In today’s episode we continue our discussion of advanced strategies to overcome urges and illustrate the risks of “friendly fire”, i.e. when friends try to convince us to party with them. Through advanced role play, we see how these common urges can be successfully overcome.

Watch on our YouTube channel.

SMART Recovery Handbook

Role Playing Video

Subscribe to the SMART Recovery YouTube Channel

Video storytelling is a powerful tool in recovery, and we are proud to share our SMART Recovery content free-of-charge, available anywhere, on any device. Our videos hope to inform, entertain, and inspire anyone in the recovery community.

Subscribe to our YouTube channel and be notified every time we release a new video.

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.

• Be kind in tone and intent.
• Be respectful in how you respond to opinions that are different than your own.
• Be brief and limit your comment to a maximum of 500 words.
• Be careful not to mention specific drug names.
• Be succinct in your descriptions, graphic details are not necessary.
• Be focused on the content of the blog post itself.

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 The National Suicide Prevention Hotline @800-273-8255, https://suicidepreventionlifeline.org/

We look forward to you joining the conversation!

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

Join us on Wednesday, December 8th at 1:00pm for A Year-in-Review Community Townhall.

As 2021 winds to a close, President Bill Greer and Executive Director Mark Ruth, want to take a minute to reflect on everything that we, as a SMART community, have accomplished and the impact we have made to those in recovery, in the last year.

The Zoom event is free with registration.

The Zoom link will be emailed to you a few days before event. We hope to see you there!

Registration closes Monday, December 6th 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.

• Be kind in tone and intent.
• Be respectful in how you respond to opinions that are different than your own.
• Be brief and limit your comment to a maximum of 500 words.
• Be careful not to mention specific drug names.
• Be succinct in your descriptions, graphic details are not necessary.
• Be focused on the content of the blog post itself.

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 The National Suicide Prevention Hotline @800-273-8255, https://suicidepreventionlifeline.org/

We look forward to you joining the conversation!

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

I was thinking about writing on something entirely positive in the recovery space, and yet here is the piece which does not fit that Bill, pun noted. All things considered, I am optimistic about our future, and underpinning this is the knowledge that a primary facet of recovery (and the recovery movement) is acknowledging uncomfortable truths and facing them, together. This piece and all my writings are intended in the most positive way possible – to generate thinking about what we want and what we need to do to move in that direction. It is vital to ensure that we help develop a recovery service and support systems that can meet the needs of the next generation. What each of us, our agencies, communities, and governmental institutions do to respond to challenges we face matters a great deal to how each of us, are families and communities heal into the future.

We are face unprecedented challenges, what Dr H Westley Clark referred to in his interview with me as a syndemic. Dr Clark was referencing the addiction epidemic, exacerbated by the COVID-19 Pandemic, influenced by social strife and strain on all of our societal institutions over the last decade or so. One new development is the great resignation of 2021 people are walking off their jobs across America. Our substance use care system was already deep into a severe workforce crisis, simmering for over two decades. In May of 2019, the Annapolis Coalition released a report commissioned by SAMHSA that discussed our workforce crisis in pre COVID times and estimated that we needed an additional 1,103,338 peer support workers and 1,436,228 behavioral health counselors, as part of the 4,486,865 behavioral health workers conservatively estimated that we need. Do we have a system that is inviting for people to work in, focused on healing or one that is steeped in trauma and not able to deliver its full promise?

We consistently make it more difficult for recovering people to get into the SUD workforce. Ostensibly, this is done out of sense that  our recovering workforce are less capable or have more ethical issues than non-recovering people, suggestive of implicit bias against us. We are raising the bar as the bottom is falling out of our SUD workforce. Maybe on some level, it is done because our people are not seen as worthy of helping. Maybe we don’t want an effective care system because we don’t think “they” should be helped.

Systemic stressors place a lot of strain on agencies. Such dynamics have been examined and explored in many contexts, one that resonates with me is the work of Dr Sandra Bloom who has written about these forces present in all human service organizations. They had a devastating impact on the Sanctuary Program, a program she developed and nurtured for many years. She termed it destroying sanctuary. I have referred often to her work over the years, but I don’t think it has ever been as relevant as it is right now.

Dr. Bloom describes that as internal and external challenges become more profound, people and systems become progressively overwhelmed, they lose capacity to constructively deal with the challenges. They become more top-down authoritarian and less inclusive of feedback from the those within these systems. Workers leave or stop trying to be effective. The system further losses capacity to address the needs of the people it serves. As part of this dynamic, systems then tend to eliminate those who share uncomfortable truths to raise the alarm about the problems and move towards solution. We kill the messengers and ignore the messages. Our ability to serve those in need becomes more impaired as it is clear our systems are not open to input and punitive.

Dr. Bloom was seeing how the economics of managed care were squeezing the care out of our programming. Similar dynamics played out in the SUD service system in the mid to late 90s, when the value of substance abuse insurance coverage declined by 75% between 1988 and 1998 and there was a drastic reduction in frequency and duration of inpatient hospitalization with no offset in increased outpatient care. It was a cost shift to the public care system and related to a focus on criminalization of addiction. It was a primary facet that led to the rise of the new recovery advocacy movement in America.

These dynamics lead to learned helplessness. People feel like they have no power to change things when exposed to prolonged aversive stimulation. When overwhelmed, they simply stop trying to solve problems. This is exacerbated by the bystander effect. The term was coined after the brutal murder of Kitty Genovese on a hot summer night when dozens of people could have done something but assumed that someone else would, but no one did. These are the dynamics of people, organizations and systems that become eroded by the threats they face and become increasingly unable and unwilling to acknowledge and face these challenges. They freeze or flee. I suspect that this is part of what is happening in respect to the Great Resignation of 2021.

On a systems level, are we part of the problem or part of the solution, or a mix of both? What can we do as individuals or collectively?  What are our personal and professional obligations to our field and the people we pledged to serve? What is our own responsibility for what is happening, and can we assume a role that moves things in a more positive direction? Have we seen similar dynamics before? What lessons may we learn from the past to apply to our current situation? How do we want to be remembered, by jumping into the lifeboats as our ship founders or by bailing it out and getting our vessel back on course?

We are undergoing a mass trauma event, or more accurately a complex combination of traumatic events at the micro mezzo and macro levels of our society. How do we create safety for ourselves and those in our families, workplaces, and communities? Each of us has the power within us to create greater safety for ourselves and those we love. Are we doing so or spreading trauma?

We face formidable challenges, but we are capable people and seasoned institutions who are well suited to facing adversity. I for one will be identifying challenges and working with others so inclined to fix them. I don’t know the specifics of how we will rise above the challenges we face, but I know that when more of us are working towards solutions than are adding to them or sitting by the sidelines, the more likely we are to overcome them and create safety and restore the dynamics of healing in ourselves, our families, our communities, and our systems of care.   

Why can’t she hear anything I say?

Overcoming the challenges of communicating with a loved one struggling with addiction

Communicating with someone you love is not always easy.  Too often, conversations end with disagreements, misunderstandings, and even broken relationships. If you are struggling to communicate with a loved one suffering from addiction, here are some helpful guidelines that may get your relationship back on track.

Always start with “I love you”

It’s true that “I love you” is one of the most powerful phrases one can say to another.  Although it is not enough to cure a loved one of addiction, letting your loved one know that you are coming from a place of love is the best way to start any tough conversation.  It assures them that what you are saying is not meant to cause hurt feelings but must be said because you care deeply about them and their well-being. Make your communication direct, honest and most importantly loving.

Acknowledge that you understand their difficulty

Empathy goes a long way when supporting someone struggling with addiction.  They may want to quit but find it’s not that simple.  Many factors are at play when it comes to addiction.  They may be on an emotional rollercoaster, working through feelings that range from happiness, anger, loneliness to shame and embarrassment.  Your loved one may also be facing old friendships that are not conducive to their recovery, challenging their decision to remain clean and sober.  Your loved one wants to know that you understand they are having a difficult time.

Set boundaries

It is healthy for your loved one to know your limits: how far they can go with you and how far you will go with them.  Setting boundaries establish that you are willing to support them in recovery but unwilling to engage in enabling behaviors. Participating in a treatment program for family recovery is a great way to discover your enabling behaviors and learn how to set boundaries for yourself and your loved one.

Make yourself available to listen without judgment

This step has two parts.  The first is making yourself available to listen, not just to talk. When relationships are strained due to the erratic behaviors of addiction, it easy for both the family members and the addict to become dismissive of one another while telling their side of things. However, it is important to know that your loved one needs you to listen and pay attention to their thoughts and feelings.  Part two of this step may be the hardest: listening without judgment.  Judgement is when you impose your beliefs and values on someone else.  It is an act that can shut-down communications immediately with you. Remember, criticizing and judging only make someone hurt more and is counterproductive to helping your loved one.

Understand that addiction is a disease

Educating yourself on the disease of addiction will help you keep the emotional or moral perspective out the conversation.  Saying things to your loved one like, “Why don’t you just stop,” or having thoughts such as, “I need to fix this for them,” are removed once you understand that addiction is not a behavior problem, but a medical diagnosis just like heart disease or diabetes.  It’s a chronic brain condition that causes compulsive drug and alcohol usage despite the harmful consequences it may cause to the user or others around them. Also, understand addiction needs proper treatment for recovery, just like any chronic disease.

Using these few steps can help you hone your communication skills and build a stronger relationship with your loved one in a constructive and supportive way.

About Fellowship Hall

Fellowship Hall is 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.

I have decided to post this on both blogs I write on, my own and Recovery Review it is a personal reflection on recovery service and related tribulations and what keeps me going. This week was my recovery anniversary. I am getting closer to two thirds of my life in active recovery. I got into recovery at age 21. There was no one around me getting into recovery at that time in my area in my age group. It was not easy, but it has been a high yield endeavor. I faced a terminal illness at age 21 and recovery has improved every single facet of my life.

Early in recovery, I decided that a life of service helping people into recovery was what I was going to do with my time here. I have done a lot of work in the recovery space, from the lowest entry level jobs to running programs, trainer, advocate, educator, and writer. It has been a surprisingly difficult road, with discrimination being the greatest challenge to the work in my view. Despite all the obstacles, it has been the right path for me.     

I know now that from the first moments I started to be open about recovery, there were people around me who saw me as flawed. Not a worthy member of the community. I did not fully see it even with my eyes wide open. It is hard to see something so painful, sometimes especially when it is right in front of you. It has taken decades to fully appreciate how it plays out. I think that the first time I realized that there was such discrimination against us was in 1987. I was volunteering for Habitat for Humanity. I hoped it was a safe place. I was vulnerable and in early recovery. There is no discrimination free zone, it happened there as it happens everywhere in our society.

A church deacon was working on the house with me. He asked what I wanted to do with my life. I told him I wanted to help people get into recovery from addiction. He said “those people” were not worth the effort, it would be a waste of my life. I felt deep shame. I knew he was talking about me, even as he did not. It has taken me decades to fully appreciate the pervasiveness of disdain and discrimination in our society. It is ever-present. Work I am currently doing has been dismissed as worthless and attempts in process to dismantle it. It hurts on a level that will be with me until my last breath. A pain scale that words fail.  

This week, I had a conversation with a colleague who is experiencing similar discrimination. We spoke about our common experiences. Because of this person’s skin color, they experience it in ways I never will, yet their words resonated with me to my core. Their view was that it comes from the belief if we are treated so very poorly, we will simply quit and go away. This person resolved to never ever give up. I agree. I get knocked down daily, but I get up one more time than I get knocked down, each day. It is the painful and Sisyphean side of recovery advocacy that many of us experience. We continue to stand back up, because bearing such pain and discrimination is actually a lighter weight than walking away as our friends, family and neighbors needlessly die. That would be unbearable. We will never give up; we will never go away. One must imagine Sisyphus happy.

On the other side of the ledger of this labor of love is having the honor of deeply listening to people from every different walk of life and working to understand their perspectives and their experiences. That alone has been life altering in so many beneficial ways. I have seen many lives through other eyes. I have a deeper reservoir of empathy as a result. I have also seen so many people flourish in recovery and the positive ripple effect that they have had in their families and communities. I am humbled to have been a small part of their recovery processes. I have even been provided the responsibility at times to take the things I have seen and speak truth to power for people who otherwise would not get heard. Someone did it for me. I pay it forward despite the challenges.  

We have a lot to offer, even as we face overwhelming discrimination. I sincerely think America would be a better nation if we pursued and supported a greater focus on long term recovery for persons like me with severe substance use disorders. The primary barrier to doing so is the pervasive societal belief that we are less than others. Not worth the effort. It is entrenched in all of our social institutions. What heartens me is that there are many of us working towards this goal despite these pervasive barriers. History shows us we prevail if we persist. Recovery has given me the ability to get up every day, live my life and carry this message forward with all of my agency. I am grateful for it all.

What are you grateful for today?   

Born and raised in Southern California, Jeff is the father of four children. Currently semi-retired, he lives in the Coachella Valley, California with his husband Jason. He facilitates LGBTQ meetings for SMART Recovery.

Watch on our YouTube channel.

Learn more about becoming a SMART volunteer.

Subscribe to the SMART Recovery YouTube Channel

Video storytelling is a powerful tool in recovery, and we are proud to share our SMART Recovery content free-of-charge, available anywhere, on any device. Our videos hope to inform, entertain, and inspire anyone in the recovery community.

Subscribe to our YouTube channel and be notified every time we release a new video.

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.

• Be kind in tone and intent.
• Be respectful in how you respond to opinions that are different than your own.
• Be brief and limit your comment to a maximum of 500 words.
• Be careful not to mention specific drug names.
• Be succinct in your descriptions, graphic details are not necessary.
• Be focused on the content of the blog post itself.

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 The National Suicide Prevention Hotline @800-273-8255, https://suicidepreventionlifeline.org/

We look forward to you joining the conversation!

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

Traci is the mother of five wonderful kids. She is a board member for Beneath the Shade Women’s Transitional Living House. Her father struggled with alcohol and drugs. She volunteers at River Haven Women’s Residential Treatment Center and the Tuscarawas County Jail. She leads three SMART Recovery meetings including a women’s only meeting for Beneath the Shade, and a meeting at River Haven Women’s Residential. In addition, she leads a meeting at the Tuscarawas County Jail as part of their transformation program, which combines SMART Recovery and learning other skills such as budgeting, exercise and healthy meal planning.

Please note: although SMART actively seeks to refrain from using labels like “addict” and “alcoholic,” we recognize that when others describe their experience they may choose to do so. Thank you for understanding.

Watch on our YouTube channel.

Subscribe to the SMART Recovery YouTube Channel

Video storytelling is a powerful tool in recovery, and we are proud to share our SMART Recovery content free-of-charge, available anywhere, on any device. Our videos hope to inform, entertain, and inspire anyone in the recovery community.

Subscribe to our YouTube channel and be notified every time we release a new video.

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.

• Be kind in tone and intent.
• Be respectful in how you respond to opinions that are different than your own.
• Be brief and limit your comment to a maximum of 500 words.
• Be careful not to mention specific drug names.
• Be succinct in your descriptions, graphic details are not necessary.
• Be focused on the content of the blog post itself.

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 The National Suicide Prevention Hotline @ 800-273-8255, https://suicidepreventionlifeline.org/

We look forward to you joining the conversation!

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

Nobody gets to recovery from a good place, and Mike Hooper was no exception. “I reached out to the VA crisis line because my addiction to alcohol had reached a point of total destruction of my life.” Hooper, a veteran who is now SMART’s Ohio Outreach Director, says he hadn’t connected with any type of recovery program and felt like he was out of options and headed for more trouble. Then he unexpectedly found SMART Recovery.

At first, he was cynical and skeptical about whether it could help, but it turns out his concerns were completely wrong. One big reason it worked for him was that he had never come across a self-empowering pathway like SMART that put the participant in the driver’s seat while providing practical tools and mutual support, “[it] began my road to self-management, acceptance and forgiveness.”

Now he is a SMART employee and spends his days connecting SMART with people and organizations. Mike says his best reward is being able to pay it forward by helping to save lives from addiction and maladaptive behavior. Based on his own success, he has a lot to contribute to the cause.

Here are Mike’s responses to the Take 5 Spotlight questions:

1. Are there tasks you perform regularly during your workday? Basically, anything to do with creating new connections, which I really enjoy. I do this throughout Ohio and beyond by sharing the specifics about the SMART Recovery Program and how it can be an asset to individuals and organizations.
2. What are a couple of the ways you interact and coordinate your job with other national office staff? I love being part of a newly developed Outreach Team with Jessica Shapiro and Cheryl Simmons. It’s a welcome change to be able to work directly with headquarters employees on a regular basis.
3. What is one of the ways that you think you personally make a difference at SMART? I feel the most direct impact I’ve had for the organization is bringing awareness about SMART and its resources to others who didn’t even know we existed. It gives me great pride to make a connection with a potential recovery resource so that they can utilize us directly in their recovery efforts.
4. What is your message to all those dedicated SMART volunteers across the country? Three for the price of one: you matter, you are the reason we’re saving lives, you are SMART Recovery!
5. What kinds of things are you interested in outside of work? There are so many—fitness, family, reading, writing, MMA & boxing, gaming, Japanese language and culture, movies, and singing.

It’s clear that Mike believes that Life Beyond Addiction includes embracing new experiences, enjoying a wide variety of people and activities, and just plain having fun. He knows that he’s not wrong about SMART this time—it’s a pathway to a happy and healthy life.

Learn more about the Take 5 Spotlight series and see others who have been profiled.

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.

• Be kind in tone and intent.
• Be respectful in how you respond to opinions that are different than your own.
• Be brief and limit your comment to a maximum of 500 words.
• Be careful not to mention specific drug names.
• Be succinct in your descriptions, graphic details are not necessary.
• Be focused on the content of the blog post itself.

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 The National Suicide Prevention Hotline @800-273-8255, https://suicidepreventionlifeline.org/

We look forward to you joining the conversation!

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

The redoubled focus on recovery within our federal administration is heartening. This is an area in which history is instructive. Many years ago, advocates from the recovery community, including those in my own home state of Pennsylvania met with SAMHSA and educated them on the value of creating a funding stream for recovery community on the substance use side similar to what already existed on the mental health side. We got their attention, and the focus on recovery in SAMHSA started with David Mactas, and was carried forward by Dr H. Westley Clark. This is how the modern recovery era started.

They listened to us and our whole country benefited. SAMHSA established the Recovery Community Support Project (RCSP) grant, later the Recovery Community Services Project. These grants catalyzed recovery communities nationally. Here in PA, our statewide Recovery Community Organization (RCO) got one of these grants and for a long period of time experienced similar funding support from our state. The RCSPs seeded the discussions and focus on recovery at the historic Recovery Summit in Saint Paul Minnesota, widely acknowledged as the start of the New Recovery Advocacy Movement in America. We changed history.   

I am so very pleased to see that SAMHSA has launched an Office of Recovery. I know a number of the people involved in this, but more importantly, I know what they know as part of their lived experience. They know that the recovery movement is fragile and vulnerable to cooptation, and that the remedy to this is to include the authentic recovery community. They know the vital role of RCO’s, including statewide RCO’s. They know that, despite all our visible squabbles, there is far more that we all have in common than that which separates us, and that these common themes are the key to progress forward. They know that recovery values, including honesty, openness and integrity are fundamental to our future success.

My recent interviews on the recovery movement included the first SAMHSA RCSP grant officer, Cathy Nugent. She realized from the very beginning that recovery community organizations were the experts on recovery. She saw SAMHSA’s role was to bring those experts together to serve the needs of their respective communities. She did not devalue us. She led by supporting the movement, not taking its energy for some other agenda. It was key to what was accomplished. Countless lives have been saved and communities revitalized as a result of her wisdom. I have a list to thing I would hope that the Office of Recovery to focus on, but first and foremost, I suggest a focus on ensuring that the values that its leaders have learned and supported us over the last generation are passed on to the next generation. That is paramount.

One thing we must watch out for is what happens when we are coopted. Pennsylvania is a cautionary example of what happens when state administrations move away from recovery. We had training for peer supports that were developed by and for the recovery community that ended up being taken away in a no bid, closed door process by our Single State Administration (SSA). Our federal funding makes up a large portion of what the state expends, and it was used by the state to remove us from the training we quite literally owned. Peer training in Pennsylvania, developed by us and for us, no longer includes us. The new training has even revised us out of our very own histories, much like European colonizers set out to eliminate the cultures of indigenous peoples, the teaching of our own history to new Certified Recovery Specialists does not include our own contributions. What is taught about out culture and our history is no longer in the hands of the recovery community organizations. The state has decided who will control what new certified peers learn about our history and who teaches it in a questionable and closed-door process. They are attempting to erase us. This is cultural appropriation of the recovery community of Pennsylvania. It creates a wound hard to heal. It is ugly and wrong and serves as a cautionary tale to other states and the federal government.

I humbly suggest to SAMHSA and those reading beyond it at the SSA level to consider how to honor and meaningfully include the recovery community in matters that impact us. Do not devalue us. Do not coopt us. Do not take our contributions for your own agendas. Do not revise us out of our own histories. Do not try and erase us. Do respect our contributions and acknowledge our role in our own care and support. Treat us equitably not just in words but actions. We have a lot to offer when so treated.

What has happened here in Pennsylvania to our recovery community is fundamentally wrong, and highlights all of the concerns that Bill White presciently spoke about in Texas in 2013. Funding is not transparent; it is narrowly focused, and it pits small grassroots organizations against each other to keep us divided. I was in the audience on that day in Texas and knew in the moment what he was saying was what we had to watch out for. He was spot on. He ended up writing an article about it State of the New Recovery Advocacy Movement and I encourage people to read it. Last week he wrote a piece about Recovery Renaissance, and he focused on key points to consider when determining if we are being treated with equity and respect, it is also worth reading.

How do we ensure that such values become so ingrained that we twenty years from now, we have a SAMHSA Recovery Office centered on equitable and meaningful inclusion of our recovery community?  How can the moral injuries that have been inflicted on us be healed? How do we get back on track as equitable partners in what happens in our own communities and not as a commodity to be marketed by taking our stories but not actually including us in meaningful ways?

I don’t pretend to have all the answers but believe our own history shows us we must be involved in matters that impact our community or everyone loses. Our history is replete with examples of our communities being marginalized by outside entities to support their own agendas. It is happening in my home state, with our tax dollars. History also shows that we always rise up – Bill White also showed us that in his seminal work, Slaying the Dragon: The History of Addiction Treatment and Recovery in America. We will overcome.

There has been no better opportunity than right now to ensure we are meaningfully included in the next chapter of our history. We must not be revised out of our own movement by outside interest groups. We must not lose control over the teaching of our own history. We must be seen as equals and collaborators, not groups to marginalize, devalue and cash in on.

The Office of Recovery within SAMSHA is a great opportunity to move our national recovery agenda forward. Their efforts will only work as they support efforts out in the recovery community, including at the state recovery community level. I have faith in these national leaders because I know their history.  I know that they know this, but I also challenge them to consider how we all work together instill recovery values into the next generation. I offer my hand in support to ensure it happens so that the SAMHSA Recovery Office of 2031 has the values that we can trace back to the late 1990s with leaders like Dr Clark and Cathy Nugent. I bet others would as well. That would be a legacy for all of us.

We must ensure our movement is carried forward for the next generation and our inclusion is key to ensuring that it becomes reality for who comes next.

Many lives depend on us succeeding, it only works when we do so together.

Data from a nationally representative survey indicate that in 2019, nearly three-fourths of U.S. adults reporting buprenorphine use did not misuse the medication in the past 12 months. In addition, buprenorphine misuse among people with opioid use disorder trended downward between 2015-2019, despite increases in the number of people receiving buprenorphine treatment. The study, published today in JAMA NetworkOpen, was conducted by the National Institute on Drug Abuse (NIDA), part of the National Institutes of Health, and the Centers for Disease Control and Prevention.

Buprenorphine is an FDA-approved medication to treat opioid use disorder and to relieve severe pain. Buprenorphine used to treat opioid use disorder works by partially activating opioid receptors in the brain, which can help reduce opioid cravings, withdrawal, and overall use of other opioids.

In 2020, more than 93,000 people lost their lives due to drug overdoses, with 75% of those deaths involving an opioid. However, in 2019, less than 18% of people with a past-year opioid use disorder received medications to treat their addiction, in part due to stigma and barriers to accessing these medications. To prescribe buprenorphine for treatment of opioid use disorder, clinicians must do so within a certified Opioid Treatment Program, or submit a notice of intent to the federal government, and are limited in how many patients they can treat at one time. Only a small proportion of clinicians are eligible to treat opioid use disorder with buprenorphine, and even fewer prescribe the medication.

“High quality medical practice requires delivery of safe and effective treatments for health conditions, including substance use disorders. This includes providing lifesaving medications to people suffering from an opioid use disorder,” said NIDA Director Nora D. Volkow, M.D. “This study provides further evidence to support the need for expanded access to proven treatment approaches, such as buprenorphine therapy, despite the remaining stigma and prejudice that remains for people with addiction and the medications used to treat it.”

In April 2021, the U.S. Department of Health and Human Services released updated buprenorphine practice guidelines to expand access to treatment for opioid use disorder. However, barriers to the use of this treatment remain, including provider unease with managing patients with opioid use disorder, lack of adequate insurance reimbursement, and concerns about risks for diversion, misuse, and overdose. Misuse is defined as patients taking medications in a way not recommended by a physician, and can include consuming someone else’s prescription medication, or taking one’s own prescription in larger amounts, more frequent doses, or for a longer duration than directed.

To better understand buprenorphine use and misuse, researchers analyzed data on use and misuse of prescription opioids, including buprenorphine, from the 2015-2019 National Surveys on Drug Use and Health (NSDUH). The NSDUH is conducted annually by the Substance Abuse and Mental Health Services Administration. It provides nationally representative data on prescription opioid use, misuse, opioid use disorder, and motivation for the most recent misuse among U.S. civilian, noninstitutionalized populations.

The researchers found that almost three-fourths of U.S. adults who reported buprenorphine use in 2019 did not misuse buprenorphine in the past 12 months. Overall, an estimated 1.7 million people reported using buprenorphine as prescribed in the past year, compared with 700,000 people who reported misusing the medication. Moreover, the proportion of people with opioid use disorder who misused buprenorphine trended downward over the study period, despite recent increases in the number of patients receiving buprenorphine treatment.

Importantly, for adults with opioid use disorder, the most common motivations for the most recent buprenorphine misuse were “because I am hooked” on opioids (27.3%), indicating that people may be taking buprenorphine without a prescription to self-treat craving and withdrawal symptoms associated with opioid use disorder, and “to relieve physical pain” (20.5%). Moreover, among adults with buprenorphine use, those receiving drug use treatment were less likely to misuse buprenorphine than those not receiving drug use treatment. Together, these findings highlight the urgent need to expand access to buprenorphine treatment, because receipt of treatment may help reduce buprenorphine misuse. Furthermore, it is necessary to develop strategies to continue to monitor and reduce buprenorphine misuse.

The study also found that people who received no drug use treatment and those who lived in rural areas were more likely to misuse the medication. However, other factors, such as being a racial/ethnic minority or living in poverty, had no effect on buprenorphine misuse. The study authors suggested that to address the current opioid crisis, both access to and quality of buprenorphine treatment for people with opioid use disorder should be improved.

“Three-quarters of adults taking buprenorphine do not misuse the drug,” said Wilson Compton, M.D., M.P.E., Deputy Director of NIDA and senior author of the study. “Many people with opioid use disorder want help, and as clinicians, we must treat their illness. This study also underscores the urgency of addressing racial and ethnic, health insurance, economic, and geographic disparities in treatment access, to ensure that everyone with opioid use disorder can access this lifesaving medication.”

Reference: B Han, CM Jones, EB Einstein, WM Compton. Trends in and characteristics of buprenorphine misuse among adults in the US. JAMA Network Open. DOI: 10.1001/jamanetworkopen.2021.29409 (2021).