Stigma has many targets. It reaches beyond people addicted to various drugs to affect family members and those providing addiction treatment and recovery support services. Such secondary stigma, for example, is the source of the peculiar pecking order within the addictions field through which status (or stigma) is bestowed across varied settings based on one's recovery status or lack of recovery experience. It also is the source of coded conversations between those working in the addictions field and members of the larger community. As a result, addiction professionals and recovery support specialists may find their legitimacy, their value, and even their sanity challenged by professional peers and by members of the larger culture. The ways in which we respond within such conversations can mark an appeasement (passivity in the face of insult or aggression) or a challenge to addiction-related stigma.
Below are some frequently heard comments (and their coded meanings when combined with certain voice tones and facial expressions) that people working in addiction treatment or recovery support roles hear when they disclose their life's work to acquaintances outside the worlds of addiction treatment and recovery. It is tempting for some of us in these social situations to hide one's occupation, quickly divert to other topics, flee and avoid such future encounters, or escape into a social network made up almost exclusively of others working in the field. But such encounters with the larger community hold great opportunity. They provide a means of challenging the imbedded myths and stereotypes that feed addiction- and recovery-related stigma and its harmful progeny.
Below are some stigma-busting responses to such comments.
Comment: "That must be very difficult work." (Code for: Alcoholics and addicts, as bad people doing bad things, are morally disreputable and dangerous. )
Response: Actually, working with individuals and families affected by alcohol and other drug problems is very rewarding. Many of the people I work with are bright, attractive, and engaging. They represent people from very diverse backgrounds and life stories. I enjoy guiding and observing people regain health and happiness. I also like working within a team of very competent and committed service professionals. Many of those I work with have suffered multiple and quite severe problems, but I continue to be in awe of their persistence and resilience in rebuilding their lives. I could make more money and have more professional status doing other things, but I don't think I would love doing them as much as what I do now. I would not trade what I do for anything. The most difficult part of what I do is not the people I work with but the community resource limitations and the paperwork and other administrative red tape that can demand so much of my time.
Comment: But what about all the treatment failures and deaths I read about (Code for: Why would you work in an area in which success is so rare)
Response: Such losses are horrible and personally painful, but they are an inevitable part of working within any sector of healthcare. But most importantly, addiction-related deaths among those I work with are the exception. Far more common are individuals and families who positively transform their lives and express their gratitude for the help that we have been able to provide them. And what we do through our harm reduction, treatment, and recovery support activities reduces the incidence of such deaths. The deaths that do occur provide an opportunity to recommit myself to improving the accessibility and quality of the services we as a field are able to provide, particularly services that help keep people alive until they achieve stable recovery.
Comment: I guess what you do would be valuable even if you only help one person. (Again code for: Recovery is the exception to the rule--a miracle exception to "once an addict, always an addict.")
Response: If only one person was helped by my organization, we would have to seriously re-evaluate our treatment approaches. There are more than 23 million Americans who once experienced alcohol or other drug problems who have resolved these issues. In treatment, we deal primarily with the most severe and complex of these problems, but the vast majority of people seeking our help will recover, sometimes after multiple efforts. It is a great feeling to be a critical link within this healing process. And we have the opportunity in addiction treatment to see very sick individuals and families get well and go on to achieve significant levels of social contribution. Many of the men and women I work with get better than well.
Comment: "It must take a very special person to work with THOSE people; I don't think I could do that. (Code for, "You must be insane to choose to spend your life trying to help alcoholics and addicts! Who in their right mind would want to do that?)
Response: Thank you. It's true that not everyone is suited to work effectively in addiction treatment and recovery support roles. It requires education, training, and supervised work experience, and it also requires particular values and traits of character such as compassion and empathy. Addiction treatment and recovery support remain frontier areas of healthcare so working in them also requires constant learning. Have you ever been in a situation where you were asked to help someone who was experiencing a difficult or life-threatening problem? I find there are common values within the long-term addiction recovery experience that are very attractive--values such as honesty, gratitude, humility, humor, simplicity, tolerance, forgiveness, gratitude, and service. Working with people in recovery provides daily reminders of these important values.
Comment: "How did you happen to get in that kind of work?" (Code for, "Were you an addict? or "Could you not find another job?")
Response: I had known people who recovered from addiction and went on to make considerable contributions within their professions and communities. It seemed to me that helping people overcome such conditions would be a personally fulfilling way to spend one's life. That has proved to be true. I was equally motivated by seeing so many communities that had so few high-quality addiction treatment and recovery support resources. (Optional: I also thought lessons I drawn from my own personal/family recovery experiences might be of benefit to others facing similar challenges.)
Comment: I have been reading about the arrest of people in addiction treatment for fraud and exploitation of patients. (Code for: "Addiction treatment is a scam the modern equivalent of the snake oil salesman. Are you such a person?")
Response: There are unethical or incompetent people within any service industry who seek to exploit it for their own profit. In the addictions field, we have tried to minimize such exploitation through program accreditation and licensing standards and codes of professional ethics. We try to hold organizations and individuals ethically and legally accountable for breaches of these standards, but some still occur, as they do in all industries. Such breaches do great harm to those needing help and to reputable organizations and service professionals. Unfortunately, the day in and day out delivery of effective and ethical addiction treatment does not make headlines.
The comments noted above rarely spring from maliciousness; they are rarely intended to consciously disparage or shame us and those with whom we work, and some are intended as genuine compliments. The issue is that such comments, when accompanied by repugnant voice tones and facial expressions, are drawn from the core ideas that buttress social stigma and misrepresent the sources of and solutions to alcohol and other drug problems. Such ideas are best changed not from direct confrontation but through personal encounters that provide an alternative way of viewing these problems and solutions. We can be the change agents within this process.
It is easy to cave into the stigma. But silence or weak responses leave stigma and stereotypes intact. As the advocacy slogan declares, "By our silence, we let others define us." Challenging stigma and stereotypes require a much different response. In 2001, I posed the following challenge to people in recovery:
"There are whole professions whose members share an extremely pessimistic view of recovery because they repeatedly see only those who fail to recover. The success stories are not visible in their daily professional lives. We need to re-introduce ourselves to the police who arrested us, the attorneys who prosecuted and defended us, the judges who sentenced us, the probation officers who monitored us, the physicians and nurses who cared for us, the teachers and social workers who cared for the problems of our children, and the job supervisors who threatened to fire us. We need to find a way to express our gratitude at their efforts to help us, no matter how ill-timed, ill-informed, and inept such interventions may have been. We need to find a way to tell all of them that today we are sane and sober and that we have taken responsibility for our own lives. We need to tell them to be hopeful, that RECOVERY LIVES! Americans see the devastating consequences of addiction every day; it is time they witnessed close up the regenerative power of recovery."
Today, I am challenging those of us who work within this special ministry to be more assertive in sharing the transformative power of recovery with all those we encounter socially and professionally and to share the privilege we have experienced as a guide and witness to such transformations. The public is constantly bombarded with addiction's bad news; it's time we shared with them the good news of recovery. Each time we introduce ourselves and what we do to a new acquaintance stands as a potential community and cultural intervention. We too are the faces and voices of recovery--regardless of our recovery status.
Acknowledgement: I would like to thank the following members of the Recovery Rising Book Club whose recent discussion inspired this blog: Brian Coon (PavillonMill Spring, NC), Matt Statman (University of Michigan Ann Arbor, MI), Jason Schwartz (Dawn FarmYpsilanti, MI), Ken Schuesselin (NC DHHS, Division of Mental Health, Developmental Disabilities, and Substance Abuse ServicesRaleigh, NC), Scott Luetgenau (SouthLight HealthcareRaleigh, NC), Brandon Robinson (Fellowship Health ResourcesRaleigh, NC), Amanda Blue (Healing TransitionsRaleigh, NC), Shane Phillips (Duke University Medical CenterDurham, NC), and Chris Budnick (Healing TransitionsRaleigh, NC).