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Psychiatric Times
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DeAndra's story: I came into the rooms and realized after a while that I had the attitudes and behaviors of an addict way before I ever picked up a drug. I remember growing up and being at my family's parties, [where] my aunts and uncles would give me and my brothers beer. There are pictures in our photo albums of us, all under 6 or 7, with cans of beer in our hands. At an early age I learned to manipulate to get what I wanted.
DeAndra's story:
I came into the rooms and realized after a while that I had the attitudes and behaviors of an addict way before I ever picked up a drug. I remember growing up and being at my family's parties, [where] my aunts and uncles would give me and my brothers beer. There are pictures in our photo albums of us, all under 6 or 7, with cans of beer in our hands. At an early age I learned to manipulate to get what I wanted.
I was molested at a young age by my uncle and felt that something was wrong with me, that it was my fault. When my mother and father separated, my world collapsed. My mother never showed me love; my father was my world. I started to feel so ashamed around other kids. I felt ugly and I felt they all knew I was doing something bad with my uncle. I was lonely and longed to fit in and be a part of something.
I picked up my first drug at the age of 13-marijuana. All the kids were doing it and my best friend convinced me to try it. Once again, I just wanted to be a part of the kids who were having fun. I didn't like marijuana, but I also began to drink a lot of beer around this time. Sometimes I would have a joint and a can of beer for breakfast.
I got pregnant at 17 and had to start working to support myself and my daughter. We were living with my mother, who constantly nagged and put me down. I started hanging out with friends more and more. I was introduced to uppers, cocaine and mescaline. Cocaine was my drug of choice, after using it I became alive, I could dance, joke, party and be one of the guys. Eventually my using started to interfere with work. My mother was complaining all the time. The only solace I got was from using drugs.
My daughter's father introduced me to crack. This was the beginning of years
[spent] losing jobs, desperation, loneliness, degradation, losing my kids to BCW [Bureau of Child Welfare] and living in shelters. I was totally out of control. I was arrested for selling drugs. I also turned tricks and allowed others to use my home as a drug spot.
After losing my kids and being arrested for the second time, I came in for treatment. They forced me to attend NA meetings. I didn't think it would help. I didn't really think I had a problem. But I took the suggestions of old-timers. I kept making meetings and held on. I started to do service, and I got a sponsor. My sponsor pointed out that I had no power over drugs and that's why I did the things I did. I finally felt I was a "part of" [something] and it was the best thing that ever happened to me. I'm learning how to be a better person. Without my Higher Power, none of this would have been possible.
(DeAndra's name and details of her story have been changed to protect her identity.)
For the past year, our research group has collected stories like DeAndrea's. Stories of fear, pain and isolation. Stories of hope, change and personal growth. These are the stories of Narcotics Anonymous (NA), the stories one addict tells another in hopes of saving his or her life.
Overview
In 1993, our research group embarked on a journey to understand the spiritual nature of addiction and recovery. We were conducting an ethnographic study of a South Bronx treatment program and were struck by the number of individuals who credited their sobriety to the help, support and guidance of a "Higher Power." People attending the treatment program frequently made reference to their Higher Power and the change that had taken place in their lives. They spoke of this change with ease and comfort. The topic came up spontaneously in meetings. Its importance was underscored by the frequency of such discussions and by the intensity of the emotions that were revealed when it was discussed. Such conversations occurred in both formal and informal settings. It became clear to us that spirituality was an important aspect of recovery.
In order to better understand the nature of spirituality in recovery, we conducted a series of interviews and focus groups designed to delineate the ways in which spirituality played a part in recovery. We learned that there were distinctive teachings about spirituality that were shared in the recovery community (Green et al., 1998). Concepts
of faith, acceptance and surrendering were eloquently described by focus group parti-cipants. To emphasize the importance of these concepts, participants told stories of the changes that had taken place in their lives. The stories were elaborate statements that vividly described the devastating impact of drugs and the circumstances that led them to recovery. These stories were similar in nature to those commonly told in NA meetings.
Twelve-Step Storytelling
One of the most brilliant devices in 12-step fellowships is the use of the shared narrative or story (Khantzian and Mack, 1994). Addicted people tell stories as a way of understanding their own addiction and sharing it with others. Storytelling informs the newcomer about the habits and practices that lead to recovery. It reinforces spiritual messages. The stories underscore the disappointments, failures, separations, losses and abuses endured by individuals.
The telling of these stories helps individuals discover they are not alone in their suffering and that the shame associated with their problem is not unique. The stories remind them that they need the help of others to obtain and maintain their sobriety and to understand their own and others "defects of character that led them to the point where they could not control their addictions or their lives" (Khantzian and Mack, 1994). Storytelling also exposes the storyteller's personal development, allowing those with more experience to make course corrections if the process appears to deviate from the expected pathway of recovery.
The content of these stories assists individuals in tapping into an unexpected inner resource and in identification of this resource as "their own conception of a Power greater than themselves" (Smith, 1994).
Self-Examination
Twelve-step fellowships provide a special forum to examine the human tendencies toward arrogance, self-centeredness, psychological denial and self-destruction (Khantzian and Mack, 1994). In telling their own personal stories, members admit their inability to control substances and their vulnerability as addicted individuals. They describe (often in great detail) the psychological debilitation and deterioration that followed or resulted in the use of drugs and alcohol. In the story outlined above, DeAndra gives details about her life prior to her initial use of substances and about her experiences while using. In telling her story, she not only forces herself to examine her own character defects and shortcomings, but also challenges those attending the meeting to do the same.
Willingness to examine shortcomings and admit loss of control begins a process of self-acceptance and personal growth. Twelve-step fellowships stress the need to acknowledge moral failure, begin restitution, repair defects of character and be of service to others (Peteet, 1993). Individuals who experience conversion from guilt to altruism through this process of repentance report a renewed sense of integrity, that is, of congruence between their attitudes and their ideals (Peteet, 1993).
Pain of Addiction
Our lives are beset with disappointments and losses. If the pain is too great, and our psychological and material resources disproportionately meager, we will turn to maladaptive or pathological forms of affect management or regulation (Khantzian and Mack, 1994). During storytelling, 12-step members constantly speak of personal losses, separations, abuses and failures. It is in the context of these remembered painful subjective states that people reveal the exhilarating and liberating effects of alcohol and drugs, which suddenly made them feel normal for the first time (Khantzian and Mack, 1994).
DeAndra's willingness to reveal that she was molested and mentally and emotionally abused assists others in identifying with her story. She also speaks of the comfort provided by substances. Such accounts provide compelling testimony to the suffering individual. In a supportive atmosphere, newcomers are encouraged to forgive the transgressor and start the process of healing wounds, without the aid of addictive substances.
Acceptance
Progression to abuse or addiction is found more frequently in individuals who lack a developed sense of self or belonging (Peteet, 1993). Addiction, in turn, contributes to a negative sense of self. For many 12-step members, being a part of the fellowship is the first time they have felt accepted by others and free to accept themselves. Many newcomers are impressed by the group cohesiveness and credit the fellowship for saving their lives. Twelve-step fellowships provide a context for shared experiences, a sense of acceptance and antidotes to shame, problems that are common among substance abusers (Khantzian and Mack, 1994). Meetings can be extraordinarily supportive and comforting, as expressed by DeAndra in her final statements.
The process of recovery gradually leads users into a new way of life. Newcomers are slowly taught to think and act according to a new set of standards. Newcomers gradually give up acquaintances and relationships that were essential to drug use and begin to establish new ties that support sobriety. Over time, newcomers are weaned away from a life of self-destruction and guided to a new life in which they are, once again, a productive member of society.
Spiritual Awakenings
The recovery process can be likened to an initiation (Naifeh, 1995). At the outset, the active user is suffering from excessive ingestion of drugs but cannot stop the process. The needs of self and others are subordinated to the biological drive for drugs. In the context of 12-step fellowship, spiritual growth is deemed an integral component of the transformation of the initiate; spiritual awakening may be said to be a key goal of the 12 steps. We are struck by the fact that the 12th step does not read, "We became sober." Rather, it says, "Having had a spiritual awakening as a result of these steps, we tried to carry this message to addicts, and to practice these principles in all our affairs." Therefore, we infer that a process of spiritual awakening is embedded in the initiation process directed by 12-step fellowship and that storytelling is a primary means of conveying this process.
We would like to emphasize that the phrase, "Having had a spiritual awakening..." is an accepted part of 12-step fellowship but is poorly understood by mental health practitioners. It is our hope that by understanding stories like DeAndra's, we will answer such questions as: What is the process of awakening? What triggers awakening? What supports its development? What obstacles might block the awakening? What are the components of a spiritual awakening?
It is clear that spiritual awakening, experienced by many individuals in recovery, provides a process for finding meaning in often incomprehensible situations. As described by Alcoholics Anonymous and NA literature, those addicted to substances have had deep and effective spiritual experiences which have revolutionized their whole attitude toward life, toward other people and 7toward God's universe (Mathew et al., 1996). Examining the stories of 12-step fellowship will assist addiction clinicians in understanding these spiritual experiences.
References
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Khantzian EJ, Mack JE (1994), How AA works and why it's important for clinicians to understand. J Subst Abuse Treat 11(2):77-92.
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Peteet JR (1993), A closer look at the role of a spiritual approach in addictions treatment. J Subst Abuse Treat 10(3):263-267.
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Smith DE (1994), AA recovery and spirituality: an addiction medicine perspective. J Subst Abuse Treatment 11(2):111-112.