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Mixing advocacy with treatment

March 1, 2010
by John de Miranda, EdM and Kevin McGirr, RN, MS, MPH
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A California treatment center helps clients find a voice on community issues

In recent years a growing appreciation has formed about the importance of involving recovering individuals in activities that promote civic engagement. The 2008 election season's “Recovery Voices Count” campaign of Faces and Voices of Recovery offers an example of this trend to bring a recovery voice into national and local electoral politics through policy advocacy. Similarly, the Recovery Community Services Program of the federal Center for Substance Abuse Treatment (CSAT) attempts to organize local networks of recovery advocates to work on policy change and create more recovery-friendly communities.
We have come a long way from the late 1980s when former U.S. Sen. Harold Hughes created the Society of Americans for Recovery (SOAR). According to an obituary of Hughes by Gerrit DenHartog, Hughes believed that the voices of recovering people could become a potent force to make recovery “an American priority.” SOAR described itself as the voice of the nation's grassroots recovery community-“those in recovery or in hope of recovery from alcoholism and drug addiction, as well as their families, and other concerned citizens.” A concept ahead of its time, SOAR never counted more than a few thousand members.

A number of national advocacy organizations have emerged recently to challenge ingrained public attitudes about individuals in recovery (http://www.facesandvoicesofrecovery.org), medication-assisted treatment (http://www.aatod.org; http://www.methadone.org) and national drug policy (http://www.drugpolicy.org). These efforts are an integral component of what historian William White and others have termed The New Recovery Movement.

Our society continues to marginalize people actively addicted to illicit drugs and alcohol, as well as those in recovery. This “second-class” status is the driving force behind advocacy efforts, and underlines the importance of demonstrating that the “faces and voices of recovery” are also the faces and voices of mainstream America. Traditionally, activities aimed at recruiting recovery advocates have focused on identifying individuals in long-term recovery and convincing them to become active in self- and societal advocacy efforts. In San Diego, a new program exposes residential and outpatient treatment clients to advocacy as a component of their addiction treatment regime.

Stepping up at Stepping Stone

Founded in 1976, Stepping Stone of San Diego (SSSD) is a nonprofit alcohol and drug treatment and recovery agency that creates and delivers alcohol/drug treatment, HIV and other health interventions, recovery, education and prevention services focused primarily but not exclusively on the gay, lesbian, bisexual and transgender communities of the greater San Diego region. The organization is known for its progressive and innovative response to client needs. At the beginning of the methamphetamine epidemic it developed a harm reduction philosophy that was reflected in a media campaign as well as its service portfolio. More recently, Stepping Stone's Discovering Sexual Health in Recovery program was profiled in the July/August 2009 issue of Addiction Professional.

Stepping Stone clients are both challenging and challenged. Besides drug recovery status, the SSSD client often shares other characteristics that add to societal marginalization, including HIV/AIDS and lesbian/gay/bisexual/transgender sexual orientation.

In 2009, with funding from the Drug Policy Alliance's Advocacy Grants Program and help from an outside consultant, SSSD staff created and field-tested an advocacy training curriculum for clients called Stepping Up.1 The curriculum's objectives are to expose clients to organizations seeking to change societal attitudes and to “integrate concepts of self and community empowerment and advocacy into all services for clients at Stepping Stone.”

The rationale for the Stepping Up training states:

Empowerment and self-advocacy are goals of behavioral health interventions. Stepping Up's facilitating principles including that individuals: have power; are responsible; have some degree of autonomy; can take initiative; and can make choices to provide a base for improved consciousness about one's physical and emotional health. Empowerment and advocacy, however, do not occur in a vacuum. Individuals are empowered and advocate in a social context. That context can enhance or detract from an individual's well-being.

The need to advocate and become empowered arises from the inequalities of our society and the discrimination that these inequalities engender. Thus, self-advocacy connects directly to efforts to change society and reduce the marginalization of our clients due to their status as gay, lesbian, transgender, bisexual, HIV+, and former drug user. Therefore, the Stepping Up curriculum also includes information about societal change and the importance of social justice activism.


As defined at Stepping Stone, “Self-advocacy is standing up for yourself, and whether you are trying to change the world or your own life, advocacy means finding your voice. If you are asking for something, you need to be clear about what it is and why you want it.”

Seeking additional services, applying for employment and taking care of one's health all require the ability to assert oneself. Stepping Up participants are taught six steps to self-advocacy:

  1. Get educated. “Know your rights.”