Week Three Discussion & Knowledge Exchange Forum: Special Considerations within Recovery

Comment IconWelcome to Week Three of the 6th Annual Addiction Day: Advancing Recovery within Addiction & Mental Health Website Discussion & Knowledge Exchange Forum

This week’s discussion and knowledge exchange focuses on Considering Special Issues in Recovery. By participating, your opinion will be incorporated into the conference’s plenary panel discussion. There are two ways to participate:

  • The first is through an anonymous survey, located within this post.
  • The second is by adding a reply to the bottom of this post! Let us know your views on the topic and add to the interactive discussion in the comments section!

Click the “Read More” button below to participate! The discussion topic, brief literature scan, anonymous survey, and the comments section are available within.

We would like to give special acknowledgement to the 6th Annual Addiction Day Presenters who have contributed to advancements relevant to this week’s discussion topic:

Mark Griffiths

David Crockford

Jennifer Hibbard

Jonathan Stea

Considering Special Issues in Recovery

Some individuals perceive a shift towards recovery-oriented practice as representing a radical change in the health system and a better way of delivering services. In contrast, other individuals would argue that recovery-oriented reforms do not contribute anything new, and that “Recovery” is simply a politicalized “buzz” word in health discourse.

(Piat & Lal, 2012)

Perhaps a neutral ground of agreement is that there exists various challenges and many considerations of the special issues related to implementing recovery-oriented practice across the populations and care continuum.

We would love for you to share your thoughts and opinions!

Brief Literature Scan:

(Please note this is not an exhaustive, nor preferred list of publications. Rather, it is simply introductory literature to generate discussion. Please feel free to reference publications/resources/webprofiles of your choice in the website discussion & knowledge exchange forum).

  1. Challenges & Issues in Addiction. http://learn.genetics.utah.edu/content/addiction/issues/
  2. White (2012). Medication Assisted Recovery from Opioid Addiction: Historical and Contemporary Perspectives. http://www.williamwhitepapers.com/pr/2012%20Perspectives%20on%20Medication-assisted%20Recovery.pdf
  3. Kuss & Griffiths (2011). Online gaming addiction in children and adolescents: A literature  review of empirical research. http://www.academia.edu/1146881/Kuss_D.J._and_Griffiths_M.D._2012_._Online_gaming_addiction_in_adolescence_A_literature_review_of_empirical_research._Journal_of_Behavioural_Addiction_1_3-22
  4. Rapp, Bugra, Riecher-Rossler, et al., (2012). Effects of Cannabis Use on Human Brain Structure in Psychosis. http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3474956/
  5. White, W. (2006). Sponsor, Recovery Coach, Addiction Counselor: The Importance of Role Clarity and Role Integrity. http://www.oasas.ny.gov/recovery/documents/WhiteSponsorEssay06.pdf

Anonymous Opinion Survey

To participate in this week’s survey, please click the following link: http://www.surveymonkey.com/s/MR29MNT

Website Discussion & Knowledge Exchange Forum

We would love to hear your thoughts/reflections/suggestions regarding this week’s topic of discussion: Considering Special Issues in Recovery.

To leave a response, add your comment at the bottom of this page. Please be aware that comments will be manually approved to help filter out spam, and there may be a short delay before they appear on the page.

We ask that all responses posted on the 6th Annual Addiction Day website are respectful of others and adhere to appropriate communication etiquette. We will be doing our outmost to filter out any spam or unwanted posts that arrive to our site.

10 comments

  1. Shannon Middlemiss says:

    I find it very frustrating when I am regularly faced with a gaping lack of resources to assist a client when they are in their “recovery.” As many of us are aware, the shame and guilt some can experience while admitting and accepting their addiction can be overwhelming and at times crippling for them. For some individuals, sharing their personal journey into the hell that their life has become can be too much. Society judges them, calls them names, labels their addiction or behaviour and shuns the vulnerable and marginalized population. Heaven forbid you have a mental illness in addition to your addiction. We tend to throw the term “Concurrent Disorders” around a fair bit, though having simultaneous treatment for both is difficult to find. One stop shopping is what is promoted, yet not what is often provided. 2 problems = double the stigma attached to it. Then, add a forensic history and it can be “third strike you’re out.” Clients that have a criminal past can instantly be denied services despite extensive advocacy from the staff within the centre. How do you “recover” while serving a jail sentence with such limited and restricted resources?

    I believe Recovery to be a process … a journey that is unique to each individual. I find it ironic that an insulin diabetic isn’t labeled for having that extra piece of pie or not taking their insulin as prescribed, yet an addict can be mocked for having a “slip”. We don’t tend to judge a relapse of gout or lupus, though going out and having a binge can be portrayed as an evil sin. I think we still have a ways to go to be truly able to meet the client where they are at. We need to get society to judge less and listen more.

    • Trish Dribnenki says:

      I couldn’t agree more. The tricky part is how do we do that?

      The American Society of Addiction Medicine defines addiction as:

      Public Policy Statement: Definition of Addiction

      Short Definition of Addiction:

      Addiction is a primary, chronic disease of brain reward, motivation, memory and related circuitry. Dysfunction in these circuits leads to characteristic biological, psychological, social and spiritual manifestations. This is reflected in an individual pathologically pursuing reward and/or relief by substance use and other behaviors.

      Addiction is characterized by inability to consistently abstain, impairment in behavioral control, craving, diminished recognition of significant problems with one’s behaviors and interpersonal relationships, and a dysfunctional emotional response. Like other chronic diseases, addiction often involves cycles of relapse and remission. Without treatment or engagement in recovery activities, addiction is progressive and can result in disability or premature death. (Information taken from http://www.asam.org)

      Perhaps each of us need to take every opportunity to inform and educate and advocate around addiction as a chronic disease. We might have to start by challenging our own thinking, or even the thoughts of our colleagues, friends, public….

      Funny, just a few years ago I remember saying, “I’m not really interested in working with addictions” and in just a few short years and some learning experiences and meeting some wonderful people who have struggled with addiction, my perceptions and opinions have changed considerably. It is so important for us to listen to our clients and not let ourselves get distracted and fixated by their appearances or behaviors.

      Ugh. Stigma is so awful.

  2. Mila Wendt says:

    May I raise the issues of treating adolescents? Trying to connect and build a therapeutic alliance with teens can be a challenging process. I believe that if our systems allowed us to connect with young people through varied technological avenues, even humble texting, we could be much more present in their awareness and day to day lives, and make a greater impact. In order to do this we might need some training, infrastructure, equipment and support, but I hazard a guess that the return would be worthwhile.

    • Tuxephoni says:

      Mila!
      I think you raise a vital if not crucial “special consideration”, especially during this time when our health system is re-examining efficiency and effectiveness.

      The infusement of technology across the Addiction & Mental Health care continuum would offer TREMENDOUS promise!!

      Specifically, and as you suggest, by significantly increasing “the reach” to our clients (especially adolescents who live by their mobile devices)…and even more exciting (and highlighted within Dr. Lisa Marsch’s numerous publications)…. the potential for technology to create entirely new and innovative models of behavioural health care that GREATLY reduce costs!!

      It is a very exciting time and a window of opportunity to harness all the advances in technology and consider their application for increasing quality and reach of effective and cost efficient healthcare!

      Now I will get off my soapbox!!
      Thank you so much for bringing up this discussion point!

      Reference:
      Marsch & Ben-Zeev. (2012). Technology Based Assessments and Interventions Targeting Psychiatric and Substance Use Disorders: Innovations and Opportunities. http://www.tandfonline.com/doi/pdf/10.1080/15504263.2012.723308

      • Mila Wendt says:

        Thanks Tux, for your voice lending support! Yes, it very might be cost saving, efficient and effective to utilize technology with our clients.
        However, even if it were not so, I would still urge that it is vital to connect with our clients, as the old saying goes “where they are at”. If we cannot be at the cutting edge, let us at least try to keep up.

        • Chester says:

          Since there is so many fields of speeailtics that I have a choice of, I still really can’t choose one. So I am going base on my personal experiences. My original goal back in high school and maybe even before that, was to work in a Neonatal ICU! I had a brother that passed before he had his first birthday from heart complications, and that year I spent a lot of time at hospitals with my parents. My goal the first couple of years was to work with babies just like him. That was until I had my own children, I would of still loved to have worked in that career field but the heart ache I would most likely endure when one of those babies did not make it home. I could not have handled!On to more positive experiences, I have worked with the elderly and Geriatrics interests me very much. Being surrounded with people that have lived a fulfilled life is so much more rewarding. Even though at times it is the ending stages of their lives, and it is sad when someone does pass. It’s less of a heartache to know that most of the time they are ready to move on. They are still very dependent on you and when you are able to help them with their needs that’s the most rewarding of all, plus you form a special relationship with the patients and their families.

  3. Although I have seen this undercurrent in the field, I cannot understand how ‘recovery’ can be regarded as a trend given that people with substance use issues have been… ‘recovering’ for as long as the human race has existed and found ways to alter their consciousness in ways that became maladaptive. I think the root of the issue here is that some 3 or 4 decades ago there was in the US at least (and this is hearsay for me as I was not in the US back then) a previous attempt at a shift that i think involved TC’s- the word ‘recovery’ was tied to this change as I have heard. Moreover, unlike in other biomedical fields where rigorous scientific research has been conducted by experts on the factors associated with the process of managing a chronic condition (getting well), in the addiction field the ‘movement’ started with advocacy, not science. Advocacy though much needed, is perceived by many outside the stakeholder community as angry, loud, and not much else. Not my opinion but a fact nonetheless. I will probably anger some and outrage others here by accidentally omitting some large studies published decades ago but there is the added fact (here comes the potentially controversial statement) that the few studies presuming to examining ‘recovery’ scientifically until not long ago were… not that methodologically strong- they were mostly qualitative and that is most unfortunately not regarded as solid science by many. Yes this is sad but this is also a fact. So I digress. [here’s another controversial statement…]As one of the only scientists who has devoted their career to building the science of recovery to inform service development and policy, I understand only too well why even now so little science is devoted to studying recovery : THERE IS NO FUNDING. We strive to document and elucidate the process of wellness from a disease that is stigmatized and vilified and we are not throwing in medications, vaccines or rodents. How not sexy is that? SO we have a group perceived as angry and loud (the advocates) demanding recovery services and policy NOW, and we have little science to back up the needs and processes of recovery-or its benefits to the nation’s wallet-, so it’s easier for many who feel their professional career threatened by a ‘movement’ saying WAIT, treatment isn’t enough, we need peers etc… to say, ‘it’s just a fad this recovery movement’. RECOVERY IS NOT A FAD. IT’S A REALITY FOR MILLIONS OF AMERICANS. we can help more people get recovery, improve their lives and contribute to society. We need services and policy to promote that. And yes we need science to guide it. Look at the scientific knowledge base for any other chronic condition (diabetes, cancer, asthma), you will find thousands of studies on quality of life (not a bad proxy for recovery) among ‘patients’ with that condition. Until less than a decade ago, fewer than 100 scientific studies on quality of life in the addiction had ever been published. That says something. The public hasn’t quite made up their mind whether addiction is a brain disease or a moral failing, especially if they are one of the few who have not been personally touched by the disease. The field at large is more turned on by (and funded for) studying brain imagery, new medications and biological mechanisms than spiritual growth and hope, many clinicians though very well meaning, may misunderstand ‘recovery oriented services’ and are scarred their job will change for the worse. FOLKS, WE HAVE AN IMAGE PROBLEM and people are dying. Time to do something?
    Off my soap box I go:) see you in Calgary!

    • Trish Dribnenki says:

      Oh my gosh, it is indeed frustrating! Not only is there the challenges of lack of funding, image and stigma within our own communities, there is the media, perpetuating the stigma, sensationalizing the plights of Charlie Sheen and Lindsay Lohan, making a “hilarious” spectacle of these individuals during their very public struggles with addiction.

      Another challenge I’ve observed is the “hierarchy” to addiction. We all know someone who “loves their wine” and we have likely, on occasion, minimized their excessive use, however, as a society it is easy to judge the individual who uses crack or meth or steroids……And in addition to the general perceptions, I’ve noticed there is stigma even WITHIN the culture of addictions! I have worked with individuals who inject prescription drugs who will say, “At least I’m not a crackhead”, and someone who snorts cocaine will state, “At least I’m not injecting anything”. Add factors such as obvious mental health concerns, being a woman, homelessness, being pregnant, etc and even individuals experiencing addiction will be judged on a scale.

      I would like to echo Alexandre’s point that a big barrier to addiction treatment is stigma and image. It’s so important for us as individuals working with addictions to advocate that EACH person has a story, a history, a life that is more than the addiction, not only to the general public, but to other individuals with addictions/mental health and even within ourselves.

      Maybe a big factor to recovery is how we perceive the addiction in the first place.

      • Jonathan N. Stea says:

        I agree with everyone here and have also noticed Trish’s perceived “hierarchy of addiction”, especially with respect to cannabis use disorders. I have heard many clients and research participants express their confusion as to whether cannabis is even a drug, and whether it can be addictive or merely “habit forming.” Education to the public and health professionals about the realities of cannabis use disorders and other addictive/mental health disorders more generally is one critical (ethical) step to help dismantle the misperceptions.

  4. Daniel Scott says:

    In 1950, 66,000 Canadians were patients in psychiatric hospitals. (This was more than the total number of all patients hospitalized for non-psychiatric reasons) At the same time, almost the only available treatment for addiction was AA. (Anyone using other substances was just punished). Addiction and mental health seemed to be on opposite poles. The psychiatric hospital patients received little more than custodial care. On the other hand, many people in AA were recovering their lives.
    63 years later, the line between addiction and mental health is becoming blurred. Both are disorders rooted in neurobiology, both have effective medication and psychotherapies, and both are now using a recovery based understanding of living with the illness.
    There are challenges and special issues but I think that if we step back far enough, we can see a dramatic merging of addiction and mental health that will result in finding many better ways of delivering services.

    Reference:
    Canadian Senate (2006) Out of the Shadows at Last: Transforming Mental Health, Mental Illness, and Addiction Services in Canada. Ottawa.

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