the Dulwich Centre website  ... a gateway to narrative therapy, community work and psychosocial support                                       Dulwich Centre Publications Pty Ltd www.dulwichcentre.com.au On the need for creating a community based resource for deconstructing addiction informed by narrative practice. by Anthony C   This paper was created from a phone interview with Dulwich Centre Publications' Staff Writer David Denborough in August 2002. Anthony  celebrated three years of continuous sobriety on April 8th 2005.   Anthony can be contacted c/o dulwich@senet.com.au An invitation I am hoping here to invite others to join in creating an alternative community resource for those of us struggling with issues of addiction. At present, there is really only one viable community resource available – this being the 12-step model of Alcoholics Anonymous (AA) and other associated fellowships such as Narcotics Anonymous (NA) and cocaine Anonymous (CA). As I describe below, there is much about these fellowships that is extremely valuable and I myself am part of the AA and NA community here in Florida. It is however, only one model, and will not fit or work for everybody. Here I will offer a little of my own history to try to convey why generating an alternative resource and alternative discourse around addiction will be beneficial. After you have read this piece, I would welcome your reflections and ideas. I hope you will contribute to this project of creating an alternative community resource for those of us grappling with issues of addiction. A little personal history Some years ago, I realized that I needed to change my lifestyle. I had always told myself that if I became physically addicted to heroin then I would take whatever measures necessary to stop. When the time came, I wasn’t exactly sure where to turn. The only community resource available to me at the time was AA or NA and I knew that this wasn’t necessarily the type of approach that was going to be most suitable to me. I had studied family therapy and post-structuralist approaches in graduate school and I knew that I was going to struggle with some aspects of AA. My sister had been in the program of AA for six years and through her involvement I had become aware of various differences of perspective. My critical studies class taught me that AA consists of a community of believers not actors, and its orientation is geared towards the salvation of individuals or a private self. I was concerned that this "individual" would lack the self in world perspective I had developed, and instead would be a self relating to one’s own conscience. I was certainly needing help as an individual so that wasn’t so much of a problem for me. The problem was in the believing. AA is based on religious belief but more significantly it is based on believing in a fixed notion of truth. This is something that runs contrary to my own understandings of life. I was encouraged to think away from absolutes, and I believed this to be a liberating departure. I was not looking forward to making a return to or being recruited into the will to truth. I was desperate for help, however, so I called up one of my teachers from graduate school and shared with him the situation that I was in. He told me that it didn’t necessarily matter so much what the approach was, he said that trying to leave heroin behind on my own would be the most difficult and that working with other people would be vital. So I decided to go to a 12-step rehab in Connecticut. There were aspects of this rehab that were helpful to me, but ultimately the differences in belief system were too great. I could not genuinely believe in the philosophy of the 12 steps and so a month after rehab I left the program of A.A. It seemed to me that A.A. was an "our way or the highway" type of program. I then sought out all the literature I could on narrative approaches to working with addictions and tried to find out if there were any groups or programs run along these lines that I might be able to access. I also tried to make it to one of the international narrative therapy conferences in Adelaide, Australia but unfortunately as a result of using drugs I developed a hernia and ended up in the hospital instead. Upon leaving the hospital, I called a number of narrative therapists in a northern state. While they were kind to me, three of them said that they wouldn’t work with me because of the problems I described – problems of addiction. They said that this wasn’t something that they’d had a whole lot of success with and that they wouldn’t be comfortable working with me. This was a let down but they did give me a referral to another therapist who I then went to see. This therapist was a terrific person and very familiar with narrative ideas and we had a good conversation. I was really excited at this point and said, okay, what can we do here? Can we create some sort of alternative approach? Can we create a new group? I knew it was a big thing for me to try to put on someone – to create something new - but I was desperate and almost pleading at this stage. I need an alternative, I was saying. But the therapist said no, that she didn’t have time to create something new and that if I wanted to see her I had to go to A.A. At this point I broke down and started to cry because I thought there was no way I was going to find a place that would help me. My experience with AA up until that point had not been a good one. I didn’t think it was going to work for me if I couldn’t believe in a fixed notion of truth. If it was just a matter of the program asking me to do something, I could fulfill this, but if they were requiring me to believe in something that I don’t believe in, then I would never be able to do it. Let me express right now without going into any detail how terrible the next year and a half of my life was. During the summer of 2000 I went to a place to have a rapid detox from heroin. They knocked me out under anesthesia and put various chemicals into my body including an opiate blocker. The anesthesia nearly killed me due to aspiration, but the procedure gave me a three-day window where opiates would have no affect on me. I entered another rehab at this point and things came together for me. I knew I couldn’t use, so I gave it more of a chance. This treatment center was again based on AA ideas. Initially, I once again struggled with having to believe in things I did not believe. I knew that if I could not immerse myself within the experience of the program that it would not be successful. But one day, after having been joking about all of my near death experiences and not having seen any white light, I suggested that in order for me to believe, I was going to need to see a little white light. At about 3 in the morning, I was in the shower when I thought to myself - ‘maybe at this point in my life it would just be better for me to believe than not to believe.’ This was a huge realization to me that belief didn’t have to be grounded in some absolute truth, that I could take a more strategic approach to belief. But it was also more than a realization, it was an epiphany if you like, because at the exact moment I decided that it was simply better to believe, a flash of white light came from the corner of the shower where I saw a firefly. I hadn’t seen a firefly for many years. This was perhaps a spiritual response to a time of crisis. And it was right for me. It made many things possible including other mystical experiences of the same magnitude. From that moment on I could engage with the practice of AA more genuinely and this made a difference. From there I decided to move to a half way house in Florida. I stayed there for six months and between July 4th 2000 to March 2002 I would go about 4 months at a time without using anything and then maybe one night I would get high. AA was one of the key supports that made this turn around possible. Over those two years I also had the support of a range of other health professionals. In the early part of this year, I basically let myself go and used for a month and a half. This was the first time this had happened for some years. Then on April 8th, I didn’t go to a treatment center, I didn’t go to a half way house, and I didn’t turn to a case manager or psychiatrist. Instead, I decided that it was important for me to simply go to AA. Since then, something has definitely changed. I have had six months of continuous sobriety and I’ve been able to do things that I wasn’t able to do in the past. I’ve followed up on commitments and I’ve been learning new skills. Gradually things are coming together, and I feel that my "sobriety" is stronger than ever. The need for an alternative approach Even though the AA approach has been very helpful to me, I still see the need for an alternative approach. It could be a parallel approach, one that offers different things than AA. I still yearn for a place in which to discuss a whole range of things that are not possible to talk about within AA. Before I discuss these points of departure with AA, I will first describe in more detail what I think has been helpful for me about the AA fellowship. A community resource – empowering the people most affected The AA inspired rehabs that I have attended have been particularly helpful because there have been no doctors or psychologists there. They were completely run by people who had been through their own experience of addiction and who had been through AA. This encourages people to reach out and help each other. The idea of one alcoholic or one addict helping another guides much of AA and this philosophy, this ethic of community, makes an enormous difference. Acts of care When I showed up at the first AA rehab I was really sick. I was vomiting and freezing cold and people came to my aid. They offered me blankets. I think I had five blankets wrapped around me even though it was 80 degrees outside. People were really nice to me and at times of crisis this means the world. Seeing that people cared, and were willing to act towards me out of care, helped. The whole supportive element of the program was excellent. Acts of respect What also meant a lot was that I could attend groups in which people were not going to try to ‘break me down’ or talk about how I was in ‘denial’ or call me on my ‘bullshit’. These are all common approaches to group work in the realm of addiction. The groups in the rehab were not like this. They were genuinely informed by a love that people who had been through the worst of addictions had to give to others, just by talking and encouraging one another. Choice Because AA is so well established there is a whole array of choice as to which meetings to attend – especially here in Florida. This element of choice is critical. It means that you can more easily find spaces for conversations that fit for you, that resonate with your beliefs and what is important to you. Linking lives together There are many aspects of AA in which your life is linked with others in trying to live a different life (a sober life). You have a sponsor and you attend meetings that really act as powerful rituals of performance of an alternative (sober) story. The elements of the meetings that reduce isolation and create community have been helpful to me. Invited into spiritual considerations Being invited into reconnecting to a spiritual outlook on life has also been helpful to me, as it has given me a lot of hope. Right before I made a decision to go back to the program, I was significantly depressed and a spiritual outlook can definitely help with that. It is really easy to slip into self-doubt when struggling with addiction and being asked to take another look at spiritual matters was helpful. I discuss later in this piece some particular approaches to understanding spirituality to which I most readily respond. Other things outside of AA have also been significant: Making the move – towards community Making the move to Florida was a difficult one, but I think it also helped. Down here in South Florida there are many treatment facilities and half way houses, it is one of the hubs for recovery in the USA. I knew if I stayed up north either in New York or Connecticut that I would be somewhat isolated. I would join with people in meetings but I didn’t think my social life would be meaningful. I chose to move here because there is a sense of community here that acts as a social safety net. Points of departure Having outlined some of the aspects of the AA model that have been, and continue to be very helpful in my life, I also wish to describe here some of the points of departure I have with this particular model. This will, I think, provide an explanation of why I am interested in joining with others to create an alternative discourse and an alternative community resource in this area. Beyond identifying as an addict or an alcoholic When you enter AA it is expected that you will declare yourself ‘an alcoholic’ and that this declaration, and the ‘recognition’ that you will always be an alcoholic, is a pre-requisite towards developing a sober life. When I went to my first AA meeting and said, ‘My name is Anthony and I am an alcoholic’, the first thing I thought was …. well what does that mean? While addiction is still part of the DSMIII, and the label of addict remains a psychiatric disorder, I don’t believe it has the same implications as other psychopathologies. Within AA I believe the spirit of the initial statement ‘I am an alcoholic’ is different than that which exists around various diagnoses. The big difference is that within AA, someone is seen to be an alcoholic or an addict when they say they are. Within AA, the meaning of calling oneself an’ alcoholic’ is different than when someone else determines that this is what you are, because within AA the term is supposed to be a matter of self-diagnosis. It has nothing to do with someone from the outside making expert pronouncements. There can be some possible benefits to naming oneself an addict or alcoholic. For one thing, since addiction is considered to be a treatable "disease", if a person actually has health insurance the policy should cover the exorbitant cost of treatment. Furthermore, when someone uses a label like ‘addict’ it often indicates that there is much about their experience of life that is relevant to me, it links our lives in some way. In these ways, when these terms are used as self-diagnosis I do not experience any considerable degree of intrusion. Having said all of this however, I would prefer to live my life outside of such fixed descriptions or labels. I am interested in moving beyond an internalized description of myself as an addict. Building on the ethic of self-care When I decided to go back to AA, just the fact that I walked in through the door meant that I was going to take it seriously. For me, taking this issue seriously doesn’t have to do with the fact that I identify as an addict or alcoholic. It wasn’t so much having to admit that I was an addict that helped me. I already knew I had to stop using everything. It was just the knowledge that I was doing something to take care of myself. That’s what going into that room meant. It meant I was saying, ‘I want my life to be better. I’m willing to give it a shot here’. To my mind, it was not identifying as an addict that was significant, instead, what was significant was that I was demonstrating an ethic of self-care. I think this is an important distinction. It is one that means a lot to me. Having acknowledged that entering the group was a demonstration of self-care, I was then really interested to build upon this. I knew this had to happen in small steps. I began to exercise, I began to use the computer, and I began to explore what other skills I could learn. I think if an alternative approach was interested in identifying ways in which people were demonstrating self care just by turning up to a group, that this could be a starting point for generating richer descriptions about this. This is to take a different direction than inviting an identity description as an addict for now and for always. Politics I have always thought that it would be very helpful if there were a community resource that could be reflective and even critical of some of the institutional power practices that are involved in the ‘treatment’ and punishment of those struggling with addiction. It is not as if most treatment programs explicitly state that it is ‘wrong’ to take drugs. But what they do say is that certain drugs are illegal and that certain consequences follow from taking these drugs. Rather than questioning whether the criminalisation of certain drug taking is an appropriate cultural practice, it is a given, it is taken for granted in most treatment contexts. One might think that people who have gone through recovery would be more liberal, that they wouldn’t necessarily be pro-incarceration, but because the dominant treatment approaches (including AA) do not in any way question the politics of drug use, the status quo reigns supreme. As the mainstream sees punishment for addiction as an acceptable practice, this goes unquestioned in most treatment settings. In fact, punitive practices then find their way into many ‘treatment regimes’. The lack of a political perspective reinforces dominant cultural practices. This is especially so within a spiritual program like AA in which a high value is placed on notions like ‘acceptance’. Throughout the program you are encouraged to accept the things that you can’t change. If a war on drugs is the standard cultural response to drug use then this is seen as something that one must ‘accept’ if you are serious about dealing with your addiction issues. This has been difficult for me. Any time I have raised questions of politics in relation to either treatment programs or the broader culture I have been looked at as unruly or unwilling to toe the party line. When you think outside of the line you are looked upon as someone who is probably going to turn back to drugs any day now. You are looked at as someone who is unwilling to go to the necessary lengths for recovery. If I try to draw upon another tradition of healing, then I will be viewed as unwilling to do what is necessary to recover from my disease. Other AA members are likely to think that I am going to try to ‘do it my own way’. There is a specific term for this within the recovery community – ‘terminal uniqueness’. If you have ideas of your own you are considered ‘terminally unique’! This is seen as an obstacle to recovery. I think it would be valuable if an alternative discourse could be created in which discussions about politics do not have to represent ‘terminal uniqueness’. I think it would be valuable to create possibilities for discussion about some of the cultural practices that support addiction and hinder recovery so that people could share and acknowledge forms of resistance to these dominant cultural practices. This could, I believe, assist recovery, not hinder it. Powerlessness Related to matters of politics are questions of power. When one enters AA one of the beliefs you are expected to take on is that you are an alcoholic and that you are powerless in the face of your particular drug. Having read Foucault, however, this notion of absolute powerlessness does not make sense to me. As Foucault writes, where there is power there is always resistance. So, rather than seeing myself as powerless to alcohol, I have come to acknowledge that I have ‘less power’ than alcohol. While this may seem a minor clarification, it actually has major implications. Rather than seeing myself as a solely passive figure under the sway of alcohol I can instead acknowledge not only the over-powering influence of alcohol in my life but also the ways in which I actively resist alcohol’s influence.1 Power These distinctions in relation to power are also important because within some treatment programs practices of power and humiliation play a significant part (I am not referring to AA facilities here). There are therapeutic communities originally designed for people coming out of prison in which the assumption is that these people need to be broken down and corrected, made to see the truth. These are aggressive and frightening facilities. There are also privately owned facilities modelled after therapeutic communities, which are referred to as Nazi boot camps. They believe that ‘addicts’ have to hit rock bottom before they will get better and so they believe in taking people as low as they can go. This can consist of cutting people’s ties to their family, and encouraging family members not to offer any support – financial or otherwise. The workers in these facilities genuinely believe that they know what is best for others and that they can make choices on their behalf. When workers believe this, and that it is only when ‘addicts’ hit rock-bottom that they can improve, it leaves considerable room for abuses of power. Within many programs, even those less punitive, there are strict rules that one has to follow and there is considerable surveillance to ensure that you are complying with them. This constant watching and enforcement often made the experience of these programs much more difficult for me. It seemed to imply that I didn’t really want to change my using and that therefore I had to be placed under surveillance at all times. But actually I did want to make changes. That’s why I had chosen to be there. It seems to me that what is often operating within these programs is a measurement of the person’s progress according to the norms and rules developed by the program. When I was only using once every four months, this to me was a very significantly good outcome. If someone had told me the year before that I would have only gotten high three times in the course of a year, I would have said that’s fantastic! But according to the program I was within, the fact that I got high a few times completely overruled any of the progress I had made. Now, I can understand why people think in these ways, because it is so easy to lose control of your using when you begin again. But surely there is some way in which participants in a program can be involved in self-assessing their progress, in setting goals and in determining the norms and values against which their actions are to be measured. Beyond internalising descriptions Within many treatment programs, addiction is viewed as a disease that resides within you. While in some ways this can be freeing (‘It’s not my fault it’s the disease’), to start viewing yourself as a sick person can be self-deprecating and kind of scary. When I understand addiction as being something within me, something intrinsic to who I am, it elicits a bizarre feeling in me. It encourages self-doubt and I find it very difficult to change under a negative connotation. Viewing addiction either as a psycho-pathology or as disease locates the problem solely within the individual. It ignores the cultural factors that influence addiction - for instance that we live in a culture of consumption. Externalizing conversations can be really helpful in separating one’s identity from the identity of the problem. They enable me to instead see that I have a relationship to the substance use, to the addiction. And this then creates space for a rite of passage metaphor to be evoked. Rather than understanding my life as being about ‘recovery’ from an illness, I can say that I am on a rite of passage; I am undergoing a migration from drugs and alcohol and towards a life of my own. To me that sounds so much more positive, uplifting. It’s something I can talk to a stranger about. To create an alternative discourse about drug use, one that doesn’t take for granted that excessive consumption is a disease, would be helpful as there are always going to be people who will not identify with the disease discourse. We need to be providing community resources for those people who want to address their using, but who do not understand their drug use as a disease. At present, within treatment programs that internalize addiction, people are invited to look inside themselves and assess themselves. If the programs instead invited people to see themselves as living in relation to the addiction, then I believe that this would enable far more honest evaluations of the effects and tactics of addiction. It would, I think, be easier for people to honestly acknowledge the real effects of addiction if it wasn’t located as internal, as something within one’s body or soul. Away from clashing ethics While the discourses associated with drug use in treatment settings remain individualizing, pathologizing and disease-based, there will often be a clash of ethics when people try to access these services. A person may really wish to change aspects of their drug using, but when they enter a program they find elements of it humiliating and/or degrading or they simply cannot agree with the assumptions that underlie the program. This can result in a clash of ethics, a clash between an ethic of self-care, and an ethic of social justice. This clash can be very confusing and can make it far more difficult for people to stop their using and to reclaim their lives. I think we need to be devising community supports that minimize the risk of people experiencing such clashes of ethics. Considering spiritualities of the surface As I mentioned earlier, being invited into spiritual considerations of life has been significant to me, as I have tried to redirect my life. I am particularly interested now in what Michael White (2001) refers to as ‘spiritualities of the surface’ or material spiritualities. These are forms of spirituality that are about people’s personal ethics, about the care they take in living their lives. I have been drawn to think more about this in my own life and have found myself noticing more regularly the ‘sacraments of everyday living’ – moments and interactions that resonate with the sort of life I am seeking to lead, the sort of ethics I am wishing to live by. Within AA most discussions about spirituality involve ascendant forms of spirituality, in which an external force is described as guiding our actions. These can be very meaningful and helpful conceptions, especially when one’s life seems out of control, but sometimes they can also lead to some confusion. It is not always easy to work out how to translate ascendant forms of spirituality to the task of living a spiritual life on a day-to-day basis. I would be very interested in creating forums for people to talk about how their everyday actions are linked to their values and beliefs and indeed their spiritualities. How can we understand actions of self-care and actions of care for others in relation to spirituality? An invitation… In this paper, I have tried to describe some of the possibilities created by the AA/NA model and also some of the hazards. I need to state again here, that the community of support provided by AA has played a large part in enabling me to be in the position to be writing this piece. In no way do I wish to diminish its enormous contributions in many people’s lives. I am writing here because I wish to invite others to join with me in creating an alternative community resource in relation to addiction, one that could sit alongside the AA model and could offer additional conversations. A number of us are very interested in how narrative ideas could inform community resources around issues of drug use. One of the great strengths of the AA model is that it is not professionalized. The people facilitating the groups are not paid professionals; instead they are people with insider experience of the issues. We would very much like to see the development of a similar community resource informed by narrative ideas. Perhaps it could take the form of a league for deconstructing addiction (similar to the Anti-Anorexia and Bulimia League). As next steps towards the development of such a community resource, we would be very interested in hearing from anyone who: has engaged with externalizing conversations in a community context has worked with the rite of passage metaphor in groups and/or in their own community has explored using definitional ceremonies without therapists has developed questions to ask that create space for conversations about spiritualities of the surface – that richly describe personal ethics and that allow people to think about how they apply these ethics in their daily lives has spoken with others about preferred stories in relation to self-care   has found ways to deconstruct the broader politics and cultural context of certain problems in a group or community context.   has developed self-diagnostic tools in relation to drug use. [ I am interested in how a narrative therapist would work with someone who said that they had a problem with drugs and were trying to work out whether they needed to stop altogether or not. In AA there are particular diagnostic tools, if you take one drink and you can’t stop then you are an alcoholic and you need to abstain for the rest of your life. How would people using a narrative approach determine what is right for them? What type of questions can help for self-evaluation? To my mind this is important, because if there is no way to clearly evaluate this, if there are no clear definitions, it can be very easy for someone to slip back into thinking that it is okay for them to use when in fact this using will soon run out of control.]   has explored a relation to pleasure that does not involve the use of alcohol and other drugs.   has incorporated the practice of returning the gaze in an institutional setting.   These are just some of the areas about which we would like to hear people’s ideas. We’d also like to begin gathering together therapeutic documents, letters, stories, questions, and articles about this issue. We will place these up on this web site. So, we look forward to hearing from you with any reflections, ideas, stories, thoughts that you may have in response to this paper.           Thanks! Footnote 1. Although I use the term powerlessness a bit differently than is used within AA, I would like to clarify that the AA use of this term does not imply some type of personal deficiency. In AA it is considered to be empowering to admit that one is powerless over alcohol. I use the expression 'less power' because it describes my own experience of using drugs more accurately. Reference White, M. 2001: Reflections on Narrative Practice: Essays and Interviews. Adelaide: Dulwich Centre Publications back to deconstructing addiction page back to homepage