September 2021

National Recovery Month 2021; Understanding Recovery and Recovery Capital; What to say to someone who doesn’t want AA; Katie’s story

In SAVVY, I explore what we mean by Recovery and Recovery Capital.  It isn’t all about abstinence and mental health stability, but rather whole person and whole systems perspectives.

In SKILLS, I focus on how to assess Recovery Capital and also how to approach a person who doesn’t want to go to Alcoholics Anonymous and prefers an alternative support group.

In SOUL, Katie, a person in long-term recovery, shares her recovery story.

savvy

National Recovery Month (Recovery Month) is a national observance held every September to promote and support new evidence-based treatment and recovery practices, the emergence of a strong and proud recovery community, and the dedication of service providers and community members across the nation who make recovery in all its forms possible.”

When I completed my specialty psychiatric training, I was assigned to an addiction treatment team not because of my exquisite knowledge about addiction, but because they couldn’t get anybody to work on that team.  So I had to learn about frontline addiction treatment and recovery from counselors in long-term recovery.

Tip 1

Recovery is much broader than abstinence or mental health stability

Here are some definitions that emphasize the whole person concept of Recovery:

Recovery in Addiction 

  • “Recovery is the process through which severe alcohol and other drug problems (here defined as those problems meeting DSM-5* criteria for substance use disorder) are resolved in tandem with the development of physical, emotional, ontological (spirituality, life meaning), relational and occupational health.”

(White, W. & Kurtz, E. (2005). “The Varieties of Recovery Experience”. Chicago, IL. Great Lakes Addiction Technology Transfer Center. Posted at http//:www.glattc.org) (* Updated to reflect DSM-5)

  • “The immediate goal of reducing alcohol and drug use is necessary but rarely sufficient for the achievement of the longer-term goals of improved personal health and social function and reduced threats to public health and safety.”

(McLellan A.T., McKay J.R., Forman R., Cacciola J., Kemp J. (2005) Reconsidering the evaluation of addictiontreatment: from retrospective follow-up to concurrent recovery monitoring. Page 448 Addiction 100:447-458.)

Recovery in Mental Health 

“Recovery occurs when people with mental illness discover, or rediscover, their strengths and abilities for pursuing personal goals and develop a sense of identity that allows them to grow beyond their mental illness” 

(Mueser KT, Corrigan PW, Hilton DW, Tanzman B, Schaub A, Gingerich S, Essock SM, Tarrier N, Morey B, Vogel-Scibilia S, Herz MI (2002): Illness management and recovery: a review of the research. Psychiatr Serv. 2002 Oct;53(10):1272-84.   https://pubmed.ncbi.nlm.nih.gov/12364675/)

  • People with mental illness are not the walking embodiement of their diagnostic label. Their identity is not as a schizophrenic, borderline, an obsessive compulsive, a sociopath or a bipolar. Recovery in mental health is about discovering or rediscovering a sense of identity that maximizes their mental, physical, social and spiritual potential.

Tip 2

What is Recovery Capital?

Recovery Capital is “the breadth and depth of internal and external resources that can be drawn upon to initiate and sustain recovery from alcohol and other drug use.” It is the sum total of person’s resources that can be brought to bear on the initiation and maintenance of recovery. 

I have summarized some of the content you can read more about in White, W. & Cloud, W. (2008). Recovery capital: A primer for addictions professionals. Counselor, 9(5), 22-27.

Internal resources:

1. Personal recovery capital can be divided into physical and human capital:

  • Physical recovery capital -physical health, financial assets, health insurance, safe and recovery-conducive shelter, clothing, food, and access to transportation.
  • Human recovery capital – a client’s values, knowledge, educational/vocational skills and credentials, problem-solving capacities, self-awareness, self-esteem, self-efficacy (self-confidence in managing high risk situations), hopefulness/optimisim, perception of one’s past/present/future, sense of meaning and purpose in life and interpersonal skills.

External resources:

1. Family/Social recovery capital encompasses intimate relationships, family and kinship relationships (defined here non-traditionally, i.e., family of choice), and social relationships that are supportive of recovery efforts. 

  • Willingness of intimate partners and family members to participate in treatment
  • The presence of others in recovery within the family and social network
  • Access to sober outlets for sobriety-based fellowship/leisure, and 
  • Relational connections to conventional institutions (school, workplace, church, and other mainstream community organizations).

2. Community/Cultural recovery capital encompasses community attitudes/policies/resources related to addiction and recovery that promote the resolution of alcohol and other drug problems. Community recovery capital includes:

  • Active efforts to reduce addiction/recovery-related stigma
  • Visible and diverse local recovery role models
  • A full continuum of addiction treatment resources
  • Recovery mutual aid resources that are accessible and diverse
  • Local recovery community support institutions (recovery centers/clubhouses, treatment alumni associations, recovery homes, recovery schools, recovery industries, recovery ministries/churches), and
  • Sources of sustained recovery support and early re-intervention (e.g., recovery checkups through treatment programs, employee assistance programs, professional assistance programs, drug courts, or recovery community organizations).

3. Cultural capital is a form of community capital. It constitutes the local availability of culturally-prescribed pathways of recovery that resonate with particular individuals and families. 

  • Examples of such potential resonance include Native Americans recovering through the “Indianization of AA” or the “Red Road,” or 
  • African Americans recovering within a faith- based recovery ministry or within an Afrocentric therapeutic orientation (Coyhis & White, 2006)

skills

The concept of recovery capital reflects a shift in focus from the pathology of addiction to a focus on the internal and external assets required to initiate and sustain long-term recovery from alcohol and other drug problems.  (White, W. & Cloud, W. (2008). That means our assessments need to include looking at strengths, skills and resources, not just severity of illness.

Tip 1 

Assessing Recovery Capital

One instrument to check out is the Assessment Of Recovery Capital (ARC).  Here is a summary of the ARC from a paper by Carson McPherson, Holly Boyne, Lyn MacBeath, Rida Waseem, “Using the Assessment Recovery Capital at an Addiction Treatment Centre: A Pilot Study to Validate Utility”. ARC Journal of Addiction. 2017;2(2):17-23.

The ARC is a self-administered measurement of recovery capital that is useful in outcome monitoring for individuals with substance use disorders (SUD) before, during and after treatment. 

  • The scale consists of 50 items assessing recovery strength, subdivided into 10 subscales: substance use and sobriety, global psychological health, global physical health, citizenship, social support, meaningful activities, housing and safety, risk-taking, coping and life functioning, and recovery experience.
  • The ARC includes a simple scoring methodology with each subscale including 5 associated items at a value of one point per item. 
  • Each ARC subscale therefore receives a score between 0-5, with 5 being the highest recovery capital score within each subscale. Thus, the total ARC score is calculated out of a possible 50. 
  • The ARC is able to distinguish where participants are in their recovery journey, and what growing needs they have as they progress.
  • The ARC takes approximately 5 to 10 minutes to complete.

Tip 2

What to Say to a Person who says they don’t want to go to Alcoholics Anonymous or Prefers an Alternate Support Group

Over the years of my training career, some have told me it is helpful when they hear an example of how to convert a clinical principle or policy and procedure into actual words to say to a client. In May 2018 I offered some “scripts” of what to say in different situations. It is not unusual for a client to object to having to attend AA or to prefer groups other than 12-Step groups. Here is how to address such clients:

There are AA meetings and groups that appeal to different members in different ways. If you haven’t tried a number of different groups, it may be that just haven’t yet found the meeting that works for you.

Now if you are saying you just don’t want to go to AA for whatever reason, I don’t want to push that on you.  Maybe you have another self/mutual help group that works better for you. But before you give up on AA, let’s discuss where else can you find a support group where:

1. You can have access to regular meetings every day and even more than once a day if you really need them – and all for free?

2. You can have a coach like an AA sponsor, who is ready to have you call them at all hours of the day and week if you really need them?

3.  You can be with a whole group of people and have sober fun while there are temptations and triggers all around you on New Year’s Eve, Mardi Gras, or St. Patrick’s Day?

4. You can have many friends who have been exactly where you have been with addiction; understand what you are going through from deep personal experience; and will be there for you if you reach out?

Maybe you have a group like that at your church, synagogue, community of faith, or some other group.  If you get support from that group with all the same effective features of what AA has to offer, then by all means embrace that group. This is about getting you the ongoing support and guidance you need to establish and maintain recovery and well being, not pushing AA on you.

References:

1. White, W. & Kurtz, E. (2005). “The Varieties of Recovery Experience”. Chicago, IL.  Great Lakes Addiction Technology Transfer Center. Posted at http//:www.glattc.org

2. McLellan A.T., McKay J.R., Forman R., Cacciola J., Kemp J. (2005) Reconsidering the evaluation of addiction treatment: from retrospective follow-up to concurrent recovery monitoring. Page 448 Addiction 100:447-458.)

3. Mueser KT, Corrigan PW, Hilton DW, Tanzman B, Schaub A, Gingerich S, Essock SM, Tarrier N, Morey B, Vogel-Scibilia S, Herz MI (2002): Illness management and recovery: a review of the research. Psychiatr Serv. 2002 Oct;53(10):1272-84. doi: 10.1176/appi.ps.53.10.1272. PMID: 12364675.

4. White, W. & Cloud, W. (2008). Recovery capital: A primer for addictions professionals. Counselor, 9(5), 22-27.

5. Coyhis, DL & White, WL (2006):  “Alcohol Problems in Native America : The Untold Story of Resistance and Recovery – the Truth about the Lie”; White, W. & Sanders, M. (2008). “Recovery management and people of color: Redesigning addiction treatment for historically disempowered communities.”  Alcoholism Treatment Quarterly, 26(3), 365-395.

6. Carson McPherson, Holly Boyne, Lyn MacBeath, Rida Waseem (2017): “Using the Assessment Recovery Capital at an Addiction Treatment Centre: A Pilot Study to Validate Utility”. ARC Journal of Addiction. 2017;2(2):17-23.

7. Groshkova, T., Best, D., & White, W. (2012). The assessment of recovery capital: Properties and psychometrics of a measure of addiction recovery strengths. Drug and Alcohol Review, 32(2), 187-194.https://doi.org/10.1111/j.1465-3362.2012.00489 Laudet, A. B. (2007). What does recovery mean to you? Lessons from the recovery experience for research and practice. Journal of substance abuse treatment, 33(3), 243-256.

soul

Katie’s story as a person in long-term recovery:

On October 1, I’ll be sober 42 years. I was 27 when I received an ultimatum at  3 AM, “I won’t put up with this anymore.” My first AA meeting was at 9 AM that day. I was still drunk and there was nothing but a bunch of old people there.  I was shocked to recognize some prominent people from my small town of Oconomowoc, Wisconsin.  To say I was terrified is an understatement.  I cried the entire meeting.  I wondered why people were telling me stories of infidelity, overnights in jail, and lots of stories of how they made asses out of themselves at public events.  When asked if I wanted to say anything at the end, I blubbered something about not knowing why I was there.  Seven words took me home. “We’re all in the same soup, kid!”

These 42 years have been glorious, heartbreaking, trying, and at times, enraging.  Three divorces, births, breast cancer, multiple surgeries, deaths (including fellow AA members lost to their addictions), family discord, indescribable loss.  After two years sober, memories of sex abuse flooded into my consciousness. That was not going to make me drink.  I plunged into that dark place.  I stayed sober. 

My biggest problem in recovery has been relationships.  I believe it is the one thing that will make one bend the elbow with glass in hand.  Recovering people don’t just have a drinking problem.  Before we ever picked up a drink, we had people problems. Addictions in our  families, physical, emotional, sex abuse, a myriad of family dysfunction, inability to resolve conflict, lack of permission to express feelings, secrets, 

shame, shame, SHAME.  We were forever questioning our reality because someone told us that what we felt and thought was wrong or didn’t matter. 

Shortly after that first AA meeting, I made a deal with myself.  I would give it ONE year.  If, after one year, life seemed pretty okay, I would give it another. I have made that yearly  decision 42 times.  I’m lucky that I’ve never had a lapse, but I certainly have made some really dumb decisions, hurt others, and hurt myself.  The one thing that passes through my mind most days is my last drunk.  It was not one of my proudest moments.  But I feel nothing but pure gratitude for my then husband who was fed up enough with me to tell me he was done with my drunken antics. That gift is immeasurable.

Once I quit drinking, AA taught me how to live.  A bunch of misfits had answers to life.  Really!  A bunch of failures who had lost everything had answers. A bunch of miscreants showed me that if I just didn’t pick up a drink, life would unfold in a way that I could never dream of. They promised. 

Words of advice? Don’t do recovery the way I have.  I suffered years of emotional binges that seemed so crippling at times that I could barely lift my arms to ask for help. I don’t have any sobriety wisdom to pass on.  What I can tell you is to hold on to your a$$, hang on for the ride, do not entertain thoughts of drinking for more than 17 seconds, do something for someone else, call someone.  Most of your problems are first world problems.  Someone always has it worse than little old me.

I’m about to turn 70.  I love my misfit status.  I love every other AA misfit who shared their experience, strength and hope with me over these 42 years.  Living a sober life, I have had low lows and the highest of highs. I am tearful as I write these words. I’m one of the lucky ones. I didn’t die from alcoholism. Thank goodness that last night, Sudafed didn’t do the trick.

To all of you who have the good fortune of being an alcoholic, don’t give it more than 17 seconds. Do something for someone else.  You are winners.  The world needs YOU!  

We’re all in the same soup, kid!

Bio: 

Kathryn (Katie) Kilian, MA, LPC received her Master’s degree in Counseling Psychology from Regis University, Denver, Colorado.  She has worked in the field of addictions for over 30 years. Born in Wisconsin, she is a shameless Cheesehead.  She lived in Denver for 28 years before moving to Sacramento in 2016 to be near her two grandchildren.

August 2021

Five key principles in helping people change; Skills to implement those principles; Vaccine hesitancy and using the five principles of the Better Arguments Project

In SAVVY and SKILLS, I share the wisdom of Marvin Goldfried, Ph.D. who presented in one paper five key principles on how people change. He wrote about the common principles of change that he distilled from hundreds of schools of thought and approaches to change. For each principle, I offer a few SKILLS to help implement it.

In SOUL, I don’t plan on talking with my daughter and her family about their vaccine hesitancy.  I respect their right to make their own choices.  But in case the topic of vaccines arises, I want to be grounded and centered to know what to say and do. So I used the five principles of the Better Arguments Project to help guide me.

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July 2021

Hard questions in the interface between Treatment and Justice Teams; Scripts on what to say to participants; What’s your Olympic Game?

In SAVVY, I preview a couple of hard questions that New Hampshire Chief Justice Tina Nadeau and I will discuss in the final General Session of RISE21, the National Association of Drug Court Professionals annual conference at the Gaylord National Resort and Convention Center in National Harbor, Maryland.   

In SKILLS, to help convert a clinical principle or policy and procedure into actual words to say to a client, I give some “scripts” of what to say to orient participants in Drug Court; and what to say about positive drug screens.

In SOUL, I have two connections to the Olympic Games and get into the spirit of the Games with my lifelong friends inventing new Olympic games.

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June 2021

Father’s Day, Lessons from 40 years of parenting – a grandfather’s perspective; RULER; Out of the mouths of babes.

In SAVVY, to help children, students and even adults “name their emotions to tame their emotions”, Marc Brackett coined RULER to develop critical and inter-related emotional skills.  Honor your feelings, desires and hopes for your child, but help them learn how to express feelings and needs in a way that fits their temperament and personality, not yours. But there is relief in understanding “good enough parenting”.

In SKILLS, I apply RULER to help parents have a discussion with their children about their feelings, needs and values especially in the context of the family’s values. In the immediacy of the situation, there isn’t time to have a feelings, needs and values discussion.  But in a quiet moment, parents can help their children “become the best them, not the best you.”

In SOUL, “out of the mouth of babes” is when a child says something that surprises you because it seems very wise. My 6 year old granddaughter had one of those moments of wisdom and pointed out that love for each other and arguing are not mutually exclusive.

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May 2021

Overdoses are up, but do we really need just more residential beds?; How to determine initial length of stay and authorization periods; Freddy enters my world.

In SAVVY & STUMP THE SHRINK, is residential care the first priority in responding to the increase in opioid overdoses?  Some States mandate certain periods of time that ban managed care authorizations and requirements for individualized treatment.  I suggest that what we really need in addiction treatment is not just more residential beds and time.

In SKILLS & SYSTEMS, treatment providers and Managed Care Organizations should not be “lined up on different sides of the aisle”.  To determine initial length of stay and authorization periods for an addiction client, think about what you would do for other health conditions.

In SOUL, Fred IV enters my world and joins Siri, Google and my Toyota Prius to help me navigate my cleaning, driving and knowledge worlds.

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April 2021

Rules or Treatment Plans? Relationships and Hooking Up; Getting your head and heart around understanding addiction

In SAVVY, STUMP THE SHRINK & SKILLS, in this combined section, I address co-ed relationships and hooking up while in treatment; Treatment, Rules, or Discharge, not just about these behaviors but also how to address any behavior concerns while in treatment.

In SOUL, I wonder about how hard it is for Justice teams and treatment providers to pivot away from consequences and sanctions for addiction flare-ups; rules and regulations; and compliance and mandates for prosocial behavior. Talk to people in long-term recovery.

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March 2021

Guest writers focus on Problem Gambling Awareness Month; Letting the chips fall where they may

Welcome to the March edition of Tips and Topics and guest writers focused on Gambling in honor of

Problem Gambling Awareness Month

In SAVVY, George Mladenetz informs us about Gambling Treatment Diversion Courts.

In SKILLS, Olubukunola Oyedele, PhD shares results from a small sample study he did on gambling and COVID-19 in New Jersey residents.

In SOUL, I share some natty little phrases that are rich in concept and meaning, but poor in follow through – easy to say, but hard to do.

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February 2021

Two years since I lost my wife; Hope Edelman on “The AfterGrief”; Carrying our loved ones forward; Getting back more than what you lost.

In SAVVY, the history of grief shaped our thinking that grief should be a process to be completed and from which we move on.  Hope Edelman challenges those concepts of grief and speaks of understanding grieving as a lifelong process.

In SKILLS, a couple of tips on how to move forward with grief as a lifelong process.

In SOUL, I share about work, love and play and how you really can get back MORE than what you lost.

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January 2021

Can terminology reduce stigma in opioid addiction? Different terminology for different stigma goals; Facing up to saving and losing face. FaceTime needed.

In SAVVY, a new study researched what terminology would reduce stigma in the prevention and treatment of opioid addiction.

In SKILLS, the choice of terminology may depend on the purpose of communication. Use medical terminology to decrease blame for addiction.  Use non-medical terminology to increase confidence that the person can recover and is not dangerous.

In SOUL, it is not about “losing face” or “saving face” over the Presidential election results.  It’s about “facing up” to “face our problems” and use some “FaceTime” to listen to each other.

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December 2020

Conflict, compromise, compassion; Better Arguments; Grieving a lost sister

In SAVVY, apply the three Cs to your family relationships, your clients and patients, or to your friends and neighborhood as well as bridging the political divide and the ongoing rancor.

In SKILLS, I highlight the dimensions and principles of the Better Arguments Project, a group with an initiative to heal America in the aftermath of the 2020 election.

In SOUL, two sisters’ relationship is severed prompted by the political divide and who voted for the “other side”. How about your family and friends?  Are you grieving over a fractured relationship?

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November 2020

Braver Angels and coming together after the election; marriage counseling techniques to bridge the political divide; CHEMMites.

Welcome to the November edition of Tips and Topics.  For readers in the USA, may you have a safe, joyful and meaningful Thanksgiving whether you are together with your loved ones in person or online.

In SAVVY, I just learnt about a group called Braver Angels, an initiative to heal America in the aftermath of the 2020 election. I connect you to them in hopes you may be interested.

In SKILLS, I summarize techniques and tips based on marriage counseling skills that Braver Angels has found effective in bridging political gaps.  These skills apply across all conflicts to improve understanding and empathy.

In SOUL, I share WhatsApp texts with my longtime childhood friends in Australia when they asked me about the Presidential election.

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October 2020

Addiction – Disease? Willful misconduct? Harm Reduction?; How to be a child.

Welcome to the October edition of Tips and Topics.

In SAVVY, I answer two follow-up questions arising from last month’s edition. The first asks how addiction is compared to other health issues. The second asks about a Harm Reduction approach to addiction versus a “medical model”.

In SKILLS, I have excerpted learning points and comments from several readers who responded to the dialogue about “After a patient is discharged… is there a period of time that patients should have to wait before being readmitted to the clinic?”

In SOUL, I reflect on how children are focused on fun, joy, laughter and full self expression. Then we adults gradually suppress that spontaneity only to devote time, money and energy in personal development workshops to rediscover and reawaken that “inner child”.

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