September is Recovery Month: Reinventing Recovery

 

Welcome to the September 2018 edition of Family Matters – Families Matter, our new blog authored and curated by FSDP’s Guest Blogger–pioneering harm reduction therapist, educator, advocate and author Dee-Dee Stout. To learn more about how your family can join our growing community of enlightened friends and advocates sign up here now.

In the first of a series of our Fall 2018 blogs, since September is Recovery Month for SAMHSA, this seemed the perfect time to write about the word, or concept of, “recovery” specifically as it’s typically applied in substance use disorder (or “addiction”) treatment.

September is also the traditional “back to school” month and many of us have kids who are returning to school or perhaps young adults transitioning to college. This is a good time to to review constructive ways to talk to our kids about alcohol and other drugs, and also to take a new look at treatment, drug policy, binge drinking. and how to negotiate the holidays  Therefore, for the remainder of 2018, our blogs will take a look at those topics and more. See you next month! #recoverywithoutabstinence #stopthestigma #familiesmatter

And now our 2018 “Recovery Month” edition:

Reinventing Recovery

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Photo by Toa Heftiba from unsplash.com

Usually when we hear (or often use) the term “recovery”, it has a very specific meaning: nearly always 12-Step oriented, abstinence-only based, and says to us this is a disease you’ll have forever. I want to definitively make the case for a new kind of recovery in the world of addiction(s): an “inclusive v exclusive” recovery that does not require the elements we’re used to – including abstinence – but whose definition can certainly contain it …and so much more. 

Recovery. It’s a truly loaded word (pun intended). Let’s go on a bit of a journey to see how and from where our concept(s) of recovery stems as it’s a word that comes with a lot of baggage, both positive and less than positive.

According to etymonline.com, the origin/first use of the word “recovery” comes in the mid-14th century and meant “return to health.” “Recovery” originates from the Anglo-French word “recoverie” meaning “remedy or cure.” The additional meaning of an “act of righting oneself after a blunder, mishap, etc.” is from the 1520’s. Could this also be at the root of the word having such moral implications?

In his July 2014 article for Psychology Today, well-known addiction expert, author and former Harvard Medical School professor, psychiatrist Dr. Lance Dodes discusses some of the problems we have with the word “recovery.”[1] In part, he sees the word as acceptable in the context of “recovering from a medical illness”, meaning that 1) relapse/lapse is normal, and that 2) one is headed toward a cure or an ending of the condition/illness. Quoting from the article, Dr. Dodes says, “In most of life, ‘being in recovery’ means a person is making progress even though s/he isn’t ‘cured.’” This is far different than how we too often hear the word used in addiction treatment circles or our greater culture. In both places, “recovery” typically means that one is abstinent and attending a 12-Step group – “working the program” to use the language of AA for example. This is meant to establish an “us vs. them” quality: you’re either attending meetings, working the Steps, and have a sponsor so you’re “in recovery” or you’re not and therefore you’re not in recovery. Black or white; right or wrong. Plus, the implication is that anything short of a 12-Step traditional recovery means you’re not doing recovery “right.” A lot of people – including many professionals – believe this is what the word means and ONLY what it means. I, too, believed this for a long time.

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photo by Danielle MacInnes for unsplash.com

I went to residential treatment here in Oakland, CA, in the late 1980’s. These were the “salad days” for residential treatment, coming on the heels of First Lady Betty Ford openly discussing her addiction to alcohol and pain medications.[2] No one of her stature had ever talked about their alcohol and other drug problems in the US and her “coming out” can’t be understated; it was also a huge step in reducing the stigma/shame for others to seek help for their substance misuse/problems. Finally, this event was also partly responsible for opening the doors of treatment to become the Big Business it is today (more on that in another piece).

In treatment, we were taught that addiction is a 3-fold disease: bio-psycho-social (some also added “spiritual”). It was like a, sleeping tiger, always waiting to pounce on you unless you were constantly vigilant in your recovery (meaning abstinence, attending meetings regularly, and “working a good program.”). We were taught phrases such as, “Your mind is like a dangerous neighborhood: don’t go in it alone” and “Avoid old people, places and things to stay sober.” In other words, 1) don’t trust your own thinking because you’re an addict/alcoholic and “your best thinking got you here”, 2) you’re never fully recovered, and 3) you must cut off all your old friends as they were only using friends and therefore not interested in your well-being; your relationships were only based on drug use. I remember someone saying that everything I had done up to the point of my entering treatment/recovery didn’t count – but now my life could really begin: “Today is the first day of the rest of your life”[3] was up on a wall somewhere. Scary stuff. And I was scared straight.

In what’s known in 12-Step circles as the Big Book (Alcoholics Anonymous 3rd edition), there are several references to the word “recovery” and “recovering” (somewhere around 15) but also references (about 10) to the word “recovered” which is akin to blasphemy today in most 12-Step circles.[4] This is another point of contention for many of us. Can we ever say we’re “recovered” or even “cured?” I say, “yes we can,” to borrow a phrase. And that we should. Why? Because to those outside of traditional treatment/recovery, I hear folks constantly say, “Apparently treatment doesn’t work because you people are never recovered!” I had never thought of the phrase “recovering” as potentially responsible for this perception. I personally say that after over 30 years of continuous abstinence, I am completely comfortable declaring that I’m “recovered;” the problems I have today have nothing to do with illicit drug and/or alcohol use (sometimes that would be simpler, frankly). The first paragraph in Chapter 2 of the 3rd edition of the Big Book titled, “There is a Solution,” also appears to see an end state to addiction. It states: “We, of Alcoholics Anonymous, (italics theirs) know thousands of men and women who were once just as hopeless as Bill. Nearly all have recovered (emphasis mine). They have solved the drink problem.”[5] This passage certainly seems to imply that one can indeed recover. But then what exactly does it mean to recover? And how do we achieve this state of being?

Mindfulness + Connectedness + Inner Growth

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Photo by Austin Chan for unsplash.com

 

A Phrase is Born. While working for the large American HMO Kaiser in the 1990’s, I was charged with developing and leading a relapse prevention track for patients in our Chemical Dependency Recovery Program (CDRP). These were folks for whom the course of treatment we offered (intensive outpatient program or IOP) didn’t work – or, as we phrased things back then, patients who didn’t try hard enough, were in denial of their “disease,” or simply relapsed back into drug/alcohol use due to inattention to “people, place, and things.” During one of our evening groups we were working on a definition for “recovery” and decided to see what we could come up ourselves. After all, we surmised, how can one relapse if you don’t have a clear idea of recovery?

Mindfulness, connectedness, and inner growth was the phrase we all agreed described the basic ingredients for recovery. It wasn’t until later that someone noticed we neglected to include anything about abstinence/sobriety, 12-Step attendance, or the other usual things we associate(d) with recovery. I remember that night well because a gigantic light bulb didn’t just light up, it blew up in my head! This was the moment I began to wrap my head around the idea that perhaps alcohol and other drug use itself – and abstinence specifically – really had nothing to do with one’s healing or recovery; recovery wasn’t in fact begun with stopping drug use first (which is what we always told folks). What was at the core of the concept of true recovery of one’s life we decided were these 3 elements defined here – which may or may not include an end to one’s drug use:

Mindfulness: paying attention – to what you’re doing, who you’re with, what you’re putting in your mouth/arm/throat/etc., really everything that’s happening as well as you humanly can, plain and simple.

Connectedness: this means getting reacquainted with yourself, a vertical connection, we called it – your body, your mind, your spirit – and fully trusting them. This also spoke to the idea that your mind is connected to your body (yes, no matter what Descartes[6] said, they’re attached; it’s called a neck!). This vertical connection could also be to a higher power or great spirit of some kind. Connectedness includes a horizontal connection, too, or connection with others.[7]

Inner growth: this was a bit more difficult to flesh out at the time but we settled on it meaning whatever an individual does that leads to their seeking out new information and new ideas, being a part of the world at large. This could be going to school, walking in the park, dating, making new friends, a yoga practice, meditation, attending synagogue/mosque/church/temple/circle, or even reading. Or anything else that “feeds” a human’s curiosity and need for knowledge.

And that was it. Drug use, abstinence, continued using or something in between, wasn’t mentioned. Why? Because we realized that in any other bio-psycho-social illness (which nearly all are), one did not have to recover perfectly. In fact, in my definition humans cannot do this – at least not all the time. And we realized that it wasn’t the alcohol or other drugs that were at the core of the problems we had: they were but a symptom. [8]

Therefore, one could indeed be in recovery and use drugs. Not problematically because then you’re not connected or mindful or growing. But we agreed (again to our collective surprise) that yes, one could be using alcohol or other drugs – having a healthy relationship with them – and be mindful, connected, and growing internally: in recovery. And we also agreed that for some folks, to have these 3 elements in their lives could require abstinence: total, partial, forever or for a while, we made no comment on those notions. That would remain up to the individual (which also fits within AA/12-Step guidelines of no one being able to tell another that they are an “alcoholic or addict.”). In fact, we realized that having healthy relationships of all kinds could be achieved through these three elements. What a jolt to the brain this was to us all!

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Photo by Ron Smith for unsplash.com

YOU GOTTA GIVE THEM HOPE”, Harvey Milk[9]

These days, I have come to realize that it appears these elements or ingredients of recovery also build on one another: for example, you first need to improve or have some mindfulness about what you’re doing before you can truly connect with others and yourself, and that action can lead to growing internally. And again, we made the argument then which I’ll repeat here, drugs and drug use (including alcohol of course) don’t necessarily impede one’s ability to recover or regain health from having problems with them – or being “addicted.” The problem is in one’s relationship with substances or behaviors that have become problematic or compulsive, and that we continue to engage in despite negative consequences – what we call “addiction.” So here’s the Big Question: what if we as a collective culture decided to work on these 3 ingredients and the issues that get in one’s way of achieving them? What if we decided to help those in need to uncover why they – or collectively, why so many of us in the wealthiest nation in the galaxy – need to use substances in order to cope? Hmmm…

It’s time to reinvent the word recovery to mean this: “I have recovered my life and my health. with or without abstinence. I am mindful, connected, and growing.” Now that’s real recovery!

One of the ways to address these issues of the lack of mindfulness, connectedness, and inner growth is with what the Canadian author, physician, and addiction expert Dr. Gabor Mate calls “compassionate inquiry.”[10] Dr. Mate makes the case for needing people in our lives who can/will listen deeply, compassionately to those of us involved in using substances/behaviors that are causing pain in our lives. Another advocate of doing things differently in treatment is Stanton Peele, PhD, JD. In his newest book on addiction, Recover! Stop Thinking Like an Addict and Reclaim Your Life with The Perfect Program,[11] Dr. Peele discusses these issues at length, as he has for over 50 years. As an early adopter of harm reduction principles, he has tried to get us all – but especially we Americans – to see that the way we have come to view addiction is all wrong: 1) it’s not a disease, 2) most people quit on their own (so how can it be a disease), and 3) not all people are susceptible to becoming addicted. In fact, by viewing addiction as a disease, our society has actually increased the possibility of relapse[12]. It reminds me a bit of Charlton Heston’s famous line at the end of the film, The Planet of the Apes, when he realizes where he really is – back on Earth: “You finally really did it. You maniacs! …God damn you. God damn you all!” In looking for the reasons for addiction, we have to consider that perhaps, unintentionally, we have done much of the damage ourselves with our racist policies, unscientific treatments/interventions, and blaming of the people who use drugs (and often their families as well). It sure is easier to blame a drug(s). It’s much harder to look within, compassionately and deeply, for the reasons so many of us are in pain (of all kinds) and need relief to cope with living.

I see September’s Recovery Month as a great time to take a look at what we’ve done with addiction treatment and recovery. And to take a hard look in the Mirror of Truth about our society and its complicity in addiction(s). It’s time to stop the unscientifically-tested treatment of this “medical-and-more” complicated condition. It’s time to demand professionals who are highly trained and compassionate – always. It’s time to radically change how we view people with substance problems – and their loved ones – regardless of whether you believe this is a condition of their making or not.

It’s time to reinvent the word recovery to mean this: “I have recovered my life and my health. with or without abstinence. I am mindful, connected, and growing.” Now that’s real recovery!

DON’T MISS NEXT MONTH’s EDITION: 

COMMUNICATING WITH LOVE ABOUT DRUGS WITH SOMEONE YOU LOVE. 

[1] https://www.psychologytoday.com/us/blog/the-heart-addiction/201407/what-does-it-mean-be-in-recovery

[2] A Johnson Institute-style intervention was held in 1978 for Mrs. Ford leading her to seek treatment for her substance use. In 1982, she founded The Betty Ford Center which is now part of the Hazelden family of programs.

[3] As discussed in our last piece on “tough love,” the originator of this phrase is the founder of Synanon, Chuck Dederich.

[4] “A Reference Guide to the Big Book of Alcoholics Anonymous” by Stewart C.; (1986). Recovery Press, Seattle, WA.

[5] p17. Note: The “Bill” that is referenced here refers to the co-founder of AA, Bill Wilson.

[6] Rene Descartes was a 16th c. French philosophermathematician, and scientist; dubbed the father of modern Western philosophy who famously argued that the human body and mind were separate. Wikipedia.com

[7] Remember that church I mentioned in my first blog, the United Church of Christ or UCC? There we were taught that God was within each person and living thing on Earth and that we were all connected. Very Deepak Chopra. Hmmm…

[8] Interestingly enough, a similar idea can be found in AA’s Big Book on p85, in this line: “What we really have is a daily reprieve contingent on the maintenance of our spiritual condition.” And I was taught that “spiritual” merely meant connected.

[9] Quote from slain San Francisco Supervisor Harvey Milk, one of the country’s first openly gay politicians. This is from a tape recording (1977-11-18) to be played in the event of his assassination, quoted in Randy Shilts book, The Mayor of Castro Street: The Life and Times of Harvey Milk. (1982), p. 277. Wikipedia.com; personal communications.

[10] From Dr. Mate’s website, drgabormate.com: “Through Compassionate Inquiry, the client can recognize the unconscious dynamics that run their lives and how to liberate themselves from them.”

[11] For more information, view the results of the NESARC study and more, discussed in Dr. Peele’s book, p36-42. (2014), Da Capo Press.

[12] Miller et al; “What predicts relapse? Prospective testing of antecedent models.” https://onlinelibrary.wiley.com/doi/abs/10.1046/j.1360-0443.91.12s1.7.x