Recovery doesn’t happen in a vacuum

photo credit: davegray
photo credit: davegray

In Addiction Today, David Best pulls together 3 themes we’ve discussed in this blog.

What I will do is overview three key component parts of a theoretical model of recovery, then draw them together to derive conclusions about what we should do next to make policy and practice stronger in this area.
1. Recovery capital – personal and social resources – the journey of growth
2. Social identity and social contagion in recovery – the role of friends and connections
3. Therapeutic landscapes of recovery – the role of location.

Please read the whole thing. It provides a very concise summary of some very important concepts. For example, on social contagion and identity:

Belonging to these groups has another effect: it changes how people see themselves and what is possible in their world. This is social identity – that we define ourselves in part by the groups we belong to (and by those we don’t) and that process provides us with a lens for seeing the world through. That is part of the reason why belonging to recovery groups is so important in helping people to build the skills and confidence (personal capital) that they will need. Belonging matters. It also provides a safe space for making changes and growing recovery strengths.

Toward the end of the piece, he provides an optimistic call to action:

So what does this mean? We now know that personal recovery is a complex journey that might take years and involve false starts – but it is one that we know will probably end in success. We also know some of the things about personal skills and social supports which will dramatically swing the odds in favour of recovery. We must link this to a commitment to measuring and mapping recovery pathways.

The confines of culture

I recently read a series of great posts that had no direct relationship to addiction or recovery but they got me thinking about the power of culture as a sustaining force in addiction.

The series was sparked by a Forbes blogger who wrote a post entitled, If I Were A Poor Black Kid.

It inspired Ta-Nehisi Coates to write about, what he refers to as, a muscular empathy. As usual, Coates writes in a way that makes it difficult to pull quotes, but here goes:

It is comforting to believe that we, through our sheer will, could transcend these bindings — to believe that if we were slaves, our indomitable courage would have made us Frederick Douglass, if we were slave masters our keen morality would have made us Bobby Carter, that were we poor and black our sense of Protestant industry would be a mighty power sending gang leaders, gang members, hunger, depression and sickle cell into flight. We flatter ourselves, not out of malice, but out of instinct.

This basic extension of empathy is one of the great barriers in understanding race in this country. I do not mean a soft, flattering, hand-holding empathy. I mean a muscular empathy rooted in curiosity. If you really want to understand slaves, slave masters, poor black kids, poor white kids, rich people of colors, whoever, it is essential that you first come to grips with the disturbing facts of your own mediocrity. The first rule is this–You are not extraordinary. It’s all fine and good to declare that you would have freed your slaves. But it’s much more interesting to assume that you wouldn’t and then ask “Why?”

This is not an impossible task. But often we find that we have something invested in not asking “Why?” The fact that we — and I mean all of us, black and white — are, in our bones, no better than slave masters is chilling. The upshot of all my black nationalist study was terrifying — give us the guns and boats and we would do the same thing. There is nothing particularly noble about black skin. And to our present business it is equally chilling to understand that the obstacles facing poor black kids can’t be surmounted by an advice column.

The answers are out there. But they will not improve your self-esteem.

The original Forbes post also inspired Megan McArdle to write very good post, which inspired Coates to write a response.

In this post he writes about an experience a few years back where he socialized in very rich circles that he was unfamiliar with:

They were all nice and everything, but subtly–in ways cash can’t explain–very, very different from me. For instance, at dinner, no one finished their plate. Many of them went so far as to decline desert, or if they indulged they’d eat half and sip coffee. We are not talking about large plates, or heaping deserts.

For the first couple of nights, I looked at all these rich white people like they’d lost their mind. To my mind they were being wasteful and unappreciative. I was not out the projects but I had–like most of us–come up in a house where you are told to finish your food. By the third night, I started to feel weird. I began to believe that by finishing my dinner and plowing through dessert I was committing a faux pas. No one said any such thing to me. But I just felt like I was sticking out. The next night I came to dinner and only ate half, I nibbled at dessert. I sipped the coffee. By my final dinner, not only had I joined the culture of withholding, I actually felt full and marveled at the fact that I’d ever been any other way.

This was in the span of a week. It was about then that I started to notice that I may well have been the only overweight person in the entire town.

Culture is a set of practices which people adopt to make sense of their environment. I was raised in a house where the memory of going hungry had not faded. I never went hungry, but I was raised around people who’d grown up with that. Moreover, all of my friends and relatives were raised the same way. Everyone I knew for the formative years of my life was raised in the culture of “Finish Your plate.” And given the environment our parents had come up in, it made perfect sense. As Megan says, I didn’t know anything different. Moreover my peer group didn’t know anything different. I would actually go further then Megan and say that there wasn’t even a sense that we were making “bad decisions”–even if objectively we were.

The “culture of addiction” is something we frequently discuss at Dawn Farm. But it’s easy, even for us, to underestimate the power of this for clients whose identities, social connections, economic connections, environment, sexual norms, social norms, diet, spiritual views, thoughts, values, behavior, intuitions, imagination and hopes, are all organized around or shaped by drug addiction. (Though, not all addicts are enmeshed in a culture of addiction.) These countless personal, social and structural connections to addiction are often invisible, making them that much more powerful—you can’t even think about changing what you aren’t aware of.

Now, there’s nothing neurobiological or genetic about the barriers that this culture creates for addicts seeking recovery. It goes to demonstrate the complexity of treating addiction (Or any chronic illness, for that matter.) and that helping these kinds of addicts recover will always demand comprehensive bio-psycho-social treatment. I once saw a talk that identified four tasks for treatment and recovery:

  1. Recovery from the other genetic, biochemical, social, psychological, or familial influences which initially contributed to the development and trajectory substance problems.
  2. Recovery from the pharmacologic effects of the substances themselves.
  3. Recovery from the adverse psychosocial consequences of the substance use.
  4. Recovery from an addictive culture.

That empathizing with people from other cultures can be so difficult, demand so much of us and be so ego deflating may help explain why addiction is so persistently misunderstood and stigmatized, even by recovering people who have now attached to another culture.

Stick with the winners

photo credit: davegray

Jonah Lehrer reviews recent findings on “social contagion” and obesity:

It turns out that the habits of others shape our own, that we unconsciously regress to the dietary norms around us. Because we’re not particularly good at noticing when we’re sated and full – the stomach is a crude sensory organ – we rely on all sorts of external cues to tell us how much to eat. Many of these cues from other people, which is why our eating habits are so contagious.

This fits nicely with the experience of anyone who has spent time talking with an alcoholic about their drinking. They measure their drinking by their observations about others. “Everyone drinks like me!” “Most of my friends drink more than I do!” “I’ll quit if I ever get as bad as that guy!”