In Addiction Today, David Best pulls together 3 themes we’ve discussed in this blog.
What I will do is overview three key component parts of a theoretical model of recovery, then draw them together to derive conclusions about what we should do next to make policy and practice stronger in this area.
1. Recovery capital – personal and social resources – the journey of growth
2. Social identity and social contagion in recovery – the role of friends and connections
3. Therapeutic landscapes of recovery – the role of location.
Please read the whole thing. It provides a very concise summary of some very important concepts. For example, on social contagion and identity:
Belonging to these groups has another effect: it changes how people see themselves and what is possible in their world. This is social identity – that we define ourselves in part by the groups we belong to (and by those we don’t) and that process provides us with a lens for seeing the world through. That is part of the reason why belonging to recovery groups is so important in helping people to build the skills and confidence (personal capital) that they will need. Belonging matters. It also provides a safe space for making changes and growing recovery strengths.
Toward the end of the piece, he provides an optimistic call to action:
So what does this mean? We now know that personal recovery is a complex journey that might take years and involve false starts – but it is one that we know will probably end in success. We also know some of the things about personal skills and social supports which will dramatically swing the odds in favour of recovery. We must link this to a commitment to measuring and mapping recovery pathways.
6 thoughts on “Recovery doesn’t happen in a vacuum”
Really thoughtful look at broadening the definition of ‘recovery’ Jason. Especially as it relates to to role of abstinence in mutual support groups. You’re on the front lines of treating this disease, and I think your organization position pieces and your blog in particular play an important role in the evolution of the treatment of this epidemic.
I can only qualify my comments as being my own experiences, but I couldn’t help considering a lot of the questions that you posed as I have wrestled with my disease. I tried MMT for a period of about 6 months while going to meetings and found it to be problematic. The main problem was that I was intoxicated while on the medication. The clinic that I went to dosed it at very high levels and while I didn’t feel ‘high’, I was very drowsy throughout the day. It wasn’t compatible with the overwhelmingly positive energy that you find in meetings. I didn’t feel the sense of spiritual well-being that others had in the rooms. Additionally, I quickly found out that I had to omit this very relevant fact with my sponsor. I felt like a fraud, and I firmly believe that he rigorous honesty these programs demand can not be sidestepped. Eventually, I stopped going to the meetings so that I could handle looking myself in the mirror. I think it’s important to contrast that with the experience I had at a long-term treatment center that used buprenorphine to taper me off narcotics over a period of about 6 months. I won’t go into the specifics of my medical history, but I was on extremely high doses of heavy-duty narcotics for about 8 years. While I was on the buprenorphine the ‘light came on’ pretty quickly. I felt normal for the first time in 18 years. I found that I could function at a high level and I was happy to be rid of the normal narcotics. I didn’t find the taper to be too tough and I never felt high in any way.
I think it’s important for mutual recovery groups to have a ‘big tent’ approach. Judging whose sobriety is more legitimate really seems to run contrary to the primary purpose of these groups. It reminds me of something I heard from a member of the Amish community that I met once. He said that the sin of pride was paramount in their churches. It’s why they wear plain clothing and avoid the consciences of modern technology. However, they take it to the opposite extreme. They will try and outdo one another as far as who is the least prideful. It becomes a sort of contest to see who has the dustiest clothing, shabbiest buggy, etc. I have nothing but empathy for those who had to “kick” cold-turkey, but neither do I think that he/she is in a position to judge the quality of my sobriety because I did it a different way. One of the most insidious aspects to my addiction was the feeling of ‘otherness.’ That I didn’t belong. It’s something I struggle with even now. For me, that is helped a lot by going to meetings. I’m not naive though. I realize a lot of people have strong feelings about medication in the rooms. I just don’t understand why.
You’ve described a conundrum we talk about often. I hear that a growing number of NA meetings fully accept members on maintenance, but that’s only anecdotal.
I’m seeing a lot of very young addicts who are being put on Bupe who might not need it (4-5 Vicodin/day). I talked to a specialist who didn’t have a license to write for it. He said that people with “bad” habits should use MMT, and typically Suboxone was given to teenagers. Abstinence was somehow not even an option. Scary that some doctors seem pretty clueless about addiction.
Jason thanks for picking up on my article. I would be really interested in your thoughts on it!
I am hoping to persuade someone in the UK to give me some funding to write a book looking at the ‘successful’ therapeutic landscapes there
good to make contact
I’m familiar with all three components and discuss them with colleagues and visitors on a nearly daily basis, but I’ve never seen them pulled together and presented so concisely
I like it enough that it’ll be assigned reading for a course I’m teaching in the fall. I teach social work, so this does a great job addressing our person-in-environment perspective.
I admire your work and am pleased to have you read and comment here. Thanks!
By the way, I just looked at the PDF of your article and noticed the recovery capital image with the star. It was small and hard to read. Where can I find that? Thanks!
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