If someone graduates from an academic degree program then that person is an alumnus of that institution, by definition. And of course, by definition, the status of being an alumnus is permanent.
But concerning an addiction treatment program, some people might claim they are no longer an alumnus. At some point in the future they might call themselves a “former alumni”, even though in the past they did in fact graduate from that program.
Former alumnus?
What does that even mean?
We can assume that the claim of being a former alumnus does have some kind of meaning. And for the person who’s making the claim, perhaps it has a meaning that’s not limited to the simple and common definition we’re all accustomed to.
If an addiction counselor in an addiction treatment program hears the claim from a graduate who continues to do well that they are a “former alumni”, does the counselor actually know what is meant?
- What does it mean to refer to yourself as a “former alumni” when you’re doing well?
- Could such a claim be a marker of continuing and deepening improvement?
- Could such a claim be an indicator of a long-standing struggle with identity?
- Could that statement be an early marker of decompensation from a recovery dynamic into a relapse dynamic, well before a return to use?
- From a disease management perspective, and from a recovery management perspective, for whom does the answer really matter? And how would we know if it did?
- Does this claim of being a “former alumni” carry any prognostic importance?
From a practical perspective, if we heard someone describe themselves as a “former alumni”, and we knew that for them it really does serve as an early indicator of deterioration, we could take indicated action.1 For example, we could surround such a person with recovery carriers in an effective and timely way. And we could also apply social connections, installation of hope, and other contagious forms of uplift – and perhaps prevent a serious relapse.
I wonder what ways of knowing can we use to understand this claim of being a “former alumni”?2
- Can we use hard empirical science?
- Or clinical intuition?
- And can those two approaches be combined?
Toward developing a body of theory, and a method of empirical inquiry with immediate clinical relevance, consider the following long-standing dream projects of mine. As you read them, consider the methods of understanding that are inside these stories. And consider how those methods of understanding could be applied to the puzzle of figuring out who the future “former alumni” are that will be doing poorly before, during, and after making such a statement. And the implications for clinically-driven recovery support therein.
Dream Projects
I’ve previously written about some dream projects of mine concerning the future of our field.3
One dream project I’ve written about I first imagined many years ago. I said I wished we had pocket-sized fMRI in the shirt pocket of each patient in group, and if we did, then we could view that part of the change process of each patient during group therapy. Actually, I imagine pocket-sized fMRI coupled with in-ear feedback from a real-time clinical supervisor who’s watching the wall of screens for all the patients in group, during group. That arrangement could allow us to be more accurate, efficient and timely in our addiction counseling.
Well, with that in mind, think about this…
An interesting paper came out very recently that’s all about trying to identify and develop various physiological biomarkers that are associated with Pavlovian conditioning in drug addiction.4
Naturally, if the identification and development of such biomarkers is actually completed, that would mean we could add lab tests for those biomarkers to the very limited labs we already have available (toxicology tests, liver function tests, etc.).
For example:
- Imagine being able to know the patient’s level of sensitivity to specific environmental cues that are associated with previous using (specific music, types of cups, people/places/things).
- Imagine being able to know, from a lab test, how full or how extinguished the person’s physiological reactivity to such situational cues and triggers actually is.
Could that information be helpful in a real, clear, and practical way?
I was previously involved5 in research looking at Pavlovian conditioning6 with human subjects who were in addiction treatment. For me the idea of developing accurate awareness of useful and specific biomarkers associated with Pavlovian conditioning, and their ability to show improvement during addiction treatment, is very exciting and welcome news. After all, in 2025, our amount of salivation to a bell seems like a comparatively primitive type of marker or measure.7
With “former alumni”, what should we be trying to assess?
I’ve been meditating on this for the last year or so and I just can’t shake myself free from thinking about it.
I really do wish we had a biomarker or an fMRI indicator for the phenomenon of a graduate of a treatment program years after completing the program saying they are in fact no longer an alumnus of the treatment program.
Of course, at the simplest level the statement is false because they did graduate and they are an alum.
But the idea of a treatment program “graduate” factually being a “graduate” is not my point. Nor is the idea that a program “graduating” you from the program in fact doesn’t fit a long-term disease or recovery management model, but actually reflects an acute care model instead.
My point is deeper than that. To see the point I’m after, read on…
Research in two different areas: trajectory and identity
Research in the most recent 15 years or so has examined long term experiences of those with severe SUDs. Generally speaking, such studies examine the trajectories of people over several years and longer.8-20 This has included examining addiction careers, treatment careers, and recovery careers.
That body of work has shown, among other things, that some people:
- stay in mutual aid and do well;
- attend mutual aid but later “graduate” from it and continue to do well;
- attend but later “drop out” of mutual aid and struggle;
- seem to not attach or bond, ricochet off, and continue to struggle significantly.
And thus, my question: “What are we to make of a person who is seeming to do well, and in that context makes it known they are now no longer an alum?”
Our understanding of this, and its potential importance in certain examples, might be at least partially seated in the question of identity. And for me that’s another area of research that comes to mind.
I was previously involved in a study examining what are called “Possible Selves”.21 We all imagine future possible selves, both hoped-for and feared. Earlier in the process we imagine a relatively wider range and various kinds of future possible selves. For example, we do this in the early part of the process in choosing a job, a career path, or college major. Initially we explore our options and it can be hard for a while to narrow our choices down. Eventually though, we finally do.
Many times, we use hoped-for and feared possible selves to consider and develop our own thinking. “I hope I become…” this, and “I hope I don’t become…” that. And this can also apply to our life goals, and type of life we want or don’t want to live.
I have written previously22 about how alcohol damages a specific region of the brain that is involved in and produces our sense of our self – our very identity.23
Do some individuals struggle with identity, given this damage? And does their clinical course, recovery career, and addiction career differ as a result?
For these reasons as well, I wonder how to interpret that statement about no longer being an alumnus.
I wonder if the person is…
- improving, and their announcement about no longer being an alum is a marker of that improvement?
- stuck, and their announcement is a non-defensive revealing of a continuing outlier status (without a social home) that is prognostically concerning?
- someone who didn’t attach and bond when they first encountered a mutual aid fellowship, ricocheted from it, and still struggles?
Looking ahead
If we could develop fMRI of social support bonding, and if we could develop biomarkers of social support bonding, addiction treatment 50 years from now might know who is at what risk of which difficulty related to identity and bonding. And who is not. And we could know whose developing and changing identity in either direction (“I am” or “I am not”) is a marker of doing well.
We could really know exactly what it means when someone says “I’m not an alumni”. But we could also know who’s at risk of dropping out and struggling regardless of whether they say anything about their membership or not.
In such an evidence-based scenario, providing social support might finally meet “medical necessity”. And in that kind of empirical context, a person might get timelier and more accurate help, and not enter the bio-psycho-social-spiritual status of a “Recovery Orphan” before years of life are lost to a full reactivation of their addiction illness.
During the active treatment phase, I wonder: “Who are the future ‘former alumni’?” And what does saying that indicate, as an early yet clinically-relevant sign? And that makes me consider the alumni services department. Maybe they need a “Phase 2” set of services for those who say they no longer designate themselves as alumni, and would drop out of alumni services for the reason of the “alumni” label alone. If we had a palatable option in alumni services for former alumni, we could continue to serve and do so in an accurate and helpful way that the individual would welcome.
For those that might not know, there’s a book24 that’s written from the perspective and experience of long-term recovery. And the topic of identity is included in the work. It’s a valuable read.
References
1 https://recoveryreview.blog/2025/01/06/a-fresh-look-at-the-topic-of-recovery-orphans/
2 https://recoveryreview.blog/2022/03/03/addiction-understandings-and-enactments-of-the-current-era/
4 Addiction Cue-Reactivity Initiative (ACRI) Network. Parameter Space and Potential for Biomarker Development in 25 Years of fMRI Drug Cue Reactivity: A Systematic Review. JAMA Psychiatry. 2024;81(4):414–425. doi:10.1001/jamapsychiatry.2023.5483
5 Corty EW, Coon B. The extinction of naturally occurring conditioned reactions in psychoactive substance users: analog studies. Addictive Behaviors. 1995 Sep-Oct; 20(5):605-18. doi: 10.1016/0306-4603(95)00020-d. PMID: 8712058. https://pubmed.ncbi.nlm.nih.gov/8712058/
6 Siegel S, Ramos BM. Applying laboratory research: drug anticipation and the treatment of drug addiction. Exp Clin Psychopharmacol. 2002 Aug;10(3):162-83. doi: 10.1037//1064-1297.10.3.162. PMID: 12233979. https://pubmed.ncbi.nlm.nih.gov/12233979/
8 Dennis, M.L., Scott, C.K., Funk, R., & Foss, M.A. (2005). The duration and correlates of addiction and treatment careers. Journal of Substance Abuse Treatment,.28, S51-S62.
9 Dennis, M.L., Foss, M.A., & Scott, C.K. (2007). An eight-year perspective on the relationship between the duration of abstinence and other aspects of recovery. Evaluation Review. 31(6), 585-612.
10 Galanter, M. (2014). Alcoholics Anonymous and Twelve-Step Recovery: A model based on social and cognitive neuroscience. The American Journal on Addictions. 23, 300-307.
11 Kaskutas, L. A., Bond, J., & Ammon Avalos, L. (2009). 7-year trajectories of Alcoholics Anonymous attendance and associations with treatment. Addictive Behaviors, 34(12), 1029-1035.
12 Kaskutas, L. A., Ammon, L., Delucchi, K., Room, R., Bond, J & Weisner, C. (2005). Alcoholics Anonymous careers: Patterns of AA involvement five years after treatment entry. Alcoholism: Clinical and Experimental Research, 29 (11), 1983-1990.
13 Kelly, J.F., Hoeppner, B., Sout, R.L. & Pagaon, M. (2011). Determining the relative importance of the mechanism of behavior change within Alcoholics Anonymous: A multiple mediator analysis. Addiction, 107, 289-299
14 Kelly, J. F., Magill, M., & Stout, R. L. (2009). How do people recover from alcohol dependence? A systematic review of the research on mechanisms of behavior change in Alcoholics Anonymous. Addiction Research and Theory, 17(3), 236-259.
15 Kelly, J.F., Stout, R. L, Magill, M., Tonigan, J.S. & Pagano, M.E. (2011). Spirituality In Recovery: A lagged mediational analysis of Alcoholics Anonymous’ principle theoretical mechanism of behavior change. Alcoholism: Clinical and Experimental Research, 35(3) 454-463.
16 Klingemann, J.I. (2012). Mapping the maintenance stage of recovery: A qualitative study among treated and non-treated former alcohol dependents in Poland. Alcohol and Alcoholism. 47(3), 296-303.
17 Moos, R. H., & Moos, B.S. (2004). Long-term influence of duration and frequency of participation in Alcoholics Anonymous on individuals with alcohol use disorders. Journal of Consulting and Clinical Psychology. 72(1), 81-90.
18 Morgenstern, J., Bux, D. A., Jr., Labouvie, E., Morgan, T., Blanchard, K. A., & Muench, F. (2003). Examining mechanisms of action in 12-Step community outpatient treatment. Drug and Alcohol Dependence, 72(3), 237-247.
19 Witbrodt. J., Kaskutas, L., Bond, J. & Deluchi, K. (2012). Does sponsorship improve outcomes above Alcoholics Anonymous attendance? A latent class growth curve analysis. Addiction, 107, 301-311.
20 Witbrodt, J., Mertens, J., Kaskutas, L. A., Bond, J., Chi, F. & Weisner, C. (2012). Do 12-step meeting trajectories over 9 years predict abstinence? Journal of Substance Abuse Treatment. 43, 30-43.
21 Dunkel, C. S., Kelts, D., & Coon, B. (2006). Possible Selves as Mechanisms of Change in Therapy. In C. Dunkel & J. Kerpelman (Eds.). Possible selves: Theory, research and applications (pp. 187–204). Nova Science Publishers. https://psycnet.apa.org/record/2006-04587-010
22 https://recoveryreview.blog/2023/06/24/the-question-of-identity/
23 Ramey, T. & Regier, P. S. (2019). Cognitive impairment in substance use disorder. CNS Spectrums. 24,102–113. https://pubmed.ncbi.nlm.nih.gov/30591083/
24 Narcotics Anonymous (2012). Living Clean: The Journey Continues. Narcotics Anonymous World Services: Van Nuys, CA.
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