Peer Recovery Support by Prison Correspondence

The “helper” therapy principle proposed in 1965 by sociologist Frank Reissman suggests that those providing help are as likely, if not more likely, to benefit from the helping relationship as those receiving help (Reissman, 1965). Recently, research has confirmed the value of helping others in elevating long-term addiction recovery outcomes (Pagano, Post, & Johnson, 2011; Zemore, 2007; Zemore, Kaskutas, & Ammon, 2004). This article describes a novel approach to involving people in a primary social model recovery program in corresponding with incarcerated men and women who are seeking recovery support. Such an approach has particular relevance for addiction professionals due to the 2.5 million incarcerated adults in the United States, two-thirds of whom meet medical criteria for a substance use disorder (CASA Columbia, 2010). It is also of import in light of the growing interest in the integration of peer-based recovery support services within professionally-directed addiction treatment. The article will discuss an approach used by The Healing Place of Wake County that the authors believe could be adapted in a wide variety of addiction treatment and recovery support settings across diverse cultural contexts.

Background

The Healing Place of Wake County (THPWC), located in Raleigh, NC, is a 501(c)(3), not-for-profit organization that provides overnight emergency shelter, nonmedical detoxification, and a long-term, social model recovery program for homeless adults with a substance use disorder. Replicated from The Healing Place in Louisville, KY, THPWC has been in operation since 2001 and provides recovery support services before and after the period of primary residential care.

Individuals participating in services at THPWC can be characterized as having high problem severity, complexity, and chronicity as well as substantial personal and environmental barriers to successful recovery initiation and maintenance. While participants range from their late teens to their late sixties, most are middle-aged, with an over-representation of African Americans compared to their proportion of the Wake County population. A majority of program participants have prior or current involvement in the criminal justice system, and it is not uncommon for a current or former participant to be sentenced to prison for past criminal offences.

A series of incidents triggered THPWC’s interest in the potential of peer support for THPWC constituents who experience incarceration. In 2009, a THPWC participant was sentenced to 138 months in prison for crimes committed before her seven-month involvement in THPWC. At that time, it became clear to us that we needed to do a better job of providing support to people who were trying to sustain their recovery in such a recovery-deficient environment. Up until this time, the only form of support consisted of staff writing occasional letters of encouragement. Following the 2009 incident, a more formal procedure was implemented that created a process for consistent letter writing, as well as opportunities for involvement of current program participants. About the time THPWC’s letter writing campaign started, a former participant who had completed the program became a certified substance use counselor and was hired at the very penitentiary where our 2009 female participant was incarcerated. He was able to provide a first-hand account of the full-spectrum impact that the letters were having in supporting her continued recovery.

A second powerful incident occurred in 2013. A program participant serving a five-month sentence after being at THPWC for eleven months came back to THPWC upon his release. When asked if he had received any letters from his fellow THPWC participants while in prison, he revealed that he had amassed 281 letters in less than five months. While it had not been his intention to return to THPWC, the accumulation of letters and the support of his peers convinced him that he would benefit from returning to THPWC for transitional support during his community reentry. These incidents led to the development of a more formal program of peer-based recovery support for incarcerated men and women.

Recovery through Correspondence

One aspect of the recovery program at THPWC involves the gathering of current members of the latter two phases of the program. These “Phase I Community” meetings are peer run, and are designed to address issues and concerns among members of their respective cohorts. The Phase I Community also elects members to serve in various leadership positions. One such position, the “scribe,” is a nominated position responsible for writing notes during the meeting and posting a daily recovery history event on a public whiteboard. The scribe also takes responsibility for recruiting other program participants to write letters to former participants who are incarcerated. At the end of the two week commitment, the scribe turns in a report indicating how many program participants wrote letters, how many prisoners they wrote to, and how many letters were written in total. It did not take long for this practice to expand to potential program participants who expressed an interest in THPWC after learning about it from a fellow inmate who had received a letter.

The THPWC men’s facility currently houses approximately two hundred participants, around one quarter of which are in Phase I, and it is during this period that participants are encouraged to write letters to inmates. THPWC staff members maintain a list of approximately twenty-five inmates, representing about fifteen correctional facilities, who have been a part of the THPWC community or who have communicated their desire for recovery support to THPWC. Of the around fifty participants in Phase I of THPWC’s program at any point in time, there are usually fifteen to twenty participants who each write two to three letters every two weeks to fifteen to twenty inmates on the list. Since starting the practice, over 1,500 letters have been written, with more letters being written each month. In 2014 alone, THPWC saw 1,201 letters mailed to inmates from its men’s facility, with an additional 331 from the women’s.

Preliminary Evaluation

Recently, the lead author began evaluating what this recovery support strategy meant to those receiving letters, those writing letters, and to THPWC staff. This entailed staff interviews, surveys of those who had sent and received the letters, and a survey of current program participants who had been previously incarcerated.

The strongest themes amongst those incarcerated were feeling inspired to stay positive and gratitude for simply not being forgotten:

Prisons can be a lonely place. It’s also a time where, it’s been my experience, that one ponders the past and future a whole lot. – Shayne

When you are incarcerated it is like a complete disconnect from the world, and when you receive letters from your peers in recovery it gives you the feeling of still being connected. Many a day it served the purpose of getting me out of my self-pity and the depressive attitude that goes along with life in prison. – Dennis

They write and offer encouragement, advice, strengths, and hope. They let me know that I’m not forgotten. They let me know that they still believe in me. They let me know there is still a plan and purpose in my life. They let me know that I’m still able to be of help to someone [sic] else even in my incarseration [sic]. They let me know that I can make it. I can’t begin to tell you how elated I am that even in my absence I’m present in thought on a daily basis. – Pauletta

It is of particular importance to note that Pauletta describes feeling like she has something to offer others. This sense of opportunity for contribution is paramount to the health of any community and its members, and is reflected by some of the other inmates as well:

I understand it is helping them in their recovery process. It is always encouraging to share with another recovering person and hearing about their experience. Being a former resident of The Healing Place, I understand the roller coaster of recovery and how hard refocusing on life can be. – DeMorris

This same satisfaction from providing support is gained by participants of THPWC who write to the inmates:

Writing guys like Michael gives me an opportunity to get outside of myself. It gives me an opportunity to forget all about my troubles. It gives me relief from the bondage of self. It gives me the chance to carry the message of hope to the still suffering addict/alcoholic. – Mitch

Writing letters to inmates, for me, gives me a chance to get outside of myself and tell a little part of my story to someone who is struggling due to their addiction. I hope they feel some sort of connection between us, because I have been where they have been, and hopefully they find some motivation and hope in what I write. If I can help just one of those guys find some motivation and optimism, then I have done my job. Reaching out to those men hopefully is a symbiotic relationship, but I know I gain peace and serenity just knowing that we have at least let those guys know that there is a solution and that they never have to sit where they sit again. – Will

The main purpose is to get outside myself and share the hope and gratitude that has grown in me while here at The Healing Place and in AA. I can share with others that there is a better way to live, it is possible for anyone no matter what their past wrongs, and I am proof that change can happen one day at a time . . . I have gotten more out of writing letters than I could have expected . . . It would not be possible without the support of The Healing Place. They provide envelopes and take care of the postage. The rest is being willing to jott [sic] down a few words of hope. – Kyle

Kyle, who provided the last quote, was a recent scribe for THPWC, and proved exceptionally fit for the job. His enthusiasm for the letter-writing program earned him a rare second appointment to the post, and his accomplishments serve as explanation: in his two-term tenure (a total of four weeks), Kyle oversaw the mailing of 155 letters of support. To give perspective, there had been 253 letters mailed in the six months prior. This eruption in production reflects THPWC participant perception of the benefits of these letters.

Many participants of THPWC go out of their way to write letters to inmates because they know exactly how it feels to get mail:

Being a former jail prisoner and then state prisoner, I know firsthand the importance and emotional significance of recieving [sic] personal corrispondence [sic] from persons in the free world. There is not a more lonely and lost feeling of waiting in the mail line every day hoping to recieve [sic] some type of mail . . . So I write to them, the alone and forgotten in the hopes that I might give them some form of friendship and encouragement . . . [and] it has enriched my life to a degree I cannot explain. It thrills me just as much to recieve [sic] answers to my letters as I hope it does to them. – Marlin

There is even a current staff member at THPWC who had to serve a one-year sentence immediately after completing the Healing Place program, giving him a unique and comprehensive perspective on the letters:

When I reported to prison I had a feeling of that I would be “forgotten of” by most people. But when I received letters from the fellow clients at The Healing Place it really gave me a new sense of value in life. Today, I am on the other side of the fence and by writing to inmates I experience the same feelings and that maybe I am helping someone just the way it helped me. I cannot see anything but good results coming from the practice of writing inmates and former clients. I know it is a great benefit to all parties involved. Maybe more so to the inmate than the sender, but it’s beneficial to both. – Dennis

But in addition to the relationships fostered by the content within them, the letters served an additional purpose, as Dennis notes in describing how other inmates reacted to him receiving letters while in prison:

They were inquisitive about what The Healing Place was and wanted to know what it was all about. And if they get out and decided they needed to go to a treatment or recovery program how to get access to services. – Dennis

This attraction to “Mail Order Recovery” was exciting to personally experience when the return envelope provided for response in preparing this article was passed from the intended inmate to another, who wrote to express interest in becoming a participant of the Healing Place:

I’m from [rural] NC, but I can’t go back when I get out or I will be back on drugs since everyone I know and most of my family use . . . I’m really thinking of going to a drug rehab when I get out . . . I’m trying to find out more about your program and what you do? Another inmate told me other people in your program would write me. That would be great since I don’t get any mail from the outside. – Roger

Summary and Implications

The soul of most helping professions, and of particular importance to efforts of attraction to recovery, is relational connections. Sometimes intense efforts are needed to foster a connection with people seeking recovery from addiction. But at other times, they just need a simple reminder that there are others out there who care about them, even if it’s a stranger. In a place meant to separate and sequester, even a minor connection can represent a shining beacon of hope.

Encouraging program participants to correspond with inmates is an extremely cost-effective medium for delivering recovery support services through The Healing Place. The letters afford both participants and persons who are incarcerated opportunities to strengthen their peer network through supporting each other—a form of mutual support that has been found to be extremely effective in enhancing long-term recovery outcomes and reducing both addiction treatment and prison recidivism. Connection to a peer-based recovery support network provides critical continuing care that stands as a marked alternative to the norm of “aftercare as afterthought” (White, 2009).

References

CASA Columbia. (2010). Behind bars II: Substance abuse and America’s prison population. Retrieved from http://www.casacolumbia.org/addiction-research/reports/substance-abuse-prison-system-2010

Pagano, M. E., Post, S. G., & Johnson, S. M. (2011). Alcoholics Anonymous-related helping and the helper therapy principle. Alcoholism Treatment Quarterly, 29(1), 23–34.

Riessman, F. (1965). The “helper” therapy principle. Social Work, 10(2), 27–32.

White, W. L. (2009). Peer-based addiction recovery support: History, theory, practice, and scientific evaluation. Retrieved from http://www.attcnetwork.org/regcenters/productDocs/3/Peer-Based%20Recovery%20Support%20Services.pdf

Zemore, S. E. (2007). Helping as healing among recovering alcoholics. Southern Medical Journal, 100(4), 447–50.

Zemore, S. E., Kaskutas, L. A., & Ammon, L. N. (2004). In twelve step groups, helping helps the helper. Addiction, 99(8), 1015–23.