I’m Rick Berger, Director of Clinical Services at Greylock Recovery in Williamstown, MA.
I’ve gotten and stayed substance free since my senior year of college back in 1987. My first career was as a teaching English and Social Studies in the US, Japan, and South Korea. My first step to enter this field was spending a year at Hazelden Graduate School of Addiction Studies in 2009. I would like to discuss the Rat Park studies in the 1970’s and 80’s by Dr. Bruce Alexander and assert there is a Geography of Recovery. His work is probably the most important paradigm shift in addiction treatment research since Dan Anderson ‘threw away the keys’ with the Minnesota Model, opening the doors of institutions to make treatment a choice instead of a sentence served behind locked doors.
First, why were Alexander’s Rat Park studies revolutionary? Before Alexander, it was ‘shown’ that rats would use morphine or cocaine laced water until death and even burn their feet to get high if access was ‘protected’ by an electrified plate. The rats had no socialization, no choices; just themselves and were trapped in a cycle and circumstances. They had to use these drugs to simply stay hydrated. Alexander’s research offered his rats a chance to socialize fully with other rats and to have ready access to both pure and drugged water. Lo and behold, the rats largely ignored the drugged water and continued with happy lives of running on exercise wheels, socializing normally, and living content rat lives. Why use provided drugs when offered better choices in activities and build a community? However, the lives of rats, addicted or not, are quite different from those of humans, addicted or not.
My question is: How can the conclusions we get from the research about the Rat Park lead to a Geography of Recovery? Can we create a more effective, sustainable Ecology of Recovery? Geography is the study of the environment that we live within. Ecology is an assessment of that Geography. More simply, the placement (geography) of the person allows for access to a better, higher functioning life while more challenges evolve as SUD becomes worse and/or with each relapse. The Ecology of Recovery is about the functions that lead to growth and stasis, or decay and necrosis. The Geography of Recovery builds institutions, relationships, and opportunities that create a better life. The 12 Promises of AA flesh out what can be expected to happen in a life (a Geography) of Recovery. The 12 Steps explain how to build and maintain a healthy, sustainable life (an Ecology) of Recovery.
Ecology is a physical science, and Geography is a social science. The process of recovery improves along with bringing more generative people, places, and things into our lives. Families grow stronger, work becomes more meaningful, hobbies switch from using or using related pursuits to emotionally broader and deeper activities. The Ecology of Recovery is how we maintain and strengthen these processes. We create more time for deeper, more meaningful friendships and the people around us grow healthier along with us.
Unlike human subjects –the rats- entered into the Park without meeting important criteria- physiological dependence, increased tolerance, craving and overdoses. My conclusion from Alexander’s work is: it answers crucial questions about prevention, but it does not necessarily ‘cure’ addiction. Rat Park provides answers concerning prevention and making of recovery better (an Ecology). These topics are essential as we have suffered from a failed Hundred Years War on drugs in the USA (from the Harrison Act of 1914 until today).
A person needs to change their environment and behavior as they move toward long-term abstinence and recovery. These decisions are highly individual. My argument is that there is a Geography of Recovery as there is also a Geography of Addiction along with a Geography of Despair, or Poverty, or Faith, or Success… Altering the physical, emotional, and even geographic environment that people live in is paramount for success in recovery. Social and physical cues (or triggers) for addiction need to be reworked or eliminated. Safe, predictable housing and transportation are important. Establishing new and/or more meaningful friendships and social connections need to be created. This is the central reason for the skills developed when people enter PHP, IOP, or halfway houses. Hierarchies of value and meaning need to change for the better. These steps specifically focus on this development.
What exactly is a ‘Geography of Experience’? First, imagine four separate families renting a VRBO home for a week each, in March, and visiting Los Angeles, CA. One family, with small children, will present a Disneyland-focused explanation of their experience and the city. Perhaps they would see LA through the eyes of Mickey Mouse? The next family, with teens and young adults, might describe their trip to see the NBA’s Lakers and Clippers and the NCAA’s UCLA and USC play and visit the beaches and will ‘see’ a very different city. Another family will miss all the above but happily lay by a pool, read books, and order food through Doordash. Perhaps another family will come to visit nearby university campuses. The parents might see debauchery and public drunkenness while the child sees potential peers having fun in the sun. Most every person in this scenario can leave the airport with an “I love LA” T-shirt. Every person creates a map of their surroundings, creating a geography of value based on what they perceive as important and meaningful. Arbitrarily mixing up the groups traveling through these geographies would radically change their concepts of what LA is and is not. They all visit a significantly different city, yet it is the same. They move and respond to signage and structures according to their experience and what they value.
Simply, people with Substance Use Disorder assign value and importance to dealers, distributors, users, and access to their drugs of choice. Perhaps, to discuss this geography in a simple, concrete manner- America battles a culture of disorderly eating. It is important to note that the “Golden Arches” now are decoded (read) by children that are too young to have learned how to decode our alphabet. They quickly understand what McDonalds is without ‘reading’ the 9 letters letting customers know they are at McDonalds. Smokers in a new environment will identify nicotine distributors to make sure they do not experience the discomfort of withdrawal and with hope of not needing to change their process and usage patterns of their nicotine addiction.
This reminds me of the story of the four blind men and the elephant. They described what they knew of what an elephant is. One felt a wall, another a rope, another a tree trunk, another a hose when they touched its side, tail, leg, and snout. What we ‘see’ is what we understand. All four blind men were both correct yet incorrect in their descriptions based on their experience.
My point is that recovery requires the creation of an individually designed, created, and curated geography of recovery. The curating of that geography of recovery is an ecology of recovery. We need a new psychic landscape and architecture. The person with a substance use disorder constructs a pattern of living that becomes more and more focused on resources used to acquire and use drugs. The 12 Step adage is, “People don’t go to a bordello to listen to the piano player.” However, if I go to Nashville, Tennessee tomorrow I will be in honky-tonks for the music and not the booze and bad behavior. Our geography of recovery can flip in a matter of minutes as well. Thirty-five years ago, I went to see Jerry Garcia and Bob Weir of the Grateful Dead. I was two years into recovery and after an hour was overwhelmed by the active addiction around me. It was time to change my geography and leave the show but I saw my friend coming across the parking lot, and just before walking out through the gate, I turned around and enjoyed the show with my friend. The change was social connection, and with it, I returned to the show and my geography switched from relapse (prompting fear of and the need to leave) to one of recovery (and enjoying the rest of the show)- even if surrounded by Deadheads using drugs I once struggled with.
Most people with a substance use disorder have a first experience that is sublime, transcendent. Where and when we get high and who we get high with are tangible structures of our geography of substance use disorders -the people, places, and institutions that allow for regular access and usage. Other parts of regular life lose importance in active addiction and can vanish. People leave us, places no longer wish to have us visit, and emotional loses mount. People with SUDs see and focus on streets, parks, houses, and businesses as places to get intoxicated. Thus, Substance Use Disorders get in the way of communities, work, people and recreation, and relationships and institutions lose importance. If something powerful happens, a Geography of Addiction changes to a Geography of Abstinence, and then into a Geography of Recovery.
The investment is in building and rebuilding meaningful institutions and personal relationships. We build and share a “Geography of Recovery” with others. What each person needs to build and restore is a life that works for them. It might be: a sober biker club, temple, job, or new and/or improved relationships. What has meaning, value, and beauty inevitably changes in recovery. For want of a better description, the construction of these new Recovery Parks is individual as well as collective.
Furthermore, the landscape we live in evolves over time. In fact, it evolves over a lifetime. I do not like the term Rat Park but building of a Geography of Recovery makes sense to me. We travel outside of the patterns of the disease and into new geographies of work, new lifestyles, and institutions. Subtle or stunning in nature, recovery creates new spaces in life where new or established families reunite or are formed, new positions and careers are explored, and physical surroundings are changed.
A significant problem is that many focus on a reductionist approach to recovery. We tend to focus on the least level of treatment and expenditure possible. However, recovery is worth a sizable investment and allows for a significant return. Case management can help with planning budgets and an effective return to the workforce. Transitional housing is important. What do people do when they return to their home which served as a place where they got high and their addiction(s) grew worse. This intersects with developing community connections where recovery is normalized instead of stigmatized. Religious and community organizations (including 12 Step and other recovery groups), create a sense of belonging and peace of mind. After all, we wouldn’t limit cancer treatment to surgery? For the most effective treatment, chemo, surgery, radiation, and lifestyle change work. The question for what treatment is best answered with whatever is needed to make it work.
Early in recovery, goals are clear: get the body physically stabilized and start (re)constructing a positive, productive life. Hanging out with the same people, places, and situations where we used ensures eventual and catastrophic failure. We need to find people that both love and support this re-creation of our lives as functioning, and most often, fully abstinent members of society. We learn how to ‘adult’ or play roles that build our recovery. We poach ideas that make for effective living and designs in our lives. We shine a light on and clear out the people, behaviors, and places that made up much of our lives when we were active in our SUD. This work is in the open air and sunshine and with other people who are living successfully. These changes to our lives assure our own success.
