Overcoming Problems With Substances Is Great—But "Recovery Month" Rubs Me the Wrong Way

Sep 26 2016

Overcoming Problems With Substances Is Great—But “Recovery Month” Rubs Me the Wrong Way

September 27th, 2016

The year I graduated from Yale, I dropped a couch on my foot.

It was the most horrible pain I’ve ever been in, and I had to go the Yale New Haven ER. I waited there with people with gunshot wounds and stabbing wounds. Finally, they got me in, and they had to drill a hole in my toenail to let the blood gush out. I was crying hysterically, and having horrible visions of never being able to wear open-toed shoes or get a pedicure again—a terrifying prospect!

I limped for a few days and had to keep my gross-looking toe covered up for a few months, but eventually the dead toenail turned blue and fell off and a new one grew back. Now I wear open-toed shoes all summer and even to parties in winter, and I get a pedicure every two weeks. (Extravagant, I know, but it’s my money and my feet.)

I don’t think about this incident much. I don’t avoid sitting on couches, seek out other people who have dropped large objects on their feet, or avoid open-toed shoes just because I dropped a couch on my foot 20 years ago almost to the day. I basically forgot about it. It was the worst pain I’ve ever felt, but, at the risk of quoting Katy Perry, these days, it’s no big deal.

A harrowing toe injury is very different, of course, from problematic substance use. But if the standard treatment for the latter were a little more like the treatment I received for my toe—in the sense of there being no presumption of long-term involvement—I believe that millions of us would be better off.

This month has been National Recovery Month, sponsored by SAMHSA. I applaud anyone who is able to overcome a problem with substances, in whatever way. I’m less keen on how my social media feeds fill up during this time with people posting their “clean” dates, but we’ll get to that.

Let’s first remember that most people who use substances problematically stop doing so on their own, with no “treatment” or support groups. Life factors such as becoming a parent, or finding a job you care about, a positive relationship, or better social support, for example, frequently help people move beyond a problem with drugs.

For those who do get treatment, the dominant form encourages them—or forces them, if they are court-mandated or pressured by families practicing “tough love”—to identify as an “addict” or “alcoholic.” Repeating over and over again, “I’m ___ and I’m an addict,” is deemed to demonstrate that one is out of “denial.”

But how is this helpful?

People do what they think they will do. I started calling myself an epidemiologist years before I got my Masters in Public Health and was accepted into a PhD program because I knew this. By identifying as an epidemiologist, I got into online groups that followed hot topics in epidemiology. I networked and found people to write papers with. I made friends who threatened to physically drag me back to school if I didn’t finish my MPH.

I became who I said I was: I am now an epidemiologist.

What if I had spent all that time identifying as an “addict?” Focusing on drugs, spending time talking about them, involving myself in a world of people who had problems with drugs and continue to view that part of their lives as defining? I don’t know, but I don’t think it would have worked for me.

Of course, many people who self-identify that way enjoy success, both in avoiding future substance problems and in their wider lives.

There is some evidence, however, to suggest potential harms. One well-known study, asking “What Predicts Relapse?”, identified “belief in the disease model of alcoholism” (with its determination that once you’ve had a drinking problem, you’re always an alcoholic) as “optimally predictive.”

We live in a time when more and more people believe that you can and should choose your own identity and take pride in it. The transgender equality movement is proof. People are who they say they are. They are who they want to be.

So why people are encouraged to take on an identity focused around the worst, most difficult time in their lives, focusing on their previous problematic drug use, talking about it, viewing it as self-defining, is beyond me.

Why be perpetually “in recovery” when you no longer have a problem?

I believe that in too many cases, the self-hatred that is instilled in people who suffer from problems with substances lingers long after the drug problem is solved. Twelve-step programs like AA and NA can encourage this self-hatred, as people confess their sins over and over again in meetings and Fourth Steps, and make amends for them in Ninth Steps.

I support people’s right to identify as they choose. But I wish people who have had substance problems could be better protected from feeling that shame—which is often driven by government and media support for the very models that encourage this.

And I wish people would stop posting their “clean” dates. Regardless of its implications for the person doing it (that’s their business!), I believe it stigmatizes people who choose to continue to use substances.

Saying that you’re “clean” now implies that you were “dirty” before—and that people who currently use drugs are still “dirty.”

Outspoken members of Recovery Nation claim they’re setting a good example. I beg to differ: I think they are perpetuating the stigma that discourages people from getting help. Many avoid getting help or being honest about their substance use because they don’t want to be labeled forever.

If, instead, they knew they could just get help when they’re going through a difficult time, then simply move on with their lives—even have a glass of wine at the office happy hour if that’s what they choose–they would be a lot more likely to seek help if and when they needed it.

Instead, people typically avoid seeking help until the problem gets so bad they can’t avoid it.

We don’t identify people who were once obese but lost weight as still fat. We don’t call people who went into credit card debt in their 20s “debtors” when they have perfect credit at 42.

So why do we identify people who once struggled with drugs as “addicts”—and that language is a whole other debate that has played out in The Influence before—years after they have experienced any problems?

I paid off my credit cards at 31 and have had perfect credit since. I lost 40 pounds at 29 and kept it off, then gained some back. I gave up sleeping with Irish men in 2014 but quickly “relapsed.”

None of those facts define who I am (though you may find them to be Too Much Information).

The content of our bloodstreams, past or present, does not define who we are. We are worthy of love and respect and a voice in our society. We have the right to choose our own identities, without being pressured into defining ourselves as others would wish.

I’m April, and I’ve been an epidemiologist since 2011.


April Wilson Smith is an epidemiologist who lives in Philadelphia. She was previously a union organizer for 18 years. Her last piece for The Influence was “Why Is There Still No Basic Standard of Medical Care for Addiction?

  • I am a drug addict and alcoholic. I got clean with the help of AA (thank GOD). If you think you can keep drinking or drugging then that will surely be your own undoing. Beware – relapse happens when you least expect it. I am scared for you and the people around you. Get help. I’m tired of this AA bashing. It’s not a cult. The only cost of attendance is to drop a dollar in the bucket. It’s a small price to pay for saving a life.

    • bethmarywhite

      Where in this article did Ms.Smith say that AA is a cult? Me thinks ye protests too much. (or is it thou? Oh I don’t know – that Old English saying) It seems odd to me that you would jump on this site so quickly to defend AA. If you want to see AA-bashing, try the Orange Papers, but I believe this article was just Ms. Smith stating her opinion and observations.

      • Zakariya

        AddictionMyth is being sardonic and sarcastic

      • Steppers are indeed crazy and must defend their CULT at all costs.

      • Tom

        hilarious

      • ஐ~angelbrite~ஐ

        both this article and the Orange Papers speak the truth

      • peter8888

        Thanks for telling it like it is bethmarywhite! Also, AA claims that “there are no dues or fees.” Why, then, is AddictionMyth reporting that “The only cost of attendance is to drop a dollar in the bucket”? Sounds like bait and switch to me. One dollar is far too much to pay for that sideshow.

    • ஐ~angelbrite~ஐ

      AA does far more harm than good so this AA bashing is the truth. if you cant handle the truth then go to AA & continue to be comforted by their lies.

  • Great article. The 12 step cult religion keeps people stuck forever in nothing but self-hate. Mix those vulnerable/afraid/stuck people with the predators lurking in every “room” and you’ve got a recipe for disaster and tragedy. Then the predator is protected by the group with the “find your part” bills*it. It’s a powder keg of a cult!

  • Tom

    “Life factors such as becoming a parent, or finding a job you care about, a positive relationship, or better social support, for example, frequently help people move beyond a problem with drugs.” I think this is really important. AA tells people not to get involved with any ‘intimate relationships’ for the first year of sobriety. How does that help anyone. Does that mean that relationships in AA are not intimate and are therefore disposable? That does nothing but help 13 steppers do what they do. Social support is limited to AA social support. Moving is considered a ‘geographic’ form of denial.

  • ஐ~angelbrite~ஐ

    wow excellent and very accurate article

  • John Barry

    Speaking as a man of Irish descent I think you may be on to something. Perhaps there should be a recovery program for our sexual partners. God knows the experience can be traumatic for them:)

    • Gail Arnett

      I married an Irishman, and it was always a very dramatic (but not traumatic) experience! I’m sure Pat would laugh hearing there was recovery program for lovers of Irishmen!

      • April Smith

        Only one? I could never have just one. I think I’ve dated like ten. 🙂 Then again I live in Philadelphia.

    • April Smith

      Some of my best friends are Irish! But still. It’s a dramatic adventure to date an Irishman. I’m Scottish American. We are a little more reserved.

  • Mark Carmichael

    Whatever Ad Sponsor you’re allowing just above the Comments section bites ass. Is it Satan, btw? lol

  • Nels Bertelson

    This article obviously wasn’t written by someone who once had a drinking or doping problem. It seems strange to me that people would go to these lengths to rip on something they really know nothing about. Take it from me and the hundreds of others I know when I say, and I quote, “one is too many and a thousand’s never enough!!” For people who have had a true problem with drugs and alcohol this rings true. So “even have a glass of wine at the office happy our if that’s what they choose” isn’t an option. Now I’m not a member of AA or NA, although I once was, and I truly believe that what I learned and apply in my daily life as a result has led me to 11 years drug and drink free. Oh and by the way my clean date is 8/25/05!! There are so many things wrong with this article but I’ll just talk on one more. I don’t think people aren’t likely to seek help for fear of being labeled “forever” The problem is fear of the unknown. You see for people like me who have struggled with addiction, that’s all we know. Fixing up is what calms us. It helps us get through life and taking that away is a very real and scary thing to cope with. Not to mention the pains that come along with withdrawal being unbearable!! I’ll tell you that it does take a certain individual to clean up their act. That individual has to want it bad enough to do whatever it takes to right the wrong. That person needs a support group to help them make it through those tough times and to teach them how to act and react to what life throws at them without using or blowing up. Some of us have burned all our bridges and nobody wants anything to do with us. Not family, friends, old coworkers. Nobody!! Some of us need the rooms of AA and NA to find that kind of support and camaraderie. And sometimes, and I do mean sometimes, people like me can start to rebuild lost relationships and make new ones and live a fulfilling life.

    • April Smith

      That’s terrible that you went through such an awful experience, and I’m glad you’re happier now. Sounds like you’re doing great! I congratulate those who get better from a problem with substance by any means. It’s just that the evidence says that your experience is by far the least common. Anecdote is not evidence, whether it’s your story, mine, or anyone else’s. The studies I cite are evidence.

      Unfortunately a one size fits all approach to “treatment” puts many into a mindset that reinforces their feelings of lack of control. No one is actually physically incapable of stopping once they start… ie no one shoots up in front of the cops. But it can get very difficult for some people. The actual evidence is that belonging to groups that reinforce a “powerless” identity is more likely to lead a person to acting powerless.

      I facilitate a SMART Recovery meeting, where we emphasize self-efficacy and making better choices. We provide tools that many find helpful. That seems to help quite a few who don’t find they identify with a “powerless” or diseased label.

      To each their own. Best of luck on your journey. Sounds like you’re doing really well pursuing the path of your choice.

      Be well!

  • Jessica

    I appreciate the viewpoint that the “chronic, often relapsing disease” concept doesn’t work for a lot of people and neither does the front-and-center self-identification as an “addict” or “alcoholic” but I think the idea behind Recovery Month is broader than the way it’s characterized here. A person can celebrate the process of overcoming struggles with addiction without subscribing to some of the concepts you criticize here.