RECOVERING COUNSELORS & THE ADDICTIONS FIELD :

1. RECOVERING COUNSELORS & THE ADDICTIONS FIELD: Where have we been & what does the future hold? Chuck Adcock, LCSW, CSAC Jimmy Christmas, LCSW Maryann “Mimi” Cox, LCSW, TEP Virginia Summer Institute for Addiction Studies July 20, 2010 Williamsburg, VA

2. WELCOME

3. Our plan for today • A history of the addiction treatment field in the United States • What recovering paraprofessionals and professionals have brought to the field • Future directions for the treatment field • How we can have an impact in shaping the future of the field and in creating our own vision

4. Let’s find out a bit about ourselves

5. Here’s a interesting little tidbit • Called the process through which the drunkard • becomes progressively addicted to & finally • destroyed by alcohol “a disease of the will.” • Suggested that chronic drunkenness was a progressive • medical condition, for which the treatment was that • “persons who have been addicted should abstain • from the substance suddenly & entirely.” • In 1810, Rush recommended the establishment of special • institutions where alcoholics could be helped until they • were cured; the creation of a “Sober House.” • He was a signer of the Declaration of Independence • & Physician-General of the Continental Army. Benjamin Rush (1746 – 1813)

6. The temperance movement(approximately 1808 to 1918) • Re-evaluation of alcohol & its role in American society • Founding Fathers involved in this conversation (Washington, Jefferson, • Adams, Franklin) • Public education campaigns to encourage moderation in use of • alcohol • By 1850, the tide began to turn toward abstinence as a goal & legal • prohibition as the means. • Motivated primarily by religious & moral philosophies. • Billy Clark founded the Union Temperance Society which set the model • of early temperance groups. Singing hymns outside a saloon in aid of the temperance movement

7. Early recovering contributors • John Henry Hawkins (1840) – Eventually joined the Washingtonians. • made a profession of lecturing on the temperance circuit & held a paid • position with the Massachusetts Temperance Society. He organized total • abstinence support groups for alcoholics. • John Gough (1842) – He was paid for his impassioned lectures and amassed • a small fortune during the 30 years after his pledge of abstinence. He had two • relapses during this time. His popularity was resented & some of his early • Washingtonian buddies accused him of exploiting the temperance cause • for his own gain. • Henry A. Reynolds, MD (1884) – started a medical practice in Maine & treated • alcoholics. He was responsible for all the Maine reform clubs. • Francis Murphy (1871)- Francis Murphy’s Blue Ribbon Reform Club. He killed • a customer of his bar accidently in a brawl. He was confined in jail & was • visited by a religious person. He was converted to Christianity & the cause of • temperance.

8. The Washingtonians • First mutual self-help group. • It began in a Baltimore tavern in 1840. • A public meeting of the society two years after it’s founding drew • 12,000 people. • Included active women’s division. One slogan was “Total abstinence • or no husband.”

9. Inebriate Homes • The American Association for the Cure of Inebriates. • Two types of inebriate associations • Inebriate homes- temperance workers provided care. • Inebriate asylums- large, medically-directed facilities. • From 1870 to 1902, inebriate institutions grew from 6 to 100 • facilities.

10. The Keeley Institutes • Founded by Leslie Keeley, MD, who was famous for • his “Double Chloride of GoldCure” • By mid-1893, there were 118 Keeley Institutes in the US & Europe. • Known for franchising addiction treatment. • Significant number of Keeley’s physicians, attendants & agents were themselves • graduates of the program. • Success of the Keeley Institutes spawned many other treatment institutes & gold • cures for alcoholism. • Approached in 1940 by Alcoholics Anonymous representatives about integrating • AA into the Keeley treatment & holding meetings at Keeley facilities.

11. Turf wars/bad blood The turf wars between mental health & chemical dependency have a long history. Heads of insane asylums did not want to have the inebriates there, Because it would damage the reputation of their facilities. Heads of Inebriate treatment facilities did not want to send their inebriates there Because Insane asylums Frequently treated patients with free & liberal use of whiskey, opium & other Drugs, which could not be administered to the alcoholic patient.

12. Towards the end of the 19th century, recovered inebriates frequently worked within inebriate homes and asylums as personal attendants. The practice evolved out of observations of the benefit of mutual support provided among patients in treatment.

13. Harrison Tax Act of 1914 Restricted the use of opiates & cocaine to legitimate medical purposes. Access went from open to access regulated by physicians. Physician’s prescriptions for the use of opiates had to be in continually lowering doses. In 1919 morphine maintenance was made illegal by the Fed (the Webb decision). Motivation for such regulation was greatly influenced by tax revenue as opposed to the practice of medicine. The Harrison is the prelude to the War On Drugs declared by Ronald Reagan decades later. This act was largely superseded by the Controlled Substances Act of 1970.

14. Alcoholics Anonymous Bill Wilson & Dr. Bob

16. The early AA program had many elements in • common with earlier mutual-aid societies of • alcoholism, including • Recognition of the physical, mental &spiritual dimensions of alcoholism • Acceptance of total abstinence as a method &goal of recovery • The use of charismatic speakers to bolster one’s Resolve for recovery • A focus on self-reflection, self-inventory, confession, & restitution. • Service to other alcoholics as a means of strengthening one’s own sobriety • An emphasis on establishing an enduring sobriety based network.

17. *A*A* INSTRUCTIONS TO HOSPITALS • Call a physician immediately. • The hospital shall make out a complete history. • The hospital will be furnished official AA Visitation Record, which must be kept for each patient. • No one excepting AA members will be permitted to visit patients, except at the discretion of • attending physicians. • No visitors will be permitted after 11:00 PM • Patient will not be given street clothes until the last day, except on occasions when sponsor brings him to a • meeting. Upon retuning from the meeting, clothes are to be taken from patient. • All packages for the patient must be inspected by the person in charge. • Hospitals and sanitariums will not permit more than two men to talk to any one patient at any one time. • Patients will not be permitted any outside contact, such as mail or telephone calls, except through his • sponsor. • Hospitals will have patients available to visitors at all times, up to 11:00 PM, except where it conflicts • with hospital rules. • Hospitals and Sanitariums will be used for the purposes for which they are intended, and not as meeting • places or club rooms, except at the Women’s Hospital. • Under no circumstances may a patient in Hospital or Sanitarium be taken to a meeting, without • the approval of his sponsor. • Wives or husbands of AA members will not be permitted to be present, when a patient is being contacted. • Hospitals and Sanitariums are not to make any reference to AA in their promotional or publicity programs. • Attachment, AA Central Committee Minutes, July 7, 1942, Cleveland, Ohio (From Clarence S. Papers)

18. Modern History • Founding of the New York City Medical Society on Alcoholism. This group is • known today as American Society of Addiction Medicine (ASAM). • AMA defined alcoholism in 1952. In 1956, the AMA passed a resolution declaring • that chronic alcoholism should not bar hospital admission & the alcoholic should • be viewed as a sick person. This statement paved the way for the statement, issued • 11 years later, that alcoholism was a disease. • AHA (American Hospital Association) issued series of resolutions stating that • alcoholism treatment services were best provided in community hospitals. • In the late 1940s to 1950s, state-sponsored • alcoholism services began to be developed.

19. The contributions of recovered alcoholics to the success of the modern alcoholism movement were often hidden behind masks of personal discretion or AA anonymity. Marty Mann- recovery advocate who had a vision of a national organization & a national campaign to educate the public about alcoholism. She founded the National Committee for Education on Alcoholism, known today as the National Council on Alcoholism. She greatly influenced public policy regarding alcoholism & public opinions. R. Brinkley Smithers- father was one of the founders of IBM. Smithers Chartered the Christopher D. Smithers Foundation, which provided the Resources for the bridge between the rise of alcoholism movement in the 1940s & the government’s significant entrance into the arena in the 1970s. provided funds for the 1961 move the Center of Alcohol Studies from Yale to Rutgers.

20. Minnesota Model

21. Minnesota Model • created a means of of preparing & credentialing (professionalizing) the recovering alcoholic to work in the field • accepted the recovering counselor as a legitimate member of a multidisciplinary treatment team • began the clarification of boundaries between a person’s responsibilities as an AA member & his/her status & responsibilities as a professional alcoholism counselor • Pioneered the establishment of halfway houses & services

22. The Minnesota Model legitimized the involvement of professional disciplines in the treatment of alcoholism. “No self-respecting professional in their right mind wanted to work with alcoholics.” By the time these same figures ended their careers, work with alcoholics had become a legitimate professional specialty in psychiatry, psychology, social work & counseling. The Minnesota paved the way for legitimizing the use of non-professional recovering persons as staff.

23. Changing Views of the Alcoholic In 1960. E. M. Jellineck’s The Disease Concept of Alcoholism was published.

24. Narcotics Anonymous • Formed sometime between 1947 & 1953 • Originally called Addicts Anonymous (Narcotics farm in Lexington, KY) • Instability marked early years & inconsistent practices across groups. Took about 20 years for the program to gel. • Synanon • The beginning of the use of ex-addicts in professional capacity • The birth of therapeutic communities as a treatment modality • A cautionary tale

25. Methadone • Ambulatory treatment of addicts by drug maintenance banished with Harrison Act. • 1962 Robinson v. California decision- compelling addicts to undergo treatment was • a preferable alternative to incarceration & punitive sanctions should be used only • when addicts refused to enter treatment. • The conclusion was reached that sustained abstinence was not a realizable goal for most narcotic addicts • Mid-1960’s methadone treatment for daily maintenance begun to be experimented with & models developed. • In the 1970’s, Nixon implemented widespread expansion of methadone clinics as a response to reducing urban crime & increasing treatment capacity for heroin addicts returning from Vietnam.

26. Creation of NIAAA & NIDA, as a separate organization from NIMH- 1970. The Hughes Act(1970) - The Comprehensive Alcoholism Prevention & Treatment Act. Senator Hughes was a publicly declared recovering alcoholic. Created a national system of addiction treatment for the first time.

27. James Kemper, Jr. of Kemper Insurance Companies brought his • recovery to the field. • internal alcoholism program for Kemper Insurance Company • employees in 1962 • he added alcoholism coverage to the group insurance plans • offered by the Kemper company. The majority of insurances • did not offer this coverage until the 1980s. • reimbursement for alcohol treatment with facilities that • were not located in or affiliated with accredited hospitals. • reimbursement was extended to outpatient • treatment.

28. In 1972, Joint Council on Accreditation of Hospitals (JCAH) developed accreditation standards providing entry into the mainstream health-care system. What we often look like right before JCAHO arrives!

29. Professionals who worked in the addictions field in the 1960s & 1970s were an Interesting mix. There was great debate at this time as to who was better suited to work with alcoholics & addicts – professionally trained individuals who could manage the complex nature of the disorder or those who had struggled with the disease them- selves.

30. The coming of age of addiction treatment agencies- and of addiction counseling as a distinct discipline- • Was marked by the emergence of a formal professional infrastructure. This infrastructure had 6 major • elements: • National & state treatment advocacy organizations through which agency directors could protect & • advance the interests of the field. • 2. Standards for licensing & accreditation of treatment programs • 3. National & state alcohol & drug counselor associations • 4. Creation of academic & non-academic training programs • 5. Development of systems for credentialing, certifying & licensing alcohol & drug counselors • 6. Ancillary support institutions that generated addiction-related research & professional literature (books, • pamphlets, journals, newsletters, magazines).

31. By the 1970s, the early goals of the alcoholism had been achieved. Much of the stigma associated with alcoholism. The public came to View the alcoholic as a sick person & there was broad public support For legislation to create a national network for addiction treatment. The VA hospitals were treating alcoholics. The next shift was from Skid Row to the house next door. The 1980s saw Many public & notable announcing their entry into recovery. During the Late 1970s & early 1980s, twelve step recovery became something of a fad. Addiction recovery had gone from the shameful to the “chic”. Between 1978 – 1985, twelve step recovery became nothing short of a phenomenon of American pop culture. Like other such phenomena, it was popularized, commodified and commercialized. The explosion in adaptations of the AA program to problems other than alcoholism.

33. This time also saw the new addiction-recovery mutual aid societies come about as alternatives to AA. One of the first was Women for Sobriety (WFS), founded by Jean Kirkpatrick. WFS was created out of the idea that addiction & recovery for women was fundamentally different for women. Women did not need ego deflation as AA espoused; they needed ego inflation. She suggested a focus on empowerment rather than powerlessness & surrender.

34. The first alternative to AA was Secular Organization for Sobriety (SOS) was founded by James Christopher in 1985. If one imagined support groups that operate much like AA, but without references to Higher Power, God or prayer, one would be very close to the SOS milieu. There are approximately 75 SOS meetings in the USA currently.

35. The second alternative to AA was Rational Recovery, founded By Jack Trimpey in 1986. RR provides a non-religious, non-spiritual Approach to alcoholism recovery. There is emphasis on the use of reason And rational self-interest to solve alcohol-related problems. RR groups have a professional sponsor- usually a RET therapist- and are viewed as being needed for only a limited period of time.

36. Program directors talk about the benefits of recovering professionals • It’s not necessary to teach the counselor the 12 steps. • A living example of hope & change. • Seasoned counselors are aware of the life-and-death struggle of addiction. • A passion for recovery. • Making recovery a little less arguable. • Ability to relate to clients. • With everything being equal, recovery is seen as asset in the employment • decision.

39. Program directors talk about concerns/issues of recovering professionals • Boundaries- therapeutic alliance vs. sponsorship • Therapeutic use of self & the use of self-disclosure • Relapse issues • Missing medications- recovery person first suspected • Too “touchy-feely” at times • Too much process at times (slows down work) • Lack of a wide repertoire of tools

40. If the only tool you have is a hammer, everything looks like a nail. How many recovering counselors have intervened on clients

41. Interventions developed for the substance dependent client • You’re in denial!! 2. If that doesn’t work, see number 1.

42. Working in the field & not being in recovery- an LCSW in the addictions field • When I started in the field, I spent the first part of my career apologizing for not being • recovering….. • What are some of the difficulties? The intensity, mood swings, the rigidity. • Anyone who uses is an alcoholic or addict. If they drink, they must be in denial. • Staff meetings can feel like encounter groups at times. • Are you on caffeine or off caffeine this week? Off or on sugar?

43. I learned too late that this was the very worst thing I could have done. I was all the time expending the very strength I so much needed for the Restoration of my shattered system. Luther Benson, 1896 One of the first peer support individuals One must be careful in carrying a light to the community to not leave one’s own home in darkness. -Advice from a wise father on his son’s decision to pursue a career in addiction counseling.

44. What the future holds Additional clinical training & degrees will be necessary to remain in the field- full mental health skills will be required. A very favorable employment outlook. Mentors are needed in the field. We need mentors to help (e.g., with the business aspects) & we also need to be willing to provide such mentorship to others. Use our sponsorship skills to manifest this. Let’s not limit ourselves. Universal health care- what’s ahead? Network yourself to include PCPs. Recovery oriented systems- use of peer support networks & community. Exploration of non-traditional approaches to addiction & recovery. Harm reduction, motivational interviewing, recovery coaches.

45. Recovery management • Shift from acute model to a recovery management model. • Focus on post-treatment monitoring & support • Community oriented interventions (both substance abuse & mental health) • Treatment industry to reconnect professional treatment • to the larger and more sustained process of addiction recovery. • Applying recovery principles that grew out of addictions treatment field to • chronic primary illnesses (e.g. diabetes, heart conditions)

46. Contact Information Chuck Adcock. LCSW Family Counseling Centers for Recovery 804.354.1996 cadcock@fccr-va.com Jimmy Christmas, LCSW River City Comprehensive Counseling Services 804.683.6590 jchristmas@rivercityccs.com Maryann “Mimi” Cox, LCSW 804.359.2424 mimicox@mac.com