If you’re in recovery, the 12 steps have more than likely become the foundation on which you have built your life in sobriety. These steps have helped individuals suffering from substance use disorder restore purpose and structure in their lives for many, many years.

What can these steps offer to those who are not religious, or even to those not in recovery? At first glance, someone who has never abused substances might feel as though these steps aren’t applicable to them…I’m not powerless over alcohol! A new individual in recovery may see steps 5, 6, and 7 and think, I don’t even believe in God, how can the steps help ME? The beautiful thing about the steps and step-based programs is that they can provide solace, structure, and some wisdom to everyone.

1. We admitted we were powerless over alcohol—that our lives had become unmanageable.
2. Came to believe that a Power greater than ourselves could restore us to sanity.
3. Made a decision to turn our will and our lives over to the care of our higher power as we understood it.
4. Made a searching and fearless moral inventory of ourselves.
5. Admitted to our higher power, to ourselves, and to another human being the exact nature of our wrongs.
6. Were entirely ready to have our higher power remove all these defects of character.
7. Humbly asked our higher power to remove our shortcomings.
8. Made a list of all persons we had harmed, and became willing to make amends to them all.
9. Made direct amends to such people wherever possible, except when to do so would injure them or others.
10. Continued to take personal inventory and when we were wrong promptly admitted it.
11. Sought through prayer and meditation to improve our conscious contact with our higher power, as we understood it, praying only for knowledge of its will for us and the power to carry that out.
12. Having had a spiritual awakening as the result of these Steps, we tried to carry this message to alcoholics, and to practice these principles in all our affairs.

Take a page from the big book…why AA/NA wisdom can be helpful for all.

Powerlessness

As a human, you probably often think that you have autonomy over your life—that you can manipulate and control each variable to will things to go your way. Everyone gives into this illusion at times. The very first step reminds you that you are powerless. Not just over alcohol, but over most of the situations that occur day-to-day.

You can’t control whether or not it rains today, just like you can’t control how bad traffic is on your way to work. You can control how you respond to these events—maybe you grab an umbrella, or leave just a little earlier, or perhaps you make the most of your time in the car during your commute. By understanding that you’re powerless, you provide yourself with the opportunity to live in a greater sense of acceptance and peace.

Taking self-Inventory

What parts of yourself are hardest for you to accept? What comes to mind when you think of your flaws, your character defects, or your biggest failures? These aren’t comfortable things to think about, but in that discomfort, you will find growth.

Write these things down, tell someone you feel comfortable with, and work to fix the things you can change, and accept the things you cannot. As you work to improve yourself, you’re able to show up in a more positive way for those around you.

Turn your life over to something bigger than yourself (addressing the “God” word)

The truth is, you cannot handle all of the dealings of life alone, and you don’t have to. Whether you take your struggles to a higher power, a sponsor, a counselor, or the collective wisdom of a home-group, you must find some sort of greater purpose beyond just yourself. There’s an old saying that goes, “Practice waking up like it isn’t an accident,” This quote means that you should remind yourself each morning that there is a reason for every moment of your life, a greater purpose that you aren’t always able to zoom out and see.

When discussing greater powers and purpose, it’s important to note that AA/NA are not religious organizations. The entities do not offer this encouragement exclusively to believers of a higher power. A.A. co-founder Bill W. wrote in 1965:

We have atheists and agnostics. We have people of nearly every race, culture and religion. In A.A. we are supposed to be bound together in the kinship of a common suffering. Consequently, the full individual liberty to practice any creed or principle or therapy whatever should be a first consideration for us all. Let us not, therefore, pressure anyone with our individual or even our collective views. Let us instead accord each other the respect and love that is due to every human being as he tries to make his way toward the light. Let us always try to be inclusive rather than exclusive; let us remember that each alcoholic among us is a member of A.A., so long as he or she declares.

Bill’s words serve as a reminder that you are bound to others by your common struggles, regardless of your individual characteristics and beliefs. As the Agnostic and Atheist Members in A.A. Pamphlet says, “What we all have in common is that the program helps us find an inner strength that we were previously unaware of — where we differ is in how we identify the source. Some people have thought of the word “God” as standing for “good orderly direction,” or even “group of drunks,” but many of us believe that there is something bigger than ourselves that is helping us today.”

Whatever you believe to have a power greater than yourself is what will allow you to find purpose in your recovery, your mornings, and/or your life, every day.

Make amends and admit when you’re wrong

Unless you’re a robot, chances are, you’ve made some mistakes in your life. There’s probably someone, somewhere that you have an unresolved conflict with. Sometimes, admitting that you’re wrong can be the hardest thing to do. It can be hard to accept that you don’t always know the right way, have the right answers, and especially that you don’t always do the right thing.

It takes vulnerability to admit that you’re wrong. It opens you up to a discussion with yourself and others that may not be easy—but it will be worth it. When you think about life in its simplest form, you’re able to realize that all we have on this Earth is each other. The connections you have with your friends, family members, and co-workers matter. They shape your day-to-day interactions and your growth as an individual. When you begin thinking about someone you need to make amends with, reach out and ask for help by admitting your wrong-doings to someone you trust, a sponsor, a counselor, or a close friend. Repair relationships and practice admitting your imperfections so that you may continue to grow.

Help others and keep going!

As you work to practice the principles of the 12 Steps, you will gain infinite insight, wisdom, experience, and knowledge. You learn best when you teach something to others—yet another reason why strong interpersonal relationships are incredibly valuable. Pass on the things that you learn from practicing these steps of AA/NA. Most importantly, remember that this work is continuous, and requires conscious decisions made each day to learn and grow.

The 12 Steps are for everyone…

…because the steps focus on building a strong and solid foundation in life that supports personal well-being, self-care, care for others, and improve the quality of living. Anyone can benefit from principles rooted in those goals, both the believer and the non-believer, the recovering alcoholic, addict, and even someone who has never used a substance.

***

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

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.

Event Description

I was poking around in some journals looking for something to post about.

I found 3 articles that interested me. One describes the intuitive truth that insight is associated with change, while the other two seem to complicate acquiring that insight.

Broken brains?

Curing the broken brain model of addiction: Neurorehabilitation from a systems perspective challenges the brain disease model of addiction (BDMA) and proposes what they call a systems theoretical framework.

The article starts off with a fair description of the brain disease model:

From this perspective, now often referred to as the brain disease model of addiction (BDMA, Hall et al., 2015, Heather et al., 2018), a vulnerable brain may get “hijacked” by addictive drugs (Nesse & Berridge, 1997). Various neuroadaptations are thought to make behavior increasingly less voluntary and more compulsive, especially when cues indicate the presence of an opportunity to engage in addiction-related behavior.

Key words here are less voluntary and more compulsive. The description continues with appropriately qualified language like reduced control. It then transitions into framing the brain disease model as promoting “loss of free will” based on a lecture on YouTube from Nora Volkow in which she says:

I devoted all of my life to study the effects of drugs in the human brain. To try to understand what is it that they do to our brains that in some people that are vulnerable that can lead them to the complete loss of control with severe catastrophic consequences.

This hardly seems like a declaration that addiction is universally characterized by a complete loss of control. In fact, though articles like this frequently suggest that people who believe in the brain disease model of addiction asserts a complete loss of control, I find that view to be rare. Most describe impairment and episodic loss of control.

They reject the brain disease model on the basis of this characterization and its framing a a chronic condition with continuing vulnerability with “no road back to controlled use or recovery.” It attributes this thinking to 12 step programs. It seems strange to suggest that 12 step programs suggests their is no road to recovery.

It also object the chronic brain disease model on the basis that neurorehabilitation could “only be partially effective” because the “brain would remain hypersensitive.” To me, this is a strange objection. That a treatment might help put a chronic disease in remission is not a small accomplishment.

So what is the treatment? Neurorehabilitation is described as such:

Current (neuro)cognitive training or neurorehabilitation efforts in addiction can be categorized into two broad classes: training of (suboptimal) general functions, such as working memory (WM), and re-training of abnormally strong cognitive-motivational processes (“cognitive biases”) triggered by addiction-related cues, known as cognitive bias modification or CBM (Wiers, 2018). Regarding the first class of neurorehabilitation, there is evidence that training can improve the targeted general function (typically WM), and generalization to other relevant functions has been reported, such as delay discounting (Bickel, Yi, Landes, Hill, & Baxter, 2011), and future episodic thinking (Snider et al., 2018).

The chronic brain disease model doesn’t suggest that neurorehabilitation is of no value, it just would suggests that neurorehabilitation isn’t a cure.

The model seems to have a lot to offer and it does not seem incompatible with the chronic disease model or 12 step recovery. In fact, I could imagine an article on 12 step recovery as neurorehabilitation.

Harm to others?

Applying a ‘harm to others’ research framework to illicit drugs: political discourses and ambiguous policy implications examines “harm to others” as a framework for measuring social costs of substance use and developing policy.

During the past decade, ‘alcohol’s harm to others’ (AHTO) has emerged as an international approach to studying alcohol problems and advocating for improved policy. For example, the World Health Organization (WHO) has adopted AHTO as a stream of work in its global strategy to reduce harmful alcohol use. This approach seeks to identify and measure harms beyond the person who drinks (e.g. family members, co‐workers) in order to increase political will for enacting alcohol policy. The approach follows the way in which evidence of ‘passive smoking’, a form of harm to others, became influential in the debate and development of tobacco public policy.

Of course, this harm to others is frequently discussed in treatment and recovery, but I’d never seen this explicitly described or used as a research framework.

The article raises concerns about the framework on the basis of methodology (imprecision and inattention to micro level considerations), issues of individualism causality (“falsely delineating a perpetrator from a victim, as well as individualizing the cause of alcohol problems”), and stigmatization of individuals.

These measures focus on harms related to alcohol and the authors consider the application of the framework to drugs. They recommend rejecting “harm to others” in favor of “harm from others” on the grounds that it’s more accurate and less stigmatizing.

Of course, there is merit to the questions and concerns raised about the framework. And, the collateral harms experienced at the individual level are real, significant, and important.

There is a great deal of concern for harms experienced at the individual level by people who use drugs, but there appears to be remarkably less concern among AOD researchers for harm experienced by children, family members, neighbors, etc. via interactions with people who use drugs.

Stigma is a very important consideration, but our attention to stigma is an attempt to preserve the humanity of people who use drugs. We can’t erase the experience of others while trying to protect the humanity of people who use drugs.

This framework may not capture THE truth, but it does capture important truths and one important dimension.

Insight

Insight in substance use disorder: A systematic review of the literature found that “better insight was generally related to negative consequences from substance use, better treatment adherence and maintaining abstinence.”

A predictable challenge is determining how to define insight. There were 20 studies selected for the meta-analysis and there were 13 different measures used. The most frequently used tool was the Hanil Alcohol Insight Scale which is described as such, “The measure focuses on perceptions of drinking harms (e.g., ‘My drinking did no harm to any member of the family’) and the need for treatment (e.g., ‘It was fortunate to have a chance to be hospitalized’)”

The discussion lays out the relationship between substance use, consequences, insight, and motivation this way:

It is often only when there are other consequences such as loss of job, relationship problems, legal problems, or financial problems that people start to think they may have a problem that needs treatment. This could explain results from studies where participants with better insight also reported higher use, and more consequences of use such as relationship or work problems (Kim, Kim et al., 2007). An important finding from this review was identification of a relationship between readiness to change and insight (Kim, Kim et al., 2007; Slepecky et al., 2018). People with higher insight were more ready to change than their low insight counterparts.

What’s the throughline?

If insight is associated with higher levels of readiness to change, treatment adherence, and abstinence, it invites the question “insight into what?”

The articles about the brain disease model and harms to others are typical of a lot of academic work on drug and alcohol problems.

A lot of people generating academic knowledge seem focused on casting doubt upon and destabilizing the ideas that patients would achieve insight into.

The realizations that “I can’t control my substance use” and “my substance use is hurting the people I love” serve as an inflection point for so many people, leading them to seek help and change.

I don’t completely understand this consistent effort to destabilize these insights and who it serves.

This week, I listened to an excellent interview on The Best Minds Podcast featuring Harvard trained physician and internationally recognized addiction expert Dr Robert DuPont. I was struck by his humble wisdom. He spoke about his early work with methadone patients and how many of them eventually died from alcoholism. He spoke about how narrowly focused, well-meaning care focused on opioids and not on addiction, of which opioids is only one facet. We owe Dr Dupont and others like him a great debt for their contributions and the humility of acknowledging who the experts on recovery are – people with lived recovery experience. He and others of his caliper and wisdom made space for us to talk about the value of community in recovery and strengthen recovery efforts.

Such wisdom is unfortunately rare. It reminded me of a few years back of an encounter I had with Mr. David Mactas. We brought him in as our keynote speaker for our agencies 20^th anniversary celebration. He was the first Director of the Center for Substance Abuse Treatment for the US Dept. of Health and Human Services. He played a major role in establishing the federal Recovery Community Service Project – State Network Grants. The grants were vital to establishing the first recovery community organizations in America, and PRO-A was an initial recipient. Space was being made for lived experience to inform our care systems and strengthen our community. Recovery history was being made.

One of the best parts of the event was getting to spend time with him. He is a brilliant man with deep insight into treatment and recovery efforts. I spoke with him about what those grants meant for recovery community organizations across the nation and the fruit that his efforts had yielded. We spoke of the New Recovery Advocacy Movement and the progress and challenges that we had experienced.

He noted in our conversation that movements end. The words hit me like a ton of bricks and still resonate. Movements do indeed end and not necessarily with accomplished objectives. They have been in the back of my mind ever since.

How will we answer that question?

For readers who may not be aware of what the New Recovery Advocacy Movement is, I would point to to the immense contributions to our history and the conceptualization of recovery efforts by thought leader Bill White. His collection of papers can be found HERE.  It would be hard to overstate the contributions he has made to our efforts to save lives and heal communities through the power of recovery community. He has also done more than anyone else to catalogue and preserve our history.

I view Bill White’s work as essentially the Svalbard Global Seed Vault of recovery. The global seed vault stores seeds in the event that pestilence, drought or other events wipe out essential food crops. It holds the food security of humanity inside its very walls. Bill White has established out recovery seed vault trough his vast collection of writings. When the new recovery movement ends, our history and the things that we have learned along the way are preserved within his vault. Accumulated wisdom for future generations to use these seeds to replant and start over.  

The potential end of the new recovery advocacy movement has been very much on my mind over the course of the last year. This is not the first time I have written on this topic. Many others are concerned. I am regularly taking to people from across the nation about the myriad of ways the recovery community is currently being marginalized. Key policymakers in varying positions do not actually believe we get better because they lack lived experience. Our system is replete with academic and medical experts who lack lived experience and direct knowledge of what works in real life conditions or the wisdom and humility to listen to our community. There is a growing dialogue that treatment does not work, recovery is not for everyone with addiction, we cannot possibly help everyone and some people do not want to break out of addiction. Money related to the “opioid epidemic” which is actually an addiction epidemic never actually reached us, instead it went to large academic groups, think tanks and institutions who became interested in addiction the moment there was money to be had. The results for us have been nothing other than tragic. We are dying. It is not an academic exercise for our community it is life or death.

If there was ever a time to get our nation focused on getting more people into long term recovery, it is right now.  COVID-19 is fueling some of the underlying facets that drive addiction in America. Developing and sustaining the type of care and community support system we will need to save lives and heal communities is simply not possible without meaningful inclusion of the recovery community.

To do this we need sustained, collaborative efforts focused on care that focuses on recovery in meaningful ways.  If we fail this, the movement will end sooner than later and it will end without achieving our goals. 

What should we focus on if we are to sustain our movement and accomplish meaningful, recovery focused changes to our care system?

• Full inclusion of persons in recovery in the design, implementation, delivery and evaluation of services in order to ensure that care meets the needs across the full spectrum of diverse persons seeking help.
• Tools to hold our care systems accountable when disparate, short term care is provided to ensure that applicable laws around access and duration of services are consistent with applicable laws.
• Long term, whole person recovery focused research that examines recovery over the long term in order to understand what works for whom and under what conditions.
• Focused effort to reorienting our entire addiction care system to fully create and sustain the five-year recovery care model as the research is showing us is that this is the point at which 85% of persons will remain in recovery for life.

I am grateful that we have a seed bank of recovery, but would prefer to be adding stock to it rather than closing the doors and preserving it in hopes that the next generation can pick up where we left off and more of us die needlessly.

What happens with the new recovery advocacy movement depends on us, and most likely what we do in the coming months. We tend to accept stigma and discrimination at the very moment we should rally against it.

The words of Harold Hughes ring in my ears:

“We in recovery have been part of the problem. We have both accepted and perpetuated the stigma that kept us from getting help and that has killed millions of addicted victims. By hiding our recovery, we have sustained the most harmful myth about addiction disease: that it is hopeless.  And without examples of RECOVERING people, it’s easy for the public to continue thinking that victims of addiction disease are moral degenerates – and those that are RECOVERING are the morally enlightened exceptions. We are the lucky ones – the ones that got well, and it is our responsibility to change the terms of the debate, for the sake of those who still suffer.”  – Senator Harold Hughes

Are we going to hide our recovery and descend back into the basements, tear each other up in factional disputes or continue to be coopted by outside groups? 

The answer is up to us. Right here, right now.

In times past, for those with opiate use disorder who were in treatment in therapeutic community settings, as progress was made and days abstinent from opiates grew, a beer might be allowed by staff, say on a Saturday night, in a supervised and supported fashion.  Not in any service I have worked in, but nevertheless true in some settings. For some, it didn’t end well.

As I’m writing the words, I’m thinking of the numerous patients I’ve known who, despite warnings, have relapsed to opiates through drinking alcohol, or who have remained abstinent from opiates and gone on to develop an alcohol use disorder. Unhappy memories.

One reason for this disconnect or blind spot is our tendency to make diagnoses in limited silos like ‘opioid use disorder’ or ‘opiate dependence’ when the vulnerability is to substances (and harmful behaviours). When considered in the light of the neurobiological, trauma-related, learning and genetic evidence on addiction, it makes sense that we think in a broader fashion.  

Robert Dupont, an early pioneer of methadone clinics in the USA, makes this point powerfully in the interview that Jason linked to the other day when he began to realise that despite his patients being in a high quality MAT programme, some of them were dying of alcohol dependence. Dr Dupont was forced to reconsider what he thought he knew about addiction. It’s an illuminating podcast.

Opiates & Alcohol

In opioid replacement therapy populations it has been reported that as many as a third of people misuse alcohol, which has all of the usual negative health consequences that alcohol problems bring but is clearly also dangerous because of the risks inherent in mixing depressant drugs. SAMHSA indicates that between a half and two thirds of opiate-dependent individuals are problem drinkers.

In a study from last year, Dr Shannon Kenny and her colleagues explored patient expectations after detox. They looked at 417 patients who had gone through an opiate detox programme. They found that patients often didn’t have any intention of stopping using other substances. 

The researchers remind us that use of alcohol, benzos and cocaine at treatment entry into opioid treatment programmes predicts poor outcomes. (Therein lies the problem – if we consider we are only offering opioid treatment to those with polysubstance dependence, then we are not addressing the full picture.)

In their sample, around 50% reported alcohol use recently, nearly half had used cocaine and nearly half had used benzos.  About a quarter reported using all three substances. This fits with my clinical experience.

They reference previous research showing that in medication treatment programmes, clients find it ‘too much’ to quit both opioids and other substances at the same time.

In their sample, around half of those undergoing opioid detox did actually intend to quit drinking, but this was much lower for benzos and almost non-existent for cocaine. They state:

Despite near universal intention to quit heroin—our past work has found that 98% of withdrawal patients intend to quit heroin—our results suggest that many people initiating heroin withdrawal management have no expectation of participating in the total abstinence model of recovery.

They conclude that ‘inpatient heroin withdrawal programs need to address and educate patients about how polysubstance use complicates recovery from heroin use.’ I agree, we need to be really clear about what’s going to help people reach their goals and what’s going to stop them dead in their tracks. There is a clear role for harm reduction here, but also, I would argue, for raising the bar on what’s achievable overall.

We can learn from research, but we can also learn from the past.

Important lessons

History promises us important lessons if we sit at her feet and listen carefully to her stories

William White

Bill White looks to experience to give some pointers on drinking in recovery from opioid dependence in an old article from Counselor Magazine.

He details the start of the Therapeutic Community movement (Synanon) when clients in treatment (generally recovering heroin addicts) could gain ‘drinking privileges’. 

Sounds progressive. So how did it go?

White relates that alcohol problems grew within Synanon in the 1980s and contributed to Synanon’s eventual implosion as an organisation.

Okay, not so well then, but what about other organisations?

White also reports the experiences in ‘Daytop’ a New York therapeutic community. This time there were safeguards: drinking was only permitted for those with no prior history of alcohol problems. They reasonably assumed that in this group the risk of dependence would be about the same in the general population (6-10%). They also had a policy of non-acceptance of intoxication.

So how did that go?

‘The first signs of problems with the alcohol policy within Daytop and other TCs followed a predictable two-stage pattern. The first stage was the appearance of drinking at social events within the TC community (e.g., staff parties) and at outside professional conferences that exceeded the bounds of social drinking and sparked other inappropriate behaviors. The second was the development of severe alcohol problems (or relapse back to heroin and other drugs while under the influence of alcohol) among some TC staff and graduates.’

Any red flags?

White details some factors reported, but not evidenced, which might predict future problems:

1) A family history of alcohol problems,

2) A history of alcohol problems predating the emergence of another pattern of drug dependence,

3) Co-addiction to alcohol and other drugs prior to entry into treatment,

4) The presence of a co-occurring psychiatric illness,

5) A history of childhood victimization,

6) Later developmental trauma (e.g., loss via death or separation), and

7) Enmeshment in a heavy drinking social network.

When I apply these criteria to the people I typically work with, then there aren’t many left outside the fold.

I know some people in recovery from heroin addiction who drink alcohol, apparently without problems. They are few in number in my experience but they exist. I know many more who have tried to drink in a healthy fashion following opiate detox and treatment who have failed. I believe that the things that make people vulnerable to heroin addiction, also make them vulnerable to alcohol and other substance dependence and that although we cannot precisely quantify the risk, it is significant.

Helping our patients (or clients) make informed choices is a fundamental part of what we do in addiction treatment settings. Addressing the risks around drinking (and using other substances) for those with opiate use disorder needs to be at the heart of our treatment programmes and our programmes need to be designed to tackle addiction, and not be so focussed on single substance use.

The answer to the question – ‘is it okay to drink if you are in recovery from opiate dependence?’, is most likely – no.

This interview was done by Chris Budnick. Thanks Chris and Jude!

Who are you?

Well, I will first start by saying I’m a woman in long term recovery. What that means is that I haven’t found a reason, since June the 13th, 1991, to use any substance. I’m also a mom, a grandmother, a wife. I am a therapist. I work in the [addiction and recovery] field. And what else? Oh, I’m a minister. I don’t want to leave that out. And I’m a life coach.

What do you do professionally?

So professionally, I work with women and children. I serve as a coordinator for the Perinatal Substance Use Project with the Alcohol and Drug Council of North Carolina. I also serve as a consultant for the division of Mental Health Development Disabilities and Substance Abuse Services, and also Public Health, the Women’s Health branch, that’s one position. I do capacity management with them to make sure that the programs are reporting their weekly beds, and that I compile those numbers into a report that goes out to over 600 people in the state of North Carolina. I do technical assistance around gender responsive treatment. I also have a private practice. So I see clients… Now it’s virtual, but I see them in my office in Holly Springs when I’m seeing clients in-person. So that’s what I do professionally. Also, I do some ministerial work at Victoria’s Praise in North Carolina. I’m a part of the ministerial staff there.

And we’ve been fortunate in Healing Transitions to have you do some mentoring for our staff.

Yes. And I love it. It’s been such a great experience.

So you already mentioned that you’ve been in recovery since June 13th, 1991, do you have any additional experience that you’d want to share about your addiction and recovery?

Well, you know what, the one thing I will say is that when it comes to recovery, some people have the idea that things are gonna be perfect once you come into recovery, that is not the case. Things are gonna continue, life happens, that’s the bottom line. It rains on the just and unjust. So that means that things are always going to be going on, and it’s up to you to personally take care of your recovery. As I would say, especially for people that work in the field, there are often people who come in the field, might have their own personal experiences with addiction or personal experiences that needed counseling, and they think, “Well, I wanna be able to give this back.” And that if they come in, and they help other people, that will help them. It may help you a little bit. But the bottom line is your personal work that you do for yourself is what stands. I mean, you do your clients and anyone that you work with [a disservice], if you don’t take care of your own personal recovery, it’s just like when you get on a plane and you see the stewardess say, “Put the mask on yourself first.” So if you don’t have that mask on yourself first, you can’t help those that you serve. So I think that is very important to know.

Tell us about your professional experience in the area of addiction and recovery, maybe you could get into a little more detail about what aspect of the work that you’ve done and what’s been meaningful about it.

Okay, so I’ve been working in this field for over two decades. I used to work as a lab technician. I initially started volunteering, again, trying to help my own recovering. So I started with teenagers because I was very young when I came into recovery. That worked for a little while for me, but that just wasn’t my fit. Then I worked in a halfway house with men over 80 men in this facility. That was nice. I learned a lot there. But that just wasn’t my fit either. So, I think in 1998, I was a part of a major project that was about bringing gender responsive care in my area. I’m from New Jersey, and this was one of the first women’s programs, and we had an opportunity to do partial care, where the women was with us all day long and it was an 18 month program, which was very long, if you think of it, but they needed that. So, it was an 18 month program, maybe 22 women at the most, two clinicians, and we had case managers.

So that was where I found my love. I grew so much, I was able to really be able to pour into those women, but also grow myself emotionally, physically. I did that work for a long time and that program was very successful. They were there in place for over 20 years. Then, something fell into my lap, it was a position, and I wasn’t qualified for it. I didn’t have a master’s degree at the time, but it was being the coordinator of FASD, Fetal Alcohol Spectrum Disorder. So I went in that direction and it is pretty much the work that I do today, the only difference is it’s not specific to Fetal Alcohol Spectrum Disorder. So that allowed me to be able to do public speaking, technical assistance, work specifically with the providers that were able to offer those services for the women.

So, I love working with women, and in my private practice, I have now been working a lot with the children. I’m not specifically working with FASD, but I do have some clients with that particular diagnosis. 

I went back to school, got my graduate degree, and I’m a licensed clinical mental health counselor, associate, because I’m new to North Carolina so I had to get those 3000 hours. So that’s the work I do today, and I absolutely love it. There’s definitely a need for someone that has the passion and to show compassion and love for the work that we do.

What are you most proud of, professionally?

Well, I am most proud of that, the work with the women, I really… I love it. Some people burn out in this field. I haven’t because I’ve had great supervisors that taught me through supervision that I have to take care of myself in this work. So what I’m very proud of is that I never allow my love for working in counseling to wear me down. I really knew and learned that it’s important for me to take care of myself in order to be an asset to those that I serve. So I’m very proud of that, that I’ve been in this field for over two decades.

What keeps you working in addiction and recovery as opposed to something else?

Well, I would say that one of the things that when I did go back to school, I did wanna have that opportunity to work more specifically with the children that may have been affected by [addiction] or are affected by other things like divorce. So I would say, continuing to grow in this process, always keeping myself educated, always staying on top of the next thing, not keeping myself at a place where I started because things are forever changing. When I came to North Carolina, I had 19 years in recovery, and I actually had been working in the field for 18 years at that point. I was on a trajectory of really climbing in my field… people knew me. So, when I came to North Carolina, I felt I had to start completely over, but I’m glad I came in with a mindset, being open, willing to learn, not coming in as if I knew it all because I had been in the field almost 20 years at that point. So I allowed myself to come in as a sponge and I learned that I didn’t know all that I thought. North Carolina is doing great work when it comes to recovery, and not putting down North New Jersey where I was from, but the work was different here. So I am glad that I allowed myself to come in and be open, be a student, and continue to be at that place where I’m willing to be a student, not ever getting to the place where I have arrived.

So I would say that’s what keeps me here… It’s always growing and changing, and we’re doing great work when it comes to working in the field of addiction, being able to have peer support specialists that are able to help the clients that we work with. So I would definitely say, being able to never allow yourself to get to that place where you feel you have arrived or that you know it all, or that the way you got it was the way that every client you serve is going to get recovery, because it’s not.

How has the pandemic affected your work?

I would say it’s busier than ever at this point. For the women that I work with, what we’re seeing now is a lot of primary mental health. If your primary is mental health, if you have a diagnosis of schizophrenia, then that is your primary diagnosis and, if you’re using substances, then that would be your secondary. So we’re not able to refer that particular woman to the women’s programs because she doesn’t meet the qualifications and might not be able to keep up with the groups that are going on, being unable to get along with her peers and the staff. So I would say with the pandemic there has been an increase in mental health, there’s definitely been an increase in our calls at the Alcohol Drug Council. In my private practice, there is an increase in clients that I’m seeing.

What effects of the pandemic are you observing in the people that you serve, particularly women in need of perinatal substance use services?

Well, when it comes to them being able to access the services, one of the concerns that some of them have or many of them may have is that if they are referred to a residential program, are there protocols in place? Now, some may say, why would they wonder if there’s protocols in place if they are homeless and don’t have anywhere to go, but they have every right to wonder if there’s COVID protocols in place, and wonder if they and their children are going to be safe. They have the right to know that. Some people will believe that every person that uses substances, that they are neglecting their children or that they have lost all of their humane decisions. That’s not always the case, and some of them are concerned about that.

All of the programs have COVID protocols in place. We are meeting with them… there’s a management team meeting that we meet weekly. My leader, Starleen Scott Robbins, is making sure that she keeps us abreast of what’s going on. That’s what I see a lot of, but once the women know that they’re gonna be fine, it’s a great resource for them, then they’re excited that there are still choices, because that’s the other thing… folks are thinking because of COVID that there are no resources available at this time, or that they stop taking referrals when that is not the case. We’re still taking referrals, and there are actually a lot of beds available at this time.

What, if any, long-term effects do you anticipate on the field?

Well, as I said, there’s been an increase in mental health [problems]. I think about how it will affect people socially, when you think of people that have connected themselves to 12-step meetings, not having that in-person relationships that are able to bond as opposed to doing virtual, I think that that will be a long-term effect. I believe that financially, we’re gonna see a big change when it comes to hotels and restaurants and all of the things… Even when you drive downtown Raleigh, just what has happened there, I believe that we’re gonna be seeing years of this effect in our country, and our state of North Carolina. So I do believe that will make a difference. One of the things I appreciate is that if this would have happened 10 years ago, we might not have had platforms like Zoom and be able to still do training, and still do conferences, and see clients. That has been good. That’s a nice thing, and I hope that the boards that we work with, the addiction board, the LPC board, the Licensed Clinical and Mental Health Counselor board, the Social Worker boards, allow this to continue. I hope that this is something that is here to stay. Because, if you think about it, we’ve had clients that are in rural areas that are unable to access services, and they’re able to do it now.

That kind of goes nicely into the next question about any benefits or new opportunities in the pandemic, so anything additional to add to that?

I would just say that I hope… I put my plug in at the board, sent a email at my board, and I’m hoping that that is something that stays. I think even when you speak to the programs that have clients that have been able to access meetings or access groups via virtually, they loved it.

You also have your people that have issues with social anxiety, so they might not even come out and say, “Well, I don’t wanna go to the meeting because I’m uncomfortable with being around people,” and it just gives them that opportunity to take away that fear of facing someone head on, especially, when you’re at a place where you’re pretty vulnerable right now. So I think that is something that’s been nice. 

I believe it’s gonna be here to stay. I have a women’s conference that I participate in every May in Asheville. I was really upset that we couldn’t go this year. And I remember a few years ago, when I first started participating in that conference, it was at Kanuga, which is a lake in Hendersonville, and so many people were very upset about us not being at Kanuga when we moved it to Asheville to the MAHEC, but it was easier for us to maintain and work on the conference there for the people that were a part of the conference planning committee. So we went through that transition, and what we saw was little bit by little, our numbers started coming back up, ’cause we did lose quite a few because people wanted that place to be able to come to the campgrounds and unplug.

So when this happened, and our conference was cancelled, it was almost like that same kind of feeling, “Wow, the conference has been cancelled.” I remember that week I was really mourning not being there because I looked forward to it. And so that day, I had a training, and the training was with FIRST at Blue Ridge, so they’re out of Asheville. And so when I got on the conference, one of the things I saw was a couple of the women from the women’s conference, and that allowed me to plug in, be present, and participate in some different breathing exercises, so that allowed me to plug in to that and participate. 

We had our women’s conference in September, it was successful. I mean, we kind of felt like, “Wow, how is this gonna go off?” But it did, it went off, and it was a successful conference. And so, I hope that as time moves on and we’re putting things back into place, that we will allow virtual platforms to be a part of what we do.

If you were able to work on a fantasy project to improve treatment and recovery support, what would it be?

I would say, an opportunity to help those women that have that primary mental health diagnosis because… Okay, imagine you’re getting a call from five, six, seven, eight women that have mental health primary, but they’re pregnant and they’re using substances, but we have no resources for them. What do we do? Even if we find a way to put them in, maybe Walter B. Jones, which is one of your alcohol-drug treatment centers, they are very helpful when it comes to that difficult population, but once time is up, then what? Her time is up once she delivers her baby. So is the plan that she’ll deliver her baby, and automatically that baby is gonna go into the system? So if I could have any project that I could work on, it would be a project that look at how to help that population because it’s pretty sad when you think about it. When you have a woman that, even if she’s in a state of psychosis, there are times she has her moments of clarity. And so it might be at her moment of clarity she is reaching out to your agency for some help. And so the answer is, “We can’t help you because your primary is not substance use.” And so that would be the project that I would love to work on.

For you, as a woman of color, I could see these questions being asked in a different way, what effects of the recent racial injustice have you been observing on the people you serve? Do you have any thoughts or reflections about how some of these questions that we’ve explored about the pandemic and its impact on the people that are being served that would apply to the racial injustice that’s been going on in our country?

Well, I would not say that we’re seeing that in the population… Of course, it is something that is pressing for people of color. A couple of years ago I had an opportunity to go to a training. I think it’s REI, the Racial Equity Institute out in Greensboro. Every person that is in North Carolina should participate in that training, black, white, whatever. Because in that training, some of the things that we feel as a person of color… See, when you see me, if I’m presenting, I’m always dressed a certain way. I have that mentality because of my parents told me that I had to always dress a particular way, I had to speak a particular way, and I just had to work harder than my next white counterpart.

Now, that was the message that I got. And so as we go through these times and… I mean, it’s horrible. But what we people of color is that we’ll say that we’ve been feeling these injustices for a long time. In the programs that I work for, because of the leader that I’ve had and Starleen Scott Robbins and Flo for the many years, every woman no matter what her color is, is treated fairly. I know that. I could say for each program that they’re in. I think that that makes a difference, the leadership and understanding that, even if you don’t recognize it, that there’s something that we feel different on the inside. 

I grew up in a town, Asbury Park, New Jersey. So it’s on the shore. That’s where the boss [Bruce Springsteen] is from, right? We were sandwiched in between some pretty wealthy towns. And so I was next door to this town called Deal. I mean, they were filthy rich, and we went to school together. So I never experienced that at school because we had that multicultural thing going on at my school. But when I got to college in Buffalo, New York, I experienced racism like I had never experienced before. Oh my god, I was devastated. It happened a few times. Even though my parents gave us that preparation, they didn’t prepare me for that. 

So I will say that your leadership matters. The way you lead and how you treat the people that you serve is what matters. When it comes leadership, we know that trickle down. It trickles down. Everybody should have that same message. So that means that if your woman at the front door is not trauma-informed, then it doesn’t matter, because she might be the first person they see. So it’s the same way. If you’re at the top and you have a very present issue with racism, it will trickle down all through your organization.

Thank you, Jude.

Justice For Vets Launches Veterans Treatment Court Academy

Schedule one-on-one virtual office hours with veterans treatment court experts

Make your appointment

Veterans Treatment Court Academy is now open! This new resource from NADCP’s Justice For Vets offers interactive learning tools from seasoned experts on topics critical to treating and caring for veterans in treatment court settings.

Veterans Treatment Court Academy is offering virtual office hours with veteran support experts November 5 and 6. Schedule your appointment today! 

Just like a professor in college, virtual office hours allow practitioners to schedule one-on-one discussion time with experts and receive individualized, confidential instruction via video chat or conference call.

Schedule your appointment now with Justice For Vets Director Scott Tirocchi and Project Director David Pelletier to answer any question on veterans treatment court issues, including:

• Trauma
• Mental health
• Recovery support
• Behavior modification
• Sustainability 
• And more!

Make your appointment

The post Justice For Vets Launches Veterans Treatment Court Academy appeared first on NADCP.org.

Event Description

Apply Now to Help Build Recovery Capital in Juvenile Drug Treatment Courts

Application deadline: Friday, November 20

Apply now

NADCP is thrilled to announce an exciting new project to help participants and families in juvenile drug treatment courts (JDTCs) build recovery capital. The Adolescent Recovery Oriented Systems of Care (AROSC) Project is a multi-year endeavor for JDTCs that want to lead the field in applying the principles of recovery capital to improve operations and enhance positive youth development. This project is funded through the Office of Juvenile Justice and Delinquency Prevention.

How does it work?
NADCP will select six JDTC programs to participate in the AROSC project through a competitive application process. The selected programs will be asked to re-envision operations through a recovery-oriented lens. Each team will be assigned an NADCP coach over the two-year project. Coaches will engage in site visits and support teams through training, technical assistance, strategic planning, and networking with other AROSC sites to help each court align operations with the recovery capital model.

Is my JDTC eligible?
Your JDTC is encouraged to apply if it meets the minimum criteria below:

• Has been operational for at least three (3) years
• Accepts participants diagnosed with substance use disorder
• All core JDTC team members agree to participate
• Can identify and describe local, youth-oriented recovery resources
• Has support from administration and other decision-makers
• Is willing to engage in change processes and measure outcomes

NADCP is now accepting applications, and the application deadline is November 20, 2020. Don’t wait, just six spots are available!

Apply now

The post Apply Now to Help Build Recovery Capital in Juvenile Drug Treatment Courts appeared first on NADCP.org.

Celebrate Veterans Day in Your Treatment Court

Justice For Vets Veterans Day 2020 toolkit – available for download now

Download the toolkit

Veterans Day is an opportunity for treatment courts to pause and recognize the service of members of the U.S. armed forces, past and present. NADCP’s Justice For Vets assembled a toolkit full of ideas for programs to safely recognize and celebrate Veterans Day – Wednesday, November 11. 

November is the ideal time for veterans treatment courts to engage their community. This toolkit contains a wealth of resources to help you plan and execute events, as well as educate your elected officials and the media. In addition, Veterans Day can bring up mixed emotions or usher in a difficult holiday season for some veterans in your program. For these reasons, we have also included tips on ensuring your staff, participants, and mentors have the support they need.

We encourage you to share what your program is doing on social media. Tag us on Twitter @Justice4Vets or on Facebook @JusticeForVets.org!

Download the toolkit

The post Celebrate Veterans Day in Your Treatment Court appeared first on NADCP.org.