The Two Pillars of Recovery® Introduction
Not long after becoming medical director of an inpatient addiction unit at a hospital in New Hampshire in 1988, I realized that most of my patients—two-thirds or more—had been in treatment before. Their stories of relapse were unique, but also remarkably similar. All the relapsed patients wound up back on addictive substances because they did not take their addiction seriously enough, and they made two key mistakes. They went back to being physically near addictive substances and people who were using them. And they stopped turning to other people for help with recovery—if they ever turned to them at all.
To help my current patients avoid the dangers and inconvenience of relapse, I warned them of the mistakes made by so many others. I stated my warning in various ways, but eventually settled on urging all patients to adopt two protective actions: “Keep your distance!” and “Ask for help!”
In the 1990s I realized these actions represent more than practical wisdom. They summarize what anyone seeking recovery from addiction needs to know about brain science (neurobiology). Addictive chemical substances change the brain and can change behavior in harmful ways, such that people with addiction can’t trust themselves. (Therefore, Keep your distance!) Positive interpersonal relationships change the brain and change behavior in helpful ways, such that people with addiction succeed in recovery in part because they connect openly and honestly with others. (Therefore, Ask for help!)
I continued to include the exhortations Keep your distance! and Ask for help! in group discussions about recovery. At the hospital in Maine where I worked in 2001, the legs of a conference table along the side of the group room consisted of two sturdy pedestals. I got into the habit of pointing at the two pedestals to emphasize my message, referring to the two crucial actions as “the two pillars necessary to support your recovery.”
The metaphor “The Two Pillars of Recovery” stuck. It encapsulates both practical wisdom and relevant science—and its simplicity helps individuals seeking recovery from addiction remain mindful of their basic responsibilities.
Three NCADD Addiction Medicine Updates available on this website (The Two Pillars of Recovery®, Keep Your Distance! and Ask for Help!) offer more detail. A recovery workbook based on the material will be available soon.