I think the dynamic model is a good start but it seems to leave out a few highly significant factors. In the outer ring, there is no mention of cultural norms around alcohol and alcohol advertising and promotion. In the inner ring, although crime is mentioned, I think the broader idea of safety should be included - e.g to encompass domestic violence, psychological safety. At an individual level, I think self compassion/lack thereof is an essential component and should be called out.
Iām inspired to have a go at my own less technical version! š
These are very good thoughts, thanks for writing. I'm especially struck by advertising and agree that's a notable omission (and not just alcohol; consider cannabis, or for that matter gambling). It's a great reflection on how culture isn't something that just "happens" but is actively shaped by many forces.
I think it's great to come up with your own version and for one's own local context, that's basically what we're doing all the time, at least implicitly.
Yes, agree with all of these - we were very limited for space within the figures, so the list of factors are not exhaustive. The ones you mentioned should absolutely be considered too. self-stigma and self-compassion are also critical at the individual level.
nice perspectives, thank-you. also a shocking coincidence!!
I was drawn to āflourishingā simply because we discussed this word at my Caduceus group 2-weeks ago.
I raised the topic after hearing a marvellous Sociologist out of Emory U talk about the concepts from his discipline. He also shared treatment suggestions or preventative measures to moderate symptoms - 5 vitamins, or 5 nonpharm approaches.
Most seem to resemble the fundamentals of Twelve Step Fellowships / SMART recovery
That's great, thanks for sharing. I hadn't seen Corey Keyesās work but that is interesting and a nice framework breaking down languishing va flourishing. (Learn, connect, transcend, help, play).
It has always struck me as an odd word choice! I suppose they were looking for a more original term than "recovery resources." You don't even have to be particularly anti-capitalist to recognize it as a bit skewed.
Hi Carl -- so great that you are here on Substack. I really appreciate your work on addiction and I often refer to your book The Urge, which has helped me along the way.
I wonder, though, about all of this effort to frame things in terms of "recovery," especially _personal_ 'recovery capital' vs what you term as _community_ capital.
I think we need to pay a lot more attention to the communities that we're creating and living in, and that if we did, much of what currently shows up as problems (and addiction) at the individual level would simply go away... which is why, personally, I want nothing to do with "recovery" at all, since using that world inescapably dredges up a hundred-odd years of addiction and recovery dogma.
As it happens, I published a piece Against "Recovery" just the other day. I'd be interested to hear how this lands with you:
Hi Bowen, thanks for the comment and glad you're here! I see your point about being skeptical about the word "recovery." I certainly don't think everyone has to identify as being in recovery, or that recovery concepts are necessarily universalizing. I have done podcasts with people such as Zach Siegel who identify as having had an addiction, but who choose not to adopt the label "in recovery," and I'm sure that works for plenty of people.
I agree that there are a lot of messy and sometimes contradictory and confusing ideas attached to the word "recovery." But this is also true for "addiction," "wellness," etc. For me, the benefits outweigh the costs. That's not true for everyone and again I don't think everything has to be framed in terms of recovery or that it's for everyone.
What I'm more interested in is this: given that recovery is a massive phenomenon, with many different ideas and possible lessons, I would like to explore what it has to offer, not as a prescription but as a set of considerations. If nothing else, a set of considerations about what are the possible questions and dimensions of change.
Thanks for the tip about your piece. I think there's a lot of good ideas there. I disagree that recovery ideas and movements necessarily center the individual, and I think there are many forms of recovery--again within a movement that is quite heterogeneous--that attend to broader community and social considerations. If nothing else, that's part of the conversation I'm trying to have here.
I appreciate your thoughtful reply. I appreciate that you feel to further explore, build upon "recovery" ā perhaps that will lead to some further evolution of what it means that appeals more broadly. For me though, the long history of meaning embedded in the word has only made it less appealing over time. Perhaps even more than centering the individual, I feel that "recovery" centers "recovery" vs just... life. But of course, we each have our own feelings and preferences. I respect your approach & my goal is to present my own experience and offer some light on another point of view...
Love the article. I am a substance abuse therapist and I found this article to be very interesting. I'm an advocate of the disease model in the brain. If you are going to do things that will bring about diabetes such as eating sugar sodas high carbs very little protein and your predisposition towards diabetes you're going to end up with diabetes. It's the same thing with drug abuse and alcohol abuse. There are things that you can do in your life with bad habits that can give you heart disease. Same with the brain disease if we're going to drink and drug well guess what. So putting the biological with his sociological in my mind would be a good start. It's like having a table that needs four legs but only has three. You can't do one without the other. Just comment but still loved your article and I'm going to be doing some new reading because of your article. Thank you so much.
Hi Kim, glad you're here! Personally I have reservations about "disease" language, but I think it's complicated, with costs and benefits for different people in different situations. Suffice to say, it was a major theme in my book, so I considered it something that needed a lot of space to unpack. I do think we have to keep multiple dimensions in mind--as you say, yes there are individual behaviors that may contribute to a health problem, but those behaviors occur in a broader context of life history, relationships, community resources, economic and power relationships, etc. One of the biggest problems is if we try to reduce the problem to just one level of analysis; like you say, we need them all.
I donāt fully agree with the parallel you are drawing between addiction and diabetes. Itās less about āabusingā drugs (inc alcohol) and more about drugs being inherently addictive. Itās not necessarily about developing ābad habitsā around drugs, some people are addicted from their first hit or drink. Can there be āgood habitsā around toxic, addictive, carcinogenic substances?
I also don't think the diabetes parallel is perfect, but the compassionate intention (and the reason it was used a lot by academic writers over the past 20 yrs) was to emphasize that behaviors played a role in some general health conditions. I.e., it's not that heart attacks or diabetes just "happen" to people, whereas addiction is "self-inflicted". There's some fuzzy overlap, where individual behaviors interact with personal risk from other contributors (life history, other psychological struggles, etc) as well as broader community and environmental risk factors
I do agree with you Kate that overall we tend to default to the (industry-influenced) notion that alcohol is benign and good as a "recreational" thing
I think the dynamic model is a good start but it seems to leave out a few highly significant factors. In the outer ring, there is no mention of cultural norms around alcohol and alcohol advertising and promotion. In the inner ring, although crime is mentioned, I think the broader idea of safety should be included - e.g to encompass domestic violence, psychological safety. At an individual level, I think self compassion/lack thereof is an essential component and should be called out.
Iām inspired to have a go at my own less technical version! š
These are very good thoughts, thanks for writing. I'm especially struck by advertising and agree that's a notable omission (and not just alcohol; consider cannabis, or for that matter gambling). It's a great reflection on how culture isn't something that just "happens" but is actively shaped by many forces.
I think it's great to come up with your own version and for one's own local context, that's basically what we're doing all the time, at least implicitly.
Yes, agree with all of these - we were very limited for space within the figures, so the list of factors are not exhaustive. The ones you mentioned should absolutely be considered too. self-stigma and self-compassion are also critical at the individual level.
Great to see you on here Katie!
nice perspectives, thank-you. also a shocking coincidence!!
I was drawn to āflourishingā simply because we discussed this word at my Caduceus group 2-weeks ago.
I raised the topic after hearing a marvellous Sociologist out of Emory U talk about the concepts from his discipline. He also shared treatment suggestions or preventative measures to moderate symptoms - 5 vitamins, or 5 nonpharm approaches.
Most seem to resemble the fundamentals of Twelve Step Fellowships / SMART recovery
reputable interview source (Canadaās CBC)
interview is around the 19-20min.
https://www.cbc.ca/listen/live-radio/1-63-the-current/clip/16049943-feeling-invisible-you-might-languishing
That's great, thanks for sharing. I hadn't seen Corey Keyesās work but that is interesting and a nice framework breaking down languishing va flourishing. (Learn, connect, transcend, help, play).
Also donāt love the framing of recovery ācapitalā - does even recovery have to be framed in the language of capitalism?
It has always struck me as an odd word choice! I suppose they were looking for a more original term than "recovery resources." You don't even have to be particularly anti-capitalist to recognize it as a bit skewed.
Hi Carl -- so great that you are here on Substack. I really appreciate your work on addiction and I often refer to your book The Urge, which has helped me along the way.
I wonder, though, about all of this effort to frame things in terms of "recovery," especially _personal_ 'recovery capital' vs what you term as _community_ capital.
I think we need to pay a lot more attention to the communities that we're creating and living in, and that if we did, much of what currently shows up as problems (and addiction) at the individual level would simply go away... which is why, personally, I want nothing to do with "recovery" at all, since using that world inescapably dredges up a hundred-odd years of addiction and recovery dogma.
As it happens, I published a piece Against "Recovery" just the other day. I'd be interested to hear how this lands with you:
https://bowendwelle.substack.com/p/against-recovery
Thanks again for your work!
Hi Bowen, thanks for the comment and glad you're here! I see your point about being skeptical about the word "recovery." I certainly don't think everyone has to identify as being in recovery, or that recovery concepts are necessarily universalizing. I have done podcasts with people such as Zach Siegel who identify as having had an addiction, but who choose not to adopt the label "in recovery," and I'm sure that works for plenty of people.
I agree that there are a lot of messy and sometimes contradictory and confusing ideas attached to the word "recovery." But this is also true for "addiction," "wellness," etc. For me, the benefits outweigh the costs. That's not true for everyone and again I don't think everything has to be framed in terms of recovery or that it's for everyone.
What I'm more interested in is this: given that recovery is a massive phenomenon, with many different ideas and possible lessons, I would like to explore what it has to offer, not as a prescription but as a set of considerations. If nothing else, a set of considerations about what are the possible questions and dimensions of change.
Thanks for the tip about your piece. I think there's a lot of good ideas there. I disagree that recovery ideas and movements necessarily center the individual, and I think there are many forms of recovery--again within a movement that is quite heterogeneous--that attend to broader community and social considerations. If nothing else, that's part of the conversation I'm trying to have here.
I appreciate your thoughtful reply. I appreciate that you feel to further explore, build upon "recovery" ā perhaps that will lead to some further evolution of what it means that appeals more broadly. For me though, the long history of meaning embedded in the word has only made it less appealing over time. Perhaps even more than centering the individual, I feel that "recovery" centers "recovery" vs just... life. But of course, we each have our own feelings and preferences. I respect your approach & my goal is to present my own experience and offer some light on another point of view...
Cheers Carl!
Love the article. I am a substance abuse therapist and I found this article to be very interesting. I'm an advocate of the disease model in the brain. If you are going to do things that will bring about diabetes such as eating sugar sodas high carbs very little protein and your predisposition towards diabetes you're going to end up with diabetes. It's the same thing with drug abuse and alcohol abuse. There are things that you can do in your life with bad habits that can give you heart disease. Same with the brain disease if we're going to drink and drug well guess what. So putting the biological with his sociological in my mind would be a good start. It's like having a table that needs four legs but only has three. You can't do one without the other. Just comment but still loved your article and I'm going to be doing some new reading because of your article. Thank you so much.
Hi Kim, glad you're here! Personally I have reservations about "disease" language, but I think it's complicated, with costs and benefits for different people in different situations. Suffice to say, it was a major theme in my book, so I considered it something that needed a lot of space to unpack. I do think we have to keep multiple dimensions in mind--as you say, yes there are individual behaviors that may contribute to a health problem, but those behaviors occur in a broader context of life history, relationships, community resources, economic and power relationships, etc. One of the biggest problems is if we try to reduce the problem to just one level of analysis; like you say, we need them all.
I donāt fully agree with the parallel you are drawing between addiction and diabetes. Itās less about āabusingā drugs (inc alcohol) and more about drugs being inherently addictive. Itās not necessarily about developing ābad habitsā around drugs, some people are addicted from their first hit or drink. Can there be āgood habitsā around toxic, addictive, carcinogenic substances?
I also don't think the diabetes parallel is perfect, but the compassionate intention (and the reason it was used a lot by academic writers over the past 20 yrs) was to emphasize that behaviors played a role in some general health conditions. I.e., it's not that heart attacks or diabetes just "happen" to people, whereas addiction is "self-inflicted". There's some fuzzy overlap, where individual behaviors interact with personal risk from other contributors (life history, other psychological struggles, etc) as well as broader community and environmental risk factors
I do agree with you Kate that overall we tend to default to the (industry-influenced) notion that alcohol is benign and good as a "recreational" thing