…by Matt Robert…
Consider what you believe about the causes of addiction. Now consider what you think about the importance of anonymity in recovery communities. Is there a relationship?
Yes, at least historically. In the very early days of AA, most people viewed addiction as a moral failing or a character defect. There was no disease model to ground the argument that addiction should be treated. In the 1930s, anonymity was a saving grace in the design of AA. People could enter recovery in the company of others who understood their experience. Progress could be made without the shame of exposure to the society at large.
Currently, it’s useful to make a distinction between two kinds of anonymity: personal anonymity and public anonymity. Personal anonymity is a right that any person has to choose when, how, and whether to reveal their personal circumstances to others. In my view, as long as there is addiction, some will choose to remain personally anonymous in their recovery efforts, and this right must always be respected. Public anonymity is something else. It refers to the requirement, put in place in the early days of AA, that a member can never “go public” with their membership in AA, or talk about the enterprise in a public way.
Recently, a number of strong voices have come out arguing that public anonymity has outlived its usefulness in the recovery community. This does not mean that meetings would be televised, or that rosters of membership w
ould be published, or that individuals would have to reveal themselves in any way. Rather, it means that when some individuals choose to go public they should not be censured or ostracized by the recovery community, particularly the 12-Step community. The film The Anonymous People makes this issue vivid and compelling.
The film draws a link between public anonymity and beliefs about the causes of addiction. When the disease model became more prevalent and well-accepted, personal anonymity was still useful for most people as they entered treatment. But as the comparison between alcoholism and diabetes, or heart disease, became more commonplace, it became possible for some people to imagine a world of recovery that allowed personal anonymity but did not require public anonymity. If it’s a disease, just go into treatment. And furthermore, let’s publicly advocate for more treatment funding!
Even thoug
h the policy of public anonymity in AA is motivated by the goal of subordinating personal aims to larger principles—no monomaniacal “leaders” needed, thanks—some feel that it is now getting in the way of the recovery community’s need to advocate for more treatment and less shame. And that brings us to the latest views on the causes of addiction.
Many of us are now contemplating the views of Stanton Peele, Gabor Mate, Maia Szalavitz, Marc, and others, in which addiction is not a disease but a phenomenon of deep (and pernicious) learning triggered by personal suffering. 
What—if anything—does this view imply about anonymity of either kind, personal or public? When addiction is conceptualized as learning rather than disease, maybe we should go back to feeling ashamed—ashamed that we were dumb enough, miserable enough, or indulgent enough to allow ourselves to learn to be addicted. Or maybe we were just unlucky enough to be born into a situation where addiction was the best option out of a limited set of coping mechanisms. But still, that’s not quite as innocent as contracting an illness, which could happen if you were in the wrong place when someone sneezed (or because you just happened to get the wrong copy of some dopamine receptor allele).
Or perhaps the learning model of addiction will allow us now, even more clearly than before, to see addictions as something to be accepted and addressed in the open, where we can come to grips with the developmental and environmental variables that make people vulnerable. This post is a call for us to begin to consider the complex issue of anonymity from the new vantage point of addiction as learning.
Informed by unparalleled neuroscientific insight and written with his usual flare, Marc Lewis’s The Biology of Desire effectively refutes the medical view of addiction as a brain disease. A bracing and informative corrective to the muddle that now characterizes public and professional discourse on this topic.” —Gabor Maté, M.D., author of In The Realm of Hungry Ghosts: Close Encounters With Addiction
Hey Matt,
I was asked to speak at a showing of the “Anonymous People”. I thought “Oh boy, I’m probably going to feel all nostalgic about NA”, but my gosh, I moved very much in the other direction – “this thing is clearly a cult!” is what I found myself thinking. My partner, a clinical psychologist who has only attended a single open AA meeting out of academic interest, also had the same reaction.
I understood why people wanted to remain anonymous with all the “once an addict always an addict” messaging that was going on! And the group-think! What is the point of being anything but anonymous in something that presents all “addicts” in such and unhelpful homogenous way?
Hopefully as we begin to see “addiction” as part of the human condition, but usually linked to circumstances that are exogenous, we can come to accept those that have a problematic relationship with drugs. Hopefully we can also begin to deconstruct the stereotypes and mythology around what a drug user looks like!
In their book, Why God Won’t Go Away, Newberg and Waldman point out that because each of our brains is a dynamic, living, ever-changing, learning machine, after interviewing and scanning the brains of hundreds of people involved with organized religions, they came to the conclusion that there is no such thing as a Buddhist or a Christian or a Muslim.
Instead, what they found were completely singular individuals, with unique brains and bodies, each performing their own dynamic, living, ever-changing, learning version of Buddhism, Christianity and Islam. Might it serve to consider people struggling with addiction to be doing very much the same thing? That there is no such thing as an addict; there are only unique, dynamic, ever-changing people learning and practicing their own idiosyncratic version of addiction?
There is the view that “Everybody is addicted to something…” Was Mozart addicted to music? Einstein to physics? And isn’t the world a different place because of it? Granted, it’s a matter of degree and maintaining balance in one’s life, and just what the obsession revolves around…But might energy not be better spent figuring out how to redirect that powerful energy rather than quashing it?
AA’s tradition of public anonymity was not developed in a vacuum, but grew out of painful experiences with early individual members attempting to speak for, promote, or otherwise publicize AA. Since we know that AA works for many people as is, my recommendation would be to let AA be AA and not mess with the traditions that have worked for them. AA needs no publicity – the world is well aware of its work – and those who want to learn about it can read the literature and talk to members.
I believe that AA’s tradition of public anonymity is not about shaming the addict, it’s about protecting the institution from the depredations of individual human folly. One huckster with a big megaphone could do a lot of damage to AA by having their personal foibles and beliefs and idiosyncrasies become overly associated with AA in the public mind. Imagine if a very polarizing public figure (name any staple of gossip or political blogs – Donald Trump, anyone?) decided to appoint themselves as an ambassador for AA. Though perhaps they would raise consciousness and membership and even money (for whom?), they would also become a very public face of the AA brand. For potential members who found that persona unattractive, or when that person got caught doing something unsavory, AA would be damaged. AA seeks no controversy and has no opinion on outside issues. It’s for EVERYONE who wants to stop drinking. Encouraging its members to keep their AA affiliation out of the public eye helps to keep the group coherent and available to all, “ever reminding us to place principles before personalities”, as the 12th tradition states.
So, I like the idea of reducing shame and “normalizing” the experience of becoming addicted. Society would likely benefit from shifting its views from the current disease model to one that is learning-centric. Publicizing individual stories may indeed help move that process along. However, I believe such public story-telling can and should co-exist alongside AA’s tradition of public anonymity for AA members. Social science research which advocates for change is typically done with strict protections for research subjects, and so it is certainly true that one can promote social change and raise consciousness without breaking public anonymity of individual AA members. Also, as a practical matter, AA’s position on public anonymity is AA’s responsibility, and I think it very unlikely that there would emerge a group conscience to change it!
Fred–
Thank you so much for spelling out so articulately this important point (that I briefly alluded with my one-off comment “…no monomaniacal “leaders” needed, thanks–”). I feel like should be listed as a co-author.
The problem isn’t with AA, or SMART or LifeRing or SOS or behavioral psychology or modern medicine. It’s with humans being human and acting out of ignorance thinking they’re doing the right thing, often with grave consequences. AA has done just fine for 80 years helping millions of people, and the concept and philosophy of anonymity has in large part made that possible. And it should remain that way. Why mess with what’s working? However, it’s not working for everybody…
You make a very confusing point about public anonymity very salient and I want to clarify what I mean by it. People’s privacy concerns need to be respected, just as they are in the general society. and just as they are as subjects in research protocols. People should be free to discuss their experience in recovery without violating the personal anonymity of other members. I have a question for you. I had been assuming in my post that what I called “public anonymity” is never about revealing **another person’s** participation in AA. It’s about revealing one’s OWN participation. When you bring up human subjects protections, you seem to be implying that breaking public anonymity might reveal the participation of those who have not agreed to be “outed”. Am I understanding you right?
I was not concerned about violating third party personal anonymity – telling another named individual’s story. I was simply pointing out two things – conflating personal stories in public with the principles of AA is something AA discourages because it has the potential to harm the ability of AA to be useful to others who might benefit from it. The point I was trying to make with the comment about social science research is that individuals who are part of AA can still tell their stories in public forums without using personally-identifiable details – which may help the cause of changing public attitudes without violating the AA traditions. For example, I’ve chosen not to use my full on this blog! Thank you for your kind words.
Thanks so much for clarifying, Fred. I think it’s important in this forum discussing such charged issues to always be clear about what we mean, and continue to refine our viewpoints for the benefit of all the readers. It enhances everyone’s understanding and encourages people to ask questions…
Thanks again!!
Interestingly, this is exactly what happened vis-a-vis promulgation of the ‘disease concept’ that Marc deconstructs in his new book. An early member of AA who was also a public relations professional took it upon herself to publicize the idea that alcoholism was a disease, in the ‘scientific’ meaning of that word, ostensibly for good reasons (to de-stigmatize it; to help secure medical treatment beds for detoxing addicts, etc.). In terms of our progress toward taking public shame out of the equation these might have been good initiatives in their day, but the linkage between her successful PR campaign and AA, which in its own literature made no scientific claims and used the term ‘dis-ease’, aka discomfort with living, in a more general and metaphorical way, remains. Even many 12 step members don’t understand this early history and may be confused by the conflation of metaphor with actual medicine/science.
So there is indeed a good reason for this tradition, and it isn’t merely ‘protection of cult values.’ I myself feel like individuals are entitled to ‘out themselves’ in whatever way they want, so long as they are very mindful of speaking for themselves, but I can see why the tradition exists. Lots of celebs (literary folks, performers, etc.) basically out themselves by using euphemisms like “support groups” that ‘meet in church basements’ etc. And since there is no Uber-AA Security Force exiling people or preventing them from taking their seats in meetings, I’m not sure the fellowships can be excoriated for the behavior of particular groups or members who take it upon themselves to be sobriety police.
I’m sure individual 12-Step devotees do behave like fanatics or cultists, and that’s too bad for the programs and people trying to recover who have bad experiences with them. I’m very lucky that in 29 clean & sober years I have not encountered or at least not paid any attention to members or groups who think they know what’s best for anyone other than themselves. But in any case what individuals do or say, or what groups or institutions declare as policy, and what AA or NA essentially are, are very different things.
I always make an effort to discern between what the programs ideally are, and what individual groups/members do, and how the ideals/traditions/ meanings are distorted by people who either don’t really understand them; who take literally and rigidly what is open to an infinite number of interpretations; or when the programs are perverted and deformed by being adapted and used in ways actually inimical to their own principles; aka being ‘institutionalized’ in the form of profit-making rehabs; made mandatory by ‘treatment professionals’ or courts, etc.
I agree 100%. I didn’t know the history of how AA and the disease model became entangled. Thank you.
I am really happy to read posts like this where the learning model is applied. We need more like this….operationalization of the theory, so we can consider it in practice.
I agree Michele…It’s good to entertain the practical implications of the model and possible effects on how we view and do things…Can you think of any other pertinent ramifications that could be out there?
I believe the word “addiction” is used ever so loosely in society that whenever someone likes or perhaps has a passion for something such as sports, hobbies, specific foods or taste etc…, they may be deem Addicted. The real dilemma is when thought itself creates the “idea” of addiction and then boxes or packages it up nice and neat. Much the same as “balance” it is just an idea.
The world, in my respects, is based and/or rooted in “Relationship” with itself and it’s environment. We have all been conditioned as a direct or indirect result of this relationship and thus give meaning to it as well as to ourselves. It appears that we are constantly trying to either describe or define particular aspects of life in hopes to bring about a Truth, which, again, is just another idea.
Can I ever see the world the way it is or is it only possible to see the world the way I am?
In the process of trying to find meaning and prehaps makings sense of the world it can be quite stressful and/or confusing in ones’ ability to relate. How we relate begins in the family among mother and father, that is if you were raised by both parents, not my case, then among siblings, neighborhood friends, school, college, workplace etc…, It is no wonder we all look for escapes which may include, alcohol, other drugs, gambling or entertainment, food, sex, shopping, sports or a long awaited vacation.
For many of us, escape means getting out of our own heads that get bogged down with worry or overload. Escape itself isn’t the problem, however, always looking to escape may be!~
Rather addiction is a disease, learned behaviour or just a bad relationship it is a reflection of our society as a whole. In a society where you can be anything you want, “but yourself”, whatever that is, is a society of disillusionment and disorder.
Really great post, Gary. Among many thought provoking points, you remind me to think more expansively – to look at the big picture. Sometimes I over think the specifics and forget that there are multiple contributing factors. The word “relationship” is such a perfect word to use here. It somehow opens doors to solutions – regardless of how culturally common or uniquely individual those solutions might be. Your understanding of the valid reasons we all have to escape is also a huge reminder that we all have valid reasons to do so – and its a good thing to allow ourselves to do so – through a means that brings us peace and relief – as opposed to further shame and/or suffering. Thank you a lot for your illuminating perspectives.
I think one of the reasons that the treatment of addiction so often fails is the trend to separate “addicts” from the rest of the human population. Often when “addicts” are discussed or spoken to (or speak to each other), it is implied that there are actual distinctions between an “addict” and a “non-addict”. While I understand from vivid, personal experience that “addiction” can lead to tragic or fatal consequences, the urgency that comes about from that leads us down a deceptive path – one that compels us to misidentify the fundamental issues – and the reconciliation of those issues.
Every human being struggles. I’ve not yet met a fellow human being who doesn’t struggle and who wouldn’t profoundly benefit from “re-learning” one thing or another throughout his lifetime. Within a person’s individual struggle, there exists an inherent opportunity for his resolution- to un-learn and re-learn better, healthier, more fulfilling ways. Some people recognize and seize that opportunity while many others do not. When an “addict” does NOT seize the opportunity – which is often a consequence of bad treatment – we all know that the path of “addiction” can lead to tragic consequences. Yet the potential tragedy of an “addict” does not convert his struggle into a disease or something that cannot be resolved similarly to an unresolved struggle that doesn’t necessarily end in tragedy.
I never fully understood the anonymity thing – as it was presented by AA. However, I am a huge fan of discretion. While I may have gone and cried on my best friend’s shoulder about my issues – with alcohol and otherwise – I would absolutely NOT do the same with a stranger or take my struggle to the local newspaper. I always feel a little sad when someone comes up to me and identifies himself as his struggle, disorder, or traumatic life experience. I don’t think it is healthy to latch on and identify with any struggle that can otherwise be transitional. It somehow stands in the way of the many, profound gifts we receive when that struggle is reconciled.
Loved your latest book Mark, found myself and concurrence in several stories. Loved the first too greatly. Much help was there, understanding and staying the course. Have a great summer and all the best…
mjs
Thanks so much, Michael. You too!
I always like to imagine (since I apparently have the “genetic predisposition” to addiction), what would happen if I were stranded on a desert island. Would I become addicted to talking to myself? (Hmm…that might actually be helpful) Would I get addicted to experimenting with building sandcastles, or more effective shelter, or better ways of lashing bamboo together to build a raft? Or would I spend my time figuring out how to ferment coconut milk, or tasting every nasty looking plant to see how it made me feel? Based on endogenous needs and drives coupled with exogenous factors and means, I can imagine any of these having some utility to an end that might help my situation… or one might kill me.
When people are in desperate situations they need guidance and understanding of their circumstances. They don’t necessarily need to be controlled or have their options limited. Discretion is the better part of valor, and it also allows one to choose the better option from an array of possibilities. When I feel wedged in a corner with limited options, my discretion suffers.
Excellent point, Matt. This reminds me of something I read recently about the Feldenkreis technique. It’s a technique for people with severe physical problems to get their bodies and brains back in shape, and it’s done by virtue of making really fine, conscious discriminations among movements that are usually clumped together automatically.
So why don’t we say: Discrimination is the better part of valor.
Okay, let’s…
when presented a forced choice decision with arbitrarily limited options, yes, my discrimination suffers…
Loved this post! I struggled with whether or not to “out” myself as a person who has struggled with alcohol use disorder. When I am at AA, I identify myself as an alcoholic, but that’s more to be polite than to embrace any grand truth about myself. I actually believe in the learning model, and find it profoundly unhelpful to identify oneself too much with any struggle one has had. I don’t walk around introducing myself as, “Hi, I’m April, I’m a sexual abuse survivor, had alcohol abuse disorder, and broke my foot in second grade.” I’m more likely to identify myself as, “I’m a union organizer turned epidemiologist with a focus in addiction treatment and policy.” That’s about my strengths, the paths I’ve chosen, and my interests. That’s much more of who I am than what I’ve put into my body and its rather unpleasant effects.
I think we all tend to read our own history into our definition of addiction and our approaches to treatment (I actually hate the term “treatment” as it is medicalizing.) I wrote about this on my blog recently, in an entry called Neurobiography. https://epiapril.wordpress.com/2015/07/20/neurobiography/
April, I very much appreciate the context and choice-based way you relate to the issue of introducing yourself. Makes a lot of sense to me.
And I loved your comment. The way we identify ourselves does indeed seem to be a weather-vane that has the option of facing the past or the future. What an interesting idea to use it deliberately to help reinforce whichever choice we make.
Your blog looks really interesting. I hope to get to it soon.
Thanks Marc! 🙂
This discussion is excellent! I just wanted to reiterate that I meant this as an open question, not an examination of 12 Step’s anonymity practices, their motivation or effectiveness– which is well documented. Personal and public anonymity should remain the choice of the individual or the organization. However, more and more people are now posing questions about the value of going public with certain kinds of information. See this NYTimes article about friends and family dealing with the sudden outbreak of heroin overdoses. This article cites the movie “The Anonymous People” http://www.nytimes.com/2015/07/12/us/obituaries-shed-euphemisms-to-confront-heroins-toll.html?emc=eta1&_r=0
The question I want to foreground is this: does Marc’s model shift what we might think about our own choices about personal anonymity, or the larger question about the risks and benefits of public anonymity?
I believe everyone’s story is their own. It should be respected, protected and told by the individual when and how they see fit. In my view, dealing with the shame of my behavior and the havoc that I created in so many lives was actually harder to deal with then stopping. I had long since stopped and was still dealing with that shame, guilt, regret, you name it.
The single biggest thing that helped me in this regard is that I found an outlet where I felt I could safely start to share pieces about my transformation and some of the feelings I was dealing with. Being around others also willing to share a little bit helped me realize I was not alone. Feeling safe enough to share in certain settings helped me slowly let go of the incredible shame that I felt. I don’t think I would have come so far without that outlet. At the same time, if someone I shared with or someone else started blabbing what I had shared to other people, it would have been very hurtful and may have hindered my recovery. At a certain point, we have to determine when it is safe to be vulnerable and hope that the vulnerability leads to additional personal growth. That is exactly what happened for me.
With all that I have learned over the last 10 years, I am only convinced of two things.
1. There is no single right answer when it comes to overcoming an addiction. Each person must find the path that works best for them and trust that each turn the path takes is leading them where they want to go.
2. One way or another, however the person sees fit, the underlying reasons for the behavior need to be examined and reconciled, more than the behavior itself. Chopping of the head may be a short term solution, destroying the root lays a real foundation for transformation.
Hi Mark
This is powerful. And I agree with the power of our shame at the loss of control of behaviors and consequences seemingly at odds with our core values. This shame is pretty universal in addiction. Might it be that the shame is actually driving the addiction more than motivating us to stop?
And on your last 2 points on lessons learned:
No 1. Agreed… because the factors that precipitated, motivated and maintained the addiction are unique to one’s personal development and path in life. No single disease vector or biological mechanism sent us on this path, and no single remedy is going to work for everyone.
No. 2 I’m with you here, but I think this is where a confounding, seeming contradiciton lies. If the compensatory behavior that relieves the underlying condition motivating this powerful habit behavior is not removed, why would we want to look at the painful, precipitating factors for an alternative to our present behavior? It doesn’t make sense to our brain, nor should it from an evolutionary perspective. The overwhelming negative consequences from the addiction, some physical and some social/psychological, are what get us to change. But we can’t see the causes until we remove the compensatory behavior, its consequences, and have to find another way to cope. Then the veil is removed and we can investigate and understand the causes in the sober light of day, and start a new life.
I completely agree. Trying to solve the underlying issues without addressing the immediate substance problem is like talking to a barking dog. The self-medication doesn’t address the fact that many people with terrible childhoods and past trauma don’t become addicts. I do believe genetics have a lot to do with it, from my reading and from my experience. Every woman I met in treatment came from a long line of alcoholics and addicts, as do I.
I think the key point is that no two people are the same. One thing I find extremely frustrating about AA is the insistence that we are all alike, and that if we assert that we are in any way different that we are in denial. I’m not in denial – I’m sure that if I drink again right now I will die. Came close enough to not want to repeat the field research. However, that does not make me any more a carbon copy of the folks I meet in AA than the fact that I went to Yale makes me a carbon copy of George W. Bush.
…a disturbing yet compelling comparison!! 🙂
I think the views on heritability and predisposing factors are getting changed now with epigenetic research. Is it nature or nurture? Probably a combination of both…
Very interesting stuff, from both a personal and a research perspective.
I’m curious about the the thinking of those who have successfully recovered. Which beliefs about addiction are correlated with getting control over one’s life? And does it change when one defines success as permanent abstinence or as never again suffering negative consequences from a substance… not losing control? I’m hoping to investigate this as part of my Masters in Public Health research… getting ready to do my thesis project this fall and spring. I’m thinking about doing qualitative interviews with people who have maintained long term sobriety to see what they believe addiction is: disease, habit, choice, learning, or something else? Demonic possession? All of the above? How do these beliefs affect one’s approach to being well, and do they change over time?
Thoughts and suggestions are most welcome!
I think this will be a very productive enterprise and I would love to participate! I think my relationship to the coping behavior and to myself changed over time leaving me more confident in my own values and what is important to me….
Excellent, thank you! I love the community here… and the fact that we don’t have to check our brains at the door!
Thank you, April…and for the important work you do. Isn’t checking our brains at the door what got us into this to begin with? 🙂
Hi April, I would love to participate in your research project! Please contact me if you’re interested at lisebrun@bellaliant.net
I love reading this blog! Keep up the good work Marc!
…and if you don’t get to No. 2, do we ever really recover? I don’t think so. At least not the kind where we experience happiness or satisfaction with our lives once again…
AA’s public anonymity provision simply means that no one is a spokesperson for the fellowship. While not perfect, it does minimize demagoguery, narrow-mindedness, and expertise.
Hi Nicolas
Thanks for this. I’ve written a number of responses, but let me start with this approach to the question we’re entertaining here:
I think the problem is getting clearer from the contributions. The key question is this: what are the limits of the AA rule of public anonymity? Some might think that the tradition of public anonymity rules out any public statement whatsoever from anyone who participates in any AA group. So imagine this public speech by a politician who is a member of AA:
“I’ve been sober now for ten years. What helped me was my participation in a group that supports my sobriety. The fellowship has been a life-saving source of help of all kinds.”
Is that a violation of the rule? How about this:
“I’ve been sober now for ten years. What helped me was my participation in a 12-step group that supports my sobriety. The fellowship has been a life-saving source of help of all kinds, and it allowed me to connect with God again. I was raised a Catholic but I had fallen away. Now it’s a source of strength.”
How about this one:
“I’ve been sober now for ten years. What helped me was my participation in an AA group that supports my sobriety. The fellowship has been a life-saving source of help of all kinds, and it allowed me to connect with God again. I was raised a Catholic but I had fallen away. Now it’s a source of strength.”
Now let’s imagine one that clearly violates the rule:
“I’ve been sober now for ten years. AA is what saved me. It relies on a relationship with the Christian God and it’s the only way that will work for most people. My public life reflects AA principles.”
So the question is this: do the AA traditions prohibit any member of AA choosing to go public with their story of sobriety in any form whatsoever? Or is it possible to forego anonymity in order to help the larger cause, so long as one does not claim special knowledge of how AA works or must work?
So the strictest interpretation of this norm would be that no AA member can ever talk about their path to recovery in public. A more reasonable interpretation would be that no member of AA can claim to speak for AA. But there is a lot of ground in the middle. Can we shed light on a reasonable dividing line?
The word “Addict” may be losing its foreboding identity in society.
The Music field has used the term, and now there is a new movie titled:
“Peggy Guggenheim: Art Addict”.
The word “addict” may be losing its purely negative connotations.
Also,
It may become more apparent that “once an addict, always an addict” is simply not true. Just as terms like “ex-spouse, “ex-smoker”, don’t imply these people are constantly restraining themselves and maintain control from returning to a previous way of being.
And in the same may the term “ex-addict” may loose its foreboding identity and use in society.
Choosing to remain anonymous may not be such a weighty decision.