Substance Abuse: Growing Beyond 12 Step Program Dependency

The notation after the story excerpts shows the subject's code number, gender (F = female, M = male) and addiction (A = alcohol, P = polydrug, B = bulimia, N = nicotine, S = sex, G = gambling).

AA Story
About one fifth of the stories referred to AA or GA as decisive for recovery; almost all were told by men. These AA narratives typically started by descriptions of the first drinking experiences in youth. Increased drinking then led the protagonist to various life problems. Reasons for quitting emerged, such as being sacked from work, spousal complaints or the tension between one’s ideals and reality, but they did not lead to sobering up. Continued drinking led the protagonist to ever greater isolation and "cosmic loneliness": "Pera noticed to his horror that in the end he would be completely alone, alone with his powerlessness, anxiety, fears, and guilt. And no one of those around could understand him, and none of them, not his wife, relatives, friends, acquaintances, fellow workers, nor occasional lovers could help him- they only asked in amazement, why Pera drank so often and almost always too much (66/M/A)." The problems culminated in the "hitting bottom" experience, in which continuing drinking was felt as impossible as quitting. The only way out seemed to be death.

Hitting bottom was followed by a period of experimentation, during which the protagonist searched for a solution with the help of professionals or by relying on his willpower. The idea of going to AA emerged, but the thought of joining this "odd group" felt somehow shameful. "It could be a meeting place of some skidrow alcoholics, but he was not one." (40/M/A) Decisive help could not be found before the person grew humble enough to attend an AA meeting. The change of attitude took place at the very first meeting: senior members of AA seemed to have led a life exactly like his own, yet they had managed to overcome their compulsion to drink.

An important experience was the insight that alcoholism is a disease: "Eureka! Now he knew that he was not a bum but a victim of a disease called alcoholism." (10/M/A) With the aid of AA the protagonist was able, slowly and painstakingly, to quit drinking and start a "decent life" as a member of straight society. By joining AA he took his place in the chain in which he could receive help from the elders and give it in turn to the newcomers. "During his first sober year Martti went to AA meetings 5-6 times a week and step by step he made progress in the program... Results from his efforts could already be noticed, and he served his one-year anniversary cake to his AA friends on the 20th of October 1980. In the following year he got a job and started to save money for an apartment. Later he got two children, a girl and a boy. He bought a house and a summer cottage. He worked overtime and paid back his loans. Fortune smiled on him, growth continued, AA had become an inseparable part of him." (19/M/A)

The AA story ends with a moral and an expression of gratitude: "No worship, no worldly acceptance, no obedience to any rules nor sects, nothing that starts from disgrace, but something that is available, free, and demands only the will to relate with others and the will to recover! I owe you much. You have taught me well. Thank you!" (13/M/A)

In the AA story alcoholism is explained as a disease and an inherent feature of the alcoholic. To recover from the disease one has to hit bottom, admit one's helplessness with regard to alcohol, and rely on the help of recovered alcoholics. In the moral sense the AA story absolves the person from guilt, since it does not blame any one for the alcoholic's drinking. After joining AA the protagonist is, however, portrayed as a responsible actor who pursues sobriety by the help of the AA community. However, the gratitude expressed in the narratives implies that the recovery is conceived essentially as a gift, and that the protagonist is not to be praised for his success (Arminen, 1998, ch. VI). On the level of values the "vice" or evil of the story is the individual hubris, a life-style revolving around one's drinking and illusions of control. Good", on the other hand, is the connection with other people and merging into a larger hole with similar aspirations.

Personal growth story
Another prominent story type depicts recovery as a matter of individual growth and emancipation from oppressive relations. These personal growth stories were typically written by women, just as the AA stories were mainly produced by men. The growth story began by describing the protagonist's childhood as overshadowed by disregard of the child's wishes and emotions. The protagonist learned to please others to be accepted and to conceal her true feelings and thoughts. "She was too small and too afraid to remember. And when she remembers, she is flooded by the memories of cuffs, scolding, and eternal shame whatever she tried." (2/F/A) Later, the protagonist tried to meet the internalized standards set by her parents and was prone to become involved in oppressive and abusive relations. Alcohol was used to alleviate the anxiety caused by these problems. "Throughout her childhood Galja had been afraid of her father. It took a long time before Galja had dared to cast doubt on her father's truths... One could not discuss things with the father. One could only obey him." (26/F/B)

Recovery involved breaking loose from both internal and external boundaries and restrictions, and the gradual opening-up of new possibilities. In the implementation of change help from other people, such as an encouraging therapist, was often needed. They acted as "midwives" in the birth of the new self. Recovery was made possible by the process in which the protagonist was able to find and accept herself, to strengthen her will and find her own voice. This implied getting in touch with her own feelings and desires. "What really made her start to recover was her love for her children and the fear and grief that their emotional lives would become as gloomy and full of anxiety as that of Tuija herself. It was the motivating force and propeller and it is still the same even today. But its meaning may have changed a bit. Now Tuija has a will to live for herself, too, which was totally missing before... During the first year one just somehow learned to recognize, recognize one's own features and characteristics. And in this way Tuija was able to define what she wanted herself." (7/F/A) Finding oneself was accompanied by emancipation from oppressive relationships. "... and her wish to decide for her own life grew so strong that she did not want to be somebody's puppet any more." (7/F/A) Through self-discovery it was also possible to create equal relationships with others. Trust in people began to be restored. All this was experienced as a great liberation. "The freedom he felt after cutting his umbilical cord was a totally new feeling for him. He was not aware then that this liberation and emancipation started his new life and meant breaking loose of the old one." (28/M/A)

The theme of the growth story is the transformation of the person from a victim or a puppet to a consciously acting independent subject. It brings to mind the image of a butterfly that breaks out of a cocoon, unfolds its wings, is startled by their shining colors and takes off to fly. In the growth story the loss of contact with one's true feelings and attempts to please others form the basis of addiction. The conditions of recovery are finding one's goals, attending to one's needs and loving oneself, instead of seeking love from others. In the moral sense the growth story releases the protagonist from guilt by seeing oppressive relations as the cause of the problems. The responsibility for one's life required for staying sober is seen to emerge as a part of the personal growth process. On the level of values, the growth story celebrates individuality, authenticity and freedom. The philosophical roots of this story-line can be traced back to Aristotle and so-called romantic expressivism, according to which every person should be given a chance to actualize his or her own potential. These ideas are also emphasized by humanistic psychology (Rogers, 1951).

Co-dependence story
In the co-dependence story the key to recovery was the protagonist's insight that he was inclined to become addicted to almost anything. This type of story was told by three male polydrug abusers. The starting point of the story was the emotional atmosphere of the protagonist's childhood family. The parents had problems and secrets about which it was forbidden to talk. Negative feelings were not expressed. "Simo grew up in a home where feelings were denied. There were secrets that were not allowed to come out. Simo did not know that his father had shot himself when Simo was two
to three years old. Three months later his eldest brother ... was drowned or more probably drowned himself when having a sauna bath. Simo never leamed to recognize his own feelings. He only recognized agitation or gratification. The gratification followed from being able to prove his superiority, for example, through winning, sex, and alcohol." (63/M/A) The life of the protagonist was a chain of addictions: quitting one addiction was followed by becoming hooked on another. Finally came the realization that all forms of dependence had been pans of the same problem, the denial of one's emotions. Cure was sought from therapy or self-help groups. "Unveiling self-therapy resolved Simo's fortune. After getting into contact with his features that had enabled his alcoholism and after getting a chance to confess the causes of his guilt feelings that had reigned for decades, Simo regressed no more to drinking, he regressed to confessing. Confession was a new experience of deliverance." (63/M/A) In the co-dependence story the hero lives blind, driven by a nameless anxiety from which he finds only temporary relief but no freedom. Realization of the true nature of the problem is like finding a lamp, the light from which shows clearly the entire previous life. The light is cold, however, since it shows that all former attachments— whether to alcohol, love, work or God— have been "only" addictions.

From the moral point of view the co-dependence story releases the protagonist from guilt by depicting him as a victim of a curse that extends over generations. He has been led by forces unknown to him. Gaining awareness makes him a responsible subject. The co-dependence story sees secrecy and repression as the main sources of problems, whereas openness and bringing shameful problems into daylight pave the way for a better life.

Love story
In five stories the key to recovery was seen in receiving love and care. The most clear-cut versions could be found in the narratives of two women with eating disorders. Analogical to the love story was the religious story told by a former excessive drinker. At the beginning of the love story, the protagonist longed in vain for love and tender care. This led her to seek consolation, self-esteem and attention from others by various excessive behaviours. This lack of love was compensated by extreme dieting or binge eating. The result was, however, contrary to the person's intentions: the indifference of her parents was revealed, friends abandoned her, shame isolated her from the others and self-disgust from herself. "Vomiting became worse, the relations with the parents became worse. Ida's feelings and self-esteem deteriorated... Mother mocked her and degraded her even though what she needed was tender affection and love." (45/F/B) Finally, at the eleventh moment, the protagonist was rescued: into her life entered a person who accepted her, loved her and took care of her. "Then she met a man. For the first time in her life Tiina received the love and care she had sought for all along. Tiina just had to find a cause to live." (74/F/B)

In its explanation of addiction the love story bears traces of psychoanalytical thinking, according to which an unsatisfied psychological need is redirected on a compensating object. The need for addictive behavior recedes when the need of being cared for is satisfied. The love story releases the protagonist from guilt by depicting her addiction as a justified way of striving for the feeling of security of which she has been deprived. On the ethical level, the love story emphasizes intimate relationships as a basis of the meaning and significance of life. This notion, according to Taylor (1989, pp. 289-292), emerged in the 17th century as a part of the "affirmation of ordinary life", and is still one of the basic moral sources of our life.

Mastery story
The central theme of the last story type was gaining mastery of one's behavior. Mastery stories were almost exclusively told by ex-smokers, both men and women. For the protagonist of the mastery story, starting to smoke during youth meant a transition from childhood to the world of adults. Since smoking was forbidden, it carried danger and suspension, and declared independence of the norms and prohibitions of adults. In young adulthood, smoking served as a buffer alleviating the pressures of adult life. In this sense, it increased the sense of mastery. "When Riitta's father died and the home was disintegrated and Riitta started to study in the Art Academy, tobacco was her refuge... It was a clear escape from reality and a protection in the midst of everything confusing and new." (71/F/N) The meaning of smoking changed when the protagonist became aware of her dependence. It was now seen as an obstacle to maturity, which requires self-control. Smoking cessation demanded willpower and resolution, which could be supported by different techniques. "A concrete aid was found from a wooden stick of about 80 cm that looked like a cigarette. The quitting day was marked with a pen on its white part and a line was drawn as a sign of each smokeless day." (50/F/N)

The protagonist of the mastery story had two selves: the weak but defiant "smoking self" and the strong and rational "non-smoking self". One of the techniques of quitting was based on psychological warfare between the two selves. Other people acted various important roles in the mastery story. Non-smokers who demanded that the protagonist should quit provoked more defiance than motivation to quit. Other nonsmokers aroused a feeling of shame, which encouraged not smoking in their presence. Still-smoking peers tempted one to relapse, while those who had quit smoking provided moral support. Finally, their own children created the felt necessity to quit. "The daughter's playful smoking in the country was the straw that broke the camel's back. How could a mother forbid her child to smoke, if she herself did the same?" (54/F/N) Cessation of smoking was rewarding in terms of health, finances, initiative and, above all, the feeling that one's life was in control.

Discussion
Every story type articulated one central value, in the light of which the former life as an addict was seen as problematic and the new life as valuable. Articulation of a new guiding value thus seems to be an important part of maintaining such a demanding life change. Every story type also described a change in the protagonist's relationships with other people. In the AA story, a self-sufficient figure finds his way to communion with others; in the growth story a "puppet on a string" breaks loose of oppressive relationships; in the co-dependence story the protagonist learns to disclose his feelings to other people; in the love story the protagonist receives the love and acceptance she has longed for; and in the mastery story defiance gives way to responsibility. This suggests that addictive behaviors may stem from various fundamental problems in human relationships. The profound differences between the story types found in this study indicate that an addiction can stem from various kinds of problems and that there are many routes to recovery. This suggests that the attempts to find one all-encompassing explanation or one patent solution to all addiction problems might be not only futile but even harmful in repressing the deviant voices. Clients in treatment should be encouraged to create and express a story that fits their own experience, to make full use of the cultural stock of stories and not to comply blindly with any pre-existing narrative model.
- Hanninen, V., & Koski-Jannes, A. (1999). Narratives of Recovery From Addictive Behaviours. Addiction, 94(12), 1837-1848. doi:10.1046/j.1360-0443.1999.941218379
The box directly below contains references for the above article.

Update
Some days I am a lunatic that thinks I can moderate':
Amalgamating recovery and neo-liberal discourses within accounts of non-drinking
among women active in the 'positive sobriety' community on Instagram in the UK

Atkinson, A. M., Matthews, B. R., Nicholls, E., & Sumnall, H. (2023). 'Some days I am a lunatic that thinks I can moderate': Amalgamating recovery and neo-liberal discourses within accounts of non-drinking among women active in the 'positive sobriety' community on Instagram in the UK. The International journal on drug policy, 112, 103937. https://doi.org/10.1016/j.drugpo.2022.103937

Peer-Reviewed Journal Article References:
Freimuth, M. (2018). A new look for addiction training in psychology programs: Comment on Dimoff, Sayette, and Norcross (2017). American Psychologist, 73(5), 693–694.

Sayette, M. A., Norcross, J. C., & Dimoff, J. D. (2018). Addiction training and multiple treatments for all clinical psychologists: Reply to Freimuth (2018). American Psychologist, 73(5), 695–696.

Stolzenburg, S., Tessmer, C., Corrigan, P. W., Böttge, M., Freitag, S., Schäfer, I., Freyberger, H. J., & Schomerus, G. (2018). Childhood trauma and self-stigma of alcohol dependence: Applying the progressive model of self-stigma. Stigma and Health, 3(4), 417–423.

Online Continuing Education QUESTION 19
What are the 5 types of stories told by recovering addicts? Record the letter of the correct answer the CEU Test.