William White describes how somewhere in the process of the professionalisation of addiction treatment in the US, treatment got disconnected from the larger more enduring process of long-term recovery.
He points out that we are recycling large numbers of people through repeated episodes of treatment. Their problems are so severe and recovery capital so low, there is little hope that brief episodes of treatment will be successful. We end up blaming them for failing to overcome their problems.
“Addicts are made, not born, and the most common precursors are early childhood privation, neglect and abuse. For several generations, Canada’s native children have been far more likely to suffer grinding penury, abuse and childhood substance addictions than non-natives.” Gabor Maté
Marlene, a 46-year old native woman, sat in my office last week, slumped on her chair, blinking away her tears. I’d just shared the news that her most recent blood test confirmed she had “seroconverted” to HIV, become infected with the AIDS virus.
Although an injection drug user, Marlene had always been careful to use clean needles. Her route of infection was sexual contact – with the resigned naiveté characteristic of so many aboriginal women in Vancouver’s Downtown Eastside, she had trusted a man, himself a drug addict, who assured her that he was a safe partner.
During the many years I spent working in the addiction and mental health field, first as a neuroscientist and later helping empower people to facilitate their recovery (healing), I rarely heard the word ‘trauma’ being used.
Few practitioners I met mentioned that the person with the substance use problem might be self-medicating to ameliorate psychological pain. And yet in society, there were plenty of people visiting their doctor and obtaining a prescription of benzodiazepines such as librium, which are highly addictive substances, or antidepressants, which also produce problems, to help them deal with unpleasant psychological states of anxiety or depression.
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 Addiction. Just 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:
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.
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.
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.
This is eighth post in this particular Series, which comes from my book Our Recovery Stories: Journeys from Drug and Alcohol Addiction. It 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.
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.’
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]
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.
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.
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
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.
Traces the history of cocaine, linking the Incas, Freud, Thomas Edison, Sherlock Holmes and Coca Cola. (880 words)
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.’
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…
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)
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.’
Stories of people recovering from a serious substance use problem are an important tool for understanding the processes involved in recovery, showing people with a problem that recovery is possible via a multitude of different pathways, and helping communities create empathic environments in which recovery can flourish.
More about the book >>
Available now as a downloadable eBook
Connection uses ‘faces’ and ‘voices’ of the past to take you into a world where Aboriginal children rise above great adversity to create beautiful landscape drawings that are acclaimed on both sides of the world. Connection is a story of trauma, and the overcoming of trauma. A story that resonates in today’s world of the oppressed and their oppressors. A story of Hope, Heart and Healing.
‘… the book is nothing short of incredible.’
Carlie Atkinson, CEO, We Al-li Programs
