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Editorial Comment 5/7: Graduations

by William Haning, MD, DFAPA, DFASAM | May 6, 2019

Editorial Comment:  Graduations

All around us during this last month of spring are the phenomena of emergence: graduations, convocations, celebrations. Students complete some phase of their education and are reminded by high-minded pedants that they are just about to enter another phase of it. Military enlistments, repatriations, and transfers reach their peak.  Marriages, and other hopefully-lifelong relationships are commemorated. And, somewhere in there, is the less seasonal ceremony that accompanies completion of a cycle of treatment for a substance use disorder. This is a long tradition, probably even preceding the establishment of the Minnesota Model in 1949, maybe even before the Keeley Institutes of the mid-1800s; and in which our patients who emerge from one stage of their recovery speak of how it feels. The speeches from the celebrants are normally brief, and commonly are a mixture of enthusiasm for recovery and, sometimes, anxieties about its durability. We reassure them, at the same time that we do not wish to be too reassuring; we are ambivalent. We worry that it is a little like whistling in the dark, to scare away the bad spirits.

Of course, we don’t engage in this kind of ceremony when people are discharged from a behavioral science unit - less euphemistically a psychiatric facility - and certainly not after an extended hospitalization for diabetes and its consequences. Likely it is because those recovering from addiction are a cohort, a group that has shared a similar trajectory in recovery; in the other examples the treatment experience is individual, unaccompanied. The ceremony is a reminder that while acquisition of the illness of addiction is an individual matter, however tribally-influenced, aftercare and recovery may best rely on the conjoined strength of a group. All the kids hold hands; all look both ways; all cross the street safely, together.

- Editor-in-Chief: William Haning, MD, DFAPA, DFASAM