rockville, maryland; dr. a. thomas mclennan, deputy director, white house office of national drug control policy, washington, d.c.; dr. alexandre laudet, addiction and recovery scientist, new york, new york; james smallwood, founder and ceo, the choice is yours, inc., camden, new jersey. pam, how many people in the united states are in recovery? well, the estimates are about 20 million people are in recovery, working on being free of drugs and other-and alcohol. and, alexandre, what is recovery? what are some of the common paths to recovery? well, that's really two different questions. what recovery is, according to people in recovery themselves, is usually, especially for people severely addicted, it is abstinence from drugs and alcohol, as well as

significantly-significant improvements in other aspects that constitute quality of life, such as employment, social relationships, mental health, physical health, housing, as well as access to leisure and-and activities that contribute to a healthy and productive life. and tom, why don't we give you the second half of that question, then. what are some of the most common pathways to recovery? i think that's an excellent question. i had the privilege of being with alexandre as a matter of fact, being part of a betty ford panel that-that looked at just that question. and i think, while aa 12-step is perhaps the most common, it was the agreement of that group that there is no single way to recovery, that, in fact, there are many ways. expanding a little-that's important because at least in that setting it was agreed that you could be on-in recovery, meaning the qualities that

alexandre just talked about, but also be on a maintenance medication. and so i think many people don't realize that. some people can be sober, have good personal health, good social relationships, good citizenship, and be maintained on-on-on a medication. it took a while to get there. i remember when the first concept of recovery came along, you know, we had to work at the concept of including medication-assisted therapy, individuals within that cohort of what was considered recovery. pam, what are some of the principles of recovery? well, i think in order to talk about the principles, you have to know a little bit about addiction and why you're trying to get to recovery. because addiction does more than just make it hard for people to stop using drugs and alcohol-it disrupts their lives, it disrupts their families, it disrupts their living situations, their friends.

so i think some of the principles have to do with all of those things. there's many paths to recovery. so just as every human being is individual, their path to getting there is individual. there are principles about getting your life back, and that's why what alexandre said is so important-is that recovery has to do with all of those aspects of life. james, you've been there, along the path to recovery. you want to share with us some of your experiences? well, my experience has been that in-in-in the addiction itself, we're addicted to a drug, to a substance, and that the-the problem with that is that there's a problem within us that causes us to want to use a substance to hide from that-from-from, hide from the problem. and that my path was that there was a problem in me that i'd never took a look at. and so i chose to use crack, whatever it was, or other substances to-to medicate that,

until i came to the point to realize that i was sick and tired of being sick and tired of following that path, of living that way which had led me to homelessness and other things like that, that i said well, you know, what can i do? and at that point i had very little answers. but as-as-as my word says, i just needed the faith of a mustard seed to realize that i couldn't do it, if somebody else could do it, so i-i-i walked many, many miles to a rehab center. what was that aha moment? you know there usually comes a moment along the path of someone that has an addiction that finally-you know, in aa you said you're sick and tired of being sick and tired, for example. but what was the moment where you basically said this is enough? you say this is enough when the crack no longer gets you high, when the heroin no longer has an effect, when the marijuana which is laced no longer has an effect. when these things no longer have an effect, you're just doing it now out of an addiction, not really getting high any more, but becoming

more and more frustrated. and it comes to a point where you just say, well, you have two choices left in life: to die or to live. i chose to live. so i chose another path not knowing what i was doing, but something different than what i was doing. i had no answers at all to-to-to what the addiction thing was. but i knew that i was sick. tom? you know, i'd like to add to what james said there. a lot of people think that addiction is just a lot of drug use. it's not. what james just talked about is a change, a biological change in his body. he wasn't getting high any more. his brain was adapted to the-the drugs that were used. and that's so typical. and the other thing he-he mentioned is there's something wrong with us. you-you-you have to understand that while substance use is really a function of availability and access, almost anybody will use, addiction itself is largely biological and genetic. you have a gene that gets expressed.

and that-and we don't know how, we don't know what goes on, but once that happens you've got a disease, and it's a disease that frankly we don't have a cure for. but it's one that can be managed, through recovery. and that is indeed the whole issue of dealing with it as a medical condition, and-and, as such, how do we begin to heal the whole person? pam? well, i think the conversation we had a little bit earlier about medication-assisted treatment goes along with this, because the more we understand the biological nature of addiction, and we're learning more and more through research about what chemicals happen in the brain and why this happens to some folks and not others, but it helps us understand the diseased process of this. so whether it's a medication that assists-assists that process or whether it is a mutual self-help approach or whether it is frankly-some people go through natural approaches, some people use ... or spontaneous.

or spontaneous. some people use nontraditional approaches, like acupuncture, yoga, or meditation. some people use all of those. and i think not only is the path to addiction pretty individualized, but the path to recovery is very much individualized as well. if i may add to what pam just said, addiction is-has been said thus far, more than substance use, it's a biological disease, but it's also a condition that affects all aspects of functioning. and therefore to get to your-answer your question about how to recover, to help the whole person recover, promoting and sustaining abstinence from drugs and alcohol is perhaps the first step for many, but it's not all there is. and these aspects, when you ask me what recovery is, and i mentioned other domains that constitute quality of life, recovery is giving people strategies and tools and resources to have a chance to improve those other areas of functioning.

if you just get the person to stop using, but their housing doesn't improve, their physical, their mental health, their employment, their family functioning, they will go back out and relapse in all likelihood. so that's the whole person, and every aspect of the person's functioning, really has to be promoted and improved. and, tom, really that is-that is the crux of it. i mean, there are some conditions that call for not only the person being treated for their addiction but also for their mental illness. and in those cases the process is a little bit more complex, and-and-and it entails more inputs, correct? yes, absolutely. but it's not different for these illnesses than it is for other illnesses. if you look up dual disorder, for example, in medical term-you'll see hypertension and diabetes. so most people have multiple conditions, and it does make things more difficult, but not impossible. we have very good treatments.

we have good ways of arresting symptoms. but, as alexandre said, recovery is much more than simply not using drugs. and i-i really want to emphasize for people who might be watching this and saying "oh, i don't know, i can't imagine giving up my drugs." you know, i think james is probably the expert at this table, but the untold secret is that recovery is a very attractive, happy way of life. that's what sustains it. it's that quality of life. abstinence is a cardinal feature. but abstinence by itself is not going to do it. and like you said- james, go ahead. if i may add to that, that abstinence alone, you're correct, does not do it-that just like the attraction to using drugs was being around people who used drugs. that was part of it right there. and so once we choose to come out of the box and say "i don't want to use it anymore, but what do i do?" it's being around those people now in the 12-step programs who have stopped using and seeing people with 25,

30 years who have been without drugs is the other attraction for me. now along with that you also mentioned diseases that come along, the diabetes, the hypertension, all the other things. that's part of it. so we are left with a scar of some sorts. but does that require to go back and use again? no, because we've been given the tools necessary to stay clean and sober... right. ...and still have the diabetes, the hypertension, the other things that come along with it, the arteries, those things, the heart disease maybe, the leaking valve in the chest, and all those kind of things or the things which are produced from using drugs. when we come back, we will be talking about more on the vein of how to sustain individuals in recovery and also to look at some of the models that we currently have. we'll be right back. (music)

sustaining recovery and maintaining resilience really has to do with creating structures in which people can get help they need when stressors happen, when issues arise that make them think they need to go back to the drug and alcohol use that they may have engaged in before. this is not any different than any other disease; there are things that happen that make people with diabetes go back into the hospital or go back into treatment or go into a different kind of care. same thing is true with substance abuse. there are stressors, there are oftentimes when people will relapse; this is normal. what we want to do is help people maintain ways not to relapse and have the kinds of structures and support, the friends to call, the nondrinking, nonusing atmosphere to be in, the right kinds of places to live and be that they can

get away from those stressors. those are kinds of things that will help that process. i don't think we should think of relapses or slips as an indictment of the recovery; i.e., a person who has had a slip or a relapse shouldn't be viewed as having failed recovery. what that person should recognize is that slips and relapses may occur, they're not inevitable, but they may occur. and if they occur what the person needs to do is to engage in support and treatment if it's indicated, so that they can pursue their recovery with new emotional or psychological vigor. people who suffer from drug or alcohol addiction sometimes say hurtful things. they drive the people who love them most away. if you know someone suffers from drug or alcohol addiction, listen, try to hear what they are really saying, know that there is hope, and help them find their voice again.

for drug or alcohol treatment referral for you or someone you know, call 1-800-662-help. brought to you by the u.s. department of health and human services. people trapped by drug or alcohol addiction often feel like there's no hope, no way out. but for every lock, there's a key. and if you have a problem, it's good to know there are real solutions to help you get free. for drug or alcohol treatment referral for you or someone you know, call 1-800-662-help. brought to you by the u.s. department of health and human services. (music) i've been able to pay back and help those who try to

seek recovery by my focus on my own recovery, focusing on how do i stay where i am in my recovery, focusing on not only on-on-on the drugs, the alcohol, and those kinds of things, but focusing on the positive part of recovery, such as staying in the business i am right now, such as maintaining relationships with my family, such as being able to continue to pay my mortgage or my rent, or be able to have the things of life i didn't have when i was on the streets in my addiction. tom, i'm going to start with you. what are some of the economic benefits of getting people into recovery? now there's an untold story if ever there was one. let's start with the economic problems associated with addiction. and let's just start with some of the common drug-related occurrences. arrests-an arrest is about a $12,000 incident. incarceration is $35-$25 to $45,000 a year

for an incarceration. separation of a child and a mother through welfare separation due to substance use-i don't actually know what the number is there, but it's a very big number. now let's move to health. an emergency room visit is about $2,500 to $5,000. you know, chronic problems, as james was saying earlier, chronic problems caused by addiction, you know, that's a huge amount. in health care alone, addiction is expected to cost $100 billion. okay? so recovery is a tremendous economic investment. now here's the other problem, though. we know a lot about the problems of addiction. we know a lot about the cost. we have not studied recovery near as much as we should. alexandre is one of the few people here who has been really studying this.

we need a science of recovery just as much as we need a science of addiction. ivette, this is one of the biggest costs to businesses. and i think sometimes the u.s. chamber of commerce or business leaders don't understand that. and we need to really help them understand that. lost productivity-just as you've heard people being concerned about their child or having to be in treatment, ending up in emergency rooms, whatever, it really goes to the cost of doing business. and that's something we really need to get the word out about. james, i'm-i'm going to go back to your experience. and i-i-i want to be able to frame it in a way that, as we're talking here the focus of our show is-is on recovery. obviously you went through a program, and you were out. did you feel at that point that you didn't need any other support, that basically you had done your duty, you had gone to the various x number of units of care, and you were ready to-to rejoin society?

how did that transition take place? and how, what types of-of components or elements did you find were necessary for you to sustain your recovery? well, coming out of the streets, coming out of the actual use, going into a rehab, and coming out of rehab was only the beginning of the road to recovery. i like to say that the abstinence from the drug itself is one part, but dealing with the mental and the-the-and the emotional effect that the drug had on you after recovery is another part. a lot of us today still deal with the, with the part of, whether it's paranoia, which might remain with us, which is the part of unsured-ness with ourselves, although we're not using, those things might remain with us. so what helps us is the fact that we still have a support system, whether it's aa, na or whether it's other people like us who are still in recovery, which helps us to maintain that recovery that we desperately want so much. i realized that the problem that i have right now is not a drug problem.

but if i don't deal with the mental aspect of what's wrong with me, that i could go back to drugs. so i must steadily stay focused on the fact that if i have the other paranoia, if i have the other schizophrenia, one of the things that can remain with us after recovery, that i must take a look at those and deal with those on a daily basis. we don't want to go back. i've been over 20 some years now in recovery, which i'm proud of, but i realize that there's some things today in my life which still go on, which resembles me back to... but what did james do? in other words, you got out, and how did you you obviously right now, you have a wonderful model program that i want you to share with us at some point, but tell us how you came out and you said, "i'm going to remake my life?" and what steps did you take in order to-to basically pull yourself out of the whole addiction process and into your recovery? well, let's say this to you, when i came out and i went to my first meeting and i went to my second and third meeting that i was still afraid to come out, outside.

i live in new jersey; i was still afraid to cross that bridge back into philadelphia. so i spent most of my first year at home doing oil paintings by the numbers and doing things like this to really talk to myself and regroup myself until i was able to come out. this was not done without the supervision of a sponsor, who was very, very heavily in my life, who loved me enough to criticize me and let me know what i was doing wrong. but getting to that point, i don't think there's nothing that james did all by himself. i think it was a group effort by a lot of people who influenced me, who had already been where i was, who was 20 and 30 years sober when i was only two years sober. so i lived, i trusted them enough, i loved them enough, and i wanted what they had enough to try to emulate them and try to take a look, how did you do it, i'm going to do it. and so today i am here today, proud as i say of not using drugs today, but there may be some symptoms from the actual use, which still may be present.

go ahead, tom. well, actually, pam and i are now both in government jobs, and we come in contact with congressional people. and what james just said is the single toughest thing for people who don't know this field to understand. they say, okay, james, you were-you had drug problems, let's just put you in jail, the drug problems will dissipate, you won't have a drug problem, what's the problem? it's done. and that's the difference between abstinence and recovery right there. what james said-it's the gift that keeps on giving-you have these habits that are deeply engrained, you're surrounded by stimuli that call you back to the old ways. and you, especially if you've been using drugs for a long time, you haven't developed social skills and good friends and social supports to help you. so putting it in a very proactive way; individuals after treatment need to develope those... a new lifestyle ...connections, right, pam? that's right. sometimes people need to deal with housing.

they literally need to go live a different place, in a different neighborhood, maybe they ended up as james did homeless and had to start over with just finding a house. they need to find different friends. their whole life before was based on friends that drank or took or used with them. they have to develop different inner strength. and that may for some people be spiritual, it may for other people be meditation, other kinds of things. so it's like, literally i think, rebuilding aspects of people's lives that sometimes we take for granted. and i do just want to build on something tom said, because i think it's really important; i hope people don't think this is heresy, but there are so many communities who want to build a detox center, and i tell them over and over and over again, you are wasting your money if all you're going to do is build a facility with all of its capital costs, put in operating dollars, so you can bring someone in, detox them, and send them right back out there.

so if we don't have something happening once somebody walks out of that facility, then we might as well not do the detox in the first place. this is where the oxford house, you know, i was there at a meeting of theirs, and-and it's-it's a marvelous concept. it really provides the housing, they are self-managing, and they get work, and then they pay the rent. right, alexandre? yes. i think one of the, two of the points that james made are that, and one of your main contributions to the field and there are hundreds of them, it was saying addiction is a chronic relapsing disorder. and so i always ask people, when i make presentations about the science of recovery and the science of addiction, that if you have diabetes you don't graduate from diabetes treatment. people graduate from addiction treatment, and i think, even though society apparently is coming closer to buying the disease model as opposed to the moral failure view of addiction, people still think,

as you just said, stop using-just say no, stop using, and everything falls back into place; and then people stop using, suddenly become with a clear head aware of all these other problems they have in housing, family, they're hiv positive, and all that. and they have really no strategies to deal with it other than going back to substance use. so we need to do a better job at addressing these other areas of life which were affected by chronic addiction. and that needs-needs to be improved, and have hope, as you said, models and hope that we can get better, that people can get better. i just want to tie it back to what pam said-if addiction were just drug use, then a detox would be the perfect answer: it's quick, it's expensive, but it's quick. it's not. that's the reason we're talking about recovery. recovery is a whole different thing. eliminating the symptoms of addiction is a good start, but it is not the end.

it's not the end of the journey. and when we come back, we'll continue to talk about the journey. we'll be right back. (music) it's important to be familiar with the proper terminology surrounding addiction and recovery. one of the terms you'll want to be familiar with is "peer-to-peer recovery supports." peer-to-peer services support recovery and are designed and delivered by peers: people who have shared the experiences of addiction and recovery. for more information on this and other recovery jargon, visit the recovery month web sites. (music)

treat me. treat me with understanding. treat me. treat me with courtesy. drug and alcohol addiction is an equal opportunity disease. individuals in recovery come from all walks of life and deserve to be treated with respect and admiration for winning one of the hardest battles there is. treat me without judgment. treat me with humanity. alcohol and drug addiction deserves proper treatment. for drug and alcohol information and treatment referral, call 1-800-662-help. i'm a sophomore in college this year. man, if you had known me when i was a sophomore in high school, nobody could tell me anything. i gave all my teachers a bad time. they all gave up on me, except my english teacher. eight years teaching high school english, 10 years in recovery for alcohol addiction. to be or not to be. i got help.

that's it right there. when you get help, who knows just who you'll help along the way. for drug and alcohol information and treatment referral for you or someone you know, call 1-800-662-help. (music) chase partnership house was formed about 24 years ago actually when a guy by the name of william chase froze to death on the streets of rockville. the chase partnership has a number of supports and-and-and programs that we run here to help develop and sustain recovery. we have relapse prevention groups. we have core care and disorders groups. we have general counseling. the staff is always available for the guys to talk to when they have issues or problems going on. we have house meetings and life skills groups.

good afternoon, chase partnership house, yolanda morris speaking. we provide a lot of services. we assist them with all the things that's going to help transition them to independent living, because we're transitional housing. and part of the things that people forget, they think it's just, okay, they went from a shelter, they're trying to get their life together by staying sober, but staying sober is not just it; you know, they need to learn, a lot of the guys need to learn how to do applications, they need to learn how to do resumes. they need to know how to present themselves. when i moved over here, it was different. it was more therapeutic here. you know, you come in the door, you have to take your hat off, you know. everything was therapeutic. and really, and i sit back and i look at that now-that's what grounded me, because i had to start over, like a kid. we promote stabilizing long term. there's no way that 28 days is enough when some of these guys have been using and drinking for 30 or 40 years.

mind you, detoxing programs like that is a necessity. but they need to have some place else that they can fall back on to-to-to make that foundation strong. the benefit in being at chase and the reason why we're successful is that we help that foundation get strong through the peer-on-peer, through the meetings, through the groups, through the interaction. we-we pretty much do everything together. one thing that helps me maintain my recovery is working at chase. it keeps me fresh. i see the guys, their struggles, and it reminds me of me, many, many years ago. peer-to-peer recovery service, i think, is really the only way that things can work for a person who doesn't have any knowledge about what it's like to deal with day-to-day stresses without some type of drug or-or alcohol.

when you have others that have experienced some of the challenges and have made it through without pickin' up, you have a chance to talk to somebody about it before you make a decision one way or the other about how to handle the situation. yeah, if you look back over and ask the guys "where you got most of your help," they will say somebody, maybe a counselor or a director, gave him an idea or pushed him in the direction. but when you ask them about "well, where did your real support come from?" it comes from the network that they're building a program like this that helps them through this program and helps them and follows them out into the community. when i think back to when i first started, i felt there was no hope. but, the key is-is there's other people out there that don't think that of you. and i-i found that i had to lower my ego and accept help. all the people filter through my life, and this is what i got out of it.