Factors Facilitating Recovery: (Gaining) Recovery Capital

Here’s the last of the 11 factors facilitating recovery that I wrote about in my book Our Recovery Stories: Journeys from Drug and Alcohol AddictionJust because it is last, does not mean it is the least important factor. In fact, it is one of the most important!

Recovery is better predicted by someone’s assets and strengths, rather than their ‘pathologies’, deficits and weaknesses. People can make progress by identifying and building on their personal assets and strengths. Interventions to facilitate recovery must focus on helping individuals build their recovery strengths, more often referred to as ‘recovery capital’. 

Recovery capital is the quantity and quality of internal and external resources that one can bring to bear on the initiation and maintenance of recovery [1]. It takes three main forms:

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The Drug Experience: Cocaine, Part 2

While cocaine is portrayed as having a very high addiction potential, the majority of people who use the drug do not have a problem. Research by Dan Waldorf and colleagues reveals a number of social and social psychological factors that influence how a person uses a drug. (887 words)


Cocaine is often portrayed as having a very high addiction potential, and that most people who use it are risking serious physiological and psychological harm. Whilst some cocaine users do develop difficulties, the majority do not.

The most comprehensive ethnographic study of heavy cocaine users was conducted by Dan Waldorf and colleagues in Northern California. They interviewed 267 current and former heavy users of cocaine, a sample that did not include people in treatment programmes or in prison. Most of the respondents were ‘solidly working- or middle-class, fairly well-educated, and steadily employed.’

These researchers showed that about a half of interviewees maintained a controlled pattern of cocaine use, some of them for even up to a decade. According to Waldorf, controlled use can be defined as either, ‘regular ingestion without escalation to abuse or addiction, and without disruption of daily social functioning’, or ‘a pattern in which users do not ingest more than they want to and which does not result in any dysfunction in the roles and responsibilities of daily life.’

Based on their observations, Waldorf and colleagues described the ideal type of controlled users:

  • ‘Controlled users tended to be people who did not use cocaine to help them manage pre-existing psychological problems, and did not also abuse other drugs, especially alcohol.
  • Controlled users generally had a multiplicity of meaningful roles which gave them a positive identity and a stake in conventional life (e.g., secure employment, homes, families). Both of these anchored them against drifting toward a drug-centered life.
  • Controlled users, perhaps because they are more anchored in meaningful lives and identities, were more often able to develop, and stick to, rules, routines, and rituals that helped them limit their cocaine use to specific times, places, occasions, amounts, or spheres of activity.’

This research suggests that a stake in conventional life and identity are central for understanding continued controlled use. Such stakes seem to keep a person’s drug use from overtaking their life and identity. They also facilitate an individual reasserting control after a period of problematic use (I will discuss this issue in a later Briefing).

The fact that these social and social psychological factors mitigate against cocaine misuse and related problems suggests that not everyone need develop a problem with cocaine, even when using heavily as this population was.

At the same time, it follows that those people with the least stake in conventional life may be at the highest risk for problematic cocaine use. Cocaine, and in particular crack, have had a marked impact in poor neighbourhoods, causing problems to many individuals and communities.

Obviously, these forms of social control are not fool-proof for maintaining controlled use. Some people with a large investment in conventional life did lose control of their cocaine use and develop serious problems. Waldorf and colleagues report that:

‘… after scouring our other interview transcripts, we could not put our fingers on any one magical ‘factor X’ that explained why some people get into trouble and others did not.’

Other researchers in the US and other countries have reported controlled use of cocaine by a significant proportion of users (see Decorte, 2000 for review).

Waldorf and colleagues recognise that some well-intentioned parents and policy makers might not want to broadcast findings about controlled use for fear of facilitating the denial of some misusers or increasing the risks for some new users.

However, they contend that the:

‘… considerable possibilities for exercising control over cocaine use can be seen as cultural resources that can facilitate personal capacities for control and social capabilities for harm reduction.’

The researchers made the very good point that if the only frameworks in society for interpreting one’s drug-using behaviour are addiction and abstinence, then the idea that one can and should exercise control can atrophy. The interviews revealed that one important reason that control was possible for so many of the participants was that they believed that it was possible. They believed that cocaine was ‘not necessarily addicting, that it could and should be used in a controlled fashion.’

Whilst cocaine is often portrayed as a powerful reinforcing psychoactive drug, we sadly do not often hear that its powers are also mediated by users’ norms, values, practices, and circumstances. We underestimate the powers of social, social psychological and cultural aspects, whilst overestimating the pharmacological power of the drug.

Waldorf and colleagues point out that heavy cocaine users have taught us:

‘… that beyond the drug itself, how users think about and behave towards drugs matters a great deal. Cultural norms matter. Subcultural practices matter. How closely we look out for each other matters. The uses to which we put consciousness-altering substances matters. The personal and social resources of users matter. The values placed on productive daily lives matters. And, of course, the social distribution of opportunities for productive lives matters…’

Recommended reading:

Cocaine Changes: The Experience of Using and Quitting by Dan Waldorf, Craig Reinarman and Sheigla Murphy. Temple University Press, USA.

The Taming of Cocaine: Cocaine Use in European and American cities by Tom Decorte. VUB University Press, Belgium.

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> Part 3

Ruby’s Healing Story

It’s hard to believe that it is over seven years ago since I launched Sharing Culture, an educational initiative to facilitate the healing of intergenerational trauma. [I don’t upload new content on the website now, but the content is still there for viewing.]

It is also over seven years since Michael Liu and I went out with Professor Marion Kickett to her home country in York to film her describing her life, country, culture, spirituality, family, education and resilience. Marion is a Noongar Elder from the Balardong language group, who is Director of the Centre for Aboriginal Studies at Curtin University in Perth.

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Voices of Loved Ones Indirectly Affected by Substance Use Problems, Part 2

Continuing the qualitative research project conducted by Gemma Salter, a talented undergraduate student working with me back in 2004. The research involved interviewing nine parents and one grandparent (who had assumed the role of parent) of people with a drug and/or alcohol problem. The participants were recruited from West Glamorgan Council on Alcohol and Drug Abuse (WGCADA) in Swansea and Drug and Alcohol Family Support (DAFS) in Blaenau Gwent, South Wales.

…. It doesn’t take long for the effects of stress to manifest itself in physical and psychological health problems. Physical symptoms come in the form of eating and sleeping problems, high blood pressure, stomach problems, irritable bowel syndrome and tension aches. Some parents are prescribed antidepressants by their GPs.

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Voices of Loved Ones Indirectly Affected by Substance Use Problems

Continuing to look back at my career in the addiction recovery field and what I have learnt. After reading the excellent book Beating the Dragon: The Recovery from Dependent Drug Use by James McIntosh and Neil McKeganey in 2003, I made the decision to start a research programme involving qualitative analysis of interviews. The first piece of research, which focused on the effects of substance use problems on the family, was conducted by Gemma Salter, a third year undergraduate. Gemma was awarded the prize for the project of the year in my Psychology department.

Gemma’s research involved semi-structured interviews (lasting 42 – 129 minutes) with nine parents and one grandparent (who had assumed the role of parent) of people with a drug and/or alcohol problem. The participants were recruited from West Glamorgan Council on Alcohol and Drug Abuse (WGCADA) in Swansea and Drug and Alcohol Family Support (DAFS) in Blaenau Gwent, South Wales.

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Factors Facilitating Recovery: Overcoming Stigma

This is eighth post in this particular Series, which comes from my book Our Recovery Stories: Journeys from Drug and Alcohol AddictionIt ties in nicely with a previous blog, Nothing to mourn; just a drug addict, by Dr David McCartney.

Stigma can be defined as social disapproval of personal characteristics, actions or beliefs that go against the cultural norm. It can occur at a variety of levels in society, i.e. individuals, groups, organisations and systems. A person can be labelled by their problem (e.g. addiction to drugs and/or alcohol) and they are no longer seen as an individual, but as part of a stereotyped group, e.g. a junkie, alkie, etc. Negative attitudes and beliefs toward this group create prejudice which leads to negative actions and discrimination. 

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A Parent’s Story

I met Mike Blanche in around 2003 and he was the first person to help me understand the impact of a person’s substance use problem on family members. Mike was an inspiring figure who had played a key role in the setting up of Drug and Alcohol Family Support (DAFS) in Blaenau Gwent in South Wales. He organised a conference, Families in Focus, at which the following talk was given. We first posted this talk on our SubstanceMisuse website back in 2003.

‘Good morning ladies and gentlemen. I am a mother and I have been invited here today to talk about my experiences as a service user. I have a son who is living at home with my husband and myself. He is addicted to drugs.

He first started dabbling with substances when he was still in school. At first it was ‘glue sniffing’, but it wasn’t long before he started experimenting with cannabis. When I tried to approach him to warn him of the dangers of drug abuse, his typical reaction was to say, ‘Don’t worry Mam, I can handle it.’

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Factors Facilitating Recovery: Gaining a Positive Identity

People with serious substance use problems lose a lot of the roles or personal characteristics that help define their normal identity (e.g. loving son, athlete, generosity, intelligence) as their dependence on their substance(s) increases, relationships wither and isolation increases. Eventually, their identity as viewed by others may become ‘a useless, dirty addict’. They will also have personal views of what they have become and these views can lead to lowered self-esteem or even intense hatred of oneself.

On the basis of qualitative research with over 100 heroin addicts who had recovered from their addiction without professional treatment, Patrick Biernacki argued that: ‘To change their lives successfully, addicts must fashion new identities, perspectives and social world involvements wherein the addict identity is excluded or dramatically depreciated.’ [1]

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The Harms and Risks of Substance Use

Reflections on the harms and risk factors related to drugs, alcohol and solvents. (979 words)


There is much discussion about the harms and risks of drug use, particularly in the popular press. The relative harms of different drugs are compared, and the law tries to operate a control system with drugs purportedly graded by their dangers, albeit with alcohol and tobacco forgotten.

Heroin and cocaine are considered to be particularly dangerous. And yet, there are people that have taken cocaine or prescribed heroin for many years and have suffered no physical harm. There is no given in the world of drugs—except that all substances (even water) can kill if given in sufficient quantity.

In his excellent book Matters of Substance: is legalization the right answer – or the wrong question [1], the late Griffith Edwards points out:

‘With drugs nothing is always. Their use does not carry a guarantee of danger, but neither is their safety guaranteed. What one needs to ask about any substance is not whether in absolute terms it is safe, but rather the degree of risk which may attach to its use.’

The harm caused by substance use needs to be considered in a variety of ways. Use of drugs, alcohol and solvents can carry risk to different aspects of life. They may threaten physical or mental health, social circumstances, educational and employment status, and may put a person at risk with the criminal justice system.

Substance use may also affect the safety and welfare of others. Other people may be affected negatively by the transmission of blood borne viruses through sexual contact with an infected drug user, through violence committed by a person who is drunk, or by someone who is driving while under the influence of a sedative prescription drug. The harmony and happiness of families can be disrupted, and in the extreme whole communities can be affected.

Harm done by substance use can be major or minor. It can also be a one-off or chronic. Harm may be caused directly by the drug itself, and/or by the lifestyle associated with use of the drug, for example, with street heroin.

For some harm, an increasing risk is associated with longer-term and heavier substance use. However, for other types of problems, the risk can be much more random: the twentieth experience with ecstasy or a solvent may trigger some reaction leading to death; the first injection of heroin may lead to infection with hepatitis C which kills the person years later; the heavy drinking session may lead to the person tripping on the pavement into the path of an approaching vehicle.

With illicit drugs, there is the possibility of contaminants in the drug which can cause illness and even death. In one example, heroin users in California injected unknowingly a synthetic drug known as MPTP, which produced symptoms of Parkinson’s disease. This movement disorder, caused by a massive depletion of dopamine in the brain, mostly occurs in people over 60 years old. In this case, young heroin users developed the symptoms within 24 hours of taking the drug. The condition was irreversible and could only be alleviated by l-Dopa or neural grafts of foetal tissue [2,3].

The particular harm caused by substances is also dependent on the route by which they are administered. Injecting drugs can lead to the transmission of blood borne viruses, smoking can cause lung damage, and drinking of alcohol to cancer of the gullet. Accidental overdose is more likely to occur following injection than ingestion of tablets. Users of illicit heroin are also unaware of the purity of the substance they purchase—an unusually pure, or contaminated, batch of heroin can cause overdose.

One of the dangers of drugs and alcohol is their propensity to cause addiction or dependence. In simple terms, addiction can be seen as an impairment in a person’s ability or power to choose. The drug becomes more important to the person than other aspects of their life, which the majority of people would consider as essential. Addiction drives forward heavy and persistent drug use, ultimately increasing the likelihood of self-harm.

The particular effects of a drug, and the development of addiction, are influenced not only by the intrinsic properties of the drug and its route of administration, but also by the previous drug experience of the user, their physical and psychological characteristics, and the setting in which the drug is taken. Therefore, these factors can influence the harm caused by drugs.

Overdoses are more likely when a heroin user leaves prison, since he is likely to forget or not understand that his body has lost its tolerance to the drug. Amphetamine psychosis will be more likely to occur in an individual with a propensity to schizophrenic symptoms. Alcohol-induced violence is more likely to occur in certain environments than in others. Life-threatening seizures can occur when a person withdraws from long-term use of the prescription drugs Valium and Librium.

Finally, and not least, is that the dangers of many substances can be exacerbated by taking another at the same time. For example, the likelihood of overdose after heroin is increased if the person is also drinking alcohol.

Psychoactive substances have been used in society for thousands of years. They will remain with us for as long as mankind wishes to change his state of consciousness, for whatever reason. These substances—be they legal or illegal—will always have harm and risks associated with them.

What is important in today’s society is to keep people well-informed about the potential harms of drugs, alcohol and solvents and the circumstances in which they can be dangerous. We do not need media hype or campaigns that over-exaggerate the risks. We need to be objective and realistic.

Endnotes:

[1] Matters of Substance: is legalization the right answer – or the wrong question, Griffith Edwards, Penguin, 2005.

[2] MPTP, Wikipedia.

[3] The MPTP Story, J. William Langston, Journal of Parkinson’s Disease, 7, S11-S22, 2017.

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Factors Facilitating Recovery: Understanding

Here is the next section from my chapter Factors Facilitating Recovery in  my eBook Our Recovery Stories: Journeys from Drug and Alcohol Addiction.

Understanding is essential for recovery. People with substance use problems and those on a recovery journey need information and education about a variety of matters, including: the nature of addiction and their own substance use problems; the range of interventions they can use to help them overcome or manage these problems; opportunities that allow them to exercise their strengths and assets; supports they can use to facilitate their recovery journey, and self-management skills that help them cope with situations that might lead to relapse. 

Recovering people are a major source of information that can facilitate another person’s recovery journey.

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What Happens to Women in Recovery: Stephanie Brown

In the Resources section of the website, I have a series of my posts under the title Stephanie Brown on Recovery. These posts are based on Stephanie Brown’s wonderful 2004 book A Place Called Self: Women, Sobriety, and Radical Transformation. In her book, Stephanie talks about what happens to women in recovery, how they think, how they feel, their problems, the good things, etc. (The book is relevant to men as well!) Here is the main part of the first of my posts, entitled ‘What is Recovery’, according to Stephanie Brown (Part 1).

“‘Recovery has held so many surprises for me. Some good. Some bad. I didn’t know I could hurt so much. But I also didn’t know I could love so much and be so loved. I had no idea that recovery was also learning how to be in intimate relationships, learning how to have close, wonderful friends. Then there’s my marriage. My husband and I have developed a rich life together. And get this – I really like myself now. Learning about who I am and accepting me, that’s been the hardest part of recovery – and the best. I wouldn’t trade this path for anything in the world.’ Anne, Recoveree

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Learning About Addiction Treatment, Part 5

I continue my series of blogs, starting here, about my journey into the addiction recovery field after I changed ‘career’ in 2000 from being a neuroscientist to working in the community. At the same time, I was still working as a Professor in the Department of Psychology, University of Wales Swansea (now Swansea University) in the UK.

In an earlier blog, I briefly described how I led the national team that evaluated all projects funded by the National Assembly of Wales’s Drug and Alcohol Treatment Fund (DATF) for two years from mid-2000. Here is what I wrote in my recently published book Our Recovery Stories: Journeys from Drug and Alcohol Addiction about the DATF evaluation and my views about the UK drug treatment system at the time.

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Historical Perspectives: Cocaine

Traces the history of cocaine, linking the Incas, Freud, Thomas Edison, Sherlock Holmes and Coca Cola. (880 words)

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Journeys – Making Recovery from Addiction Visible

Huseyin Djemil from the UK has this week launched a new podcast focused on recovery from addiction, which he describes as such:

‘A new series from Towards Recovery CIC – making recovery from addiction visible.

Huseyin Djemil speaks to people who have lived experience of recovery from addiction, people who have been affected by addiction and those working in the addiction and recovery field – in its many contexts. There is a lot of information about addiction, but people get better and their stories need to be visible to give others hope.

Recovery is not a linear path from A to B, it’s more of a winding road and we want to explore those journeys and get those stories heard, because our stories have power.’

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A Life-Changing Time

In an earlier series of blogs starting here, I described what I initially learnt about addiction treatment at a local treatment agency in Swansea, West Glamorgan Council on Alcohol and Drug Abuse (WGCADA) in the early 2000s. Later, in 2005, I was commissioned to write a profile of the agency, which ended up being over 180 pages long and containing a number of Stories. Here’s is one such Story, of someone recovering from a serious alcohol problem:

‘I am writing about an amazing two years in my life. It has truly been a life-changing time. Not only have I stopped drinking (and that in itself I would never have believed possible!), but I’ve really begun to live life more fully and have been able to put my life back together again in a very positive way. Throughout this time, I have had great support and help from WGCADA. I can’t speak highly enough about the organisation and the staff I have been in contact with…. so please read on…

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Historical Perspectives: Opium, Morphine and Opiates (Part 2)

Continues a brief history of the opiates, which includes describing the different responses of the United States and Britain to opiate problems in the earlier parts of the 19th century. (880 words)

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Addiction Recovery

Here is a section about the nature of addiction recovery from my new eBook, Our Recovery Stories: Journeys from Drug and Alcohol Addiction.

“There have been various definitions of recovery proposed over the years. For the purpose of this chapter, I am going to use a definition proposed by leading addiction recovery advocate William (Bill) L White [1]:

‘Recovery is the experience (a process and a sustained status) through which individuals, families, and communities impacted by severe alcohol and other drug (AOD) problems utilize internal and external resources to voluntarily resolve these problems, heal the wounds inflicted by AOD-related problems, actively manage their continued vulnerability to such problems, and develop a healthy, productive, and meaningful life.’

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Learning About Addiction Treatment, Part 4

I’ve spent three blog posts, the first of which can be found here, describing my experiences and what I learnt during my initial visits to a local treatment agency, West Glamorgan Council on Alcohol and Drug Abuse (WGCADA) in Swansea. In addition, my last blog focused on an article written by my oldest daughter Annalie about a day in the life of an addiction treatment support worker at WGCADA, Dave Watkins.

Many of the clients I met at WGCADA and in other treatment services I visited over the years knew what they wanted—a valued and meaningful life. They just did not know how to achieve what they wanted, and they lacked the internal and external resources to take the journey to recovery and the life they wanted. 

My early experiences at WGCADA resonated loudly when some years later I read How Clients Make Therapy Work: The Process of Active Self-Healing, a seminal book written by Arthur C Bohart and Karen Tallman and published by the American Psychological Association. The following quotes are particularly pertinent. 

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Learning About Addiction Treatment, Part 3

I continue describing my experiences at the local treatment agency West Glamorgan Council on Alcohol and Drug Abuse (WGCADA) and what I learnt about how treatment facilitates recovery from addiction. You can read the earlier parts here and here.

‘Dave Watkins was a Community Support Worker for WGCADA. He was originally an engineer, but changed career after a member of his family suffered a substance use problem. In simple terms, Dave helped clients with every aspect of their lives that could interfere with their progress on their recovery journey. This included helping put a roof over their heads, getting their social security benefits, dealing with legal problems… and sometimes involved painting walls or cleaning up vomit! Dave immersed himself in his clients’ lives. He worked with some of the most chaotic substance users you would ever meet.

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Learning About Addiction Treatment, Part 2

In this post, I continue the description of what I learnt about addiction treatment by talking with practitioners at a local treatment agency in Swansea, West Glamorgan Council on Alcohol and Drug Abuse (WGCADA). You can read my previous post here.

The Primary Treatment programme at WGCADA used key principles of AA and the 12-Step Minnesota model. It was based on the disease concept and on the belief that the illness of addiction is physical, mental and spiritual. A holistic approach was used to help the person recover from addiction, and clients underwent considerable self-examination during the treatment process. Clients could not be drinking or using illegal drugs when they entered the Primary Treatment programme.

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