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Combating Stigma.

7 December 2016

I was at a meeting yesterday where a researcher was asking for recommendations for his grant on public health. It involves, among other things, surveying a population about its attitudes toward addiction and alcoholism stigmas. I was there as a public health researcher, not as an alcoholic. No one in the room knew my background. The purpose of the grant is to identify, and eventually influence, public attitudes toward sufferers of addiction and associated mental illnesses.

I tweeted that I find researchers efforts around stigma to be often kind of pointless, and counterproductive. I often vex the addiction research community with my opinions on addiction research because I don’t think we can be cured – ever, and I think that well-meaning attempts to reduce stigma often make things worse. I was asked to elaborate by a friend who is a rather prominent addiction researcher, but on the neurochemistry/biology side.

I’m a little bit hamstrung because even in this anonymous forum, I don’t want to describe the methods of a grant-in-progress, and torpedo a colleague’s work even if I think it’s unlikely to do the good they think it will. So let me speak generally about medical and sociological attempts to reduce stigma associated with addition. I’ve written about it before, almost exactly a year ago.

There are about three types of stigma associated with addiction as I see it, and researchers concentrate on two: (1) The belief that addiction is a moral failing or weakness; (2) The mistrust and suspicion of addicts in recovery. They get both of these wrong, in important ways. Case by case:

Researchers are correct in that addiction is not a moral failing or weakness. It is a disease that some suffer from. However, addiction requires a behavioral solution that an addict must willingly participate in to recover. Concomitant with the attempt to repeal the stigma of ‘moral failing’ comes, inevitably, a stripping of the expectation that addicts have to actually take action to recover. This excuses us of the need to take ownership and responsibility. Without that, we will not recover. Just as a cancer patient needs to actually go to the hospital to receive treatment, so too do addicts need to actively engage in our recovery to effect and maintain it.

When researchers and health care providers attempt to simply medicalize treatment of addiction – to remove responsibility for action from the addict and translate it to the medical community – they kill us. Addiction is not a moral failing, and it is not the result of weakness. But that doesn’t mean that addicts are just absolved of the responsibility and need to engage with and confront their disease. But refusing that is a symptom of addiction. We are highly susceptible to being told we’re victims of a disease and have no responsibility to change. We hear what we want to hear.

In the second case, researchers are often looking for ways to reintegrate the recovering addict back into society. Thus, they seek to minimize or eliminate suspicion that addicts will relapse, that recovery is fragile, etc. The problem is, recovery is often (especially in the beginning) fragile, and addicts usually relapse. In part because of the misguided efforts of the prior two paragraphs (but really, it’s mostly on us).

As I’ve written before: reasonable caution is not stigma. I am an alcoholic. Alcoholics relapse. It would be perfectly reasonable to subject me to extra scrutiny especially if my job required me to operate heavy machinery. It is appropriate to charge me higher auto insurance. It is appropriate to consider me a higher risk for anti-social behavior because I am a higher risk for anti-social behavior. It is ridiculous to expect employers and institutions, armed with the knowledge that I am in recovery, to consider me to have the same risk profile as normal people. I do not.

So that’s the two things that researchers and activists get actively wrong. But there’s an important passive wrongness too: the low expectations. This is what I wrote about in the post linked above. I don’t tell people about my recovery in my work, and not really because I’m afraid of the other two types of stigma. The first no longer applies to me – I haven’t avoided or failed treatment because anyone thinks I’m morally weak. The second does apply to me, but as I’ve said, that’s not really stigma. And I’ve already reintegrated. The ways my disease could be held against me are small and not likely significantly harmful.

The third I get all the time. Ordinary accomplishments are exaggeratedly praised because I’m in recovery. People have diminished expectations of an alcoholic in recovery. Being in recovery is seen, apparently, as accomplishment enough. Anything beyond that is amazing. And so we are praised for things like making it to work. Things that for other people are mere hobbies for me are seen as triumphs of the human soul. Ugh.

I’m an ordinary dude who has a disease that is in remission. Does that represent some kind of accomplishment? Yes. I’ve worked hard and I’m proud of the work I’ve done. But I can’t really take credit for my recovery. I’m no better or smarter or stronger than my many friends who died rather than recovering. I’m just lucky that for whatever reason the actions and rewards of recovery overwhelmed the actions and rewards of addiction. Recovery is a world of contradictions.

Soft stigmas are not much better than hard stigmas. They may allow us entry back into society at low levels, but they limit us just the same. If it’s “good for me” that I’m able to contribute by holding down a job, it’s also “good enough” to leave me in a low position. After all, I’m doing great just to be here, right? I should be grateful I’m not still in the gutter.

I’d rather keep my addition generally private. And be judged by the same measures as all you normal people. I don’t want an advantage getting my foot in the door. And I don’t want a hindrance rising further. I don’t want your treacly pity. I don’t want your insincere admiration. I want to be a regular person with a regular life. Yes, I had to overcome something difficult. I am still working at that. And if you haven’t done it, you don’t know what it took.

It’s fine to admire or find inspiration in people who’ve recovered from addiction. And as I said, I’m proud of what I’ve accomplished in recovery. It was harder than you think. And it was easier than you can imagine. Recovery is as much relief as labor. But measure us against the same yardstick you measure yourself. Because we are not different from you in any way that does not involve a bottle.

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