Guest blog by Tom Horvath Ph.D.

Stanton Peele’s latest book, A Scientific Life on the Edge: My Lonely Quest to Change How We See Addiction, (#14) is a personal autobiography, an intellectual autobiography, and a detailed comparison of his work with that of many other authors and scientists, including Maia Szalavitz, Carl Hart, Marc Lewis, and Johann Hari. For those unfamiliar with Peele’s work, this book would be an excellent introduction. If you already appreciate him, the historical and comprehensive nature of this book (379 pages, plus 52 pages of online references) will likely be appealing. The references online are helpful and save the reader from flipping pages back and forth.

Peele revolutionized our understanding of addiction. Love and Addiction, published in 1975 and co-authored with Archie Brodsky, presented a new perspective on what addiction is, how it arises, and how it can be addressed. His insights are still far from being fully understood and acted upon, especially in the U.S. As this book presents in detail, more often his ideas have been ignored or attacked. As someone said, “the first one through the wall always gets bloody.” Those interested in a fact-based approach to addictive problems are in his debt.

The book is overviewed in three places: Prologue (7 pages), Chapter 1 (“I can’t get no respect,” 10 pages), and a Conclusion (33 pages). For Peele the personal and the intellectual are well blended (as I suspect they are for anyone so immersed in a body of knowledge). However, chapters 2 and 4-8 are primarily personal. Chapters 3 and 9-11 are primarily focused on his intellectual history (including the influence of Winick, Zinberg, and many others) and the comparison of his work with other work. For those less interested in Peele’s personal life, the overviews and intellectual autobiography chapters are well worth reading by themselves.

The prominent themes of the book include the following:

Peele is generous. He makes kind comments about many people. He is, however, also frank. If he views someone as having behaved badly, he says so. He is also entirely clear about what he disagrees with.

He wants to set the record straight. Where his work is not fully understood, even by those who are familiar with it, he offers clarification. In reviewing the current group of prominent addiction writers, he states that “all of them fail to make some essential leap” (p. 227) in their understanding of addiction. He also identifies authors who have benefited from his contributions (given what they are writing) but do not acknowledge them.

He identifies small positive changes being made in U.S. addiction treatment and the U.S. view of addiction. However, he mostly perceives substantial delay in the adoption of scientifically defensible positions. Some of this minor progress is made without acknowledging his contributions.

Peele regrets that his life has been “on the edge,” the life of an outsider, yet he also appears to accept this situation and to have been prepared for it. As he states, “my career in the addictions field is largely a string of rejections” (p. xv). Nevertheless, he continues to write and to be read. He is hopeful that in time that his ideas will fully gain acceptance. He has also received, among other noteworthy accomplishments, the Mark Keller Award, and the Lindesmith Lifetime Achievement Award. Beyond this recognition, however, he states that “I fantasize about winning a Nobel Prize in medicine for my practical and theoretical work with addiction.” An outrageous idea? Peele adds that “economist Gary Becker did win a Nobel Prize for his 1988 paper on a ‘Theory of Rational Addiction.’ One of the handful of references in his Nobel-winning article is to my book, The Meaning of Addiction” (p. xvii).

The individuals who do recognize Peele’s contribution are prominent and numerous. Many of them are quoted on the covers, inside the front cover, or in a closing section, “Afterword: Observations about Stanton Peele.”

As one summary of Peele’s comprehensive and profound contribution to our understanding of addiction—you could begin reading the book here—I suggest reviewing the 10 recommendations he made to the Drug Policy Alliance for goals they should be encouraging society to adopt (p. 257). How long it will take us to accept these goals is, for me, one of the critical questions of our time.

Peele wonders about how his own personality may have contributed to his status as an outsider. He refers to himself as having a “reckless personality” (p. xiii). He quotes William White: “Stanton’s persona can dwarf his written words, leaving both his most avid supporters and rabid critics more focused on him and his most inflammatory rhetorical flourishes than the more nuanced points that can be found in his books” (p. xv). Peele immediately states that White’s statement allows the reader to “see my problem” (p. xv). He opens Part I (consisting of the first 4 chapters) with: “My mother treated me as a genius, told me to disregard those who minimized or ridiculed my ideas or person. I never lost that protective shield. I can’t be deterred.” It seems likely to me that his persistence has both helped him and hindered him.

For those who know or have read individuals he comments on, the book could appear to contain gossip. Upon reflection I think his comments are a useful addition to the historical record. (I am mentioned or quoted on a handful of pages, always in a positive or matter-of-fact manner. Perhaps I would feel differently had I been critiqued.)

Regardless of how one feels about Stanton the person, “the modern understanding of addiction and recovery begins with Love and Addiction” (so I am quoted just inside the front cover). Peele of course has debts to his predecessors–and he acknowledges them. However, he offers the first complete description of addiction that fits with our actual observations about it.

Other books by Stanton Peele:

Recover:! Stop Thinking Like an Addict and Reclaim Your Life with The PERFECT Program

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What’s Grief Got To Do With It?

From Kelly Scaggs, Clinical Director at Fellowship Hall

What does grief have to do with addiction? I would venture to say a lot more than most people think. Grief can be a huge relapse risk, especially when it goes unaddressed. At Fellowship Hall we have long recognized grief as an obstacle in the recovery process, which is the reason our grief group was developed and our extended treatment program delves deeply into the process.

Grief can often feel like being stuck in quick sand and barely keeping your head above the surface. What better way to “escape” from the pain than alcohol or drugs? The chemicals can keep us “numb,” but as soon as you attempt to get sober, the feelings that have not been addressed rear their ugly heads and the temptation to return to what you know “works” comes back with a vengeance.

We challenge the notion of grief as something you “get over,” or as something that can be done a right way or a wrong way. We face head-on the grief that comes from being in active addiction, the multiple losses…family relationships, control of your life, financial stability, health, friends to overdose, and the list goes on. These are the losses that are often over looked or negated, but are no less painful.

Recovery requires breaking this cycle, stepping into the grief work, developing skills for addressing uncomfortable feelings, and freeing ourselves from being “stuck.” Healthy grief work restores hope, a necessary commodity that drives recovery. At Fellowship Hall, we believe one of our primary jobs is to restore hope for the still suffering alcoholic and/or addict.

Over the years we have witnessed the positive impact addressing grief can have on an individual’s recovery. The goal is learning healthy ways of addressing grief so you can learn how to move with life again. It’s not about moving on, it’s about moving with and incorporating the experiences into the fabric of your story.

We know that a little bit of hope can make a big difference for someone feeling mired in the quick sand of their grief. Healing doesn’t mean the pain never existed. It means the pain no longer controls your life. Never forget, pain is real, but so is hope.

Clinical Director Kelly S. Scaggs, LCSW, LCAS, CCS, MAC, ICAADC has over 25 years of experience in behavioral health. She holds a Bachelor’s degree in Psychology from Mercer University in Macon, Georgia and a Master’s of Social Work from the University of South Florida in Tampa, Florida.

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.

Forward: I am quite sure I had never met or spoken with Betty before this interview. She is 83 years young and her zest for life and learning came through the telephone line loud and clear.She was modest when sharing her significant life accomplishments. I felt like some additional context on what Betty contributed to support the new recovery advocacy movement would be helpful. I decided to talk to Tom Coderre who had worked closely with Betty when he was National Field Director for Faces & Voices of Recovery. 

Coincidentally, a few days after I did her interview, I also had the opportunity to introduce Greg Williams at an event focused on family recovery in my community. I was able to talk about Betty and her work to support the recovery community from the podium. I talked about the history of services in our area and how they linked to other efforts nationally. I shared some of Betty’s family recovery story she had shared publicly over the years and how she got help because of a family connection. I noted how rare that would have been back in the mid-1970s in rural New York State. After Greg took the stage, he spoke warmly about her and how she changed how he spoke about recovery with the Faces & Voices of Recovery messaging training. He then educated the audience about Marty Mann and how her work as the founder and Executive Director of the National Council on Alcoholism and Drug Dependence over many decades which helped create the very services in central New York state that Betty and her daughter got help at in 1976. We have such a rich history. Each generation builds things that then lift up the next generation, who uses that foundation to do even more and pass those things on to the next generation.

A few days later, when I was able to catch up with Tom Coderre, he gave me an overview of his own recovery process that many readers may be familiar with as his story was included in the movie the Anonymous People. Tom told me about how the messaging training helped him develop ways to talk about recovery beyond the recovery community in ways that reflected our resiliency and not simply focus on the devastation of addiction. He also spoke warmly about Betty, and that she had done so much for him in respect to recovery messaging through the training. He called her one of his favorite people in the recovery movement. One of the first things she did upon retiring and moving to North Carolina was to get involved with the recovery community and help train yet another recovery community using her considerable talents. He spoke about how she has consistently showed up over the years and continues to train and help carry the message forward. We call this service in the recovery community, and she has the value of service to others at the core of her being.

During his tenure with Faces & Voices, Tom traveled around the country facilitating the “Our Stories Have Power: Recovery Community Messaging Training” for two years with Betty and other facilitators. One of the stories he shared with me was near the end of his work as national field director for Faces & Voices of Recovery. It was in December of 2008, right before he went back to work as Chief of Staff to the Rhode Island Senate President in the very Capitol building in the political world that addiction took away from him a few years earlier. They were recording the training to DVD to make it available to a wider audience. It was being filmed in the Baltimore area. Greg Williams was also there as the project was being filmed. Tom told me that some of the conversations that occurred during that time led to the production of the Anonymous People.   

He talked about filming the DVD with Betty. From Tom’s perspective, her experience of long-term recovery and deep involvement in 12 step recovery was integral in communicating recovery messaging to members of those 12 step fellowships. He was the new guy with five or six years of recovery, and she had the wisdom of years and the communication skills to take the material and make it resonate with attendees. Listening to Betty during the interview below, I could feel the generations of advocacy efforts that it took for services to be there for her and her family. I could see the positive influence and the lives she changed by combining her background as an educator with positive messaging on recovery and the recovery value of service. I never met Betty Currier before this interview, but I am certain that her work on recovery messaging influenced people around me and in turn positively impacted me and thousands of other people in those early years of the new recovery advocacy movement. Tom Coderre was right when he told me that Betty Currier is a jewel of a person. I hope that comes through in the interview!

First and foremost, I am a woman in long term recovery, and that means to me I have not had to have a drink since January 6th, 1976. Recovery has changed the way I think, feel, and act as I have sustained my recovery over the last 45 years. I am currently retired and living in North Carolina, but for most of my life I was in New York State. I grew up a few miles from the Canadian border in that upper flat section of the state. It is quite remote. I became a secondary school teacher and moved to central New York State where I was in a marriage of 18 years. 

At the time I got in recovery, we were living in Otsego County. It was a winter evening, and we were upstairs when we heard our oldest daughter who was 16 come into the house from an evening out. We did not hear her come upstairs. We went down to investigate, and she was passed out on the couch.  We woke her up and walked her around. She did not seem ok, and she kept passing out. I called an EMT friend of mine who came over and she ended up in the hospital. She had overdosed on phenobarbital and brandy. Had we not come downstairs, she would have died. 

The hospital had one of the early addiction programs, there was very little around in that era, but our hospital had one. The next day, the counselor George wanted to talk with me. I’ll never forget his first words: “Your daughter says you drink too much. Do you?”  I gave him a long list of “I nevers” and he said to me, you told me what you don’t do, but tell me about what you do do.  I was speechless. He sat there calmly for a moment and then went on to describe alcoholism. I burst into tears and told him that he was describing me. I went to some meetings and found support. That is how my journey to Saint Paul really started.

Over time, I started to pull together the community. As you mentioned, these were very early years after federal funding become available after the Hughes Act and there was not much around. As I mentioned to you, I was a teacher and I thought it was important to use my skills in recovery. I started to bring people together in our community and do things to educate the community about recovery. This eventually formed into Friends of Recovery of Delaware and Otsego Counties Inc. (FOR-DO) which we founded in 2001 as we recognized the gaps in services, the stigma and discrimination that affects individuals in recovery.  I suspect that part of how I ended up in Saint Paul was my work on Friends of Recovery. As we formed, we started to connect with other groups and people working on similar issues around the nation. I think it was Pat Taylor who encouraged me to go to Saint Paul for that historic summit.

It has been a lot of years, but what I recall most distinctly is how dynamic a group it was that came together for that recovery summit in 2001. People had come to similar conclusions, that we needed to change how we think and talk about addiction and move it into a recovery framework. We wanted to form a national recovery organization and over the three days we met it was a constant topic of discussion. We needed a national presence, and out of this came the seeds of Faces & Voices of Recovery. We spent a lot of time together sharing our experiences, our strengths and our hopes for the future. I think more than anything else, simply coming together and realizing we had a lot to share with each other and that we were stronger together than we were as individuals was the power that came out of that event.

I think many of us in the recovery world were seeing what was happening in respect to addiction and recovery and we were realizing that things needed to change. We saw other diseases being addressed far differently than addiction. We saw services and supports and research being invested into other chronic conditions, but we did not see these same things happening in respect to addiction. We could see things like heart disease and cancer where there was an emphasis on getting help and on recovery. Yet in respect to addiction, nobody was talking about it, care was hard to access and when it was available it was in very short durations with no community supports beyond acute care in place. We knew if we did not talk about this,  nobody else was going to. We knew that if we did share about recovery and wellness, America was not going to hear about it. We had a lot of positive influences, most importantly the contributions of Bill White.  He was instrumental to what we did.

We accomplished a whole lot. One thing we were able to do was form Faces & Voices of Recovery, one of the things we set out to build. We did this because the summit pulled together the movers and the shakers across the country. I think that bringing everyone together in the way that we did created a power greater than ourselves as individuals. People inspired each other and that made a very real difference in what happened in the years after that summit. I can most clearly talk about how it influenced me and what I did when I got back to my community. We had started Friends of Recovery Delaware and Otsego counties, we came together in 2001, it became formalized in 2004. We initiated conversations around the state, and I began doing messaging trainings. Over time, we organized Friends of Recovery New York as a statewide recovery community organization. What started as small community conversations blossomed into a statewide effort. There was an immense desire in our communities to start talking about recovery and start changing the way we address it. We began to shift things to a recovery focus. 

This led to so much more. We developed messaging trainings, we started peer services using peer coaching and we developed recovery centers. It opened up a world of support for our communities. It has led to the visibility of recovery in our communities and an emphasis on hope and resiliency. I was proud to be part of what happened. Like many of us, one of the most important lessons that recovery taught me is that we need to give away what we want to keep. An emphasis on service to others is a foundational element of recovery for many people. I was able to use my skills as an educator to teach people about the power of recovery.

Those of us who were there knew we needed to change the way we talked about recovery, so the work on recovery language was very important. We set out to teach people how to talk about recovery. Up until this time, recovering people were doing what they had become accustomed to in 12 step fellowship meetings. They would say that they were recovering addicts or alcoholics and then share stories about the destruction that comes with addiction. It is important to understand that this kind of story sharing is really important in private settings where we share such stories to remind ourselves and each other about where we came from and what we risk if we do not practice self-care. But that kind of messaging does not help the general public connect with hope, healing, and the reality that recovery is for millions of people across America. 

We knew we needed better messaging! I got involved in the “Our Stories Have Power: Recovery Community Messaging Training” and traveled across New York State and the country providing training. I was able to combine my love for education with my passion for recovery and help people talk more constructively about recovery. I had the opportunity to work with people like Tom Coderre. I recall one training we did in Washington DC in 2008. People came in from all across the country to attend that training. Greg Williams was there and clips from that training ended up in the movie the Anonymous People. I think the work we did to highlight the hope and the resiliency of recovery was a significant contribution. A lot of work has been done on recovery sensitive messaging since then, but it started with the seeds that came out of that recovery summit twenty years ago.

I really don’t think so. I would not want to frame it like that at all. What we started was more of an evolutionary process, where things build on top of earlier insights and gains. It is a growing process and we needed to go through the process to get to where we are today. The things we identify we need to do today are visible to us and more in reach than they were because of all the work that came before, including the work that came out of the recovery summit.

I am not sure that I would think of it as concern. I suspect my view is influenced by my own experience in recovery from alcoholism over 45 years ago. I was one of those persons who were “just” using alcohol, which certainly is deadly when left unaddressed. In the last few decades, addiction to multiple substances had become more commonplace. These changing dynamics have greatly influenced how we support people seeking help. I think it is important that we stay fresh and consider what the changing needs are in our communities. We need to make sure we stay focused on our current generations needs and including new faces in our work. 

As I mentioned earlier, service is key. The notion that we have to help others to help ourselves. Service needs to remain a fundamental element of work to expand recovery moving forward.  It will look different than it did in the past because it is a different generation with different needs, but what will remain the same is the foundational role of service to others. I would tell young leaders to keep an open mind. I would tell them to keep learning across their entire lifespan and I would tell them that we have the capacity to grow as long as we live, and if we approach every day as an opportunity to learn and grow, we stay vital for ourselves, our families and our communities.

Last week, the first grant awards were made for the HEALthy Brain and Child Development (HBCD) study, which will recruit a large cohort of pregnant women at 25 centers around the country and follow them and their children from the prenatal period through early childhood. Similar in conception to the Adolescent Brain Cognitive Development (ABCD) study already underway, HBCD will utilize regular neuroimaging in the infants and children as well as collecting a wide array of biospecimen and behavioral data to chart the development and health of the participants through the first decade of life. The cohort will include a population of mothers who used drugs during their pregnancy as well as mothers from similar backgrounds who did not use drugs, in order to answer longstanding questions about the long-term impact of environmental adversity during pregnancy, including prenatal substance exposures, neglect, trauma, and social and economic challenges.

In a world radically changed by the pandemic, longitudinal studies of child development have never been more crucial, and these grant awards couldn’t come at a more opportune time. For the past year and a half, parents and caregivers have been burdened by troubling questions about their children’s development and mental health. Those who have had to improvise non-optimal childcare solutions for young children wonder about the effects of reduced physical activity and socialization and increased screen time. Parents of school-aged children want to know whether a year of at-home learning may have set their kids behind academically. And researchers want to know how traumatic events associated with the pandemic, like loss of a parent or home eviction, influence their developmental trajectories. These are exactly the kinds of questions ABCD and, soon, HBCD will be poised to answer.

Despite challenges caused by the pandemic, the ABCD study, currently in its fifth year, continues to collect vast quantities of data on a wide range of topics including early adolescent substance use and obesity, brain development as related to socioeconomic status, and the impact of discrimination on suicidality. Researchers are already publishing data on changes in adolescents’ alcohol and nicotine use after the start of the pandemic. That study cohort is large and diverse enough to be able to compare brain development and other health and behavioral outcomes in adolescents who participated in at-home learning through the entire 2020-21 school year with those whose schools remained open for some of that time. Now the HBCD study will enable scientists to examine how early childhood development and health are impacted by some of the stressors affecting young families that have arisen during the pandemic, including the impact of maternal COVID-19 infection on their offspring. 

We still have major gaps in our understanding of how infants’ and children’s brains develop and how that development is affected by exposure to adversity. Because the brain undergoes major and rapid development throughout infancy, childhood, and adolescence, many of our traits and aptitudes, as well as our resilience or vulnerability to challenges that may lead to substance use and mental illnesses, are being powerfully shaped by our experiences throughout the first two decades of life. Social disruption and dislocation produced by wars, natural disasters, economic crises, social unrest, and pandemics may have lasting impact, sometimes in ways that are not immediately apparent and that manifest in problems years down the road.

Yet while the extreme plasticity of the developing brain makes children vulnerable, it can also be a strength. Children can be enormously resilient, and studies are showing that with the right supports and targeted prevention programs, the neurocognitive impacts of adverse environments like poverty can be compensated for or overcome. Information provided by HBCD and ABCD will help us understand the relative magnitude of different risks such as lack of social interaction or physical activity or financial instability, as well as how different risks interact, who is most affected, and whether some environmental adversity can be countered or compensated for. With insights gleaned from these studies, it may be possible to predict which children are most at risk from the multiple and varied stresses of the pandemic and to design interventions to prevent adverse consequences or intervene early with those children.

The pandemic has posed an unprecedented challenge to life, health, and well-being for everyone on the globe. Science rose to the challenge of developing vaccines in record time. Now, with two major longitudinal studies of development covering the prenatal period through young adulthood, NIH-funded science is poised to address some of the urgent questions facing America’s parents: How are kids affected by the stresses and transformations that are reshaping our society before our very eyes? What challenges can they expect? Which children are the most vulnerable? And how can we help them meet those challenges and thrive?

Earn up to 14 hours of continuing education

From August 15-18, 2021, NADCP held the world’s preeminent conference on addiction, mental health, and justice reform. Now you can experience RISE21 on demand and earn up to 14 hours of continuing education credit!

NADCP has curated some of the most popular RISE21 sessions and presenters and recorded them in-studio just for you. These sessions are now available for purchase through the end of the year to all treatment court practitioners. With purchase, all on-demand registrants will also receive the incredible opening and All Rise ceremonies, including the Leslie Jordan performance that garnered over 500,000 views on Instagram!

If you attended RISE21, you will receive access to this exclusive on-demand content at no cost. Check your email for details on accessing RISE21 On Demand. If you do not see it, please check your spam folder for an email from the address “noreply@talentlms.com”.

Learn More

The post RISE21 On Demand Now Available appeared first on NADCP.org.

I’ve been reading a bit recently about the challenges of healthcare funding in the United States – an ‘international scandal’ according to Noam Chomsky. And although the problems are not the same, those issues have become linked with my thinking on the difficulties of accessing funding for residential rehabilitation in Scotland.

The Lord Advocate’s recent statement allows more discretion to police officers when dealing with class A drug possession.  In effect this creates a facility to issue a warning for simple possession. While not all those in possession of drugs will have a problem, it does feel as if we could have moved a little closer to treating substance use disorders as a health, rather than a criminal justice issue. 

Where drug problems do develop – particularly for those associated with high mortality like opioids and alcohol, treatment is generally available via the National Health Service (or a partnership of health and social care) – free at the point of delivery. Further support comes from the third sector. There can be delays to access this treatment, particularly for opioids, but these are being addressed through the MAT standards implementation. Sadly, as I’ve written before, alcohol does not seem to have the same urgency or resource applied, despite killing as many people.

There’s a caveat here. An anomaly. When I say treatment is available via the NHS, for the moment, for the most part, we must exclude residential rehabilitation treatment. It’s much more available to you or your loved one if you have insurance, or money, or you live in the right place, or you have powerful advocates, or perhaps if you are very, very persistent. In some places you can access rehab via the NHS, but it’s generally not an easy process. Where it is available, it is often not available on NHS principles.

While there are hundreds of rehab beds across Scotland, relatively few are funded by the public purse and even where they are, funding can be tortuous to obtain. Although pathways to rehab are being addressed by the Scottish Government, it saddens me to say that I am still regularly hearing stories of access being blocked, opportunities missed and negative consequences accruing. 

A few years ago, on a visit to a large, well respected, residential rehabilitation facility in the United States I was given a tour of the site by the director. It was striking – nice buildings, lovely location, and access to an impressive range of professionals in a multidisciplinary team. I was struck by some differences to Scotland though. The residents were predominately middle class. Most had opioid use disorder, but the route in had been through prescribing or via diverted prescription medication rather than heroin. The biggest difference was the cost – around £25,000 for 28 days. That’s a short treatment dose at a premium price.

That wasn’t the greatest shock though. As I was shown around the facility, I’d seen various offices, been in patient spaces and met teams of therapists, psychologists, and a couple of doctors. However, the busiest room was choc-a-bloc with admin staff. They were engrossed on phones, animated in conversation. Naively, I asked the director why on earth the facility needed so many admin staff. The answer was simple – they deal with the insurance companies who fund the patients. 

In this industrious place we listened briefly. One of the staff was pleading (yes pleading) with someone on the other end of the phone for two more days funding for a patient. I was stunned, and to be honest, upset.

In a team meeting later, therapists presented on their clients’ progress. Again and again, the issue of pursuing further funding came up – treatment planning seemed to be largely dependent on whether more time could be negotiated from the insurance company, and not so much on what was best for the patient. 

NHS or not?

In 2005, the Scottish Government elected to fund five pilot projects aimed at introducing choice into the treatment system. These were to support individuals whose goal was abstinent recovery. There was a fair bit of resistance to this. 

With the support of what was at the time the equivalent of the Alcohol and Drug Partnership I submitted a proposal for the service which became LEAP.  Early on in development, there was discussion around where best to site the service. Should it be delivered via the third sector, in social care or in the NHS? The decision was easy. I felt access to residential treatment for addiction should be on the same basis as access to treatment for heart disease, diabetes, or cancer.

This meant embedding the principles that access to the service should be based on clinical need, there should be clear and simple referral routes and equity of access. Treatment should be free at the point of delivery and treatment standards should aim to be excellent.

Furthermore, we should be accountable – and we should be fully integrated into other parts of the NHS, allowing patients access to the full range of healthcare available. This approach was an easy sell, and the treatment part of LEAP was set up within the NHS where it operates to this day. Of course, we work in close collaboration with essential partners in the statutory and third sector to deliver the complete service. 

As I say, this is not the norm for residential rehab in Scotland, where residential treatment services can sometimes feel like silos, disconnected from NHS and other services. This can cause barriers to referral, poor connections to detox and a lack of buy-in generally. 

Now I don’t believe for a minute that rehab needs to be delivered via the NHS across Scotland (though it’s clear this can be done effectively and economically) – there are plenty of advantages in the third sector doing this – but surely the same principles ought to apply. Whether we call rehab ‘healthcare’ or ‘social care’, we need to be moving towards a system where funding is simple, equitable and based on need. We need a system where there is real choice and where there are straightforward and obvious routes to get there.

In the past this has not necessarily been easy to do and there are good reasons why. Leaving aside the poor perception some professionals have of rehab and the historically poor resources, in some places those charged with making funding decisions found themselves in difficult positions. Working with a small budget, they were expected to have the wisdom of Solomon in deciding who could go to rehab and who could not. Those tasked with this may not have had any training about rehab, could have had no experience of working in that setting, or indeed had any evidence-based guidance to support the decision making. That needs to change.

Later this year, we will hear more about the reality of the state of play in residential rehab in Scotland which will help inform actions to make matters better. However, things are already changing. Work is afoot to increase capacity, to develop and improve pathways to rehab, to prepare people for it, and to support them better and for longer afterwards. Significant financial resource from the Scottish Government is behind this and there will be more accountability on how effectively it is utilised. Funding models are likely to change for the better.

Thankfully, in Scotland we don’t have to navigate the for-profit difficulties of a system like that of healthcare in the US. I hope we will never see banks of staff begging for funding, but at the moment we have our own unique challenges, not least of which is getting the funding process right. Why should funding for a treatable condition be accessible on a completely different (and more difficult) basis than that for other health issues? It feels discriminatory – stigmatising. Those seeking rehab ought not have to sit in front of panels judging their readiness, or have delays based purely on funding difficulties. 

We need to iron out anomalies and inequities and it is likely we will have to take a national approach to do this. As we develop and improve rehab, I’d like to think that a few threads of NHS principles woven into the system would go a long way to making things better.

This week, I am attending Mobilize Recovery in Las Vegas. Recovery advocates from around the nation, have gathered together here for a third year through the Recovery Advocacy Project. PRO-A the statewide recovery community organization of Pennsylvania has been honored to participate in it since its inception. The message here is that together, we can address America’s greatest public health challenge, the devastation caused by addiction in our families and communities and turn it into our greatest asset, people in recovery. Our inclusion is fundamental to effective strategies.

Patrick Kennedy a person in long term recovery himself, noted as much in his opening remarks. He spoke about how people in recovery are the very assets that America could use more of right now. We know how to turn adversities into strengths. Isolation and despair into hope and strong civically engaged citizenry. We get involved in our communities and learn that purpose in life means everything, and often that purpose involves helping others achieve theirs. We do have something that America could use more of, and we are eager to share it. We are only asking for a chance to do so.

We are seeking opportunities to expand recovery in our communities through the historic 10% in the our SABG federal block grant, We can do great things, provided the states then also pass some of those dollars to our recovery community organizations and work collaboratively to get such resources to recovery communities. This is not what has occurred here in Pennsylvania or other states as this letter to Congress early this year noted. Our organization, the statewide RCO of Pennsylvania historically received modest support for decades from what is called the state single county authority, but now we receive not one single penny. Resources seem to go to larger, politically connected national organizations and academic institutions outside of the recovery community. This trend started around the time federal funding dramatically increased. It must change, these are our dollars too.   

Patrick Kennedy also gave an impassioned speech on the profound disparities in our medical and behavioral health care systems. He spoke about the profound disparities for behavioral health in our healthcare payment system. He noted that although researchers have discovered the brain is connected to the body, we do not treat brain conditions (like substance use disorders) in parity with physical health care. This from the author of the Mental Health Parity and Addiction Equity Act of 2008.

He noted the entity that had the largest disparities was not some huge insurance entity, it was the federal government.  Congress recently moved towards including vision and dental benefits to Medicaid, but left out behavioral health. Medicare benefits are not as extensive as for other services. Tricare, the benefits for our military vets include disparate mental health and substance use benefits. This for our combat service members who ended up with service-connected injuries like Traumatic Brain Injury and Post Traumatic Stress Disorder in military service to our nation. He called it shameful, it is that and more.

Congressman Kennedy, a gifted communicator then compared how we treat skin cancers like melanoma to how we treat addiction. Melanoma in its earliest stage is easier to treat. It can be treated in an office visit with high rates of success. However, when melanoma reaches stage four and has metastasized throughout the body, it is often fatal. Radical medical care is required to save a person’s life in stage four. He noted that this is why we do regular screening for skin cancer, because it makes sense to do. It saves lives and it saves money. Medical care does not wait until people reach stage four to initiate care, we have set up and funded a system of care designed for early detection and intervention because it makes sense in all respects.

He then completed the comparison to addiction and noted that with addiction is also common, and it is also fatal when it tragically runs its course. With addiction we consistently wait till stage four to do anything at all and with disparate funding as noted above. This is tragic and it is morally wrong. It is expensive in lives, resources, and its splintering of our communities. We ignore addiction simply because of pervasive negative views across our entire society. We see it as something that happens in other people families and to other people’s kids. As a society we still see addiction as a moral failing that people are not redeemable from and not the promise of recovery noted above. In our landmark survey with our partners at RIWI and Elevyst of over 26,000 Americans reported that 73%  believe society at large views individuals who are dependent on drugs as having moderate, low, or no chance of maintaining recovery. The truth is we can and do recovery and when we do, we are assets to our communities. America needs to learn our value.

One place to really see this lack of focus on early identification and intervention of substance use disorders is by looking at care to our young people. Our very future. Here in Pennsylvania, we have actually lost ground over the last two decades in respect to the care of our young people. We now have almost no publicly funded residential care for adolescents in Pennsylvania. We had much more 20 years ago than we do now. If you are poor or of modest means, you have almost no options for your kids. This ends up reinforcing the prison pipeline in our black and brown communities who have disparate access to privately funded care. That alone should compel us to focus resources here. Seeing the dramatic loss of our adolescent care infrastructure, two years ago I advocated for and facilitated a hearing in our Pennsylvania House Human Services Committee. We focused the hearing on what had occurred that led to the loss of our adolescent service system and ideas it while also developing a recovery support system for our young people. This should be an easy lift, it is not. I am unaware of any plan within the state administration to address these needs.

Then COVID hits. Last year, I testified in a PA House Human Services Committee hearing on the impact of the COVID pandemic on our fragile SUD service system infrastructure, it was also reported on by Spotlight PA. We lost even more of our SUD infrastructure as this pandemic has unfolded. Our challenges are stacking up as we are seeing drinking rates swell and increased overdose rates. We are moving further into a stage four focused system that waits until the last minutes of life to provide disparate services in a decaying system of care that is crumbling before our very eyes.  

To put it another way, given that we are experiencing a syndemic, the combined impact of an addiction epidemic and a COVID pandemic, which is unfolding synergistically. Heading in the direction we are, we can well expect to see many more “stage four” substance use problems in coming years. We are not even looking at early intervention as the body count swells. We can’t address these challenges without a significant focus on our infrastructure, deep commitment to our SUD workforce and widespread engagement of our recovery communities. These issues should be a state and national imperative.

As mentioned at the conference, an old African proverb says that if you want to stop more people from drowning, you must go upstream and find what is throwing them into the river and stop it. Right now, we can see far enough up stream to see that more people are being thrown into the water even as disparate funding mechanisms tie one arm behind our backs. We have a crumbling service infrastructure and a workforce withering from trying to provide care late in the addiction cycle with minimal resources and even fewer of us left downstream to pull them out. It is an unfolding tragedy of epic proportions.

The common theme between all of these threads and challenges is that we in the recovery community have been attempting to call attention to these needs for years. It is time to include us in supporting our own communities. Our friends and families are dying even as you read this. We know what we need to do. Systemic screening for addiction, early identification, and comprehensive long term focused intervention. We have a long way to go but seeing these people and the kind of commitment that is visible in our communities, I am hopeful. We will fight on for these things as we know that they are needed.  

We will prevail because we have no other option. I hope you are with us.

We can no more do without spirituality than we can do without food, shelter or clothing – Bruce Lipton

Despite the fact that there are plenty of us about, we don’t have as much information as we would like on people in long term recovery. In one study[1], Mark Galanter and colleagues took the opportunity to interview physicians in long term abstinent recovery at a professional CPD meeting in the USA. All of them were members of Alcoholics Anonymous (AA). The researchers wanted to get a better understanding of the role of spirituality in AA membership and if/how the programme helps to stabilise abstinence. 

While most studies look at early outcomes after treatment episodes, the 144 doctors in this study had an average recovery time of 12 years. It was hoped that in studying them new insights would be revealed. 

In my recent blog about humanity in substance use disorder treatment I referenced a paper on spirituality in recovery. Spirituality is to do with meaning and purpose in life and it has been associated in other research with better outcomes for people recovering from alcohol and drug problems. 

Questions

The researchers had some questions they wanted to look at:

Demographics

The average age of the doctors was 58 with the majority (81%) being male. 86% were in employment. 46% had presented with a primary alcohol problem; 6% with a drug problem alone and 44% with a mixed alcohol and drug problem. Almost 60% had been in outpatient treatment for their dependence, but half of them had also been in residential settings.

Going to AA

77% had been referred by a professional and most were active in AA activities such as having a sponsor (82%); doing service (88%), having sponsored others (72%) and the average number of meetings attended a week was between two and three.

Spirituality

Most (60%) believed in God, but more than one in five believed in a ‘higher power’ only and just short of one in five believed in neither, further evidence that at least some atheists settle in AA. Four out of five respondents acknowledged having ‘a spiritual awakening’ which was associated with longer periods of abstinence and fewer cravings (half the craving of those who did not identify a spiritual awakening). Doctors were found to be relatively more spiritual and less religious than the general population and also to score higher than the norm on measures of anxiety and depression.

What does it mean?

The authors point out links between spirituality and recovery from previous studies:

“Measures of increased spirituality have been found to be associated with a positive outcome of participation in both abstinence and psychosocial outcomes of treatment.”

The authors conclude that the strong spiritual orientation in AA is distinct from ‘denominational commitment’, but ‘serves as a key element in the movement’s effectiveness’.

This study is interesting and useful, but it is highly focused on a professional group in a particular setting and involves a questionnaire administered at a point in time rather than following the doctors up over a period. Doctors are not necessarily the same as non-doctors of course. There are controversies around mandating attendance at a specific mutual aid group (even with a strong evidence base). It’s also interesting to wonder about the differences in belief systems between the US and the UK which is more secular, although many do differentiate religion from spirituality. Nevertheless, the findings are in line with other research and still have agency.

Given that ‘epiphanies are hard to manufacture’ and ‘spiritual awakenings’ can’t be ordered on the internet, what does this mean for those coming for help with substance use disorders? If we accept that spirituality has a part to play, ought we be actively addressing this in our interactions with clients? Should we be steering those we work with towards spirituality or encouraging them to talk in those terms? There can be problems problems with professional approaches on the subject, as the paper points out.

Attitudes toward AA among professionals in the substance use disorder field itself are variable, with treaters in the United States perhaps more positive than those in certain other international settings. One sample of American clinicians, for example, all referred at least some patients to Twelve‐Step groups, and most held a highly positive view of the fellowship’s utility. Research from elsewhere suggests a much lower referral rate and ambivalent attitudes to 12-step groups.

And other mutual aid?

A common theme for all mutual aid groups is positive social networking. There are other mutual aid groups around – SMART Recovery and LifeRing for instance, which do not emphasise spirituality per se. But if spirituality is framed in terms of finding meaning and purpose, the instillation of hope, and connection to things outside of oneself, could membership of those groups also contribute to ‘spiritual’ growth in an equivalent fashion or does AA’s spiritual core have the edge in this specific area? Does it matter what we call it?

Attitudes here are changing though as evidence accumulates. If ‘spiritual awakening’ is associated with a reduction in craving and helps those suffering from substance use disorders to remain networked with other recovering people in the long term, then perhaps addressing spirituality is indeed something all of us working with those seeking recovery, in all its forms, ought to be doing.

Continue the discussion @DocDavidM

[1] Galanter M, Dermatis H, Stanievich J, Santucci C. Physicians in long-term recovery who are members of alcoholics anonymous. Am J Addict. 2013 Jul-Aug;22(4):323-8. doi: 10.1111/j.1521-0391.2013.12051.x. PMID: 23795870.

Photocredit: https://www.istockphoto.com/portfolio/PeterSchreiber?mediatype=photography (under license)

This is an updated version of a previously published blog

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Guest blog written by Christopher Sullivan

Most people in recovery do so for themselves; because they want to take back control of their lives. And rightfully so. You should be recovering for yourself. But, it may also be important to consider how your recovery gives life to those you love.

In my case, I watched my father give in to alcohol each day. Instead of standing by my father’s side, I felt like more of a bystander. I wanted to be by him every step of the way, but my hands were tied: at least that’s what I told myself. Being fresh into high school, my worry and anxiety towards my dad’s well-being took a backseat. Yet, it was not long until the message-less nights and the alarming Instagram posts started to remind me of the severity of his addiction. 1-0 alcohol. I would call him until I knew his voicemail by heart, and I would text him until, no matter how far I scrolled, the only color I saw was blue. Once in a while I would get a text saying, “I’m okay”, but I saw through that. Yet I still did nothing.

Fortunately, my grandmother took initiative. My father was sent to rehab in Florida, where he got better by the day. Every week he made a phone call to me, and every week I would heal a little inside. I went from getting two-word responses, to having him go through a whole breakdown of his day, and I couldn’t have been happier. 1-1.

When I was reunited with him months later, the change was evident. No lack of communication, no depressive behavior, and best of all, no tipsiness. 2-1 dad. I was just about ready to hear his victory speech, when alcohol struck again. A drunk driver had crashed into my grandmother’s car, killing her. Although I was in a state of grief, I was also afraid of what this meant for my father. And sure enough, after nearly 6 months of being sober, my father’s trips to the bar resumed. I was back to frantically reaching out to my father, but to no avail. This time, on top of depression and alcoholism, my father was going up against immense grief as well. To top it all off, without my grandmother, he had no one to keep him in check. It was only 2 months later when the police found my father on the floor: his heart finally giving out.

My point in sharing his story is: his story is my story. I was recovering vicariously through his recovery. His losses were my losses, and his victories were my victories. Seeing his bloody face on Instagram after a fight at the bar made me feel like I took a punch to the face myself. On the contrary, hearing he was getting stronger and healthier at rehab empowered me to actively improve my life.

Now I look back at the scoreboard between my dad and alcohol, and I see that alcohol is winning by a landslide. But it’s not over yet. My father and I are a team, and he simply tagged me in. I currently volunteer at SMART Recovery, trying to tie up the score for us, only to find out that my dad and I had a lot more teammates than we thought. Each person at SMART is working to fend off addiction. There’s no judgement here and SMART even offers a helping hand to the friends and family of those in recovery. Speaking of the friends and family of those in recovery, if you are an individual who is watching a loved one battle addiction, remember that you’re their teammate. Even though it may be their battle against addiction, don’t be afraid to help, like I was. Because as it turns out, your support could help them through their toughest battle, and because their victory is your victory.

Watch Christopher’s Life Beyond Addiction 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.

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.*

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