Thanks to Treatment Magazine for the story about us. You can find it here.

Churchill famously said that the US and Great Britain are two countries separated by a common language. Arguably TV and movies may have bridged the divide a bit, but nuances of language and spelling are not the only things that differentiate us; something I was aware of when reading Marc Galanter & colleagues’ paper on the construct of ‘God’ in 12 step recovery settings.

The first thing in the paper that struck me was the percentage of the general American population who believe in God (89% vs 60% in the UK). In the study population (450 US Narcotics Anonymous members), this God belief was slightly higher still (91%). Now I don’t know for certain, but I’m pretty sure that figure would be much lower here in the UK.

The question might be forming in your mind as you read this – so what? Well, in my experience here in Scotland, one of the commonest reasons that professionals are reluctant to refer into AA, NA or CA is that ‘God’ word. Indeed many patients here are also hesitant or downright opposed for the same reason. If you have a population where belief in God is much lower, the odds are there will be more resistance.

There is reason to be much more hopeful, however, as this paper shows. In a nutshell, the authors (big names in recovery research) recruited the NA members through cooperation with meeting organisers across 34 meetings in 9 separate states. The the vast majority of meetings attenders completed the survey forms.

It turned out that ‘belief in God’ was more nuanced than might initially have been thought. Less than half of the NA members surveyed actually defined ‘God’ as explicitly ‘God’, if you see what I mean, and slightly more than half believed in some other entity. About 1% in one section of the survey identified as atheist, though in another section 17.4% said they were agnostic and 3.5% said they were atheist. I read this as some fluidity in definition and belief.

The authors looked at the relationship between what they called ‘antecedent 12-step items’ (things like how many steps had been worked, whether a life had been ‘turned over to God’ etc.) and symptoms of craving and depression. The findings were in line with previous research that showed an inverse relationship between these negative symptoms associated with addiction and with spirituality.

What was interesting, if I’m reading this correctly, was the finding that it didn’t matter if you explicitly believed in God, believed in some other entity or didn’t believe in God at all – the association with improved symptoms was still there.

The authors said:

The finding that there was no difference in certain key variables across respondents suggests a broad bandwidth of tolerance and accommodation to varying viewpoints.

What this means is that there’s plenty of evidence in flexibility of belief in Narcotics Anonymous. This can give referrers a bit of reassurance. With the recent Cochrane review of the evidence for the impact of getting people along to Alcoholics Anonymous (at least as effective as other evidence-based interventions), then all of us working with people seeking recovery can have confidence that a breadth of perspectives and beliefs can be accommodated in 12-step mutual aid groups.

The authors also say:

The cost-free resource of 12 Step groups may be potentially useful to clinicians as adjuncts to care if they can assure their patients that there is a diversity of options in how members define God, particularly given the growth of secular wings within 12 Step fellowships created by and for atheists

Many clinicians may therefore be making less use of 12 Step groups than they might, witness the fact that 65% of the respondents had been hospitalized for SUDs, but only 37% of them had been referred to NA by a health-care professional.

And then:

The cost-free resource of 12 Step groups may be potentially useful to clinicians as adjuncts to care if they can assure their patients that there is a diversity of options in how members define God, particularly given the growth of secular wings within 12 Step fellowships created by and for atheists

It seems that even for us heathen Brits, there is hope.

[Chris Budnick did this interview with West. Thanks to both of them!]

Who are you?

My name is Darryl West, and I just go by West. I’m a person in long-term recovery, and I also work in the field treatment.

What do you do professionally?

Professionally, I am a certified substance abuse counselor here in the state of North Carolina. I work for the Department of Public Safety within the Department of Adult Corrections, I work for the Division of Alcohol and Chemical Dependency Programs, and I wanna say as a disclaimer, I do not speak on behalf of the ACDP [the Alcohol and Chemical Dependency Programs]. I’ve been working with them since 2005, so over 15 years. We provide SUD services for offenders within the Adult Corrections.

Do you have any personal interest in addiction and recovery that you’d like to share

Like I said, I’m a person in long term recovery. I’ve been in recovery since January 24, 2001, so that’s 19+ years. Personally, [addiction has] affected my community. I have a brother that has even more time in recovery, some other family, some friends. So yes, I have definitely been personally affected. I’m also fortunate to have found recovery and to have received treatment services that led me to the recovery process.

Tell us about your professional experience in the area of addiction and recovery

I got into the field through my own personal treatment. I guess as a safeguard to continue my treatment, I started working or started working at The Healing Place (now known as Healing Transitions), in the detox and shelter area. At the time, I didn’t realize I was performing some of the core functions of addiction counseling. Later, I went on and got some courses and got deeper into the field, and I think I got certified in 2009.

I’ve worked with women, men, and youth, in detox services, inpatient, outpatient, with different modalities, Minnesota Model, and CBT. I’ve stayed actively involved professionally, as much as I can.

I also worked with Southlight for a while, doing some ADETS [Alcohol Drug Education Traffic School] classes.

Professionally, what are you most proud of?

West: I don’t know who he or she is that I’m most proud of, but I’m sure there is some child or grandchild who has been touched by something that I’ve shared with one of their parents, or relatives, or friends. Something that had a ripple effect, helping them have a more whole life because of it. I think that’s what I’m most proud of–the unknown of who might have been touched by what I was given to give to them.

What keeps you working in addiction and recovery?

What do they say about insanity? Haha.

It’s just fulfilling. Is there anything else to do, but give back? I’m sure there are other forms of service that we can give to our community, to our country, to our families. I just found this is my niche. 

I didn’t plan to do this as a form of service or even a plan of employment, but it’s something that is fulfilling… that you can’t buy it, you can’t find it in headlines. Yeah, I’d like to play in the NBA or be a comedian, or be a music star, but this is where I was meant to be.

I don’t fight it and I don’t force it. It just works naturally.

How has the pandemic affected your work?

First of all, I want to say it has affected my work and me personally, but let’s go with work. 

Nobody was prepared for this… many people have suffered… many people are still dealing with it and trying to cope.

I’m fortunate that I have work, I haven’t lost a minute of work since February, March, whenever this thing was declared… but how has it affected my work? 

I work at a maximum security women’s prison.

At the beginning of the pandemic, we had over 1500 women at the prison. I think we’ve reduced our census greatly, for a lot different reasons. For example, all the pregnant females were released or moved.

I work in an outpatient program, which sounds funny for a prison. We have 102 women, in a four to six month program, where women receive services Monday to Thursday, and we try to give them in a minimum six hours of programming–group, one-on-one, skill building, and recreational.

Since the pandemic started, of the 1500 women that are assigned to the facility, we’ve found over 270 known positive cases among the “inmates” and many of them were in treatment at the time. (We call our clients “clients.”)

In March, we tried some preventive measures and safety measures, of course, but the women weren’t really receptive to the restrictions (or guidelines) that were presented to them–as far as wearing masks, social distancing, hand washing, on and on. It is pretty hard in a facility of that size without the space to provide some of those essential needs to stay safe from the virus. 

We started implementing precautions by making our groups smaller. We normally have 102 women and six counselors, so each counselor should carry a caseload of approximately 17 people. At present, my caseload is down to 5 people. That’s from people getting released. I think our total census is down to maybe 34 or 35.

So, in March, we went with some preventive measures, but at the end of June, we went to total lockdown at the prison, which meant there was no movement. Our clients started receiving their food in the dorm. They weren’t allowed out 24 hours a day. They were locked down from, I believe, June 30th until maybe the end of August. There was no movement. They didn’t come out, they didn’t move.

They live in a quad, with 34 or 36 women to a quad. It was repressive. I’m sure that they’re still recovering. They were suffering. There was no air conditioning or fans. They were just locked in there all day–no recreation, no time out, no matter what. 

Of course, that limited treatment services, they couldn’t come to us for services. 

Like I said, we’re an outpatient, but what that means is they live in their quarters, but they come up to our building and we provide the services, groups, and so forth.

We were sending assignments to them… but is that really treatment? Or, is that just sending the assignments? And, we didn’t collect the assignment because of course, we didn’t want cross-contamination from the paperwork or the books.

It has really affected the women. There’s no physical contact within a group… no touching one another… no being in a group setting… not even one-on-ones with the counselors… they can’t do treatment plan updates. 

I haven’t done an assessment on a client since March or April because I haven’t gotten any new clients, so we’re not putting people into treatment. So, the whole program has definitely been shut down.

People are getting released, so it’s not like they’re put on a waiting list or in a holding pattern. 

But, here’s the weird thing, when you’re in a North Carolina prison, and if you’re assigned to certain programs or services, you get what they call gain time. So you can be in treatment for 30 days and you might get, let’s say, four days off your sentence. They’re still receiving this gain time, which is great, but are we setting them up? Will they have the proper tools for when they do return society, and return to their normal situation?

It’s also affected us as counselors and me professionally. We are still receiving virtual clinical supervision from my supervisor. We do monthly trainings. We still have staff meetings, and we still try to staff clients, to go over their needs and preferences, and wants. So now I might see my clients maybe five, six minutes a day. Services like setting up aftercare plans, and home plans, and transitional services for when they do release is limited. 

It has definitely put a burden and a hindrance on the program that I’m in. There are other programs within the prison system that are up and running because they didn’t have the magnitude of virus in their facilities, so it has definitely impacted the services that we can provide.

I know that’s a lot, but there’s a lot that needs to be heard.

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

It’s weird, we’ve got plans for everything but a pandemic. When you talk about a prison and state government… they have countermeasures for countermeasures for countermeasures. There were no countermeasures for something of this magnitude.

I think we’re definitely gonna have to reduce group sizes. They say a good group is what… maybe 10 to 12 people… we might even have to look at 6 to 8 people as an effective group size. Spacing, of course, is gonna be important.Simple hygiene, and not just HIV and AIDS, but other hygiene training and services and information, that’s gonna need to be passed on the clients and staff. How does the staff [protect themselves]? We’re not immune from contraction.

Also, how are we going to provide services virtually? Is there an effective way to provide virtual treatment services? That’s a hard one, because this is such an insidious disease. Addiction is so weird, that people sometimes need the feeling of feeling… not just touching, but feeling… and sometimes virtual can be sort of cold and… I don’t know… it just seems distant. 

It’s weird, I remember my daughters being in the back seat of the car and texting each other. I would be like, “what in the world?” But maybe that’s the world we’re moving to. I just can’t get it. 

I like to be around people. I like to feel people. I like to hear people. I like to smell people. Some of the dynamics of treatment are definitely going to have to be readjusted. Even, you know, the lights of the room, the color of the room. You know, do I put a false backdrop when I’m doing virtual work from home? Do I put up waterfalls and butterflies? Or, do I keep it real and just have a bare white wall?

I guess there’s a lot of things that we’re gonna have to look at as professionals.

Have you seen any benefits or new opportunities in the pandemic?

Like I said, there are definitely improvements in hygiene. 

A lot of people like to hug in this field… that touch, that feeling of being connected, that heartbeat to heartbeat type thing has sort of diminished. But, I’ve also seen that people care about each other. It also brings out that humanness. How many times do we hear people say, “Now, stay safe, be careful”?

It also brings out the sense of selflessness. I think the pandemic has definitely brought out a sense of caring about somebody. We know that the core of addiction is self-centeredness. I think one of the things that the pandemic has brought about is a momentary lapse of that selfishness. We’re concerned about others, we’re concerned about straightening up or cleaning up behind ourselves a little more. We’re not just assigning it to the janitor. People are more mindful… we are more aware of our surroundings and aware of other people. 

But also, somebody can have a normal sneeze and everybody freaks out.

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

Well, I’m gonna go from my experience and my arena of where I work. Women, and men, do well in prison treatment services. We follow it statistically and they have less recidivism. They have fewer infractions while in treatment services. They also say that even once they complete treatment services and are reintroduced to the regular population that their infraction rates go down… definitely, their violent infraction rates go down.

So, they do well in prison and they do well in treatment, but the big gap is transition. 

On the outside, we’re getting all these treatment high schools. One day it’s going to be great when we have Recovery University (you know, like Liberty University) we will have Recovery University.

So, my treatment fantasy would be a do-all treatment facility for criminals, where they serve their time in a dedicated treatment facility. NOT a unit in another facility, but a dedicated treatment facility. Then, during their transition period, sanctioned by the state, they get  treatment services, mental health, social work–throughout that transition period as part of their sentence.

I think that would be my fantasy. That’s the treatment that I would want for a person that has to pay their debt to society, but also has the chance to live in a recovery safe zone–even in prison. That’s what I would try.

Imagine this scenario. You get the terrible diagnoses of cancer, like addiction, it is terminal if left on its dreadful course unimpeded. You are in the depths of despair, facing everything this terrible diagnosis means for your life.

The treating professional turns to you and says “recovery is possible. It is POSSIBLE you might survive this, it does HAPPEN.”

I would not be reassured by such a scenario, and the truth of the matter is that people beat cancer every day. This is a result of an advancement in science, a commitment to fund care and a dedication to follow multiple pathways of care, people who get that diagnosis survive. This occurs because the care team never gives up and keeps working until they hit on the combination of care needed for the person to move into remission. In respect to cancer, the truth of the matter is that the death rate from cancer in the US declined by 29% from 1991 to 2017. This occurred in large part due to a commitment to study outcomes over the long term and to fund care.  What this means for a person sitting in the chair learning that they have cancer is that the treating professional knows which treatments have the best chances of getting you into and sustaining them in remission for five years. They also know that there is wide variation in what works for whom. This means that they use multiple treatments and combinations of care to achieve remission

We know that addiction recovery is a probable outcome given the proper care and support they need 85% of the people who stay in recovery for a period of five years stay in recovery for the rest of their lives. 

Let’s start using more accurate language:

Recovery is the probable outcome for people with substance use disorders when they provided proper care and support.   

We need to focus on long term recovery as our focus of all addiction policy. Let’s study long term recovery and support multiple pathways and service strategies. Let’s do a moon shot, national focus on recovery so that in twenty years we can say that we reduced deaths from addiction dramatically, just like we did with cancer.

That starts with framing our discussion with the proper language of recovery as the probable outcome when people get what they need to get to get better and acknowledging we are a long way from achieving a system that provides that focus for all Americans.

So please stop saying recovery is possible and let’s focus on recovery being probable if we move towards recovery focused policy so we change our care systems to reflect the needs of persons seeking help with a substance use disorder.  

The SMART Community had the opportunity to hear from Board President Bill Greer and Executive Director Mark Ruth as they shared their perspectives on what the SMART community has accomplished in 2020 and where we are headed in 2021.  

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This post was originally published on September 27, 2015.

This post focuses on an article critically examining the use of recovery as an outcome measure by professionals. They distinguish between recovery as a process (an individual journey rather than a specific outcome – a deeply personal experience related to one’s life goals, needs, and striving) and recovery as an outcome (a cure – a complete absence of symptoms of illness and/or a return to premorbid functioning – rather than as developing a satisfying life in spite of symptoms or vulnerability).

Pat Deegan (with Robert Drake) published a recent article on measuring recovery as an outcome. Their focus is on mental illness, but it offers some interesting food for thought about parallels with addiction recovery outcome research. As access to care grows, an important question is whether actually facilitates recovery.

Perhaps we can measure some of the processes corresponding to the recovery concept: More people with serious mental disorders have the freedom to live outside of institutions, avoid medications and coercive mental health systems, and pursue employment, friendships, and love relationships in their communities. These are measurable variables. Yet recovery processes are clearly compromised by the ubiquitous problems of poverty, lack of safe low income housing, dangerous neighborhoods, victimization, constant threats of coercion (sometimes by the criminal justice system as well as the mental health system), stigma, the lack of educational and employment opportunities, and the dearth of evidence-based interventions that could enhance functioning.

The evidence that recovery outcomes are improving is minimal. One of the most widely assessed recovery outcomes is competitive employment – a primary goal for the majority of people with serious mental disorders. The evidence shows that employment remains very low (under 20%) (60–61) and has actually decreased during the recent recession (60,62) because people with disabilities suffer greater job loss during recessions (63).

Raising awareness of the recovery concept has not actually improved positive outcomes; current measures of recovery fail to capture the process concepts and individual goals that inspire service users; and generic recovery measures cannot assess personal goals, diversity of populations and programs, and cultural context. What should be done?

Disappointing. Especially since every provider identifies their services as recovery-oriented. They offer an interesting response. They step back to reassess. On the one hand, the push for recovery-oriented services may result in simple re-labeling of approaches. And, quantitative quality of life measures can incentivize interventions that don’t feel like recovery to the client. On the other hand, the pushing of recovery measures, while imperfect, may at least help broaden the focus of providers.

Perhaps we should accept that recovery is a personal journey – a concept developed and owned by people who have lived experience – and avoid co-opting the term to advance professional, program, research, and system goals. If recovery is indeed a process, perhaps the mental health system should focus on measuring positive and negative outcomes (both are important) without asserting that some are recovery outcomes. But processes are also critical. Focusing on outcomes exclusively may devalue the ideals and the process issues that are important to users of the mental health system and may lead to manipulations to show good outcomes despite poor processes. For example, placing people in work enclaves for jobs that do not match their interests achieves high employment rates but violates the process goals of choice, self-determination, and quality of life.

Perhaps we should accept the problems and complexities of measuring recovery and continue to operationalize processes and outcomes that are consistent with recovery. Recovery is an inspiring ideal, and programs need to assess the outcomes that align with recovery as well as with their goals. Labeling some outcomes as recovery may at least help program managers to select outcomes that are important to participants. For example, people with mental health symptoms clearly advocate for safe housing, jobs, and quality of life – all measurable outcomes – rather than medication compliance.

Perhaps genuine attention to recovery outcomes could help professionals to understand processes and goals that their clients value and also recognize that clients need to be centrally involved in developing and assessing programs. Inclusion would be consistent with the principles of community engagement research (64) and might lead to innovative approaches to developing services and assessing their success. For example, programs that empower people to make decisions about life-goals and treatments may facilitate self-management. One method of doing this would be to distribute electronic self-management systems and self-referral systems directly to people with disorders. Users of mental health services could then select the services they want (65–66).

Perhaps involving clients in measuring processes and outcomes might deter professionals from relabeling traditional clinical approaches, such as case management, skills training, and medications, as recovery-oriented. Instead, programs might develop and implement services that people truly want: services that emphasize financial, residential, and personal independence; normal adult roles such as education, employment, home ownership, and intimate relationships; and personal choices regarding treatments and illness management.

I’ve written frequently about the need for an increased emphasis on quality of life measures rather than building an evidence-base grounded in measures of reduced drug use, reduced crime, reduced disease transmission and reduced OD.

It’s interesting that they see themselves as grassroots advocates seeking to overcome deeply entrenched professional interests that emphasize medication as the primary tool and medication compliance as a primary outcome measure.

Simultaneously, in addiction treatment, we’re seeing professional and institutional advocacy to increase use of medication. These advocates see themselves as seeking to overcome deeply entrenched grassroots and grassroots-rooted professional interests that are skeptical and resistant toward medications. (Believing that the effectiveness of treatment medications are overestimated, that they may undermine goals of recovery, that their PHARMA’s bad behavior makes them untrustworthy, and that medications have a tendency to become treatment rather than treatment tools.)

This article does a great job laying out the mental health experience and some important questions that we need to attend to as our field changes in ways that will be for the better and ways that will be for the worse.

This post shares a few loosely connected tabs that have been open in my browser for a couple weeks.

An advocate’s sad end

Over the years, I’ve expressed concern about peer supports being placed in high risk situations with inadequate training, supervision, and support. My concern has grown as the OD crisis has accelerated, along with the use of peer supports on the frontlines of this crisis.

My concern has typically centered on people in the first months and years of their recovery being placed in environments and relationships involving regular exposure to drugs, cultures of addiction, trauma, etc. Peers are often the addiction professionals with the least training, supervision, structure, and institutional support. Because the onramp to being a peer is short, they are also often in early recovery.

Stories like Jesse Harvey’s are the kind I had in mind. It sounds like Jesse ran some recovery homes that, at first glance, look like decent programs. It was his harm reduction work–The Church of Safe Injection–that got him some national attention.

Of course, workers in recovery-oriented treatment settings sometimes relapse and OD too, but there are expectations of internal and external structures to support, guide, and protect workers.

From afar, Jesse Harvey’s work was interesting to me because he seemed legitimately inhabit both worlds–recovery and harm reduction. (I’m aware that many see no need to distinguish between the two.) It is sad to see his story end this way.

For me, it’s been important to distinguish between harm reduction as an approach to working with and engaging people who use drugs and harm reduction as a philosophy. I wonder if that distinction can serve as a protective factor for people in recovery. I don’t know, just a thought.

‘Peer’ work as precarious

A paper entitled ‘Peer’ work as precarious recently caught my attention. I imagined it was about the risks peers in recovery (recovery coaches) might encounter.

I was mistaken. It’s about the experiences of peers who currently use drugs.

They interviewed 15 peers who use drugs and work in harm reduction services.

One might imagine that people-who-use-drugs who are hired, as people-who-use-drugs, to help other people-who-use-drugs, would find that experience validating. This isn’t the case for the subjects of this paper.

Instead, the paper described the subjects’ reports of feeling exploited. This is one of the four themes explored:

Peer workers lacked access to workers’ rights and were unaware of what their rights included. Nonstandard arrangements systematically constrained access to rights as there was no formal employee-employer contract. Some said: “there’s no rights” ; and “[peers] have no rights”. These perceptions were concerning but reinforced by the numerous violations to provincial workers’ rights reported by participants, including wages that were below provincial minimums, a lack of social benefits (i.e. sick and vacation pay), physical and verbal intimidation, and no access to safety standards. Another participant shared a unique perspective on the lack of access to workers’ rights: that they were a PWUD.

“There’s also the question of drug use at work and how that impacts people and that’s one of the reasons why people get paid so less or much less…. if people are using drugs at work it’s, like, okay, fine, you can use drugs. But you’re not going to have any workers’ rights or be paid a basic wage type of thing.“

Negating workers’ rights was seen as necessary in a work culture that tolerated PWUDs substance use needs. This quote underscores the structural vulnerability of PWUD produced from the criminalization of drug use – even in harm reduction work.

Model for drug policy?

British Columbia (BC) and Vancouver have been touted for having model drug policies for 2 decades. This blog has followed their drug policy for most of that time.

BC and Vancouver are at the vanguard of harm reduction policies and the experiment does not appear to be the success that many hoped for.

From CBC:

British Columbia has nearly matched its monthly record for deadly illicit drug overdoses, with 175 deaths during the month of July.

The BC Coroners Service saw 177 fatalities in June, which surpassed the previous high of 174 deaths in May. The service initially reported 175 deaths for June but updated the number on Tuesday.

A statement said the service has detected “a sustained increase” of illicit drug toxicity deaths since the first peak of the pandemic in March, and it’s now confirming five straight months with more than 100 such deaths.

The proposed solution? More harm reduction:

Medical leaders, physicians and advocates speaking Tuesday all called for the same measures to save lives. They pushed for decriminalization, a safe supply for users and erasure of the stigma surrounding substance use. 

“Given the toxicity of the drug supply, now is the time for all of us to demonstrate compassion and empathy,” said Lapointe.

Communities that haven’t embraced harm reduction are struggling too and there’s no doubt that the pandemic has interfered with access to both harm reduction and treatment services, but it’s clearly not just the pandemic.

See: Overdose crisis? Or, addiction crisis?

To me, the problem isn’t the interventions being used. It’s the absence of attention to treatment and recovery. The words “treatment” and “recovery” appear zero times in that article. There isn’t even mention of opioid agonists, just access to a safe supply of drugs.

This is where I get uncomfortable with harm reduction as a philosophy rather than a set of strategies/interventions. Harm reduction isn’t enough. (Treatment also isn’t enough. Too many people will die or get a chronic illness before achieving stable recovery.)

Seeing this through the philosophy of harm reduction leads people to framing this as a problem of toxic supplies and people using alone, rather than seeing it as an addiction crisis and seeking ways to better treat that illness–as though we’d want that life for a loved one… if only they had a safe supply and a using buddy.

We need a recovery orientation. That doesn’t require an either/or decision. I believe that can be done in a both/and manner.

This is the second in a series of interviews of people in and around the Recovery Space.

1. Who are you?

My name is John Winslow and I am a person in long-term recovery. For me that means that I have not used alcohol or other substances for over 44 years. I’m what we refer to as a “Snowbird”. My residence is in Bradenton, Florida on the beautiful Gulf Coast, but I spend my summers “up North” at Virginia Beach, Virginia during the hot season. I’m married with a daughter, a son, and three grandchildren.

I had just turned 26 years old when I entered into recovery. At the time I couldn’t imagine a life without alcohol and other substances. I was what some might refer to as “a sick pup” and my life was a wreck. As a result of having had a great treatment experience and throwing myself into recovery, my life turned around 180 degrees. I shifted from self-loathing, shame, humiliation, remorse & regret, and despair to learning to love myself, gaining self-respect and the respect of others, and leading a life of love & service.

2. What do you do professionally?

I’m retired! However, that doesn’t mean that I simply spend all day walking along the beach looking for seashells and golden doubloons. Read on and I’ll tell you more…

3. Do you have any personal interest in addiction and recovery that you’d like to share?

Yes, I absolutely have a personal interest in addiction and recovery. When I first got sober, I realized that if I was going to maintain my recovery over the long haul, I would need to establish a career that would support my long-term goals. Through the process of prayer and meditation along with consulting with my recovery guides, I felt spiritually led to enter the emerging field of addiction treatment. At the time there were few young people in recovery working in the addictions field. I have always believed in the power of example. As people began to recover at younger and younger ages, I believe it was helpful for them to see someone with whom they could identify staying sober and living a life of service.

4. Tell us about your professional experience in the area of addiction and recovery.

My first job in the addictions field was as an evening counselor at Springfield State Hospital in Sykesville, Maryland. I left a good paying job with the Federal government to get my foot in the door as a neophyte counselor. The pay was so low that I was forced to live on the grounds of the hospital in a small one-room bedroom overlooking the psychiatric patients below, doing what we then referred to as the “Thorazine Shuffle”. It was a wonderful training ground for the rest of my career. I ended up returning to school, having had only a high school diploma. I obtained my master’s degree in Human Services and over time became a Licensed Professional Counselor. Having worked in a variety of settings, I eventually established and ran my own private outpatient addictions treatment practice for 20 years. In 2004, I relocated to Maryland’s Eastern Shore where I became the director of Dorchester County’s outpatient program and founded one of the state’s first recovery community centers: Dri-Dock Recovery & Wellness Center. During that time, I was elected president of the Maryland Addictions Treatment Council.

Over time, my focus and passion shifted from addiction treatment to that of recovery services and advocacy. I was recruited by the Maryland chapter of the National Council on Alcoholism & Drug Dependence as Coordinator of their Recovery Leadership Program. It was in this capacity that I expanded my growing interest in connecting the dots of recovering individuals, families, and communities which in time led to the creation of International Recovery Day.

5. What are you most proud of?

I would say that of the things that I am most proud is far and above – that of my continuous recovery. *in saying this I must note acknowledgement that my recovery was (and is) a gift ~ but I do take credit for the footwork that I’ve put into this miracle of miracles occurring in my life! As they say… “it’s a simple program, but it ain’t easy”.

On September 11, 2001 our lives changed. A few days later I sat in a classroom at Eagleville Hospital taking my examination for Licensed Professional Counselor. Immediately upon completing this grueling test I drove into New York City and landed at Ground Zero where I served with a Red Cross Mental Health team offering support to the police & firemen attempting rescue efforts.

Lastly, I’m proud of having established International Recovery Day, Inc. The premise is based on the concept that “We can do together what none of us can do alone.”  We’ve created a global recovery event that embraces all addictions and all recovery pathways all on the same day!

6. What keeps you working in addiction and recovery?

I am driven and guided by my inner voice (which I identify as the God within). The world has suffered too much heartbreak and devastation at the hands of addiction. My hope is to shift the focus from the ravages of addiction to the hope offered through the recovery movement. We need to collectively demonstrate to the world that we can and DO recover.

7. How has the pandemic affected your work?

The Covid-19 pandemic has been devastating to addiction treatment and recovery efforts. Most Recovery Month events have historically been held in person. Unfortunately, many of those events were cancelled this year. Due to the fact that International Recovery Day is an on-line event, we were not hampered in that regard. There were a number of exceedingly large in-person events through which we had planned to inform recovery audiences about our event. Those plans had to be scrapped. However, we’ve attempted to take full advantage of social media to move our message forward. The other primary segment of International Recovery Day is our “Recovery Lights Around the World” campaign that has not been significantly negatively impacted by the pandemic. We have well over 80 structures around the world that are going purple on Sept. 30^th, to include Niagara Falls, the Ben Franklin Bridge, Aloha Towers, and the Rock & Roll Hall of Fame, to name a few.

8. What effects of the pandemic are you observing in the people you serve?

We know that in addition to a significant increase in alcohol consumption within the general public and the reduction of services and closure of treatment programs… suicide, relapse, anxiety, and depression have all increased significantly as well within the recovery community. The recovery community more than ever needs to hold out a beacon of hope to those still in need of help and services. International Recovery Day serves to offer that beacon to the world!

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

As with other segments of our society, the pandemic is taking a significant toll on prevention, treatment, and recovery organizations, institutions, communities, and individuals. I’m mindful of catastrophe movies such a “Deep Impact” in which the survivors gather together afterwards clinging to the words of their leaders proclaiming the time for rebuilding is at hand. We of the Recovery Movement know all about surviving catastrophes and of rebuilding. We’ve rebuilt our own lives and lived through tough times – assured by those who came before us that “this, too, shall pass”. We need to have faith and take heart, to trust the process, but to also be prepared to grab a shovel and dig in ~ for there will be much work to be done.

10. Have you seen any benefits or new opportunities in the pandemic?

I am sometimes accused of being an optimist. I’m OK with that. I always believe that if we look hard enough, or step back, take a deep breath, and look at the bigger picture a vision of new possibilities will emerge. I continue to trust the process and look forward to seeing what is revealed.

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

I really don’t need to envision a fantasy project for me to tackle. My Higher Power has already dropped it in my lap when upon reflecting on the words of William (Bill) White and a biography of Marty Mann the idea for a global celebration of recovery was revealed to me. On that day the concept of International Recovery Day was born.  Our website: https://internationalrecoveryday.org/

I always suspected that I was the food equivalent of an alcoholic, though I’d never admit it. I could never stick to a diet. I ate out of habit, not out of hunger. I’d have trouble paying the rent on time, but I’d always find money for some large-sized fast food meal. I was out of control, and I was determined to follow in the footsteps of my father, who ate himself into an early grave a dozen years earlier.

“You don’t have a problem,” I’d tell myself. “People who are addicts have real problems. You’re just a fatass who can’t stop eating.”

This voice was both right and wrong. By choosing food over the things that really mattered, such as family and health, I was playing with fire, and I knew it. But at the same time, I knew there was something more, something else I needed to resolve.

I entered treatment for an eating disorder late last summer. At first, it was easy to stick to the meal plans. But after a few weeks, I found myself consumed with negative emotions. Without that crutch of junk food, I was forced to deal with the real issues that I was trying to avoid. Every bad meal was an attempt to keep these issues hidden, in order to keep up the act for everyone else.

I’d gone five years without self-injuring, a streak I was extremely proud of. But in my food-deprived sense of despair, those old tingles came back again. So many times I considered going back to my old ways. After all, a razor blade has zero calories.

It was at that moment that I realized I was exactly what I thought I was. I was an addict.

I was down 30 pounds after treatment. People started to notice. As they asked me about “what I did,” I felt so violated. My weight issues were tied to much deeper, much darker issues. Every question brought my lifelong struggles with self-worth to light. As a result, it didn’t take me long to resume blocking out negative thoughts with food. It was just easier to not wage an internal struggle that would destroy me one way or another.

I found Sober Mommies through a friend’s Facebook feed, and I was blown away by the stories I read. These people, who are much braver than I, shared their stories for the world to see. These stories struck such a chord with me. I admired everyone who told their stories… and for the first time, I wanted to be one of them.

The stories on Sober Mommies detail the lives of people from many different situations. But they all share one common theme—the journey of an individual who eventually comes around to deciding that she’s worth saving. I’ve never believed I was worth anything. And in retrospect, I can see that I was trying to overeat to the point that I’d go away permanently. Reading these success stories showed me that it was possible to come around, to gain some semblance of love for myself.

I’m not an alcoholic. I’m not a drug addict. But I easily could be. It just so happens that food is my vice.

My ultimate goal is to be able to look at food as just food, without any of the thoughts and feelings that accompany eating. I’m not there yet. But I’m closer than I’ve ever been.

This post was submitted by Bryan.

A Sober Mommies Contributor is most often a non-professional – in and out of recovery – with reality-based experience to share about motherhood & active addiction, the multiple pathways to recovery, or a family member’s perspective.

But a few years before that, I had begun to soften after hearing challenges to empiricism and EBP’s from some advanced and credible sources.  Ironically, part of what started to soften me was that these challenges used objective scrutiny. 

I eventually started quoting a number of these newer challenges while providing formal, professional continuing education lectures.  Here are a few of them:

1. “Why should addiction treatment be held to a relapse-free standard of remission?” 
   • With any other disease when a treatment is effective, later removed, and the result is relapse – that is considered a demonstration that the treatment was effective, not ineffective.
2. “What about practice-based evidence?” 
   • Does a surgeon who has done 10,000 of the same procedure have anything valuable to say about the illness, the course of care, or getting better?
3. “Residential addiction treatment is too cookie-cutter.” 
   • But what’s more cookie-cutter than a CBT manualized protocol?
4. We are better at identifying and counting behavior than we are at measuring intrapsychic change processes.
   • And so, CBT “wins”.
5. “If you need surgery, or a plumber, do you want the seasoned one? And why?”
   • Is experientially-based knowledge a thing?  And, is it considered valuable (as academically-derived knowledge and empirically-based knowledge already are)?

Here are the two experiences I had. They happened close together in time. 

One of those experiences was reading an article¹ that someone handed me.  It was a critique of the “evidence-based practice movement”.  And to me it was a splendid piece of logic. 

General challenges in the paper included key questions like:

• Which proposed studies get funded and why?
• Why and when are null-findings published or not published?
• Do we find what is, or what we measure?

The paper also included more specific challenges to research concepts and methods, such as noting:

• over-emphasis of prescriptive technique (vs other practices)
• setting aside of non-diagnostic characteristics of the person (aspects of the person as a person)
• lack of real-world inclusion criteria for who gets studied (very tightly controlled)
• lack of real-world clinical settings within which research is conducted
• emphasis on symptom suppression (rather than aiming toward wellness, for example)
• lack of attention to cultural factors
• lack of attention to family system factors, and
• a generally mechanistic world view.

The other experience was listening to Lee Feldman on a few occasions, the last of which was him speaking to me in an un-interrupted monologue of 3 full hours.  Listening for those 3 hours went by very quickly, and the impact of that experience is with me to this very day.  What did Lee talk about?  “Spy satellites, cream of mushroom soup, and eating a peach.” 

Lee gave me permission to share these publicly.  He taught them to me in the order I will present below.  He started with a seemingly strange and irrelevant topic, but by the end I was captivated.  Listening to him was transcendent and sublime. 

Spy satellites.  Lee told of working for the Department of Defense (DOD) and being the one to write an algorithm for complex decision making based on a wide variety of data inputs.  The purpose of the algorithm was to prioritize photographic opportunities of satellites (versus other factors like the lifetime of the satellite, the life of the battery, and what it took to recharge the battery, etc.).  He pointed out that the algorithm worked perfectly unless and until “policy” matters were added as variables, even when corrected as weighted variables.  The look on Lee’s face when he said, “policy” made it clear that he meant something quite problematic for the essence of the decision making process.    

• Lee discussed how the field of complex decision making could be applied to our field.  Listening to him describe that application was a “wow”.    

Cream of mushroom soup.  Next, he told of a company that approached DOD for help in keeping the flavor of soup consistent.  I was incredulous that such a problem existed and that a company would approach DOD for the solution.  The company said the list of ingredients and cooking methods could be controlled but the flavor profile for some ingredients would change across seasons of the year (such as the flavor of milk vs the greenness of grass and when the grass is eaten).  The company said the master soup makers check the flavor of the almost-finished industrial vat of soup and ask for certain ingredients to be added at the end to keep the flavor consistent.  The company said master soup makers are aging out and none of the younger people want to go into apprenticing as master soup makers.  Lee said when DOD heard this they said, “That’s a Lee Feldman problem” and gave him the project because of his work in complex decision making. 

Lee told me how his project team tried to use behavioral observation, interviewing, and other techniques to pull the competency and skill out of the master soup makers and transform all of that into an algorithm for automation or that others could use.  Lee’s final advice to the company was: “Continue to apprentice master soup makers”.  He told me the state of the art of behavioral neuroscience could not replace those highly skilled and seasoned chefs. 

• Listening to Lee, at that point all I could think about was the clinical supervision of counseling, and the clinical supervision of clinical supervision.  And that was exactly how Lee applied the lesson.   

Eating a peach.  Lastly, Lee taught me the word “qualia” and said it was the plural form of a word for individual experiences of human consciousness. 

He asked me if I had ever eaten a peach.  When I said “Yes” he told me to imagine trying to convey that experience (the flavor, the feel, how I experienced it, etc) using only words to someone who had never eaten one.  Lee said qualia could not be transmitted in words from one person who had the experience, to one who did not. 

It is profound to consider Lee’s input to me that:

• No experience a person has is truly shared or identical in a literal qualitative sense. 
• Each of us is an individual, and each of us lives a life of qualia that are not the exact same as anyone else.
• Our individual differences as people also come from the total accumulation of all the experiences of our lives; qualia add up within us and we differ accordingly. 
• We can’t really, exactly, share our unique experiences in the form of mere words.    

And so, back to stark empiricism and evidence-based practice. 

All of this leaves me with various questions.  Here are some of them:

• What do we measure, and why?
• Are we able to identify and measure the most important variables?  Would it even matter if we could?
• What is it like for someone to be them?
• Shall we meet and treat the total person?  Or shall we merely apply a protocol in order to stop a problem that we (the clinicians and researchers) happen to notice?

Reference: ¹ Marquis, A., Douthit, K. Z. & Elliot, A. J. (2011).  Best Practices:  A critical yet inclusive vision for the counseling profession.  Journal of Counseling & Development. 89: 397-405.

Suggested Reading: Freedman, N, Hurvich, M, Ward, R., Geller, J. D. & Hoffenberg, J. (2011). Another Kind of Evidence: Studies on internalization, annihilation anxiety, and progressive symbolization in the psychoanalytic process.  Karnac Books, Ltd., London.