It’s National Recovery Month. But I won’t be evangelizing about my recovery, taking the first or any other step on a recovery walk, or sharing Substance Abuse and Mental Health Administration social media slogans about how recovery is possible… provided you get “treatment and support,” as defined by SAMHSA.
In fact, I don’t identify as being “in recovery” at all, even though I could qualify. I have experienced substance use disorder (SUD)—alcohol, to be specific. These days, having had periods of both abstinence and moderation, I’ve learned how to avoid drinking problematically or chaotically.
But my relationship with alcohol does not define who I am. It’s not how I choose to present myself to other people. I don’t even particularly like to talk about it, though I’ve written on the topic because it matters to me, so I tend to get dragged into conversations. On a day-to-day basis, I’m focused on moving forward with my life—not on my reaction to a distressing period of it.
I absolutely respect the right of people who wish to identify as in recovery to do so. But I want to explain why I don’t wish to—and why I think National Recovery Month may set back the cause of harm reduction.
First, it always risks being exclusionary and reductive. “Recovery,” at least in the United States, has almost always meant abstinent recovery in a 12-step program. Many people and organizations in the harm reduction movement have laudably worked to rescue the term—broadening it to include various pathways, including non-abstinence, and people’s self-definitions. But sadly, 12-step based abstinence is still what “recovery” means to most.
Most of us are just moving on—and perceptions that we can never really do so are stigmatizing.
So if you say you are in recovery, people around you will often make certain assumptions.
That you are, or should be, abstinent from all consciousness-altering substances (except nicotine, caffeine and prescription drugs that they approve of).
That you have been, or are, in some kind of “treatment.”
And that there’s something permanently wrong with you.
Let’s spend a moment on that last one. American culture has so internalized the 12-step vision of “Once an alcoholic/addict, always an alcoholic/addict,” that the stereotype of a person who may seem nice, but will turn into a raging monster if they come into contact with even one drop of alcohol, is still pervasive (flashback to the time my stepmother, trying to help, warned me that there might be alcohol in the tiramisu).
But most of us who have previously experienced SUD are not forever teetering on the brink like this. Most of us do not dedicate large portions of our lives to ongoing recovery “work.” Most of us, in fact, are just moving on—and perceptions that we can never really do so are stigmatizing, more subtly but just as definitely as words like “alcoholic” or “addict.”
Common terms perpetuate this. For example, the inherent suggestion of “in recovery”—rather than, say, “recovered”—is of an ongoing condition. The phrase “active addiction” similarly implies that addiction persists whether or not your patterns of use continue.
The related tragedy is that people’s internalization of the disease-model, “always an addict” perspective can become self-fulfilling, as research has shown.
This assumption harmfully feeds into the narrative that rehab “fixes” people and is the right thing to do.
Stepping back to the treatment point, mentioning your recovery will routinely lead people to assume that treatment of some kind, likely residential rehab, has been part of your journey. In my case—disastrously so—it has. But I’m in the minority.
This assumption harmfully feeds into the narrative that rehab “fixes” people and is the right thing to do, when traditional 12-step rehabs aren’t demonstrated to be effective.
“The last study done on the effectiveness of ‘substance abuse’ treatment which included an untreated control group was published by the Brandsma group in 1980,” Kenneth Anderson, a harm reduction colleague of mine who authored of How to Change Your Drinking and a comprehensive series on the history of US addiction treatment, told Filter. “At one-year follow up, the group who were not treated at all were doing just as well as those who underwent treatment … we know that most people who go to rehab do not sustain abstinence, and are not taught the skills of harm reduction or moderate drinking.”
The most recent iteration of the National Survey of Substance Abuse Treatment Services was conducted in 2020. Of 16,066 facilities of all kinds included, 10,517 (65.5 percent) reported using 12-step facilitation as a primary treatment modality. Of 2,427 non-hospital short-term residential rehabs, 90 percent reported using 12-step facilitation.
Natural recovery is the process by which the majority of people with SUD recover as they get older, with no treatment or program involvement.
“When someone has a substance use issue, the knee-jerk reaction is, ‘Go to rehab,’” Anne Fletcher, author of Inside Rehab: the Surprising Truth about Addiction Treatment and How to Get Help That Works, told Filter. “Traditional 12-step rehabs are one-size-fits-all, meaning most of the treatment is group treatment, and there is very little individual counseling. The truth is that most people who recover don’t go to rehab.”
This reflects the key reality that the rehab narrative ignores: Natural recovery, also known as “aging out” of addiction, is the process by which the majority of people with SUD recover as they get older, with no treatment or program involvement.
The continued suppression of this proven good news is baffling—until you consider the treatment industry’s profit motives, and drug warriors’ vested interests in demonizing drugs.
Then there’s abstinence. Many people who have experienced SUD practice it, and that’s great for those of us who find it works best. But most don’t—not from all drugs at all times.
Acknowledging this can strike some people to whom abstinence is personally important as threatening, in my experience. But it’s absolutely vital that we do acknowledge it—first because failure to do so stigmatizes drugs and people who use them, and second because we otherwise exclude the majority of experiences from the recovery narrative.
Our national fixation with abstinence has deep roots, from Temperance to Alcoholics Anonymous, and it continues to distract and deflect from what should be our overwhelming priority: reducing harms.
The concept of “recovery” draws a sharp dividing line between those who have ever been open about a problem with a substance and the rest of humanity. This is palpably absurd and unhelpful.
On a personal level, publicly identifying as “in recovery,” I have found, can effectively invite anyone you know to police your substance use. Perhaps you had alcohol use disorder but now drink moderately on occasion without problems. Perhaps you had opioid use disorder, but now use cannabis, or buprenorphine, instead of illicit opioids.
Whatever the circumstances, you can bet that unless you’ve spent a lot of time educating them, someone in your life will express concern that you’re not “sober,” and worry that one thing may lead to another. The myth of “gateway” drugs and the specter of “cross addiction” will continue to haunt us, possibly driving us to use in secret.
More broadly, the concept of “recovery” draws a sharp dividing line between those who have ever been open about a problem with a substance and the rest of humanity. This line is palpably absurd and unhelpful.
Substance use issues, as the DSM has begun to acknowledge, exist on a spectrum—not as a binary yes or no. Many cases are borderline and a matter of interpretation, and the quantity of a substance consumed is rightly not considered an adequate determination.
It shouldn’t need saying, but probably does, that many people have been “sober” for years yet are not one bit happier or safer, while many others who reduce or change their use may thrive.
And what about the countless people who experience addictions that somehow aren’t included? Food is an obvious one, with a growing crisis of obesity. And curiously, even though nicotine is a psychoactive drug—and when addiction to combustible tobacco is associated with far more deaths than any other substance—quitting cigarettes is never framed as “recovery.”
People react to life’s stresses in many ways. Some drink too much. Some eat too much. Some take it out on coworkers, spouses or their children. Others practice self-harm. Yet if the problem does not manifest as an issue with certain substances, people rarely identify as “in recovery.” Our use of the term artificially siloes some groups of people from others, in a stigmatizing way—much as US methadone clinics, for example, are separated from the rest of health care.
I have a problem with how SAMHSA privileges one group while ignoring the equally valid, and often better-evidenced, paths taken by many others.
To give SAMHSA some credit, their National Recovery Month messaging this year has some positives. They do, in one tiny blurb underneath “pathways to recovery,” mention natural recovery as a possibility. That means they admit it exists!
They still let you know where they’re really coming from, though. For instance, on their social media “shareable” about their Walk for Recovery, they say, “Recovery begins with the first step!” In what universe is that not a knowing nod to Step One of AA?
Yes, I accept that for certain people on certain recovery journeys, these events and campaigns can be positive and affirming. I just have a problem with how SAMHSA privileges one group while ignoring the equally valid, and often better-evidenced, paths taken by many others.
Of course they can’t help but insist that “peer support” (read: recovery groups) is required. From their social media shareable for Week Four: “Peer support is crucial for people at every stage of their recovery journey. You can find peer-based support groups—online and in person—for people of specific ages and shared experiences. Learn more.”
Some people may find this to be true. Many more of us—at least in the sense of any formal peer program—do not. Remember what you just said about natural recovery, SAMHSA? What about those of us who find it detrimental to spend hour after hour with people talking about substance use problems, even after years of “sobriety?”
And then there’s the insistence on “support” in the form of treatment by those professionals who, even though their track record is abysmal, claim to be necessary. From another shareable: “With the right support, #recovery is possible for every individual facing challenges. This #RecoveryMonth, find health care professionals, programs, or support groups … #RecoveryistheExpectation.”
Beyond the implication here that recovery is not possible without such interventions, these “professionals, programs or support groups,” to me, sound very much like the people who once convinced me that my identity was “alcoholic,” that just one drink would always lead to a binge, and that all of this was my fault and mine alone.
No thanks. Treatment and recovery groups made me worse, not better. And many people I’ve interacted with over the years would say the same.
National Recovery Month messaging has nothing to say, meanwhile, about the direct responsibility of prohibition for many drug-related harms. Indeed, it manages to drive a national drug-related conversation each year that has little to do with harm reduction at all—something that’s hard for me to get my head around in these times.
Instead, it feeds into the drug-war narrative that people who use drugs are diseased, damaged and need “treatment” in order to recover. It obscures harm reduction in the name of certain approved recovery models. As such, it acts as a feeder for a corrupt, ineffective treatment industry. That’s why I want no part of it.
Image via SAMHSA
