Multiple Pathways Of Recovery
FAVOR Greenville champions all Pathways to Recovery. This includes 12-step recovery meetings. We believe the fellowships of Alcoholics Anonymous and Narcotics Anonymous are a first option for many of our participants. In nearly all cases it is the first outside resource discussed via recovery planning. If people are willing, we run with the plan for meeting attendance. However, we do not believe that recovery is a one size fits all process and there are many ways to find recovery. All of these are worthy of celebration. We just want to see your life get better.
Therefore, when we shine light on one size fits all treatment, we are not doing so in reference to AA or NA. We are doing so in reference to the professionalization of 12-step recovery and a private system that, in many cases, denies the patient access or information regarding alternative pathways of recovery. With that in mind I wanted to put forth some random thoughts on multiple pathways.
1) Multiple Pathways Exist: Perhaps the most controversial thought concerns the fundamental reality that multiple pathways of recovery exist. Because of the stigma and shame surrounding addiction relatively little research has been done on recovery. Our culture, as a whole, considers addiction a “moral failing” so there is little demand or interest in gaining scientific insight into the recovery process. In addition, many professionals in the field have little concern with research on recovery. Especially if they have had their own personal experience in recovery. This leaves a void of knowledge which has, unfortunately, been filled with clichés and conventional wisdom. To paraphrase Randy Gage and his new book Mad Genius: this void has allowed the mysterious people in charge of the secret system that runs (addiction treatment) to simply proclaim there is only one way to recover. I don’t know how many individual people believe this. It is a very difficult thing to assert and still consider yourself a rational person. However, the herd mentality frequently kicks in and people jump on board with this type of claim even in the face of evidence to the contrary.
This void has allowed the mysterious people in charge of the secret system that runs addiction treatment to simply proclaim there is only one way to recover. No one knows who these people are. They are the ones who established all the things that have “always been done this way” (adapted from Randy Gage, Mad Genius).
Typically, the pathway most commonly promoted is 12-step recovery found in Alcoholics Anonymous or Narcotics Anonymous. AA and NA are the most well-known pathways and many have found recovery through these programs. In fact, they are the most common “formal” pathway of recovery. My concern has nothing to do with the programs of AA or NA. My concern is with the professionalization of AA and NA. I have heard professional counselors proclaim that AA is the only way to find recovery. I have heard stories of patients being required to complete steps while in facilities that claim to be licensed inpatient rehabilitation facilities. This is a big problem. If you find yourself in the presence of a therapist who says something along the lines of “you must do AA in order to recovery” you should look around for other options. Insurance should not be paying for 12-step sponsorship. The responsible thing, from a medical perspective, is to promote all pathways of recovery and develop aftercare plans that are truly individualized.
One of the problems with exploring pathways to recovery lies in the definition of recovery. Does it mean complete abstinence? Does it mean complete abstinence plus a defined program of self-improvement? Does it mean complete abstinence plus a “spiritual awakening”? Is mediation assisted treatment a viable pathway to recovery? What about the reality of substance use disorder full remission? In other words, a person had a substance related problem but no longer does. These individuals may or may not use, either way they are no longer destroying their lives. How do we characterize these individuals? I think that is a good thing if their lives are improving.
When you explore substance use in a realistic manner you find much complexity and nuance. If you are a self-help attendee, you have little responsibility beyond the black and white. A person is in recovery if they do “the program”. However, if you are a professional healthcare or treatment provider you have an ethical responsibility to explore all angles and gain a deeper understanding. For the sake of research there has been a general agreement on recovery as “remission of symptoms”. It is the most quantifiable variable and from a public health perspective the most important.
In addition to 12-step recovery, The Recovery Research Institute (RRI) out of Harvard lists the following as “clinical” pathways which have been proven effective: pharmacology, Acceptance and Commitment Therapy, holistic based recovery services, Community Reinforcement Approach, CBT based approaches, Contingency Management, Relapse Prevention Therapy, Motivational Interviewing/MET techniques, 12-step Facilitation, Behavioral Couples Therapy, and Family Therapy. Among “non-clinical” alternative services you find: Recovery Community Centers, Peer-Based Recovery Support, Education Based Recovery Support, Employment Based Recovery Support, and Faith-Based Recovery Support. Furthermore, alternative mutual support groups existing including: SMART Recovery, Rational Recovery, Women For Sobriety, HIP Sobriety, LifeRing, Secular Recovery Organizations and many others.
In addition, some achieve recovery or “remission” without any formal help. From the RRI:
“Some individuals can achieve substance use disorder remission without formal help from professional treatment or mutual-help organization participation”.
Again, because of the mysterious people in charge of the secret system that runs addiction treatment we have allowed our professional systems to ignore these facts. Even Bill Wilson knew there were many ways to recover. The following are all quotes from the esteemed Mr. Wilson:
–“AA has no monopoly on reviving alcoholics.”
–“The roads to recovery are many… any story or theory of recovery from one who has trod the highway is bound to contain much truth.”
–“Upon therapy for the alcoholic himself, we surely have no monopoly.”
–“In no circumstances should members feel that Alcoholics Anonymous is the know-all and do-all of alcoholism.”
Professional organizations, counselors and addiction treatment centers should be held accountable to standards that include a full menu of recovery options. Are we not “withholding” possible solutions when we discuss only 12-step recovery? This seems like an advocacy issue that those of us in the recovery management movement should take on.
2) It is likely that “new” pathways will be invented: As we often hear in the rooms of recovery, recognizing and accepting the problem is the first step. If we are in denial of the problem we can never find a solution. If we are unable or unwilling to look at the situation from a reality based perspective, we will never make a change.
I would argue we are in denial regarding this issue. 90% of the treatment programs in America operate from the same fundamental philosophy, and it is not working. As it currently stands only 10% of those in need are engaged in services. It is logical to assume that some of this is the result of a one size fits all approach. If we opened the door wider more people would walk into the recovery process. If we offer alternatives and programs that meet people where they are you will see improved engagement.
I also believe there is a shelf life on the current approach. I do not think this business model is sustainable and people will start to differentiate. Marketing programs that are all identical will not be effective as you get a more educated and knowledgeable patient base.
And I believe that as soon as we acknowledge the problem we will innovate and develop new solutions. It is already happening in small pockets around the country. Including Greenville, South Carolina. We will develop alternatives that we cannot even envision right now. Technology will help. However, I believe the real break-through will occur when we educate, train and supervise a new workforce. One that emphasizes engagement and connection over dogma and acute care rinse and repeat models.
We will realize that “the way we have always done things” makes no sense. We will rise up and challenge the mysterious people in charge of the secret system that run the addiction treatment system and develop new protocols, payment systems, and norms. We will develop an entirely new culture of professional recovery services. Twenty years from now people will look back on this day and time as the transformation point. They will wonder why it took so long to make changes.
3) Co-Occurring Recovery will be one of the new pathways: Double trouble or dual diagnosis groups have always existed. However, they are few and far between and they are not available for many in need. We know that upwards of 60% of those with a substance use disorder also suffer from some type of mental health issue. The days of mental health issues being cleaned up via the natural progression of recovery are over. We can no longer just wait for the person to sober up and see if the depression goes away. Some studies indicate trauma is present in up to 80% of women in recovery. Trauma symptoms can be made worse if mishandled and there will be a need for specialized support in these areas. This is all good stuff. We have advanced as a society. We are more informed and educated than we were in the past and our needs have changed. That is not unusual. It is predictable and healthy.
In addition, people with mental health issues sometimes struggle to fit into “regular recovery” groups. Medication is one reason. Social anxiety would be an example of another reason. It is likely that new recovery groups will spring up to meet the needs of participants with co-occurring disorders. At FAVOR Greenville, we are developing a curriculum that certifies a coach as a COD specialist. This will be a positive development in the fight against addiction. 
4) Medication Assisted RECOVERY will be one of the new pathways: Despite the best efforts of many people in recovery, many people on medication assisted treatment have felt alienated from recovery rooms. I have no interest in entering into that debate in this blog post. It would require much more time than I have at the current moment. Suffice to say, there is likely to coalesce a specific recovery program for people on medication replacement therapy. A place where they can talk and share openly on all matters including the use of Suboxone or Methadone. We know this is a very contentious subject in some recovery rooms. At FAVOR Greenville, we welcome you into the recovery process no matter what stage you are in. We want you to keep coming back. Medication assisted or not. I believe we will see more specific programming and services related to medication assisted recovery. We know community is exceedingly important to the recovery process and it is going to be necessary to address this glaring issue as we move forward.
In closing I want to reiterate. At FAVOR Greenville, we are big fans of 12-step recovery. However, we are also big fans of SMART recovery, Women For Sobriety, FAVOR primary recovery, clinical recovery, medication assisted recovery, and any other recovery you can think of. Our interest is in seeing your life improve.