by Edie Montana
As a queer woman, God and determinism don’t sit well with me – I don’t want to sit at the same table with them at all. For this reason, I felt rather triggered and uncomfortable the first time I went to an NA meeting. Between the bitter taste on my tongue left by having to start every sentence I spoke with “My name is Edie, and I am an addict” and the abundant references to God and a higher power, I asked myself if I was at the right place. After talking to some friends who had been going to NA meetings for years, I was explained that, when the Twelve-Step program mentioned a “higher power”, that should be interpreted as any force greater than ourselves, and not necessarily in a religious way. Yet, I cannot unsee the history behind it all – in a sort of “can-you-separate-the-art-from-the-artist” dilemma.
The Twelve-Step program AA and NA are based on were invented in the 30’s by and for white men. The program starts with an imperative: it tells addicted people they are powerless over their substance, and that they should be humble and give up their agency to a higher authority. On top of that, it also promotes the identification of the individual with their addiction. None of this sounds very feminist or queer-friendly to me. Yet, to this day, AA and NA have become the authority in the field – and it’s a male authority.
I first came across this reflection while discussing working in a strip club and staying sober with a fellow stripper, who recommended me the book Quit Like a Woman by Holly Whitaker. I don’t feel like the concept of giving up your agency as a woman or a queer person to a higher power is beneficial at all. Yes, I had a problem and I had to acknowledge that. No, I didn’t think that falling into determinism about it would be helpful. It goes beyond admitting the problem. Psychologists teach us that we should avoid sentences like “I am depressed, I am ADHD, I am borderline, etc.” and use “I have depression” instead, so why do Twelve-Step programs encourage us to do the opposite?
This is, needless to say, my own experience and journey around recovery. I recognize that Twelve-Step Programs have helped countless people, and I don’t want to take it away from anyone. This article is not about that. This article is for the people who, like me, need a new approach to addiction and recovery. What is the success of AA and NA showing us? And how can addicted women and queers still get the help they need, but with a more feminist approach that allows them to take agency back in their own recovery?
What the success of Twelve-Step programs shows, in my opinion, is the need for two things: accessible resources and community. Rehab and professional treatments are not always a viable option, especially in countries where health care is a billion-dollar industry that exploits people’s desperation. In this case, free support groups like AA and NA can be a lifesaver – and the only option. Moreover, the accessibility of these groups is not only financial: you can find a wide range of such meetings, from in-person to online, at any time of the day, almost anywhere in the world. Some of them are specialized, catering to queer people, sex workers, women, etc. No other recovery group can compete with the accessibility of AA and NA, and I feel that’s one of the biggest reasons why they established themselves as the most authoritative voice.
If we talk about the need for community, the advantage Twelve-Step programs presents is the offer of a so-called sponsor: an experienced member available for support between meetings. At the same time, it goes deeper than that. I believe the revolution brought by AA has been reinforcing the notion that addicts should not be treated as criminals and therefore denied community, because they see addiction as a disease – not as a crime. That’s definitely a step forward. Yet, in the most recent years, some neuroscientists have argued that the disease model might not be the most helpful (and accurate) paradigm. An approach where addiction is identified as a disease does not seem to address the real problem, and neither do AA and NA: they don’t recognize the active role of learning. Quoting Maia Szalavitz, author of the book Unbroken Brain, “dependence isn’t the real problem in addiction. Compulsive and destructive behaviour is.”
Summarizing the different ways in which addiction has been framed, we should start with the crime paradigm, where addicts are identified as criminals. The so-called war on drugs can be put in this context, and it’s a model with strong political and racial implications. Less moralistic approaches have later emerged and switched to the disease model, where addiction is framed as a chronic illness. The disease model is, to this day, the most widespread approach. Even though this is a big improvement compared to accusing addicts of being criminals, because it attempts to reduce the stigma associated with compulsive drug use by focusing on biology rather than morality, there is still no scientific evidence proving a possible genetic cause for addiction. What seems to be genetic is addiction risk and certain personality traits related to drug use, like risk-taking and impulsivity – not addiction itself.
The disease model still separates addicts from the rest of society, by promoting the binary Sick vs. Well. But are the brains of addicts really abnormal? A newer, revolutionary approach that sees addiction as a learning and behavioural disorder argues that no, addicts’ brains are perfectly normal. I first came in contact with this paradigm through neuroscientist and clinical psychologist Marc Lewis, who talks about substance use as a natural response of the human brain to a challenging environment; one of the ways humans try to cope. When the learnt pattern in using substances becomes compulsive and automatic despite detrimental consequences, it turns into addiction.
The difference may sound subtle, but the implications of this newer way of framing addiction are deep, especially for people belonging to minority groups. Seeing addiction as a maladaptive habit transfers agency back to the addict and their recovery: if it’s something you have learnt, you can also unlearn it. This challenges the deterministic notion of the Twelve-Step program that addiction is an irreversible disease and that addicts are powerless over the substance – as if substances had a power of their own. As Maia Szalavitz explains, nothing is addictive by itself, and “addiction only develops when vulnerable people interact with potentially addictive experiences at the wrong time, in the wrong places, and in the wrong pattern” (Unbroken Brain).
This conversation is not new, but what I would like to add to it is a reflection on how these different ways of seeing addiction and recovery entail different levels of responsibility. When addiction is called a crime, it implies a personal responsibility: your addiction is your fault. When called a disease, I see it as a way of getting rid of responsibilities altogether. A disease is something that happens to you, it is not your choice. Even though I see the appeal of it, the notion of no one bearing responsibility for it doesn’t resonate with me. Calling addiction a “choice” might be judgmental, and a disease might be more socially acceptable, but I don’t think we should stop here.
What I believe approaching addiction as a learning/behavioural disorder implies is the involvement of a collective responsibility. In other words, this paradigm is all about the interaction between the individual and their environment. Each individual has agency over building and unlearning habits, addiction included; at the same time, their environment has a decisive influence on the process. The type of environment a person is brought up in will influence their probability to become an addict and, in the same way, a successful recovery does not depend only on the individual’s goodwill, but also on the support system around them. And maybe that’s why the dominant paradigm in framing addiction is the disease model, where state infrastructures and society don’t have to take responsibility and can still profit from people’s addictions (or ignore them).
Women and queer people have often felt like their gender was a defect. Is a model telling us that we have another disease nobody is responsible for the most helpful we can have to overcome addiction? Does it help us to be seen as powerless? As passive patients? If it does, great. If not, I believe it shouldn’t be the only framework through which an addicted person can get help, and I wish our society would start admitting its responsibility in shaping an individual’s addiction journey and offering other accessible recovery methods besides the one-size-fits-all Twelve-Step programs.
Addiction is mutable, and so is recovery. So are humans. Whatever approach to addiction and recovery people prefer, I would like them to remember that, as marginalized people, we shouldn’t give up our power. Substances don’t have agency – but we do.
Recommended resources this article is based on:
- Unbroken Brain by Maia Szlavitz
- The Biology of Desire: Why Addiction is Not a Disease by Marc Lewis
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- Quit Like a Woman by Holly Whitaker
- The Urge: Our History of Addiction by Carl Erik Fisher