It’s like a three-legged stool – each leg is needed to assure stability and safety.
After you published your monograph on
Recovery-oriented methadone
maintenance
, you said that your views on methadone had undergone ‘profound
changes’ over your working life – what were they?
My earliest experiences in the field
were within ex-addict-directed therapeutic
communities and 12-step treatment programmes, and my direct exposure to
methadone was from the worst methadone clinics and the least stabilised
methadone patients. To mention the word methadone to me in those years was
like waving a red flag in front of a bull, and my anti-methadone rants continued
until I enrolled in an addiction studies programme where one of the leading
addiction experts in the world quietly suggested that my passion about
methadone maintenance treatment (MMT) was outstripped only by my seeming
ignorance of the subject.
Following this humbling milestone, my investigations into the scientific
studies of MMT led to a begrudging intellectual acceptance of methadone as an
important treatment adjunct for some people. But I didn’t really ‘get’ MMT until I
got to know people in MMT with a high quality of recovery. They showed me living
proof of its value and legitimacy, and my attention shifted from a focus on
methadone as a medication to the lack of recovery-orientation within MMT
programmes. That’s when I began the collaborations with Lisa Mojer-Torres to
promote a model of ‘recovery-oriented methadone maintenance’.
Today, I continue to work to transformMMT milieus into strong cultures of
recovery, but I don’t think these milieus and attitudes toward them will change until
a vanguard of people in medication-assisted recovery step forward to put a face and
voice on this style of recovery, and challenge the low level of expectations and the
low levels of recovery support that have existed within MMT programmes.
One of the greatest challenges people face is stigma. Is that changing in the US – has
the success of the recovery movement managed to challenge some of the stereotypes?
The intensity of the social stigma attached to addiction
continues into recovery,
but the larger picture that is unfolding is a positive one. The dilemma we face is
that the addiction problem is very visible but the recovery solution has, until quite
recently, been invisible. If all one sees culturally are high profile addiction-related
deaths and celebrities crashing and burning and heading to rehab it’s little
wonder that pessimism prevails about the prospects of long-term recovery. What
we have figured out is that attitudes about addiction and recovery change only
superficially through the process of professional and public education – what
does change attitudes and beliefs is personally knowing individuals and families
whose lives have been blessed by addiction recovery.
One of our US recovery advocacy posters says it all: by our silence, we have let
others define us. What’s changing is that hundreds of thousands of people whose
life circumstances allow are standing with others to put a face and voice on
recovery. That’s how we are making progress on the stigma front, but it will take
sustained work for many years to reverse the decades-long demonisation of
people whose lives have been wounded by addiction.
Both the US and European economies are in poor shape, and things could get a lot
worse before they get better. What kind of impact do you think this might have on
people’s recovery aspirations, when jobs, decent housing, community and self-
esteem are so pivotal?
Ironically, this is the perfect climate
within which recovery advocacy movements
will rise. The need for recovery will intensify in this climate – funded services will
shrink and the need for a larger safety net for people seeking recovery will grow.
What history teaches me is that when existing structures of support prove
inadequate or collapse, recovering people and their families and allies will rise to
create new systems of recovery support. That’s what recovery advocacy
movements around the world are beginning to do. Thousands of recovering
people marching in the streets of UK cities and new indigenous recovery support
organisations will do far more to raise the recovery aspirations of individuals and
families suffering from addiction than throwing more money at the treatment
industry. What addicted people desperately need is connection to community and
this is the climate in which strong communities of recovery will rise – what this
movement has to offer is something money cannot buy.
You’ve said that the field is unique in that it offers the opportunity to see people
completely transform their lives – is that what sustains you?
This has been a source of deep joy in my life
. Witnessing and sometimes
participating in this transformative process we call recovery and to further
witness the ripples of such recovery into families and communities are sacred
privileges granted to those of us in this field. I think you have to stay in touch with
that if you are going to be effective and survive working in this field.
How do you see the field developing in the future – are you optimistic? You’ve
spoken of a potential ‘death by absorption’ into bigger, more powerful institutions.
I am concerned about the future of addiction treatment
. In the US, we are on the
brink of a rush to integrate addiction treatment into mental health care and primary
health care. That trend has great possibilities of widening the doorways into
addiction recovery, but I worry that there are core ideas, values and technologies that
could get lost in the process. I think the big picture for addiction treatment
worldwide is to move beyond models of acute care and palliative care toward models
of assertive and sustained recovery management, and to wrap these latter models
within broader efforts of recovery community development and mobilisation.
Perhaps it’s also time we talked about the fact that many neighbourhoods and
whole communities have been wounded by addiction and related problems, and
that these larger social systems may need a recovery process of their own. In
Native American communities there is no distinction between the individual, the
family and the tribal community – to wound one is to wound all and to heal one is
to heal all. I don’t think we will be able to significantly elevate our ability to heal
individuals without facilitating these larger intergenerational processes of family
and community recovery.
Finally, do you have any closing message for the readers of DDN?
I know such thinking is woefully out of fashion
and may be seen as the romantic
notions of an old man, but there are
DDN
readers who may have been born for
this moment in history – call it calling, call it destiny, call it whatever you want.
There are brief windows of opportunity in our personal lives in which powerful
events and experiences forever cast our lives into the categories of before and
after. There are similar windows of opportunity within the history of addiction
treatment and recovery, and I belief we are entering one of those moments. There
is a rising worldwide/UK recovery advocacy movement and to those readers who
feel a voice calling them to serve this movement I would say, “Come join us – it’s
time for recovering people and their allies to create not just recovery-oriented
treatment but a world in which recovery can flourish’. And in doing that, we may
also bring badly needed larger recovery processes to communities and countries
around the globe.
DDN
22 |
drinkanddrugsnews
| December 2011
Profile |
William White
www.drinkanddrugsnews.com
‘There are brief windows of oppor-
tunity in our personal lives in which
powerful events and experiences
forever cast our lives into the
categories of before and after...’