Boris Rabtsevich
Andy: Remember Red, hope is a good thing, maybe the best of things, and no good thing ever dies.
Red: Hope is a dangerous thing my friend, it can kill a man.
--The Shawshank Redemption
In earlier blogs, we explored the curse of low recovery expectations expressed in policy, professional, and public contexts and how those who work in addiction treatment and other recovery support roles can counter addiction-related stigma in their public and professional interactions. The present blog addresses how those working in such roles can ignite hope among addicted people and their families who may themselves have internalized the socially and professionally pervasive pessimism about the prospects of long-term addiction recovery.
Recovery from severe addictions has long been framed as a pain quotient: Recovery becomes possible when the pain of addiction gets greater than its experienced rewards (e.g., when people "hit bottom"). Belief in this equation has two unfortunate consequences. First, it provides the historical rationale for heaping untold pain (shame, social shunning, arrest, incarceration, and invasive and humiliating treatments) on those addicted with little awareness that such interventions may actually thrust the individual deeper into addiction. Second, it ignores the critical role hope plays in recovery initiation. Escalating pain in the absence of hope is an invitation to, at best, accelerated drug use, or, at worst, suicide.
The pain of addiction-related consequences serves as a catalyst of recovery only in the presence of hope. The natural history of addiction will provide sufficient quantities of pain to incite recovery readiness, but what and where are the sources of hope essential for recovery initiation? And what roles can addiction professionals and peer recovery support specialists play in nurturing such hope? Below are some prescriptive actions that addiction professionals and those providing recovery support services can use to elicit hope in the face of addiction-fueled despair.
Practice a Ministry of Presence Addiction is a disorder of disconnection, with hope for recovery most often rising in the context of relationships--relationships marked by empathy, compassion, respect, and encouragement. The first gift we give those in need of recovery is our time and attention. Practicing this ministry of peaceful presence requires quieting the roar of our own pressing needs in order to be fully present, to listen, and to experience another's story. It is helpful to recall people in our own lives who gifted us with such hopeful presence. The first acts of help and hope? Listen, Listen, Listen.
Capitalize on Crisis Most people seeking our help will arrive in crisis, and the crises will keep unfolding well into recovery--the legacy baggage of addiction. Some of those we serve will be as addicted to such crises as they were to the drugs in their lives. Each crisis is a window of potential opportunity--a turning point, a teachable moment, a developmental window of opportunity, a crossroads to help those we serve see the larger picture of their lives, understand how such crises are created, learn how they can be shed, and, most importantly, how they can be prevented. Rather than simply rescuing, crises are opportunities to teach critical thinking and problem-solving skills. Hope rises exponentially with the expansion and application of such competencies.
Normalize Ambivalence Addiction and early recovery are each marked by extreme ambivalence. What the individual wants to do more than anything is to maintain the drug relationship--the very definition of addiction. What the individual wants to do more than anything is to sever the drug relationship--the essential requirement for recovery initiation. It is helpful to acknowledge this ambivalence. The scales of such ambivalence can often be tipped towards recovery by periodically conducting a pro-con analysis of drug use and the rewards each person hopes to gain from recovery. This first involves reviewing what drugs did for (+) the person and what drugs did to (-) the person. The second involves envisioning the promises of recovery.
Express Confidence in Their Capacity to Recover Let those you are helping know that recovery is the norm rather than the exception and that, with concerted effort, they can join millions of people who have achieved long-term recovery and its gifts. That confidence can best be expressed by hanging in with them in the face of setbacks after which they have been historically abandoned by others in anger and disgust. Let those we serve know that those seeking recovery can achieve together what each was unable to achieve alone. Let them know that previously hidden powers within and beyond themselves can be mobilized to speed this journey. Conduct a formal inventory of each person's assets (recovery capital) and acknowledge incremental changes as a way to stoke confidence and sustain the momentum for change.
Offer Living Proof of Recovery Share your own story of recovery and/or your witness of the recovery of others over the course of your career and expose the newcomer in recovery to as many people in long-term recovery as possible, particularly people with whom they may experience strong mutual identification. Make sure such exposure includes recovery carriers people in recovery who make recovery contagious based on their infectious personalities, character traits, and their service activities. Offer living proof that people whose lives were diminished by destructive addictions now experience purpose-driven lives day after day, year after year, without the need for chemical anesthesia. Expose them to the laughter of recovery--that raucous, joyous expression of relief, release, and gratitude.
Acknowledge the Varieties of Recovery Experience Convey to those seeking recovery that there are many pathways and styles of recovery and share descriptions of such variations, e.g., with and without treatment, through varied treatment methods, with and without medication, with and without recovery mutual aid participation, through a variety of mutual aid choices, etc. Choice of recovery goals and methods incentivizes recovery initiation and enriches quality of life in recovery.
Share Iconic Stories Expose those you are helping to the stories of earlier recovery pioneers with whom they can identify. Good storytellers are among the most effective professional helpers. Collect stories that inspire and elevate those you serve. Use stories to convey catalytic words, phrases, and metaphors that are personally and culturally meaningful. For members of marginalized groups, link the personal story to the larger story of recovery of a people, e.g., drugs as a tool of oppression and recovery as an act of personal/cultural/political resistance.
Facilitate Story Reconstruction and Storytelling Help the person seeking recovery make sense of the chaos they are experiencing via their own story: 1) Who was I before I began using? 2) Who and what did I become as a result of my use? 3) Why me? How do I explain what happened? 4) What led to my decision to change? 5) Who and what am I now? 6) Where am I going and what do I need to do to get there? Exploring these questions activates the push and pull forces of recovery and opens the further question, "Recovery to do what?"--a self-questioning that in some cases involves the retrieval of childhood dreams and aspirations.
Provide Exposure to the Culture of Recovery Guide those seeking recovery into relationships with people, places, and things that support recovery. Help them discover recovery-friendly people and places within their local community. Provide exposure to the language, symbols, rituals, literature, music, film, theatre, and art of recovery. Articulate recovery values. Note the growing number of recovery support institutions. Introduce those you serve to others in recovery with shared backgrounds, vocations, avocations, and aspirations. Social support is the glue that binds elements of a recovery lifestyle.
Provide Systems Navigation Those with the most severe and greatest number of problems who you serve may need resources across multiple systems to initiate and sustain their recovery. Navigating the ever-complex helping systems can be extremely frustrating and lead to pessimism about one's prospects for change. Providing a map and tour guide through these systems can minimize such frustration and allow clearer visualization of a later life in recovery.
Convey The Promises of Recovery Let those you are helping know that recovery is more than the deletion of problems from an otherwise unchanged life. Let them know that recovery brings with it an unlimited range of possibilities to not just get well, but to get better than well. Let them know that recovery comes with the potential for a new life of meaning and purpose.
Recovery opens a doorway to a new life. In this rebirthing process, hope is a glowing new skin. The above are among the actions I have found that stimulate hope in the recovery process. What actions would you add to this list?
Before closing, a final note of warning from Red is warranted. Hope has restored and transformed untold number of lives, but there is also a risky side of hope. Elevating hope without the necessary resources to fulfill that hope risks fueling endless despair and self-destruction. When we offer hope, we must have the capacity to deliver on the promises of recovery. Achieving "recovery by any means necessary under any circumstances" doesn't require perfect resources, but it does require that we fulfill our commitment of continued recovery support over time--again, that ministry of presence.