“A proper community, we should remember also, is a commonwealth: a place, a resource, an economy. It answers the needs, practical as well as social and spiritual, of its members – among them the need to need one another.” ― Wendell Berry

One does not have to look very hard to see there is a general malaise in America. We are mired in a time with a myriad of complex challenges in which solutions seem elusive. We are experiencing profoundly difficult economic conditions, war, supply chain disruptions, social isolation, and a level of vitriol toward each other unrivaled at any point in American history since the Civil War. It is moments such as this that offer us the opportunity to rise to our collective challenges and build something anew. We must look beyond despair to restore hope to sustain our society. Drug use to numb pain and addiction have become more prevalent. Our times require narratives of healing to overcome collective despair.

Despair is pervasive in our era. Partially as a result, our life expectancy rates continue to fall, even as other nations began to rebound after the first year of the pandemic. Overall, U.S. life expectancy decreased from 78.85 years in 2019 to 76.98 years in 2020, slipping even further to 76.44 years in 2021—a net loss of 2.41 years as noted in a recent study by the University of Colorado Boulder, the Urban Institute and Virginia Commonwealth University. There is a lot of despair, which seems a central facet in the shortening of our expected lifespans, and the impact can be uneven. Black and Indigenous people are experiencing overdoses at a rate greater than the white community.

As this NPR article describing the work of Princeton economists Anne Case and Angus Deaton, examining why US life expectancies were falling notes, “Americans are drinking themselves to death, or poisoning themselves with drugs, or shooting or hanging themselves” at unprecedented rates starting around the year 2000. The evidence suggest that these trends are getting worse. What we are doing is not working. What we have not done involves investing in community.

The conceptualization of these fatalities as deaths of despair was an important step. It allowed us to understand the antecedent factors leading to these tragic losses. Such a narrative is important to help us consider what we are facing. However, to move to solution we need to develop narratives that place our communities on pathways of hope and healing. We cannot stay stuck in the problem. We have a systemic challenge, and we need to conceptualize how to reverse these deaths of despair on a society wide level by restoring community by developing narratives of healing in our communities. We must develop a solution narrative to overcome a problem narrative.

The opposite of despair is hope, a commodity in short supply for too many Americans. We must restore hope on the collective level to save lives and heal communities. If we want to restore hope in large scale ways, we must nurture such communities and help them grow. We need to focus resources on the communities impacted to the greatest degree, which means investing in black and indigenous communities as a priority. As addiction is a central factor in deaths of despair, solutions must center on recovery.

Recovery narratives are stories of post-traumatic growth (PTG). PTG is a form of positive change that people experience as a result of struggling with major life crises or a traumatic event. PTG can be considered an outcome as well as a process. It is about maintaining a sense of hope that not only can a person who has experienced trauma survive but they can also experience positive life changes as a result. Addiction has facets of trauma imbedded in it. Often, but not always, addiction rises out of traumatic life experiences, and even when its roots are more firmly from other causation, like genetics and heavy use, life in addiction invariably involves significant trauma either antecedent or subsequent substance use initiation. Addiction can be seen as a communicable condition, but so can recovery.

Recovery stories are most often seen in the context of personal narratives, and they are highly individualized, no two people have identical recovery pathways. Restoring hope at the point of deepest despair is a common theme of addiction recovery narratives. Thousands of people experience the restoration of hope every day across the United States. But these are not just individual narratives. They are also shared narratives. Hope is often restored in small groups of people who support each other’s process. They work to regain their lives and provide service to each other in support of their common goal, recovery. They establish islands of healing. We need these islands in all communities.

Post traumatic growth occurs on the level of community. All addiction mutual support process can be viewed in the context of communal post traumatic growth and recovery. Communities’ recovery together from a variety of traumas beyond addiction. Natural disasters, mass shootings and economic collapse are several that come to mind. Often, communities develop stories of how they came together to heal and build anew. Narratives that help people conceptualize common cause and rise up together through the devastation and redefine themselves. They form new islands of mutual support.

An example of a shared narrative of healing occurred through the New Recovery Advocacy Movement (NRAM). NRAM occurred at a time many of us saw as a crisis time, and they came together to change it. Groups of dedicated people with few resources came together and changed a lot of what we do and think about addiction, they started focusing on the healing and not just the pathology. They shifted the narrative to recovery. They began to share their stories of healing and developed community-based strategies of healing. Investment by SAMHSA was fundamental to what happened. Several people at SAMHSA, including Dr H. Westley Clark and Cathy Nugent understood that communities can heal themselves and with even modest resources could build things sustainable over the long term through the Recovery Community Support Program (RCSP). They had the insight that communities that are resourced to heal form a process collective traumatic growth. Islands of hope, connection, and purpose. Communities that can help heal other challenges beyond addiction and bring us together as a nation.

In looking for articles on how to systemically address deaths of despair, little has been written on solution narratives. Five years ago, Bill White in his piece The Role of Recovery Communities in Cultural Healing posed the question: “Is it possible that people in addiction recovery and diverse communities of recovery could serve as a force for cultural and cross-cultural healing?” It seems to me to be the question of our times and the narrative we build to do so is crucial.

What we may want to think to change the direction we are heading:

• How do we conceptualize and articulate community wide solutions to address deaths of despair?
• What can we do as a society to fuel efforts to strengthen resiliency in all of our communities?
• Where are our narratives of hope to bring people together to reverse these deaths in diverse communities across America? 
• How can we form recovery narratives of hope that we can share with each other so that communities can start to heal themselves?

One of the reasons we may have difficulty developing a collective hope narrative is that we approach solutions primarily with a service focus, rather than a community building focus. I suspect having interviewed and worked directly with several the initial RCSP grant holders that community building was a core feature of the success of these projects. They brought people together. They saw the community as the healing agent, not an isolated set of services, but hives of hope and connection emphasizing restoration of community. The grants were shifted from a support focus to a service focus in early stages of the grant project and so we did not fully yield what this initial focus could have realized. Support focuses on drawing community together; service delivery is oriented in traditional treatment infrastructure where units of care are delivered at the individual or group level with all of its inherent limitations. The likely risk of founding a new idea in an old model is the replication of the old model that was unable to deliver critically needed new growth.

We have identified the problems; the critical next step is conceptualizing and articulating solutions. Humans are motivated to change when there are stories that they can identify with and strive towards. History is replete with examples of overcoming immense problems occurring when how we thought of those things shifted to seeing new opportunities and developing new narratives. We need a collective recovery story in America right now. We can start with elevating the stories of islands of healing that are rising out of the sea of despair. We can start by recognizing that recovery communities are vital to overcoming other challenges we have here in the United States. We can start by rethinking solutions that are oriented in community rather than as a traditionally delivered unit of care.  

We can develop narratives of community healing across this great nation.  

Guest blog by Stefan Neff, Regional Coordinator British Columbia, Canada

As the regional coordinator for SMART in British Columbia, Canada, my mission is to help as many individuals seeking self-empowerment and evidence-based tools as a process to help themselves. When I became the coordinator a few years back, I ventured out as a newbie, eyes wide open, finding as many resources as I could to help grow SMART Recovery in the community that I love so much. 

In September 2019, I found out about the Recovery Day BC event and I wandered myself down to see what the fuss was all about. Well, there were people lining the street all celebrating their own recovery, live music playing, and kids playing and laughing in the KIDS ZONE. At that moment I said to myself, I would love to have a SMART booth proudly displayed for all to see. A few years went by and COVID happened; a lot had changed in British Columbia. We lost many in-person meetings, some facilitators retired, and many of the determined facilitators dove into the online Zoom platform. 

Now, 2022 is here and many things have levelled out. Meetings are going back to in-person, but this feeling never went away to have a booth at this massive event in September. What happened next was super special. I got an email from SMART Toronto Canada that the event organizer wants SMART to be a part of the 10th-anniversary Recovery Day BC event, with over 25,000 people expected to attend. Wow! What an opportunity to have a booth with a SMART banner showcasing what SMART is all about and how the program works.

I went into overdrive, searching for volunteers to help man the booth and what supplies I needed on a tiny budget. To tell you the truth, it was a little overwhelming, designing and ordering the banner, renting a popup tent, and asking volunteers to help find tables and chairs. The biggest joy was when SMART Recovery offered two training combos as raffle giveaways. I am so grateful to have two amazing volunteers who really stepped-up. One helped deliver all the heavy stuff and Bernice Lee, who is the SMART volunteer coordinator for Vancouver Coastal Health Authority, helped cover the booth. 

Now here’s the fun and extremely heartfelt aspect of this Recovery Day BC event – people who attend the SMART meetings came up to the booth with big SMILES on their faces, hugs and hi-fives, saying how SMART saved their lives and how amazing the program is. Some participants from the three online meetings I host gave me huge hugs, their spouses thanking me for helping their loved one towards recovery. My mind was racing with so many emotions, tears of joy flowing down my face, it was very emotional for me. It gets even better, meeting treatment centers, other non-profits wanting to work with SMART or already running meetings in their facility, you name it wow, what a great opportunity to speak with so many people who want to help others help themselves. 

I will be back bigger and better next year. The planning starts now!

Watch Stefan in his Facilitator Spotlight video.

PLEASE NOTE BEFORE YOU COMMENT:

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

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

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

IMPORTANT NOTE:

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

We look forward to you joining the conversation!

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

We all have family that we can turn to in times of need. We look to our family for support and love during our toughest moments. In the case of recovery, families may not know everything about the disease of addiction. As a family member of someone in recovery, you might struggle to communicate with your loved one or understand where they’re coming from. This is completely normal – it’s hard to put yourself in the shoes of someone in recovery. However, there are many steps you can take to make sure you are being the best support system possible for your loved one.

Substance use adds stress and strain to any family dynamic – and understanding that you, as a family member, play a key role in your loved one’s recovery, is a big step in healing wounds and friction caused by addiction. After all, addiction is known as a “family disease” – it does not simply affect the addict, but the close family members around them as well.

What role do family members play in recovery?

When someone is in active addiction, the support of close family and friends around them is crucial to the success of their recovery. As a family member, you can play multiple roles throughout the entire process of recovery, from beginning to end:

• Accountability: Telling your loved one the truth, straight from a source they know, love, and trust. Holding your loved one accountable, rather than simply brushing off their mistakes, reinforces that they need to change.
• Helping during treatment: Your loved one’s success in recovery is severely hindered if you are not willing to help them get through the process of treatment. Be the supporter that accompanies them to treatment facilities, talks with them on the phone, and visits them to encourage them to keep going.
• Participating in the family program: Ensure that you are being the best possible supporter to your loved one. The family program will guide you through the addict’s way of thinking, allowing you to see things from their point of view. You’ll learn how to set important boundaries, and you’ll be able to begin the healing process. When your loved one returns home from treatment, you’ll be all set to communicate with them in a healthier, more productive way.
• Acknowledging your own needs: When your loved one is in active addiction, it’s easy to get wrapped up in their life and, accordingly, blame yourself for anything that goes wrong. However, you need to keep your own mental health in check, because your loved one requires your full support and love – which isn’t possible if you’re mentally struggling. Take time out to practice self-care, attend individual therapy, or anything else that can help keep you in a healthy mindset.

Remember — other family members to your loved one are struggling as well, so it’s important to let them know the number of ways they can help both your loved one and themselves. Through willingness to help and determination to see your loved one succeed, you can all go forward as a family, knowing that you are doing everything in your power to be their best support system.

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.

Doug Tschann realized he needed a recovery program that focused on the nuts and bolts of addiction. He found this in SMART. Today the retired schoolteacher is a facilitator in Mankto, Minnesota. He finds it rewarding and it makes him happy knowing he’s helping others on their recovery journey.

Watch on our YouTube channel

Find Doug’s online SMART meeting #4697

Learn more about becoming a volunteer

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

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PLEASE NOTE BEFORE YOU COMMENT:

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

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

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

IMPORTANT NOTE:

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

We look forward to you joining the conversation!

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

For Brad Glaser, SMART’s Project Coordinator for Fletcher Group Grants, coming to work for SMART seems like a kind of natural progression, “I have been a participant in SMART Recovery going back nine years and became a facilitator in 2019. When this position with SMART became available, I was so excited to come to work for an organization that has meant so much to my life.”

Brad now focuses on bringing SMART Recovery, specifically the Successful Life Skills curriculum, to recovery homes nationwide. He gets to witness firsthand the positive impact the program has on their residents. This is especially important when you consider the participants are at a transitional time in the recovery process, “When you see a concept truly click into place for someone or hear a resident recount how they used a SMART tool in their own life, it is affirming and inspiring.”

A background in sales and marketing provided Brad with a lot of experience dealing with people of all kinds, “My experience with clients has been a huge help in working with the recovery homes both in the recruitment and implementation process.” More recently, Brad’s work in peer support has deepened his understanding varied recovery experiences. 

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

1.  Are there tasks you perform regularly during your workday? It varies, everything from recruiting homes to scheduling to troubleshooting technology. I also facilitate the classes for a couple of homes, officially to have a hands-on feel for the initiative, but mostly because I love facilitating SMART meetings!
2. What are a couple of the ways you interact and coordinate your job with national office staff? There are so many people in the National Office who touch this project! I really can’t list them all (but I’ll try). I interact in myriad administrative ways with Alena Kuplinski, Lorie White, Jodi Dayton, Renee Mathey, and Joanne Wyant. When I need strategic guidance, I turn to our Acting Executive Director Christi Alicea. For help in recruiting and communicating with volunteers, Melina Gilbert is always there to help. It is a total team effort! 
3. What is one of the ways that you think you personally make/want to make a difference at SMART? I think expanding the reach of our Successful Life Skills program makes a difference in many lives in both practical and socially positive ways.
4. What is your message to all those dedicated SMART volunteers across the country? As a volunteer facilitator myself, I count that work as the most important of my life, volunteer or otherwise. I always keep a focus on the fact that everything we do here is about supporting what happens in SMART spaces, especially meetings. The work of our volunteers is where the rubber meets the road, and the number of people who volunteer their time in running meetings and nurturing SMART communities is inspiring.
5. What kinds of things are you interested in outside of work? Any hobbies? First off, I spend a ton of time with my amazing wife Julia and our beagle Fern. Being borderline rabid sports fans, we all cheer our favorite teams, including the New Orleans Pelicans and Saints. We live just outside of New Orleans, one of the great restaurant and music cities in the world, and we take regular advantage of both. I’m also a huge nerd, and I have a great group of gamer friends with whom I play board games and RPG’s.  

Food, fun, and SMART facilitation. Sounds like Brad’s life in the Big Easy is really rolling nicely on the river.

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

PLEASE NOTE BEFORE YOU COMMENT:

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

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

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

IMPORTANT NOTE:

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

We look forward to you joining the conversation!

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

David Koss, JD, is a member of the SMART Recovery Board of Directors and the Director of Government Relations. In his role as director, David monitors what the federal government is doing in terms of addiction and recovery legislation, and advocates for SMART and people with substance use disorders.

David works directly with members of Congress to pass legislation that helps those with substance use disorders receive the care and treatment they need and deserve. For example, the recently passed House Bill HR7666 focuses on mental health funding that directly affects individuals either seeking or already in recovery.  

David’s time is also spent on facilitating SMART meetings and coordinating the East Coast Regional Conference. The conference will be held on Saturday, October 22^nd in Laurel, Maryland. This year’s theme, Shifting Paradigms, New Opportunities, will focus on new kinds of intervention, treatment, and aftercare – meeting people where they are in their recovery.

Because this is an election year, David urges people to vote and get as involved as possible. He believes it is important to support those in Congress who are fighting to end the addiction epidemic and save lives.  

For more information on how you can join the SMART Insiders+ Program, go to: www.smartrecovery.org/insiders

Listen as a Podcast:

Click here to find all of SMART Recovery’s podcasts

PLEASE NOTE BEFORE YOU COMMENT:

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

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

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

IMPORTANT NOTE:

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

We look forward to you joining the conversation!

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

GET EDUCATED

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

PRACTICE EMPATHY

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

Being empathetic includes:

• Avoiding judgement
• Avoiding criticisms
• Addressing issues in a non-confrontational way
• Showing concern
• Providing solutions without pushing
• Meeting them with love and compassion

PRACTICE SELF-CARE AND SET BOUNDARIES

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

• Not allowing them to be in your space if they are drinking or using
• Walking away from a conversation that becomes argumentative
• Not giving the individual money

COMMUNICATE EFFECTIVELY

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

• Asking questions that encourage open conversation and reflection instead of making statements that may come across as accusatory.
• Communicate the way the individual’s actions make you feel with stern compassion. This means you are owning your own individual feelings, while making sure that they know you will not tolerate actions or words that cross your personal set boundaries.
• Make sure the individual knows that you are willing to help them seek proper treatment and eager to support them in doing so.

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

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

About Fellowship Hall

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

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

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

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

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

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

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

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

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

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

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

Abstinence goals more reliable

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

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

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

Stutz and colleagues, 2022

Recovery capital grows most strongly through participation in recovery groups

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

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

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

Härd and colleagues, 2022

Mutual aid membership improves wellbeing

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

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

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

Marcin Wnuk, 2022

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

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

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

Continue the discussion on Twitter: @DocDavidM

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

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

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