Does it matter whether it’s viewed as a disease?

The maker on The Anonymous People recently wrote:

“Is addiction a disorder, a matter of human frailty or something else?”

This debate about whether addiction is a disease or a matter of choice continues to garner headlines and direct our collective discussion away from the only thing that really matters: “How do people enter recovery from addiction and stay well?”

He points to the fact that addicts are dying and there are “23.5 million people in recovery.”

About that number, I’ve written about it before. Now, Young People in Recovery throw a little cold water on it:

“There are 23 million people in long-term recovery in the United States.” This widely cited statistic, sourced from a 2012 survey conducted by the Partnership at Drugfree.org and the New York Office on Alcoholism and Substance Abuse Services (OASAS), is often used to justify the need for increased recovery support services in the United States. However, in fact, what this survey actually asked to adults (ages 18 and over) was, “Did you once have a problem with drugs or alcohol, and no longer do?” Each respondent who answered “Yes” to this survey question has subsequently been labeled by the recovery community as a person in “long term recovery.” This begs the question: if a person has struggled with drugs or alcohol at one point in their life, is he or she automatically “in recovery”?

I think it does matter that it’s a disease and I think it matters that we distinguish between those with the chronic, impairing illness of addiction. I tend to believe that failing to distinguish will actually add to stigma. It will perpetuate the conversations that sound something like, “Greg, when your Uncle Tom was in the Navy, he drank too much and got into some trouble. Then he had kids and knocked it off. Why can’t you just do the same?” The reason they can’t do the same was that Uncle Tom was a problem drinker and Greg is an alcoholic.

Non-alcoholics using the drinking experience of non-alcoholics (themselves or others) to understand the experience of alcoholics only increases stigma.

It’s not a different degree of the same thing. It’s a different kind of thing.

In my experience, it’s only when people understand that it’s a different kind of thing—that the experience of the alcoholic cannot be understood by reflecting on your own experience of drinking too much in college—that stigma can be challenged.

So, to me, it’s a political fiction and reasonable people can disagree on whether it’s a useful political fiction. It reminded me of this old post.

Recovering community as political fiction

Ta-Nehisi Coates explores the challenges and political fiction of political movements by unpacking this passage from a feminist:

“She, who is so different from myself, is really like me in fundamental ways, because we are both”: This is the feminist habit of universalizing extravagantly–making wild, improbable leaps across chasms of class and race, poverty and affluence, leisured lives and lives of toil to draw basic similarities that stem from the shared condition of sex…

Inevitably, the imagined Woman fell short of the actualities of the actual woman it was supposed to describe, and inevitably, the identification between the feminist who spoke and the woman she spoke for turned out to be wishful, once those other women spoke up…

But although the Woman at the heart of feminism has been a fiction like any political fiction (“workers of the world,” “we the people”), it has been a useful fiction, and sometimes a splendid one. Extravagant universalizing created an imaginative space into which otherwise powerless women could project themselves onto an unresponsive political culture….

I’ve sometimes struggled with the recovery advocacy movement suffering from the same thing. I think you could substitute “woman”, “feminist”, etc with recovering people and it would be pretty accurate.

We often struggle with how inclusive to make definitions of recovery, who we include in the “community”, etc.

This push to universalize recovery has, I think, been helpful. It’s pushed many people in the recovering community to think of themselves as something larger than their small group and how more people might be helped. (It’s worth noting that Bill Wilson has been described as obsessed with how to reach and bring more people into recovery.) But, it has its limits and, at some point, I suspect it could be harmful. The same walls that inhibit inclusiveness also serve as a container for shared identities, concerns, sentiments, etc. So, I think some caution is probably a good thing.

Ta-Nehisi offers this thought:

But what I like about her analysis is that it doesn’t stop at noting the very obvious point, that political fictions don’t live up to realities.Instead she pushes on to assert that people create political fictions for actual reasons, and often those fictions have actual positive results.