For the Initiation and Maintenance of Addiction Recovery William L. White, MA
We must begin to create naturally occurring, healing environments that
provide some of the corrective experiences that are vital for recovery.
-Sandra Bloom, Creating Sanctuary , p117
Models of addiction treatment that view the sources and solutions to severe alcohol and other drug (AOD) problems as rooted within the vulnerability and resiliency of each individual stand in marked contrast to models of intervention that focus on the ecology of AOD problem development and resolution for individuals, families and communities. An integration of the latter model into mainstream addiction treatment would necessitate a reconstruction of the treatment-community relationship and new approaches to community resource development and mobilization. Such an integration would redefine core addiction treatment services and to whom, by whom, when, where, and for how long such services would be delivered. This article draws on historical and contemporary events in the history of addiction treatment and recovery that illuminate the relationship between recovery and community. The article ends with a discussion of principles and strategies that could guide the development and mobilization of community resources to support the recovery of individuals and families.
The development of severe alcohol and other drug (AOD) problems involves intrapersonal, interpersonal and broader systems-level processes. In parallel fashion, recovery from severe AOD problems often depends upon the mobilization of previously unknown strengths within the self, a connection to resources and relationships beyond the self, and involvement in recovery support institutions in the larger community. Most addiction professionals would express agreement with these two opening statements, but the dominant modalities and levels of care of addiction treatment are distinctly intrapersonal in their orientation. Within this intrapersonal model, the roots of addiction are defined in terms of one’s biological and/or psychological vulnerability. Professional services within this model are directed almost exclusively to individual clients with “collaterals” and the community viewed as sources of treatment support or treatment sabotage but not as targets of focused intervention. The overriding goal of services that flow from this model is to modify the physiology, thoughts, feelings and behavior of individual service consumers. Little effort is exerted to “treat” the larger physical and relational world in which individual recovery efforts succeed or fail.
Several influences are converging to push this intrapersonal orientation to a more relational and systems-focused perspective. There is growing recognition that recovery initiation in institutional settings does not assure sustained recovery maintenance in natural community environments (White, 1996). The growth and diversification of addiction recovery mutual aid societies and broader patterns of recovery community building activities are also shifting focus from institution-based to community-based helping processes (Humphreys, 2004; White, 2004). Recovery community building activities include the rapid spread of recovery homes, recovery schools, recovery industries, recovery churches and new recovery community organizations and service roles (Jason, Davis, Ferrari, et al, 2001; White & Finch, 2006; Valentine, White & Taylor, 2007; White, 2006b). In a related development, a new grassroots addiction recovery advocacy movement is: 1) calling for a reconnection of addiction treatment to the larger and more enduring process of addiction recovery, 2) advocating a renewal of the relationship addiction treatment institutions and the grassroots communities out of which they were birthed, and 3) extolling the power of community in the long-term recovery process (Else, 1999; Morgan, 1995; White, 2006a; 2007).
Scientific evidence is also confirming the limitations of current intrapersonal, acute-care models of addiction treatment as measured by such performance indicators as attraction, access, engagement, retention, post-treatment relapse rates and treatment re-admission rates (See White, 2006 for a review). Scientists and clinical leaders are advocating that addiction treatment shift from a model of acute bio-psychosocial stabilization to a model of sustained recovery management that would emulate the treatment of other chronic health conditions (O’Brien. & McLellan, 1996; McLellan, Lewis, O’Brien & Kleber, 2000; White, Boyle & Loveland, 2002; Dennis & Scott, in press). There is also increased interest in public health and harm reduction strategies that integrate environmental and clinical strategies of AOD problem resolution (Kellog, 2003; Tatarsky, 2003).
Recovery is emerging as a new organizing paradigm for behavioral health care policy (White, 2005a; DHHS, 2003; IOM, 2006), addiction and mental health services integration (Gagne, White, & Anthony, 2007; Davidson & White, in press), federal service program initiatives (e.g., CSAT’s Recovery Community Support Program and Access to Recovery program)(Clark, 2007), and state and local behavioral health system transformation efforts (Kirk, 2007; Evans, 2007). This has in turn sparked interest in the scope and meaning of the term recovery (Betty Ford Institute Consensus Panel, in press) and a growing interest in the pathways, styles and stages of long-term recovery (White & Kurtz, 2006) as well as the ecology of addiction recovery. The ecology of recovery can be defined as the study of how the relationships between individuals and their physical, social and cultural environments promote or inhibit the long-term resolution of severe AOD problems.
Over the past decade, the author has conducted a sustained meditation on the role of community in addiction recovery (White, 1996, 2002, 2003; White & Hagen, 2005; White &
Kurtz, 2006a). I have defined individuals, families, kinship and social networks and physical/cultural communities as organisms that can all be wounded (addicted) and in need of recovery, that can constitute potential sources of resistance and resilience to AOD problems, and that can serve as catalytic agents of healing and recovery. Families, kinship and social networks and communities can be considered in need of treatment and recovery when the health and performance of its members and the system as a whole have been severely impaired by alcohol- and other drug-related problems. In this view, parallel processes exist between the wounding and healing of the individual, the family and the community. Much of what is known about the recovery of individuals is paralleled in the recovery of families, kinship and social networks and whole communities (See Table One for an illustration of such parallel processes.)
Table One: Individual, Family and Community Recovery
Parallel Processes in Personal, Family and Community Recovery
Honest acknowledgement of AOD problems and their severity
Admission that past problem solving efforts have failed
Recovery initiation, resource mobilization and recovery stabilization
Management of self-defeating patterns of thinking, feeling, acting, interacting.
Character and identity (story) reconstruction (who we were, what happened, who we are now and are becoming)
Reconciliation and reconstruction of key relationships
Recovery maintenance rituals (centering rituals, sober fellowship, acts of self-care; acts of citizenship and service)
The key point here is that individuals, families, kinship networks, and communities, through their interactions within one another, can perform both wounding and healing functions. The purpose of this current paper is to set forth a set of historically grounded principles that can guide the development and mobilization of community resources to facilitate the processes of recovery initiation, consolidation and maintenance for individuals and families. The focus of this paper will be primarily upon the development and mobilization of community resources to support the individual resolution of severe AOD problems, but we will return at the end of this paper to the reciprocal relationships between individual recovery, family recovery and community recovery.