Tag Archives: recovery coaching

Recovery Contagion within the Family

Posted on March 10, 2022 by Melissa Killeen

By Bill White

Addiction runs in families, but far less known is the fact that recovery also runs in families. Recovery Contagion is a phenomenon have captured my attention in recent decades and been the focus of numerous articles. Recovery contagion is defined as the recovery from a disease spread by close contact.

Scientific studies are unravelling the factors that combine to elevate risk of intergenerational transmission of addiction and related problems. These mechanisms of transmission include genetic and neurobiological influences, fetal alcohol spectrum disorders, assortative mating (attraction of those exposed to parental addition to individuals who share this family history), co-occurring conditions, temperament, developmental and historical trauma, family dynamics (e.g., parental/sibling modeling and collusion), early age of alcohol and other drug (AOD) exposure, and disruption of family rituals. (See Here for review of studies). Rigorous studies have yet to be conducted on the prevalence, patterns, and mechanisms through which addiction recovery of one family member increased the probability of other addicted family members also initiating a recovery process. The purpose of this article is to offer some observations on these issues drawn from decades of observation of families impacted by and recovering from severe and persistent Alcohol or Drug misuse problems. The following suggestions should be viewed as hypotheses to be tested via scientific studies and more expansive clinical observations.

  • Innumerable patterns of recovery transmission exist within families. Recovery transmission may occur intergenerationally (e.g., parent to child) and Intragenerationally (between siblings) and reach the extended family and social network. The recovery influence may also be bi-directional, e.g., mother in recovery to addicted child, child in recovery to addicted mother). Recovery transmission, like addiction, can also skip generations.
  • The probability of recovery initiation of an addicted family member increases as the density of recovery within an addiction-affected family network increase. The contagiousness of recovery and the push and pull forces towards recovery increase exponentially as other family members initiate recovery and as overall health of the family system improves.
  • The mechanisms of recovery transmission within affected families include:

1) infusion into the family of increased knowledge about addiction and recovery by the family member(s) in recovery,

2) withdrawal of family support for active addiction,

3) truth-telling about the addicted family member’s behavior and its effects on the family, 4) elicitation of hope,

5) recovery role modeling,

6) active engagement and recovery guidance by family member(s) in recovery,

7) assertive linkage and co-participation in recovery mutual aid and other recovery support institutions,

8) assistance when needed in accessing professional treatment,

9) post-treatment monitoring and support, and

10) adjustments in family life to accommodate recovery support activities for recovering members and family as a whole.

These individual mechanisms achieve heightened power when sequenced and combined over time.

  • Recovery of a family member can spark personal reevaluations of AOD consumption of other family members, resulting in a potential decrease in AOD use and related risk behaviors, even among family members without a substance use disorder. This may constitute a hidden benefit of recovery in lowering addiction-related costs to community and society.
  • The recovery contagion effect on other family members exists even when the recovering family member isolated themselves from the family to protect his or her own recovery stability. The family’s knowledge of the reality of his or her continued recovery and its effects on their health and functioning exerts pressure towards recovery even in absence of direct contact.
  • One of the most complicated forms of recovery contagion is between intimate partners who both experience AOD problems. The recovery of one partner destabilizes the relationship and increases the probability of recovery initiation of the other; addiction recurrence in one partner increases the recurrence risk in the other partner. Recovery stability is greatest when each partner established their own recovery program in tandem with activities to support “couple recovery.”
  • Where conflict exists between a family member in recovery and a family member in active addiction (e.g., a father in recovery and an actively addicted son), the conflict can serve as an obstacle to recovery initiation of the addicted family member. Though recovery initiation may be slowed, recovery prognosis is still increased, and the conflicted relationship is often reconciled when both parties are in recovery. When not reconciled, conflict can continue to be played out via different pathways of recovery.

It is rare to escape injury to family within the addiction experience. Such injuries increase progressively within families in which multiple people are experiencing AOD-related problems. For those of us who find ourselves in such circumstances, the greatest gift we can offer our family is our own recovery.

Related Papers of Potential Interest

Evans, A. C., Lamb, R., & White, W. L. (2014). Promoting intergenerational resilience and recovery: Policy, clinical, and recovery support strategies to alter the intergenerational transmission of alcohol, drug, and related problems. Philadelphia: Department of Behavioral Health and Intellectual disAbility Services. Posted at http://www.williamwhitepapers.com/pr/2014%20Breaking%20Intergenerational%20Cycles%20of%20Addiction.pdf

Navarra, R. & White, W. (2014) Couple recovery. Posted at http://www.williamwhitepapers.com/blog/2018/03/couple-recovery-robert-navarra-psyd-lmft-mac-and-bill-white.html

White, W. & Savage, B. (2003) All in the Family: Addiction, recovery, advocacy.   Posted at http://www.williamwhitepapers.com/pr/2005AllintheFamily.pdf

White, W. (2014) Addiction recovery and intergenerational resilience Posted at http://www.williamwhitepapers.com/blog/2014/07/addiction-recovery-and-intergenerational-resilience.html

White, W. (2017). Family recovery 101. Posted at http://www.williamwhitepapers.com/blog/2017/12/family-recovery-101.html

White, W. Addiction/Recovery as a family tradition. Posted at http://www.williamwhitepapers.com/blog/2017/12/family-recovery-101.html

White, W. (2015) All in the family: Recovery resource review. http://www.williamwhitepapers.com/blog/2015/11/all-in-the-family-recovery-resource-review.html

White, W. L. & Chaney, R. A. (2008). Intergenerational patterns of resistance and recovery within families with histories of alcohol and other drug problems: What we need to know. Posted at http://www.williamwhitepapers.com/pr/2012%20Intergenerational%20Resilience%20%26%20Recovery.pdf

 White, W. L. & White. A. M. (2011).  Tips for recovering parents wishing to break intergenerational cycles of addiction. Posted at: http://www.williamwhitepapers.com/pr/Tips%20for%20Recovering%20Parents.pdf

About the author:

Bill White published this article on his web site on September 05, 2019.. Bill White is a preeminent researcher on addiction and recovery. He received a Lifetime Achievement Award from the Faces and Voices of Recovery in 2015. 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.

His web site is: http://www.williamwhitepapers.com/

*Definition of Recovery Contagion:

The recovery from a disease spread by close contact.

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POWER OF PEER SUPPORT- an abbreviated chronology

Posted on August 28, 2018 by Melissa Killeen

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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New Training Resource for Supervisors of Peers and Recovery Coaches

Posted on May 27, 2017 by Melissa Killeen

Recently, a new resource on the Supervision of Peer Based Recovery Support Services has been published under a grant from the Regional Facilitation Center and the Oregon Health Authority, specifically from the Health Services Division of the OHA. This is a resource is designed for the training of supervisors of Peer Recovery Support Specialists and Recovery Coaches.

Peer-based recovery support services (P-BRSS) have grown exponentially in recent years as an adjunct, and in some cases, an alternative to professionally-directed addiction treatment. P-BRSS are also being integrated within allied human services, primary health care, the child welfare system, the criminal justice system, and managed behavioral healthcare organizations. Reviews of the research to date on P-BRSS (See White, 2009; Reif, et al, 2014; Boisvert, et al, 2008) suggest salutatory effects of such services on long-term recovery outcomes. A growing body of literature explores such areas as the history and theoretical foundation of P-BRSS, the role of such services within drug policy, the integration of P-BRSS into recovery community organizations, avoiding role ambiguity and role conflicts in the delivery of P-BRSS, and ethical issues that arise in the delivery of P-BRSS.

But surprisingly little has been written on the supervision of peer recovery support services. Through support of a grant from the Oregon Health Authority (Health Services Division), Substance Use Disorder Peer Supervision Competencies has just been completed. The report is authored by Eric Martin, Anthony Jordan, Michael Razavi, Van Burnham, IV, Ally Linfoot, Monta Knudson, Erin Devet, Linda Hudson, and Lakeesha Dumas. J. Thomas Shrewsbury. Dr. Jeff Marotta, Dr. Ruch Bichsel, and Kitty Martz served as editors. The supervisory competencies are organized within four sections of the report: Recovery-Oriented Philosophy, Providing Education & Training, Facilitating Quality Supervision, and Performing Administrative Duties. This document is an invaluable resource for organizations involved in the recruitment, selection, orientation, training, and on-going supervision and evaluation of recovery coaches and other support specialists. It stands as an excellent complement to SAMHSA’s 2015 Core Competencies for Peer Workers in Behavioral Health Services.

I think the greatest mistake that could be made in guiding the delivery of P-BRSS would be to assume that traditional models of clinical supervision within addiction treatment can be indiscriminately applied to the supervision of P-BRSS delivery. If that occurs, peers providing recovery support service will be turned into little more than junior counselors and the potential vitality of that role and the broader role of community in long-term recovery will be lost.

P-BRSS require a distinct role definition, different standards of practice, and different models of supervision. Substance Use Disorder Peer Supervision Competencies will help assure such distinctiveness. I commend this report to all organizations providing peer-based recovery support services.

This blog post has been written by William White. The link to this article at the William White Papers web site is:

http://www.williamwhitepapers.com/blog/2017/05/new-resource-on-supervision-of-peer-recovery-support-services.html

William (Bill) 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 street worker, 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 18 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.

You can contact Bill White at: http://www.williamwhitepapers.com/ or bwhite@chestnut.org

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