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On Social Stigma.

11 December 2012

There’s a rather facile article from Salon that has made the rounds on the internet in the past few days, called “Eight Reasons Addiction Carries a Stigma.” They list a bunch of reasons that include the failure of the medical community to properly treat addiction, the discriminatory practices of insurance payments, etc. A lot of their reasons simply beg the question: addicts get sent to jail because of the perception of moral failing. Essentially “there’s a stigma because there’s a stigma.” Tautology rarely, with this case being no exception, provides any new light on a subject. Or: addicts are always under suspicion of relapse, because of the stigma associated with addiction. That’s a consequence, not a cause. So the article isn’t particularly well written, and doesn’t offer any solutions, or suggest alternatives. Of the eight reasons they give, only one seems to be an actual causal reason that addicts face a stigma: we often fail to seek treatment.

Additionally, the writer takes a silly pot-shot at 12 step programs that reveals his deep ignorance of them. He says that patients directed there, and then finding themselves uncured, are reluctant to pursue further treatment. No one who understands 12 step work claims that it cures addiction. It does not. Nothing does that. What 12 step programs do is allow a person committed to recovery to find a path that leads there. Rarely do people “directed” to AA or other such programs recover (though it does happen!). If you have to be directed to a 12 step program, it’s unlikely you’ll arrive in the frame of mind needed to recover. Those who recover arrive of their own desperation willing to do whatever it takes. And those people recover with very high frequency.

The article has entirely left off the two biggest reasons that addiction carries a stigma. The first is that we addicts, we alcoholics, enjoy our drug. Yes, when finally in the deep grips of addiction we no longer take pleasure or joy in drinking or using, but for the most part, we enjoy getting high, we are in denial about the consequences, and we defend our ability to successfully use even in the face of profound, catastrophic evidence to the contrary. And – whether this can be described as a preference in the same way there might be a preference for red vs. blue or not – we prefer to drink and use rather than to engage in life and fulfill our other responsibilities of living. Of course there’s a stigma associated with it. When a person would rather get drunk than raise their children, when the choices they make show a clear preference to drugs and alcohol over human society and basic responsibility, it is utterly natural to see them as failing morally. We abandon our rightful places in the company of effective and useful people, and prefer squalor and misery and inebriation.

The other fundamental aspect of the stigma missing from the article is that we addicts do bad things. We steal. We lie. We sometimes murder. We drive drunk and we kill people in our cars. We neglect children and abandon spouses. We consistently make terrible choices which leave other people in debt, in trouble, or in hospitals and in graves. We do these things, and then we refuse to take moral culpability for them. We hide behind any excuse we can muster, including the disease of addiction, if we think that will get us out of the trouble we’ve caused.

Why is there a stigma associated with addiction and not, as the author suggests, with cancer? Does this question need to be asked? Cancer doesn’t make you lie. It doesn’t make you steal, or prostitute yourself. It doesn’t make you kill. It doesn’t make you abandon those who love you. It is simple and straightforward and obvious why there is a stigma associated with addiction that is not present with other diseases: addicts behave anti-socially.

I’ll go further. It’s not an entirely bad thing that there’s a stigma. When I was in my late stages of active alcoholism, I was unemployed, rootless, and my wife was about to leave me. And she’d have been right to. It’s hard to imagine it being the right thing to do for a spouse to leave a partner with cancer, because of the disease, even if the sick partner refused treatment. But it is absolutely defensible for a spouse to leave a partner with untreated addiction. I’d help one pack today. The stigma associated with our disease can save lives. It can save the spouses and children of an embittered and abusive drunk. And the pain of losing everything can help drive an otherwise hopeless alcoholic or drug addict into recovery.

I know hundreds and hundreds of recovered people. But I don’t know a single one who says: “If only people had been nicer and gentler to me while I was using, maybe I’d have recovered sooner.” There’s a word for being nice and gentle with addicts. Enabling. We will use any crack in someone’s resolve as a toehold to fuel our drug use. We will use people up until they have absolutely nothing left, and then we will discard them as trash. Unless the pain of being a user, the pain of being a drunk, is worse than the fear of recovery.

I came to recovery when I was so sick, when my moral desolation was so complete, that the choice between drinking or recovery or dying was no longer clear. When I was so lost that I had no place to set my next footstep, for fear of the ground collapsing underneath me. And I landed in a soft place: a treatment center that was based in the 12 steps, where they showed me how to follow a path, step by step, day by day, to recovery. By looking hard at my moral failings, at what I drank to suppress. By being honest and brutal about the true nature of what I had become.

It would have made my life far worse, and very possibly ended it, if I had had gentle doctors trying to relieve the stigma of my addiction.

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