“It’s simple, hun—you have the disease.” Bill says this as he hands me a wooden chip inscribed with the serenity prayer:
“God, grant me the serenity to accept the things I cannot change, the courage to change the things I can, and the wisdom to know the difference.”
An biker who somehow landed in Westbank, Kelowna, Tom is paternal. I’ve never been told that I have a disease, but his words incite relief. I cannot stop drinking, and illness is better than badness. I have done horrible things.
I accept a tattered copy of the Big Book and devour it, highlighting, underlining, and earmarking earnestly until I have it memorized. I meet others who do the same. We form unexpected kinships, our lives irrevocably intertwined through a singular, obstinate pursuit of wellness. I repent. They hold me. I have never felt such intimacy.
When I leave 28 days later, we promise to stay in touch. I never speak to them again.
I am 18 years old.
I have been sober for 45 days, and something is very wrong. My legs have stopped working, and when I try to articulate how physically enervated I am—how utterly incapacitated—my councillors tell me to pray.
“God, grant me the serenity to accept the things I cannot change, the courage to change the things I can, and the wisdom to know the difference.”
I am drowning in a vast, violent emptiness. Anhedonia. Near-catatonia. The obsessions, the compulsions, the counting, the rituals; these I must relinquish to a Higher Power (though without them, I’m not sure who I am).
“Stop thinking so much.”
“You need humility.”
I eat 1175 calories a day—no more, no less. Identical meals at breakfast, lunch, and dinner. To deviate would trigger a binge. Pleasure is not safe. I attend group sessions and while other women weep, I try to stay awake.
Am I a sociopath?
All I want is chocolate.
I am 19 years old.
I arrive with a black eye and hematoma on my chin. It obscures my jawline and deforms my cheekbones, my reflection as grotesque as the memories I suppress. I don’t know how it (I) got there.
“Third time’s the charm.”
I am too tired to have hope. After nearly three years of homelessness, I am also too tired not to. Alcohol and bulimia have been replaced by crack cocaine. I no longer feel human. The things I did at 18 pale by way of comparison.
“Your brain is broken.”
I am hostile. My mind is a rabid animal, and I don’t trust this place—these people—to tame it. One month becomes two. Two becomes three, then six, then seven. Something shifts. I listen in a way I never have before. I believe in a way I never have before. The obsessions, rituals, counting, compulsions; they haven’t left, but they have transmogrified into something like spirituality.
“I could drink.”
I stop what I am doing.
Fall to my knees.
Pray.
“God, grant me the serenity to accept the things I cannot change, the courage to change the things I can, and the wisdom to know the difference.”
Once. Twice. Three times.
Six if the thought returns. Nine times. Twelve. Fifteen.
I am terrified of myself.
“Every moment you spend in treatment, your disease is outside doing push-ups in the parking lot. It gets stronger as you do. It will never go away.”
In my sixth month I enrol in two university courses. One of them is introductory sociology. I am intrigued.
The councillors become trusted confidantes. They convince me I can leave. They expect to see me regularly.
I move into a basement apartment two blocks away. I visit the councillors every day, sometimes once, sometimes twice or more. I relay my academic successes.
“Don’t let it go to your head. Recovery must come first.”
I am 22 years old.
“Fuck you!”
The voice is not my own. A new woman has just arrived, and she is detoxing—hard. I am five months sober, and I have entered treatment voluntarily. I may return to my PhD, but I know I’m not prepared. I was promised that staff were trauma-informed.
That was bullshit.
Publicly funded, there are two councillors for thirty patients. Most have been street-entrenched for years or decades. We are told not to discuss drug use. Or violence. Or sex work. Or poverty.
“If you get triggered, we don’t have the tools to contain you.”
Twelve-step meetings are optional. AA members come bi-weekly to share their experience, strength, and hope. When they do, I look away.
“God, grant me the serenity.” —
I walk past the door, my fists clenched tightly. Bile rises in my throat.
I see myself in them. I will see myself in them when a month, two months, a year, from now they use again. They will hate themselves. It will not be their fault.
“This place is a joke!”
This time the voice is mine. I am with the psychiatrist. I denigrate her profession.
“I do not consent to being pathologized.”
She raises her eyebrows; takes notes; says nothing.
I leave early. In addition to bipolar disorder, obsessive compulsive disorder, borderline personality disorder, possible dissociative identity disorder, complex post-traumatic-stress disorder, somatoform pain disorder, possible autism, and, of course, severe alcohol and stimulant use disorders, my discharge summary notes that I present as rather angry.
I am 30 years old.
As I write this, I am 31 years old. I have been abstinent from alcohol and illicit drugs for nearly two years. Before my last relapse, I had been abstinent for eleven months. Prior to that (and prior to the two-year bender that was my Masters’ degree), I hadn’t touched drugs or alcohol for well over five years.
My adult life has been shaped by substance use (or lack thereof): freneticism during periods of active use; temporal boundaries demarcated by surges of euphoria and devastating loss; rigidity and suffocation while sober; crystalline awareness that despite my Herculean efforts to think, look, and act normal, the best I’ll do is pass.
Panic, regardless. I fully expect to use again. Perhaps not immediately but eventually, definitely.
I am still recovering.
Only now, I don’t say that I’m recovering from addiction. Alcohol and drug use were never the problems. In a society that was built on oppression, though (that is, in a society that wouldn’t exist without the ongoing displacement, dispossession, and disappearance of Indigenous peoples; that has been designed to control, regulate, and disadvantage Black communities; that approaches disability as a fatal character flaw; that produces enormous wealth disparities and prohibits anyone who can’t or won’t conform to White, cis-hetero patriarchal standards of productivity from access to power or resources), alcohol and drugs are convenient red herrings.
I am still recovering.
Rather than focus on recovering from a “hopeless state of mind and body,” however, I have turned my efforts outward.
For someone who once espoused the merits of sobriety (and who viewed sobriety as the pinnacle of addict achievement), to now be unbothered by the idea of substance use (mine and anyone else’s) is a radical departure.
How did I get here?
During my third round of addiction treatment, I found sociology. I had very few expectations, but “the systematic study of society” seemed interesting, and it also fit my schedule. I still lived in extended care at treatment centre three, so I took the bus to campus between morning check-in, individual and group therapy sessions, and my daily chore routine. I wrote my first essays in the communal kitchen I shared with 120 other patients, and I asked staff to proofread my work because I didn’t own a computer (not that I would have been permitted to use one even if I had).
At first, education was jarring. After four years immersed in twelve-step programs, to be introduced to the social determinants of health (that is, the socio-cultural, economic, and political conditions that positively or negatively influence one’s health status) was de-stabilizing. Specifically, the insight that exclusion on the bases of income, race, sex, gender, and disability, among other facets of one’s identity, is correlated with outcomes such as substance use confounded me. I had been taught that addiction was solely my responsibility. It was the product of a malignant mind, nothing more, and so extraneous conditions such as homelessness were consequences of one’s usage, not causes.
The more I reflected, however, the more sociology made sense. I developed an “awareness of the relationship between personal experience and the wider society,”1 and was able to understand patterned behavior responses among social groups as they pertained to rates of addiction.
Indigenous peoples, for example, report much higher rates of alcohol and illicit drug addiction than other ethnic groups. Why? Because White frontiersmen introduced alcohol as a tool of colonization. Not only was it a profitable trade good, but authorities knew it would distract from the violence they enacted.3 The attempted genocide that followed included confining Indigenous peoples to reserves, apprehending and abusing generations of children through the residential school system and, in Canada, the “60’s Scoop,” prohibiting cultural engagement, non-consensual medical experimentation, and legislation that continues to disproportionately inflate Indigenous rates of poverty, homelessness, unemployment, and murder. Furthermore, mainstream addiction treatment approaches substance use through a Western world-view, erasing traditional knowledge systems and perpetuating colonial disruption.
Is it any wonder, then, that Indigenous people are more “prone” to substance use?
This is not to say that personal stories aren’t unique, or that individual trajectories won’t be informed by multiple, intersecting forces throughout the life course. We can’t accurately predict behavioural outcomes based on one or two bits of demographic information, but we can (we must) analyze trends (addiction-related and otherwise) within their historical contexts.
This is hard to see. I was a member of the New Westminster “recovery community” circa 2007/8. I was 19 y/o and in my 2 (of 5) abstinence based treatment centres.
— Nicole Luongo (@nicolemluongo) December 12, 2021
Long, rambly thread: https://t.co/pn52iktYj3
Initially, I was fascinated by this information but didn’t think that it applied to me. I was raised in a wealthy suburb. I’m White. I had been sexually harassed, sure (and raped multiple times while homeless), but every AA sponsor I’d had told me this was further evidence of my powerlessness over substance use. “We put ourselves in vulnerable positions while using—when you stay sober, you’ll stop being taken advantage of.” My life chances hadn’t been constrained by systemic oppression (other than ableism, but I did not yet identify as neurodivergent), just my own bad choices, so I remained convinced that while addiction is beyond some, less privileged, people’s control, the origins of my own usage still lay firmly within me.
Then I learned about trauma. My professors introduced me to the implications of interpersonal trauma, and they demonstrated that prolonged developmental trauma, regardless of perceived severity, fundamentally alters one’s nervous system.2 I won’t disclose intimate details of my childhood, but I will say that one needn’t be raised in poverty or contend with racism to regularly feel afraid. This can have enormous physiological consequences in childhood, as being in “fight or flight” mode can lead to mood disturbances4, emotional dysregulation5, and loss of connection6—all potential roots of addiction.
Over time, it became evident that personal traumas are inextricable from broader (“macro-level”) structures such as the economic system. Our “micro-level” communication is shaped by the norms and expectations of society, so values such as individualism, a product of capitalism, invariably affect our actions. AA itself is hyper-individualized: It treats addiction as a “spiritual malady,” and in so doing it mars one’s ability to interrogate how social inequalities (and the maladaptation they evoke) make substance use desirable—and sometimes very necessary.
With this, I questioned everything.
“What if I had been raised differently because my parents had been raised differently? If my Grandparents hadn’t been impoverished immigrants, would we all have been a bit more inclined toward tenderness? Would I still have developed an eating disorder?”
“What if I developed an eating disorder, but the response to it had been less informed by a lineage of poverty? Rather than see bulimia as indulgent, would my parents have had the skills to inquire about the feelings underneath? Would I still have started drinking?”
What if, when I started drinking, I hadn’t been sent to addiction treatment that taught me that sickness was innate? Would I still have blamed myself for all that had happened, prompting an endless cycle of institutionalization, homelessness, self-flagellation via health-negating behaviours, subsequent institutionalization, and even fiercer destruction each time it didn’t have the desired result?
On and on and on. But, most importantly:
“Wait. Why is high-intensity alcohol and illicit drug even considered bad in the first place?”
I specialized in the medicalization of deviance (“abnormality”) as a mechanism of social control.7 In so doing, I catapulted head-first into a voyage of unlearning everything I knew about addiction. I was enabled in part by research, yes, but mostly grew from a) leaving AA and figuring out who the hell I was beneath the meetings and the chanting; and b) connecting with drug user activists. They, more-so than any text, instilled in me that the war on drugs, not drugs themselves, is a threat to our survival.
The history of alcohol and drug prohibition has been thoroughly documented elsewhere, so I needn’t repeat it here. Suffice to say that some substances are illegal not due to their chemical properties, but because they used to afford racialized immigrants and descendants of slavery economic and festive alternatives to wage labour. This threatened colonial nation-building projects, so state officials criminalized anything that might undermine their access to a compliant, exploitable workforce. Substance use also triggered fears of racial mixing (a major no-no among White European settlers obsessed with racial purity), and it threatened Victorian-era morality because ultimately, getting high feels really fucking good.
We must understand what is at stake: the alternatives to abstinence and “the program,” we are told, are jails, institutions, and death. Many arrive at treatment having already experienced a sort of social death. We are excluded from our families, the economy, housing, etc.
— Nicole Luongo (@nicolemluongo) December 12, 2021
Today, the “disease model of addiction” has been naturalized in common discourse. That frequent, high-intensity substance use is a “chronic, relapsing condition” is a taken-for-granted assumption, with few publicly questioning why so many of us get and stay afflicted.
But, when we closely examine the most damaging outcomes of addiction—unemployment, incarceration, lack of access to medical treatment, homelessness, fatal overdose, suicide—we see that most are derived from the stigma, discrimination, and legislation surrounding use, not the actual act of using.
If, for example, heroin were to be publicly available, regulated, and normalized, people wouldn’t have to use in secret. They would know exactly what and how much they were getting instead of being poisoned by a toxic drug supply, and this would substantially reduce one’s risk of overdose. Beyond this, not getting fired or acquiring a criminal record by using would enhance employment options, and homelessness due to “unemployability” would thus be less prevalent.
Additionally, sustained illicit use necessarily propels one into a nefarious shadow world, one in which using becomes priority and social norms are suspended in favour of acquiring one’s next fix. How much of deviance is the result of not caring to participate in society, and how much is learning to not care after being treated like a degenerate? We internalize the labels ascribed to us, and we begin to act accordingly.
So where does this leave me?
Ultimately, I have come to see my own alcohol and crack-fueled binges, which now happen roughly once every 12 – 18 months, as the culmination of economic, political, legislative, institutional, and inter-personal failures. When I have tried to prevent benders by seeking help for post-traumatic stress (and the terrifying dissociative and somatic symptoms that accompany it), my first option is a sterile psychiatric ward, where I exist behind locked doors, am medicated beyond recognition, and am released with an appointment slip reminding me that a month later I am to meet with a harried psychiatrist who will review my medical records, tell me to consider permanent institutionalization, and prescribe me sufficient doses of antipsychotic and mood-stabilizing drugs to kill myself should I opt to (which I always seriously consider).
Mid-bender, trying to seek support looks like presenting at an emergency room, waiting for hours while hallucinating or in severe withdrawal, being given hefty doses of diazapam with the instruction not to ingest while drinking (ha!), and continuing to use. My roommates don’t know how to cope, I invariably lose my housing and employment, and those I should be able to call for help have been told by well-intentioned but misguided acquaintances that offering shelter, food, and safety is “enabling” my addiction (for the record, it is not).
To counter this, we need political education. Incorporating this is tough, because disease models of addiction actively de-politicize it. But there are inroads we can make.
— Nicole Luongo (@nicolemluongo) December 12, 2021
I am left to fend for myself, and after four or so weeks of this I am so depleted and ashamed that I crawl into detox (after a bed becomes available, which can easily take weeks). Afterward, I’m still broke, alienated, and I have nowhere to go.
When I went to addiction treatment for the final time, I thought that perhaps my experience would be different. I was going of my own volition, I hadn’t just been scraped off the street, and I was optimistic that I might receive the trauma care that I still desperately need. Instead, I watched horrifically abused women be blamed for their condition, and as I felt myself deteriorate, I got the hell out of dodge.
I am not broken. The system is.
In some ways, medical sociology ruined me. I can no longer cope with the cognitive dissonance of sitting in twelve-step meetings while people discuss their “selfishness” and “self-centeredness” (the true etiology of addiction, according to the Big Book) while all I see are oppression and bad policy. I’ve tried many times over the years, and each meeting I attend reinforces that these are not, nor have they ever been, my people.
I also no longer pray to accept the thing I cannot change. I work (even as I oft question whether doing so is useful) to change that which I cannot—will not—accept. The former was easier, but given what I know, being passive in the face of injustice is not a viable option
I am still recovering.
By working with other user-activists on drug policy reform, I am recovering from loneliness and despair.
By supporting a homeless encampment, I am recovering from isolation and political impotence.
By writing, I am recovering from years of capitalist-induced performativity and my realities being denied.
According to AA, I am delusional. I most certainly will die soon. To this I say, maybe, but at least I’ll have died not hating myself.
I also refuse to invite people into my life whose love for me is conditional, so when (not if—when) I use again, I will not be alone. This fills me with great comfort, and it is now more important than a sobriety date ever was.
I dare call it spirituality.
Notes
Please note that I’m not claiming that trauma is the sole cause of addiction, which would be as reductive and deterministic as the program I malign. I broadly define trauma as structural violence, symbolic violence, and the more obvious interpersonal troubles it induces. With a background in medical sociology, I have been trained to minimize biological contributions to addiction; but severe, sustained use (which is more prevalent in marginalized groups), leads to physiological adaptations that make reducing or stopping one’s use more difficult.
I fully believe that some people (most people, actually) can transition away from problematic use and learn to use moderately. I am not one of those people.
I don’t wish to dispute that sustained substance use can have deleterious mental and physical health outcomes. As someone who narrowly evades death semi-regularly, it absolutely can. Still, I maintain that this is mostly a result of policy and stigma.
References
- Mills, C. W. (1961). The sociological imagination. New York, NY: Grove Press
- 2. van der Kolk, B. A. (2014). The Body Keeps the Score: Brain, Mind, and Body in the Healing of Trauma. (pp. 99)New York, NY: US: Viking
- Frank, J. W., Moore, R. S., & Ames, G. M. (2000). Historical and cultural roots of drinking problems among American Indians. American Journal of Public Health, 90(3), 344–351.
- Lanius, R., & Olff, M. (2017). The neurobiology of PTSD. European Journal of Psychotraumatology, 8(1), 1314165
- Hopper, J. W., Frewen, P. A., Kolk, B. A. V. D., & Lanius, R. A. (2007). Neural correlates of reexperiencing avoidance, and dissociation in PTSD: Symptom dimension and emotion dysregulation in response to script-driven trauma imagery. Journal of Traumatic Stress, 20(5), 713 — 725. doi: 10.1002/jts.20284
- Sherin, J. E., & Nemeroff, C. B. (2011). Post-traumatic stress disorder: The neurobiological impact of psychological trauma. Dialogues in Clinical Neuroscience, 13(3), 263 — 278.
- Conrad, P. (1992). Medicalization and social control. Annual Review of Sociology, 18(1), 209–232. doi: 10.1146/annurev.so.18.080192.00123
