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.

Therapeutic principles underlying behavioural change and recovery

What are the key therapeutic principles that underlie behavioural change and recovery? Here are some of my reflections on this issue. These principles need to be an integral part of any treatment programme that aims to help people find their path to recovery. What do you think?

Reflections on Treatment

Firstly, if you were waiting for my Blogs in the second part of the week, my apologies. My three youngest children have come to stay with me for their summer holidays, before moving abroad with their mother. I will also be wanting to spend as much time as possible with them this week.

Last week, I reflected on recovery and pointed out that formal treatment was one form of help that can help a person move along their path to recovery. I attach a short document which outlines some other thoughts about treatment.

Some Words on Recovery

I had a nice comment on yesterday's Blog - thanks Mike! He went on to say that he will be sending my Blog to his boss at the DAAT where he  works as the latter is 'striving to develop his understanding of the whole recovery debate.' I have often wondered how many DAAT teams read my Blogs - and how many understand the concept of recovery.

Following on from yesterday's Blog on 'drug, set and setting', I have linked to a short document that I wrote some months ago on recovery from heroin addiction. Hope you find it useful. I am writing much more detailed material on recovery for our forthcoming online community site. Stay tuned.

The role of 'drug, the person and their social context' in the development of problematic drug use and recovery

In yesterday's Blog, I pointed out that the effects of a drug (or alcohol) on an individual are determined by an interaction between the drug, the person and their social context (commonly known as 'drug, set and setting' in the field). This principal holds in a variety of situations.

For example, the ‘person’ and ‘social context’ factors influence early substance use and the likelihood that a person will develop problematic use and addiction. In general, individuals are less likely to develop substance use problems if they have fewer complicating life problems, more resources (social, personal, educational, economic), and opportunities for alternative sources of reward. One explanation is that these individuals develop a weaker attachment to the substance in that for them substance use does not serve as many emotional, psychological or social needs.

On the other hand, people are in general more likely to develop substance use problems if they have complicated personal problems (e.g. co-occurring mental health issues), few personal resources, and live in a deprived social environment offering few alternative rewards. 

Serious substance use problems often occur as part of a larger cluster of psychological, medical, family and social problems. However, it must be remembered that addiction can affect anyone, whatever their age, gender, financial situation, family stability, intellect, religion, or race. 

A variety of factors can change problematic substance use once it has developed. For some people, the problems are transitional in nature and they mature out of them as their setting changes, e.g. other life events become more significant, such as setting up a home with a loved one. Other people spend years misusing substances and suffering negative consequences and losses, before dying without overcoming their problems.  Most people, however, experience multiple attempts either to stop using or to bring their use under better control before they eventually resolve their substance use problems.

The ease with which people overcome substance use problems, and achieve recovery from addiction, is largely dependent on two factors, namely problem severity and recovery capital. Recovery capital is the quantity and quality of internal (‘person’) and external (‘social context’) resources that one can bring to bear on the initiation and maintenance of recovery. The interaction of problem severity and recovery capital shapes both the prospects of recovery and the intensity and duration of resources (e.g. formal treatment) required to initiate and sustain recovery.

In general, it is easier to resolve substance use problems at earlier and less severe stages of problem development. Moreover, substance use problems are easier to overcome if a person has good internal and external resources.

The Vietnam War Experience

Most people assume that the effects of psychoactive drugs are fixed and predictable, being dependent on their physiological actions in the brain. In fact, the psychological effects of a drug are also dependent on a variety of characteristics of the individual, as well as the influence of the social context in which the drug is taken. In the field, this is known as 'drug, set and setting'.

If we are to better understand the impact of drugs and alcohol on the lives of individuals, and help them find their path to recovery from addiction, then we need to appreciate the importance of 'drug, set and setting'. Sadly, this is not a widely appreciated fact in the field.

Many people assume that once you have tried heroin you become addicted to the drug. It is also commonly assumed that it is extremely difficult to give up using heroin. Whilst this may be the case for many people, it is not for many others. The most dramatic illustration of this point, and of the role of 'setting' in addiction and recovery, is provided by research conducted with US soldiers returning from the Vietnam War.   

Please read about this fascinating research study in the attached short document.

The 100th Posting

So this is it, the 100th post on this Blog. Not quite my 100th, since Lucie and Kevin posted some material whilst I was on holiday, but all the same I feel chuffed.

For regular readers, you will know that my colleagues and I at Wired In are committed to radically altering the way that society helps people overcome serious substance use problems. We are strong recovery advocates. We aim to show people affected by serious substance use problems and addiction how others have found their path to recovery. We want to help create a society that is more understanding of addiction and provides a better environment for individuals and families trying to find recovery.

I would like to use three quotes in this 100th posting, quotes that have influenced the way that I think about this field. The first two quotes are from the Tom Peters book, 'Re-imagine!', a book that has nothing to do with substance use problems.

'Some people look for things that went wrong and try to fix them. I look for things that went right and try to build on them.' Bob Stone 

'Find Heroes. Do Demos. Tell Stories'

The final quote is one I have used before, from 'Slaying the Dragon: The History of Addiction Treatment and Recovery in America' by William L. White.

'In the future, this locus will be shifted from the institution to the community itself. Treatment will be something that happens in indigenous networks of recovering people that exist within the broader community. The shift will be from the emotional and cognitive processes of the client to the client’s relationships in a social environment. With this shift will come an expansion of the role of clinician to encompass skills in community organization. Such a transition does not deny the importance of the reconstruction of personal identity and other cognitive and emotional processes – or of the physical; processes of healing – in addiction recovery. But it does recognize that such processes unfold within a social ecosystem and that this ecosystem, as much as the risk and resiliency factors in the individual, tips the scales toward recovery or continued self-destruction.'