Most people who work in recovery or are in recovery themselves, or both, would agree that social connections are important for long-term recovery from addiction. The level of external support individuals have is often referred to as Social Capital or Recovery Capital, which for the purpose of this article, we are defining as:
The abundance of positive social relationships and connections, specifically across the domains of social supports, spirituality, life meaning, and involvement in a recovery community.
Individuals coping with substance use or dependence are often treated as patients with an acute illness, as one would be treated in the ER or urgent care:
- Treatment; and
which research proves is not an effective approach to achieving sustainable recovery. Alexandre Laudet, PhD., Director of the Center for the Study of Addictions and Recovery (C-STAR) at the National Development and Research Institutes suggests that if one considers addiction to be a chronic condition, a conjecture increasingly accepted in the field, then being in remission (recovery) should be thought about in terms of a long-term process that unfolds over time, rather than a time-limited ‘event’.
The theory of recovery capital suggests that the more abundant our recovery capital, the greater the likelihood we will remain in recovery. We see the value of this connection to community at the very core of sober living environments and groups like Alcoholics Anonymous, an international fellowship of more than 2 million men and women with an alcohol dependence, and their associated groups including Narcotics Anonymous and Cocaine Anonymous. Not surprisingly, we see poorer outcomes and frequent relapse in those who leave treatment, even long-term treatment, without a social network to support them in recovery.
Longitudinal studies, like that of Dr. Laudet’s, exemplify the critical value of social and recovery capital at the various stages of recovery, allowing us to most effectively incorporate these practices into assessment, treatment planning and discharge planning. Whether you’re a staunch supporter of 12-step recovery, a believer in the value of psychotherapy or biomedical treatments, or have embraced the combination of these approaches, it is becoming increasingly more difficult to deny the impact of connections and social support in long-term recovery, both positive and negative.
Taking into consideration the number of connections isn’t enough to determine the impact they will have on an individual in recovery; rather, we must account for the value of each connection, or perceived value. The complex web below shows that our social and peer connections differ in impact based largely on perception. For example, communication can be seen as a sign of caring and concern–a component of emotional support–and therefore, helpful to recovery. In contrast, criticism (a form of communication) may be perceived as unsupportive and therefore harmful to recovery, regardless of intention.
What if having a large, closely-knit social and peer network was detrimental to recovery? The role of social networks and peer support in recovery has been studied for quite some time; and although the research overwhelmingly sways in the direction of the positive impact social networks play in our recovery, a recent NPR article about the increase in opioid abuse in rural communities–in sharp contrast–points to social networks as a main contributor.
The story follows Melissa Morris, whose story of addiction started like many others–with a prescription to Percocet, an opioid pain killer. She got hooked, and when the Percocet stopped getting her high, Morris then started injecting Oxycontin. After that, she got her hands on Fentanyl patches, a highly addictive and potent opioid, and would chew on them instead of applying them to skin as the package directed. When the prescriptions stopped coming, she turned to a cheap and easy option: heroin. Morris’ story is much like what we are seeing across the country, and especially in rural communities.
- The CDC reports three out of four new heroin users report abusing prescription opioids prior to trying heroin.
- In the U.S., heroin-related deaths more than tripled between 2010 and 2015, with 12,989 heroin deaths in 2015.
- According to the U.S. Centers for Disease Control and Prevention, opioids were involved in more than 33,000 deaths in 2015 — four times as many opioid-involved deaths as in 2000.
- A recent University of Michigan study found the rates of babies born with symptoms of withdrawal from opioids rising much faster in rural areas than urban ones.
So what role do social networks play in the opioid epidemic? The publication about rural Colorado, titled “Rural Colorado’s Opioid Connections Might Hold Clues To Better Treatment”, in addition to limited access to alternative treatments for pain like physical therapy, found in speaking with individuals struggling with opioid addiction that these communities saw an increase in misuse and dependence because rural residents know and interact with roughly double the number of people an average urban resident does. Counterintuitively maybe, this “small town” social network provides members of rural communities twice the number of opportunities to access drugs, according to Kirk Dombrowski, a sociologist at the University of Nebraska-Lincoln.
“So some of those social factors of being in a small town can definitely contribute,” Dombrowski says.
Melissa Morris of Sterling, Colorado. Credit: Luke Runyon/Harvest Public Media
But, like Dr. Laudet’s findings, the Colorado resident Melissa Morris describes how the size of your social network doesn’t define the risk, but rather, the value of the network is often at play. She says that close social ties in her town may have contributed to the spread of opioids there as those bonds can spread drug use quickly, however they can reduce the spread of drugs in other ways. Morris, who is now on Suboxone to help her with her opioid addiction, recently recruited two opioid-dependent friends to the clinic she goes to weekly for treatment.
“I used to sell them pill and heroin,” says Morris, who is now helping these friends get clean. “And so I do have hope. I’ve seen those success stories.”
This consideration of the value, and perceived value, of social networks has great implications for the field of addiction research and treatment. Often times, providers ensure clients broaden their social network and surround themselves with “positive influences”, but as treatment providers, it should be a regular practice to give individuals in recovery the tools needed to regularly take an inventory. We should assess the impact individuals have (are they helpful or harmful?) often as this can frequently change, as our once drug dealers can enter treatment and have a positive impact on our recovery.
What if I told you that there were three (very simple) things you could start doing today that would make you a happier person?
Ex-Google engineer turned mindfulness expert, thought leader, author and philanthropist, Chade-Meng Tan, discovered there really are a couple of things every one of us can start doing each day that will bring joy into our lives, and as a result, make us happier. Meng, as he likes to be called, meditates for hours each day, which the majority of us cannot do… but thankfully, he offers the world the practical application of his education, practice and teaching.
I heard Meng speak on a few podcasts, which I highly recommend if you have the time to check them out: 10% Happier and Note to Self.
I began doing these things as soon as he suggested, because, well, who wouldn’t want to bring more joy, compassion and loving kindness into their daily lives? It works. Meng offers that in order to achieve the depth of cultivation of one’s mind, one must practice like anything else; however, if you have 15 seconds to spare right now, you can improve your outlook, your state of being, and your life.
So here they are, your keys to joy:
1. Bring attention to your breath.
Sounds simple, right? For some people it is, and for others who find it difficult to sit and be present, this can be massive undertaking. Meng says, give yourself 15 seconds for this exercise, 5 seconds per breath.
First breath – Just bring attention to it, be aware of the breath in, and the breath out.
Second breath – Do the same, but this time relax your body, whatever that means for you.
Third breath – Now smile, while you breathe in and out with your body relaxed.
Now, try it. That smile should have brought a subtle sense of joy.
2. Wish happiness to others.
This is the practice of raising the thought to your conscious mind when you see someone of wishing them to be happy. You can do this for people who walk by you on the street, or you can bring the thought of someone in your life and just think to yourself as you picture them, “I wish them happiness”.
You’ll notice that as you do this, being the giver of compassionate loving kindness to others makes you feel this loving kindness yourself.
3. Raise your awareness of the tiny slices of joy already present in your life.
How often do we go our entire day, caught up in our routines and responsibilities, that we forget to appreciate the little things? Too often, is the answer I was looking for.
Our world is filled with what Meng calls “tiny slices of joy”–from taking the first sip of coffee in the morning, the feeling of the hot water from the shower hitting you, laying down in bed and feeling your head sink into the pillow–these wonderful, fleeting moments that we don’t take the time to acknowledge. His belief is that if we allowed ourselves to be present in these moments, we could experience this joy all day long.
Practicing these three simple things each day, experiencing joy and allowing yourself to be present in the moment will inevitably improve your well-being. On why the practice of mindfulness works, Meng says:
To worry you need to be in the future, to regret you need to be in the past. So if you take one breath of being in the present, then for that one breath you are free – you are free from worrying and regret.
And we agree.
Chade-Meng Tan (Meng) is a Google pioneer, award-winning engineer, international bestselling author, thought leader and philanthropist. He is Chairman of the Search Inside Yourself Leadership Institute, and Co-chair of One Billion Acts of Peace, which has been nominated eight times for the Nobel Peace Prize.
In 2014, Dr. Nadine Burke Harris gave a brilliant talk at TED Med describing what she discovered about childhood trauma as she began digging into a trend of high incidence of ADHD in children in her Bayview-Hunters Point clinic in San Francisco.
The featured image in this post is from photographer Alex Welsh, who spent two years documenting images of the violence, gang involvement, grief and loss, and other trauma the children and adolescents of Hunters Point are regularly exposed to. To see more, visit his site.
Watch the 16-minute TED Talk here:
Nadine Burke Harris’ healthcare practice focuses on a little-understood, yet very common factor in childhood that can profoundly impact adult-onset disease: trauma.
Why you should listen
Pediatrician Nadine Burke Harris noticed a disturbing trend as she treated children in an underserved neighborhood in San Francisco: that many of the kids who came to see her had experienced childhood trauma. She began studying how childhood exposure to adverse events affects brain development, as well as a person’s health as an adult.
Understanding this powerful correlation, Burke Harris became the founder and CEO of the Center for Youth Wellness, an initiative at the California Pacific Medical Center Bayview Child Health Center that seeks to create a clinical model that recognizes and effectively treats toxic stress in children. Her work pushes the health establishment to reexamine its relationship to social risk factors, and advocates for medical interventions to counteract the damaging impact of stress. Her goal: to change the standard of pediatric practice, across demographics.
Will I lose my job if my employer finds out about my current or past substance use or mental health disorder?
How will I get the time off of work to go to treatment?
Am I protected if my company discriminates against me for being in treatment or recovery?
These are probably the most common questions we get asked when someone calls for treatment for themselves or a loved one. These concerns can create unmanageable and unnecessary fear if one is not aware of how you or your loved one is protected by state and federal laws. First and foremost, if you are coping with a substance use disorder and are employed, you are not alone.
The National Council on Alcoholism and Drug Dependence reports that:
- 70% of the estimated 14.8 million Americans who use illegal drugs are employed.
- Workers who report having three or more jobs in the previous five years are about twice as likely to be current or past year users of illegal drugs as those who have had two or fewer jobs.
- Large federal surveys show that 24% of workers report drinking during the workday at least once in the past year.
- A hospital emergency department study showed that 35 percent of patients with an occupational injury were at-risk drinkers.
Fear of what might happen at work can often push people into the shadows and prevent workers from seeking help. The reality is that not seeking treatment for a drug or alcohol addiction is more detrimental to one’s health and can lead to more damaging effects in the workplace. Fear of discrimination should never be a deterrent for seeking treatment when considering the levity of the situation, which is often life or death. Understanding that mental health and substance use disorders as debilitating to daily functioning, protections and federal laws are in place to ensure you or your loved one are extended the same liberties as someone suffering from a heart disorder or cancer.
The Four Protections in Place
From the Substance Abuse and Mental Health Services Administration’s Know Your Rights:
Federal civil rights laws prohibit discrimination in many areas of life against qualified “individuals with disabilities.” Many people with past and current alcohol problems and past drug use disorders, including those in treatment for these illnesses, are protected from discrimination by:
- The Americans with Disabilities Act (ADA);
- The Rehabilitation Act of 1973;
- The Fair Housing Act (FHA); and
- The Workforce Investment Act (WIA).
Non-discrimination laws protect individuals with a “disability.” Under these Federal laws, an individual with a “disability” is someone who –
- has a current “physical or mental impairment” that “substantially limits” one or more of that person’s “major life activities,” such as caring for one’s self, working, etc.;
- has a record of such a substantially limiting impairment; or is regarded as having such an impairment.
Whether a particular person has a “disability” is decided on an individualized, case-by-case basis. Substance use disorders (addiction) are recognized as impairments that can and do, for many individuals, substantially limit the individual’s major life activities. For this reason, many courts have found that individuals experiencing or who are in recovery from these conditions are individuals with a “disability” protected by Federal law. To be protected as an individual with a “disability” under Federal non-discrimination laws, a person must show that his or her addiction substantially limits (or limited, in the past) major life activities (SAMHSA)
Leaving work to Get Treatment
California law provides stronger protections to employees who suffer from alcoholism and drug addiction than the federal law does. One legal site reports, “Alcoholism and drug addiction are medically recognized diseases that affect millions of Americans, and under both California and federal law, they are considered disabilities. Employers are required to provide reasonable accommodations to permit affected employees to seek treatment and are prohibited from discriminating against employees because of alcoholism or drug addiction.
While employers are free to terminate and can refuse to hire anyone whose alcohol or drug use impairs their ability to perform the duties of their job, employers cannot fire or take other negative employment actions against an employee because of their status as an alcoholic or drug addict. California and federal laws recognize alcoholism, and to a lesser extent, drug addiction, as a disability and many employers are required to to provide reasonable accommodations – usually time off to seek treatment – to employees who seek help”.
The following California Labor Codes can be used as a reference:
- California employers who employ more than 25 people are required to provide reasonable accommodations to employees who wish to participate in an alcohol or drug rehabilitation program. Typically, this means that the employer must allow the employee to take leave or time off to participate in the program. The accommodation must be provided unless it would cause an undue hardship for the employer. Cal. Labor Code § 1025.
- Employers must also make reasonable efforts to preserve the employee’s privacy concerning his or her participation in an alcohol or drug rehabilitation program. Cal. Labor Code § 1026.
- While employers are not required to provide paid time off for employees to seek treatment, employees may use any paid sick leave time they have accumulated to attend a rehab program. Cal. Labor Code § 1027.
Employee Assistance Programs (EAPs)
Employee Assistance Programs or EAPs are “workplace-based programs designed to address substance use and other problems that negatively affect employees’ well-being or job performance” (Merrick et al., 2007). The vast majority of workplaces with 100 or more employees and almost all of Fortune 500 firms (90%) have an Employee Assistance Program. A journal published by Dr. Elizabeth S. Levy Merrick reported that, “Most contemporary EAPs are ‘broad-brush’ programs that address a wide spectrum of substance use, mental health, work-life balance, and other issues. In some cases, short-term counseling is sufficient to address a client’s needs. In others, the client is assessed, referred to behavioral health treatment outside the EAP, and provided follow-up support as needed”.
The director of your EAP may recommend a treatment program where they have a relationship or one they’ve heard about, but remember that you have the option to go anywhere you choose. Depending on your insurance coverage, treatment through Roots through Recovery may be covered in full or at least in part once your deductible and out-of-pocket are met. If your employer does not have an EAP, speak to your company’s human resources representative, and remember that you are protected from discrimination.
What if I’ve been discriminated against?
Attorney Brook Pollard of the firm TLD Law in Long Beach, CA offers the following:
“Discrimination or harassment against a disabled person, failure to accommodate a disability and/or retaliation against someone for requesting an accommodation, are against the law. If you believe you are a victim of unlawful action (or inaction), you can file a complaint with the California Department of Fair Employment & Housing or the Federal Equal Employment Opportunity Commission. You should also promptly consult private legal counsel to discuss your rights and obligations (such as ensuring that applicable Statutes of Limitation are met). Make sure you have journaled dates, times and the content of all conversations and events so that when you present your claim, you have all material information at your fingertips.
TLD Law has employment attorneys that can assist both companies and individuals to navigate these important matters. Check out their website to find an attorney to assist you: www.tldlaw.com