By John M.
This past February at AA Agnostica, I wrote about my ten favourite recovery websites. The William White Papers was included among them not only for the wide range of material one can access there but also because I believe William White to be one of the most gifted and knowledgeable practitioners in the field of recovery research as well as one who is also able to speak from first hand experience about addiction.
White is Director of the Research Division of the Chestnut Health Center established in 1986 employing about 90 people engaged in a “science based understanding” of addiction and recovery. What happens in recovery over the long term is the center’s particular research mandate and is not solely for what happens to those in recovery over the first thirty days to six months. The science of addiction is continuing to be produced and collected to better evaluate many issues that were previously known only anecdotally (though sometimes falsely or at least ambiguously). More than 600 scientific studies/papers are used by White and his colleagues.
At his website you will find over 400 scholarly (but highly readable) articles by him including interviews with some of the most well known research professionals and advocates in the field of addiction and recovery. You will also find a stunning array of addiction bibliographical material as well as very useful chronologies listing the histories of such societies like AA, NA, Smart Recovery, the Addiction Recovery Advocacy Movement (dating back to the 18th Century), and more. You will find book reviews by White on some of the most relevant texts to appear over the past few years. There is much to explore at this site!
What I want to draw your attention to, however, is White’s three-part video of his 2009 Recovery Oriented Systems of Care (ROSC) Symposium. The total viewing time is about 4 1/2 hours but with it’s three-part format, and between 15-23 segments in each of the three parts, separated into easily navigated portions, you can simply set your own timeframe for relaxing and taking it all in without wasting time later searching for where you were in the video from your last viewing.
White is an engaging speaker who confesses that in this presentation he will sound at times like a country preacher and he does so as a recovery advocate and as a person himself in long term recovery; at other times, he says he will sound like a stuffy researcher, flashing graphs and numbers at us; and finally, he shares that he will give voice to the experience of a number of pioneering groups that are helping to transform behavioural health care in a number of American cities today.
The common theme reiterated by White on numerous occasions throughout the symposium is a paraphrase of Bill Wilson’s often forgotten acknowledgement that there are many paths to recovery and ALL are cause for celebration. He will argue that we have to give up the single pathway recovery model and adopt a multiple pathway model conducive to the needs of each individual while, at the same time, taking into account multiple patterns of addiction and multiple sub-cultures. This includes a “menu” of all sorts of recovery philosophies and support services and sometimes combining and sequencing them as they apply to the unique needs of individuals within a particular environment.
There is such a vast range of material covered by White here that I cannot adequately do justice to it by providing a synopsis so I hope only to tweak your interest by highlighting a tiny sample of salient points that caught my attention.
1 Science is discovering that alcoholics/addicts fall into two distinctive categories: transient and chronic. Transient recoverers “mature out,” or “naturally recover,” or are said to undergo “spontaneous remission” after around a 24 month period of alcohol and/or drug abuse. The data indicates that after five years most are healed or are healthy in ways we commonly use to define personal well-being. The chronic sufferers, or those who are said to manifest “chronicity” through longer periods of time, need the standard intervention we have come to know as treatment and recovery “programs.”
2 The data indicates that four to five years is the time it takes to statistically predict a sustainable and stable point of recovery for alcoholics and heroin addicts. Eighty-five per cent of alcoholics who attain four or five years of continuous sobriety stay sober after this point whereas 75% of heroin addicts will not relapse. Researchers, White points out, do not know why there is a ten per cent difference between the recovery rates of alcoholics and heroin addicts. No studies have been undertaken to track cocaine, marijuana or narcotic/prescription drug addicts over the long term. The science is simply not yet there for these latter types.
3 Science shows that you cannot predict the success of recovery from an alcoholic’s/drug addict’s initial contact with and/or motivation for entering treatment facilities or peer support programs. Rather, motivation is an outcome, not a pre-condition, of the criteria for successful treatment and support. How many of us have met enthusiastic, highly motivated newcomers who we thought would definitely “make it” only to find that the initial motivation could not be sustained by that individual within the program or the group he or she was associated with. (White has lots more to offer on this subject!)
4 A qualification, however, must be raised for the previous observation. In his many years as a street worker, treatment centre worker (and Director) and as a researcher, White has often speculated (given AA’s disinterest in rigorously gathering data on the progress of its members) that AA has perhaps been far more successful than membership lists, numbering slightly over two million, suggest. Just because a newcomer arrives at a group, stays around for a period of time, and then is no longer seen again, does not mean that when that person no longer attends they have “failed” and have “gone out” again. Some of AA’s hidden success may lie in the fact that AA provides readily available meetings and often serves as a catalyst for getting the newcomer’s attention for the very thing that needs his or her attention and they subsequently follow a different path to recovery - and do, in fact, recover. All paths to recovery, White reiterates, are cause for celebration.
5 When clients in treatment find themselves recycled four to five times (or more) and are told that they have entered the “best” treatment facility, is it the client who fails or is it the “system?” Are these clients actually being given a realistic chance at recovery or have they merely been “set up” to fail?
6 The recovery model should mirror the medical model if we are serious about designating alcohol and drug abuse as part of a “disease model.” In reality, we either do so half-heartedly or do not really believe that addiction is a disease. If we were serious or if we begin to correlate scientifically the data coming out of recent research with the data that has been present for some time now in the treatment and care of cancer, diabetes, or heart disease patients, then addiction treatment falls short. It cannot therefore just be tweaked to improve it but must undergo a radical paradigm shift and be redesigned.
We know with alcoholics and heroin addicts that four to five years is a key indicator of success and we know that cancer patients, for example, have five years of follow-up care and tracking from their medical practitioners. The medical community knows that five years for cancer remission is the time-period for essential post-treatment monitoring but given that the statistics tell us that the five year period is essential to the well-being of alcohol and heroin recoverers, why don’t we in fact follow the medical model? Instead we leave it to recoverers themselves, to their families and friends (and to peer groups, like AA) to get them to the five year “safety mark” without any medical and, in most cases, long term, treatment centre post-recovery monitoring.
7 The current addiction treatment and recovery model is politically and medically unsustainable. It mirrors the following analogy used by Native American Don Coyhis of the Wellbriety movement. Coyhis compares current treatment models to digging up a dying tree which is rooted in bad soil, replanting the tree in good soil, watching it grow and thrive and then digging it up and replanting it back in the bad soil. What do we expect will happen! The current treatment model is like this. We take the alcoholic/addict and place them into a treatment centre, and even the small percentage that want to be there and who thrive in that treatment environment, we return them to their previous lives and communities and expect them to thrive as if we expected the rejuvenated tree to remain healthy when returned to bad soil.
8 We have to start talking in terms of “recovery capital.” It is a threefold engagement by the recoverer drawing on: one, strengths from within himself or herself; two, an engaged group of family and friends; and three, a recovery-friendly community within which the recoverer interacts on a daily basis. Unless this threefold multiple support network exists we will continue to see the recovery data reflect perpetual cycles of relapse in and out of treatment centres as well as low percentages of recoverers making it past the five year stability point for long term recovery.
Recovering doctors, for instance, statistically have the best recovery rates because they have access to the most “recovery capital.” (And no, we are not solely talking about money here, though wealth certainly factors into all kinds of individual, family, and community-engagement opportunities.)
On a personal note, I am not abundantly wealthy, though I am comfortable, and as I reflect on my past six years of recovery in light of what White says about “recovery capital,” I am less mystified as to why my “miraculous” recovery occurred. I had certain core strengths, in spite of my alcoholism; I had a loving and supportive wife, sisters, in-laws, non-alcoholic friends as well as new-found friends in the rooms of Alcoholics Anonymous. My bosses at work; my fellow employees; a job I love to go to each day; and a wonderful psychiatrist to work with on my fourth and fifth Step - all the above point to White’s notion of “recovery capital” as a legitimate and profound concept. With this concept in mind and looking back on the early days of my sobriety, I now have to ask myself: how would it have been possible for me NOT to get sober? You can call it “grace.” I certainly recognize the graciousness of all those who helped and supported me and I am exceedingly grateful to them. But I will call it “recovery capital.”
9 Faith based, spiritually based, and secular based models are all legitimate pathways to recovery and all are cause for celebration. Taking just one example, Project Match’s eight-year study beginning in 1989 comparing Cognitive Behaviour Therapy, Motivational Interviewing and 12 Step based programs, despite some methodological weaknesses, consistently showed that there was statistically pretty much the same success rate of recovery among the three.
10 Among various ways to categorize certain typologies, one way is to look at three types of responses to the uses and abuses of alcohol and drugs: abstinence based, moderation based, and medication-assisted based recoveries and these as legitimate options, White insists, should no longer divide us into antagonistic camps.
White confesses that early in his career as an addictions worker and as one fully committed to a 12 Step model, he attended a lecture by Dr. Ed Senay (later to become a friend) who had talked about the importance of methadone-assisted recovery for a great number of addicts. White was appalled that this learned man could argue for anything that didn’t get to the root of the sufferer’s problems, and methadone, White felt, only addressed the symptoms among other physiological problems. With arms flailing, looking a bit like a lunatic, White proceeded at the end of the lecture to tell the man how very wrong he was. Dr. Senay stood patiently, arms folded, and when White had finished speaking Senay responded: “Young man, your passion is in inverse relation to your knowledge.”
White laughs at himself now but he asks how many of us have taken our well intentioned and passionate belief in our own model (12 Step based or others) and tried to impose it on those who might not be helped by it, or at other times when we have failed to acknowledge and support other methods that at least deserved a fair hearing.
11 Advocacy with Anonymity: “By our silence we have let others define us!” White believes it is time to deal with one of the great barriers to recovery that exists in the form of social stigma and shame. To rid society of the stigma and shame that many people in recovery still feel even after many years of being clean and sober requires the kind of social movement which has parallels with the civil rights, women’s, and gay rights movements of earlier decades.
As an historian of all recovery movements, White understands that for the fellowship of the recovery community of Alcoholics Anonymous, the AA Traditions seem to prevent loyal members from participating publicly in gatherings and marches designed to show the face of recovering addicts and alcoholics as happy and responsible citizens of the nation just like everyone else. (See the link to the upcoming film, Anonymous People, here at AA Agnostica.) But White points out that no AA Tradition needs to be violated by its members since people gather and march as part of the larger movement of “persons in recovery” (New Recovery Advocacy Movement) and no one identifies as particular participants in any such organizations like AA or NA or WFS or any other autonomous entity.
Individuals who are comfortable with their sobriety and who are in a position where stigma and discrimination have little or no social and employment repercussions (not everyone is in such a position) are needed to advocate on behalf of addicted people of all sorts and shapes in their communities at large and to the politicians who can propose and enact beneficial social policy.
12 A note of concern by White: If we continue to sell, highlight and promote the treatment model as it currently exists in most forms, we could be in danger of what White calls the “perfect storm” of the recovery movement’s possible demise. Here is his final slide in his three-part presentation:
Overselling what the Acute Care model can achieve to policy makers and the public risks a backlash and the revocation of addiction treatment’s probational status as a cultural institution that can threaten the very existence of this addiction field.
ROSC and RM (Recovery Management) represent not a refinement of modern addiction treatment but a fundamental redesign of such treatment.
As resources are needed for a full commitment to this necessary recovery management remodeling (i.e., ROSC and RM), given the times we live in, White sees the “perfect storm” playing itself out in something like the following:
We could have a “virtual avalanche” of celebrities moving in and out of rehab to escape the responsibilities of their latest indiscretions in ways that can totally discredit the reputation and integrity of addiction treatment. Coupled with this we could have a financial crisis of unprecedented proportion that would force State and Federal politicians to make a decision whether to fund roads, schools, or addiction treatment.
13 White admits that some of the scientific research often verifies many past practices of which any old time AA’ers with grade five educations could have told us. Still, science must either confirm or dispel what is sometimes indistinguishable between wisdom and fact, ideology and myth.
14 New ground, White tells us, is being explored every day. But the science of addiction and recovery is still really just scratching the surface of what needs to be positively and adequately known and this means mobilizing and coordinating social and political awareness which is just gaining momentum in breaking through the stigmatization and the ignorance of the past. White is excited about the future yet as an historian – and he talks about the demise of a flourishing recovery movement in early 20th Century America – he is quite realistic as to what can happen to any movement which fails to seize the appropriate moment at the appropriate time and place.
If science is only scratching the surface of addiction and recovery research thus far, this introduction to William White’s video has also only done just that. In fact, the best reason for viewing White’s presentation for me and why I highly recommend taking some time out to watch the video is the following: if White had purposely set out in these 4 1/2 hours to address every question or issue you have ever heard raised about addiction, 12 Step models, AA, and other recovery, medical, and scientific modules, he would pretty much have succeeded in his intent.
It is clear from the format of his PowerPoint presentation that he did not set out to do so. But, so knowledgeable is he within the contours of his presentation, and so quick to respond off the top of his head in detail to questions from his audience of recovery professionals, you can only be amazed at the breadth of his research and his ability to apply this research to the most pressing issues facing the addiction and recovery community today (as well as addressing those politicians who must realistically and adequately begin to put the addiction epidemic at the top of their social policy agendas).
White accomplishes all this by calling for a veritable “fourth step” of current treatment models to see where existing strengths ought to be preserved but also where the models themselves are inadequate or are “working” at cross-purposes or are downright self-defeating.
I hope you will take some time to share in the experience of this simply magisterial presentation. Enjoy!
One of the other videos at William White’s website is a wonderful in-depth interview of White’s friend and colleague, Ernest Kurtz. They talk about Kurtz’s books: Not God: A History of Alcoholics Anonymous, The Spirituality of Imperfection, and Shame and Guilt. Highlighted in the video, the following excerpt from “Models of Alcoholism Used in Treatment,” co-written by William R. Miller, sets the record straight about what AA writings do NOT claim.
AA writings do not assert that: (1) there is only one form of alcoholism or alcohol problems; (2) moderate drinking is impossible for everyone with alcohol problems; (3) alcoholics should be labeled, confronted aggressively or coerced into treatment; (4) alcoholics are riddled with denial and other defense mechanisms; (5) alcoholism is a purely physical disorder; (6) alcoholism is hereditary; (7) there is only one way to recover; or (8) alcoholics are not responsible for their condition or their actions. (Miller & Kurtz, “Models of Alcoholism Used in Treatment,” 1994)
For an even more exhaustive exposé of what AA literature does or does not say see White and Kurtz here at AA Agnostica: A Message of Tolerance and Celebration.
You can read a review by Martin N., founder of LifeRing Secular Recovery, of Bill White’s classical historical work right here: Slaying The Dragon: A History of Addiction Treatment and Recovery in America. Also on AA Agnostica is a review of a wonderful essay by Bill White and Ernie Kurtz, The Varieties of Recovery Experience.
John M.’s previous articles on AA Agnostica:
My 10 Favourite Recovery Websites (February 24, 2013)
Thinking About Christopher Hitchens (February 19, 2012)
You Cannot NOT Interpret the Steps! (October 12, 2011)
Waiting: A Nonbeliever’s Higher Power (July 27, 2011)