Recovery Cascades (Bill White and David Best)

Addiction recovery is best viewed as a process rather than an event, but the transition into recovery can sometimes be more a cataclysm than a product of incremental steps—more a lightning strike than a process of maturational learning—and the factors that sustain recovery over time may be quite different than those that trigger recovery initiation. Where recovery stability is achieved in gradual stages and within later stages of enhanced global health and functioning in recovery, there are can be surges in growth that exert profound effects on personal identity and character and one’s relationship with the world.

My original interest in such catalytic surges of growth within the recovery process came from my introduction to William Miller and Janet C’de Baca’s book Quantum Change, which explores how sudden breakthroughs in perception of self and the world can spark sudden dramatic changes that are unplanned, profound, and permanent. I then investigated the transformative change experiences of seven prominent individuals within the history of recovery in the United States (Handsome Lake, John Gough, Francis Murphy, Jerry McAuley, Bill Wilson, Marty Mann, and Malcolm X).

More recently, I have been captivated by the ecology of recovery: how physical and social contexts influence recovery initiation and the quality of personal and family life across the stages of long-term recovery. The resulting meditations led to collaborations on the concepts and clinical applications of recovery capital, recovery-oriented systems of care, recovery space/landscapes, community recovery, the contagiousness of recovery, and the potential role of recovery carriers. Collectively, this work focused on the role of community in recovery and how community resources could be mobilized to support long-term recovery. Much of this work is aligned with Dr. David Best’s social identity model of addiction recovery and his work on recovery-inclusive cities.

The most recent addition to these explorations has come through my interest in the idea of recovery cascades, which resulted from Dr. David Best introducing me to the work of noted criminologist Dr. John Braithwaite. Dr. Braithwaite graciously shared with me a pre-publication copy of his paper, “Crime as a Cascade Phenomenon,” in which he explored the dynamics of sudden surges or declines in criminal behavior at community and cultural levels. For me, this idea of “cascades” immediately raised the question of how to best understand sudden surges in recovery initiation at personal, community, and cultural levels. Cascades of quite different influences may also affect the risk of addiction recurrence.

The idea of recovery cascades suggests several possible principles.

1) Each increment of change lowers the kindling point for initiation of future change—at personal, family, community, and cultural levels. There can be periods of rapid recovery initiation and the resulting fruits of recovery. Repeated efforts resulting in only small increments of change or no observable change can be followed by exponential leaps toward recovery stabilization and quality of recovery life. A recovery cascade within one condition can ignite recovery initiation or progression within allied conditions and broader problems of living, potentially amplifying recovery benefits to individuals, families, and communities. Later stages of recovery contain the potential of becoming “better than well”—a stage of enhanced health, functioning and service to others that helps build community capital and overall connectedness and wellness, particularly when a critical mass of recovery prevalence within a community is reached.

2) A recovery kindling effect suggests that the threshold of effort required to produce positive change is incrementally or suddenly lowered with a resulting rapid surge in behavioral change even where multiple prior efforts resulted in no sustainable change. That’s why newcomers to recovery are admonished, “Don’t quit before the miracle happens.”

3) Recovery as a stage-dependent process is often characterized by alternating periods of rapid growth and periods of consolidation and respite, with the risk that one can get frozen within any of these developmental stages if some forward momentum, no matter how slow, is not sustained. The pace of change also varies across dimensions of recovery, e.g., physical health, emotional health, intimate and family relationships, etc. In general, present change incubates future change within and across recovery domains, but change that exceeds an individual or community’s overall coping capacities can lead to excessive rigidity (resistance to change) and emotional/behavioral regression.

4) Invisible upstream influences (economic, political, social, and religious) can exert profound effects on addiction cascades and recovery cascades. As such cascades unfold, addiction/recovery exerts reciprocal influence on these upstream conditions, potentially amplifying or altering their direction. (Thanks to Jason Schwartz for pointing out such influences.) Similarly, the cultural and political mobilization of people in recovery and their allies may exert positive influences on these larger economic, political, social, and religious contexts.

5) One person initiating recovery within a social network increases the probability of other members initiating recovery. As density and visibility of recovery within a social network increases, the pace of recovery initiation can accelerate at an exponential rate, leading to a neighborhood, institutional, or community-level recovery cascade. Recovery cascades at a systems level imbed key ideas and values within the larger community, e.g., restorative justice, community service, tolerance, and inclusion.

6) Increased density of recovery within a social network, by spreading multiple degrees of separation, reaches contiguous social networks that can trigger population-level changes in the prevalence of AOD problems as well as core community values and related behaviors. For example, in the 2015 UK Life in Recovery study, 79% of people in long term recovery were volunteering in their communities compared to 40% of the general public!

7) Growth or decline in recovery prevalence is not linear and is subject to dramatic surges within relatively short periods of time. Just as individuals with prolonged AOD problems experience transformational change experiences that are unplanned, positive, and permanent, communities experience collective surges of recovery initiation once a critical “tipping point” of recovery prevalence is reached. John Braithwaite suggests this is a process of self-efficacy spurring a surge in collective efficacy (community healing and health) that results in fundamental changes in community connections and structures.

8) Cascade effects are influenced in part by the mathematics of addiction and recovery. If each person in recovery reaches out to encourage and support the recovery of others within their past drug-using social network, then recovery achieves critical mass within the population over time in ways that effect not only rising recovery rates but decreased prevalence of substance use disorders within the population. To reach population level effects on AOD problems, the number of people exiting the problem pool (e.g., via recovery initiation and stabilization) must exceed the number of people entering that pool. Strategic efforts to stimulate recovery cascades constitute an untapped strategy in reducing the prevalence of AOD problems at community and cultural levels. Strategically stimulating and sustaining recovery cascades have yet to be fully tested as a strategy of primary prevention and public health enhancement.  

9) People who visibly model recovery via their community or cultural visibility, the quality of their own character and lives, and their personal charisma constitute powerful recovery carriers. The prevalence of recovery from addiction and the broader spectrum of AOD problems can be strategically increased by elevating the density and visibility of recovery carriers within a community or culture. Contagion effects exerted by recovery carriers constitute mechanisms of interpersonal recovery transmission.

10) Prolonged stigma and discrimination infuse self-hatred (I am not worthy of inclusion in the mainstream community) and defiant rejection of the values and efforts of control from the larger community. Peers in recovery may have more influence in inviting recovery initiation than authority figures/institutions associated with past experiences of stigma (e.g., contempt and social exclusion). Using peers as a fulcrum for recovery engagement may enhance recovery prevalence at the same time it opens pathways of community inclusion for other historically excluded groups.

11) Recovery carriers are conduits of kinetic (actionable) ideas and values that may vary across demographic populations and cultural contexts. Recovery cascades sparked through their influence will vary in unique ways based on the local social structures and conditions in individual communities.

13) The speed of addiction and recovery cascades has increased exponentially as people became less involved in face-to-face interactions and more involved in near-instantaneous e-communications.

14) Recovery cascades at community and cultural levels threaten powerful professional and institutional interests (e.g., predatory individuals and institutions that profit from addiction and fuel “commercially purposive cascades of mass addiction”; Braithwaite, in press) and can trigger counter-cascades of resistance to recovery advocacy and recovery support efforts. Creating sustainable recovery-friendly communities requires weathering such inevitable backlashes.

15) To be sustainable, surges in recovery initiation must be anchored: habituated at a personal level, ritualized at a family level, and institutionally imbedded at a community/cultural level. Without such anchors, recovery remains fragile and unstable across these dimensions. A central goal of creating recovery-oriented systems of care is to assure such anchoring processes.

These emerging ideas need considerable refinement and rigorous testing across diverse cultural contexts, but they collectively add to a growing body of thought about the role of community in addiction recovery.

References

Best, D. & Coleman, C. (2018). Let’s celebrate recovery inclusive cities working together to support social cohesion. Addiction Research & Theory, 27(1), 55-64.

Braithwaite, J. (2018). Crime as a cascade phenomenon. Accessed March 20, 2019 at https://thebscblog.wordpress.com/2018/05/02/crime-as-a-cascade-phenomenon/