Sunday, 31 August 2008

New Seminal Monograph from William L White

I'm back after a period of looking after my three youngest children during their summer visit - and a period of recovery!

I have just received notification from William L White of his new publication, 'Recovery Management and Recovery-Oriented Systems of Care: Scientific Rationale and Promising Practices', that has just gone to press and can be downloaded from the Faces and Voices of Recovery website. As pointed out by Arthur C. Evans in his Prologue, this monograph will be regarded as a seminal work in the addictions treatment literature, as it is the most comprehensive attempt to lay out the empirical support for moving to recovery-oriented systems of care.
In America, there is a major shift in thinking about how we must help people overcome serious substance use problems. There is a shift away from focusing on the problem (addiction) to focusing on the lived solution (long-term addiction recovery). There is also 'a shift away from crisis-oriented, professionally directed, acute-care approach with its emphasis on isolated treatment episodes, to a recovery management approach that provides long-term supports and recognizes the many pathways to healing.' 
This approach is key to society improving long-term outcomes of addiction treatment. We in the UK have no option but to follow the approach being adopted in America. Our overall success as a nation in helping people overcome serious substance use problems and find recovery has been disappointing over recent years, despite a significant investment in funding from government. 
Whilst a shift to a recovery-oriented system of care represents a major challenge for this country, we are very fortunate in being able to read the writings of Bill White and implement the changes that are being advocated. White is providing a framework that can be used to guide the planning of policy makers and help them understand the key issues that must be addressed.   
I urge people working in this field to read this seminal monograph! There is a lot to take in and think about, but the people suffering from substance use problems deserve us devoting the attention that is needed.

5 comments:

Leon said...

I think the monster of addiction as a brain disease is poking it's head through our fence again and giving hope to the pharmaceutical industry. White on the surface offers blandishments and nice fuzzy stuff but this does not look that different from the AA and abstinence line of a pharmacological/physiological basis to addiction and if you read White's take on the biography on one of AA's founders, you know which side of the fence he is on. I am not against AA OR abstinence but the disease model only fits for a percentage of users and moving to recovery may again become a forced experience if we go down this line. I like some bits of Whites stuff but such profligate publishing should always be examined carefully.

tim1leg said...

This is what we now know, but what is done with it will be up to you.

Thanks to Mr. White’s work, we
have a solid foundation, and our vision of the future is much clearer.
Hear hear, wow if only those in policy and stategy could understand this........
annemarie

David Clark said...

Leon,
I am afraid that I strongly disagree with your sentiments. White does not describe a simple disease model - nor does he give hope to the pharmaceutical industry. I can only assume that you have not read his series of articles on the disease model. And in relation to the latter (i.e. drug industry), you couldn't have read his book on the culture of recovery and a variety of other books/manuscripts.
As for examining his prolific writing, I have been a scientist for over 30 years and I can say that I have rarely ever seen someone with such an impressive publication list (and quality of writing). White's ideas will in time have a major impact on society, I am sure. NB. My standards are high - having worked closely with a Nobel Laureate and won awards for my work - and I am generally a cynic about research.
Trust me on this one, this guy has talent and we should be paying attention. Sadly, very few people in this country have read his writings - which does not say much good for us working in the field.

Peter O'Loughlin said...

Perhaps it’s time I left this business, since I find myself yearning for those days when it was widely accepted that addiction is an irreversible condition, (a fact which remains unchanged,) and that recovery began with the acceptance of that fact, together with the fact that if one wanted addiction to go into lasting remission, abstinence was the first step in the long and difficult process of recovery.

It was clearly understood that sobriety, which is entirely different from abstinence, could only be achieved, through fundamental changes in attitude, outlook and lifestyle on the part of the addicted, changes for which they were entirely responsible, and which no one could make for them; it is from that, the transtheoretical model of the process of change emerged. That is neither coerced nor forced abstinence; in truth there is no such thing since no one can prevent the addicted from using their choice of drug(s).

Providing the addicted are mentally and, physically capable of making a free choice between increasing the severity of their addiction, or taking action to put it into lasting remission, the choice was and remains theirs, and theirs alone. and that remains the case today. It is therefore to be regretted that those who seek to do that are encouraged through social learning theories, current treatment protocols and strategies, together with declared and undeclared agendas, to believe otherwise

It was further understood that as part and parcel of the process of recovery, relapses would occur, but that did not mean the addicted had failed. On the contrary, old fashioned counsellors like me, would discourage the addicted from such thoughts, pointing out that failure could not occur until they stopped trying. We would point out that Edison had some ten thousand attempts to invent the light bulb before he succeeded, and that when asked by the media how it felt to have ‘failed’ 9,999 times he replied that he had not failed, they were all experiments. Thus we used what are now referred to as ‘Motivational Techniques.’ The addicted were free to go or stay as they chose, and I’m delighted that both AA and NA operate along those lines. Whether or not the addicted are able or willing to accept it, addiction is a three fold condition, involving mind body and soul.

For those unwilling or unable to accept that, keep it simple, just keep on using, but do not kid yourself that you have the right to expect others to subsidise your choice; everything has a price, it’s your obligation to find out, before it’s too late, whether or not you can afford it.

Tom Kirkwood said...

I agree with David. Bill White is an inspiring writer with exceptional credentials. His paper is a great piece of work and i sincerely hope those who work in the field spend some time to read it. His observations are so accurate and his recomendations for the development of a long term support model for people who choose recovery i applaud.
I run a recovery community with over 100 people living in it and from a personal perspective too know it take longer than a detox or 12 week primary treatment episode of any modality to get a high quality of recovery. I spent 24 years in active addiction so I am not surprised it took a while for me to get fully recovered.
I pray Bill White ideas are given serious consideration by the drug and alcohol treatment strategists.