Eve Tushnet offers a really thought provoking discussion of a dialectic involving competing recovery narratives.
First, “sublime” recovery:
In this narrative, addiction and recovery are basically spiritual. Forgive me for drastically oversimplifying a novel I’m loving, but in IJ [Infitite Jest] addiction is often an enslavement of the will or an escape from the self. Recovery is even more insistently spiritual. You recover by giving up and doing as you’re told: Unconditional surrender is the only path to personal peace. If you don’t learn humility through obedience and accept total transformation through surrender to some kind of obscure Higher Power you will destroy yourself and everything you care about.
Then, “banal” recovery:
There’s another narrative, though, which is emerging at sites like The Fix and Substance.com. This is a gradually-coalescing worldview, which typically includes but isn’t limited to “harm reduction” properly understood: ”Harm reduction is a set of practical strategies and ideas aimed at reducing negative consequences associated with drug use. Harm Reduction is also a movement for social justice built on a belief in, and respect for, the rights of people who use drugs. ”
She contrasts the two narratives in several ways, including their view of authority:
The two narratives have differing views of authority: The 12-Steppy model comes across as authoritarian, and can definitely be used as an excuse for cruelty, but it also has an anarchic respect for the wisdom of ordinary people. It attempts to turn followers into leaders through personal guidance. What I’m (again, super-reductively) calling the harm reduction model is simultaneously much more individualistic, and much more reliant on medical expertise. The expert-layperson hierarchy is in many ways more rigid than the sponsor/sponsee relationship. The harm reduction worldview tries to avoid the problems of class- and education-hierarchies by soliciting as much participation as possible from people on the ground, current drug users. “Nothing about us without us” is a slogan of the harm reduction movement, and one with which I agree… but it’s not a slogan AA ever needed, because AA’s whole genesis and development was by “us,” the alcoholics.
She repeatedly acknowledges that she’s oversimplifying the themes in these narratives, but she does a very interesting job contrasting these narratives and the views within them.
An especially interesting point is around “real” recovery.
The increased prominence of the dramatic 12-step narrative, what I’m calling the narrative of sublime recovery, may make it harder for us to accept that anything else is “real” recovery at all.
Maia Szalavitz, a truly invaluable journalist whose work I’ve recommended here before, recently asked, “Most People With Addiction Simply Grow Out of It–Why Is This Widely Denied?” Part of the answer, I think, is that the growing-out-of-it type of recovery is invisible–and it’s invisible because it’s boring.
I have a couple of reactions. First, that I’m not sure I buy the framing of the the “sublime” narrative as being ascendant.
Second, I’d take a step backward on the this matter. Any addict finding a way out of addiction is something to be celebrated, regardless of the path.
The article she references asks why it’s denied that addicts grow of their addiction. I’ve never heard it disputed that lots of problem users moderate or stop without any professional or informal help. I’ve worked in a fairly traditional treatment program that embraces the “sublime” narrative for more than 20 years and taught social work and chemical dependency classes for more than 10 years and we’ve always discussed the fact that the majority of young people who meet alcohol dependence criteria will “mature out”. We’ve emphasized the importance of careful assessment, looking over an extended period of time for factors like multiple failed attempts to stop or moderate, craving/preoccupation, functional impairment, detoxes with returns problematic use, prior treatment episodes, problems with multiple substances, etc., to try to differentiate between problem use and addiction. This can be especially difficult with young people who have never really tried to quit. The point is that DSM Dependence is not a good proxy for addiction. If you use those criteria for identify addicts you’re going to get A LOT of false positives.
The same problem comes up in recovery advocacy, where we hear the frequent references to 23 million recovering Americans. This number is great for advocacy, but it’s based on surveys that count respondents who report once having “a problem” with drug and alcohol and no longer have a problem. Are these people addicts?
The issue isn’t really about denying their recovery, it’s more about questioning their addiction.
It’s also hard for me to imagine that individuals involved would care much. I get the impression that most of them did not think of themselves as addicts and don’t think of themselves as in recovery.
I don’t deny that there are one-wayers who try to invalidate any path but their own. We see that in all cultures/tribes/organizations. And, I think it’s easy to overstate how much tension actually exists. I don’t hear these conversations among recovering people and I don’t hear much tension around it in professional circles. It’s mostly academics, journalists and activists.
However, where there is tension, I wonder how much of the tension around the “realness” of the growing-out-of-it type of recovery is really about the “realness” of the growing-out-of-it type of addiction.
UPDATE: This isn’t to say I believe that addicts can’t experience “natural remission”. As with any illness, it happens. My question is about the number of addicts who grow out of it.