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When Portland held the Recovery Walk

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Nonprofit organization filled with other folks in recovery that I used to partner with to collaborate as peer support.

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Peerpocalypse is a major networking and educational event for peers in recovery and others working in the recovery field.

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A community of people that I've worked with, partnered and healed with throughout the city of Portland.

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My Community: The Recovery Community in Portland

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My Community: The Recovery Community in Portland

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A brief history and timeline of substance abuse recovery.

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Psychoactive drugs have been used since the earliest human civilizations. Problematic use of substances was observed as early as the 17th century. 1

The evolution of addiction treatment, from the mid-18th century to the present, is outlined below. Several pioneers of treatment during these times contributed to a rich body of scientific knowledge that continues to influence our understanding of addiction today.

1750-Early 1800s

Alcoholic mutual aid societies, sobriety circles provide early recovery (1750 to early 1800s). These groups were originally comprised of various Native American tribes, and some evolved into abstinence-based Native American revival movements.2 Native Americans used native healing practices to treat alcoholism.³

Benjamin Rush argues that alcoholism is a disease that should be treated (1784). Rush was a physician committed to educating the public about the hazards of alcohol. Excessive use of alcohol in the late 18th and early 19th centuries was a major public health problem.⁴ His written works helped launch the beginning of the temperance movement.²

1800s

Lodging Homes and Homes for the Fallen (inebriate homes) open (1850s). These homes provided short, voluntary stays that included non-medical detoxification, isolation from drinking culture, moral reframing, and immersion in newly formed sobriety fellowships.⁵ The first inebriate homes opened in Boston in the 1850s and were modeled after state-operated insane asylums.2,5

New York State Inebriate Asylum opens (1864). This facility opened in 1864 under the direction of Dr. Joseph Edward Turner. It was the first medically monitored addiction treatment center in the U.S. and is considered the first alcohol rehab center.⁶

Keeley alcoholism cures spread (1870s). Founded by Dr. Leslie Keeley, who opened more than 120 Keeley Institutes in North America and Europe, these consisted of addiction cure institutes and proprietary home cures, such as bottled "Double Chloride of Gold Cures for drunkenness."⁵

Freud recommends cocaine to treat alcoholism and morphine addiction (1880s). Sigmund Freud began using cocaine himself, calling it the "magical drug."⁷ Freud and other American physicians used cocaine to treat alcoholism and morphine addiction. However, in the last of Freud's writings, he backed off his former defense of using cocaine to treat morphine addiction.2,7

Inebriate homes and asylums close, alcoholics are sent to drunk tanks, wards, and foul wards of hospitals (1890s). Poorly evaluated clinical therapies, ethical abuse, economic depressions, stigma, de-medicalization, and criminalization of alcohol/drug problems led to the shuttering of inebriate homes and the first generation of addiction treatment.⁵ After inebriate homes and asylums closed, alcoholics are sent to city drunk tanks, public hospitals, and insane asylums.²

1900-1950

Charles B. Towns Hospital opens (1901). Charles Towns, in collaboration with Dr. Alexander Lambert (Theodore Roosevelt's personal physician), opened this New York City substance abuse hospital in 1901, which treated affluent alcoholics with its famous belladonna elixir. Bill Wilson, founder of Alcoholics Anonymous, was a patient at Charles B. Towns Hospital 4 times. The cost of treatment was $350 a day, equivalent to $5,610 today.⁸

Emmanuel Clinic in Boston begins lay therapy for treatment of alcoholism (1906). The Emmanuel movement was a church-based form of psychotherapy to heal addictions with a combination of spirituality and psychological interventions.9 The Emmanuel movement's groundwork was instrumental to the establishment of Alcoholics Anonymous.¹⁰

Passage of state laws that call for the sterilization of the mentally ill, developmentally disabled, and alcoholics and addicts (1910s). Legislation granted the medical supervisors of asylums and prisons the authority to "asexualize" a patient or inmate if such action would improve his or her physical, mental, or moral condition. Among those affected were alcoholics and addicts, who were considered degenerate and feeble-minded.¹¹

Morphine maintenance clinics created (1919-1924). Communities established morphine maintenance clinics to treat people with morphine addiction. Most eventually close for legal reasons.²

Narcotics farms open (1935). The first federal narcotics farm opened in Lexington, Kentucky in 1935.² Lexington was a center for drug treatment and federal research, and provided free treatment to addicts and alcoholics, including the "Lexington Cure." The Narco farm was a prison where research on human subjects could be conducted.¹²

Alcoholics Anonymous formed (1935). The 4 founding members of Alcoholics Anonymous (AA), Bill Wilson, Ebby Thatcher, Rowland Hazard, and Dr. Bob Smith, were highly influenced by the pioneers of the Emmanuel Movement.10 Wilson and Dr. Bob were both alcoholics in the 1930s, unable to achieve sustained abstinence despite their Christian faith and membership in the Oxford Group, a Christian organization whose principles heavily influenced the creation of the 12 steps.13 The meeting between Bill W. and Dr. Bob in 1935 marked the formation of AA, and the famous blue book, Alcoholics Anonymous, was published in 1939.2 AA separated from the Oxford Group in the 1930s.¹³

Minnesota Model created (1948-1950). The Minnesota Model was a self-help model intertwined with the AA philosophy. Its primary treatment goals were abstinence and behavioral change.¹⁴

Disulfiram and other drugs are used to treat alcoholism (1948-1950). Disulfiram, otherwise known as Antabuse, was introduced in the U.S. as a supplemental treatment for alcoholism. Antabuse created feelings of nausea and unpleasant reactions to alcohol. Other drugs used to treat alcoholism during this time included barbiturates, amphetamines, and LSD.²

1950-2000

AA membership surpasses 90,000 (early 1950s). The reach of AA membership grew exponentially, and in 1951, AA won the Lasxfker Award from the American Public Health Association (considered to be America's equivalent to the Nobel prize).¹⁵ AA's success was due to several factors, including an increase in alcoholism-related films and a wider acceptance of those suffering from the illness.²

American Medical Association defines alcoholism (1952). In 1952, the American Medical Association (AMA) first defined alcoholism.² Eventually, the committee agreed to define alcoholism as a primary, chronic disease with genetic, psychosocial, and environmental factors influencing the condition's prognosis.¹⁶

Veterans Administration establishes alcoholism treatment units (1957). The Veteran's Health Administration began developing alcoholism treatment units within its national network of VA hospitals.²

Halfway House Association founded (1958). The halfway house movement peaked in 1958 with the founding of the Association of Halfway House Alcoholism Programs of North America.2 Halfway houses provided safe, recovery-focused housing for individuals who were suffering from substance abuse problems.

E.M. Jellinek promotes alcoholism as a disease (1960). E.M. Jellinek, a 1960s alcoholism researcher, published The Disease Concept of Alcoholism.²

Insurance industry begins to reimburse treatment of alcoholism (1964-1975). When the medical community emphasized alcoholism as a chronic disease, policymakers responded, leading to a rise in inpatient rehabs and an upswing in medication for alcoholism/addiction.2,17 In turn, the insurance industry began reimbursing alcoholism treatment in line with other illnesses.²

Methadone introduced (1964). Vincent Dole, an endocrinologist, and Dr. Marie Nyswander, a psychiatrist, introduced methadone to treat narcotic addiction. The FDA approved it to treat heroin addiction in 1972.2 Methadone is a slow-acting opioid agonist that prevents harsh opioid withdrawal symptoms.¹⁸

Lincoln Recovery Center uses acupuncture to treat addiction (1970). Lincoln Recovery was initially an outpatient treatment center in the 1970s that used methadone. In 1973-74, a community-based demand for natural, non-pharmaceutical treatments for heroin and opioid addiction spurred the use of acupuncture in the clinic. The alternative treatment proved to be highly successful, and many of the founding staff went on to study acupuncture.¹⁹

The Controlled Substances Act passes (1970). The Controlled Substances Act (CSA) placed all regulated substances into 5 schedules, or classifications, based on the substance's medical use, potential for abuse, and dependence liability.²⁰

FDA approves Narcan (1971). Narcan could counter opioid overdose effects, usually within 2 minutes. It was first made available as an injectable solution, but is now available as a nasal spray.²¹,29

Betty Ford Clinic founded (1982). Former First Lady Betty Ford sought treatment for alcohol and prescription pill addiction at age 60. In 1982, Ford co-founded the first Betty Ford Center in Rancho Mirage, CA.²²

Cocaine Anonymous founded (1982). Cocaine Anonymous (CA) adopted the 12-step philosophy embraced by Alcoholics Anonymous.²

Secular Organizations for Sobriety and Rational Recovery founded (1985-1986). Former serious problem drinker James Christopher founded Secular Organizations for Sobriety (SOS) in the mid-80s. Around the same time, recovered alcoholic Jack Trimpey founded Rational Recovery. These programs emphasize rational decision-making, not spirituality.²

American Medical Association calls all drug addictions diseases (1987). The AMA passed legislation identifying alcoholism as a complex disease that merited the serious concern of all members of the health professions.²

SMART Recovery founded (1994). SMART Recovery is a non-12-step program focused on self-empowerment. The program teaches skills for self-directed change and helps users cope with urges and manage thoughts, feelings, and behaviors that can drive addiction.²³

Naltrexone approved for alcoholism (1994). In late 1994, naltrexone became the second drug the FDA approved for alcoholism. Naltrexone is non-addictive and does not react with alcohol. It blocks opioid receptors in the brain, preventing the pleasurable effects.²⁴

Drug Addiction Treatment Act passed (1999). This bill was introduced in 1999 to amend the Controlled Substances Act with stricter registration requirements for practitioners who dispense narcotic drugs in Schedules III, IV, or V for maintenance and detoxification treatment.²⁵

2000-Present

FDA approves buprenorphine for clinical use (2002). In 2002, the FDA approved buprenorphine, a medication-assisted treatment (MAT) for opioid addiction. Unlike methadone, which is dispensed within a structured clinic, specially qualified physicians can prescribe buprenorphine.²⁶

The Mental Health Parity and Addiction Equity Act (MHPAEA) of 2008 passed. This act required insurance companies and group health plans to provide similar benefits for mental health and/or substance use treatment and services as other types of medical care.²⁷

The Affordable Care Act (ACA) expands coverage for addiction treatment (2010). The ACA expanded MHPAEA's criteria by making sure insurance plans offered through state health insurance marketplaces included behavioral health services, including substance abuse treatment.²⁷

American Medical Association petitions to drop pain as a vital sign (2016). In response to the opioid crisis and national addiction epidemic, the AMA met in 2016 to discuss dropping vital sign number 5 (pain) as a professional standard of medical care, a statute first implemented in the early 1990s.²⁸

1. Crocq, M.A. (2007). Historical and cultural aspects of a man's relationship with addictive drugs. Dialogues in Clinical Neuroscience, 9(4), 355-361.

2. White, W. (1998). Significant Events in the History of Addiction Treatment and Recovery in America.

3. White, W. (2000). The history of recovered people as wounded healers: I. From native America to the rise of the modern alcoholism movement. Alcoholism Treatment

4. Katcher, B. (1993). Benjamin Rush's educational campaign against hard drinking. American Journal of Public Health, 83(2), 273-281.

5. White, W. L. (2002). Addiction treatment in the United States: Early pioneers and institutions. Addiction, 97(9), 1087-1092.

6. Crowley, J., White, W. (2004). Drunkard's Refuge.

7. Grinspoon, L., Bakalar, J. (1981). Coca and Cocaine as Medicines: An Historical Review. Journal of Ethnopharmacology, 3(2-3), 149-159.

8. Markel, H. (2010). An Alcoholic's Savior: God, Belladonna or Both? The New York Times.

9. McCarthy, K. (1984) Psychotherapy and Religion: The Emmanuel Movement. Journal of Religion and Health, 23(2), 92-105.

10. Dubiel, R. (2004). The Road to Fellowship: The Role of the Emmanuel Movement and the Jacoby Club in the Development of Alcoholics Anonymous. Lincoln, NE: iUniverse, Inc.

11. Stern, A. (2005). Sterilized: In the Name of Public Health. American Journal of Public Health, 95(7), 1128-1138.

12. Kentucky Educational Television. (2017). Lexington's Narcotic Farm: A Pioneering Institution in Drug Treatment.

13. Dossett, W. (2013). Addiction, Spirituality, and 12-Step Programs. International Social Work 56, 369-383.

14. McElrath, D. (1997). The Minnesota Model. Journal of Psychoactive Drugs, 29(2), 141-144.

15. Kelly, J. (2016). Is Alcoholics Anonymous Religious, Spiritual, Neither? Findings from 25 Years of Mechanisms of Behavioral Change Research. Addiction, 112(6), 929-936.

16. Morse, R. (1992). The Definition of Alcoholism. Journal of the American Medical Association, 268(8), 1012-1014.

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The History of Addiction Treatment: A Timeline

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Psychoactive drugs have been used since the earliest human civilizations. Problematic use of substances was observed as early as the 17th century. 1 The evolution of addiction treatment, from the mid-18th century to the present, is outlined below. Several pioneers of treatment during these times contributed to a rich body of scientific knowledge that continues to influence our understanding of addiction today.

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The recovery community is deeply rooted in culture and community. Isolation and separation are part of what makes addiction so deadly. Fellowship is pivotal in our recovery; it provides community and support through building healthy relationships.

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It takes a village to recover from drug addiction | Charlotte Colman | TEDxGhent

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Community partnerships involve the community working together to create a safe, clean environment for our youth and underserved, high-risk communities.

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Portland Parks & Recreation’s (PP&R) Community Partnership Program expands PP&R’s capacity to reach underserved communities.

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Social Determinants of Health and Addiction

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Social Determinants of Health and Addiction

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The conditions in which people are born, grow, live, work, and age can be major factors that influence health outcomes, including substance abuse and addiction. Social determinants can put some at higher risk of addiction than others, be it influenced from family members, a poverty-stricken neighborhood where addiction and/or mental health disorders are more prevalent.

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A common saying is that "addiction doesn't discriminate," which means that it can affect anyone from any sphere of life, ranging from coal miners and truck drivers to executives, doctors, and lawyers. I have personal experience with what an equal-opportunity destroyer of well-being and happiness addiction can be, as I am 14 years into recovery from a vicious addiction to prescription painkillers. My addiction didn't care about my education, medical degree, race, gender, religion (or lack thereof), social status, or health.

Social determinants of health and addiction

But in another, critical sense, addiction does discriminate among people, in a way that is unjust and deadly, and in a way that shines a spotlight on tears in the socioeconomic web that is holding our society together. It has long been observed by clinicians that social determinants of health (SDoH) can tip the scales against people, in their already daunting quest to recover from any type of addiction. According to the World Health Organization, SDoH are defined as "the conditions in which people are born, grow, live, work, and age. These circumstances are shaped by the distribution of money, power, and resources at global, national, and local levels."

The profound effect that SDoH have on people struggling with addictions is borne out by the evidence. In a 2019 study from Drug and Alcohol Dependence it was found that "across 17 states in 2002-2014, opioid overdoses were concentrated in more economically disadvantaged zip codes, indicated by higher rates of poverty and unemployment as well as lower education and median household income." Other studies have found poverty to be a risk factor for opioid overdoses, unemployment to be a risk factor for fatal heroin overdoses, and a low education level to be a risk factor for prescription overdose, and for overdose mortality. Homelessness has been shown to be associated with overdoses as well, particularly among veterans. Terrible outcomes are associated with incarceration, particularly the period just after release from incarceration, when deaths from overdoses skyrocket. Systemic racism contributes to all of these issues.

The research on SDoH mirrors what I see clinically, in the inner-city clinic where I practice as a primary care clinician. A patient can be stable for years on buprenorphine or methadone (medications to manage cravings and help with recovery), but if they abruptly lose their housing due to no fault of their own, they can lose access to the organization and security in their lives. It becomes far more difficult for them to care for their families, to attend medical appointments or support groups, to fill prescriptions, or to practice any of the self-care that is so integral to maintaining oneself in recovery. As such, they become much more vulnerable to relapse.

Stigma plays a role in addiction

Stigma is defined as "a mark of disgrace associated with a certain quality, circumstance, or person." The poor regard with which so many people have viewed for so long those who have suffered from addiction, and the fact that we have criminalized drug usage in our increasingly unpopular war on drugs, have contributed to a "punish, don't treat" attitude. Fortunately, this destructive attitude has recently been evolving, as more people have come to understand that addiction is, at least in part, a brain disease, and that it isn't a moral failing on the part of the individual. However, a great deal of stigma remains, and provides an extra barrier to people asking for the help they need, as they suffer from unnecessary guilt and shame. Many healthcare providers don't want to deal with people suffering from addiction due to stigma. In short, stigma can lead to unnecessary suffering and more overdose deaths.

SDoH are significant factors contributing to addiction, but not the only factors

In the end, with my addiction, I was lucky enough to see it through to the other side. I'll never know to what extent this was due to my own internal resilience, my family support, resources from work and support from colleagues, genetics, luck, or if it largely came down to my favorable SDoH putting a helpful finger on the scales. Certainly not all doctors make it - several of my colleagues have overdosed and are no longer with us. At the same time, many seemingly down-and-out patients that I've treated in the past are leading healthy, stable lives in recovery, so SDoH aren't everything.

But clearly, SDoH play a tremendous role in framing the odds of whether people are able to treat and survive their addictions. As a society, and as clinicians, we have to go far beyond simply viewing the drugs as the problem. In order to give everyone suffering from addiction the best chance possible to enter and stay in recovery, we urgently need to start paying attention to the broader issues that allow addiction to fester, such as housing, employment, poverty, systemic racism, and the effects of incarceration (to name only a few). By strengthening society's safety net, so that we all have access to the basic human rights of food, shelter, and healthcare, we not only help those suffering from addiction, we help everyone else too.

About the Author

Peter Grinspoon, MD, Contributor

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Poverty, homelessness, and social stigma make addiction more deadly - Harvard Health

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Addiction can affect anyone, but social determinants of health - the factors that influence a person's circumstances in life - can have a negative impact on a person's efforts to overcome addiction. Poverty, employment status, education level, and systemic racism can make it harder for people to reach and ...

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The changes in health and state have impacted the recovery community in meaningful ways by creating measures and policies to decriminalize addiction and creating resources for people to get the help they need. Restorative justice programs have been involved in providing support to those in breaking the cycle in criminality around one's substance use.

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Measure 110 Data Report, Quarters 1 and 2

Ov​​​erview

Contains data submitted in Quarter 1 and Quarter 2 (July 1, 2022 - December 31, 2022).

Includes a county-by-county data breakdown along with a timeline for data and available provider contact information.

​​OHA has deve​​loped a comprehensive Measure 110 reporting dashboard that includes quarterly data and operational reporting, expenditures, key demographic information, and aggregated narrative sum​maries for each of the 42 statewide Measure 110 service networks. ​​This report:

Note: The data will change as BHRN partners submit new reports or​ correct previous reports.

OHA exported the data on June 8, 2023.

Client Data Colle​​ction Process:

Each BHRN provider must use an online form to submit data for each quarter they receive Measure 110 funding. They report the number of unique clients served across the seven designated Measure 110 service areas. Counties with no reports for a designated service area will show no data.

For each designated service area, the "Client Counts" field collects the total number of unique clients served by a BHRN partner. It does not reflect the number of times a client received services across service areas or BHRN partners.

OHA combines their reported client counts for the service total.

As a result, the county's service totals may count a client more than once. This may happen if the client received the same service from more than one BHRN partner in the county.

When more than one BHRN partner receives funds to provide a designated service in a county:

When clients receive more than one service from a BHRN partner (e.g., an assessment and then treatment), they will appear in both designated service counts. ​

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Drug Addiction Treatment and Recovery Act (Measure 110)

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The purpose of Measure 110 is to make screening health assessment, treatment and recovery services for drug addiction available to all those who need and want access to those services; and to adopt a health approach to drug addiction.

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Staying involved in our health and state 

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Staying involved in our health and state 

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Policies within our states organizations can help end the stigma around addiction, by humanizing the person suffering from the disease and creating resources to support them while fighting against their addiction.

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Economic insecurity impacts the recovery community as a major stressor that can trigger a recurrence in substance use addiction. Another perspective in how it can trigger a recurrence is by creating a lifestyle where work takes precedence over community in order to keep up with bills, so those in recovery lose some of their recovery capitol by not staying active in their recovery community and attending meetings.

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Drug and Alcohol Abuse: The Role of Economic
Insecurity

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We evaluate the extent to which subjective and objective measures of
economic distress account for differences in substance abuse between the
mid-1990s and early-2010s.We use cross-sectional survey data for national samples of Americans
aged 25–74…

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Under and economic downturn and an increase of unemployment, those who need support and treatment services are unable to access services without the healthcare coverage previously provided by employers or even having the ability to pay for healthcare access. Economic instability can also have a drastic impact on those currently receiving treatment services by creating additional barriers to fulfill services to completion.

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Story Highlights

Increased worry about drug use, Social Security and healthcare

Fewer are worried about energy and the environment

Six in 10 worry about inflation and the economy, highest among issues

WASHINGTON, D.C. -- Among 15 key problems facing the country, more Americans worry about inflation and the economy than any others, with six in 10 expressing "a great deal" of concern about these issues.

Americans are about as concerned with inflation and the economy as they were a year ago, but they are more worried now about drug use, healthcare and Social Security. They are less likely to say they worry about energy and the environment.

The results are based on Gallup's annual Environment survey, conducted March 1-23.

In addition to inflation and the economy, at least half of U.S. adults also worry a great deal about healthcare (54%), crime and violence (54%), federal spending and the budget deficit (52%), and hunger and homelessness (50%).

Issues of moderate concern -- with between 41% and 46% worried -- include drug use, the Social Security system, guns, energy and illegal immigration.

Unemployment ranks last among the 15 issues in terms of the percentage worried about it, with 32% concerned a great deal. The U.S. unemployment rate reached a 54-year low in January. Terrorism, race relations and the environment are also areas of lesser concern for Americans.

From a broader perspective, an average of 45% worry a great deal about the 12 issues that have been measured consistently since 2005 (these exclude federal spending, guns and inflation). That ties 2011 as the highest average worry level, although the range of this average has been fairly narrow between 38% and 45% in the past 18 years.

Economic Matters Often Among Greatest Concerns

Inflation and the economy have been the top two issues in both 2022 and 2023, as the rate of price increases in the U.S. reached levels not seen in four decades. These are the only years Gallup has included inflation on the list.

Gallup has tracked worry about the economy since 2001, and concern about it has varied in response to differing economic conditions, from a low of 33% worried a great deal in 2019 and 2020 (largely before the coronavirus pandemic) to a high of 71% in 2011 and 2012 (amid high unemployment after the Great Recession as well as the debt-ceiling crisis in Washington).

The economy was also the top issue concern in each survey between 2008 and 2014, and it tied with healthcare as the top issue in 2016. When the economy has not been the No. 1 concern, healthcare has typically occupied the top spot, including in 2002 through 2007, 2015, and 2017 through 2020. Crime ranked first in 2001, and hunger and homelessness did in 2021.

Drug-Use Concern Back Up

Americans are more concerned about drug use (46% worry a great deal) than they have been over the past three years, though they are far less worried than they were in 2001, when 58% were. Concern about drug use had fallen a total of nine percentage points between 2019 and 2022, before increasing back to near-2019 levels this year. The increase is perhaps tied to higher rates of opioid drug overdose, particularly among teens, many tied to the drug fentanyl.

Concern about drug use has increased in the past year among Republicans (up 10 points to 61%), Democrats (up 12 points to 34%) and independents (up six points to 46%).

Social Security More Worrisome

Like drug use, Americans' worry about Social Security had also eased in recent years, falling to a low of 38% worried a great deal in 2020. Last year, 40% worried about Social Security, and now 45% do. The issue gained added prominence during President Joe Biden's 2023 State of the Union address, when he challenged Republicans to commit to protecting Social Security as the GOP looks for ways to cut federal spending.

The high point in worry about Social Security was 53% in 2010.

Republicans are no more concerned about Social Security than they were a year ago, but they still express more concern (51% worry a great deal) than Democrats (41%) and independents (32%) do. The latest figures reflect a nine-point increase since 2022 among Democrats and a seven-point jump among independents.

Democrats were more worried about Social Security when Donald Trump was president between 2017 and 2020 (averaging 52%), while Republicans (36%) were far less so, but that has flipped during the Biden years.

Worry about healthcare also increased five points this year, after dropping to a trend low of 49% last year. It remains well below the high of 68% worried a great deal in 2006.

Republicans (50%, up from 44%) and independents (53%, up from 45%) are more worried about healthcare this year than a year ago, while Democrats (58%) are unchanged.

Energy Concern Subsides

Last year, when gas prices were rising rapidly before hitting a record high in June, 47% of Americans said they worried a great deal about the availability and affordability of energy, one point below the high Gallup measured in both 2006 and 2012. The 2022 figure represented a 10-point surge from 2021.

Now, with gas prices averaging about 80 cents less per gallon than a year ago, and about $1.50 less than the peak in June, concern about energy has eased. Forty-one percent of U.S. adults express a great deal of worry about energy.

There has been a similar drop in Americans' concern about the quality of the environment, with the percentage worried a great deal falling five points from 44% in 2022 to 39% this year.

The 44% concerned about the environment was on the higher end of what Gallup has measured historically, with the high point being 47% in 2017 and 2019. This year's 39% concern figure is the lowest since 34% in 2015. The record low was 31% in 2014.

Bottom Line

When there are economic challenges, Americans are usually more concerned about those than other issues facing the country. And that is the case now, with elevated inflation, higher interest rates, depressed stock values and fears of an upcoming recession. Americans' concern about the economy is higher than Gallup has measured in most prior years but still below post-Great Recession levels.

While Americans are about as worried about the economy and inflation as they were a year ago, they are now more concerned about Social Security, drug use and healthcare. Meanwhile, they are less likely to worry about energy and the environment.

To stay up to date with the latest Gallup News insights and updates, follow us on Twitter.
Learn more about how the Gallup Poll Social Series works. View complete question responses and trends (PDF download).

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Americans Grow More Concerned With Drug Use, Social Security

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Of 15 key issues, Americans worry most about inflation and the economy, with concerns about drug use and Social Security increasing in the past year.

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Addiction advocacy is a social movement aiming to remove the barriers for people suffering from addiction to get access to treatment services. Bringing awareness to the public and ending the stigma around addiction helps those who suffer from the disease and their families getting the support they need to beat addiction.

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Addiction advocacy and the power of storytelling

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The addiction advocacy movement has made strides in the last several years in succeeding in achieving policy changes to further support communities in providing resources, rallying communities and protecting the rights of those receiving services. By involving those in recovery in the process of advocacy through peer support, allies and those in recovery are able to take part in the social changes that occur by providing services.

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The landscape of recovery has changed dramatically over the past few decades, and we have the recovery advocacy movement to thank for that. While there's still a long way to go to help more people find recovery and improve public and professional perception of substance use disorder, we've made huge strides in this political and social and cultural movement. Together we've put a face to people in recovery, fought stigma, improved policy and the rights of our people, and demanded greater resources to help people find the treatment they need.

The recovery advocacy movement

Researcher Bill White summarizes the progression of our movement beautifully.

"As I entered the world of addiction treatment and recovery in the late 1960s, I witnessed the end of a very dark era in our country - an era in which those with alcohol and other drug problems festered in the drunk tanks of local jails and the back wards of aging state psychiatric hospitals or died alone bereft of hope."

He continues, "Few resources existed in most communities outside the rooms of mutual-aid fellowships. It would have been unthinkable in those early days that I would live to see a national network of addiction treatment and recovery support resources and the rising cultural and political mobilization of people in recovery. I could not have conceived of a day when I would witness more than 100,000 people in recovery marching publicly as far as the eyes could see or that I would one day stand before leaders of new recovery advocacy organizations from all over the United States. And yet we all witnessed the unprecedented numbers in recent Recovery Month celebration events, and I am here today living out the second of those unthinkable visions."

Our major accomplishments as a movement have included a mass mobilization of people getting involved in recovery advocacy, policy victories, professional influence, expansion of recovery support institutions, and the expansion of a culture of recovery.

The social movements have gained momentum over the years largely because they have been led by people in recovery and their allies. " We've come a long way since we launched the first ever Recovery Bill of Rights, in 2008 and hosted a National Call-In Day for Paul Wellstone Mental Health and Addiction Equity Act in 2008," says Executive Director of Faces & Voices of Recovery Patty McCarthy. "These, and many more campaigns and activities, have mobilized the recovery community to have a unified voice in advocacy efforts in their own communities across the nation.".

Local grassroots recovery advocacy

Now tens of thousands of recovery advocates engage in campaigns on a local grassroots level with over 100 recovery community organizations (RCOs).

"RCOs bring the recovery community together it is easy to coalesce around a single mission," says Tony Vezina, executive director of 4D, an RCO for young people in Oregon.

He believes that RCOs play a critical role in the recovery advocacy movement because they employ peers - people with lived experience. "This workforce cares deeply about 'their people' tackling issues from finding recovery to equal pay. Advocating for increased services translates into fulfilling their need to help their community while advocating for their needs," he says.

"RCOs like 4D that are Recovery Community Centers (RCC), with peer services and a diversity of recovery support mutual-aid groups, are well-positioned to be epicenters of the recovery reformation movement. RCCs bring the diversity of the recovery community center together under the same roof and the peers are educated in honoring multiple pathways to recovery."

At a local level, these organizations make a huge difference to the lives of people in recovery, and those seeking it. Together, however, we have witnessed the emergence of a much more powerful movement.

National recovery advocacy success

The greater power in our movement has been through these organizations working collaboratively: RCOs are represented by the Association of Recovery Community Organizations, and other support institutions have formed the National Alliance of Recovery Residences, the Association of Recovery Schools, and the Association of Recovery in Higher Education. Together these organizations have addressed public policy to reduce the discrimination that keeps people from seeking recovery - or moving on to better lives once they achieve it - and have supported recovery-oriented policies and programs.

Faces & Voices of Recovery has been a national leader in the recovery advocacy movement. We have helped pass l egislation including the Comprehensive Addiction and Recovery Act (CARA) and the 21st Century CURES Act, and we have fought to protect our right to privacy by maintaining the federal confidentiality law, 42CFR Part 2.

Our campaign Recovery Voices Count has made it possible for even more of our friends, neighbors and family members to experience long-term recovery from addiction by building a powerful recovery movement that recognizes the recovery community as a constituency of consequence.

Through nonpartisan civic engagement at local, state, and national levels, our goal is to support local recovery organizations develop an organized voice of people in recovery who are educated on key issues. We believe that together will have an even greater impact on the lives of people who still need help with their addiction, people in long-term recovery, and family members.

Take action!

We believe that investing in recovery support services will have great economic benefits for long-term recovery, reduce the burden on criminal justice and welfare systems, and get people the housing, employment, and education services they need.

1. Secure and expand substantial new federal funding for Recovery Support Services

2. Protect patient privacy rights

3. Enforce the Mental Health Parity and Addiction Equity Act of 2008

4. Restore voting rights for individuals with felony drug convictions

5. Support federal and state policy reform efforts to eliminate discriminatory policies and practices that create barriers to employment, housing, education, healthcare and civic engagement

How can you help continue to further the work of our recovery advocacy movement?

Download the linked list of priorities and share on social networks

for alerts that tell you how to take action

Advocate for policies that support the recovery community by getting involved with local recovery community organizations in your area

Get involved with Recovery Voices Count

Become a member of Faces and Voices of Recovery

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The recovery advocacy movement & how to get involved - Faces & Voices of Recovery

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The recovery advocacy movement has made massive progressive in the last few decades. Find out more and how you can get involved.

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The largest factoring impacts on the recovery community are health and state, economic impacts and social impacts through advocacy. The social movements have impacted the health and state greatly through Measure 110 and the creation of additional low barrier resources. Additional resources build our community through fellowship, allyship and fighting against the stigma around addiction. I've provided some links to share the sociological impact on my community, the recovery community based on these three factors.