, anything to get you talking to someone who knows what you’re going through and can offer words of support and encouragement. Utilize the connections you spent time building in treatment and during early recovery – since it is holiday time, chances are, others in your network are also struggling. In these instances, a conversation can be mutually beneficial.

 

It may seem hard to believe, but there are people in your corner who want you to be safe and comfortable this holiday season – even if that means they’ll be skipping a drink or two when they see you! Don’t lose sight of those connections during the holiday season and keep your support network close. The holidays are all about togetherness, which goes hand in hand with the philosophy of recovery. Take this stressful time and turn it into a positive experience – you already have all the tools you need. From Fellowship Hall, have a very happy, sober holiday!

 

***

For more information, resources, and encouragement, “like” the Fellowship Hall Facebook page and follow us on Instagram at @FellowshipHallNC.

About Fellowship Hall

For 50 years, Fellowship Hall has been saving lives. We are a 99-bed, private, not-for-profit alcohol and drug treatment center located on 120 tranquil acres in Greensboro, N.C. We provide treatment and evidence-based programs built upon the Twelve-Step model of recovery. We have been accredited by The Joint Commission since 1974 as a specialty hospital and are a member of the National Association of Addiction Treatment Providers. We are committed to providing exceptional, compassionate care to every individual we serve.

 

The post Holiday Hang-ups: Avoiding Common Triggers appeared first on Fellowship Hall.

Guest blog by AnnabelleW, SMART Recovery Online Facilitator

The word “gaslighting” frequently creeps into Family & Friends meetings.  A participant might share that their Loved One says “I didn’t say that I was going to go to a SMART meeting,” or “Of course I haven’t slipped back into my old addictive ways,” or “You got the time wrong, again.” All of which serves to make the participant doubt their perceptions and maybe even their sanity – classic gaslighting (reminiscent of the wonderful 1944 movie Gaslight).

So, what can we do, as Family & Friends (F&F), when our Loved One (LO) seems to want us to second-guess ourselves and our judgment?  We can, of course, turn to what we learn in F&F meetings and the Handbook:

Safety and Support (F&F Handbook, Section 8)

We can make sure that our support network is strong.  We might confide in a therapist or a close friend, and we could attend a F&F meeting.  We can, in these ways, find people who help to reassure us that we are still lucid and clear headed.  People who gaslight us thrive on our doubts – our support plans can help us to be strong in the face of criticism and manipulation. 

Self-Care (Section 2)

Self-care might include deep breathing, taking a walk outside, meditation or even cooking a good meal – whatever helps to distance us for a while from our anxiety about our LO.   By working on our self-care, we can build up some physical and mental defenses, we will be less vulnerable, and we might become more independent and better able to act if our LO is trying to control us.

ABC Tool (Sections 4 & 5)

If our LO is gaslighting us, we might sometimes think: “I am dumb. I always get things wrong. I am going crazy.”

The ABC Tool helps us to question our thoughts and beliefs, so that we can ask ourselves: “Am I dumb, or am I an intelligent, rational person? Do I always get things wrong, or do I often get things right? Is my sanity really in question?”

Using the ABC Tool, we can then move on to more helpful beliefs: “I sometimes make mistakes, but most of the time my perceptions are correct and reliable. I am a level-headed human being, with good judgment.  I can attend F&F meetings/talk to a therapist/talk to a friend and I can work on the F&F tools to deal with this situation.”

The ABC Tool can help us to be more confident in our ability to read situations, and we might, finally, be able to stop walking on eggshells.

Positive Communication (Section 6)

Grammie, one of the original SMART F&F online facilitators, suggests that we might consider gaslighting to be an extreme form of lying, and she points to a useful blog on the Center for Motivation and Change website: https://motivationandchange.com/how-to-talk-when-you-think-theyre-lying/

In this blog, Dr. Josh King examines why our LOs lie – because of guilt and shame, and because they want to try to keep the relationship running smoothly.  He goes on to suggest that if we focus on the lie, we might be moving away from our “end goal of trying to support positive behavior change.”

In order to avoid focusing on the lie, and to talk past the gaslighting, we can turn to the PIUS Model of Communication. In the example below, our LO has started to tell us when they will be coming home, so we want to acknowledge that. However, we know that our LO did not tell us the truth about where they were last night.  Grammie suggests that we might say the following:

Positive Statement:

“You have been doing a great job of telling me when you are coming home. It helps relieve my anxiety a lot. Thank you.”

“I” Statement:

“I’ve been judgmental in the past about so many things, and I’m working hard on trying to be more accepting and trying to deal with my fear and anxiety.”

Understanding:

“I understand that you find it difficult to tell me things because you think that I will get upset or judge you.”

Sharing Responsibility:

“I hope in the future that both of us will be able to talk more openly about our situation, and that I can show you that I want to better understand your struggle and be here for you.”

In these few sentences, we have opened up our lines of communication with our LO in a positive, calm way. Notice that the PIUS conversation above does not include our saying “you lied last night”. Saying this might make us temporarily feel better, but would it help our communication with our LO? Would it help our relationship with our LO?

So, the good news is that if our LO engages in gaslighting, we do not have to remain mired in self-doubt – we can attend F&F meetings for support, and we can look to our F&F handbook for the tools we can use.

Additional Information:

PLEASE NOTE BEFORE YOU COMMENT:

SMART Recovery welcomes comments on our blog posts—we enjoy hearing from you! In the interest of maintaining a respectful and safe community atmosphere, we ask that you adhere to the following guidelines when making or responding to others’ comments, regardless of your point of view. Thank you.

If you are interested in addiction recovery support, we encourage you to visit the SMART Recovery website.

IMPORTANT NOTE:

If you or someone you love is in great distress and considering self-harm, please call 911 for immediate help, or reach out to 988 Suicide & Crisis Lifeline @ 988, https://988lifeline.org/

We look forward to you joining the conversation!

*SMART Recovery reserves the right to not publish comments we consider outside our guidelines.*

From books to 12-step programs, and even through online communities, we can find inspiration for sobriety all around us, in accessible and relatable forms. I don’t think of it often, but film is another great place to turn to when we’re lacking in our sobriety. If you do end up being unable to stay sober, don’t be afraid to get the addiction treatment los angeles you need. Here are 12 recovery movies I threw together for the next time you’re feeling the desire to stay in bed. Prepare for both a cry and a laugh, and the inspiration to get yourself through. Remember, when it comes to Drug addiction – getting help is not a shameful thing to do if you’re struggling. Hopefully, these films can help you.

Pleasure Unwoven

This documentary aims to answer the great debated question, “Is addiction a disease?” With visual tools and simple lingo, Dr. McCauley explains the complex science behind substance abuse and recovery. After viewing this film five years ago, my father-in-law discovered a new understanding and acceptance of addiction, and with that acceptance came hope for his son’s recovery. Watch with your husband, your adult children, your students or yourself if searching for better compression of the addicted brain.

You can purchase Pleasure unwoven through Amazon and I found it available to stream here.

28 Days

This is a favorite in the recovery community. Sandra Bullock’s character finds herself forced into rehab for a heavy drinking habit. Like many of us she is stubborn and unwilling to admit to alcoholism but when she can no longer hide from her truth, she begins to accept her addiction. With a self-discovery driven by early sobriety and the residents she befriends, she begins to grow into a new woman learning to navigate sober life and maintain her relationship with her long-term boyfriend. While the movie may be a bit cheesy, there’s no doubt that the heartwarming feeling is real, and to many of us, relatable.

You can rent 28 days (not to be confused with 28 Days Later!) on Amazon, iTunes, Google Play and YouTube.

Recovery Boys

Break out the tissues, if you have any experience with addiction (especially drug addiction), you’re gonna cry your eyes out. This is a raw, candid documentary about a group of men living in a residential treatment home and attempting to get clean. The highs, the lows, the failures, and the wins, all sewn together with pain and the fear loved ones must face. It shows an unfiltered truth which, I believe, everyone would benefit from experiencing.

You can stream Recovery Boys on Netflix.

Russell Brand: From Addiction To Recovery

In this documentary, Comedian Russell Brand shares his inspirational story—from taking drugs and alcohol on a daily basis, to becoming somewhat of a sobriety guru, Russell shares it all. With humor and truth, he tells us what it was like and exactly how he sobered up, making it feel like your chatting with a Recovery buddy, you’ll find yourself relating to this English Superstar.

You can find From Addiction To Recovery for free on YouTube.

Smashed

This is another film depicting a woman’s journey of accepting her addiction and getting sober. The main character faces a series of ‘shameful’ events brought on by alcohol and drug abuse. Her choice to get sober is met with skepticism by both her husband and mother, but she finds support in other recovering alcoholics. Critics have called Smashed cliché, however, it’s cliché because it’s true, and those of us with a substance abuse problem will have empathy for the main character and in that, empathy for ourselves.

Smashed can be rented through Google Play, iTunes, Youtube, and Amazon.

Happy

Happy is a documentary, not on addiction, but on finding the beauty in life, despite the circumstances. The camera crew visits 14 different countries and interviews 14 people on different life paths. There’s inspiration to be found in every story and underlying lessons on positive psychology. If you’re struggling to find gratitude or the positive in your life, this movie is sure to help you discover your Happy.

This documentary can be streamed on Netflix and rented through iTunes, Amazon, Google Play, and YouTube.

Basketball Diaries

Based on a true story, Basketball Diaries depicts the dark side of heroin dependence. Jim (played by a young Leonardo DiCaprio) has a promising future in basketball, but before he reaches fame, he experiments with drugs and falls quickly in love. As his affair with narcotics takes off, he loses his mother, himself and his potential career. This film isn’t lighthearted, but neither is addiction. With a true portrayal of the dark sides of substance abuse and candid examples of how far one will go for drugs, Basketball Diaries is a must-see for those whose lives have been at all tainted by drug dependency.

Unfortunately, I could not find this movie available on any of the popular streaming platforms, however, you can purchase the DVD through Amazon.

Thanks For Sharing

Although this movie isn’t centered around ‘alcohol/drug’ addiction, it does a phenomenal job of painting a picture of recovery and sobriety. This film bravely takes on sex addiction, and while I wouldn’t recommend it to those not familiar with addiction, I do recommend it to my peers for the simple fact of the honest relatability found within the characters. Starring Gwyneth Paltrow and Mark Ruffalo, you’re sure to find some laughs and heartfelt feelings in the lives of the three main characters and their recovery from their sex addictions.

Thanks For Sharing can be found to rent or buy on Amazon, YouTube, Google Play and iTunes.

Mom

Not a movie, but an honorable mention. I couldn’t write a recovery media list without adding TV show, Mom, into the mix. Starring Anna Faris and Allison Janney, this program does a fantastic job creating highly relatable characters, with plots that are humorous but also relatable, CBS depicts an honest view of what it’s like to get sober and rebuild one’s life. It’s loosely based on the 12-step program, so if that’s a tool you utilize, I highly recommend it.

Check your local listings for Mom, or stream the full series through CBS All Access.

When A Man Loves A Woman

A married couple is forced to confront the wife’s alcoholism and their challenges that unfold as her sober journey takes off. While she flourishes in sobriety, her husband feels out of place. This movie paints a true picture of learning to stand on one’s feet, and, with an appearance from Philip Seymour Hoffman, who tragically lost his lifelong struggle with addiction in 2014, there’s an additional tug on one’s heartstrings.

When A Man Loves A Woman can be rented on iTunes, Google Play, Youtube and Amazon.

A Star Is Born

I haven’t brought myself to watch this, however, it is said the film beautifully paints an honest picture of the heartache caused by addiction. This remake, starring Lady Gaga and Bradley Cooper, is about a country singer and his battle with alcoholism. Lady Gaga recently won a Golden Globe for her outstanding performance in this powerful movie, so bring the tissues with you.

A Star Is Born Is still in theater and should be showing in a theater near you.

Beautiful Boy

Based on a father’s memoir, Beautiful Boy portrays a son’s addiction and its ability to absorb the entire family. It’s a true testament to how far our loved ones will go to pull us out of the grips of drugs and alcohol. The gut-wrenching performances and the rawness of the script, produce a profoundly genuine picture of family addiction.

Beautiful Boy can be seen in some theaters and streamed on Amazon Prime.

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