Reimagining recovery

June 14, 2018 10:17 PM

I'm going to be starting a new recovery group, so far I'm just planning a pilot group in Portland, Oregon. The format will be different than most recovery groups, and the emphasis is that everyone is in recovery from something. Help me brainstorm!

I want to start a recovery group with a new, reimagined format, one which emphasizes self empowerment about choosing what recovery looks like for you; where "take what works and leave the rest" is the starting premise. One that focuses and recognizes peoples inherent strength, intuition and potential for self-organization, rather than arbitrating a static, unchanging set of rules which inevitably become obsolete, dogmatic and potentially counterproductive.

What I've got so far is that each meeting, a specific type of coping strategy or tool or concept or group exercise* is introduced by a volunteer, discussed for a bit, then open it up for checking in, (I have more specific ideas about all this, but thats the basic idea). Also have a wiki for topics people have brought up?

*a few ideas or sessions I would hold myself:
Introduction to mindfulness
Harm reduction strategies
Medications as allies
"playing the tape out"
Living with dual diagnoses
A bunch of cbt and dbt concepts
The role of trauma in addiction
The gut-brain axis

As you can see, a lot of these concepts are applicable to recovery of any kind, not just substance use, and almost everyone's in recovery from something.

What would your ideas for such a group in general? Advice? Potential pitfalls?
Would you attend if it was in your area?
What are your complaints with current recovery culture?
What would it look like if recovery was reimagined to be dynamic and changeable?
Do you think I'll get enough volunteers to present?
What topics would you potentially being up?
Anyone want to help in any form?

Feel free to pm me, as well.

posted by mingo_clambake to Society & Culture (15 answers total)

Best answer: A big thing for therapy groups I’ve been involved with is the “ritual” involved that anchors the group and gives it focus.

Something like AA gets a lot of stick for the cliche of sitting in a circle and saying you’re an alcoholic, but the fo formula is really familiar, and new members know what to expect.
posted by Middlemarch at 11:22 PM on June 14, 2018 [3 favorites]

- Who cares about me?

- Who do I care about?
posted by amtho at 11:30 PM on June 14, 2018 [1 favorite]

Best answer: A big thing for me would be a code of conduct. It sounds obvious but some people can abuse these types of groups and behave badly, while blaming it on their addiction/illness. Coming up with a clear description of types of behavior that are allowed/not allowed, and what happens if the rules are broken, would make it a safer place for all.
posted by rogerrogerwhatsyourrvectorvicto at 11:55 PM on June 14, 2018 [12 favorites]

I've attended 2 recovery focused groups in the past, and one thing they both did was read a page from, The Language of Letting Go at the end of the meeting. It's a journal-style book with a dated page for every day in a year and each pass has a short inspirational read that is recovery-focused. It was a good way to lighten up the often heavy mood of the group before everyone departed.
posted by OnefortheLast at 12:35 AM on June 15, 2018 [2 favorites]

Best answer: Would you attend if it was in your area?

I would never attend a multiple addictions group back in the day because honestly, while in recovery I needed exposure to less things to be addicted to, not more things to be addicted to. I understand that fundamentally, all addictions are the same, but while trying to distract myself from my personal addiction, had you pointed out a person with a sex addiction, I would have been all over that person like white on rice. Which obviously would have ended poorly for them, but also for me.

Which is shitty for sure, but addicts new to recovery are not renowned for being unselfish, amazing humans at that particular point on their personal evolutions.

Twenty years out, it's very different for me, and I could do this now without issue, but it is an issue for some people.
posted by DarlingBri at 3:11 AM on June 15, 2018 [3 favorites]

Code of conduct, yes, absolutely. Also, probably not at the pilot stage but in the long term, rotating group leadership so that the group doesn’t stagnate and become one person’s personal idea of How The Group Should Be, Forever and Ever, Amen. These are things I have seen go terribly wrong in past support group settings and am not interested in being part of again.

That said, I would likely not go to such a group. The things I need support and help with re: mental health are things that are exacerbated by substance abuse discussion and I would not find it helpful to be in a combined group with people there for substance abuse recovery. The help of support groups for me is very specifically in shared experience with the specific thing I struggle with, not more generally with shared struggles re:mental health, much less mental health + substance abuse + other things.

All of that said, I don’t want to be discouraging. Recovery models absolutely need to be rethought, and dual diagnoses in particular are given short shrift, and I think it’s a great idea to experiment with new formats and approaches. I just don’t think it would be for me personally. But if it were in my area I would be willing to give it a shot for a meeting or two*, I just would be surprised if it worked for me in the long run.

*if there were a clear and actionable code of conduct
posted by Stacey at 5:05 AM on June 15, 2018 [2 favorites]

Response by poster: Oh, for sure on the code of conduct thing, that's absolutely essential, but I'd want to work the details out as a group. Open to ideas for specifics to bring up.

And perhaps I was not clear on the broader view-- I want to develop this as a format initially, but as it grows, people could start their own groups for the issues they face. That's the idea--people make their own content and change things as they evolve.

I also have a lot of ideas about the general principals and ideology to start with, but the whole thing is presented as subject to change.
posted by mingo_clambake at 6:36 AM on June 15, 2018 [1 favorite]

I might (have) attend(ed) in the early days of recovery. Am also surprised by people saying they wouldn't do "mixed substance"; we attended AA and NA meetings when I was in rehab and I found both helpful (but I was well aware I couldn't replace my one drug with another so I never would've tried).

I'm wondering if/how much you should position this as "non-AA recovery", since AA is the default and those looking for something else usually do so because they have a problem with the AA model. My worry is tho that something less dogmatic than AA (problematic as that may be) might just make less of an impact. The rigid framework is part of its strength. All the topics you list are very interesting, but I can just read about them online. So community and accountability are a huge thing IMO. (and yes, I wonder how much harder it will be to find volunteers to present a topic rather than just speak from their own experience. That's a fair amount of work.)

Reading the comments of people above, I wonder if it could be a support group without a focus on addiction at all, just on mental health issues that often underlie addiction. Anyway, I'm just rambling now, sorry.
posted by ClarissaWAM at 7:04 AM on June 15, 2018

Best answer: I did SMART when I was in treatment for bulimia. It was useful for me, and personally I was fine that most of the people were there for issues unrelated to my own. The accessibility and convenience factor coupled with the lack of twelve step weirdness were the deciding factors for me, and I thought it was cool to see how much an eating disorder and gambling addiction and alcoholism fundamentally have in common when it comes to issues around power and control, trauma, self-medication and self-soothing, etc.
posted by Juliet Banana at 7:24 AM on June 15, 2018 [3 favorites]

Best answer: Also, Portland is a great place for this. I think you will get plenty of people interested. For harm reduction strategies, I would specifically try to find a way to increase access to Narcan and Narcan training. It doesn't encourage use (you cannot get high on Narcan) and, with fentanyl popping up in drugs like coke and Xanax, it is relevant to more than opiod addicts.
posted by Juliet Banana at 7:26 AM on June 15, 2018 [2 favorites]

What you're describing is very similar to the format SMART Recovery dictates for their meetings.

I personally found the Sunday morning SMART meeting in Portland to be extremely helpful. I'm not sure if the same facilitator is running it now but they were very clear about the guidelines of the meeting and spelling out what SMART is and how it works.
posted by tmt at 8:35 AM on June 15, 2018 [3 favorites]

Best answer: We have a general all-around mental health and addiction program where I live that I've done a few times and found really beneficial. It's mixed substance, plus people with non-substance addictions (eating disorders, self harm), plus people who have trauma or mental illness as their primary problem. I think a big part of what made it work was a strong, enforced rule against going into detail about your substance or your problem behavior. No names of drugs, no dosages, no methods of administration, no calorie counts or specifics about binge foods, say "self-harm" instead of "cutting" or whatever else you do, etc. Which meant people weren't constantly triggering others with the same addictions or behaviors, and weren't constantly tempted by lovingly detailed descriptions of others' addictions or behaviors.

Actually, a lot of the other people who participated in addiction discussions there, I didn't even know what substance or what behavior they had a problem with. Which I think tended to steer the conversation towards generally applicable stuff about self-care, trauma, hopes, fears, etc, and away from specific obnoxious things that happen in specific drug scenes or whatever.

No idea if that's what you want or
posted by nebulawindphone at 9:07 AM on June 15, 2018 [2 favorites]

Response by poster: I appreciate the comments about SMART, and I've been to that meeting in particular, and it is indeed good. I find the format a bit restrictive, though, compared to what I had in mind, and honestly it seems stuck in a time warp. It's based on REBT, but there have been a lot of developments since then, and a much bigger diversity of modalities, but it is in part at least inspired by SMART. The benefit to having it set up this way is to introduce a wide variety of coping strategies by having the content be sourced largely by members.

I'm kind of thinking many people might use this as an adjunct to other things, groups, and support, and even rely on other groups for more structure, and I'm perfectly fine with that.

It's good to get a conversation, thanks everyone so far for their thoughts so far!
posted by mingo_clambake at 9:13 AM on June 15, 2018 [1 favorite]

Best answer: A little late to the post, but I think this is a great idea. I'm in the area but probably wouldn't be able to make it over to Portland very often.

One thing I would consider adding to the ideas or sessions list would be denial patterns, which are used in some treatment programs but not usually in groups like AA as far as I know. These include avoidance, minimizing, blaming, rationalizing, comparison, manipulating, and others.
posted by christopherious at 10:05 AM on June 18, 2018 [2 favorites]

Best answer: Oh man, if I were in Portland.... I've been peer support for the last five years in a few different modalities occupation wise (respite, whole health, criminal justice) and if I were in your area not only would I attend, I would volunteer.

When I read that you're imagining recovery as dynamic it gives me a piece of advice I want to give you right away: I urge you to buy and read through Intentional Peer Support. [memail if you'd like me to loan via Kindle.]
Just to gush about this particular system of peer support: Really understanding the difference between recovery narratives and crisis-logs has been transformative for me. The relationship building/conflict resolution principles laid out are simple, useful aids. Their power dynamic communication is unique, plus it's relevant in ways I didn't even realize I was missing in groups/peer support/therapy before. Many relationship difficulties and ultimately bad outcomes come down to power struggles that RESOLVE with ATTENTION. In other words, we can talk through it as long as we hold conversation as the way forward.

Reminds me of a pitfall: CODES OF CONDUCT. In my experience, there are two types of offenses: "deal breakers" and "conversation makers" -- try to figure out for yourself what specific behaviors would get any person kicked out and what actions mean they have to have a conversation with [you|the group|other authority figure as mandated by law]. Since I've never been to a good peer group that didn't start off with us brainstorming our own code of conduct, you should do that, but inevitably most of the suggestions are "don't [gossip|break confidentiality|be an asshole]" so we as moderators need to think a little ahead.
Asking for people to give us the behaviors we want works best when we can point out the behavior we want to have happen instead of what we don't want. Often I can point out areas of similarity and sum them all up with a nice verb instead of having 20 rules of "don't be [a dick specifically like this]". My gotos are often "Be respectful" (behaviors included are language, respect of the shared physical space or room as well as personal space, validating other people's experience, no asking for favors/$$), "Violations and disagreements are resolved with communication with the person in question first, then with additional conversation with [leader|the whole group|the appropriate parties] second, and never with violence." (anti-gossip/triangulation/drama plus gives you a handy escalation framework)

Remember your population when you think about the training you'll need to be the best group leader, and what insights you want to give any co-moderators/new group leaders/franchise builders: We're all of us people who needed desperately enough to escape that our escape mechanism broke, basically, which is why we're in the group to begin with--things going that badly means, rule of thumb, developmental trauma 95% of the time. Our population tends to both get taken advantage of more frequently in ways we can't easily escape AND have a hypersensitivity/allergy to problematic power dynamics, sometimes as a way to work out that first part.

The biggest pet peeves of my experience in recovery culture Bay Area style (so I assume you'll have this issue in Portlandia) is what I call So Open Minded The Flies Get In. Yes, I definitely prefer open-minded collaboration and "everyone has a role to play in the beautiful diverse universe" vs the Midwestern obsessive-self-reliance-self-destruct-on-your-own-time ethic I grew up with... HOWEVER my experience as a skeptic is that some people's bullshit detectors are full of shit. In other words: even if homeopathy, niacin flushes, colon hydrotherapy, chelation, or magnets have fixed/helped *your* problems, current verified scientific research dictates that's unusual and says more about you than the therapy. Since I'm tired of getting into arguments about whether or not water has a memory, I usually abstract this rule of thumb to:
"suggestions and advice should be at a general, not a specific level, based on our own experience." Basically, reminders that we're peers not experts applies for alternative medicine as well.

(In other words, it's fine to say "try acupuncture, it really helped me, talk to me after and I'll give you the number for the clinic I go to, they have low-income rates" but not "I take 500mg of cinnamon extract 4x daily to manage blood sugar and my A1C has dropped 1.1 so I bet you could stop taking all your diabetes meds no matter how much you over eat if you did it that way!")

The topic I'd bring up as a volunteer is self-management-- routines as actualization. 1st: physical self management, with extra strong focus on useful generalities: how do we experience our own needs for shelter, food, water, affection? How can we be good to ourselves and reconnect with our body, which often holds the trauma we are still trying so desperately to escape? But self management in terms of: How do we meet our own goals and soothe our own souls? How do we know when to reach out for assistance and when to lean back? How do we tend to our communities?
posted by saveyoursanity at 5:36 PM on June 20, 2018