How we think of addiction and recovery has changed in America, largely due to the New Recovery Advocacy Movement (NRAM). The future of NRAM and SUD Peer Services are inseparably intertwined. SUD Peer Services originated out of NRAM as a primary objective. In An Open Letter to SAMHSA and the SSA’s On Inclusion – Our History and A Cautionary Tale, I noted that the movement is vulnerable to cooptation. We will be unable to avoid being coopted if we cannot teach the lessons of our own history, to our own peer workforce. That is exactly what is occurring in my home state. What is unfolding in PA will occur nationally without intentional effort to ensure we can train our own recovery workforce in our own recovery history.


In a System That Fails to Retain Its History or Prepare for the Future, I noted that we have done a poor job of transferring our own history on any level. We do not transfer knowledge about our progress and challenges in any organized fashion. One of our most significant assets to help us do so is the life work of Bill White. He has left us a huge resource. He knew that documenting and teaching our community about our own history could save a lot of future pain and suffering. Ceding the teaching of our own history to outside groups will kill off the recovery movement as we lose the ability to transfer what we have learned generationally.


This is occurring in parallel to our concern that peer services are becoming a shadow of their unrealized potential. A mere appendage of the formal treatment system. A system of care that fails to ground services in the impacted community is perpetuating paternalism and stigma. From the beginning of NRAM, it was realized that this must be avoided. Peer services originated with the recovery community and were intended to be grounded in our community, not in the formal treatment system or some other entity. Communities, in all of their diversity are best suited to heal their members and develop community recovery capital.


Centering peer services in our traditional care system will lead to over professionalization of the role and a shift towards a clinical orientation as it is the dominant paradigm. It is already happening nationally, in no small part because recovery communities organizations, comprised of individuals protected by the American Disabilities Act receive disparate funding. The paucity of resources starves off our potential. We find ourselves with limited resources to sit at the tables we need be at to keep our services recovery community focused.


To assist with our movements goals, one of the things I did last year is to develop a short training based on  interviews with key leaders in NRAM. The training also contained references to work done by recovery historian Bill White and established history, from Operation Understanding, to the historic recovery summit in Saint Paul Minnesota and beyond. A list of the interviews and much of the related papers and material can be found here. The training is not being permitted to be taught to any of our statewide SUD workforce by the private entity that controls the content of all peer trainings taught across the state. We were not provided any feedback by this private entity on any facet that could be changed so it could be taught. We received a blanket rejection that trainings that are “ideologically and theoretically driven” or not of “durable evidence-based” content would not be permitted under new internal policies that were never announced and remain secret.


So I shared the training with key figures in the NRAM movement who I had interviewed. None of them identified anything inaccurate or that should have resulted in the training being denied. Their reactions ranged from puzzlement to outrage. One recognized that what happened here in PA could happen in any other state and urged the mobilization of our national community. Then the training was academically vetted for use nationally. I am conducting these trainings outside of PA even as they are denied to our people. Here in PA there is a tight control on the version of recover history that gets taught to the entire SUD certified workforce.  


In PA, the training provided new SUD peer workers has been scrubbed of our contributions by those who standardized the training with public funds. By not even allowing us to train on our own history, the recovering workforce is denied the opportunity to learn why these services were developed. In this way, in one generation of workers, the role of our recovery community organizations in developing and sustaining this training will be lost. The very definition of cultural appropriation experienced by marginalized communities throughout human history is happening right here, right now in the great state of Pennsylvania to the recovery community.


We have one sanctioned version of history tightly controlled by a group outside of the recovery community. This is analogous of having one history book required for use by all educators with one point of view controlled by one private interest group with the tacit approval of a government that wants only one version of history taught. As a student of history and an academic teaching at a university, I know that understanding history in its rich diversity is vitally important and the hallmark of a free society. When I want to learn about a particular event or topic in history, I read 3 or 4 books on the topic to get a sense of the event from multiple perspectives. As a social work educator, I know that we teach the history of social work in multiple contexts in multiple courses. Not so in respect to SUD peer training here in PA. We cannot allow it to remain this way.


What is happening here in PA is a canary in the coal mine for NRAM. It can and will occur elsewhere if people are not actively working to prevent it from unfolding. It is even more important an issue in light of the movement to standardize peer training at the national level. These services and the training of these peers have become quite profitable for some, yet recovery community organizations remain woefully underfunded. Money increases influence, and we have less of it than the industries that have found significant profit from the fruits of our labor. We will end up on the table, not at it. That would be history repeated.


Unless the government at the state and federal level is sensitive to these dynamics it is likely the training of SUD peers will become overly academic and not grounded in the community who developed them. I was in the audience in Dallas Texas in 2013 when Bill White expressed the challenges and opportunities that our movement faced at that moment. His concerns have been uncannily accurate in his keynote address to the Association of Recovery Community Organizations. He later wrote it up into a paper titled State of the New Recovery Advocacy Movement. These writings are part of what we have been denied teaching to our own statewide SUD peer workforce, the original training of which originated out of our effort.


It is clear that the recovery movement is at a crossroads. If that which was created by us and for us ceases to include us, it would mark a turn away from a generation of efforts to establish recovery and recovery community as the foundational element in the healing of individuals, families, and communities. That the day we would come that we would stand at this crossroad was always certain. It is a lesson of our own history.


We have the scholarly writings of Bill White in Slaying the Dragon, to show us that there have been multiple recovery movements that have risen and fallen over the course of American history. They tend to either get coopted externally or fall apart due to internal conflict or both. The best ways for an outside interest group to foment division is to amplify internal discord or simply to take it over. That is also a lesson of our own history.  


A question I posed in the Seed Vault of Recovery History and Our New Recovery Advocacy Movement, was whether we would tear each other up in factional disputes, be coopted by outside groups or rise to the challenges we face, together. Will we allow the New Recovery Advocacy Movement to wither and die on our watch? The answer is up to all of us. Our greatest contributions to helping America heal from substance use issues lie ahead, if we can sustain our efforts in an organized fashion.


Whatever we do, there is one bright spot. To borrow a quote from popular culture, in the movie, Jurassic Park, Jeff Goldblum notes that life finds a way. The long arc of recovery history is that of a Phoenix continually rising up out of its own ashes. Just as life finds a way, recovery always finds a way as well. I hope we do not allow this current recovery movement to end. But if it does, it will rise again. As life itself, recovery always finds a way! If we fail to do what we can to extend this movement for another generation, a group in the not too distant future will rise up an even newer recovery advocacy movement. They will build upon the funeral pyre we created for ourselves. Perhaps they will learn from our mistakes. One more reason it is vital for us to control the teachings of our own history is a commitment to future generations. To share what we have learned in an effort to assist them in moving forward is our most vital task.  


























Recovery Is for Everyone: 

Every Person, Every Family, Every Community


Each September, Recovery Month promotes and supports new evidence-based recovery practices, the emergence of a strong and proud recovery community, and the dedication of community members and service providers across the nation who make recovery in all its forms possible.


Now in its 33rd year, Recovery Month is facilitated by Faces and Voices of Recovery and celebrates the gains made by those in addiction and mental health recovery, just as we celebrate improvements made by those managing other health conditions.


NADCP is proud to support the 150,000 people seeking recovery through treatment courts each year, along with the treatment court practitioners who are helping them on their journeys. Throughout September, we look forward to sharing special recovery content and resources and seeing how treatment courts celebrate Recovery Month! Check out a selection of NADCP’s recovery-focused resources here.


Here are some additional resources to help you plan and share Recovery Month activities and promote recovery in your communities:


    

  • 2022 Recovery Month toolkit, flyers, images, social media messaging, and other free resources, many in both English and Spanish
    • 

  • The Recovery Month online event calendar allows people searching for events in your community to find them easily; post your event so others can join!
    • 



On social media channels, be sure to use #RecoveryMonth and tag our All Rise Facebook and Twitter accounts!











			

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The post September is Recovery Month appeared first on NADCP.org.


Every September, the Substance Abuse and Mental Health Services Administration (SAMHSA) sponsors Recovery Month to increase awareness and understanding of mental and substance use disorders and celebrate those in recovery (www.recoverymonth.gov).


At Fellowship Hall, we work to dispel the stigma surrounding substance use disorder: no one is immune to this disease. It impacts those using, as well as friends and loved ones and can be incredibly daunting and confusing to navigate.


Do you have a loved one or friend struggling with substance use disorder? Here are 4 things you can do to help:


 


GET EDUCATED


The most empowering thing that you can do is to educate yourself about the disease. There’s endless resources on www.aa.org, www.na.org, and support specifically for friends and loved ones on www.al-anon.org, www.nar-anon.org The more you know about the disease, the better you can support someone who is struggling. If someone you love is in active danger or in a situation that you believe to be a medical emergency, call 911 immediately before proceeding.


PRACTICE EMPATHY


Being empathetic is achievable without being an enabler. The disease often drives individuals to do things incredibly out of character. Your loved one may be lying to you, lashing out, and making your life feel overall unmanageable. During these times, demonstrating empathy may be the last thing you want to do, however, it is one of the most tactful ways to encourage your loved one to seek treatment while preserving your own sanity. Substance use disorder changes our loved ones, and addressing these changes is necessary to their health and safety as well as our own.


Being empathetic includes:



PRACTICE SELF-CARE AND SET BOUNDARIES


You cannot help someone else get better if you aren’t taking care of your own personal well-being first. Caring for or loving someone suffering from substance use disorder can be taxing on our physical, emotional, and mental health. Utilize support networks such as Al-Anon or Nar-Anon. Talk to a counselor or professional about what you’re going through, and prioritize your health first. Remember, you are not responsible for your loved one’s disease. Set boundaries with this individual and yourself. Make them aware of said boundaries, and hold them accountable. Boundaries can include:



 


COMMUNICATE EFFECTIVELY


If it were as easy as telling someone to “go get help,” no one would suffer from substance use disorder.  The individual has to accept that they are sick and want to get better before treatment can be effective. This is not something you can force anyone into doing.  Denial will protect them from realizing that they are sick or that they need help. You can only try to lead them to acceptance with effective communication. This may include:



Ultimately, you must remember that you cannot control those in need of treatment, in most circumstances, you can only encourage them to seek proper treatment. Be strong and be patient. For the sick individual, getting well can be a long and arduous process, but it will be one of the most rewarding things they ever do for themselves. If your loved one is interested in seeking treatment at Fellowship Hall, please visit https://www.fellowshiphall.com/admissions.


***


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.


 




“…but more research is needed.” That’s often the refrain in science, and it includes addiction research. As the addiction and overdose crises continue to claim an unprecedented number of lives and fray communities, science is an essential part of the solution.


In the science-to-medicine pipeline, there is a point when a body of evidence is so well-established that to not put the science into action would be an abdication of responsibility. When it comes to the current crisis, there are at least five things that science has shown conclusively to be effective, where communities and healthcare providers can apply what we already know works.


We don’t need to keep asking if these things work. Instead, we must find ways to help providers, people, and communities overcome the barriers to implementing these valuable interventions.


1. Naloxone saves lives.


Opioids now claim 188 lives in the U.S. every day. Among their other effects, they attach to cells in the brainstem that control respiration, slowing down breathing to sometimes deadly levels. This is an overdose. Naloxone is a medication that can quickly reverse an opioid overdose by kicking opioid agonist drugs like fentanyl off opioid receptors and blocking them, which quickly restores breathing. It must be used promptly, and it requires another person to be nearby to administer it.


All over the country, putting naloxone in the hands of first responders has saved countless lives. And because it is such a safe drug, it can be put directly in the hands of people who use opioids, their loved ones and friends, and anybody else who may find themselves in a position to save the life of someone overdosing on an opioid.


Yet despite the safety and lifesaving value of this drug, there are impediments to widespread use. Naloxone is not available over the counter, which could ease access. Doctors don’t always prescribe it to patients who need it, pharmacies don’t always stock it, the price may be prohibitive when they do stock it. While many states now have standing orders allowing anyone to get it from the pharmacist without a prescription, people often do not know that. People who offer harm reduction in communities are also affected by costs and product shortages.


NIDA is supporting research to overcome regulatory and attitudinal barriers to wider use of naloxone and educating about its use. Opioid overdose education and distribution (OEND) programs have been implemented in some areas, with dazzling effectiveness at saving lives. Despite concerns of critics, having a naloxone kit has not been shown to increase a person’s opioid use. New methods of reversing overdoses with novel molecules and delivery techniques are also in the research pipeline.


2. Medications for opioid use disorder can work.


Decades of research has shown beyond doubt the overwhelming benefit of medication for opioid use disorder (or MOUD). The full opioid agonist methadone (in use for half a century) and the partial agonist buprenorphine (first approved two decades ago) have proven to be life-savers, keeping patients from illicitly using opioids, enabling them to live healthy and successful lives, and facilitating recovery. Naltrexone, an antagonist that prevents opioids from having an effect, is also effective for patients who do not want to use agonist medications and are able to undergo initial detoxification under medical supervision.


The efficacy of MOUD has been supported in clinical trial after clinical trial, and MOUD is now considered the standard of care in treatment of opioid use disorder, whether or not it is accompanied by some form of behavioral therapy. Yet even now, only half of addiction treatment facilities offer any FDA-approved medications, and only a tiny fraction offer all three. And while recovery supports like 12-step groups can be a useful adjunct to treatment, many continue to discourage participants from taking medication—a legacy of decades of misconception that medication substitutes one addiction for another.


Science is no longer needed to show that these medications are effective. Where we are directing efforts and dollars is toward research aimed at overcoming attitudinal barriers and, again, increasing the implementation of these effective treatments. Research is also needed for strategies to improve retention in MOUD treatment, since discontinuation of medication is high. Also, because the available medications are not right for everybody, we support research to determine which of these medications work best for whom and to develop additional treatments for opioid use disorder and other drug use disorders, including addiction to stimulants and addiction to multiple drugs (polysubstance use disorders).


3. Contingency management is an effective treatment for stimulant use disorders.


We don’t have an FDA-approved medication to treat stimulant use disorders. Although opioids, especially fentanyl, still cause the majority of overdose deaths, stimulants like methamphetamine and cocaine are increasingly showing up as contributors to overdose, in many cases in combination with opioids. Even without an FDA-approved drug to treat stimulant use disorders, there is an effective behavioral treatment available: Contingency management. But regulatory barriers—and unclarity about the regulations—have thus far limited its reach.


Addiction is a disorder that profoundly affects motivation: Through repeated use, seeking the drug prevails over other goals (social connection, career, school) in part by reorienting the brain’s reward system. Even when people want to quit, they have a hard time finding the motivation to pursue a life free of the drug, since they don’t have alternative reinforcing stimuli to motivate them. Contingency management provides such reinforcement, encouraging positive behavior change with small prizes—usually, the opportunity to win a small gift card, movie pass, or similar small monetary gift—for negative drug tests, adhering to medications regimens, and other healthy behaviors.


It sounds strange that small rewards would help keep people experiencing addiction from using drugs, but when they want to quit, these token prizes can boost their incentive enough that they can do it and experience the growing benefits of a life without drugs. Contingency management has been shown in trial after trial to be especially effective for people with addiction to stimulants (including people with both stimulant and opioid use disorders), outperforming other behavioral approaches.


However, too-stringent interpretation of regulations put in place to prevent medical fraud (coercive inducements or kickbacks) have limited the dollar value of rewards to trivial amounts that often are not very effective. And providers unsure about the legality of contingency management often do not provide it at all.


We don’t need more science to show the effectiveness of contingency management. We need more treatment centers to implement it. For this to happen, there needs to be greater clarity from regulators that it is a legitimate medical treatment, not an inducement with potential legal penalties. And raising the dollar caps will greatly enhance the treatment’s effectiveness. 


4. Syringe services programs (SSPs) greatly mitigate harms of opioid use.


Syringe services programs or SSPs are another harm-reduction approach backed by massive scientific research showing their effectiveness at reducing the transmission of infectious diseases like HIV and hepatitis C among people who inject opioids and other drugs.


SSPs also have a range of additional benefits, including linking clients to SUD treatment and other needed healthcare that they may be reluctant seeking elsewhere. Staff at SSPs, who are often in recovery themselves, treat clients with dignity, a positive experience of healthcare engagement when they may experience stigma from most others.


Critics have worried that dispensing sterile injection equipment implicitly sanctions or encourages drug use, and it has led to their limited utilization. But studies show SSPs do not increase drug use or negatively impact surrounding neighborhoods. They are a win for communities and a good investment. History has shown that disease outbreaks can result when communities fail to implement SSPs. For instance, a 2018 modeling study suggested that an earlier public health response including timely implementation of an SSP might have blunted or prevented the 2014-2015 HIV outbreak in Scott County, Indiana.


SSPs are among the most-studied of harm-reduction techniques, and now we need to write the next chapter: build the evidence base to see what other harm-reduction approaches could help in the current crisis and how they can be adapted to diverse communities.


5. Prevention interventions can have broad and lasting impact.


With the current addiction and overdose crisis, our country has been playing catch-up, ramping up treatment and harm-reduction services to staunch the tide of deaths and devastated lives. What is also needed is prevention, and this is another area where research shows us the way to go.


Decades of research on periods of developmental vulnerability and the kinds of social-environmental factors that raise the risk of early drug experimentation and addiction have led to the development of numerous evidence-based prevention interventions that mitigate the risk factors as well as strengthen protective factors. These interventions, ranging from nurse-home visitation of low-income first-time parents (such as Nurse-Family Partnership) to family-based pre-teen/teen programs (Strengthening Families Program: For Parents and Youth 10-14) or school-based interventions to strengthen self-control skills (such as Life Skills Training) show multiple benefits including, in some cases, reduced or delayed drug experimentation in adolescence and young adulthood.


Some of these interventions show benefits in reduced drug use decades out—even across generations. Children of parents who received an elementary-school intervention called Raising Healthy Children showed improved outcomes too. And since many of the risk factors for substance use are shared with other mental illnesses, prevention interventions reap a wide range of mental-health benefits. Best of all, benefit-cost analyses show prevention to be an extremely good investment for communities, averting many direct and indirect costs of substance use and other related problems.


Yet such interventions are seldom adopted. Short-term thinking, unwillingness to invest in long-term solutions, plays some role. But there are real challenges in scaling up interventions that work in small trials and effectively implementing them in the real world, adapting them to the specific characteristics and needs of unique communities. It’s an area where NIDA is investing in research to find ways to bring effective evidence-based prevention interventions to scale.


A year ago in this blog, I called for radical change to solve the opioid crisis. It remains true. But radical measures are really not that radical: If we are guided by science, they are actually conservative and commonsensical, undoubted wins in any kind of benefit-cost calculus. We just need the collective will to put the science into action, and research to find ways to do it most effectively in the real world.


Video: What Radical Change Means



  


(“Wrong Way” by Jack Zalium is licensed under CC BY-NC 2.0.)


More and more frequently I’m hearing self-identified and publicly recognized recovery advocates state that providing harm reduction services with the goal of moving people toward recovery or treatment constitutes “doing it wrong.”


This perspective isn’t limited to a few outliers, I heard it voiced at a SAMHSA recovery summit and have seen it endorsed by public officials and influential leaders in and around the field.


I recently explored the limitations of framing harm reduction as liberation, particularly where people with the illness of addiction are involved.


When responding to an illness with high mortality rates, high rates of functional impairment, and high rates of negative externalities (negative effects on families, communities, public safety, and public health), it seems neglectful for public health or individual interventions to adopt a neutral attitude toward recovery and treatments that can prevent overdose and improve quality of life.


In cases that don’t involve the disease of addiction, I’d generally agree that recovery and treatment may be the wrong goals. However, the context of the overdose crisis makes it hard to be neutral about nonmedical opioid use.


I recognize the importance of things like respect, self-determination, the primacy of the relationship, and solidarity. Other relevant values might include healing, patient welfare, family welfare, community welfare, flourishing (maximizing global health and quality of life), hope, and restoration. 


These values don’t line up neatly behind one intervention or another. One value could be aligned with multiple interventions but, in many cases, different values will more clearly align with different interventions and our challenge is to manage that tension. We may manage that tension by creating space for multiple approaches, or seeking ways to mitigate the trade-offs inherent in an approach so that we’re not choosing one group over another. Recovery-oriented harm reduction is an attempt to do this — recognizing that most people using AOD are not addicted, that lower-risk use is an appropriate goal for them, that full sustained recovery is the ideal outcome for people with addiction, that these interventions shouldn’t engage in coercion, that all change should be supported and affirmed, and that the participant’s worth does not — in any way — depend on their goals or current substance use.


This approach, however, requires choosing to tolerate dissonance, managing bias, and looking for both/and responses, which is unlikely to generate lots of cheers and clicks.


In that spirit, I’d wholly support a statement like, “If you’re providing harm reduction services, and treatment or recovery are the only goals that really matter to you, you’re doing it wrong.” 



















		















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It's official: RISE22 was the single largest gathering of treatment court professionals in our movement's history. Nearly 8,000 of you gathered in Nashville to celebrate, learn, and grow together!


We invite you to view a recap of this historic event. From an unprecedented federal presence and star-studded concert, to our celebration of recovery and over 260 dynamic sessions, RISE22 demonstrated why it’s an unparalleled conference event each year.


RISE22 Exclusive Content

This year, NADCP has made excerpts from two important RISE22 general sessions available to all treatment court professionals. Click here to view deep-dive panels on harm reduction in treatment courts and addressing the ripple effects of parental incarceration and parental addiction.


RISE23 Call for Papers

NADCP is seeking session proposals for RISE23. If you are interested in presenting next year, click here to learn more and submit!


We'd like to extend our most sincere gratitude to everyone who attended, spoke, exhibited, and performed. We’re hard at work on RISE23, and look forward to seeing you in Houston!




















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The post RISE22 Recap appeared first on NADCP.org.




A few things related to recovery have caught my eye recently, things that I think are worth knowing and that ought to shape our practice..


Abstinence goals more reliable


In a study[1] from Swiss researchers involving more than 200 patients going through residential treatment, those who set clear goals for abstinence were much less likely to relapse than those who set conditional goals (like being abstinent for a while then reviewing that decision). About twice as many of those setting abstinent goals (58%) were sober at the 6-month follow-up period as those with ambivalent drinking goals. Demographically the groups were the same though those with conditional goals tended to have more mental health problems. 


I thought it striking that of those setting clear goals for abstinence, nearly 60% had achieved that six months later – a very impressive remission rate. This is in keeping with a study done on patients I work with and confirms positive outcomes associated with residential rehabilitation. The study’s bottom line: 




In summary, patients with a conditional abstinence drinking goal often do not achieve their drinking goal and start to drink earlier than planned.


Stutz and colleagues, 2022


Recovery capital grows most strongly through participation in recovery groups


Recovery capital describes the resources (internal and external) than can be drawn upon to initiate and maintain recovery. International evidence is growing around the value of recovery residences in supporting individuals to reach their goals. We have at least one such residence in Edinburgh. In a study[2] of US recovery house residents (823) a recovery capital measurement tool was used to capture changes in recovery capital over time. 


The study showed that generally recovery capital increased over time, but it didn’t do consistently. Older men who participated in recovery groups did best, with women and younger residents doing more poorly, leading the researchers to recommend that more focus on those groups in terms of housing, employment and family issues may help. While bonding withing the recovery house is thought to be important, the biggest impact seems come from participating in mutual aid groups.




Changes in recovery capital also show that, among the residents who remained, the strongest enabler is amongst those that participate in recovery groups. Living in recovery residences is about active participation in a recovery community and often requires mutual aid engagement, and residents bond as a community and support one another’s recovery”


Härd and colleagues, 2022


Mutual aid membership improves wellbeing


I find myself increasingly frustrated about the lack of academic interest in Scotland around recovery communities. We have large numbers of mutual aid groups and increasing numbers of lived-experience recovery organisations, recovery walks, recovery concerts, and a variety of other activities organised by people who have resolved their problems with substances. The impact on drug and alcohol deaths for this population (saved lives) must be significant, as must the impact on quality of life but there is almost no attention being paid – perhaps because it’s just much easier to study medical interventions. It’s such a blind spot.


So, it was good to read this Polish study[3] involving 70 members of Alcoholics Anonymous. The researcher, Marcin Wnuk, wanted to understand what was going on in the relationship between being involved with AA and how people experience and evaluate different aspects of their lives, particularly regarding mental health, life satisfaction, and happiness (subjective wellbeing). Wnuk found that this was indirectly affected by impact on finding hope and meaning in life (existential wellbeing). They recommend that: 




Practitioners, therapists, and counsellors should engage patients with an alcohol addiction diagnosis to participate in AA meetings as an effective way to cope with dependence


Marcin Wnuk, 2022








It’s discouraging to see how little research has been done in the UK on how effectively we connect individuals to mutual aid. Mutual aid participation has a significant impact on outcomes. The fact that there is almost no interest in measuring connection rates to mutual aid and of assessing the impact of such interventions is regrettable. In Scotland, the publication of the evidence behind the Drug Deaths Task Force recommendations this week kind of makes the point. 


In an otherwise impressive 223 page document evidencing the things that may make an impact on Scotland’s high drug deaths, I was initially encouraged to see that ‘Recovery’ got its own chapter. Well, I say ‘chapter’, but further exploration revealed that this was in fact a  page. Well, I say, ‘page’, but I mean two paragraphs at the top of an otherwise empty page. This will be seen by some as a slight to the Scotland’s communities of recovery and their potential to to make a difference. This is, from my perspective, a wasted opportunity. 


As has been pointed out to me recently, there is more awareness south of the border and a toolkit is available to help services connect people into mutual aid in a way that, as the Polish research shows, will improve hope, meaning and wellbeing.


Continue the discussion on Twitter: @DocDavidM




[1] Graser Y, Stutz S, Rösner S, Wopfner A, Moggi F, Soravia LM. Different Goals, Different Needs: The Effects of Telephone- and Text Message-Based Continuing Care for Patients with Different Drinking Goals After Residential Treatment for Alcohol Use Disorder. Alcohol Alcohol. 2022 Jul 31:agac031. doi: 10.1093/alcalc/agac031. Epub ahead of print. PMID: 35909224.


[2] Härd S, Best D, Sondhi A, Lehman J, Riccardi R. The growth of recovery capital in clients of recovery residences in Florida, USA: a quantitative pilot study of changes in REC-CAP profile scores. Subst Abuse Treat Prev Policy. 2022 Aug 6;17(1):58. doi: 10.1186/s13011-022-00488-w. PMID: 35933398; PMCID: PMC9356455.


[3] Wnuk M. The Beneficial Role of Involvement in Alcoholics Anonymous for Existential and Subjective Well-Being of Alcohol-Dependent Individuals? The Model Verification. Int J Environ Res Public Health. 2022 Apr 24;19(9):5173. doi: 10.3390/ijerph19095173. PMID: 35564567; PMCID: PMC9104992.

















Don Allen used to take credit for his achievements, but not his failures. Today, thanks to SMART, he has the tools to manage his thoughts and beliefs about himself and others. A participant at Above and Beyond Family Recovery Center in Chicago, IL, Don has learned that every day he has a choice and another chance to try again. And for that he is grateful.


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There have been devastating impacts on our entire helping systems workforce over the long siege of the COVID Pandemic. Recently, I read the Ohio PHP Executive Report, the Impact of the Covid-19 Pandemic on the Health and Well-being of Ohio’s Healthcare Workers. The report summarizes data collected from 13,532 respondents across 13 of Ohio’s Professional Licensing Boards between July 7, 2021, and August 20, 2021. As far as I can tell, it is the largest state sample in the nation of the impact on COVID-19 on our helping professionals to date.


The report notes that helping professionals who think about death or suicide have nearly doubled. It includes a 375% increase in those who feel hopeless and overwhelmed and a 25% increase in substance use as a way to cope during the pandemic. Our Health and Human Service care systems first need to acknowledge there is a problem, and then embrace our healing assets, deep reservoirs of which reside within those very same institutions and in recovery community organizations across the United States.  


There may be reflex to see Ohio as different from everywhere else. It is not. This survey of 8,000 healthcare workers from Australia found that 10% of respondents have had thoughts of self-harm or suicide during the pandemic, but fewer than half had sought help from a mental health professional. A survey from the American Nurses Foundation in October of 202 suggests that during the pandemic, around one in five nurses said their alcohol consumption had increased, and 3% said they had increased their substance use. They indicate that among critical care or intensive care nurses, estimates of increased alcohol consumption jump to one in three. This article from the University of Utah suggests that about half of our national healthcare workforce could be at risk for mental health issues.


In military culture, people are trained to be mission oriented. To get the job done no matter what. This means sucking it up and powering through traumatic events. We do that in our health and human service systems as well. In all these cultures, there is a tendency to ignore the cumulative costs of the work and then seeing our colleagues who experience difficulties as flawed or inferior. We stigmatize and isolate our own people. We perpetuate a culture of denial to sustain a business-as-usual model that is killing our very own workforce.


This is a culture of denial fostered by management focused on the short-term goals of getting through the next shift, the next day or the next week to the long-term detriment to all of our fields. This is at the heart of why these same systems are now struggling to serve their missions. These dynamics were bad before the pandemic, but COVID-19 pushed our care delivery systems beyond the breaking point. If there is a silver lining here, perhaps we will address our own wellbeing on a systems level as we are left with no other choice.  


There has been some well-deserved criticism for placing all of the responsibility for self-care on the individual. We have a system of care that sets people up for burnout. We push people to perform and deemphasize supervision. We do not mentor younger workers to successfully navigate the challenges they face. Instead, we tend to bring in new workers, we watch many burnout, and then we replace them. Those who survive a few rounds become hardened veterans, well-schooled in suck it up. It is a trauma infused system steeped in denial of what is occurring. Wounded healers, who have navigated through addiction into recovery hide their status to avoid mistreatment instead of being harnessed as resources to help others.


Twenty years into the new recovery advocacy movement and our systems have not fully grasped the deep reservoir of healing that exists within and across our communities and care institutions. We forget that our recovery community organizations are comprised of members of our communities, including professionals within these very same systems. This includes doctors, nurses, pharmacists, social workers and every other profession. These people and the recovery community resources they are connected to remain largely untapped as resources within the very systems who desperately need their expertise on recovery. The solution is right under our noses! Harness existing community recovery capital to help heal our wounded healers working in and across our care systems. Community is a primary agent of healing in respect to mental health and substance use recovery, yet generally, we do not center strategies on connecting people to these healing forces within our own institutions.


We have a cultural problem of “us” and “them:” a healer /patient orientation. We need to change this. What can we do?  A recovery orientation would require us to think about the healing of our helpers as well as the persons they serve. We can acknowledge the existing recovery capital within our own health and human service systems, nurture it and use it help save our own workforces.



We have festering addiction and mental health issues within our healing institutions. Dedicated professionals pushed through crisis after crisis and ended up using drugs and alcohol to numb out the very real pain associated with the work. They sucked it up day after day and experience mental health consequences. These are occupational hazard of the work. We can no longer afford to pretend this is not a reality. They did it to serve our communities and now we must help them. We need to support our own people. We must embrace the ethos of leaving no one behind. 


We cannot heal or help anyone when we ignore our own wounds. That starts with acknowledging that there remains profound stigma against addiction and recovery inside our care systems.  There is no “us” and “them.”  Those “others” are us; and we need to heal our own within our medical and human service systems or we cannot help anyone else effectively.








Pam Mulready’s “destruction of choice” started her freshman year and continued throughout college. While her friends were graduating, she was in rehab. This was not how she thought her life was supposed to go. Eventually, though, it put her on a path to recovery and led to helping teens and young adults going through the same experiences. Today, Pam is a licensed mental heath and addiction recovery counselor, working as a Project Coordinator at Youth Recovery CT and as a SMART Recovery Facilitator.


In this podcast, Pam talks about:



Additional resources:




Click here to find all of SMART Recovery’s podcasts




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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/


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