Leighton (2007:437) argues that ‘recovery from addiction takes place in a cultural context’. The individual is an active player in the ‘culture of recovery’ supported by other people such as friends and family and treatment professionals. He contends that if it’s our very culture that pushes people into addiction in the first place, then ‘exit routes from addictions may well involve cultural factors. Culture changes: it is constantly created anew. The effectiveness of interventions may well depend on how well they understand and work with culture. Traditional addictions research hardly addresses these matters at all.’ Decorte (2011:38-39) argues that we are richer and deeper in complexity than what the molecules are doing in our brains. As addicts we are more than a combination of neuro-transmissions, dopamine receptors, amygdala and synapses activity:
One can observe that the long-term use of a substance has had an impact on someone’s brain, but that doesn’t mean one knows what is going on in that man’s or woman’s mind. We cannot reduce everything that bears meaning in life (including substances to a user), and the possible problems of the mind or soul, to processes in the human brain. There is a need for more sociological, anthropological, and even economic research, because the social, political and cultural factors that contribute to an increase or decrease of the popularity of various substances deserve much more scientific attention.
118 NIDA (2002:1) is focussing it research efforts ‘on the treatment processes in TCs to better understand how TCs work. Links between treatment elements, experiences, and outcomes need to be further studies to fully appreciate and enhance the contributions of TCs.’ I think there’s a real opportunity to follow a group of residents through treatment and complete some longitudinal research. What happens to them two years after treatment? What do they remember from treatment and what have they put into practice? Are they still connected with a recovery community or are they using again, and why? What was their experience of treatment and what are their reflections two years later? What’s working and why? De Leon (2004:101) maintains ‘specification of the active ingredients of the method and understanding the treatment process is critical to substantiate the validity of the therapeutic community approach, to justify its costs, and to improve the approach itself through research and training’. Can anthropological enquiry and evidence based practice be used to establish the long-term viability of health funding for the survival of residential treatment centres (Lees, 2004)? Moos (2004:132) states:
Much has been written about the underlying theory of how these change processes work, but they have rarely been examined empirically….By measuring specific indices of therapeutic community processes and services, and by linking these indices to patients’ proximal and ultimate outcomes, researchers can make a contribution towards theory-based therapeutic community programming.
I see opportunities to complete ethnographic studies in clients when they leave treatment, when we can be at our most vulnerable and anxious as we return to the wider society and its expectations. This is a massive change in the addict’s recovery lifestyle that cannot be underestimated. Morant (2004:265) states that ‘perhaps because of the therapeutic community focus on dynamics within the community, there has been less research and clinical interest in what happens after clients leave the community. Follow up research has tended to
119 focus on relatively specific treatment-outcome variables measured quantitatively, and our understanding of what this transition feels like for clients themselves is relatively small’.
In my own volunteering work, I constantly see the message of recovery being lost on the very individuals it is aimed at. I often wonder whether the recovery-based-concepts are driven mainly from the United States and Great Britain and whether they are being ‘lost in translation’ once they reach foreign shores. Roth (2011:1) argues:
[R]ecovery requires surrender to something other than the drug or process that defines the addiction. Finding a path that is different from the path of addiction is therefore central to the process of recovery. For such a path to have sufficient appeal to the addict, the signs on the path need to written in a language accessible to the addict. The language of the Twelve Step Programs, born and raised in the United States, may have language, and therefore ideas, that seem foreign outside of the United States.
The Twelve Steps were written over seventy-five years ago and our culture, our use of language and use of technology has changed since then. I can see some individuals struggle and grapple with understanding their own interpretation of the Steps and their own inability to take stock, slow down and really understand what’s going on. I once attended a seminar on the differences between “Baby-Boomers’, ‘Generation X’ and ‘Generation Y’ and the presenter said that with the rapid pace of technological change, it’s likely that new ‘generations’ will turn over once every six years. I wonder what recovery communities will do and can do in response? But regardless, there are people from all walks of life and all different ages who manage to maintain recovery and a life free of drugs and alcohol and addiction, and this begs the old question, “Why do they get it and others don’t?” My sponsor’s response:
“You can’t save them all. We’re only after one.” Why stop there?
120