Recovery capital and capital

blindjusticeartFrom the UK Advisory Council on the Misuse of Drugs second report of the recovery committee [emphasis mine]:

…our optimism about recovery should be tempered. Evidence suggests that different groups are more or less likely to achieve recovery outcomes. For some people, with high levels of recovery capital (e.g. good education, secure positive relationships, a job), recovery may be easier. For others, with little recovery capital or dependent on some types of drugs (especially heroin), recovery can be much more difficult and many will not be able to achieve substantial recovery outcomes.

It’s great that people are discussing recovery and looking at outcomes, but I have a few important concerns.

At what point does recovery capital become a proxy for class?

I’m increasingly concerned that recovery capital is becoming a proxy for social class. Whenever I discuss health professional outcomes, the typical response is something like, “Yeah, well, they have a lot more recovery capital than most opiate addicts.” The implication is that health professionals (and people like them) are capable of achieving drug-free full recovery while other opiate addicts are not. This is particularly troubling as maintenance becomes the de facto treatment for opiate addiction and significant financial resources become more important for accessing drug-free treatment of adequate duration and intensity. (Like health professionals get.)

This question brings John Rawls and his “original position” to mind.

In the original position, the parties select principles that will determine the basic structure of the society they will live in. This choice is made from behind a veil of ignorance, which would deprive participants of information about their particular characteristics: his or her ethnicity, social status, gender and, crucially, Conception of the Good (an individual’s idea of how to lead a good life). This forces participants to select principles impartially and rationally.

We have a situation where the experts provide one kind of treatment to their peers and another kind of treatment to the rest of their patients. If these experts had to assume the original position and operate from behind the veil of ignorance–if they were to be reborn an addict of unknown class, race, gender, economic status, etc–what would they want the de facto treatment to be?

If it’s not maintenance, then we have a social justice problem.

Evidence for what?

The other important question concerns the evidence. I have several questions about discussions about evidence.

Recovery for life?

Writing Desk 2008

Our friend Bill White has been blogging. This is great news! To my mind, he’s been the most important voice in addiction treatment, recovery and research of both. His writing is very accessible and he bridges experiential knowledge and empirical knowledge.

He’s also been amazingly prolific. The downside of this is that his body of work can be overwhelming. It looks like he plans to use the blog highlight important findings/stories/lessons with links back to the source documents. 🙂

His most recent post is on recovery for life:

“When does recovery today predict recovery for life?”  After investigating all of the scientific evidence I could locate on this question, I have regularly responded that this point of durability seems to be reached at 4-5 years of continuous recovery, meaning that less than 15% of those who reach that point will re-experience active addiction within their lifetime (with opioid addiction potentially being closer to the 25% mark).

Indescribable horror turned into advocacy

Bill White appears to have started blogging!

His most recent post touches upon an issue that is close to my heart.

People in recovery and their family members are leading what is rapidly becoming an international recovery advocacy movement, but there are faces and voices notably absent from the frontlines of this movement:  the families who experienced death of a loved one from addiction before recovery was achieved.  These family members are now seeking each other out for mutual support and are adding their voices to calls for enhanced access and quality of addiction treatment and recovery support services in local communities.

He then introduces a video made by a bereaved father, Jim Contopulos, in memory of his son, Nick.

The following is attributed to Jim and reportedly from his eulogy for Nick.

For those of us here today, who have had a “front  row seat” to this disease over these past 13 years, or even to those sitting further back and have continued,  as it were, to hear “reports form the front line” we can confirm without any hesitation that addiction is truly a “cunning, powerful and baffling” disease.

Some of us sitting here today know nothing of Nick other that this courageous struggle, and it is my hope that as we allow Nick to “speak” through the songs he loved; the movies he loved; his love for animals; his love for children, especially his love for his daughter Hailey; his irreverent humor; his love and admiration for his sister Vanessa, his mom and myself; his strong desire for justice as well as his struggles with addiction coupled with mental illness, what’s known as a dual diagnosis, that you will have a much larger context for his life.

Perhaps with this better understanding, Nick would ask you simply to love, rather than judge; the addict, the mentally ill the diseased, the imprisoned, the homeless, the poor, the unlovable and the lonely, because Nick himself was, at one time or another, all of these.

None of us sitting here today wants only to be remembered for our failures and certainly not Nick, which is why he so loved the final verse to the song “These Days” by Jackson Browne, which says. “don’t confront me with my failures, I have not forgotten them”.

The worst part of this work is the terrible loss of life, often young lives. Among the parents that are left behind are some of the bravest and most admirable men and women I have ever met.

liv.townhall-2Diane Montes turned the loss of her son, Brian, into a mission to prevent deaths and support families going through a similar loss.

It was the evening of June 29, 2006, when Diane Montes returned home from work and went to her son’s room to speak with him. When she opened his bedroom door, she witnessed “an indescribable horror.” Brian Montes, a 22-year-old education major at Michigan State University, was lying dead on his bed. Police told the grieving mother that her son died from heroin use.

The family later learned that the fatal dose was mixed with the pain-killer Fentanyl, which caused respiratory failure. Brian’s family had not been aware he had a drug abuse problem. They later found out he had only been using heroin for 6 weeks when he died.

After Brian’s death, Diane and her husband Andy learned that there were more Livonia teenagers and young adults using heroin than they had ever imagined. Diane talked to a number of people who said they knew of young heroin users who either died, were hospitalized, or sent to drug rehabilitation. In addition, it was reported that Livonia police suspected the drug could have played a role in a dozen deaths in Livonia over the previous year.

Diane looked for information and support in Livonia but found little. She learned of the Royal Oak Save Our Youth Task Force, a group of school, police, medical and political leaders focused on spreading word about the dangers of heroin and other drugs and how users and families can find help. The Royal Oak group formed in response to a number of drug deaths in that community.

On October 18, 2006, Diane convened a community meeting to try and build community support for a Livonia Save Our Youth Task Force. Over 140 people with questions and stories to share attended that initial meeting. From that meeting, a group formed and the first meeting of the Livonia Save Our Youth Task Force was held on November 15, 2006.

Since 2006, Livonia Save Our Youth continues to grow and expand. In 2012, the name was changed from “Task Force” to “Coalition” to reflect the longevity of the group and intent to continue its mission and activities in the community.

I’ve called on Diane over and over again to ask if she’d be willing to speak with a parent who just lost a child. She’s never hesitated to make her self available to them.

Mark Rudolph also lost his son, Ryan, in 2007 and has been relentless in building a coordinated community response to the problem of addiction in his “safe” suburban community.

He made this video in memory of Ryan. (The voice mail he included at the end is heartbreaking and horrifying.)

mark anna beach animatedMore recently, I met Mark S. who lost his son, Andrew, just one year ago.

He’s been sharing his difficult journey on his blog and in his podcast. He recently marked Andrew’s birthday with a 12 hour podcast to raise money to provide treatment for others.

DSC00291Here’s his introduction to that 12 hour podcast.

[audio http://traffic.libsyn.com/talktherapy/Hour_1_of_12_Hour_Podcast_Mark.mp3]

These are just a few of the people I’ve met who have turned their tragedy into a heroic journey. Sadly, we’re in the midst of another wave of overdoses.  I hate this part of the job but I am so grateful to have met people like Diane, Mark and Mark.

Ten Percent in Recovery – NOT

Here’s the headline at Partnership for a Drug-Free America:

Survey: Ten Percent of American Adults Report Being in Recovery from Substance Abuse or Addiction

Very interesting news, right?

How did they arrive at that number? With a poll that asks, “Did you once have a problem with drugs or alcohol, but no longer do?”

Choose you evidence carefully by rocket ship
Choose you evidence carefully by rocket ship

Does that measure recovery? I don’t think so.

Recovery has traditionally described achieving abstinence after a severe and persistent substance use problem characterized by loss of control over use. There has been a push to expand the definition to include people who moderate. This question would catch those people. I’m not too concerned about that.

What does concern me is that there are lots (and lots) of people who have a time-limited episode of substance use problems and moderate or stop once they have reason to. Say, a college student who parties too hard his freshman year and moderates or quits once they are confronted with the possibility of flunking out.  Or, how about a pain patient who starts using more than the prescribed dose, running out of prescriptions before the end of the month and doctor shops to get more to avoid withdrawal? He/She finally talk about the problem with their doc and come up with a new pain management plan. Are these people in recovery? I don’t think so. Would they answer yes to the question above? Probably.

I’m all for normalizing recovery, but the message of this article is misleading. The question they used doesn’t really tell me how many people are in “recovery”.