The Times They Are a-Changin’Alyssa
The culture of recovery is changing. If you haven’t heard anybody say something like “My name is Michael and I’m in long-term recovery,” you will soon. If you haven’t been fortunate enough to see the documentary Anonymous People (Williams, 2012), see it soon. I first became aware of it when the American Society of Addiction Medicine (ASAM) gave it their 2014 Media Award. You can view it on Netflix or purchase it from Amazon. It’s only one of the things that points to a cultural change.
As far as I can tell, several very important things are happening at the same time.
Right here in Florida, I have seen tremendous changes since I came to work for Behavioral Health of the Palm Beaches (BHOPB) in 1999. At that time the “Florida Model” seemed like a great idea. By separating the place where patients were treated from where they resided it was possible to provide higher levels of care for longer lengths of stay. It worked well for everyone.
As we moved forward, several things began to change the culture of recovery for the better.
Seaside Palm Beach opened in 2009. The demographics of the patient population were very different. Highly individualized treatment required skilled case management. Transporting residents was taking away from the treatment day.
Four years later ASAM published the third edition of their Criteria for placing patients in appropriate levels of care (Mee-Lee, Shulman, Fishman, Gastfriend, & Miller, 2013). There were now very distinct differences in the criteria for residential care as compared to other levels of care.
Sometime later, Florida’s Department of Children and Families (DCF) began to encourage organizations providing a residential level of care to provide treatment at the same location. At the present time, almost all people being treated at BHOPB’s four centers, including Seaside Palm Beach, are treated and reside at the same dignified location. Guess what? It works really well.
There are more than twenty-three million people in long-term recovery.
Here in Florida, and nationally, one of the things that our culture is beginning to accept is that there are more than twenty-three million people in long-term recovery and that we come from all walks of life. We can have an impact on local and national politics and economies. People are actually beginning to sell us stuff.
I’ve been around long enough to know that companies selling any type of insurance used to run from us like we had the plague. More recently, some people have figured out that twenty-three million people are a market that no one wants to ignore. I’ve always thought it to be ironic that as long as drugs were flowing into my body everyone was willing to sell me insurance.
Have you seen Renew magazine? I was impressed because it’s about time that a magazine for people in recovery is as nice as any magazine on the bookstore shelf. It’s as well done as magazines about cooking, mechanics, cars, etc. It\’s not hidden, not kept under the counter. I feel good about knowing that we’re twenty-three million strong and we do buy nice magazines. People are not just talking about recovery, they’re bragging about it!
We can also be a force for change. Do you suppose that the health care system has treated us differently because we let them? What would the voice of twenty-three million people sound like? We vote! We have an impact on the economy.
What would the voice of twenty-three million people sound like?
Did you know that September was National Recovery Month? By going to the Faces and Voices of Recovery website you can see that there are many activities celebrating recovery all over Florida. Since many people from outside of Florida get well here, you can also find activities celebrating recovery all over the United States and beyond.
Now that Faces and Voices has announced its intent to merge with Young People in Recovery (YPR), the impact will be multiplied.
Twelve Step recovery is very strong in Florida. There are more than 350 meetings listed in Palm Beach County alone. Twelve Step recovery keeps us on track. Faces and Voices and similar movements make us proud. I’m just beginning to realize that there is a difference between “anonymous” and “secret.” I respect the Twelve Step tradition, but I’m fine with telling anyone that I’m in recovery. It is a little different than how I’ve been introducing myself at meetings, but it is working and it doesn’t seem to define my entire being.
I was recently talking with a friend at a local clubhouse. He doesn’t really like the way many other people think and feel about people in recovery. My thought is that what the rest of the world thinks will take some time to change, but the way we think and talk about ourselves can change very quickly.
I’ve recently become a lot more aware of the language I use. In the past, I’ve asked many people “How many times have you been in treatment?” Did I mean “How many times have you failed?” When I’ve asked, “Are you clean?” have I implied that they’ve been dirty? It really bothers me that a person like me, who has worked in the treatment field for a long time, may have been contributing to the problem. It’s time for us to change too.
Our country is beginning to truly treat addiction as a chronic disease.
Culturally, in Florida and as a nation, we are really just coming out of an era in which addiction has been criminalized. It’s been treated as bad behavior – immoral and punishable. Our prisons are full. So maybe we have to take another look at whether or not we’e gotten away from treating a chronic disease. Come to think of it, the question, “How many times have you been in treatment?” is never asked of a person with any other chronic disease. My friend, who has diabetes, has always been in treatment; it’s been continuous. A person who is diabetic has an endocrinologist, and a person with heart disease has a cardiologist.
An addictionologist is a physician who is certified by the American Board of Addiction Medicine (ABAM). Most addictionologists are members of ASAM or physicians who are ASAM members likely to be moving toward certification. In any case, ASAM members are likely to be well schooled in addictions medicine.
How come a person in long-term recovery doesn’t have an addictionologist? How come a person in long-term recovery doesn’t have an addictionologist? Currently, whenever possible, we are referring people who are leaving Seaside Palm Beach to addictionologists. It is making a difference. There are many board-certified addictionologists in Florida and elsewhere. They can be found at www.abam.net. ASAM members and information regarding membership can be found at www.asam.org.
Perhaps the most important thing that those of us who work professionally in the treatment field need to change is our expectation regarding addiction treatment being effective. I’ve been asking many professionals the question “Who relapses more frequently, addicts or diabetics?” and the only person who immediately got it right was a nurse who works with diabetics.
When a plan for recovery is followed addicts get well at an amazingly high rate (Baxter, 2012; DuPont, McLellan, White, Merlo, & Gold, 2009; McLellan, Lewis, O’Brien, & Kleber, 2000; McLellan, 2002). Studies published in professional journals indicate that 75 to 80 percent of people treated for an addictive disease, who follow every step of their plan for recovery, are stable after one year. If this is news to the people reading this article, what expectations are we passing on?
Changing how we treat and feel about addictive diseases isn’t going to happen overnight; not in Florida, not nationally. We’re not Fed-Ex. But we have a right to be proud of who we are and what we have overcome. We are fighters and survivors. We are also people who keep it by giving it away. Our pride in how we live our lives will influence others. It’s time to let go of whatever shame there may be and stop keeping what we have a secret.