Tag Archives: William White

A TRAINEE’S INTERVENTION

On December 1,  I will celebrate three years as a non-smoker. I wanted to reinforce this choice for any others making a similar decision.

RECOVERY RISING EXCERPT: A TRAINEE’S INTERVENTION

Recovery Rising Book Cover PaperbackIn 1987, I celebrated 20 years working in the addictions field. During those years, I perceived myself as a laborer rather than a “leader,” but an incident occurred in fall of 1987 that forced me to confront the role that was emerging for me. The incident in question involved the issue of smoking.

Like most of my professional peers and my clients, I had continued to smoke heavily throughout my career. I brushed off comments about my need to quit with the bluster that addicts have long made into an art form. Here’s the incident that changed that.

A training participant—a spunky, young woman who looked like she was in high school—marched up to me as I was smoking during break at a workshop that I was presenting for a hundred addiction counselors. She said the following:

“As much as you apparently know about addiction, I can’t believe that you smoke. Do you know that every smoker here loves to see you smoke? Seeing you smoke is a powerful affirmation of their addiction. Whether you smoke or not is more than a personal issue. To smoke as a role model, given what you do, is to enable addiction among hundreds of professionals in this field. You should think about that.”

Not waiting for a response, she turned and walked away. I wanted to write her off as one more overly rabid anti-smoker, but her words wouldn’t go away. They haunted me!

I had been able to justify my own potentially self-destructive smoking behavior, but was haunted by the thought that my behavior could so profoundly and negatively influence the lives of people for whom I professed great respect and affection. Within days, I no longer smoked publicly. I snuck off into bathrooms and back corners! Within a month I had made a covenant with myself to quit and within three months smoked what I hope was the last cigarette of my life. During the weeks between this trainee’s intervention and my last cigarette, I gave serious thought to how the addictions field had failed to confront the devastating issue of smoking. At this time I was writing my book, Pathways from the Culture of Addiction to the Culture of Recovery, and wrote these words in the weeks BEFORE I quit smoking: “Treatment professionals must boldly recognize nicotine as an addictive and highly lethal drug. It is time the field stopped burying its leaders, frontline service practitioners and its clients, who achieving abstinence from alcohol and traditionally defined drugs, have their lives cut short as a result of drug‑related (nicotine) disease. Day‑by‑day, month‑by‑month, the field must stigmatize and sever its continued relationship with this drug.”

I knew when I wrote those words with a cigarette burning in front of me that I could not be a smoker when those words were published. After repeated attempts, I smoked my last cigarette a few months later. I owe a debt of gratitude to this unknown trainee who taught me a lot about what it means to be a role model in this field. And the point is: we are all role models.

Are there toxic habits or other behaviors that stand as gross incongruities between your aspirational values and the life you are living? Work in this field doesn’t require perfection, but it does eventually demand congruity between our words and the lives we are living. Living your life as a role model doesn’t mean you have to lose your true self in the process. Our field has long been filled, not just with personalities, but with true characters.

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POWER OF PEER SUPPORT- an abbreviated chronology

by William White

The concept of “wounded healer”–the idea that people who have survived illness or trauma may have special abilities to help others facing similar challenges–has deep roots within the history of addiction treatment and recovery.  During the 1980s and 1990s, the perceived value of the wounded healer was eclipsed by the growth and professionalization of the addiction treatment workforce in the United States.  Between 1965 and 2010, the percentage of addiction professionals with lived personal/family experience of addiction recovery plummeted from more than 70% of the workforce to approximately 30% as educational credentials became valued more than experiential knowledge.  Today, there is growing recognition of the value of peer-based recovery support services provided to individuals and families outside the framework of recovery mutual aid societies.  A new generation of peer helpers is working in volunteer and paid roles within new grassroots recovery community organizations, within addiction treatment programs, and within such allied fields as primary healthcare, child welfare, and criminal justice. This trend reflects not a rejection of scientific knowledge and professional treatment, but an effort to integrate addiction science, cumulative clinical experience, and knowledge drawn from the lived personal/family experience of addiction recovery.

Working under such titles as recovery coach, recovery support specialist, peer helper, and recovery guide, peers are filling support roles across the stages of addiction recovery.  Their growing presence represents a historical milestone in the evolution of addiction treatment and recovery support in the U.S.–functions that falls outside the boundaries of the recovery mutual aid sponsor and the addiction counselor.   Given the increasing number of requests I am receiving for information on peer recovery support services, here is an abbreviated chronology of what I and my co-authors have written about such recovery support roles.

To explore how peer recovery support services are being implementing in diverse cultural contexts, readers may also wish to explore my interviews with:

  • Cathy Nugent on Recovery Community Mobilization and Recovery Support
  • Tom Hill on Recovery Advocacy and the State of Recovery Support Services
  • Don Coyhis and Eva Petoskey on Recovery Support in Indian tribal communities
  • Phillip Valentine on Recovery Support Services in Connecticut
  • Walter Ginter on Medication Assisted Recovery Support Services in New York City

There is a zone of energy, authenticity and effectiveness that characterizes the earliest stages of successful social and therapeutic movements.  These qualities can be diluted or lost as movements become institutionalized (e.g., professionalized, commercialized or colonized by larger forces within the culture).  The documentation of the earliest contributions of these movements thus takes on both historical and practical importance.

In recent decades, the addiction treatment field has been marked by a loss of recovery volunteers within the addiction treatment milieu, reduced recovery representation among addiction counselors, addiction counselor training that denies the legitimacy of experiential knowledge, and weakened connections between what are now defined as addiction treatment businesses and indigenous communities of recovery.  It is in this context that new peer recovery support service roles promise several unique contributions: living proof of the reality and transformative power of long-term addiction recovery, recovery attraction via mutual identification, a service relationship lacking any hint of contempt or moral superiority, knowledge of and assertive linkage to local communities of recovery, and experience-grounded guidance through the stages of recovery.

The advent of peer recovery support services is an important milestone within the history of addiction treatment and recovery.  Such services stand as potentially important resources to speed recovery initiation, enhance service retention in addiction treatment and facilitate the transitions to recovery maintenance, enhance the quality of personal/family life in long-term recovery and to support efforts to break intergenerational cycles of addiction and related problems.  Cumulative experience and scientific research will tell whether the promises of peer recovery support services are fulfilled and sustained.  If such service relationships achieve their promise but are then lost, their presence in this era will stand as a valuable artifact to be rediscovered in the future, just as this power is now being rediscovered.

 

This post was first presented on William White’s blog on August 22, 2014, and it is still an important reference article today. This post, was written by William White, an Emeritus Senior Research Consultant at Chestnut Health Systems / Lighthouse Institute and past-chair of the board of Recovery Communities United. Bill has a Master’s degree in Addiction Studies and has worked full time in the addictions field since 1969 as a streetworker, counselor, clinical director, researcher and well-traveled trainer and consultant. He has authored or co-authored more than 400 articles, monographs, research reports and book chapters and 20 books. His book, Slaying the Dragon – The History of Addiction Treatment and Recovery in America, received the McGovern Family Foundation Award for the best book on addiction recovery. Bill was featured in the Bill Moyers’ PBS special “Close To Home: Addiction in America” and Showtime’s documentary “Smoking, Drinking and Drugging in the 20th Century.” Bill’s sustained contributions to the field have been acknowledged by awards from the National Association of Addiction Treatment Providers, the National Council on Alcoholism and Drug Dependence, NAADAC: The Association of Addiction Professionals, the American Society of Addiction Medicine, and the Native American Wellbriety Movement. Bill’s widely read papers on recovery advocacy have been published by the Johnson Institute in a book entitled Let’s Go Make Some History: Chronicles of the New Addiction Recovery Advocacy Movement.

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WHO IS BEST QUALIFIED TO PROVIDE RECOVERY SUPPORT SERVICES?

Written by William White

The explosive growth of nonclinical recovery support services (RSS) as an adjunct or alternative to professionally-directed addiction treatment and participation in recovery mutual aid societies raises three related questions:

1) What is the ideal organizational placement for the delivery RSS?

2) What persons are best qualified to provide RSS?

3) Are RSS best provided on a paid or volunteer basis?

At present, non-clinical RSS are being provided through and within a wide variety of organizational settings by people with diverse backgrounds in both paid and volunteer roles. While research to date suggests that such services can enhance recovery initiation and long-term recovery maintenance, no studies have addressed the three questions above or the broader issue of the kinds of evidence that should be considered in answering these questions.

I have repeatedly suggested that these questions should be answered by methodologically-rigorous research evaluating whether recovery outcomes differ by variations in delivery setting, attributes of those providing the services, and the medium (paid vs. volunteer) through which such services are provided. There are, however, considerations beyond such outcomes that ought to be considered and factored into decisions on the design and delivery of RSS.

As for organizational setting, I have heard such arguments as follows:

  • RSS should be provided by addiction treatment organizations to assure a high level of integration between treatment and post-treatment continuing care.
  • RSS should be provided by criminal justice and child welfare agencies to assure the balance between the goals of recovery support, public/child safety, and family reunification.
  • RSS should be provided by hospitals and other primary care facilities to assure effective integration of recovery support and primary health care.
  • RSS should be provided through public health authorities to assure the integration of prevention, harm reduction, treatment, recovery support, community-level infection control (e.g., HIV, Hep C), and wellness promotion.
  • RSS should be provided by behavioral managed care organizations (or insurance companies) to assure coordination and integration of support across levels of care (and potentially multiple service providers) and the effective stewardship of limited financial resources.
  • RSS should be provided by private professional recovery coaches who can coordinate support across multiple systems and across the long-term stages of recovery.

RSS are now being piloted through all of the above arrangements, but I think a strong argument can be made for providing RSS through and beyond all of the above settings under the auspices of authentic recovery community organizations (RCOs). Allocating financial resources to deliver RSS through these organizations and to the community at large has the added advantages of: 1) maintaining long-term personal and family recovery as the primary service mission, 2) drawing upon the experiential knowledge within communities of recovery to inform the provision of RSS, 3) contributing to the growth of local recovery space/landscapes (i.e. community recovery capital), 4) financially strengthening the infrastructure of local RCOs, and 5) proving greater peer support to the workers providing RSS.

Similarly, RSS are now being provided by people from diverse experiential and professional backgrounds. I think there are many RSS functions that can be effectively delivered across this diversity of backgrounds, but I think the delivery of these services by people in recovery who have been specifically training for this role offers a number of distinct advantages. Through the delivery of peer-based recovery support services, people in recovery can uniquely offer: 1) recovery hope and modeling (living proof of the reality of long-term recovery), 2) normative information drawn from personal/collective experience on the stages and styles of addiction recovery, and 3) knowledge of and navigation within local indigenous recovery support resources. Such hope, encouragement, and guidance is grounded in more than 200 years of history in which people in recovery (i.e., wounded healers, recovery carriers) have served as guides for other people seeking recovery from severe AOD problems (See Slaying the Dragon, 2014). It offers the further advantage of expanding helping opportunities for people in recovery—creating benefits for both helpee and helper through the helping process. (See discussion of Riesman’s Helper Principle). Some of these advantages are limited, however, when the knowledge of the RSS specialist is drawn from personal experience within only one recovery pathway—thus the importance of combing experiential knowledge with rigorous training and supervision.

If we accept the delivery of RSS through recovery community organizations and by people with lived experience of personal/family recovery from addiction, there still remains the question of whether those directly providing RSS should be in paid or volunteer roles. The most prevalent model of delivering RSS is presently through paid roles, with progressively increasing expectations of education, training, and certification—similar to the modern history of addiction counseling. Paying people in recovery to provide RSS has the advantages of expanding employment opportunities for persons in recovery, acknowledging the value and legitimacy of experiential knowledge and expertise, and potentially creating a more stable RSS workforce. That said, the professionalization and commercialization of the RSS role risks undermining the voluntary service ethic within the recovery community, potentially creating an unfortunate future in which people in recovery would expect financial compensation for all service work.

One option is to provide funding to RCOs for the recruitment, orientation, training, and ongoing supervision of RSS, while relying primarily upon trained volunteers to deliver such services. Only time will tell if this option is a viable and sustainable model for the delivery of high quality RSS. If not, great care will need to be taken to avoid the over-professionalization and over-commercialization of recovery support. Questions related to the design and delivery of RSS should be answered primarily through research on RSS-related recovery outcomes, but such research should also examine broader benefits and the potential for inadvertent harm rising from particular models of RSS.

 

 Written by William White and posted on June 22, 2018 at WilliamWhitePapers.com

http://www.williamwhitepapers.com/blog/2018/06/who-is-best-qualified-to-provide-recovery-support-services.html

William L. White is an Emeritus Senior Research Consultant at Chestnut Health Systems / Lighthouse Institute and past-chair of the board of Recovery Communities United. Bill has a Master’s Degree in Addiction Studies and has worked full time in the addictions field since 1969 as a streetworker, counselor, clinical director, researcher and well-traveled trainer and consultant. He has authored or co-authored more than 400 articles, monographs, research reports and book chapters and 20 books. His book, Slaying the Dragon – The History of Addiction Treatment and Recovery in America, received the McGovern Family Foundation Award for the best book on addiction recovery. Bill was featured in the Bill Moyers’ PBS special “Close To Home: Addiction in America” and Showtime’s documentary “Smoking, Drinking and Drugging in the 20th Century.” Bill’s sustained contributions to the field have been acknowledged by awards from the National Association of Addiction Treatment Providers, the National Council on Alcoholism and Drug Dependence, NAADAC: The Association of Addiction Professionals, the American Society of Addiction Medicine, and the Native American Wellbriety Movement. Bill’s widely read papers on recovery advocacy have been published by the Johnson Institute in a book entitled Let’s Go Make Some History: Chronicles of the New Addiction Recovery Advocacy Movement.

 

 

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