I have been thinking lately of the generational shifts in the recovery movement and what it means for our collective future. Young people in recovery face an uncertain future. Less opportunity, less optimism about the future and strained social networks have made things been particularly hard for them. They have been devastated by deaths of despair. They tried to navigate an acute and fragmented SUD care system nearly impossible to use even as their friends and family died from addiction. They have lived through false promises of change that comes with every new funding initiative that never reaches the ground and experienced a myriad of scams associated with patient brokering, urine testing schemes and the business end of the treatment industry. Why would they place trust in us or the SUD care system we have developed over the last five decades? They want change now. Can we blame them for losing faith in us, and the flawed care system we have today? Should they not expect more?
Yet, those of you who are in these generations, I ask you to withhold harsh judgement on us. And I hear back “OK Boomer (although I am a generation Xer), I do appreciate the work done by the generation of recovery advocates that came before me and helped where I could along the way. They gave us what we have today. Consider what they did and not just what they failed to do. Before then we pretty much had nothing. It is important to remember that in 1970, there was no funding for drug and alcohol treatment, just jails, mental institutions, frontal lobotomies and electroshock therapy. Those recovery advocate boomers created our care system.
What they accomplished is certainly less than half a pie, but every sliver took a full court, unified effort with a whole lot of blood sweat and tears. As soon as they achieved that small slice, forces starting whittling away at it. Many of those things stem from the implicit biases that exists against anyone with addiction, persons in recovery and to some degree everyone who is involved in trying to help us. I would point out that in my state (Pennsylvania) reimbursement rates for outpatient treatment were higher in adjusted dollars when I walked into treatment in 1986 than they are now, with roughly a tenth of the administrative burdens. Members of our workforce qualify for welfare, and when people gain experience, far too often they migrate away from this work. Our peer services are moving out of the hands of our recovery community and are being over professionalized. We are repeating pitfalls of the past and failing to heed the lessons of history, yet again. Not much pie left on this fork and every reason to expect change.
I can tell you that there have been a lot of unintended consequences of our “old guard” advocacy efforts. The ones I see without exception are a result of consistently underestimating the degree of stigma and implicit bias against persons with addiction and the recovery community. We advocated for a greater voice in polices and to some degree only accomplished elevating the stigma. We advocated for more resources and when they came, they never reached us and instead went to academic groups and beltway bandits that show up when the grass is green and roll out of town as soon as the resources go away. When they are in town, they dismiss our lived experience, patronize us or shut us out when we raise inconvenient truths. We are patronized by the very systems and services we advocated for.
Yet, the only way through this is always together. History shows us that. You rightly want change now. Experience lends me to be cautious and at times to consider unintended consequences. That may look too cautious to you. A truism is that if you change too quickly or the wrong things in haste, the outcome may not be the one you want. The gains are typically realized by those who can exert the most influence. It is never us unless we are united.
It is also vitally importance to understanding our own history. People like Bill White who has documented our history are invaluable for understanding the pitfalls and opportunities we face moving forward. The word of caution I would express is to suggest that you not move forward with a mindset that we failed you and the work we did needs to be burned down to the ground, a sentiment I am hearing. If that occurs forces outside our recovery community would use it as an opportunity for further colonization and cooptation. These same lessons are also contained in our own history.
So the question, is as always, what can we build together so that more people can get into and stay in recovery than have in the past? We are only strong enough to achieve anything when we are all playing the same tune. After spending a whole lot of time listening to our community my sense of that objective is the five-year recovery paradigm. In this model, we keep people alive through harm reduction efforts, use individualized treatment and a variety of long term, low threshold recovery community support strategies to get people to five years of recovery, the point at which they have an 85% chance of staying in recovery for the rest of their lives
Does this make sense to you my millennial and zoomer brothers and sisters in recovery? If yes or no – lets keep talking and find where consensus lies. Without consensus we will have no pie to carry forward, of that much I am certain.