The Recovery Scholarship of Ernie Kurtz

Ernie GLAATC InterviewHere’s some great reading for you, from one great scholar and storyteller about another. Bill White starts the New Year with this excellent posting on his blog. Enjoy!

‘One of the distinctive voices within the modern history of addiction recovery is that of Harvard-trained historian Ernie Kurtz.

Spanning the 1979 publication of his classic Not-God: A History of Alcoholics Anonymous to the just-released Experiencing Spirituality (with Katherine Ketcham), Kurtz has forged a deep imprint in studies of the history of A.A. and other recovery mutual aid groups, the varieties of recovery experience, the role of spirituality in addiction recovery, and the personal and clinical management of shame and guilt.

Read More ➔

‘“It doesn’t work for everyone” – a take on 12-step approaches’ by DJMac

iStock_000011501444XSmall-300x199Excellent blog from the DJMac website. Good discussion as well.

‘What follows is a guest blog by a GP who gives a personal view on professional perspectives of mutual aid:

“Astonished”
I was astonished the first time I was taken to an NA meeting. I mean, really gobsmacked – you could have knocked me off my seat. The room was full of recovering heroin addicts; something I’d never seen in my 20 years (at that time) in practice.

I was both excited – at the possibilities – and ashamed – at the fact that I didn’t know such places existed. It curls my toes to think of it now, but I had not referred my patients to them. That was a while back.

Read More ➔

‘Experiencing Recovery – Part 8′ by William L. White: History of Recovery Support

Bill introduces about the various types of recovery support that have existed historically: natural support, limited generalist support within the community, peer recovery (mutual aid) and treatment. He then goes on to describe how things have been changing in recent years.

‘Experiencing Recovery – Part 4′ by William L. White: Frameworks of Recovery

In this part of his talk, Bill White discusses the degrees/depths of recovery. He describes how some better people feel ‘better than well’ after recovery.

He goes on to describe different types of recovery initiation/maintenance framework and different styles of recovery.

‘Experiencing Recovery – Part 2′ by William L. White: The Rise of Modern Addiction Treatment

I continue Bill White’s talk that he gave at the Harvard Addiction Conference in 2012, the Norman E. Zinberg Memorial Lecture. An amazing history of recovery and treatment for alcohol and drug addiction.

‘Experiencing Recovery – Part 1′ by William L. White: Early History of Recovery in the US

Last week, I highlighted the fact that a new edition of Bill White’s classic book Slaying the Dragon: The History of Addiction Treatment and Recovery in America has just rolled off the presses. I can tell you that this is one of the best (and most fascinating) books that you will ever read.

To celebrate the ‘rolling of the presses’ and Bill’s remarkable career in the recovery field, I am going to show a talk Bill gave at the Harvard Addiction Conference in 2012, the Norman E. Zinberg Memorial Lecture. I will show one part a day for the next 10 days, taken from Bill’s excellent website.

In the first part, Bill describes shows just how far back recovery goes historically in the US – to Native American Indians in the 1730s!

The Road from Crime – Extended Preview

Excellent preview, I’m heading to watch the full film.

‘What can we learn from those former prisoners who have successfully “desisted” from criminal behaviour or “gone straight?”

The exit at the prison gate often appears to be a revolving door with nearly 60 per cent of released prisoners re-offending within two years of their release. Prisons and probation departments have, almost literally, tried everything in efforts to rehabilitate offenders over the past century, but the results have been uniformly bleak leading many to conclude that “nothing works.”

Read More ➔

What Works in Treatment?: Tim’s Story

rsz_img_2891Here are Tim’s experiences of treatment. Well, actually two different forms of treatment, one which did not help and the other that helped Tim overcome his addiction to alcohol and opiates. Tim is a doctor and his Story is packed full of insights. Here, I’ll start with his moment of clarity.

‘The epiphany which did eventually provoke some help-seeking was relatively simple. I came down to the kitchen one morning feeling wretched and defeated. I opened the cupboard and reached up. With one hand I brought down the cornflakes and with the other the whisky bottle.

I flexed my elbows to bring the two closer to me and weighing them up in my hands I thought, “There’s something not right about this… there’s something very wrong with this picture.” The bit of me that wanted to drink finally began to yield to the bit that didn’t. Shortly after, I went so see my GP.

Read More ➔

‘Narcotics Anonymous Comes of Age’ by Bill White

rsz_201307diamondjubileelogoBill White has recently written a blog and co-authored an article on the 60th Anniversary of NA.

‘Narcotics Anonymous (NA) is too often relegated to the status of stepchild of Alcoholics Anonymous (AA).  NA’s unique history, culture, and distinctiveness are routinely obscured within references to “AA and other Twelve Step programs.” 

For the past several years, Chris Budnick, Boyd Pickard and I have been conducting research on the history of NA, and we recently authored an article commemorating the 60th anniversary of NA’s founding.  In this article we identified and discussed 12 things we believed every addiction professional should know about NA.

Read More ➔

Serenity Recovery Fringe Festival

cafe-shotIn an earlier blog, I highlighted an article by Bill White on Recovery Carriers.

Recovery Carriers are people, usually in recovery, who make recovery infectious to those around them by their openness about their recovery experiences, their quality of life and character, and the compassion for and service to people still suffering from alcohol and other drug problems.

I know two special Recovery Carriers in Edinburgh – and there are many more – David McCartney and John Arthur.  Here’s John’s latest blog:

Read More ➔

‘Helping Yourself to Recovery’ by Bill White

Helping Others ImageHelping others has been an integral part of the folk wisdom about addiction recovery for more than 250 years. 

From early Native American recovery circles, early Euro-American recovery mutual aid societies and the 20th century advent of 12-Step recovery through the ever-widening menu of religious, spiritual and secular recovery pathways, the message has been clear:  help yourself by helping others. 

The helping prescription is based on two core ideas.  The first is the concept of wounded healer – the notion that people who have experienced and survived an illness or great trauma may have acquired unique perspectives that allow them to offer assistance to others in similar circumstances. 

Read More ➔

‘Keeping the monkey off your back: top five tools to sustain recovery’ by Peapod

P1011013“Just because you got the monkey off your back, doesn’t mean the circus has left town” George Carlin, comedian and author.

Getting sober and drug-free is hard enough for most of us, but staying that way is a challenge. The evidence is that many people coming out of abstinence-oriented treatment will relapse in the first year and most of them in the first few weeks. Recovery initiation, the start of the journey, is just that: a beginning. In the past, we’ve treated it like the main event and had little thought for what happens next.

The circus may not have left town, but there are ways to avoid ending up in a ringside seat and having that pesky monkey trouble you again. These things are the tools of recovery. There are plenty of them and we need to find the ones that work for us. Some however are more reliable than others according to the evidence we have. Here are my own top five tools:

Read More ➔

‘Recovery: what matters?’ by David McCartney

IMG_2315Here’s an interesting Wired In To Recovery blog from David McCartney from September 2013 about the importance of social relationships.

‘If you wanted to live a long and healthy life, what measures could you take to achieve your goals? Stop smoking? Lose weight? Exercise? Drop your blood pressure? We have evidence that all of these make a difference, but a recent analysis of 148 studies on the subject found two things that made more of a difference to mortality than anything else. What were they?

Well, having strong social relationships and being integrated socially seem to protect against death. This analysis was not specifically about addiction, but suffering from addiction is strongly associated with increased death rates and it seems very likely that if we could promote strong social links in those seeking help it will reduce the risk of relapse and ultimately of early death.

Read More ➔

Message from David

P4081202A major focus of this website is to help people understand how they can recover from addiction. How to initiate the process of recovery and how to maintain recovery despite the day-to-day struggles and obstacles we all face.  How to live without resorting to the use of substances as a coping mechanism.

Some of what appears on this website will be relevant to people taking their first steps on their journey to recovery. This might involve a person using clean needles and syringes for the first time, or involve a person realising the damage that their drinking is doing to themself.

Other content will be oriented towards people who are much further along in their recovery, who are looking for things that can facilitate their recovery journey and daily living. This content may be focused on spirituality or recovery coaching, for example.

Read More ➔

‘Detoxification: the ‘nuts and the bolts’ by Peapod

“Expect the first few weeks to be rocky emotionally. Life can feel a bit ‘greyed out’ for a while and youʼll need to adopt a longer-term view. Getting to as many recovery meetings as you can manage during this period will help.”

“Expect the first few weeks to be rocky emotionally. Life can feel a bit ‘greyed out’ for a while and youʼll need to adopt a longer-term view. Getting to as many recovery meetings as you can manage during this period will help.”

Okay, youʼve got to the point where you are looking to detox but youʼre not sure what the nuts and bolts of it are. How do you go about it and how do you know you are ready? What can you do to boost success?

Here are my suggestions, which are based on guidance and my own experience of working with hundreds of people going through detox.

First things first: “detox plus”
The first thing to say is that any detox which is not connected to other things will almost certainly fail. You might get through the detox (or “stopped”) but remaining drug free (“staying stopped”) is very, very unlikely without other things added in. Not to mention that itʼs potentially dangerous too. Donʼt set yourself up to fail.

Itʼs best to see detox as a tiny part of the recovery process. Important, no doubt about it, but in the grand scheme of things not a giant cog in the machinery. Recovery is a longer-term process.

What is the “plus” part of “detox plus”: what needs to be added in?
1. Ask: am I ready? You will probably have a feel for this because youʼve been working towards this goal for a while and others have been supporting you. If youʼre using regularly on top of your script or have major stressful life events going on, you may want to wait a bit, or get referred for consideration of residential options where the support is highest.

2. Weigh up the pros and the cons. Everything involves some sort of risk. Talk to others whoʼve done it successfully. Make an informed choice.

3. My next suggestion is to get referred to an intensive community or residential rehabilitation programme. Some will offer detox as part of treatment. Your prescriber or support worker will be able to advise. Try to get onto a programme that is at least three months long and that prioritises connecting up their clients to peer-led recovery communities.

4. Get involved with local recovery community activities in any case. The most important of these is mutual aid. Groups like Narcotics Anonymous, Cocaine Anonymous (you donʼt need to have a problem with coke) and SMART recovery offer peer-based support.

The evidence suggests that engaging with these groups reduces relapse rates and adds much to quality of life too. You donʼt need to be drug-free to attend.

5. If youʼre not going to sign up to intensive treatment, then get started with meaningful activities daily. Find an educational course or volunteering opportunity and get stuck in. Structure your days and donʼt spend time in bed or stuck to the TV or computer screen.

6. Stay away from using friends and places you associate with scoring and using. These are powerful triggers to use when you are feeling vulnerable.

Detox basics

1. Donʼt do your own detox. Shutting yourself in a room with DFs and Valium might seem like a sensible idea, but it is not known for its success rates. Achieving your goals is much more likely if you have an expert in detoxification supporting you as you do it. Cold turkey is being unkind to yourself and has low success rates.

At the same time, this is your detox, so youʼll want to know you have some say in how it looks. It shouldnʼt be something that is done to you, but something you do with the support of the prescriber. Alcohol, GHB/GBL and Benzodiazepine detoxes are particularly dangerous if not medically supervised.

2. If you are coming off opiates, discuss whether you want to use methadone or Suboxone to detox. In some areas you might also have the option of lofexidine (Britlofex) too. Occasionally some doctors offer a dihydrocodeine (DF118) detox. Iʼm going to write a separate article on choosing between a methadone detox and a Suboxone detox.

3. Get as much support around you as you can. If you are in a structured day programme, residential treatment or a therapeutic community, the support ought to be built in.

If youʼve chosen to try this without that sort of intensive input, then tell your mutual aid group members what youʼre planning, get your prescriberʼs support and that of family members (non-drug using). Do some relapse prevention work and donʼt rely only on yourself. I canʼt stress this enough; most of us need help to do this.

4. If you are struggling, admit it. There are various medications that can be added in to help with any unpleasant symptoms like pain, insomnia, nausea, diarrhoea, cramps etc. Emotional support from positive people will boost your chances of success. If you know people whoʼve been through detox successfully, find out how they did it and get their help.

5. Expect the first few weeks to be rocky emotionally. Life can feel a bit “greyed out” for a while and youʼll need to adopt a longer-term view. Getting to as many recovery meetings as you can manage during this period will help.

6. Guard against relapse and if you do go back to using, remember loss of tolerance and the increased risk of overdose. Donʼt use as much, donʼt use alone, donʼt inject and donʼt mix heroin with other drugs (particularly alcohol or valium).

7. Remember a lapse is not the end of recovery. Itʼs common and not a cause for shame or giving up. Most of us need more than one go. Going back onto maintenance for a while is a viable option, as is getting referred to a more intensive treatment setting.

PDF document >

Detox and early abstinent recovery: make it easier

“If you are planning a detox, get ready for it. It’ll be much easier if you know what to expect. Don’t do your own detox, let someone else be in charge. Stand alone detoxes will almost all fail: you need detox plus. By that, I mean more has to be added in. Getting onto an intensive treatment programme (either residential or community) at least three months long is likely to help. Stay away from using or drinking friends and delete dealers’ numbers from your mobile. Always remember, you only need to do this once.”

“If you are planning a detox, get ready for it. It’ll be much easier if you know what to expect. Don’t do your own detox, let someone else be in charge. Stand alone detoxes will almost all fail: you need detox plus. By that, I mean more has to be added in. Getting onto an intensive treatment programme (either residential or community) at least three months long is likely to help. Stay away from using or drinking friends and delete dealers’ numbers from your mobile. Always remember, you only need to do this once.”

Peapod was one of the most prolific and respected bloggers on Wired In To Recovery before going into ‘retirement’. (S)he wrote a series of must-read blogs containing important hints to facilitate recovery which were very popular. Peapod’s empathy and understanding, as well as experience in the field, shone through in these blogs.

I’ve arranged these blogs into what I call ‘Peapod’s Guide to Recovery.’ This is the first of seven articles.

Detox and early recovery: what’s it feel like?
‘’Empty’; ‘cored out’; ‘flat as a pancake’; ‘anxious’; ‘aching’; ‘miserable’… all comments I’ve heard from clients after detox. It resonates with my own experience. I’ve been detoxed twice and I found it pretty hard going.

This week, I’ve spotted a few people on Wired In asking if it’s normal to feel so low after a detox. I’ve commented in each case I’ve spotted because I know what a vulnerable time it is. Have ever walked or driven across a salt pan? These are big flat expanses of endless monotony and sometimes used as a metaphor for the post-detox experience. So why is detox and the immediate time after so challenging?

A bit about the brain
Whether you sign up to the disease model of addiction or not, there’s overwhelming evidence to show that addiction causes changes in brain structure and function. As addiction takes hold, several things in the brain start to change.

Various drugs cause the pleasure chemical dopamine (a neurotransmitter or chemical messenger) to be released in large quantities. Cells near the ones that release dopamine pick it up on their surfaces through dopamine receptors stimulating the cell so we feel pleasure. Over time, the body thinks, ‘Wait a minute, with so much dopamine around, I’m feeling a bit over-stimulated; I don’t need all these receptors’ and shuts some of them down.

In addition, some drugs can suppress many of the brain’s activities. They turn the nervous system’s dial down a few notches, quietening nerves, worries and alertness. During detox, the dial gets turned back up suddenly. Lots of different neurotransmitters behave in odd ways. Pulse rises, blood pressure goes up, tremors, sweats and agitation are to the fore. It’s pretty unpleasant admittedly, but the good news is that all of this has a limited shelf life. It does get better.

Life is a bit greyed out
The first part of recovery is a bit of a pleasure desert. Scientists say that one effect of the limited number of pleasure receptors is that it is harder to feel pleasure from ordinary things early in recovery. Spending time with friends doesn’t do it. Having a meal out or going to the pictures hardly gets a blip on the pleasure radar. It’s no surprise that minds turn to the one thing that’s going to flood those limited receptors and create an oasis in the desert. Using or drinking again.

This does get better
As time goes by, the brain starts to readjust. Receptor production is switched on. The nervous system activity dial that’s been on max gradually gets turned back down again. We feel calmer, less empty and more hopeful, but only if we stick with it and get through the tough bit.

Clear and present dangers
There are three things to watch out for that might trip you up in those early weeks (or indeed at any time).

Stressful situations. Brain stress hormones can trigger the desire to use drugs or to drink. We need to find new ways of managing or avoiding stress. Sharing the journey with others is an effective way to deal with life’s stressful events.

Triggers and cues. Because drug memories and experiences end up engraved on the brain and because they encompass not just the pleasure, but the sensations, the context, where we were and who we were with, anything that reminds us of drinking and using can be a trigger to pick up again. Avoiding triggers and cues is a good idea.

The first drink or drug. It’s highly likely that this thought will pop into your mind at some point: “Maybe I’ll be all right now that my system has had a rest. Perhaps I’ll be able to drink and use normally.” Anything that floods those dopamine receptors can trigger off a powerful desire to have more. A glass of wine at the weekend, or a line of coke as a treat, are bad ideas for folk trying to recover. This kind of experiment easily leads to relapse.

What helps?
The brain’s function begins to recover in those early weeks and by two years is mostly back to normal. There are some things that you can do that are associated with making detox more comfortable, that make dealing with early recovery less grey and which reduce the risk of relapse.

In a nutshell it’s this: get connected! By that, I mean get connected to other recovering people. There’s research to show that increasing the number of sober people in your social network is associated with reduced relapse. Research from Connecticut has shown that simply by introducing one more sober person to your sober network you can reduce your risk of relapse by 27%. That sounds like a good deal to me.

If you are planning a detox, get ready for it. It’ll be much easier if you know what to expect. Don’t do your own detox, let someone else be in charge. Stand alone detoxes will almost all fail: you need detox plus. By that, I mean more has to be added in. Getting onto an intensive treatment programme (either residential or community) at least three months long is likely to help. Stay away from using or drinking friends and delete dealers’ numbers from your mobile. Always remember, you only need to do this once.

If you want success, then get involved with mutual aid groups. There are thousands of AA, NA, CA and SMART groups up and down the country. Almost everybody is nervous about going along, so phone the helpline first. If you know a member, ask them to take you along. Keep going back and check out lots of different meetings; don’t judge by your first meeting along. The more meetings you go to the better.

If relapse happens

Many people in long-term recovery will have had experience of lapse or relapse at some point. While you don’t need to use again, some people will and this can be a danger, particularly if you have been addicted to opiates. Loss of tolerance begins very quickly on getting drug-free and your system becomes more sensitive. Hundreds of people die every year in the UK from unintentional overdose.

You can minimise the risk. Do this by:

  • Smoking, not injecting
  • Using much less than before (as if you were starting for the first time)
  • Not using alone, have someone around
  • Don’t mix downers, like heroin, valium and alcohol (very important).

And if you do lapse it needn’t be the end of the world. Get help quickly. Get honest about it with your support network and put twice as much work into your recovery.

Important to know
Detox and even treatment are only small parts of recovery: for many of us, recovery is a long-term process. Most of the recovery journey will take place out of treatment environments – in social settings with other recovering people. Recovery is not about the absence of alcohol or other drugs. It’s about all the positives that come in, but you have to work for them and most of that work will be done more easily if you are shoulder to shoulder with other recovering people.

PDF document >

Peapod’s Guide to Recovery

Peapod, now ‘retired’, was one of the most prolific and respected bloggers on Wired In To Recovery. (S)he wrote a series of must-read blogs containing important hints to facilitate recovery.

Read More ➔

Peer Support Groups

This page provides links to the home pages of a number of key peer support groups, e.g. AA, SMART Recovery. Learn why peer support is important.

Read More ➔

‘The user as expert’ by Peapod

IMG_2817Another blog on WITR from April 2009.

‘When I went to look for help for my addiction, I ended up in the care of an addiction specialist. He was good at his job. He knew all about addiction.

He was impressive in terms of assessment and he knew about methadone and antidepressants and other prescribing options. His team inspired confidence in terms of their knowlege of addiction.

Unfortunately, it turned out they didn’t know much about recovery. The specialist advised against mutual aid and dissuaded me from professional counselling.

Read More ➔

‘The astonishing power of example’ by Peapod

P1010948This blog appeared on WITR in April 2009.

‘Astonishment. That’s what I felt the first time I was taken to a mutual aid group meeting.

I was in treatment at the time in a residential centre. I was also neck deep in trouble. I had lost my job through my using. As part of the fallout from my own million megaton addiction detonation, I’d caused someone else to lose their job. The police were on my tail and I was massively in debt.

Read More ➔