Pathways from the Culture of Addiction to the Culture of Recovery: A Travel Guide for Addiction Professionals, 2nd Edition

This guide examines addiction and recovery as a cultural phenomenon and describes the cultural aspects, organization, key cultural roles, and milestones that most addicts share. This guide examines addiction and recovery as a cultural phenomenon and describes the cultural aspects, organization, key cultural roles, and milestones that most addicts share. It examines how to move clients out of their drug-using culture into a new world that promotes abstinence and healthy ways of living. A comprehensive look at the drug-using culture including concerns for intervention and treatment. William L. White, M.A., Senior Research Consultant at the Lighthouse Training Institute in Bloomington, Illinois, has nearly three decades of experience in the substance abuse field. Pathways from the Culture of Addiction to the Culture of Recovery......Page 1 CONTENTS......Page 6 PREFACE......Page 18 ACKNOWLEDGMENTS......Page 20 PROLOGUE......Page 22 PART I THE CULTURE OF ADDICTION......Page 27 1.1 Pilgrims and Pathways......Page 28 1.2 Culture of Addiction Defined......Page 29 1.3 The "Species" of Addiction......Page 31 1.4 Culture as an Initiating Force......Page 33 1.5 Culture as a Sustaining Force......Page 34 1.7 The Acultural Addict......Page 35 1.8 The Culturally Enmeshed Addict......Page 37 1.9 The Bicultural Addict......Page 39 2.1 Tribal Networks......Page 42 2.2 Tribal Selection Based on Drug Choice......Page 43 C. Instrumental Drugs......Page 44 D. Prohibited Drugs......Page 45 2.3 The Celebrated Drug Tribes......Page 46 2.4 The Instrumental Drug Tribes......Page 49 2.5 The Tolerated Drug Tribes......Page 52 2.6 The Prohibited Drug Tribes......Page 53 B. Drug Dosage......Page 54 D. Withholding Technology That Could Reduce Risks......Page 55 2.7 Relationship to Other Deviant Cultures......Page 57 3 The Psychosocial and Technical Functions of the Culture of Addiction......Page 59 3.1 Identity and Self-Esteem......Page 60 3.2 Transforming Stigma to Status: Identity in the Illicit Drug Culture......Page 63 3.3 Adolescent Needs and the Culture of Addiction......Page 65 3.4 How to Use......Page 68 3.5 Learning to Experience the Drug......Page 70 3.6 Skills to Sustain Addiction......Page 71 4.1 Language......Page 75 4.2 Religion, Morality, and Values......Page 77 4.3 Symbols......Page 80 4.4 Rituals......Page 81 4.5 History and Mythology......Page 83 4.6 Institutions (Places)......Page 84 4.7 Dress/Appearance......Page 85 4.8 Diet/Food......Page 86 4.9 Music......Page 87 4.11 Literature......Page 88 E. The Promotional Journals......Page 89 4.12 Visual Media......Page 90 4.13 Work and Leisure......Page 93 A. Sexual Trauma......Page 97 C. Sexual Values......Page 98 4.15 Family Relationships......Page 99 4.16 Social Relationships......Page 102 4.17 Time Orientation......Page 103 4.18 Violence......Page 105 4.19 Death......Page 106 5.1 The Myth of Addiction as an Escapist Lifestyle......Page 109 5.2 Hustling......Page 110 5.3 Copping......Page 117 5.4 Getting Off......Page 119 5.5 Avoiding Busts, Burns, Rip-offs, and Hassles......Page 120 Depression......Page 122 Intimacy......Page 123 Morality......Page 124 6.1 The Dealers......Page 126 6.2 The High Priests......Page 128 6.3 The Storytellers......Page 129 6.4 The Medicine Men and Midwives......Page 130 6.5 The Jailhouse Lawyers......Page 131 6.6 The Ambassadors......Page 132 6.7 The Gangsters......Page 133 6.8 The Nonaddicted Hustlers......Page 134 6.9 The Addict with Money and Fame......Page 135 6.11 The Weekend Players......Page 136 6.12 The Pseudo-Junkies......Page 137 6.13 The Pledges......Page 138 6.14 The "Crazies"......Page 139 6.15 The Marks......Page 140 6.17 The Snitches......Page 141 6.18 The Protectors......Page 142 6.19 The Cultural Rejects......Page 144 6.21 Summary: Cultural Roles and the Treatment Process......Page 145 7 Career Milestones in the Culture of Addiction......Page 147 7.1 Joining the Culture: Initiation Rites......Page 148 7.2 Chipping: The Period of Controlled Use......Page 151 7.3 Justifying Usage: Ideological Beliefs......Page 157 A. Preoccupation with Denial......Page 158 7.6 Developing Status and Reputation in the Culture......Page 159 7.8 Kicking: The Testing of Control......Page 160 7.10 Getting Busted and Doing Time......Page 162 A. Gambits to Avoid Treatment......Page 164 C. Demonstrating Motivation......Page 167 E. Assessing Your Counselor......Page 168 F. The Best Rationalizations for Why Past Treatment Didn't Work......Page 169 1. The Miracle Cure......Page 171 3. The Instant Counselor......Page 172 1. The Intimidator......Page 173 2. The Staff Splitter......Page 175 I. Creating Diversions......Page 176 1. My Real Problem Is . . .......Page 177 4. The Treatment Elite......Page 178 J. The Self-Help Critic......Page 179 K. Doing Treatment, Sustaining Addiction......Page 180 7.12 Pathways Out of the Culture of Addiction......Page 182 A. Death......Page 183 B. Psychiatric Impairment......Page 184 D. Spontaneous Remission......Page 185 E. Maturing Out......Page 187 F. Getting Religion......Page 188 G. The "Super Ex-Dope-Fiend Folk Hero."......Page 189 I. The Question of Controlled Use......Page 191 7.13 Summary: The Culture as Cult......Page 194 PART II THE CULTURE OF RECOVERY......Page 195 8.1 The Culture of Addiction as an Assessment Component......Page 196 A. Cultural Assessment at Intake......Page 197 C. Self-Assessment Techniques......Page 198 D. The Social Network Diagram......Page 199 8.2 The Culture of Addiction and the Choice of Treatment Modalities......Page 202 A. Emergence of the Multiple-Problem Client and Family......Page 204 B. Multiple-Problem Clients in a Categorically Segregated Service System......Page 205 D. Enmeshed Addicts in Treatment: Past, Present, and Future......Page 206 8.3 Methadone and the Culture of Addiction......Page 209 8.4 Engaging the Client through Cultural and Personal Identification......Page 211 A. Pain-Based Interventions......Page 214 B. Hope-Based Interventions*......Page 217 8.6 Addressing Secondary Drug Use......Page 221 A. A Model of Risk......Page 222 B. Analysis of Drug-Use History......Page 223 D. Teaching Functions......Page 225 E. Relapse Interventions Involving Secondary Drugs......Page 227 8.7 The Struggle for Control of the Treatment Milieu......Page 228 8.8 Disengaging from the Culture of Addiction......Page 229 B. Diagnosing the Treatment Style......Page 234 D. Teaching Interventions......Page 236 E. Interventions to Block Self-Defeating Styles......Page 238 8.10 The Preferred Defense Structure and Cultural Conversion......Page 242 8.11 The Culture of Recovery: The Alternative Career Path......Page 243 9.1 Historical Evolution......Page 245 9.3 The Treatment Culture......Page 258 9.4 The Self-Help Culture......Page 260 9.5 The Family in the Culture of Recovery......Page 261 A. Building the Treatment Culture......Page 262 B. Building Linkages Between the Treatment and Self-Help Cultures......Page 266 C. Nurturing Development of the Self-Help Culture......Page 267 D. Including the Family in the Culture of Recovery......Page 273 10 The Psychosocial and Technical Functions of the Culture of Recovery......Page 275 10.1 Zones of Action and Experience......Page 276 10.2 The Physical Zone......Page 279 10.3 The Psychological Zone......Page 280 10.4 The Spiritual Zone......Page 281 10.5 The Interpersonal Zone......Page 282 10.6 The Lifestyle Zone......Page 283 10.8 Teachers, Healers, and Travel Guides......Page 284 11.1 From Culture of Addiction to Culture of Recovery: A Catalog of Intervention Techniques......Page 287 A. What's in a Name?......Page 288 B. Profanity and Argot......Page 290 C. Reshaping Conversational Themes......Page 291 D. The Language of Treatment and Recovery......Page 292 A. God as I Understand Him?......Page 295 1. And the Blind Shall See: The Experience of Rebirth......Page 296 3. Victory in Surrender: Sisyphus Revisited......Page 298 4. Empowerment......Page 300 5. Transforming the Self-World Relationship......Page 302 6. The Search for Wholeness......Page 303 C. The Reconstruction of Personal Values......Page 304 A. Shedding Symbols of the Life......Page 305 C. Symbol Replacement......Page 306 D. Symbols and Relapse Prevention......Page 308 E. Intervention Summary......Page 309 A. Ritual Identification......Page 310 B. Ritual Replacement......Page 311 A. A New Oral History......Page 313 B. The Traditions and Folklore of Recovery......Page 314 Heroes......Page 315 The Folk Wisdom of Recovery......Page 316 A. Places and Persona......Page 317 B. Saying Good-bye to Slippery Places......Page 319 C. Finding Drug-Free Havens......Page 320 A. The Return of Self-Care......Page 321 B. I'm Too Beautiful to Be Addicted......Page 322 C. Experimenting with New Images......Page 323 A. The Physiology of Sobriety......Page 331 B. Food and Mood......Page 332 2. Sugar Control......Page 333 D. Self-Healing......Page 334 E. Self-Healing versus Self-Pollution......Page 335 11.10 Music......Page 337 B. Neutralizing Musical Triggers for Intoxication......Page 338 C. Songs to Get Well By......Page 341 A. Art as a Tool of Disengagement......Page 343 B. The Folk Art of Recovery......Page 344 A. We Are What We Read......Page 345 2. Ensure Personal Ownership of Recovery Literature......Page 347 4. Create Local Literature......Page 348 11.13 Visual Media......Page 349 1. Anticipating the Experience......Page 350 3. Cue Replacement......Page 351 B. Television in the Culture of Recovery......Page 352 C. We've Come a Long Way Since "Chalk Talk."......Page 353 D. The Concept of "Passive Confrontation."......Page 354 1. Exploring Nondrug Values......Page 355 3. Conducting Employer Conferences......Page 356 4. Extending Support into the School or Workplace......Page 357 B. Finding Drug-Free Pleasure......Page 358 3. Providing a Forum for Leisure Planning......Page 359 A. Intimacy, Sexuality, and the Culture of Recovery......Page 361 B. Addressing Sexual Trauma......Page 362 C. Clarifying Sexual Orientation......Page 364 E. Managing Shame and Guilt......Page 365 1. Teaching Functions......Page 367 G. Including Sexuality in Relapse Prevention Planning......Page 368 A. Family: An Expanded Definition......Page 369 4. Continuum of Care......Page 370 C. Balancing the Four Levels of Family Healing......Page 371 D. Developmental Stages of Family Recovery......Page 372 E. The Intimacy Crisis: The Culture as Buffer......Page 374 F. Parenting in the Culture of Recovery......Page 376 G. Breaking the Intergenerational Cycle of Addiction......Page 379 H. The Culture as Surrogate Family......Page 381 A. Managing Visitors in the Treatment Milieu......Page 383 B. Assessing and Transforming Social Relationships......Page 384 C. From Suicide Pacts to Sponsorship......Page 385 D. From Antidrug to Nondrug Relationships......Page 387 A. From Addiction Time to Recovery Time......Page 388 B. Daily Schedules......Page 389 C. Sleep and the Body's Biological Clock......Page 390 A. Decompression......Page 391 C. Assessing Risk of Violence......Page 393 A. The Fear of Death in Early Recovery......Page 394 B. Tribal Deaths and Reaffirmations......Page 395 C. AIDS and the Culture of Recovery......Page 397 1. The Addict......Page 399 2. The Family......Page 400 3. The Professional Helpers......Page 401 12 Core Activities......Page 402 C. Seeking Strength......Page 403 D. Self-Commands......Page 404 E. Decompression Rituals......Page 405 A. Mentor Contacts......Page 406 B. Daily Contact with Other Tribal Members......Page 407 C. Tribal Meetings......Page 408 A. Acts of Self-Care......Page 409 B. Telling One's Story......Page 410 C. On Vocations and Vacations......Page 411 12.4 Acts of Service......Page 412 13.1 The High Priests......Page 414 13.2 The Elders......Page 415 13.3 The Storytellers......Page 416 13.5 The Medicine Men and Midwives......Page 417 13.7 The Ambassadors......Page 418 13.9 The Pigeons......Page 419 13.11 Pseudo-Addiction; Real Recovery......Page 420 13.14 The Bleeding Deacons......Page 421 13.16 The Professionals......Page 422 13.17 The "Two-Hatters"*......Page 423 13.19 The Fundamentalists......Page 424 13.22 Summary: Cultural Roles and the Treatment Process......Page 425 14.1 The Motivational Crisis......Page 427 14.2 The Conversion Experience......Page 429 14.3 The Initiation Rites......Page 431 14.4 Joining and Rejoining: The Experience of Relapse......Page 433 A. Relapse as Response to Drug Hunger......Page 434 E. Relapse or Go Crazy......Page 435 J. The Professional Relapse......Page 436 2. Recommitment......Page 437 14.5 The Apprenticeship......Page 438 14.6 Constructing One's Story......Page 440 14.7 Through Excess in Search of Harmony......Page 445 14.8 Dependence on the Culture of Recovery......Page 448 B. Self-Examination......Page 449 C. Confession and Forgiveness......Page 450 E. Restitution......Page 451 G. Mastery of Self-Defeating Behavior......Page 452 14.10 Reaching Out to Others......Page 453 14.11 "I'm Sober, Now What Do I Do?"......Page 454 B. Keeping It Simple......Page 455 D. Softening the Sharp Edges......Page 456 E. Personal Identity in Late Recovery......Page 457 14.13 The Therapist's Role in Milestone Management......Page 458 14.14 Recovery Milestones and the Service Continuum......Page 459 15.1 Profiles of the Pilgrims......Page 462 B. The Professionally Supported Traditional Pathway......Page 463 C. Sobriety by Mail......Page 464 D. Shifting Program Affiliation......Page 465 F. AA as a Developmental Stage......Page 466 G. Women for Sobriety......Page 467 H. "Double Trouble."......Page 468 J. Moderation Programs......Page 469 K. Adolescent Maturing Out with Controlled Drinking......Page 470 L. Drug Recovery with Controlled Drinking......Page 472 N. The Path of Islam......Page 473 O. The Politics and Theology of Abstinence......Page 474 P. The Risk-Driven Sobriety Decision......Page 475 Q. The Health-Driven Sobriety Decision......Page 476 R. The Relationship-Driven Sobriety Decision......Page 477 S. The Emotion-Driven Sobriety Decision......Page 478 U. The Anti-Script......Page 479 V. Methadone for Life......Page 480 W. Maturing Out......Page 481 15.2 Styles of Recovery......Page 482 A. Acultural Styles of Recovery......Page 483 B. Culturally Enmeshed Styles of Recovery......Page 485 C. Bicultural Styles of Recovery......Page 486 D. Style Preference and Evolution......Page 487 Appendix A Self-Assessment Instrument......Page 489 Appendix B Glossary of Clinical Interventions and Techniques......Page 492 Bibliography......Page 497 C......Page 504 E......Page 505 L......Page 506 R......Page 507 U......Page 508 Z......Page 509 About the Author......Page 510

Second Edition
This guide examines addiction and recovery as a cultural phenomenon and describes the cultural aspects, organization, key cultural roles, and milestones that most addicts share. It examines how to move clients out of their drug-using culture into a new world that promotes abstinence and healthy ways of living. A comprehensive look at the drug-using culture including concerns for intervention and treatment.

William L. White, M.A., Senior Research Consultant at the Lighthouse Training Institute in Bloomington, Illinois, has nearly three decades of experience in the substance abuse field.