The Culture of Addiction: Part 1

This is the first of two blog posts on the culture of addiction that I first uploaded to the website back in 2013. They are strongly based on the seminal writings of William (Bill) White, in particular from his stimulating book Pathways from the Culture of Addiction to the Culture of Recovery. In this book, Bill provides key insights into how we can help people move cultures—essential in their journey along the path to recovery.

‘Culture’ generally refers to patterns of human activity and the symbolic structures that give such activities significance and importance. Wikipedia

Drug users often seek out and build relationships with other people whose drug use is similar to their own. They become part of small groups within which they can nurture the rituals of drug use. These groups interact with other drug-using groups, ultimately forming a broader network of users who share common goals and attributes. These social networks constitute a fully organised culture, one that has an existence and power that transcends individual membership.

In his book, Bill White emphasises the importance of understanding the culture of addiction. He emphasises that many addicts find it easier to break their physiological relationship with the drug than to break their relationship with the culture in which they use the drug. Clearly, one needs to understand how to move someone from the culture of addiction to the culture of recovery.

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Bruce Perry’s Trauma Work

I have learnt a great deal from Dr. Bruce Perry about trauma and the healing of trauma over the past years. I have posted a number of articles about Bruce’s work on my Healing blog on The Carrolup Story website that I run with John Stanton. I thought it was time that I linked to these articles on this website due to the impact of childhood trauma and neglect on the development of addiction. 

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Journeys, Part 2: Living With Heroin Addiction

Heroin addiction often leads to changes in a person’s relationships, lifestyle, physical and psychological health, values, and identity. Some heroin addicts engage in criminal activity to maintain their habit. Heroin addicts are stigmatised by wider society. (5,643 words) *

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Stopping Heroin Use Without Treatment

Research by Patrick Biernacki reveals important insights into how people recover from heroin addiction. It also illustrates the major challenges that people with a heroin addiction face on their journey to recovery (2,283 words). 

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What facilitates recovery from mental health problems?: Scottish Recovery Network

It is important to note the close similarity in the nature of elements that underlie recovery from serious substance use problems and recovery from mental health problems. 

An excellent 2007 paper published by the Scottish Recovery Network by Wendy Brown and Niki Kandirikirira, entitled Recovering Mental Health in Scotland: Report on Narrative Investigation of Mental Health Recovery, provides important insights into the latter. This research involved the recovery narratives of 64 individuals in Scotland who identified themselves as being in recovery or recovered from a long-term mental health problems. Here is what the authors write in the Executive Summary of the Report (NB. That I have broken up one long paragraph for ease of reading online]:

‘Across the stories consistent internal and external elements could be found. For a recovery journey to begin and continue to prosper, narrators accounts of their experiences suggest that six basic internal (individual and self controlled) elements were required (though not necessarily in this order and not necessarily seen in every case):

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Good relationships are the key to healing trauma | Karen Treisman | TEDxWarwickSalon

Dr Treisman talks about the importance of forging good relationships and effective society-wide systems when it comes to understanding and healing trauma. Dr Karen Treisman, a Clinical Psychologist, has worked across the globe with groups ranging from adopted children to former child soldiers to survivors of the Rwandan Genocide. TEDx Talks. [17’21”]

Six Core Strengths for Healthy Child Development: An Overview

This brief overview provides an introduction to the Six Core Strengths program developed by Dr. Bruce Perry and The ChildTrauma Academy. The ChildTrauma Academy Channel. [4’31”]

Natalie’s Recovery Story: ‘I Didn’t Plan To Be An Addict’

Treatment staff and her peers help Natalie find a path to recovery from heroin addiction. A confronting situation years later, when she is a treatment practitioner, helps Natalie realise that she is still traumatised from her childhood experiences. A second recovery journey begins. (10,923 words)

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Relationships, Connection and Healing from Trauma: Bruce Perry & Maia Szalavitz

For anyone interested in the healing of childhood trauma, I strongly recommend you read, The Boy Who Was Raised as a Dog: And other Stories From a Child Psychiatrists Notebook by Bruce Perry and Maia Szalavitz. Here is a description of the book from the back cover:

‘What happens when a child is traumatized? How does terror affect a child’s mind—and how can that mind recover? Child psychiatrist Bruce Perry has treated children faced with unimaginable horror: genocide survivors, witnesses to their own parents’ murders, children raised in closets and cages, the Branch Davidian children, and victims of family violence.

In The Boy Who Was Raised as a Dog, he tells their stories of trauma and transformation. Dr. Perry clearly explains what happens to the brain when children are exposed to extreme stress. He reveals his innovative methods for helping ease their pain, allowing them to become healthy adults. This deeply informed and moving book dramatically demonstrates that only when we understand the science of the mind can we hope to heal the spirit of even the most wounded child.’

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The everyday lives of recovering drug users

I recently found this very interesting and important piece of research from 2012, The everyday lives of recovering drug users by Joanne Neale, Sarah Nettleton and Lucy Pickering, which was part of a Royal Society of Arts project focused on addiction recovery. Here is what the RSA Director of Research, Steve Broome, said about the research:

‘This is a fascinating, in places touching, and, most importantly, useful book. Seldom heard personal accounts from 40 recovering heroin users reveal the psychological, physiological, and emotional journeys as they overcome their addiction. Ultimately, they are human stories that reveal simple and modest aspirations: recovering heroin users want to participate and feel valued as productive members of society. In the words of several interviewees, they just want to feel “normal”.

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What is Healing to Me?: Aboriginal Healing Foundation in Canada

Unknown-5Here is a summary of the findings from interviews of clients and staff of five healing programmes in Canada:

“… healing is an active, not passive, process: it is something you do, not something you think or that is done to you. In this sense, healing is work, it is ongoing and requires dedication. First and foremost, it requires commitment from the individual. No one can heal you or make you heal. Personal agency is stressed above all else.

The dominant metaphor in our research describes healing as a journey… The journey has a clear direction toward healing, yet it is a journey fraught with challenges. Falling off the path of healing is common, even expected by treatment staff. There is no shame to temporary setbacks, nor are these seen as failures; rather, the individual is welcomed back to continue on his or her journey when he or she feels ready…

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‘A Journey Toward Recovery: From the Inside Out’ by Dale Walsh

I’ve been away visiting family this weekend and haven’t had a chance to prepare a new set of blog posts for this week. I therefore thought I would re-post some of my old favourites from the past this week, which will give me time to prepare new ones for next week. 

One of my favourite articles about recovery was written by Dale Walsh back in 1996 which really summed up what recovery and recovery principles mean to a person who has been suffering from mental health problems. I thought I would highlight some of the main points here. 

The Problem
‘For many years I believed in a traditional medical model. I had a disease. I was sick. I was told I was mentally ill, that I should learn to cope with my anxiety, my depression, my pain, and my panic. I never told anyone about the voices, but they were there, too. I was told I should change my expectations of myself and realize I would always have to live a very restricted life.

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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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Pathways from Heroin Addiction: Recovery Without Treatment, Part 2

In my last blog post, I started to look at the research of Patrick Biernacki, conducted in the US in the mid-1980s, which involved interviews with 101 people who had recovered from heroin addiction without treatment.

This research indicated that once people who have become dependent on heroin decide to stop using the drug, they are often unsure about what they should do with their lives instead. They may know what they do not want to do, but they are less certain about what they do want and how they can go about getting there.

This problem is greater for those who have immersed themselves in the world of addiction. They may have no money, no place to live, and no friends (other than other heroin users) and family to help them get out of their situation.

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Reflections on Healing: A Canadian Aboriginal Perspective

I’ve been reading a fascinating article from the Aboriginal Healing Foundation in Canada entitled Aboriginal Healing in Canada: Studies in Therapeutic Practice and Meaning. What of course is said in this article is relevant to recovery in the western world. Here are some interesting thoughts about healing:

‘The first thing that emerges from our work is that healing is a concept that is difficult to articulate, in part, because most [people participating in the research – DC] seem to feel that there is no need to articulate it and/or simply have never been asked to.

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Relationships, Connection and Healing from Trauma

UnknownI’m reading an excellent book at the moment, which I can strongly recommend to you. If you’re working in the trauma field, then The Boy Who Was Raised as a Dog: And other Stories From a Child Psychiatrists Notebook by Bruce Perry and Maia Szalavitz is an essential read.

The book really gives you a feel for how our understanding of childhood trauma and its healing has moved along over the years. Bruce Perry is a real leader in this field and I feel blessed to have learnt of both Bruce’s and Bessel van der Kolk’s work in the past year. Thank you Judy and Carlie Atkinson.

Here’s a little section from the book:

‘Trauma and our responses to it cannot be understood outside the context of human relationships… The most traumatic aspects of all disasters involve the shattering of human connections. And this is especially true for children…’

‘Because humans are inescapably social beings, the worst catastrophes that can befall us inevitably involve relational loss.

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Classic blog: ‘Talking About Psychosis, Part 1: Why Do It?’ by Marc Ragins MD

mraginsThe stuff on Mad in America just keeps getting better and better. Here’s a thought-provoking blog from another of my favourite bloggers.

‘I was taught in medical school and psychiatric residency not to talk to people about their voices and their delusions:  “It will only feed into them and make them worse.”  Nor was I supposed to argue with people with paranoia because they’ll just get agitated and won’t change their mind anyway.

We were taught that the psychoanalysts had wasted a lot of time trying to connect people with psychosis by trying to find meaning in their psychosis.  I was taught that there is no meaning.  All we needed to know about their psychosis was enough to prescribe medications and assess if the meds worked.

The venerable Chestnut Lodge where Frieda Fromm-Reichmann had treated the woman in “I Never Promised You a Rose Garden” with psychoanalysis was successfully sued for not providing research-proven meds instead of talking with patients with psychosis.

Beyond that, I was told not to try to relate to the patients in the State hospital because they couldn’t handle relationships and when I left they’d feel abandoned and decompensate.  Most of my medical school class mates were more than happy to follow that advice and left the ward as fast as possible. They already knew that “people with psychosis are creepy and frightening and frustrating anyhow” without having met any of them.

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‘Healing Trauma: What We Are Doing Wrong… and What We Need To Do To Get It Right’ by Bessel van der Kolk

338059More from Bessel van der Kolk’s wonderful book. If you want to know more about trauma and its healing, this is an essential buy.

‘We are fundamentally social creatures – our brains are wired to foster working and playing together.

Trauma devastates the social-engagement system and interferes with cooperation, nurturing, and the ability to function as a productive member of the clan.

In this book, we have seen how many mental health problems, from drug addiction to self-injurious behavior, start off as attempts to cope with emotions that become unbearable because of a lack of adequate human contact and support.

Yet institutions that deal with traumatized children and adults are all too often bypass the emotional-engagement system that is the foundation of who we are and instead focus narrowly on correcting “faulty thinking” and on suppressing unpleasant emotions and troublesome behaviors.

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Classic Blog – ‘A journey toward recovery: From the inside out’ by Dale Walsh

IMG_2364-220x165My apologies for the pause in uploading blogs, but have been very busy working on our Sharing Culture initiative. More news on that front soon.

‘I read an extraordinary article by Dale Walsh written back in 1996 which really summed up what recovery and recovery principles mean to a person who has been suffering from mental health problems. I thought I would highlight some of the main points here.

The Problem
“For many years I believed in a traditional medical model. I had a disease. I was sick. I was told I was mentally ill, that I should learn to cope with my anxiety, my depression, my pain, and my panic.

I never told anyone about the voices, but they were there, too. I was told I should change my expectations of myself and realize I would always have to live a very restricted life.

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‘Addiction Treatment (By Itself) is Not Enough’ by Bill White

‘I have spent more than four decades providing, studying, promoting, and defending addiction treatment, but remain acutely aware of its limitations. As currently conceived and delivered, most addiction treatment programs facilitate detoxification, recovery initiation, and early recovery stabilization more effectively and more safely than ever achieved in history, but most fall woefully short in supporting the transition to recovery maintenance and the later stages of recovery, particularly for those who need it the most – those with the most severe and complex problems and the least recovery support within their natural environment.

Addiction treatment as a stand-alone intervention is an inadequate strategy for achieving long-term recovery for individuals and families characterized by high problem severity, complexity, and chronicity and low recovery capital.  In isolation, addiction treatment is equally inadequate as a national strategy to lower the social costs of alcohol and other drug-related problems.  Here’s why.

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