Pathways

by White, William L.

• ISBN13: 9781568381237
• ISBN10: 1568381239
• Edition: 2nd
• Format: Paperback
• Copyright: 1996-03-01
• Publisher: Hazelden

Summary

Second EditionThis guide examines addiction and recovery as a cultural phenomenon and describes the cultural aspects, organization, key cultural roles, and milestones that most addicts share. It examines how to move clients out of their drug-using culture into a new world that promotes abstinence and healthy ways of living. A comprehensive look at the drug-using culture including concerns for intervention and treatment. William L. White, M.A., Senior Research Consultant at the Lighthouse Training Institute in Bloomington, Illinois, has nearly three decades of experience in the substance abuse field.

Table of Contents

Dedication	v	(14)
Preface	xix	(2)
Acknowledgments	xxi	(2)
Prologue	xxiii
Part I THE CULTURE OF ADDICTION	3	(172)
Chapter 1. CULTURAL ASPECTS OF ADDICTION	3	(14)
1.1 Pilgrims and Pathways	3	(1)
1.2 Culture of Addiction Defined	4	(2)
1.3 The "Species" of Addiction	6	(2)
1.4 Culture as an Initiating Force	8	(1)
1.5 Culture as a Sustaining Force	9	(1)
1.6 Styles and Intensity of Cultural Involvement	10	(1)
1.7 The Acultural Addict	10	(2)
1.8 The Culturally Enmeshed Addict	12	(2)
1.9 The Bicultural Addict	14	(3)
Chapter 2. ORGANIZATION OF THE CULTURE OF ADDICTION	17	(18)
2.1 Tribal Networks	17	(1)
2.2 Tribal Selection Based on Drug Choice	18	(3)
Celebrated Drugs	19	(1)
Tolerated Drugs	19	(1)
Instrumental Drugs	19	(1)
Prohibited Drugs	20	(1)
2.3 The Celebrated Drug Tribes	21	(3)
2.4 The Instrumental Drug Tribes	24	(3)
2.5 The Tolerated Drug Tribes	27	(1)
2.6 The Prohibited Drug Tribes	28	(4)
Quality Control	29	(1)
Drug Dosage	29	(1)
Screening Out High-Risk Users	30	(1)
Withholding Technology That Could Reduce Risks	30	(2)
2.7 Relationship to Other Deviant Cultures	32	(3)
Chapter 3. THE PSYCHOSOCIAL AND TECHNICAL FUNCTIONS OF THE CULTURE OF ADDICTION	35	(16)
3.1 Identity and Self-Esteem	36	(3)
3.2 Transforming Stigma to Status: Identity in the Illicit Drug Culture	39	(2)
3.3 Adolescent Needs and the Culture of Addiction	41	(3)
3.4 How to Use	44	(2)
3.5 Learning to Experience the Drug	46	(1)
3.6 Skills to Sustain Addiction	47	(4)
Chapter 4. CORE ELEMENTS IN THE CULTURE OF ADDICTION	51	(34)
4.1 Language	51	(2)
4.2 Religion, Morality, and Values	53	(3)
4.3 Symbols	56	(1)
4.4 Rituals	57	(2)
4.5 History and Mythology	59	(1)
4.6 Institutions (Places)	60	(1)
4.7 Dress/Appearance	61	(1)
4.8 Diet/Food	62	(1)
4.9 Music	63	(1)
4.10 Art	64	(1)
4.11 Literature	64	(2)
First-Person Accounts of Addiction	65	(1)
Technical Books on Drugs and Drug Effects	65	(1)
The Recipe Books	65	(1)
The Law Books	65	(1)
The Promotional Journals	65	(1)
4.12 Visual Media	66	(3)
4.13 Work and Leisure	69	(4)
4.14 Sexuality	73	(2)
Sexual Trauma	73	(1)
Sexual Orientation	74	(1)
Sexual Values	74	(1)
Sexual Shame and Guilt	75	(1)
Sexual Dysfunction	75	(1)
4.15 Family Relationships	75	(3)
4.16 Social Relationships	78	(1)
4.17 Time Orientation	79	(2)
4.18 Violence	81	(1)
4.19 Death	82	(3)
Chapter 5. CORE ACTIVITIES	85	(18)
5.1 The Myth of Addiction as an Escapist Lifestyle	85	(1)
5.2 Hustling	86	(7)
5.3 Copping	93	(2)
5.4 Getting Off	95	(1)
5.5 Avoiding Busts, Burns, Rip-offs, and Hassles	96	(2)
5.6 Core Activities and Personality Adaptation	98	(5)
Chapter 6. KEY CULTURAL ROLES	103	(22)
6.1 The Dealers	103	(2)
6.2 The High Priests	105	(1)
6.3 The Storytellers	106	(1)
6.4 The Medicine Men and Midwives	107	(1)
6.5 The Jailhouse Lawyers	108	(1)
6.6 The Ambassadors	109	(1)
6.7 The Gangsters	110	(1)
6.8 The Nonaddicted Hustlers	111	(1)
6.9 The Addict with Money and Fame	112	(1)
6.10 The Working-Class Addicts	113	(1)
6.11 The Weekend Players	113	(1)
6.12 The Pseudo-Junkies	114	(1)
6.13 The Pledges	115	(1)
6.14 The "Crazies"	116	(1)
6.15 The Marks	117	(1)
6.16 The Man	118	(1)
6.17 The Snitches	118	(1)
6.18 The Protectors	119	(2)
6.19 The Cultural Rejects	121	(1)
6.20 The Profiteers	122	(1)
6.21 Summary: Cultural Roles and the Treatment Process	122	(3)
Chapter 7. CAREER MILESTONES IN THE CULTURE OF ADDICTION	125	(50)
7.1 Joining the Culture: Initiation Rites	126	(3)
7.2 Chipping: The Period of Controlled Use	129	(6)
7.3 Justifying Usage: Ideological Beliefs	135	(1)
7.4 The Change in Identity	136	(1)
Preoccupation with Denial	136	(1)
Preoccupation with Acceptance	137	(1)
7.5 Letting Go of the Other World	137	(1)
7.6 Developing Status and Reputation in the Culture	137	(1)
7.7 Learning to Hustle	138	(1)
7.8 Kicking: The Testing of Control	138	(2)
7.9 Escaping and Reframing Consequences	140	(1)
7.10 Getting Busted and Doing Time	140	(2)
7.11 Doing Treatment	142	(18)
Gambits to Avoid Treatment	142	(3)
Scoping Out the Program	145	(1)
Demonstrating Motivation	145	(1)
Hustling Medication	146	(1)
Assessing Your Counselor	146	(1)
The Best Rationalizations for Why Past Treatment Didn't Work	147	(2)
The Art of Compliance	149	(2)
The Best Defense Is a Good Offense	151	(3)
Creating Diversions	154	(3)
The Self-Help Critic	157	(1)
Doing Treatment, Sustaining Addiction	158	(2)
7.12 Pathways Out of the Culture of Addiction	160	(12)
Death	161	(1)
Psychiatric Impairment	162	(1)
Criminality	163	(1)
Spontaneous Remission	163	(2)
Maturing Out	165	(1)
Getting Religion	166	(1)
The "Super Ex-Dope-Fiend Folk Hero"	167	(2)
Treatment/Recovery	169	(1)
The Question of Controlled Use	169	(3)
7.13 Summary: The Culture as Cult	172	(3)
Part II THE CULTURE OF RECOVERY	175	(298)
Chapter 8. THE CULTURE OF ADDICTION AND THE TREATMENT PROCESS	175	(50)
8.1 The Culture of Addiction as an Assessment Component	175	(6)
Cultural Assessment at Intake	176	(1)
Collateral Interview	177	(1)
Self-Assessment Techniques	177	(1)
The Social Network Diagram	178	(3)
Identifying the Bicultural Style of Addiction	181	(1)
8.2 The Culture of Addiction and the Choice of Treatment Modalities	181	(7)
Emergence of the Multiple-Problem Client and Family	183	(1)
Multiple-Problem Clients in a Categorically Segregated Service System	184	(1)
A Transitional Model of Intervention	185	(1)
Enmeshed Addicts in Treatment: Past, Present, and Future	185	(3)
8.3 Methadone and the Culture of Addiction	188	(2)
8.4 Engaging the Client through Cultural and Personal Identification	190	(3)
8.5 Sustaining the Motivational Crisis	193	(7)
Pain-Based Interventions	193	(3)
Hope-Based Interventions	196	(4)
8.6 Addressing Secondary Drug Use	200	(7)
A Model of Risk	201	(1)
Analysis of Drug-Use History	202	(2)
Focusing on Secondary Drugs in the Intervention Process	204	(1)
Teaching Functions	204	(2)
Relapse Interventions Involving Secondary Drugs	206	(1)
8.7 The Struggle for Control of the Treatment Milieu	207	(1)
8.8 Disengaging from the Culture of Addiction	208	(5)
8.9 Changing Cultural Styles of "Doing Treatment"	213	(8)
Isolation from the Culture	213	(1)
Diagnosing the Treatment Style	213	(2)
Focusing on Pain and Possibilities	215	(1)
Teaching Interventions	215	(2)
Interventions to Block Self-Defeating Styles	217	(4)
8.10 The Preferred Defense Structure and Cultural Conversion	221	(1)
8.11 The Culture of Recovery: The Alternative Career Path	222	(3)
Chapter 9. THE ORGANIZATION OF THE CULTURE OF RECOVERY	225	(30)
9.1 Historical Evolution	225	(13)
9.2 Tribal Networks	238	(1)
9.3 The Treatment Culture	238	(2)
9.4 The Self-Help Culture	240	(1)
9.5 The Family in the Culture of Recovery	241	(1)
9.6 Strategies for Development of Treatment and Self-Help Cultures	242	(13)
Building the Treatment Culture	242	(4)
Building Linkages Between the Treatment and Self-Help Cultures	246	(1)
Nurturing Development of the Self-Help Culture	247	(6)
Including the Family in the Culture of Recovery	253	(2)
Chapter 10. THE PSYCHOSOCIAL AND TECHNICAL FUNCTIONS OF THE CULTURE OF RECOVERY	255	(12)
10.1 Zones of Action and Experience	256	(3)
10.2 The Physical Zone	259	(1)
10.3 The Psychological Zone	260	(1)
10.4 The Spiritual Zone	261	(1)
10.5 The Interpersonal Zone	262	(1)
10.6 The Lifestyle Zone	263	(1)
10.7 The Scope and Intensity of Change in Recovery	264	(1)
10.8 Teachers, Healers, and Travel Guides	264	(3)
Chapter 11. CORE ELEMENTS IN THE CULTURE OF RECOVERY	267	(116)
11.1 From Culture of Addiction to Culture of Recovery: A Catalog of Intervention Techniques	267	(1)
11.2 Language	268	(7)
What's in a Name?	268	(2)
Profanity and Argot	270	(1)
Reshaping Conversational Themes	271	(1)
The Language of Treatment and Recovery	272	(3)
11.3 Religion, Spirituality, and Values	275	(10)
God as I understand Him?	275	(1)
Discovering the Spiritual	276	(8)
The Reconstruction of Personal Values	284	(1)
11.4 Symbols	285	(5)
Shedding Symbols of the Life	285	(1)
Symbols and Identity Transformation	286	(1)
Symbol Replacement	286	(2)
Symbols and Relapse Prevention	288	(1)
Intervention Summary	289	(1)
11.5 Rituals	290	(3)
Ritual Identification	290	(1)
Ritual Replacement	291	(2)
11.6 History and Mythology	293	(4)
A New Oral History	293	(1)
The Traditions and Folklore of Recovery	294	(3)
11.7 Institutions (Places)	297	(4)
Places and Persona	297	(2)
Saying Good-bye to Slippery Places	299	(1)
Finding Drug-Free Havens	300	(1)
11.8 Dress/Appearance	301	(10)
The Return of Self-Care	301	(1)
I'm Too Beautiful to Be Addicted	302	(1)
Experimenting with New Images	303	(8)
11.9 Diet/Food	311	(6)
The Physiology of Sobriety	311	(1)
Food and Mood	312	(2)
Managing Drug Hunger through Diet and Exercise	314	(1)
Self-Healing	314	(1)
Self-Healing versus Self-Pollution	315	(2)
11.10 Music	317	(6)
Identifying High-Risk Cues	318	(1)
Neutralizing Musical Triggers for Intoxication	318	(3)
Songs to Get Well By	321	(2)
11.11 Art	323	(2)
Art as a Tool of Disengagement	323	(1)
The Folk Art of Recovery	324	(1)
11.12 Literature	325	(4)
We Are What We Read	325	(2)
New Ways to Carry the Message	327	(2)
Recovery, Literacy, and Illiteracy	329	(1)
11.13 Visual Media	329	(6)
Extinguishing and Reframing Old Cues	330	(2)
Television in the Culture of Recovery	332	(1)
We've Come a Long Way Since "Chalk Talk"	333	(1)
The Concept of "Passive Confrontation	334	(1)
11.14 Work and Leisure	335	(6)
Redefining the Meaning of Work	335	(3)
Finding Drug-Free Pleasure	338	(3)
11.15 Sexuality	341	(8)
Intimacy, Sexuality, and the Culture of Recovery	341	(1)
Addressing Sexual Trauma	342	(2)
Clarifying Sexual Orientation	344	(1)
Exploring Sexual Roles	345	(1)
Managing Shame and Guilt	345	(2)
Treating Sexual Dysfunction	347	(1)
Including Sexuality in Relapse Prevention Planning	348	(1)
11.16 Family Relationships	349	(14)
Family: An Expanded Definition	349	(1)
The Future of Family in the Culture of Recovery	350	(1)
Balancing the Four Levels of Family Healing	351	(1)
Developmental Stages of Family Recovery	352	(2)
The Intimacy Crisis: The Culture as Buffer	354	(2)
Parenting in the Culture of Recovery	356	(3)
Breaking the Intergenerational Cycle of Addiction	359	(2)
The Culture as Surrogate Family	361	(2)
11.17 Social Relationships	363	(5)
Managing Visitors in the Treatment Milieu	363	(1)
Assessing and Transforming Social Relationships	364	(1)
From Suicide Pacts to Sponsorship	365	(2)
From Antidrug to Nondrug Relationships	367	(1)
11.18 Time Orientation	368	(3)
From Addiction Time to Recovery Time	368	(1)
Daily Schedules	369	(1)
Sleep and the Body's Biological Clock	370	(1)
11.19 Violence	371	(3)
Decompression	371	(2)
Stigmatizing Violence	373	(1)
Assessing Risk of Violence	373	(1)
11.20 Death	374	(9)
The Fear of Death in Early Recovery	374	(1)
Tribal Deaths and Reaffirmations	375	(2)
AIDS and the Culture of Recovery	377	(2)
The Problem of Anticipatory Grief	379	(4)
Chapter 12. CORE ACTIVITIES	383	(12)
12.1 Centering Rituals	384	(3)
Identity Rituals	384	(1)
Focusing and Evaluating Each Day	384	(1)
Seeking Strength	384	(1)
Self-Commands	385	(1)
Decompression Rituals	386	(1)
12.2 Mirroring Rituals	387	(3)
Mentor Contacts	387	(1)
Daily Contact with Other Tribal Members	388	(1)
Tribal Meetings	389	(1)
12.3 Self-Constructing Behaviors	390	(3)
Acts of Self-Care	390	(1)
Telling One's Story	391	(1)
On Vocations and Vacations	392	(1)
12.4 Acts of Service	393	(2)
Chapter 13. KEY CULTURAL ROLES	395	(14)
13.1 The High Priests	395	(1)
13.2 The Elders	396	(1)
13.3 The Storytellers	397	(1)
13.4 The Comedians	398	(1)
13.5 The Medicine Men and Midwives	398	(1)
13.6 The Organizers	399	(1)
13.7 The Ambassadors	399	(1)
13.8 The Mentors	400	(1)
13.9 The Pigeons	400	(1)
13.10 The Pilgrims	401	(1)
13.11 Pseudo-Addiction; Real Recovery	401	(1)
13.12 The Martyrs	402	(1)
13.13 The Professors	402	(1)
13.14 The Bleeding Deacons	402	(1)
13.15 The Chronically Falling Sinners	403	(1)
13.16 The Professionals	403	(1)
13.17 The "Two-Hatters"	404	(1)
13.18 The Self-Cured	405	(1)
13.19 The Fundamentalists	405	(1)
13.20 The Confused Protectors	406	(1)
13.21 The Saboteurs	406	(1)
13.22 Summary: Cultural Roles and the Treatment Process	406	(3)
Chapter 14. CAREER MILESTONES IN THE CULTURE OF RECOVERY	409	(36)
14.1 The Motivational Crisis	409	(2)
14.2 The Conversion Experience	411	(2)
14.3 The Initiation Rites	413	(2)
14.4 Joining and Rejoining: The Experience of Relapse	415	(5)
Relapse as Response to Drug Hunger	416	(1)
Relapse as Impulse	417	(1)
Relapse as a Cognitive Test	417	(1)
Relapse as Flight	417	(1)
Relapse or Go Crazy	417	(1)
Relapse and Loss	418	(1)
Relapse as Rage	418	(1)
Relapse as Self-Loathing	418	(1)
Relapse as Vacation	418	(1)
The Professional Relapse	418	(1)
The Relapse Response	419	(1)
14.5 The Apprenticeship	420	(2)
14.6 Constructing One's Story	422	(5)
14.7 Through Excess in Search of Harmony	427	(3)
14.8 Dependence on the Culture of Recovery	430	(1)
14.9 The Reconstruction of Self	431	(4)
Self-Loathing	431	(1)
Self-Examination	431	(1)
Confession and Forgiveness	432	(1)
Restructuring of Identity	433	(1)
Restitution	433	(1)
The Purging of Hate and Resentment	434	(1)
Mastery of Self-Defeating Behavior	434	(1)
14.10 Reaching Out to Others	435	(1)
14.11 "I'm Sober, Now What Do I Do?"	436	(1)
14.12 Getting Better Than Well	437	(3)
Joy	437	(1)
Keeping It Simple	437	(1)
The Mastery of Paradox	438	(1)
Softening the Sharp Edges	438	(1)
Personal Identity in Late Recovery	439	(1)
The Social World	440	(1)
The Spiritual World	440	(1)
14.13 The Therapist's Role in Milestone Management	440	(1)
14.14 Recovery Milestones and the Service Continuum	441	(4)
Chapter 15. STYLES OF RECOVERY	445	(28)
15.1 Profiles of the Pilgrims	445	(20)
The Traditional Pathway	446	(1)
The Professionally Supported Traditional Pathway	446	(1)
Sobriety by Mail	447	(1)
Shifting Program Affiliation	448	(1)
From Dry Drunk to Sobriety	449	(1)
AA as a Developmental Stage	449	(1)
Women for Sobriety	450	(1)
"Double Trouble"	451	(1)
Recovering "Rationally"	452	(1)
Moderation Programs	452	(1)
Adolescent Maturing Out with Controlled Drinking	453	(2)
Drug Recovery with Controlled Drinking	455	(1)
The Christian Path	456	(1)
The Path of Islam	456	(1)
The Politics and Theology of Abstinence	457	(1)
The Risk-Driven Sobriety Decision	458	(1)
The Health-Driven Sobriety Decision	459	(1)
The Relationship-Driven Sobriety Decision	460	(1)
The Emotion-Driven Sobriety Decision	461	(1)
Recovery and Environmental Change: Vietnam	462	(1)
The Anti-Script	462	(1)
Methadone for Life	463	(1)
Maturing Out	464	(1)
Futurism and the Prevention of Addiction	465	(1)
15.2 Styles of Recovery	465	(8)
Acultural Styles of Recovery	466	(2)
Culturally Enmeshed Styles of Recovery	468	(1)
Bicultural Styles of Recovery	469	(1)
Style Preference and Evolution	470	(3)
Appendix A: Self-Assessment Instrument	473	(4)
Appendix B: Glossary of Clinical Interventions and Techniques	477	(6)
Bibliography	483	(8)
Index	491	(6)
About the Author	497