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Recovery Movement Needs to Keep Distance from Treatment Field

by Anonymous, Join Together Online, Features & Commentary, 11/16/2000. Originally posted to on 8/20/2004.  []. This document is also available from: [,2521,265102,00.html]

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History has a lot to teach the addiction treatment advocacy movement -- including lessons about the recovering community and treatment providers aligning themselves too closely as they lobby for improved services, according to author, researcher and historian William L. White.

"History can serve as a midwife for the new recovery movement ... We have a rich tradition to fall back on," said White at the Oct. 21-23 Mobilizing Recovery Through Technology conference in New Orleans, La., cosponsored by Join Together, the National Council on Alcoholism and Drug Dependence, and the Center for Substance Abuse Treatment (CSAT).

Well before the advent of Alcoholics Anonymous, mutual-aid societies were formed by groups of alcoholics -- some as early as 1750, said White. Reflecting the early recognition for the need for cultural relevance in treatment and recovery, self-help groups were formed for women, Native Americans and African-Americans in the 18th and 19th centuries.

Some of these pioneering groups grew to impressive proportions: a self-help group calling itself the 'Hard Cases' formed in the mid-1800s and exploded from a core of six men to a membership of more than 600,000. Two years after its founding, however, the group had disappeared. Similarly, a group called the Washingtonians rose to prominence and even spun off a network of group homes, but died when its founders chose to go on the paid lecture circuit instead of building a movement.

"We need to understand not only how these groups were born, but how they died, if we want to sustain our own recovery movement over time," said White, who sees two main challenges for recovery groups: "To get born, and to avoid premature aging." He warned nascent recovery groups to be careful who they partner with; White even sees danger in accepting money from CSAT's Recovery Community Support Project, which provides seed money for grassroots groups. "If the money dries up, if CSAT builds up these programs only to stop funding them, it would be more destructive than if they never did it in the first place," White contends.

Like recovery groups, addiction treatment programs have been around a lot longer than has generally been recognized. White says the first medically oriented treatment program opened in New York in 1864, and that hundreds of private, for-profit "Keely Institutes" sprung up around the country in the 19th century to treat addiction. The Keely Institutes begat the Keely Leagues, which organized a march on the Pennsylvania capitol to demand treatment in 1894.

"By 1895, the future could not have looked brighter," said White. "We had the first addiction journal, and an all-around disease concept of inebriety. But by 1920, it was all completely gone."

White says that a too-close relationship between recovery groups and the treatment industry helped cause the downfall of the 19th-century recovery movement, leading to widespread skepticism about treatment and a return to the old way of thinking about addiction -- namely, that it is mainly a moral failure, not a medical condition. Through "co-option and colonization," White said, "recovery groups were taken over by treatment programs," leading to absorption or self-destruction. "Could you not see that happening to us if we're not very careful?" White asked the audience of recovery advocates in New Orleans, to murmurs of assent.

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"The two issues are enormously complementary, but they are not the same," continued White. "Parity is very important, for example, but it is not the [main] issue for the recovery movement." Many treatment providers have also become deeply involved with the criminal-justice system, where coercion is a major tool for getting people into programs. But White contends, "You can coerce people into treatment, but you can't coerce them into recovery. It's an oxymoron."

He stressed, "I don't think the centerpiece of the recovery movement should be 'treatment works' or 'alcoholism is a disease.' I think it should be that recovery is a reality, that there are many pathways to recovery, and that recovery is a voluntary process."

White said the leaders of the new recovery movement must be individuals in recovery and their families, not the treatment community -- a tenet embraced by groups such as the Alliance Project and leaders like William Cope Moyers. "We need to redefine the relationship between treatment and recovery," said White. "We need to act like we believe in recovery, and focus on long-term support structures for recovery in the community, not institutions. We don't want to focus on treatment, but on lifelong recovery."

Public attitudes toward addiction, which White described as cyclical, have deteriorated since the late 1970s, when Betty Ford went public with her own alcoholism, and being in treatment was briefly in vogue with celebrities. Over the past two decades, addiction has been restigmatized and demedicalized, he said. "We were so intoxicated by the victories of the late 1970s and early 1980s that it masked how superficial some of those changes were. Recovery became a pop-cultural phenomenon, but fads burn themselves out." What was left was a predatory treatment field where too many providers "profiteered on the backs of addicts," which not only fed public cynicism, but bred the managed-care system, White said.

"Our goals must be to portray addiction as a problem with viable solutions; to present living role models; to counteract images that dehumanize, objectify and demonize people in recovery; to enhance the variety and availability of treatment and self-help; and to remove environmental barriers to recovery," said White.

The issue of recovery rights must be reframed as an issue of social justice and civil rights, he added. To do so, the recovering community must be represented in policy discussions, as service-providers, and as research evaluators. In this regard, people in recovery can take a lesson from the National Alliance for the Mentally Ill, whose slogan is, "Nothing about us without us," noted White.

People in recovery not only have a right to advocate, but a responsibility to do so, he said. "Recovery gives back what addiction has taken -- from yourself, your family and from society," said White. "If you have been blessed by this movement, then you owe a responsibility to this community ... I can't think of anything more noble that participating in a movement where you can virtually see people come back from the dead."

White is the author of "Slaying the Dragon: The History of Addiction Treatment and Recovery in America." The full text of his paper on the New Recovery Movement is available on the Alliance Project web site.

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Dr. DeLuca's Addiction, Pain, and Public Health Website

Alexander DeLuca, M.D., FASAM.

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Originally posted:  8/20/2004

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