“Ultimately, recovery’s about transformation—and I don’t think it happens in isolation. I believe women recover in connection with other women. It’s primarily about this connection, and the connection with a higher power. Many people will ask: why isn’t it just about willpower? I believe there has to be an internal shift. It’s about growth and expansion.”
Is she religious? Was she brought up in a religious family? She chuckles: “Religion? I was raised a Protestant. I remember my mother saying: ‘I am so glad we belong to the Methodist Church—such a wonderful sanctuary for a wedding.’” She pauses, and then says simply: “I don’t think we do it alone.”
The third person I speak to is the brilliant Gabor Maté, author of In the Realm of Hungry Ghosts: Close Encounters with Addiction. Lying in bed, one snowy Sunday morning, I am reading these words in the Vancouver-based addiction doctor’s wonderful book: “The word God could have a religious meaning for many people. For many others, it means laying trust in the universal truths and higher values that reside at the spiritual core of human beings, but are feared and resisted by the grasping, anxious, past-conditioned ego.”
Impulsively, I send him an email: could he talk to me in the next two weeks? Minutes later, the phone rings: “It’s Gabor.” I ask him about spirituality. What, he says, do I mean by spirituality? I am caught off guard. He says: “‘Spiritual’ is nothing more than liberation from the personal history. Underneath the personality, there’s a deeper self. If you get back to that truth, that compassion, there is something essential. We’re all part of something bigger—which the Twelve Steps refer to as the higher power. The Twelve Steps work because they speak to essential truths. People don’t like to believe in a guy with a white beard in the sky—and they don’t have to.”
Why, I ask him, do we stop growing when we are traumatized? “Traumatized children shut down emotionally—and they also stop developing emotionally. Why? Because you need emotional vulnerability to grow. We are like crabs: we don’t grow where our bodies are hardened. The greatest loss is not that there was pain. The greatest loss is that we lost a connection to our essence. That’s our wound: the loss of connection to ourselves. When you recover, what do you recover? Yourself.”
Finally, I speak to Karin, a woman who has thrived in Alcoholics Anonymous. Ask her why and she has a one-word answer: “connection.” It reminds me of E. M. Forster’s epigraph to Howards End: “Only connect!”
Karin is sitting in her living room, her dog by her side, fire blazing, her tidy frame tucked up on the couch. “This is a disease of perception, and this is likely the first time in our adult lives that we have connection and unconditional support. If you look at the science of happiness, it’s about being connected to others—AA is an antidote to the isolation of drinking.” She looks troubled, and then refers to her own childhood history: “Of course, some of us had a connection and that connection abused us.”
Why do people isolate when they drink? “Shame—and the fear that no one they know will let them drink the way they want to drink. Whenever our addiction took on a life, we stopped growing emotionally. Somewhere along the way, we veered off maturing, and we couldn’t stand ourselves. When I look at my defects of character—self-pity, the urge to isolate—that’s when they kicked in: when I started drinking at eight or nine.
“The program and steps give us tools to learn how to connect to people and how to live with other people. AA says: This isn’t about willpower—there isn’t an alcoholic alive who didn’t try to use their willpower! You hand your power over to a higher power. Addiction is timeless, and this program is timeless. Just because you can tweet about it doesn’t mean that the lessons about human bonding have changed. There are Buddhists and Muslims and Jews all sitting in the same room, feeling safe and accepted, learning to see our true selves and to love what we see. We connect to ourselves.”
17.
Stigma
A CALL TO ACTION
It’s the misunderstanding that kills.
—SUSAN CHEEVER
You could say to me, “Drink responsibly,” and I’ll say: “I’ll try!”
—CRAIG FERGUSON
In our society, would you rather be known as an alcoholic or a person who suffers from depression? I have posed this question to dozens of women in the past three years. The answer? Not one woman chose alcoholic. To a person, they felt the stigma was too overwhelming. And for that reason, very few of the women I interviewed were willing to share their real names. Many considered it, but most chose to remain invisible. The rare ones—Beata Klimek, Vera Tarman, Annie Akavak, Marion Kane, Janet Christie, and, yes, my own brave mother—deserve my undying respect. They came on this journey with me, and it took true courage, real grit, to share their full names. These were the ones who decided to stare down stigma, and help others in the process.
The stigma is enormous. When I was preparing to write my fourteen-part series on women and alcohol in the Toronto Star, I did so without once identifying as an alcoholic myself. Not that I didn’t consider coming out in print. In my first meeting with my editor, I told her the truth over lunch. Her eyes widened, and then they lit up. There was no doubt: she wanted the story. To her everlasting credit, she helped me weigh the pros and cons. In the end, she summed it up this way: “When the series is over, will you need a job?” “Yes, of course,” I said. I wavered. “Do you need to work, Ann?” “Definitely,” I said. Her response was emphatic: “Then don’t do it.”
I loved her for that. I still do. She is both a perfect editor and a stellar human being. However, this wasn’t the reason I kept my story to myself. The focus of my series was alcohol policy, and I felt the reader might doubt a writer who was herself abstinent. I chose to keep myself out of the story.
With this book, all that changed—but it wasn’t an easy decision. There were many times when I would wake at 3 a.m. and think: “What sort of person wants to tell these stories on themselves? On their own mother?”
It took me six months before I could hand a book proposal to my agent. It took a lot of coaxing. But once I found my voice, I was swimming in the cool, clear water of truth.
For me, coming out is right. For so many years, I lived with the so-called secrecy of my mother’s story. The sulfur fumes of smothering that reality poisoned our entire family. This is not my mother’s fault. It’s the legacy of every family that squelches the story of addiction, and so many do.
Which doesn’t mean it’s easy to say I’m an alcoholic. When I was in rehab, heading off to a variety of evening meetings, my Buddhist counselor Terry advised me to say: “Hello, my name is Ann. I am a recovering alcoholic.” She believed our souls heard the words, and would flourish with encouragement.
And that’s what I am today: a recovering alcoholic, whose depression is currently in remission. I am a professional woman, a mother, who has dealt with a few afflictions. It’s a mouthful. It’s a life-full.
Why is it easier for me to say I suffer from depression than that I am a recovering alcoholic? Actually, neither is easy. But only one could keep me from gainful employment. Only one invites universal judgment.
Why is this? Is it because I can take an antidepressant for depression, a pharmaceutical solution that others trust? Would it make it better if we medicalized the solution to alcoholism? Somehow, I don’t think so. The taboo is still so large, the misunderstanding so deep.
When my series appeared in the newspaper in late 2011, the comments poured in, and there were two distinct schools of thought. Yes, there were laudatory emails, empathetic to the stories of addiction and recovery. My mailbox overflowed with moving personal accounts and positive messages: the series “should be required reading in every school in the country. . . . Don’t stop writing.” A woman who identified herself as T. J. Harrison wrote: “I hope that your series of articles spares future generations the anguish of ever having to try to recover from an intractable condition, and spurs thoughtful discussion of—and enlightened action on—a complex
topic.”
But while one reader wrote, “Alcoholism is a disease and it can break the strongest people,” another wrote, “Addiction is not a disease. It’s a personal lifestyle choice. . . .” “Stop calling it an illness,” wrote another. “That’s total bunk designed as a crutch for the weak . . . and this recovering rubbish is more bunk.”
“Alcohol and drugs are the means for people who lack intestinal fortitude to face trauma,” wrote another reader. “Stop glorifying addictive personalities and making excuses for lack of courage.” Yet another wrote, “Alcoholism is not a disease. Cancer, diabetes: those are diseases. Alcoholism is self-inflicted. Grow up, take personal responsibility and learn to say NO.”
More than one reader argued back: “So, you say alcoholism is not a disease? So it’s the alcoholic’s fault? We would love to be able to enjoy a drink or two responsibly, without any incident.”
For decades, alcoholism has been what some call “a disputed ailment.” Is it a disease? This is the perennial question—and it matters. So much of the stigma pertains to this debate: is alcoholism a sin of commission, or in the blood?
I asked Peter Thanos, a Canadian-born neuroscientist at the U.S. Department of Energy’s Brookhaven National Laboratory on Long Island, New York. Thanos is blunt: “We have known for more than twenty years that alcoholism is a chronic, relapsing brain disease. Science supports this truth.” Patrick Smith, CEO of Toronto’s Renascent treatment center, is also unequivocal: “The jury is in. The Canadian Medical Association calls it a disease. The American Medical Association calls it a disease.” “Our only shot is to see it as a disease because there’s much less stigma,” says the pragmatic Jean Kilbourne, herself in recovery.
But as Jungian analyst Jan Bauer writes in Alcoholism and Women: The Background and the Psychology, medical models do not accommodate the role of the psyche. “If, in fact, alcoholism is a kind of slow suicide, then it isn’t surprising that collective attitudes are similar in both, especially in our Western society which, more than most, fears death. . . . [L]ike suicide, alcoholism expresses a refusal of life in the conventional, collective understanding of it.”
Perhaps this explains why so many see addiction as a moral failure. Perhaps it’s the volitional piece: you have to pour it down your own gullet. There was a time—a very long time—when I could not understand my mother’s dependence. Why didn’t she just stop? It would be decades before I was able to fully comprehend. By then, I was tortured by the same question, different pronoun: why couldn’t I just stop? What led me to alcoholism, and not my siblings?
Thanos knows there is a genetic component to alcoholism. He has used brain imaging and behavioral studies with rats to understand human reward circuits. He has proven that certain brain receptors play a role in excessive drinking.
Here is how it works: alcohol, like all addictive drugs, increases the brain’s production of the neurotransmitter dopamine, which sends a message of pleasure and reward. Over time, the brain responds to the stimulation of alcohol by decreasing certain dopamine receptors. These receptors—known as D2 receptors—are nerve cell proteins to which the dopamine must bind to send the pleasure signal. An alcoholic will experience a reward deficiency, and compensate by drinking more to try to recapture the pleasure. “Alcoholics will continue to drink to avoid the crash that comes with the low,” says Thanos. “Alcoholics have lower D2 levels in their brains. If you have a lower D2 level, you are more vulnerable to the rewards of alcohol. And if you are genetically more vulnerable to the rewarding elements of alcohol, you are also more vulnerable to the atrophy of the brain from alcohol use.”
If Thanos’s research has proven there is a genetic component to alcoholism, it has also convinced him that there is more than one gene at play. He says: “Alcohol is a very dirty drug. The consensus is that ultimately, we will understand all the genes and then we will have to understand how they interact. We are just in the early stages of understanding the pieces of the puzzle of alcoholism.”
Thanos and his peers may be at the early stages of understanding the puzzle, but the broader public lags far behind. Patrick Smith believes that social drinkers have a difficult time understanding the physiological realities of alcohol dependence because “it’s not part of their lived experience.” Still, as he says: “No one says: ‘Just because I don’t have diabetes, it doesn’t exist.’”
Gabor Maté sees it a little differently. He believes the disease model is “valid, but insufficient.” Says the Vancouver-based addiction doctor: “Why does someone develop the disease? It’s trauma. Trauma isn’t just an emotional event: it shapes brain circuitry. On brain scans, you can see changes shaped by trauma. And the medical profession doesn’t get it. Brain changes are caused by early experiences. We are way behind the science in our understanding of addiction.”
“For a woman, the stigma of addiction is still very bad,” says Sheila Murphy, head of the women’s programs at the renowned Hazelden treatment center. “And there’s stigma for women who have gone to treatment. Which is a shame because women are taking time out of their lives to do some self-discovery, to understand on a deeper level how they want to live. It takes great courage to make changes in their lives.”
Says Stephanie Covington, author of Beyond Trauma: “I find it interesting and sad: if I ask a group to think about addiction, I get them to think of a person who was or is an addict. For most of them, the person is not in recovery. It’s all negatives: they ruined family holidays, cracked up the car, took money. You could never trust them. And that’s what makes addiction different from heart disease or cancer—that’s the attitudinal piece, the volitional piece. It’s about choosing to drink or use. But no one chooses to be an addict.”
“I’m very well-versed in stigma,” says twenty-four-year-old Rebecca. “If you have an addiction, you’re the scourge of humanity. A big process of my recovery was self-forgiveness. It’s been a process of reframing, and not letting other people’s views affect me—it’s a huge obstacle to anybody getting sober.”
Scout agrees. “I wish I could use my real name,” she says. “But I find anonymity important because people don’t understand about alcoholics. If I were to tell my colleagues that I was one, they would think I wasn’t up to the job. I tell no one—not even my family.”
Lunchtime on a blustery winter day, and the meeting is packed to overflow. As it opens, there’s a drip, drip, drip from the tap in the neighboring kitchen, but the room is still. The floor is now open for sharing. A middle-aged woman stands and announces: “I need to tell you that Anna, a member of my group, died last Friday of this disease. She was a beautiful woman, married, with two daughters. She decided she could do it on her own.”
The room is very quiet. The next person to speak is a man with more than four decades of sobriety. “This disease kills, and it incarcerates.” People bow their heads, absorbing the news.
Eventually, the meeting continues, but there’s a question on many minds: Anna who? Days later, many will have figured it out from an obituary in the newspaper, featuring her picture. A beautiful dark-haired woman, whom many recognize. But for now, her anonymity has cloaked her identity.
The underground railroad that is Alcoholics Anonymous thrives on the promise of many things, not the least of which is anonymity. What this means, literally, is that individuals must keep quiet not about their sobriety, but about their membership in AA, or any other twelve-step program for that matter. For more than seven decades, anonymity has been key, ensuring a safe haven for sharing and recovery.
In 1935, when AA was founded in Akron, Ohio, anonymity made sense. But in the era of Facebook and Twitter, there are those who argue that anonymity is a dated concept. Is it time for AA to drop the second A? Would that address some of the stigma around alcoholism?
Some say yes—most famously author Susan Cheever. She has written not only about her own drinking and that of her father, writer John Cheever, but also a biography of Bill Wilson. In 2010, she wrote a controv
ersial column in the online New York—based magazine the Fix: “We are in the midst of a public health crisis when it comes to understanding and treating addiction. AA’s principle of anonymity may only be contributing to general confusion and prejudice. When it comes to alcoholism and AA, the problem is very public, but the solution is still veiled in secrecy.”
If alcoholism is a disease, does anonymity promote a sense of shame that is outdated? Cheever obviously thinks so, especially as it relates to AA’s Tradition 11: “We need always maintain personal anonymity at the level of press, radio and films.” Says Cheever: “It seems to me that AA is the best treatment we have for alcoholism—not that it is perfect. But people do not understand what alcoholism is or that there can be recovery. And there are those who are dying because of this. Twenty-five percent of all our hospital admissions are related to alcohol.”
Is she right? Long term, is AA the best treatment for alcoholism? Yes, says Patrick Smith. “In recent years, the penny has dropped,” he says. “Post-treatment, those who remain involved in a mutual twelve-step program like AA dramatically improve their chances of remaining clean and sober.”
What about harm reduction? Johanna O’Flaherty, vice president of treatment services at the Betty Ford Center, minces no words: “Harm reduction is bullshit. Addiction is a brain disease—if we cross into addiction, there is no going back.” Vera Tarman, medical director at Renascent, agrees: “I see myself as an important dinosaur, a voice advocating abstinence. Although I want to give my respect to harm reduction, it’s a passion of mine to promote the concept of abstinence as a positive thing—freeing, not restrictive. In the professional milieu, it’s looked down upon as old-fashioned, too religious. We can make it new again. We need to make it new again.”
Which circles back to the anonymity question. “Anonymity protects,” says Cheever. “But it also hides.” She draws comparisons to the gay world and the act of coming out. So does Maer Roshan, editor and founder of the Fix—which is focused on the world of recovery. “I think that the recovery world is where the gay world was in the 1990s,” says Roshan. “Blacked-out windows and bars, a secret world.” He believes there are good reasons for the anonymity rule: “If people relapse, and they are known, it destroys the notion that AA brings success. As well, you are supposed to enter the program as equals—as ‘Peter,’ not ‘Peter Rockefeller.’ No one has the right to expose another. But I do think it’s a gray area when they say you’re not allowed to speak of your own membership.”
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