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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
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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