Judith Herman: Trauma and Recovery

511+Nl1uNdL._BO2,204,203,200_PIsitb-sticker-arrow-click,TopRight,35,-76_AA300_SH20_OU01_1. Principles of recovery (healing)
‘The core experiences of psychological trauma are disempowerment and disconnection from others. Recovery, therefore, is based upon the empowerment of the survivor and the creation of new connections.

Recovery can take place only within the context of relationships; it cannot occur in isolation. In her renewed connection with other people, the survivor re-creates the psychological facilities that were damaged or deformed by the traumatic experience. These faculties include the basic operations of trust, autonomy, initiative, competence, identity, and intimacy.

Just as these capabilities are formed in relationships with other people, they must be reformed in such relationships.

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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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Anna’s Moment of Clarity

In two recent blog posts starting here, I focused on a qualitative research project we conducted with family members who have been indirectly affected by substance use problems.

Years after this research was conducted, I received a story written by Anna, who lives here in Australia, which relates how her family coped with her brother’s heroin addiction. I published Anna’s Story on  Recovery Stories and recently updated it in my eBook Our Recovery Stories: Journeys from Drug and Alcohol Addiction. Anna’s story highlights the need for family members to accept that they cannot take ownership of their loved one’s addiction. They are not responsible for the addiction and they cannot do recovery for their loved one.

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The Drug Experience: Cocaine, Part 3

Dan Waldorf and colleagues were ‘pleasantly surprised’ by the relative ease with which so many cocaine users managed to quit. Their research emphasises the importance of one’s personal and social identity in influencing drug use. (895 words)


In the last two Briefings, we focused on the most comprehensive ethnographic study of heavy cocaine users, 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.’

This research challenged many of the prevailing myths. In the present Briefing, we look at the process of giving up use of cocaine. Waldorf and colleagues interviewed 106 quitters—30 of these had received some form of treatment, whilst 76 stopped using cocaine without treatment.

When respondents were given a list of personal reasons for quitting, the most common (47% of sample) was given as health problems. The next most cited reasons were financial problems (41%), work problems (36%) and pressure from spouse and/or lover (36%). Only 7% cited actual arrest, although 28% cited fear of arrest as a reason for quitting.

Respondents were also given an open-ended summary question on the most important reason or reasons to quit. A total of 61% mentioned some form of psychological problem or stressful state caused by cocaine as the most important reason to quit. The next most common reasons were financial problems (23%), and severe or recurrent health problems or concerns (19%).

There was great diversity in actions that respondents took to quit using cocaine. Some made a number of attempts to stop before they actually succeeded. They despaired over the hold the drug had over them and had great difficulty in maintaining a resolve to stop using.

However, over a half of the sample stopped using on their first try, although this was not always easy. Two-thirds of the untreated cases stopped on their first attempt, whilst only one in five of treated cases did so.

More than 40% of all quitters reported making some sort of geographic move as part of their successful attempt to quit. Two-thirds of these people said they moved to another city or state, at least in part to help them stay away from cocaine.

The most frequently used strategies for stopping to use cocaine were social avoidance strategies. Nearly two-thirds of the quitters said they had stopped going to places where cocaine was being used, or had made conscious efforts to avoid seeing cocaine-using friends. Over 40% had also sought out new friends who did not use cocaine.

More than 75% of the sample became more concerned about their physical health whilst quitting, and acted upon these concerns. Two-thirds improved their eating habits, and a half undertook new programmes of physical conditioning.

Over half of the quitters sought out new interests, with 39% participating in sports to help them avoid using cocaine. Similarly, 55% of the sample used informal help, such as family or friends, to stop using cocaine.

Only 17% of the sample started using other drugs after quitting cocaine. Of those that did, the majority used only marijuana, which almost all had used before and during their cocaine use. Whilst 21% drank more alcohol, most drank less after giving up cocaine.

Most of this diverse sample had used cocaine heavily for a good number of years—but few were ever merely cocaine abusers. Moreover, their use had not led them to becoming stigmatised. The majority worked regularly, maintained homes, and were responsible citizens:

‘… a commitment to their everyday lives gave them a stake in normalcy and bonded them to the conventional world.’

The sample were different to heroin addicts in other studies, many of whom came from disadvantaged backgrounds, had been criminalised and stigmatised, and had few private resources (e.g. education, jobs).

For many of the present sample, prolonged use of cocaine stopped being fun and started disrupting, rather than enhancing, everyday lives. Since these lives had meaning and value, the difficulties caused by cocaine became powerful spurs for cessation.

The researchers were ‘pleasantly surprised’ by the relative ease with which so many cocaine users managed to quit. Their strategies were in general fairly common-sensical social avoidance strategies, designed simply to put distance between themselves and the drug.

Most of the quitters were able to manage the cravings they experienced after stopping cocaine use. They realised that cravings were only transitory—distractions caused them to subside. New interests and activities provided such distractions. Many quitters found cravings:

‘… little different from yearnings one might feel for an old lover – one feels the desire, but with time it subsides and one thinks of him or her less and less.’

These findings emphasise the importance of one’s personal and social identity in influencing drug use. A commitment to a conventional identity and everyday life helps form the social-psychological and social-organizational context within which control and cessation of drug use is possible.

It is commonly stated that drugs come to dominate identities and lives. This was true in the most problematic cases in the Waldorf study.  However, for the bulk of the sample, identities and lives usually dominated drug use. This is a critical fact that must be remembered when we try to help people overcome problems caused by drugs and alcohol.

Recommended reading:

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

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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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Bill White’s Norman E. Zinberg Memorial Lecture, 2012

Researcher, historian, practitioner and recovery advocate William (Bill) L White has been the most prolific writer in the addiction recovery field. Bill’s fascinating book Slaying the Dragon: The History of Addiction Treatment and Recovery in America is a classic. You can see the Table of Contents here.

As many can testify, Bill is an amazing public speaker. Here is the Norman E. Zinberg Memorial Lecture, Experiencing Recovery, he gave at the Harvard Addiction Conference in 2012. Bill’s lecture is on YouTube, divided into ten parts:

Part 1: Early History of Recovery in the U.S.

Bill describes just how far back recovery goes historically in the US—to Native American Indians in the 1730s! (13’36”)

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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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‘Hope is the Word That Can Free Us From Addiction’ by o2b3

One of the things I will be doing over the coming months is to ‘bring back’ some of the classic blogs from our online community Wired In To Recovery, which ran from 2008 – 2012. People who know me will tell you that I always keep banging on about hope. Yes, hope is essential for recovery! Here’s a real powerful blog about hope which o2b3 submitted to Wired In To Recovery back in 2010.

‘I always thought that the word hope didnʼt apply to me! From where I come from I was never shown or given any hope. I was always put down and told, ‘Thereʼs no hope for you. You are no good. Youʼre bad, you are a liar. You are worthless and rotten to the core.’ When you keep hearing that said to you time and time again, you start to believe in what those people say. That this is you and thatʼs what you are. So I became the person that everyone said I was. I became all of the above, just to get back at those people that hurt me and put me down.

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Recovery Moments: Ian and Irene’s Story

Two of my favourite people that I have met on my Wired In journey are Ian and Irene MacDonald. I first met Ian in 2007 at a Federation of Drug & Alcohol Professionals (FDAP) meeting, although we had been corresponding earlier. Ian and Irene had lost their son Robin to a heroin overdose in 1997 and were now running a family support group, CPSG (Carer and Parent Support Gloucestershire).

Ian later asked if I would give a talk to family members in Cheltenham and I happily agreed. The talk took place in September 2008. I was still living in Cowbridge in South Wales at the time. My new partner Linda was visiting from Australia, so she came to Cheltenham with me. We spent a lovely evening with Ian and Irene. I remember thinking at the time how would I ever recover from losing a child?

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‘A bright light in a dark world’ by Maddie

One of the highlights of my career has been the development of Wired In To Recovery. Our online recovery community attracted over 4,000 members, who were from around the world and had a diverse range of backgrounds. A significant number (over 1,000) of community members blogged, generating over 7,500 blogs and 35,000 comments!

I loved reading the blog posts and had many favourites. Here is just one of the moving posts I was lucky enough to read.

“I’m almost nine months into my recovery journey, during which time I have not had a drop of alcohol. I’ve been reflecting back to my past, the time that I was drinking very heavily. Today, I can’t imagine drinking every day as I did, waking up with a hangover every morning. My mind just can’t seem to go back there.

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‘Nothing to mourn; just a drug addict’ by Dr David McCartney

When I developed Wired In and worked in the addiction recovery field, I was living in South Wales. When my daughter Annalie was in medical school in Edinburgh, I used to fly up from Cardiff to visit her. I soon came to love Edinburgh. That positive feeling for the city increased greatly when I met Dr David McCartney.

David ran Lothians and Edinburgh Abstinence Programme (LEAP), a programme that offered structured treatment based in the community using a blend of evidence-based interventions. The patient group in treatment operated as a therapeutic community. David was in recovery himself. I loved visiting LEAP every time I was in Edinburgh, and meeting the patients and staff. I’d sit in on group sessions and spend time talking to the patients. David and I became good friends and I hold him in the highest regard.

I’ve recently been checking out David’s blog on Recovery Review. He writes so well and covers a number of key themes relating to addiction recovery. Here is David’s latest post, ‘Nothing to mourn; just a drug addict’, focused on the issue of stigma.

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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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Factors Facilitating Recovery: Involvement in Meaningful Activities

Another important factor facilitating recovery involves the development of valued social roles through involvement in meaningful activities. Through these activities, recovering people gain a sense a purpose and direction in their life—they find a niche in the community. 

These meaningful activities may involve employment or volunteering, engagement in hobbies or other leisure activities, or connecting with other organisations or groups. Employment is a central way in which people can achieve more meaning and purpose in their lives and is therefore a key pathway to recovery. As described in a previous post, impacting on the lives of other people in a positive manner, ‘giving back’ as it is often called, is also important for personal recovery.

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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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Factors Facilitating Recovery: Mutual Support

I continue with my series of blog posts relating to the factors that facilitate recovery from addiction, which I have detailed in the second last chapter of my eBook Our Recovery Stories: Journeys from Drug and Alcohol AddictionThese factors are also relevant to recovery from mental health problems.

“Acceptance is just one aspect of the fifth key factor underlying recovery, being supported by others. People in recovery stress the importance of having someone believe in them, particularly when they don’t believe in themselves. They also stress the importance of having a person in recovery as a mentor or role model as they travel their journey.

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Factors Facilitating Recovery: A Sense of Belonging

I’ve emphasised the importance of hope, empowerment and self-responsibility in facilitating recovery. The fourth important factor is gaining a sense of belonging. Here is what I wrote in my new eBook Our Recovery Stories: Journeys from Drug and Alcohol Addiction.

“Recovery cannot be achieved in isolation. In fact, many people with serious substance problems have become isolated and alienated and this has a further debilitating effect on their already vulnerable psychological state. People who have had such problems need to belong and feel part of something. They need to feel the acceptance, care and love of other people, and to be considered a person of value and worth.

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Learning About Me: Paul

In a previous series of blogs starting here, I have emphasised that the effects of a psychoactive drug are not just dependent on its biochemical actions in the brain. They are related to the drug, set (person) and setting (social context). The problems that arise from drug-taking, such as addiction and dependence, are not just related to the drug—it’s drug, set and setting. And the same is true of recovery.

In an earlier blog, I revealed how Brad had been told by a  colleague that his drinking problem was not just due to alcohol. It was about him. In this blog, I’ll use the words of Paul to describe how he learnt the same truth in relation to his drug problem, a drug problem that was a ‘little’ different to what most people experience.

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Factors Facilitating Recovery: Self-Responsibility

In my last blog posting focused on factors that facilitate recovery, I discussed empowerment. This is a key factor, as it the person with the problem who does the work in recovery.

The flip side of the fact that ‘recovery is something done by the person with the substance use problem’, is that the person has to take charge of their own recovery. Although people generally need to be supported in their recovery, they can’t be care-taken or protected into recovery. Setting one’s own goals and pathways, taking one’s own risks, and learning one’s own lessons are essential parts of a recovery journey. No one else can do the work. Self-responsibility is therefore a key factor facilitating recovery.

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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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Factors Facilitating Recovery: Empowerment

Following on from my post about Hope, I include another section, this time on Empowerment, from the second last chapter, ‘Factors That Facilitate Recovery’, of my recently published eBook, Our Recovery Stories: Journeys from Drug and Alcohol Addiction.

‘As emphasised throughout this book, recovery is something done by the person with the substance use problem, not by a treatment practitioner or other person. The major sources of power driving the recovery process are the person’s own efforts, energies, strengths, interests and hope. Treatment practitioners, and others involved in the person’s recovery journey, can facilitate the recovery process by encouraging and supporting the person’s own hopes, strengths, interests, energies and efforts.

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