Iain’s Recovery Story: ‘This is Me’

A treatment agency helped Iain detox from the methadone that was prescribed for his heroin addiction. College, employment, recreational activities and romance facilitated Iain’s recovery. (9,237 words)

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Kevin and Kerry’s Recovery Story: ‘A Family’s Journey’, Part 1

Mother and son describe Kevin’s heroin and amphetamine addiction, and related activities, and how they impacted on Kevin and the family and as a whole. (7,376 words)

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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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Sapphire’s Recovery Story: ‘It Should All Be About the Person’

Things went well when Sapphire was intimately involved in decisions about her methadone-based treatment, but poorly when professionals took sole control. (7,631 words)

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Addiction, Recovery, and Treatment: An Introduction

A brief look at the nature of addiction, recovery, and treatment. (1,883 words)

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Alcoholics Anonymous (AA), 12-Step Movement, and Minnesota Model

Describes the nature of Alcoholics Anonymous (AA), other 12-Step programmes, and the Minnesota Model, how they developed, and the key assumptions that underlie their approach. (1,320 words)

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Some More of My Favourite Reads

‘NB. Please note that some of these books may be out of print or be selling any a different price to what I quoted back in July 2006. These are some of the books that enhanced my understanding of addiction, recovery and treatment, and inspired me to continue working in this field.’ David Clark, 24 January 2023.

As in my last Background Briefing, I have chosen various books as recommended reading that are related in some way or other to drug and alcohol misuse. The order is random – I’ve just picked up books from various places in the house.

“Theory of Addiction” by Robert West (£24.99)

If there was ever a major challenge in this field, it is to critically evaluate the large number of theories about addiction and try to bring together the diverse elements into a comprehensive theory. Robert West has taken up this challenge and done a brilliant job. Whilst the theory focuses on the mind of the addict, it also looks at the social and cultural forces that influence behaviour. The author makes recommendations for the development of effective interventions for addiction.

“Promoting Self-change from Problem Substance Use: Practical Implications for Policy, Prevention and Treatment” by Harald K. Klingemann, Linda C. Sobell and others (£14.72)

It is often forgotten that many people with drug and alcohol misuse problems overcome their problems without professional assistance or without using traditional self-help groups. This book is based on the first major international conference on self-change/natural recovery. It presents the process of self-change from several different perspectives – environmental, cross-cultural and preventive – and interventions at both an individual and societal level. It provides strategies and suggestions for how professionals and policy makers can aid and foster self-change. This book is an essential guide.

“Working with Substance Misusers: A Guide to Theory and Practice” Edited by Trudi Petersen and Andrew McBride (£18.39)

A practical handbook for students and people who work in the field, it covers an impressive range of topics. The book also contains activities designed to reinforce learning, including discussion points, case studies, role plays and group exercises. I used this book as the core text for my undergraduate students studying substance misuse.

“Tackling Alcohol Together: The Evidence Base for a UK Alcohol Policy” by Duncan Raistrick, Ray Hodgson and Bruce Ritson (£17.95 from Free Association Books)

The leading researchers and practitioners in the UK provide an authoritative and independent analysis of the country’s experiences with alcohol. The book examines alcohol problems, alcohol policy and makes specific policy recommendations. Published in 1999, the ideas are still relevant today.

“Get Your Loved Ones Sober: Alternatives to Nagging, Pleading and Threatening” by Robert J. Meyers and Brenda L. Wolfe (£6.11)

This is an important book for families and friends affected by substance use problems of others. It describes a programme based on the Community Reinforcement and Family Training (CRAFT) therapeutic model, which has been evaluated on a number of occasions and found to be an effective intervention. Although the book primarily focuses on alcohol, the principles are relevant to situations where illicit drugs are a problem. An engaging read, with clear and helpful exercises to be followed.

“Modernising Australia’s Drug Policy” by Alex Wodak and Timothy Moore (£6.93)

This book may focus on Australia, but its provocative arguments are just as relevant to the UK. The authors argue that mood-altering drugs are primarily a health and social issue, rather than a problem to be tackled by law enforcement agencies. The book contains a variety of interesting facts, a ten-point plan to reduce the problems caused by the drug economy, and a call for a new realism in Australian drug policy. A thought provoking read.

“Motivational Interviewing: Preparing People for Change” by William R. Miller and Stephen Rollnick (£26.98)

Motivational interviewing (MI), first described by Miller in 1983, is a directive, client-centered counselling style for eliciting behaviour change by helping clients explore and resolve ambivalence. The use of MI in this country has grown considerably in the past decade. This book describes the spirit of MI and the techniques that are used to manifest that spirit. It incorporates emerging knowledge on the process of behaviour change, a growing body of outcome research, and discussions of novel applications. This is a must-read book.

“Cognitive Therapy of Substance Abuse” by Aaron Beck, Fred Wright, Cory Newman and Bruce Liese (£17.96)

This book comprehensively details the cognitive model of substance misuse, the specifics of case formulation, management of the therapeutic relationship, and the structure of therapeutic sessions. It discusses how to educate clients in the treatment model and procedures, and manage their cravings for drugs and alcohol. Methods for working with dual-diagnosis patients are also described.

Relapse Prevention: Maintenance Strategies in the Treatment of Addictive Behavioursby Dennis M. Donovan and G. Alan Marlatt (£32.50)

This is the revised and updated second edition of the classic by Alan Marlatt and Judith Gordon on relapse prevention. This book provides an empirically supported framework for helping people with addictive behaviour problems develop the skills to maintain their treatment goals – even in high-risk situations – and deal effectively with setbacks that occur. It is an essential clinical resource and text that reflects two decades’ worth of advances in research and practice.

We have learnt so much in this field over the past couple of decades and I hope that my selection both inspires you and helps you in your work. Of course, there is so much more to learn. Keep reading!

> pdf document

> Disease Model of Addiction

The Drug Experience: Heroin, Part 7

Many people believe that if you try heroin, then you are on the path to ruin. They consider that addiction to heroin is inevitable, and the route to being drug-free again is extremely difficult, if not impossible. Many treatment professionals believe that it is essential that a person who becomes dependent on heroin has treatment to recover.

In this Briefing, we describe research showing that recovery from heroin addiction without treatment is possible. We also look at the characteristics of this recovery process, since we need to learn from this research to help others take this pathway.

The subjects in Patrick Biernacki’s study were 101 people, who had to have been addicted to heroin for at least one year, and had been free of addiction for two years. They had not received treatment for their heroin addiction. Subject interviews were analysed by Grounded Theory.

Biernacki described the findings of his research under four main headings: resolving to stop; breaking away from addiction; staying abstinent; and, becoming and being ‘ordinary’.

Resolving to stop fell into three broad categories. A small number of the sample (4–5%) stopped using without making a firm decision to do so. These people simply drifted away from their addiction and got involved in other things. They seemed to be people who had become dependent on heroin, but had never developed a strong commitment to the illicit world of addiction.

For two-thirds of the sample, ideas of stopping heroin use developed rationally and were stated explicitly. The rational decision to stop often occurred after an accumulation of negative experiences, along with some significant and disturbing personal event. The experiences were usually expressed in terms of serious conflicts between continued drug use and other desires.

The third category involved people (about 30%) who had hit rock bottom or had experienced an existential crisis. The decision to stop “emerged out of a highly dramatic, emotionally loaded life situation.”

Breaking away from addiction. When people who have become dependent on heroin resolve to stop using the drug, they are often uncertain about what they should do with their lives instead.

Whilst their life with heroin may now be perceived in a negative light, this does not mean that they know what line of action to take. This point is particularly pertinent to those who have immersed themselves in the world of addiction, since they have lost most of the conventional social relationships in their lives.

Biernacki emphasised the absence of recovery models. ‘There is little, if any, subcultural folklore to give them insight into how they might go about ending their addiction. In fact, they may feel they are treading a path on their own.’ [My bold]

One of the reasons for the dearth of recovery models is that people who become abstinent without treatment generally cease to associate with those who remain addicted. In fact, in many cases, ending these associations is a necessary condition for becoming abstinent.

‘Thus, few, if any stories circulate in the addict world about people who have succeeded in their voluntary efforts to stop further opiate use. And those addicts who try to quit, but fail, commonly return to the addict world and serve to reinforce existing beliefs in the futility of attempting to quit without undergoing a formal course of treatment.’

Many people who come to the point of resolving that they must stop using heroin are doubtful of whether they can abstain successfully and permanently. They remember initial resolutions to stop using as being fragile and weak, and they remember past failures of trying to stop.

The situation is made worse by the fact that the person is likely to be suffering from low self-esteem. They must also now deal with feelings of anxiety, which they may not have done for years, because they could mask previous anxiety with their heroin use. The person will also have to face the physical symptoms of withdrawal, in what is likely to be in a poor physical and psychological condition.

These problems are worse for those people who have been caught up in the world of addiction and have cut themselves off from family, friends and mainstream social life.

When considering what will replace their addict lifestyle, the person may have serious doubts as to whether they can establish and maintain relationships with ‘ordinary’ people. They share little in common with non-users and also face the stigma that is associated with heroin addiction.

They may also worry about their criminal record, their lack of education and skills, whether they are employable, and whether they can keep off the drug. ‘All in all, they have many and often justifiable fears that they will not be able to get along with people in the conventional world.’

At the same time, those problem users who have managed to maintain good relationships with people who are not involved in the world of addiction generally have an easier time moving through this period and realising their desire to change their lives. They can find support from non-users and realise their new identities.

Recommended Reading:

Patrick Biernacki (1986) Pathways from heroin addiction: Recovery without treatment. Temple University Press, US.

> pdf document

> Part 8

‘A Personal Story’ by Kerrie

This very moving Story was written for our Wired In To Recovery website in August 2011. I published it on Recovery Stories in August 2013.

‘Hi, my name is Kerrie. I am 37 years old. Both my parents died as a result of heroin addiction. My mum when I was 8 years old and she was 28, and my dad when I was 15 and he was 43.

I grew up in the madness of their addiction; needless to say we were a very dysfunctional family. I don’t remember my parents ever getting any real support. The only people involved with our family were the police and social services.

I learnt at a very young age to tell them nothing, as I knew if I told someone, for instance, that my sister and I had been left alone or had not eaten properly for a few days, that my parents would get in trouble. And I was fiercely loyal and very protective of them.

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The Future of Addiction Treatment: Bill White

The following quote is taken from one of my favourite books, Slaying the Dragon: The History of Addiction Treatment and Recovery in America by William L White.

‘During the past 150 years, “treatment” in the addictions field has been viewed as something that occurs within an institution – a medical, psychological, and spiritual sanctuary isolated from the community at large.

In the future, this locus will be moved from the institution to the community itself. Treatment will be viewed as something that happens in indigenous networks of recovering people that exist within the broader community.

The shift will be from the emotional and cognitive processes of the client to the client’s relationship in a social environment. With this shift will come an expansion of the role of the clinician to encompass skills in community organization.

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What Works in Treatment: Sapphire’s Story, Part 3

In my last two posts, we’ve been following Sapphire’s Story with a focus on the treatment she received, recognising that treatment can either facilitate or have a negative impact on the recovery process. We’ve seen Sapphire courageously overcome heroin addiction, crack addiction and most recently an addiction to benzodiazepines (benzos). There’s more to overcome.

‘Once I was off the benzos and feeling a little more like myself, I went back to work. I hadn’t worked since having the crack-induced event, so was really scared that I wouldn’t be able to cope with a job.

As I had come off the benzos, and now had the proper support of a partner and my family, I started thinking about reducing my methadone with a view to abstinence. I knew I had the willpower, as I’d managed eight nightmarish months of the benzo detox and I’d also kicked a crack addiction about two years earlier.

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What Works in Treatment: Sapphire’s Story, Part 2

In my last post, I looked at Sapphire’s Story, with the aim of showing the importance of person-centered treatment. Along Sapphire’s journey into and out of addiction, things went well when Sapphire was intimately involved in decisions about her treatment, but poorly when professionals took sole control.

We left Sapphire’s Story after the Community Drugs Treatment (CDT) had reduced her prescribed methadone dose against her will and she started to use street drugs again. She eventually became addicted to crack. This drug took over Sapphire’s life, until the day she ended up in hospital: ‘I’m not sure what actually happened one particular day. I know that I had been up for about five days smoking crack and I think I had a fit and was taken to hospital.’

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What Works in Treatment: Sapphire’s Story, Part 1

Sapphire’s Story shows the importance of person-centered treatment. Things went well when Sapphire was intimately involved in decisions about her treatment, but poorly when professionals took sole control. In this post, I start a short series focused on various stages of Sapphire’s treatment career.

Sapphire was being prescribed methadone for her heroin addiction, but as the dose was not high enough she was suffering withdrawal symptoms. To counter the discomfort of this withdrawal, she was purchasing methadone on the street and using benzodiazepines. Then a problem arose from her urine sample:

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Learning From the Experts, Part 2

This post continues the research relating to client views on treatment and recovery that Gemma Salter, Sarah Davies and I conducted at BAC O’Connor treatment service back in 2004.

A further factor reported to be influential in producing positive effects was the adoption of a holistic approach, whereby the ‘whole package’ of the person was addressed in treatment, and not simply the substance use problem. The range of targets included behaviours, coping methods, physical and psychological emotional problems, practical problems, social and relationship difficulties, and self-awareness.

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Learning From the Experts, Part 1

Well, I’m back in the ‘office’ after my long overdue break. It was great to have a serious ‘time-out’ and also sit back and enjoy the Olympic Games. They were awesome and many performances stunning. What stood out most was the camaraderie between the athletes.

Anyway, here is today’s blog which focuses on a piece of research we conducted years ago, research of which I am particularly proud. Gemma Salter, who conducted the main analysis I describe, was one of my star undergraduate project students in the Department of Psychology, Swansea University. She had gained an outstanding First Class Honours Degree and won the prize for the best project of the year for an earlier piece of research she conducted on the impact of substance use problems on family members

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Learning From Wired In To Recovery

As part of our Wired In strategy, my colleagues and I launched the Wired In To Recovery online community in November 2008. Our initial aims with Wired In To Recovery were to:

  • Highlight role models who show that recovery from addiction is possible, and illustrate the multitude of paths to recovery.
  • Provide information and tools that help people better understand and use the options they have to overcome the problems caused by their own, or a loved one’s, substance use.
  • Create an environment in which people can inspire and learn from each other and provide mutually beneficial support.
  • Establish a ‘people’s journalism’, or Voice of Recovery, which acts as a strong source of advocacy both for recovery and the Recovery Movement.
  • Identify key individuals who would join, or collaborate with, Wired In to help us realise our ambitions.

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Learning About Addiction Treatment, Part 8

In my third blog post focusing on what I learnt from the treatment agency BAC O’Connor back in 2004, I focus on two themes. Firstly, how staff deal with people who relapse during the treatment programme. Secondly, how the agency works with ‘clients’ to help them integrate (back) into their community.

BAC O’Connor were more realistic about relapse than many other treatment agencies. Relapse was considered part-and-parcel of the recovery process, and was an issue that was addressed in a pragmatic and humanistic manner. Clients who continually relapsed and left the Centres were always given the opportunity to return and receive the help they needed. Noreen Oliver said to me:

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An Illustration of the Manner in Which Factors Facilitating Recovery Interact

This blog post is taken from part of a chapter in my recent eBook Our Recovery Stories: Journeys from Drug and Alcohol Addiction.

Research I conducted with Lucie James back in 2008 provided important insights into factors that facilitate behavioural change and a person’s path to recovery from addiction. This study involved a qualitative analysis of the views and experiences of clients on the RAPt treatment programme [1] in one male and one female prison. 

Transcripts of the semi-structured interviews with 15 males and 15 females were analysed with Grounded Theory in order to reveal identified concepts and themes. Four inter-related themes were derived from the analysis that were labelled: ‘Belonging’, ‘Socialisation’, ‘Learning’, and ‘Support’. Each of these themes impacted on a fifth theme, ‘Personal Change’, which had two key components, motivation to change and self-esteem.

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Learning About Addiction Treatment, Part 7

I continue my story about what I learnt about addiction recovery and treatment from Noreen Oliver, and her staff and clients, during my visits to the structured day care programme at BAC O’Connor back in 2004. (See here for my first blog post relating to these visits).

The majority of the clients at BAC O’Connor had severe and chaotic drug and/or alcohol use, a variety of other problems, including being homeless, and a strong engagement in criminal activities. Many referrals came from criminal justice services. The supported housing programme allowed BAC O’Connor to house and rehabilitate this particularly vulnerable population of clients.

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Treatment and Recovery Disconnection

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.

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