transformation of the culture of recovery in america by william l. white - october 2011

The Culture of Recovery in The Culture of Recovery in America: America:

Recent Developments & Recent Developments & Their Significance Their Significance

Bill WhiteBill White

Chestnut Health SystemsChestnut Health Systems

Email: bwhite@chestnut.orgEmail: bwhite@chestnut.org

Presentation Goals Presentation Goals

1.1. Provide a historical update of the Provide a historical update of the culture of recovery in America to culture of recovery in America to include a review of diverse include a review of diverse communities of recovery and the communities of recovery and the emergence of new recovery culture emergence of new recovery culture institutions. institutions.

2.2. Explore the implications of these Explore the implications of these changes for the future of addiction changes for the future of addiction treatment and recovery. treatment and recovery.

The Handsome Lake The Handsome Lake MovementMovement

• Handsome Lake’s Handsome Lake’s conversion (1799)conversion (1799)

• The Code of The Code of Handsome Lake Handsome Lake

• The rejection of The rejection of alcoholalcohol

• The Longhouse The Longhouse ReligionReligion

Other Abstinence-based Other Abstinence-based Religious Revitalization Religious Revitalization MovementsMovements

• The Shawnee ProphetThe Shawnee Prophet• The Kickapoo ProphetThe Kickapoo Prophet• The Indian Shaker The Indian Shaker

ChurchChurch• The Native American The Native American

Church (Quanah Church (Quanah Parker)Parker)

• ““Indianization of AA”Indianization of AA”• Wellbriety MovementWellbriety Movement

The American Temperance The American Temperance Movement Movement • Early recovery biographies (1830s)Early recovery biographies (1830s)• Washingtonian Movement Washingtonian Movement • Recovery-focused Fraternal Recovery-focused Fraternal

Temperance Societies Temperance Societies • Ribbon Reform ClubsRibbon Reform Clubs• Institution-based Recovery Support Institution-based Recovery Support

Groups (e.g., Ollapod Club, Godwin Groups (e.g., Ollapod Club, Godwin Association, Keeley Leagues)Association, Keeley Leagues)

Blue Ribbon Reform Club Blue Ribbon Reform Club Pledge CardPledge Card

Faith-based Recovery Faith-based Recovery

Early Treatment Institutions Early Treatment Institutions

Early Treatment InstitutionsEarly Treatment Institutions

The Collapse (1900-1920)The Collapse (1900-1920)

• ExposExposéés of fraud and patient abuses of fraud and patient abuse

• Schisms within the fieldSchisms within the field

• Lack of scientific foundation Lack of scientific foundation

• Aging out of leadershipAging out of leadership

• Rising therapeutic pessimism & drive Rising therapeutic pessimism & drive toward alcohol/drug prohibitionstoward alcohol/drug prohibitions

The Transition PeriodThe Transition Period

Mutual AidMutual Aid

• United Order of Ex-boozers, etc.United Order of Ex-boozers, etc.

• Harlem Club of Former Alcoholic Harlem Club of Former Alcoholic DegeneratesDegenerates

Alternatives following Collapse of TreatmentAlternatives following Collapse of Treatment

• Inebriate Penal ColoniesInebriate Penal Colonies

• State Psychiatric HospitalsState Psychiatric Hospitals

• Private Sanitaria & Hospitals Private Sanitaria & Hospitals

Mid-Twentieth Century Mid-Twentieth Century Rebirth Rebirth • Alcoholics Anonymous Alcoholics Anonymous • The Modern Alcoholism MovementThe Modern Alcoholism Movement• New Alcoholism Treatment InstitutionsNew Alcoholism Treatment Institutions• New Addiction Treatment InstitutionsNew Addiction Treatment Institutions• Addicts Anonymous, Hypes & Addicts Anonymous, Hypes &

Alcoholics, Narcotics AnonymousAlcoholics, Narcotics Anonymous• Stage set for rise of modern addiction Stage set for rise of modern addiction

treatmenttreatment

AA Shared with Earlier Groups AA Shared with Earlier Groups (Not Derivative)(Not Derivative)

• Problem admissionProblem admission

• Public or semi-public commitment to Public or semi-public commitment to sobriety sobriety

• Sober fellowshipSober fellowship

• Experience-sharing meetingsExperience-sharing meetings

• Storytelling (3-part style) Storytelling (3-part style)

• Peer mentoring Peer mentoring

AA InnovationsAA Innovations

• Self-surrender versus self-assertionSelf-surrender versus self-assertion

• Focus on long-term recovery Focus on long-term recovery maintenance versus recovery initiationmaintenance versus recovery initiation

• Middle spiritual path between religious Middle spiritual path between religious and secular pathways of recovery and secular pathways of recovery

• Codification of program in writing prior Codification of program in writing prior to explosive growthto explosive growth

AA InnovationsAA Innovations

• Maintained its closed meeting frameworkMaintained its closed meeting framework --import of identification in recovery process--import of identification in recovery process• Unique organizational structure (that all Unique organizational structure (that all

external advisors predicted could not work)external advisors predicted could not work)• Creative management of the 5 Ps: Creative management of the 5 Ps:

personality—particularly charismatic personality—particularly charismatic leadership, power/privilege, possessions leadership, power/privilege, possessions (money and property), press and passion(money and property), press and passion

• Twelve Traditions were/are key to AA’s Twelve Traditions were/are key to AA’s survival survival

AA Remains Standard by which AA Remains Standard by which Pre-AA and Post AA Groups are Pre-AA and Post AA Groups are JudgedJudged• Size (2.1 million members) & Size (2.1 million members) &

Geographical Dispersion (150 Countries)Geographical Dispersion (150 Countries)• Longevity as an Organization Longevity as an Organization • Number & Methodological Rigor of AA Number & Methodological Rigor of AA

Research Research • Adaptation to Other Problems of LivingAdaptation to Other Problems of Living• Influence on Addiction Treatment Influence on Addiction Treatment • Influence on Culture Influence on Culture

Recovery Mutual Aid, 1970-Recovery Mutual Aid, 1970-20002000• Growth of Twelve Step groupsGrowth of Twelve Step groups

• Growing varieties of Twelve Step Growing varieties of Twelve Step experience experience

• Dramatic growth in total membershipDramatic growth in total membership

• Geographical dispersion in U.S. and Geographical dispersion in U.S. and internationallyinternationally

• Diversification of recovery frameworksDiversification of recovery frameworks

Spiritual Frameworks of Spiritual Frameworks of Recovery Recovery Twelve-Step Groups, e.g., -AA (1935) and NA Twelve-Step Groups, e.g., -AA (1935) and NA

(1947, 1953, 1959) (1947, 1953, 1959) Primary Drug Adaptations: marijuana (1968, Primary Drug Adaptations: marijuana (1968,

1989), prescription drugs, (1975, 1998), 1989), prescription drugs, (1975, 1998), cocaine (1982) nicotine (1985), cocaine (1982) nicotine (1985), benzodiazepine (1989), methamphetamine benzodiazepine (1989), methamphetamine (1995), heroin (2004), persons in recovery on (1995), heroin (2004), persons in recovery on methadone (1991) & generic groups i.e., methadone (1991) & generic groups i.e., Recoveries Anonymous (1983) Chemical Recoveries Anonymous (1983) Chemical Dependent Anonymous (1988)Dependent Anonymous (1988)

Non-Twelve Step, Spiritual AlternativesNon-Twelve Step, Spiritual Alternatives --The Red Road to Wellbriety--The Red Road to Wellbriety

Further Specialization Further Specialization

FamilyFamily

Al-Anon (1951), Alateen (1957), Al-Anon (1951), Alateen (1957), Families Anonymous (1971), Families Anonymous (1971), Recovering Couples Anonymous Recovering Couples Anonymous (1988) & Teen-Anon (1999)(1988) & Teen-Anon (1999)

Emergence of Concept of “Family Emergence of Concept of “Family Recovery”Recovery”

Further Specialization Further Specialization

Occupational Occupational

International Doctors in Alcoholics International Doctors in Alcoholics Anonymous (1949), Lawyers (1975), Anonymous (1949), Lawyers (1975), Anesthetists (1984), Nurses (1988), Anesthetists (1984), Nurses (1988), Veterinarians (1990), etc. Veterinarians (1990), etc.

Further Specialization Further Specialization

Co-Occurring ProblemCo-Occurring ProblemDual Disorders Anonymous (1982), Dual Disorders Anonymous (1982),

Dual Recovery Anonymous (1989), Dual Recovery Anonymous (1989), Double Trouble in Recovery (1993)Double Trouble in Recovery (1993)

Criminal Justice Criminal Justice Inner Circle Inner Circle Winner’s Circle/Community Winner’s Circle/Community

Meeting Specialization Meeting Specialization

• GenderGender

• Age or duration of sobriety Age or duration of sobriety

• Ethnicity Ethnicity

• Sexual orientation Sexual orientation

• Smoking statusSmoking status

• Degree of religiosity Degree of religiosity

• Endless varieties of meeting formatsEndless varieties of meeting formats

Secular Recovery Support Secular Recovery Support GroupsGroups

• Women for Sobriety (1975)Women for Sobriety (1975)

• Secular Organization for Sobriety / Save Secular Organization for Sobriety / Save Our Selves (1985)Our Selves (1985)

• Rational Recovery (1986)Rational Recovery (1986)

• Men for Sobriety (1988)Men for Sobriety (1988)

• Smart Recovery® (1994)Smart Recovery® (1994)

• Moderation Management (1994)Moderation Management (1994)

• LifeRing Secular Recovery (1999)LifeRing Secular Recovery (1999)

Religious Recovery Support Religious Recovery Support GroupsGroups

• Calix Society (1947)Calix Society (1947)

• Alcoholics Victorious (1948) Alcoholics Victorious (1948)

• Teen Challenge (1961)Teen Challenge (1961)

• Alcoholics for Christ (1976)Alcoholics for Christ (1976)

• JACS (1979)JACS (1979)

• Celebrate Recovery, Free N’ One, Ladies Celebrate Recovery, Free N’ One, Ladies Victorious, Overcomers in Christ, Victorious, Overcomers in Christ, Liontamers Anonymous, Mountain Movers, Liontamers Anonymous, Mountain Movers, Millati Islami Millati Islami

Important Resource Important Resource

Mutual Support Resources regularly Mutual Support Resources regularly updated at Faces and Voices of updated at Faces and Voices of Recovery Web Site Recovery Web Site

http://www.facesandvoicesofrecovery.org

Current TrendsCurrent Trends

• From recovery community to From recovery community to communities of recoverycommunities of recovery

• Cultural & political awakening across Cultural & political awakening across religious, spiritual & secular religious, spiritual & secular frameworks of recoveryframeworks of recovery

• New recovery support institutions New recovery support institutions

• Cultural development Cultural development

Culture of Recovery UpdateCulture of Recovery Update

• Diversification of Peer-based Recovery Diversification of Peer-based Recovery Support SocietiesSupport Societies

• New Recovery Advocacy Movement New Recovery Advocacy Movement • Spread of Grassroots Recovery Community Spread of Grassroots Recovery Community

Organizations & Recovery Support CentersOrganizations & Recovery Support Centers• Recovery Home MovementRecovery Home Movement• Recovery Industries Recovery Industries • Recovery School MovementRecovery School Movement• Recovery Ministries, Churches & ColoniesRecovery Ministries, Churches & Colonies

New Recovery Advocacy New Recovery Advocacy MovementMovement

HistoryHistory

2001 Recovery Summit in St. Paul2001 Recovery Summit in St. Paul

National Organization National Organization

Faces and Voices of RecoveryFaces and Voices of Recovery

NCADDNCADD

Johnson InstituteJohnson Institute

Legal Action Center Legal Action Center

Movement Goals Movement Goals

• Political/Cultural Mobilization of Communities Political/Cultural Mobilization of Communities of Recoveryof Recovery

• Recovery-focused Public & Professional Recovery-focused Public & Professional Education Education

• Advocacy of Pro-recovery Laws & Social Advocacy of Pro-recovery Laws & Social Policies Policies

• Push for Recovery-focused Redesign of Push for Recovery-focused Redesign of Treatment Treatment

• Promotion of Peer-based Recovery Support Promotion of Peer-based Recovery Support ServicesServices

• Recovery CelebrationRecovery Celebration• Promotion of Recovery Research Promotion of Recovery Research

Cultural Consciousness; Cultural Consciousness; Cultural Development Cultural Development

• Reconstruction of HistoryReconstruction of History

• Identity ReconstructionIdentity Reconstruction

• Language Audit & Construction Language Audit & Construction

• Values Definition Values Definition

• New SymbolsNew Symbols

• Musical AnthemsMusical Anthems

• Artistic ExpressionArtistic Expression

• Literature Literature

Recovery School Movement Recovery School Movement

• High School and Collegiate LevelsHigh School and Collegiate Levels• Association of Recovery Schools (2002)Association of Recovery Schools (2002)• Key ElementsKey Elements --Active recruitment of people in recovery--Active recruitment of people in recovery --Scholarships--Scholarships --On-campus recovery support--On-campus recovery support --Academic mentoring --Academic mentoring * Early Evaluations (high rates of continuous * Early Evaluations (high rates of continuous

recovery & academic excellence)recovery & academic excellence)

Grassroots Recovery Grassroots Recovery Community Organizations Community Organizations (RCOs)(RCOs)• Organized by and on behalf of Organized by and on behalf of

communities of recoverycommunities of recovery• Focus on advocacy, education and peer Focus on advocacy, education and peer

support servicessupport services• Establishing Recovery Support Centers, Establishing Recovery Support Centers,

e.g., CCAR’s Network of RSCs in CTe.g., CCAR’s Network of RSCs in CT• Some contracting to do telephone-Some contracting to do telephone-

based, post-treatment recovery based, post-treatment recovery checkups checkups

Recovery Home MovementRecovery Home Movement

• Halfway Houses (1950s) to Social Model Halfway Houses (1950s) to Social Model Rehabilitation Programs (1970s)Rehabilitation Programs (1970s)

• Oxford House (1975) (1,200 homes, 48 Oxford House (1975) (1,200 homes, 48 states, 24,000 residents per year)states, 24,000 residents per year)

• Federal Anti-Drug Abuse Act of 1988 (Loan Federal Anti-Drug Abuse Act of 1988 (Loan Fund)Fund)

• Broader Recovery Home MovementBroader Recovery Home Movement

• Philadelphia Survey (21 funded; 250 Philadelphia Survey (21 funded; 250 unfunded)unfunded)

Recovery IndustriesRecovery Industries

• Formats range from “recovery friendly” Formats range from “recovery friendly” (Zingerman’s Deli, Venturetech) to “recovery (Zingerman’s Deli, Venturetech) to “recovery exclusive” employers (Recovery at Work)exclusive” employers (Recovery at Work)

• Preparatory or Permanent Employment Preparatory or Permanent Employment • Core Elements:Core Elements: --Skill training--Skill training

--Work-based peer recovery coaching--Work-based peer recovery coaching--Linkage to recovery communities--Linkage to recovery communities

--Establishment of legitimate work history--Establishment of legitimate work history

Recovery Ministries, Churches Recovery Ministries, Churches & Colonies& Colonies• ““Recovery friendly churches” Recovery friendly churches” • Mega-churches with a “recovery pastor”Mega-churches with a “recovery pastor”• Lay leaders of recovery support groupsLay leaders of recovery support groups• recovery-focused worship services and recovery-focused worship services and

workshopsworkshops• Recovery Churches, e.g., Central Park Recovery Churches, e.g., Central Park

Recovery Church in St. PaulRecovery Church in St. Paul• Faith-based recovery colonies, e.g., Dunklin Faith-based recovery colonies, e.g., Dunklin

Memorial Camp in Okeechobee, FloridaMemorial Camp in Okeechobee, Florida• National Association for Christian Recovery National Association for Christian Recovery

Cultural Development Between Cultural Development Between (rather than within) (rather than within) Communities of Recovery Communities of Recovery • Identity Reconstruction Identity Reconstruction

• Reconstruction of History Reconstruction of History

• A New Language A New Language

• Values Definition Values Definition

• New SymbolsNew Symbols

• Musical AnthemsMusical Anthems

• Artistic ExpressionArtistic Expression

• Literature Literature

The Recovery Home The Recovery Home Movement:Movement:2010 Oxford House Convention2010 Oxford House Convention

Recovery & Education Recovery & Education

Recovery within Faith Recovery within Faith Communities Communities

Cultural Visibility & Advocacy Cultural Visibility & Advocacy (with Anonymity)(with Anonymity)

Recovery-focused Community Recovery-focused Community Education Education

Recovery Community Recovery Community CentersCenters

Recovery Media Recovery Media

Recovery & Community Recovery & Community Service:Service:Baltimore Recovery CorpsBaltimore Recovery Corps

Recovery Arts: Philadelphia Recovery Arts: Philadelphia Recovery MuralsRecovery Murals

Recovery Sports: Phoenix Recovery Sports: Phoenix Multisport Multisport

Recovery & MusicRecovery & Music

Implications Implications

• AOD arena at personal/family levels no AOD arena at personal/family levels no longer limited to Tx and mutual aid longer limited to Tx and mutual aid

• Enhanced Tx Effectiveness via potent Enhanced Tx Effectiveness via potent combinations of Tx, mutual aid and combinations of Tx, mutual aid and participation in new recovery support participation in new recovery support institutionsinstitutions

• Increased recovery without treatment Increased recovery without treatment

Implications Implications

Greater focus on role of community in Greater focus on role of community in recoveryrecovery

* Greater focus on community * Greater focus on community recovery recovery capitalcapital

* Growing interest in concept of * Growing interest in concept of community recoverycommunity recovery

Coyhis “Healing Forest” MetaphorCoyhis “Healing Forest” Metaphor

Primary ReferencesPrimary References

• White, W. (2008) The culture of recovery in White, W. (2008) The culture of recovery in America: Recent developments and their America: Recent developments and their significance. significance. CounselorCounselor, , 9(4), 44-51. , , 9(4), 44-51.

• White, W. (2009). The mobilization of White, W. (2009). The mobilization of community resources to support long-term community resources to support long-term addiction recovery. addiction recovery. Journal of Substance Journal of Substance Abuse Treatment, Abuse Treatment, 36, 146-58.36, 146-58.

• White, W. (2009). White, W. (2009). Peer-based Addiction Peer-based Addiction Recovery Support: History, Theory, Recovery Support: History, Theory, Practice, and Scientific Evaluation. Practice, and Scientific Evaluation. Chicago, IL: Great Lakes Addiction Chicago, IL: Great Lakes Addiction Technology Transfer Center.Technology Transfer Center.