Recovery Rising: A Manifesto for the Future

William (Bill) White’s new book Recovery Rising is inspiring, uplifting, and astonishing.  With every page I found myself thinking:  Whoa, what a life this man has lived!  Yet Bill’s humility shines through everything he does and every life he touches. 

Recovery Rising is more than a memoir – it is a manifesto for the future, a rousing and insightful guide for anyone and everyone working in the addiction and recovery fields.  If you add these pages to his writings – freely available on his website – you will understand the depth and breadth of Bill’s contribution to the world. 

Bill has given me permission to include in this blog two of my favorite passages from his book.  The first is titled “Stop Kicking People Out of Addiction Treatment.”  Tomorrow I will post the excerpt titled “Precovery.” 

 "Stop Kicking People out of Addiction Treatment!"

Several clinical practices in modern addiction treatment are likely to stimulate the "What the hell were they thinking?" question among future historians. At the top of my own nominations would be the practice of "administratively discharging" clients for essentially confirming their diagnosis. This practice most frequently involves discharging someone for alcohol or other drug use after he or she has been admitted to addiction treatment. Although sometimes referred to as "therapeutic discharge" and conceptualized as a motivational wake-up call, there is no scientific evidence that this practice has any positive influence on long-term recovery outcomes. Although I had thrown untold people out of treatment for this perceived volitional infraction, I became convinced that this type of administrative discharge was illogical and therapeutically counterproductive. Here was my chain of thinking.

We admit an individual for what we allege is the disease of addiction, the essence of which is the inability to refrain from alcohol and other drug use in spite of escalating consequences and the loss of control (the ability to moderate or cease drug use once it has begun). Lacking any definitive diagnostic test, we base our diagnosis of this disease on the client's self-reported history of inability to abstain and/or loss of control. We explain to the client, family members, and employers that the history of failed promises and resolutions is not a manifestation of weak character or immorality but a symptom of the disease of addiction. We argue that persons suffering from this disease require treatment rather than punishment or abandonment. Having successfully won this argument, we admit the individual for treatment of this disease and as part of that admission request that the individual refrain from alcohol and other drug use. We further state that he or she could be discharged for alcohol or other drug use—the central symptom of the disease that is being treated. When such use occurs days, weeks, or months into this treatment, the client is administratively discharged ("kicked out of treatment") for becoming symptomatic.

Let's compare this with the treatment of other health conditions. First, asking a patient to not exhibit symptoms of their disorder as a condition of entry into treatment is unthinkable on the grounds that such symptoms are not under the patient's volition or control. Second, expelling a patient during treatment for exhibiting a symptom of the disorder being treated would be unthinkable. Third, the appearance of symptoms while treatment is under way is a sign that some aspect of the treatment is not working and that the treatment protocol needs to be adjusted—not terminated.