The story of Small--Latest

My heart is sore today.I often pass through Umzinto on the way home from Scottburgh to Pennington, as there is no direct taxi to Pennington. On Saturday I attended a meeting in Umzinto and then headed for the taxi rank. This is where all the whoonga addicts hang out. Many of them know me. I always stop and talk to them, sometimes buy them something to eat.
This Saturday I saw someone I had not seen in about six months. It was Mike (read Mikes story here http://davidonymous.blogspot.co.za/2016/05/mikes-story.html ). He had at one stage been a regular attendee of meetings and we had tried to help him. We had raised money to send him to rehab and on another occasion bought him suboxone. He continued to use and eventually stopped coming to meeting, and I lost contact with him.Mike was always small and thin, but he had been full of life energy. I remember him as someone who no matter how desperate his circumstances, always had a laugh and a smile. This could very quickly turn to tears, as Mike was an addict, and a child. Incredibly manipulative, he was always ready with a tall tale that would tug at your heartstrings. I never knew Mike to steal. He never had to. People gave him money. Most people who knew him would never have guessed he was a whoonga addict. He always walked around with a bucket, ready to work, clean cars, push trolleys ...whatever it took. I once saw someone give him a hundred rand..When I asked him about it he said.'Oh that guy..he gives me every week.." And he had a round of regulars like that. . Another time i saw him on the beach collecting sand in a packet. He had literally convinced some tourist to buy some beach sand to take home.This was not the Mike I knew. The smile was still there, but it seemed like the life had been sucked out of him. He was all skin and bone. Hugging him i felt I had to take care not to break him. For all his seventeen something years he looked like an old man with not much time left in this world. I took him to a shop and offered to buy him something but all he would have was some milk....he could not hold down anything solid he said.  The doctors said it was TB. I asked about treatment. He said he had been to the hospital and been given medication, but some guys on the street had stolen it, no doubt thinking it was something they could get high on. He had been meaning to go back, but never got around to it. Sitting in queues at hospitals is not something you want to do when you have a rosta. I extracted a promise to return to the hospital as soon as possible but I doubt this will be kept.
This is a boy who has been on the streets and using whoonga since he was 10. He has never known anything else and never really stood a chance. The sad thing is that Mikes story is all to common. I know there is very little I can do … I can share my story… carry a message of hope…try and bring him into the fellowship of recovering addicts… but is this enough? Surely there is more we could be doing ? I have seen time and again the miracle of the 12 step program…I know it works….But what about those like Mike who don’t get it? There is no help for them. Society turns a blind eye to these people. We like to pass the buck…the government….the family…. And nobody does anything. The 12 step program  has taught me that I cannot change the world and I need to focus on the things I can change. But does that mean I must accept the way things are? I do not believe so… I believe it is still possible to work for a better society where all  are valued. Ultimately the fact that there are people like Mike in the world is an indictment of us all. We are all responsible. We all need to be involved in finding a solution.

Small's story

 Small passed away in April (exact date unknown) 2017 of heart failure. I will always remember him for his cheerfulness in adversity and his beautiful spirit. He leaves a hole in my heart.

Small is a young man living and begging on the streets of Scottburgh. This is his story, transcribed and adapted from an interview.  Small is his nick name and the name by which he was known to his friends.

I was born in Braemar and stayed there with my granny and aunty, I didn’t know my father. He was locked up when for killing someone when I was six months old. My mother chose to live in Umzinto selling fruit, bananas , ice-cream on the street. She couldn’t afford the daily taxi back to Braemar. My aunty used to hit me because I never helped my sisters with the work around the house. One day when she hit me I fell and cracked a bone. My mother took me to stay in Umzinto. I was 9 years old and in std.2.

One day I saw a man in the taxi rank smoking zol (dagga). I wanted to try it, so I begged for the money and went to buy some. I went to the bush to smoke it. I was not drinking smoking, even gwaais (cigarettes) at the time. It is first time I did anything like that. I got goefed.(high) I also got hungry. I went home and finished all the food. It was a nice feeling. I felt like I’m right now. I can enjoy my day, I can forget all my problems, I can sleep at night. So I smoked again, the next day and the next. There was no-one to stop me. When my mother was not working she was drinking. She would get very drunk and hit me for nothing.

After about 4 months I found four older friends who were smoking  zol and I joined up with them every day. The oldest was 19. I was then 10 years old. I was still going to school at that time, but we would meet every day after school, and sometimes we would meet during school and smoke.

I like school and did the work. I passed std 2 , 3 and 4 even when I was smoking. I stayed in school till I was eleven. After I left school my principal would see me in the road. He would ask me, what are you doing here?  You are clever you should be in school.

Then one day my friend came with whoonga (cheap heroin). He told us he found it on the floor. He showed us how to smoke. I had never heard of it. I didn’t know it was dangerous. He came again the next day, and the next. He told us he was stealing it. The whoonga goef  is stronger than the zol. It is too nice, it make you want to feel like that all the time. During the school holidays we started to smoke it all day.

Then one day he came with nothing. He told us he couldn’t get any. I couldn’t sleep that night. I suffered my first rosta (withdrawal sickness). For a whole week we didn’t smoke. I couldn’t sleep. I was shaking, feeling hot, feeling cold, even my bones were sore. It felt like someone was choking me.  At first I did not know why I was feeling like that. So I asked the guy who was bringing it. He told me it is a rosta and you get it from smoking whoonga. I asked him what I must do to stop it. He told me the only thing I can do to feel right is to smoke more whoonga. This was when I left school and started to panta (beg) everyday. I needed to smoke to keep the pain away. This was more important than school. I told people I was hungry, I needed money for food, they felt sorry for me and gave me money, food, clothes. I used the money to buy whoonga.

During this time my mother moved to Dududu with her new husband. I have not seen her or heard from her in 3 years. My father came out of jail and I met him a couple of times. He moved to the Eastern Cape, so I do not know where my parents are. My sister came from Braemar to look after me, and for a while I stayed with her. Then I started going to Scottburgh because the people there give more money.

For three years now I am here on the streets in Scottburgh. Every night I must find a place to sleep : sometimes it is an empty house, sometimes by the beach, sometimes under a bush. Sometimes I am by myself , sometimes I join with other guys. I panta everyday. I don’t like to be like this, but there is nothing I can do because I need to smoke. People don’t like us because they say we steal. I never steal. I get enough money from the panta. I get around R100 a day sometimes R150 even R200. The other day I picked up R50. Sometimes I do small jobs. I wash cars, shop windows, push trolleys. I like to work, I do not feel good to ask for money for nothing.  I was arrested one time by the police. They caught me with one straw of whoonga. They took me to the cells and then to the court. I told the judge I have a problem I need help; I want to go to rehab. He just gave me a warning  and sent me out. They could’t help, they sent me back to the street.

Many people are kind, they have a good heart. They and give me money and food. But if I get money I use it to smoke so it is not really helping. Nobody is ever coming and saying why is it you are on the streets  and trying to help me stop whoonga or get off the streets. It is the first time now that I am starting to join the NA ( narcotics Anonymous ) meetings. It is only NA that is trying to help me.

 I am tired for this thing, I want to leave it. I am smoking for eight years. Now when I smoke it  is not making me to feel good. I am just feeling sad. I want to go back to school or to get a job and to help my sister. Please I am asking for help. If you can help I will appreciate, I won’t forget. I’m liking to go to NA meeting, I am enjoying that hour ... I am learning about drugs. If I can get clean I can go to help the other addicts, to go to the  schools to tell other children the drugs is dangerous. No-one is telling me that. I want to teach other children before so they don’t start to use. 

‘Pathways to recovery from heroin addiction: An oral history account of problematic drug users in recovery on the KZN South Coast’

The aim of the thesis is to investigate pathways into addiction and subsequent recovery through the experience of  problematic  drug users engaging in a process of recovery. The stories of these individuals’ experience will be told through a series of oral histories. A secondary aim is to critically engage with the various debates about addiction and recovery in the existing literature, particularly relating to current treatment models, and to contribute to theoretical and evidential debates. This study will be guided by a qualitative research design. The primary research tool that will be used is oral histories, which will be analysed, through narrative analysis, to uncover common themes in the stories of the problematic drug users.

The focus of the study will be a group of  addicted heroin  users living in Umdoni on the Natal South Coast, mainly , but not exclusively from Umzinto. This is a poor community that has in recent years been particularly hard hit by problematic drug use, particularly heroin use. This group has been chosen purposively as it comprises of addicted drug users who are actively seeking, and involved in recovery through participation the twelve step program of Narcotics Anonymous. Some members of this selected group have been ‘clean’  (abstinent from all drugs and alcohol) for varying a mounts of time, while others are still using drugs , but engaging with the program and expressing  a desire  to get ‘clean’. The interviewees will come from a wide range of socio-economic backgrounds, many reduced to homelessness, others in more affluent conditions where they are dependent on family, or even self-supporting.  The oral history stories of 15 of these individuals will be conducted over a period of 12 months. Each participant will be interviewed twice, allowing them to tell their stories, as a continuum at two points in time. This is important because the process of recover from problematic drug use is precarious, and the aim of the study is to find out what pathways and interventions appear to be most successful in leading to longer and more sustainable recovery outcomes.

My motivation for doing this research stem from my own long-term experience as an  addicted drug user. It is also driven by a more academic interest in the literature on the recovery of  problematic  drug users and on the various academic and practical debates about ‘rehabilitation’ and how one understands the reasons for problematic drug use in the first place.

Worldwide there is growing criticism of the present approach to the international drug problem. This is best demonstrated by the recent Special UN Assembly which was called to look at alternative ways to address this problem. The traditional discourse on the subject focuses on two models; the  judicial and the medical. The first conceptualises the addicted  drug user as a criminal who needs to be punished or even removed from society. The second conceptualises the user as a patient in need of medical intervention.

A third way, the social model, as conceived by writers in the recovery movement, view addicts as vulnerable and alienated members of society in need of re-integration into the community. The proponents of this model  are split into two camps, labelled harm reduction and recovery,  often seen as hostile and mutually exclusive.  My  personal interest is in the  recovery movement  which locates the causes and resolution of problematic drug use firmly within a community context. I will also, however be exploring commonality between the harm reduction and recovery camps, which I believe is greater than the differences between them, and hope to identify and draw on the strengths of both approaches.  The recovery movement focuses on  involving recovering addicted drug users, and those affected by addiction (families and communities) in the healing process and the reintegration of problematic drug users back into their communities. William White and other writers in the recovery tradition have claimed that entire communities have  been victims of what they call “historical trauma”. Such communities, where disconnection and disadvantage is predominant, become particularly vulnerable to a wide spectrum of personal and social problems. Trauma erodes indigenous sources of cultural and personal resilience leaving communities, community institutions, neighbourhoods, families, and individuals particularly vulnerable to drug and alcohol related problems. Anne Wilson Schaeff puts it slightly differently when she argues that problematic drug use is rooted in a  society that suffers from a state of  dis-ease, rooted in alienation, in which the individual addicted drug user  is but  the symptom and carries the burden of suffering.

This movement has come to the fore in the USA where a strong network of Community Recovery organisations has emerged. These are embedded in communities through establishing recovery community Centres. The movement is also engaged in advocacy, education and research and a strong body of academic writing is emerging. It is however not widely  acknowledged in this country, where the predominant approaches are still located within the judicial and medical paradigms. In my view, the rationale of the recovery movement in terms of the underlying causes of problematic drug use (and how to deal with it) is of great relevance in the South African context where community trauma – both current and historical – is deeply embedded.  

Through my own experience, contact with other recovering drug users, and reviewing the literature I have tentatively identified the three main limitations of the current treatment approach that are most apparent. These are the inaccessibility of treatment to the vast majority of problematic drug users; the discord between the perception that problematic drug users can and should be cured by a single intervention and the reality of the chronic and recurring nature of the disease; and thirdly the focus on the individual which overlooks the community and social aspects of the problem.

The voices of problematic drug users in various stages of recovery are without doubt the most appropriate place to begin in making sense of best practice models for promoting recovery and the reduction of harms that problematic drug use creates to individuals, their families and the community.

Through the oral history stories told by drug users at various stages of recovery, as well as through a thorough investigation of the recovery movement and its relationship with other ‘treatment’ models, I hope to feed into policy debates and discussions around treatment of addiction, all of which are in a very transient stage in South Africa.

The purpose of the study is that the insight  gained may be used to identify and begin to address limitations within the present treatment models. The primary question  I will  be asking is : “What insight can we gain from the life  experience of addicted heroin users, as revealed through their oral histories, that might assist in identifying and addressing the limitations of present  treatment  models in South Africa and internationally?”  The secondary questions I will focus on include:      What is the connection between community vulnerability and what White calls historical trauma and individual addiction?  What role does time in formal treatment (rehab) play in recovery?   What role does spirituality (or connectedness ) play in recovery?   What role can recovering addicts (wounded healers)  play in recover?

Researching  problematic drug users is not always easy to do, particularly those who have been victimised by police and marginalised by their own families and communities. The possibilities for gaining access to, and the trust of  these participants, and to uncovering the stories that lie behind their drug use and their routes to recovery will, I believe, be greatly facilitated by my own personal history as a long term addicted drug user, as well as my ongoing  work  with homeless addicts. The shared experience of  problematic drug use, combined with a growing academic interest in recovery processes will, I believe, allow for research outcomes that have depth and validity.

 

 

UMDONI COMMUNITY RECOVERY PROJECT

We believe that addiction is  a symptom of a greater disease, rooted in disconnection,  which affects not only individuals but our communities and society as a whole.

We believe that addicts of all types are those who are most strongly affected by this disease.  Addicts  in recovery are thus an important resource of recovery capital that can be mobilized to serve as recovery carriers within the community.

 We believe that this resource can be mobilised to bring recovery to addicts who cannot afford the enormous costs involved in the treatment system.

We believe that Recovery from addiction is a lifelong process of learning and that present treatment models that see recovery as brief intervention are ineffective.

Our vision is to nurture and support a vibrant recovery community in which individual, family  and community healing and re-connection can take place.

 Our Mission

1.       To mobilise individual, family and community resources to promote a culture of recovery. Particularly to include recovering addicts in the process of recovery.

2.       To make such resources available  so individuals, families and communities are able to get the help they need to recover.

3        To develop and nurture a strong grassroots networks of recovery community organizations offering opportunities for people to make their voices heard, and providing a forum for community service and opportunities for community development and upliftment.

4.       To strengthen and support natural family and community ties as the first line of social support with the aim of creating a healing environment that enhances personal, family and community health.

5.       To bring the message of  recovery to the majority of people who cannot afford the expense of  rehabilitation and treatment programs.

6.       To broaden public understanding of the reality of the disease of addiction and the process of recovery and reduce the stigma associated with addiction

7.       To move beyond an  individual concept of recovery to a communal one, encompassing families and communities.

8.       To advocate for planning and policies at all levels of society to enhance recovery, and for more addiction research, prevention, and treatment.

Practical goals

1. To provide peer-based recovery support services which cover a wide range of activities not generally offered by current treatment providers. Such services may include (but are not limited to)  peer support (e.g., recovery coaching), resource access ( housing, transportation, computers, library) vocational training, community service, employment services, telephone support, access to support groups, system navigation, recovery resource dissemination, life skills training and clean living social activities.
2. To provide information on and facilitate access to existing treatment and recovery resources.
3. To provide a forum for community service. To get recovering addicts involved in community upliftment and development  projects. To challenge the stigma of addiction by demonstration that recovering addicts can be positive role models and assets to their communities. 
4.  To celebrate recovery from addiction through public events.
5.  To act as a catalyst for bringing together  community institutions, government, business, and industry, civic and neighbourhood organization, treatment centres, health and social service agencies, educational institutions, the criminal justice system; religious institutions; sports and leisure institutions; the arts community; and media institutions to find common ground in addressing this issue.
6.  Seek to expand philanthropic and public support for addiction treatment, recovery support services, and recovery advocacy .
7. To  support  research that illuminates the processes of long-term recovery and establishes an evidence base for effective strategies, in particular  peer and community – based support systems.
8.  To provide public education and foster awareness. To put  a face and a voice on recovery to educate the public, policy makers, service providers, and the media about the reality of recovery
9.  Policy advocacy. Challenging the criminalisation of addiction,  the war on drugs and advocating for more effective public policies aimed at supporting peer-and community-based  recovery and treatment. Investigating and encouraging the introduction of drug courts and diversion programs for drug related offences.

In the longer term we also aim to establish:

•  a clean living communal home which will provide a home environment for addicts  in recovery under  the supervision and care of addicts with longer clean time.
• a community centre which will provide a resource centre for the local community and  a place for community-wide sober social activities, workshops, meetings, and resource connections .

Motivation for a peer-based , community oriented recovery paradigm.

The present model of rehabilitation is based on the myth that that addicts can and should be cured by a single episode of treatment in a rehabilitation centre. This simply does not happen. Most addicts will relapse and need several visits to rehabs before they finally get clean. Addiction is a chronic ailment.  As with any other chronic ailments, recovery from addiction is a life-long process and requires ongoing vigilance and commitment to following a treatment regime. Chronic ailments are not cured, but can go into remission and the sufferer may gain a temporary reprieve from  its effects.

William White, a leading expert of the recovery movement in the US[1] claims that the  prevailing acute care paradigm is flawed and sets people up for failure “We are currently placing people with severe, complex, and prolonged addiction careers within treatment designs whose brevity and low intensity produces little likelihood of a positive recovery outcome. When resumption of addiction then occurs, as it does so often, the individual is blamed and punished (via divorce, loss of child custody, revocation of probation, job dismissal, expulsion from school, etc.) on the grounds that “they had their chance and blew [i]it.”

There is, however,  growing evidence that the longer people spend in treatment, the longer they participate in the NA and AA fellowships, the greater chance they have of recovery.

In this country the majority of addicts will never be able to afford rehab and the state does not have the resources to bring even a fraction into state subsidised rehabilitation. Even for the better off citizens who can afford rehab.... the multiple stays that are often required before true recovery starts can be a huge and debilitating drain. Many a family has gone bankrupt trying to get a loved one clean. A new model of sustained recovery management is needed  with increased interest in post treatment support mechanisms and for developing and mobilising recovery support resources within communities.

Often when an addict comes into recovery (or wishes to do so)  they have no resources left. Material possessions  have all  been sold, and  friends and family alienated.  In such a situation an addict may become desperate enough to be willing to go to any lengths to make a change in their life. Or they may simply become hopeless and give up.  If no resources are available the second scenario is most likely. Some resources are necessary for an addict to recover , even it is just a sense of hope or someone who cares enough to help. Initially all resources  need to come from an outside source.

Access to treatment will allow an addict to build up psychological, mental and spiritual resources   -- but where does that leave someone coming out of treatment with no material or community resources available to him? And how does an addict with no financial resources get into treatment in the first place?....Many treatment centres do offer reduced rates or even free treatment for a small number of patients. The state has also begun to open state funded treatment centres. While these initiatives are admirable they are  but a drop in the ocean. According to Davidson and White et al [2]  in the US   only 10% of people in need of treatment for substance abuse receive such treatment annually and only 25% will receive such treatment at any stage during their lives. Given the lower rates of access to health care in South Africa the figures here are most likely significantly lower.

What needs to be explored locally is not only the need for post-treatment recovery support but innovative ways of bringing treatment and recovery to communities and people that cannot afford to pay for extended stays in institutions...

Also important in the South African context is the idea of Community Recovery - not only in the sense of recovery in the community but of the recovery of communities. Communities that have been subject to historical traumas are more susceptible to addiction and drug and alcohol related problems. These communities are in need of healing. They suffer from a range of social ills of which drugs and alcohol are but a part. They do however play an significant  role in exacerbating those problems depriving the communities of  resources and draining hope. On a positive note recovery is contagious. Recovery is spread through exposure to recovery carriers (“wounded healers”)—people in recovery make it infectious  through carrying the message of their personal story of hope and redemption and their love and service to those still suffering. By building up recovery capital in these areas we may be able to make a beginning at untangling the web of interrelated social ills.  Individuals coming into recovery begin to be positive role models for the youth replacing the gangsters and drug dealers as people to be admired and emulated  -- representing the only path to wealth and upward mobility. Parents  begin to spend more time with their family and being a positive influence in their children’s lives. Children spend more time at school and engaged in creative, sporting and learning activities.  Less violence, less crime, less unwanted pregnancy---these could be the result of a fairly small number of people coming into recovery and beginning of a significant shift to community healing.

It has been said that an injury to one is an injury to all. We believe that a healing of one is the healing of all

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[1] ( William L. White. (2007). The New Recovery Advocacy Movement in America. Addiction,102, 696–703.)

[2]  Larry Davidson PhD , William L. White MA , Dave Sells PhD , Timothy Schmutte PhD , Maria O'Connell PhD , Chyrell Bellamy PhD & Michael Rowe PhD. (2010) Enabling or Engaging? The Role of Recovery Support Services in Addiction Recovery. Alcoholism Treatment Quarterly, 28:4, 391-416,

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PH.D CONCEPT PAPER

  

Proposed Title:

‘Routes to recovery from drug addiction: An oral history account of addicts in recovery on the KZN South Coast’  

Through my  experience with long-term drug addiction and recovery, and extensive reading on the subject I have come to believe that the present model  of addiction treatment is limited in three crucial respects.

Addiction is still by and large treated as an acute ailment which can and should be cured after a short stay in a treatment centre.  Increasingly research is showing that that is not viable. While providing short term  therapy might provide a structure for ongoing recovery, in and of itself it is inadequate. Recovery is increasingly been revealed though experience and research as a long term process which requires finding ways  in assisting drug users  to feel connected and purposive. 

Secondly, present treatment models focus on the individual,  overlooking the community and social aspects of the problem. If we are to truly understand addiction as a long term illness, it is critical to understand the role that community plays in contributing to the illness and in remedying it.

Thirdly, treatment is expensive and the vast majority of addicts will never be able to afford the costs involved. Though efforts are being made to make treatment affordable and available resources simply do not exist  to meet the need. In the meantime, addiction numbers are rising and the longer this is left untreated, the more endemic this social and public health problem is likely to become.

These limitations are the research problem to be addressed in the dissertation. The objective is to explore alternative pathways to recovery which address these. It is for this reason that it is important to gain a deep understanding of how those who are in long term recovery came to the point they are at. This dissertation therefore will focus on the pathways to recovery of a group of addicts, some of whom have been clean for a sustained period of time, some still struggling, but with a desire to find recovery.

The focus of the study will be a group of recovering addicts in Umzinto on the Natal South Coast, mainly , but not exclusively from Riverside Park, a poor community particularly hard hit by drug addiction, especially whoonga. This group has been chosen purposively as it comprises of addicts who are actively seeking, and involved in recovery through participation in Narcotics Anonymous.   This group has grown from two regular attendees at NA a year ago to a core of eight members now clean between 3 weeks and 1 year, plus a growing group of between 6-10 addicts still in active who regularly attend meetings expressing the desire to get and stay clean. This will be a longitudinal study using qualitative research techniques . I plan is to collect life stories (Oral Histories) from these addicts and follow their progress over the next few years.. not only for the three years of my doctoral studies but beyond. Further I plan to hold focus groups to discuss various aspects of addiction and recovery.  I will also interview family members and other members of the community as to the effect addiction has had in the community and, as the study progresses the effect a group of recovering addicts has on the community as they begin to reintegrate. I would also be drawing on aspects of applied research through describing and evaluating  of  community initiatives as they develop. There are a number of initiatives planned in the area (greater Umdoni) which these addicts would be part of, and which the study would cover. These would be aimed at addressing the above limitations and modelled on the initiatives of the American recovery movement.

The following objectives guide the study:

• ·         To explore and document the experiences, through addiction and recovery, of a group of recovering addicts, involved in active recovery programs as a means of gaining greater understanding of the pathways in and out of addiction. 
• ·         To explore and document the experiences of members of families and communities of these addicts as a means to gain greater  understanding of the link between individual addiction and  family and community trauma and vulnerability, as well as between individual and community recovery.
• ·         To  document   and assess the progress of a Community Recovery  program which is being developed in this community  as it unfolds  with the intention of investigating, and ultimately contributing toward designing a new and effective model for treating drug addiction that ‘fits’ with the localised South African context, taking account of the afore-mentioned limitations.
• ·         To critically engage with the various debates about addiction recovery in the existing literature, particularly that emerging from the Recovery  movement,  and to contribute to theoretical and evidential debates

The Recovery movement which has come to the fore in America has addressed these issues. This movement  locates both addiction and recovery firmly within the community. The focus of this movement is on  involving recovering addicts and those affected by addiction (families and communities) in the healing process and the reintegration of addicts back into their communities. It is strongly rooted in the ideas, drawn from the 12 step program of the Narcotics and Alcoholics Anonymous movements,  of one addict helping another and of recovery being dependent on service to others. A strong network of Community Recovery organisations has emerged. These are embedded in communities through establishing Recovery Community Centres. The movement is also engaged in advocacy, education and research and a strong body of academic writing is emerging.

William White and other writers in the recovery tradition have claimed that communities that have been victims of  what they call “historical trauma” become particularly vulnerable to a wide spectrum of personal and social problems. Such trauma erodes indigenous sources of cultural and personal resilience leaving communities, community institutions, neighbourhoods, families, and individuals  particularly vulnerable to drug and alcohol related  problems.  I believe this to be particularly relevant  the South African context. Through my own experience and through contact with other addicts I have realised that the one thing we have in common is a sense of alienation, of not being fully part of one’s family, one’ s community,  and disconnected from one’s peers. This is backed up in the literature. It seems to me that this experience is paralleled  at a community level and the communities most at risk of drug and alcohol related problems  are those most alienated from  economic and cultural processes.  White also draws from Native American culture with its concepts of the “wounded healer” and the “healing forest” (the “healthy” community.)

My contention is that our society suffers from a dis-ease, rooted in alienation,  of which the individual addict is but  the symptom and carries the burden of suffering. Perhaps through the healing and reintegration of  individuals a greater healing can begin and the lessons of addiction and recovery at an individual level could  hold some solutions for  our broken communities and for society at large.

Concept note for Doctoral studies

Proposed title:

‘Routes to recovery from drug addiction: An oral history account of addicts in recovery on the KZN South Coast’

Personal Background:

As a result of my own personal history I have chosen to do a dissertation that focuses on drug use and recovery instead. I have become interested in this field of addiction recovery  through my own experience of addiction and realised that with my experience I can make a contribution.  I have  suffered a long term battle with drug addiction and came into treatment early last year at  a rehabilitation centre in Scottburgh on the South Coast. On leaving treatment 18 months ago I decided to stay in Umdoni where there is a very strong fellowship of recovering addicts and have immersed myself into the program and activities of Narcotics Anonymous.  I have also used this time to do research, on my own volition, on addiction and recovery with a particular interest in the Recovery Movement in the USA and other treatment and recovery models around the world.

I am also a member of the Harm Reduction Advocacy Group which is co-ordinated by the UFC@DUT. I believe that my meeting up with Prof. Monique Marks has been very fortuitous. I am keen to combine my social science training with my deep interest in health sciences. The project focus of the UFC@DUT on street level drug addiction resonates with my personal and academic interests.

 While I have no formal training in the Health Sciences, I do believe that this is the correct      Faculty for me to conduct my doctoral research on pathways to recovery for drug addiction, which I view as a chronic illness. Not only do I hope that my doctoral work will assist in understandings pathways to recovery further, but I am also keen to use this doctoral programme to assist in establishing a community based organisation that centres on community recovery and makes use of alternative models of therapy and treatment. I have already began my research journey by reading extensively on the recovery movement, but also through conducting in-depth oral histories of a wide range of individuals who are currently in recovery.

It is my view that studying in the field of Health Science will enable me to be able to work more effectively, and with greater credibility, in the broad health sector. But most importantly, I view this doctoral degree as an opportunity to learn more about drug addiction recovery, and to contribute to this body of knowledge in significant ways, and within the context of KwaZulu-Natal.

Background to the dissertation:

As a recovering drug addict, and someone who has read extensively about both addiction and recovery, I have come to believe that existing models of addiction treatment are very limited. Addiction is by and large treated as an acute illness that can and should be cured after a short stay (one to three months)  in a treatment centre. Increasingly research is showing that that is not viable or effective, and that simply weaning off or detoxifying users is inadequate in the medium to long term. It is for this reason that most rehabilitation programmes fail to ‘cure’ addicts of their illness in the longer term, and instead what is most evident is repeat relapse and wasted expenditure.

Short term medical and even psychological interventions are without doubt ineffective. What is required is a real understanding not simply of the biological factors that contribute to addiction, but the more deep level motivation for getting into drug use in the first place. Much of this has to do with feelings of social disconnect and dissociation, as well as ways of coping with traumatic and stress. While providing short term  therapy might establish a structure for ongoing recovery, in and of itself it is inadequate. Staying clean is a long term process and extended recovery  requires finding ways  in assisting drug users  to feel connected and purposive. What is evident from the latest research on recovery is that that long term addicts often have little or no life-skills or resources to stay clean. What is required, then, is sustained help with reintegrating into society, and developing alternative ways to deal with the personal and social problems that led them into addiction in the first place.

Another limitation with existing addiction treatment models is that they are by and large focused on the individual. The community context from which the individual comes and the social dynamics that feed addiction habits are largely overlooked. What is required then  is more community based approach that addresses  social dynamics in much the same way as is now happening with other chronic illnesses such as diabetes and obesity. If we are to truly understand addiction as a long term illness, it is critical to understand the role that community plays in contributing to the illness and in remedying it. William White and others have claimed that communities where addiction levels are high have been victims of what they call “historical trauma”. Such trauma erodes indigenous sources of cultural and personal resilience leaving communities, community institutions, neighbourhoods, families, and individuals particularly vulnerable to drug and alcohol related problems. This, I believe is crucial to the rise in drug addiction in the South African context where whole communities have experienced and continue to experience collective trauma, and where individuals have become disconnected and alienated from family and community. It is therefore important in the South African context to gain a deeper understanding of how individual vulnerability to drug addiction is mirrored with broader community vulnerability and risk.

A third and critical problem with existing rehabilitation treatment is that it is extremely costly. The majority of addicts are unable to afford the cost of the existing treatment centres, even those that are short term in their services. And in resource poor countries like South Africa, the chances of having long term holistic intervention in the public sector is unlikely in the short to medium term. In the meantime, addiction numbers are rising and the longer this is left untreated, the more endemic this social and public health problem is likely to become.

It is for this reason that it is important to gain a deep understanding of how those who are in long term recovery came to the point they are at. This dissertation therefore will focus on the pathways to recovery of a group of addicts, some of whom have been clean for a sustained period of time, some still struggling to find recovery , but with a strong desire to do so. There are various possible paths to recovery and the point of this dissertation is to uncover what they are and to see which ones are thought to be most effective.

The thinking behind this dissertation is largely based on literature on the recovery movement. The recovery movement locates both addiction and recovery firmly within the community. The focus of this movement is on involving recovering addicts, and those affected by addiction (families and communities) in the healing process, and the reintegration of addicts back into their communities. It is strongly rooted in the ideas, drawn from the 12 step program of the Narcotics and Alcoholics Anonymous movements, of one addict helping another and of recovery being dependent on service to others. While the movement primarily started in America  where there is a strong network of Community Recovery organisations has emerged, and is spreading around the world. In South Africa though this movement is in its infancy.

 These organisations are embedded in communities through establishing Recovery Community Centres, which host a range of activities from out-patient therapy, to life-skill and job training, to providing a venue for creative and recreational activities. They also operate as a resource centre for families and social and health care workers to learn about addiction. The movement is also engaged in advocacy, education and research and a strong body of academic writing is emerging. In places like the US and Northern Ireland, the recovery movement is now gaining increasing support from both those in the health care professions and from police who are confronted with the back end of addiction consistently.

Johan Hari has also drawn attention to the importance  social context plays in driving addiction through elaborating on the famous  “Rat Park” experiment. For Hari the prime drive of addiction is disconnection and the focus of recovery should be reconnection.

Anne Wilson Schaeff argues that our society is driven by addictive behaviour. The obsession with extracting fossils fuels with no regard to the environmental damage  and our fixation with material wealth and possessions as a measure of success and happiness  certainly mirror the behaviour of an addict..

My contention is that our society suffers from a dis-ease of which the individual addict is but the symptom and carries the burden of suffering. Perhaps through the healing and reintegration of individuals a greater healing can begin and the lessons of addiction and recovery at an individual level could hold some solutions for our broken communities and for society at large.

Objectives of the study are:

·         To  discover, through Oral histories  the most effective routes out of drug addiction

·         To document the stories of users who are part of a recovery community on the KZN South Coast

·         To follow and assess the progress of a Community Recovery program which is being introduced in this community as it unfolds

·         To document the processes and the structure of the Umdoni Recovery Programme with the intention of investigating new model for drug addiction treatment

·         To understand the link between individual addiction and community trauma and vulnerability.

·         To critically engage with the various debates about addiction recovery in the existing literature and to contribute to theoretical and evidential debates

·         To ultimately contribute toward designing an effective model for treating drug addiction that ‘fits’ with the localised South African context.

Key questions to be answered:

Given the above, the following questions are viewed as central to this dissertation:

·         What are the most effective and sustainable pathways out of long term drug addiction?

·         What are the pathways into drug addiction?

·         In what way do family and community factors contribute to individual addiction?

·         What impact does addiction have on communities?

·         In what ways can families and communities be involved in individual recovery?

·         In what ways can individuals be involved in community recovery?

·         What alternatives to the mainstream rehabilitation programmes should be developed in a South African context?

Research methodology

This study will focus on a group of recovering addicts that are living in the broad Umzinto district on the Natal South Coast. The majority, but not all of these addicts are from Riverside Park, a poor community particularly hard hit by drug addiction, especially whoonga. This group has been chosen purposively as it comprises of addicts who are actively seeking, and involved in recovery through participation in a Narcotics Anonymous group of which I am a part.   This group has grown from two regular attendees at NA a year ago to a core of eight members now clean between 3 weeks and 1 year, plus a growing group of between 6-10 addicts still in active who regularly attend meetings expressing the desire to get and stay clean.

This study will mainly comprise of oral histories which will allow those in recovery to tell their stories in a manner that is not constrained nor overly directed. The oral histories will be taken over two different periods of time allowing for some evaluation of the effectiveness of the pathways that the recovering addicts that are part of the study have opted for. The two points of conducting oral histories will be 12-18 months apart.

I  plan to hold focus groups with recovering addicts in Umzinto to deliberate various aspects of addiction and recovery. I will also interview family members and other members of the community as to the effect addiction has had in the community and, as the study progresses the effect a group of recovering addicts has on the community as they begin to reintegrate.

Further a number of  initiatives are being planned in this community. An NGO is being put together to raise funding to start a community centre. This will obviously be  a long term process. In the meantime creative and innovative ways of  implementing some of the ideas of community recovery will be pursued.  Throughout this research process, I will be drawing on aspects of applied research through the describing and evaluating of these initiatives as they develop.