Against Recovery and Self-Help, Part 2

By Chris N.

In Against Recovery and Self-Help, Part 1, I argued that alcoholism/addiction is not a disease, and that “treatments” for it that regard it like a disease often neglect the social context of addiction. If addiction is not a moral failing, and not a disease, then what is it? I claim that addiction is a disability, and that regarding it as a disability could be a useful starting point for positive change.

Addiction is a disability according to the Americans with Disabilities Act. According to the ADA, those with addiction, like those who have very limited or no eyesight or those with very limited or no hearing, are members of a protected class of persons. That class has legal rights to what has been called “accommodations,” especially in public places. Textured dots at intersections where there are crosswalks is an “accommodation” for those who need to feel (or hear) the difference in the surface of a sidewalk, in order to move safely as pedestrians.

The way that understanding addiction as a disability can serve as a starting point for change does not have a lot in common with that example of ADA “accommodation.” It has more to do with a critical study and social justice movement about disability. At this point, I might as well confess that I am a college educator, and have broad knowledge of an academic field called Disability Studies, that I bring to bear upon my own experience and understanding of addiction. So, before I make the case that addiction is a disability, and that this understanding of addiction is useful, I need to provide some background about Disability Studies.

Disability Studies and the Disability Movement

The Americans with Disabilities Act was passed and signed into law in the summer of 1990. This was after a long battle by disability activists for such a federal law, culminating with the “Capitol Crawl” on 13 March, 1990. On this date, disabled protesters rallied outside the Capitol in Washington, DC. Dozens of the protesters who used mobility devices set those aside and literally crawled the 365 steps from the National Mall to the doors of the Capitol. The Crawl is credited with pushing Congress and President George H. W. Bush to enact ADA.

Not long after, academic historians, sociologists, philosophers, and members of other fields began to theorize about disability. The development of this separate field of study is in some ways parallel to the development of fields like gender studies or ethnic studies. I will present some very simplified ideas from the field of Disability Studies, and in the next section examine how addiction fits in.

In Disability Studies (DS), there is virtually unanimous agreement that the wrong way to understand disability is through what is called the “Medical Model.” Under the Medical Model, a disability is an attribute of an individual person. For example, under the Medical Model, a person who has no eyesight has a disability. The individual’s own condition is, all by itself, the disability.

The Medical Model is rejected because it does not consider the social context. An opposed concept, the Social Model of disability, claims that disability is the result of social exclusion on the basis of an individual’s situation of condition. In short, it is not having no eyesight that is the disability. The disability is the result of social exclusion of that person from much of the exchange of information, since so much of it is visual and in written text. To give another illustration, it is not a wheelchair user’s underlying condition that is the disability. The disability occurs when the society in which that person lives fails to provide access to housing, transportation, or education on the basis of that person’s need to use a wheelchair.

To explain further: A society is built. Certainly, the institutions and the literally built environment of a society are built. These are designed, and the kind of mind and body that they are designed to fit is an idealized mind and body that is deemed “normal.” Any quick visit to a public library or a school building will reveal the ways that the social world is built so that some kinds of minds and bodies can access these spaces without undue difficulty. By means of designing things for that “normal” use, the exclusion of anyone else is produced.

A recent extension of DS called Crip Theory goes further than the Social Model in its critique of social exclusion. Crip Theory examines social norms regarding work and life. It’s one thing to criticize social arrangements for excluding individuals from places of work or education. Crip Theory questions the norms of work and education that underlie those criticisms. For instance, I have several conditions that make working on the campus of my university impossible. The university has permitted me to work from home, and thus I can work around the various conditions that I deal with: working when I am able, working without a fixed schedule, working in a quiet environment, etc. But all the university has done is provide greater access to a workload that is already excessive—indeed, the excessiveness of which has been a factor in producing the disability that I work at home to “accommodate!” So you see, Crip Theory asks not only “Can I access my work?” but also “Is my workload appropriate?”

Addiction as Disability

Addiction is not an attribute of an individual. It is a way of life that a society produces, that we adopt of fall into as a route toward some goal. For most alcoholics I have heard the stories of, that goal is release from distress that is otherwise unrelieved and unaddressed. For myself personally, it was distress related to intergenerational trauma. I drank for more than 30 years without that trauma being addressed, because there were not resources in my life to address is. There still aren’t, because despite having greater access to healthcare than many full-time employees in the U.S., I do not have access to decent trauma psychotherapy—very few people do.

The relationship between trauma I experienced from birth and blackout drinking I began at 20 is obvious to me, in retrospect. Of course, I can’t be sure I wouldn’t have been a blackout drinker for 30 years if I had had social or psychological support as a child—of if my parent had had support as a child before me, and had not reproduced their trauma in my own life. But I believe we can say that if I or my parent had received more social support, the distress in our lives would very likely have been decreased. For me, that basic motivation to seek oblivion would not have been pressing. Perhaps I would not live a life now still permanently altered by trauma.

By now, many people know about the famous Rat Park study at Simon Fraser University,^[1] in which rats in an environment that was rich in interesting things to do, and other rats to be around, gave up their addictions to morphine, while rats who did not have access to such an environment remained addicted. Parallel studies on mice and cocaine have had similar results.^[2] These have been interpreted by addiction scholars (among them Gabor Maté) to suggest that addiction is what happens when all other options for release from distress, and all other forms of social support, and virtually all other ways of life, have been barred.

Alcoholism/addiction is a disability in another way. Work policies that fire employees for drunkenness or druggedness, law and social policies that prescribe specific treatments (e.g., A.A.) under threat of more severe punishment, and general social stigma are all disabling. They are also close parallels to disparate treatment that disabled activists have fought against for generations, with some success.

This is not to condone drinking or drugging at work, or at all. The point is that alcoholism/addiction is a socially produced condition, not an individual’s condition. A society that expects, even requires the individual to “overcome” their own alcoholism, would be like a society that expects a person without use of their limbs to “overcome” the lack of wheelchair access or remote-controlled mobility devices for their use. It is too often this kind of “overcoming” that is modeled as “recovery.”

Like someone denied access to transportation or education, being denied access to forms of social support and relief of distress is a disablement that a society imposes on a person’s body and mind. Those who are disabled find ways to work around, cope, or get by—or they don’t. To use concepts developed from French philosopher Michel Foucault, a society exerts a controlling “biopower” on populations of disabled people and addicts, requiring certain forms of behaving in exchange for permitting access to the goods that they are generally denied. “Good disabled people”—those who “overcome”—are better served than “bad disabled people” and “good addicts”—those who “recover”—are better served than “bad addicts.” Another group is simply “left to die,” because they do not serve the interest of the dominating class.

Against Recovery

Recovery is an ideal. Accepted as an ideal, it names a goal for alcoholics or their condition if they consider themselves to be doing appropriate things to “treat” their addictions. Whenever a word has such wide use as a term of encomium, I suspect it of being ideological. What I mean by ideological is that the word names a belief that hides the fact that it is a belief, by making it appear to be reality.

The ideology of recovery begins with the notion that it is good to recover/be in recovery. This goes without question the way it goes without question that health is good—and with the same problem that health and recovery are not objective. Recovery suggests that something is being brought back, returned to its prior condition, or indeed overcome. What is that something?

Considered carefully, it can’t be anything. The alcoholic or addict can’t recover lost time or money or relationships. For me, sobriety has led to my facing past trauma in its raw form, and not having a lot of help dealing with it. I seem to have “recovered” the condition I was in at age 20 when I started drinking in the first place! But that’s not recovery, is it?

It seems like recovery only means something that is expected to be good that is supposed to arise as a result of sobriety. But nothing follows from sobriety but sobriety. What a person can do with sobriety very much depends on the same factors that it depended on before they were drinking or drugging. Their society admits or denies access to goods like employment and education in the same ways it did before. Only now, that person likely has a history of alcoholism/addiction, of “mental” health issues, or of various damages from their drinking and using days, that may further limit their access to those goods.

The goods that recovery promises might be gained through some individual act of overcoming. But I refer you again to the disability critique of overcoming: (a) not everything is overcome, (b) not everything should be expected to be overcome, and (c) a person’s worth is not measured by their being able to overcome.

What the alternative offers

Understanding addiction as disability reveals that alcoholism or addiction is not a disease. Alcoholism or addiction is a relationship, and a relationship that is not even primarily to a substance. It is primarily a relationship of an individual to society and environment.

What this understanding calls upon us to do involves the following, in my opinion.

1. Resistance to the disease model of alcoholism/addiction. This is resistance to the model that ignores the social and environmental factors that are at the core of addiction. It requires us to speak back to those who use the disease model, and to try to change the discourse, and change people’s thinking.

2. Change how alcoholism/addiction is treated. Our current treatment models, based on the notion that alcoholism/addiction is a disease, and that no social or environmental change is needed, ignores the fundamental basis of alcoholism/addiction. It would be as if our society did not provide any ramps or elevators, or appropriate-width doors for wheelchair access, and told those using them to make due. We give alcoholics something like a wheelchair, but ignore the fact that our social environment remains the same.

3. Work for social change. Disability activism has achieved a great deal for disabled people, with some notable exceptions, mostly concerning “mental” and “behavioral” health. Present-day Crip and Mad activism, and activists in poor nations, have started to correct this; the self-identified Crip and Mad are speaking for themselves.^[3] There is not, to my knowledge, alcoholic activism or addict activism of a similar kind.

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^[1] An article about Rat Park and recovery is at: https://www.practicalrecovery.com/prblog/rat-park/ Accessed 30 October 2024.

^[2] For instance, see Chauvet, C., Lardeux, V., Goldberg, S. et al. Environmental Enrichment Reduces Cocaine Seeking and Reinstatement Induced by Cues and Stress but Not by Cocaine. Neuropsychopharmacology 34, 2767–2778 (2009). https://doi.org/10.1038/npp.2009.127

^[3] In disability circles, there is a slogan: “Nothing about us without us.” This refers to the demand to be at the table for drafting of policy, and law, or for writing academic work or medical studies. Alcoholics Anonymous practices something more like “nothing about us except to us”: avoiding the social and political like the third rail and remaining insular and unheard outside of “the rooms.”

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Chris N. is a sober non-believer. Critique of widely accepted ideas is his idea of a good time. He lives in central California.

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