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?“