Recovering From Drug Addiction: a Phenomenological Account

Elizabeth C. Hirschman, Rutgers University
ABSTRACT - This paper presents a phenomenological account of recovering from drug addiction through the support of Narcotics Anonymous. Themes such as opening and closing rituals, self-identification as an addict, the credo of identifying, not comparing, maintenance of the boundary 'clean' versus 'dirty' and the development of a surrogate family/community bond are discussed. In addition, the paper interprets the dynamics of group discussion.Recovering From Drug Addiction:
[ to cite ]:
Elizabeth C. Hirschman (1992) ,"Recovering From Drug Addiction: a Phenomenological Account", in NA - Advances in Consumer Research Volume 19, eds. John F. Sherry, Jr. and Brian Sternthal, Provo, UT : Association for Consumer Research, Pages: 541-549.

Advances in Consumer Research Volume 19, 1992      Pages 541-549

RECOVERING FROM DRUG ADDICTION: A PHENOMENOLOGICAL ACCOUNT\

Elizabeth C. Hirschman, Rutgers University

ABSTRACT -

This paper presents a phenomenological account of recovering from drug addiction through the support of Narcotics Anonymous. Themes such as opening and closing rituals, self-identification as an addict, the credo of identifying, not comparing, maintenance of the boundary 'clean' versus 'dirty' and the development of a surrogate family/community bond are discussed. In addition, the paper interprets the dynamics of group discussion.Recovering From Drug Addiction:

Drug consumption and drug addiction are two of the major social problems confronting consumers (Brister and Brister 1987). Every year thousands of consumers die from drug addiction, and thousands more enter detoxification and/or rehabilitation facilities (U.S. Department of Health and Human Services 1987). Detoxification and rehabilitation programs are designed to help the addicted consumer rid his/her body of the physical dependence on addictive substances. But they cannot live the recovering addict's life for him or for her. The recovering addict must somehow come to grips with the underlying emotional problems, issues, and inadequacies which compelled him/her to become an addict (Beattie 1989; Cermak 1986; Johnson 1980).

Many detoxification centers and virtually all rehabilitation facilities encourage their clients to enter a 12-Step program while in treatment and to continue in this program when formal treatment is completed (Johnson 1980; Hazelden Foundation 1985, 1974; Brownell, Marlatt, Lichtenstein and Wilson 1986; Gravitz and Bowden 1985; Wallen, Weiner, Mansi and Deal 1987). Twelve-step programs were originated in 1935 by the founders of Alcoholics Anonymous (A.A.). They are a system of emotional and spiritual recovery designed to help the recovering addict come to grips with the sources of his/her addiction (which generally lie in feelings of personal inadequacy and emotional disconnectedness), to make amends to those whom s/he harmed during addiction, and to provide a lifelong communal support group which accepts the recovering addict on his/her own terms.

There is a spiritual component to the 12-step system, which is derived in part from Christian theology, but, as will be described, this is not necessarily adopted in a theistic or religious sense by members. Currently, there are over 10 national programs derived from the original A.A. 12-step system. Among the most well known of these are: N.A. (Narcotics Anonymous), C.A. (Cocaine Anonymous), G.A. (Gambling Anonymous), S.A. (Smokers Anonymous), O.A. (Overeaters Anonymous) and Al-Anon and Ala-teen, which are designed for the families and children of alcoholics.

I chose to join N.A. because there were several meetings available, it was conveniently located, and there were people there I felt comfortable with. This paper is based upon my experiences in N.A., both as participant and as an observer. It provides a phenomenological account of how recovering addicts relate to one another -- and to themselves -- within a communal support group.

The two N.A. chapters I attended (and still attend) are different in member composition. They are also different in structure, as well. One is what is termed a Step meeting, which means that each meeting we cover a particular step of the 12-step program. Hence, in 12 weeks, we have cycled through Steps 1 to 12 and are ready to begin again at Step 1. Not everyone in the meeting moves through the steps at that pace, however; in fact few do. Rather, each member moves at his/her own pace; further, some members drop out, and new members are continuously added, so that the group discussion of Step 4, for example, will be somewhat different every time that step is reached. There are usually between 10 and 25 people present at this meeting. The age range is from 17 to 55; it is predominately white and has a mixture of working class to upper middle class attendees. About one-third to one-half the attendees are female.

The other meeting I attend is what is termed a Speaker-Discussion meeting; in it a recovering addict (with at least two months' 'clean time') speaks for 20 to 30 minutes at the beginning of each meeting. This is termed 'sharing.' After s/he has spoken, the meeting is opened for all in attendance to share their thoughts, concerns, and feelings. This meeting usually attracts between fifteen and thirty attendees, approximately one-third are black or Hispanic and about one-fourth are female. The age range is from early twenties to mid-forties and the group is usually evenly divided between working and middle class.

Despite their differences in structure and composition, however, the two types of N.A. meetings exhibit some strong commonalities which are important for understanding how the fellowship functions. Among the most significant of these are (1) the opening and closing rituals, (2) self-identification as an addict, (3) the credo of identifying, not comparing, (4) maintenance of the boundary 'clean' versus 'dirty,' and (5) the development of a surrogate family/community bond. Each of these is described below:

Opening and Closing Rituals

Meetings of N.A. open with the Serenity Prayer, (God, grant me the serenity to accept the things I cannot change, the courage to change the things I can, and the wisdom to know the difference.) which may appear somewhat cliched to the non-addicted reader, but actually has substantial relevance to recovering addicts. Recovering addicts must accept the fact that they are not like other people -- they are compulsive (see O'Guinn, Faber and Krych 1987; O'Guinn and Faber 1989). They cannot change

TABLE 1

WHO IS AN ADDICT?

TABLE 2

WHAT IS THE NARCOTICS ANONYMOUS PROGRAM?

TABLE 3

WHY ARE WE HERE?

this, but rather must accept it and learn to live their lives within certain boundaries. The most significant of these boundaries is that they must not resume the consumption of potentially addictive substances. Thus, N.A., as well as other 12-step programs, is premised upon abstinence from those things over which the consumer is believed to have no ability to control his/her behavior (e.g., drugs and alcohol). The text of the prayer also suggests that the recovering addict is responsible for changing aspects of his/her behavior that would improve the chances of continued recovery and improved relationships with other people. In large part, this means taking responsibility for one's actions and making amends to those one has injured during addiction.

Following the Serenity Prayer, most groups read "Who is an Addict" [Table One], "What is the N.A. Program" [Table Two], "Why Are We Here?" [Table Three], and "How It Works" [Table Four]. These texts, consistent from one meeting to the next, provide the context within which the group will discuss the issues which are raised. They are very similar in function to the liturgy at a Protestant church service, setting forth common articles of faith and providing a ritualized entry into a communal mind-set in which the group will operate.

TABLE 4

HOW IT WORKS

At the close of each meeting, the group members rise, form a circle, join hands and recite the Lord's Prayer. Although some members are uncomfortable with this practice intellectually and/or religiously (e.g., E.B., N.A. Way Magazine, 1990), most accept its textual propositions, if not its underlying Christian theology. The central idea is, as in the Serenity Prayer, not to attempt to control events that are beyond the recovering addict's ability; rather, the recovering addict is encouraged to make amends to those s/he may have damaged during addiction (i.e., "forgive us our trespasses"), as well as forgiving those who may have contributed to the addiction in his/her life (i.e., "as we forgive those who trespassed against us"). The textual portions concerning the avoidance of temptation and "deliverance from evil" are also significant to the recovering addict, who confronts a lifetime of resisting the desire to return to addiction.

Self-Identification as an Addict

After the opening texts are read, each attendee is asked to introduce him/herself. This is done on a first-name only basis, to maintain anonymity, and is always followed by the statement: "I am an addict." Whenever an attendee speaks, s/he must preface his/her remarks by again stating a first name, followed by the declaration "I am an addict." (Or "I am an addict and alcoholic," "I am cross-addicted," etc.) This public self-identification as an addict is very difficult for newcomers, many of whom are still struggling to come to terms with the stigma of being an addicted consumer. However, the verbal self-labeling within the N.A. group serves as a powerful source of achieving commonality and permits recovering addicts to come to grips with the reality of their condition, as well as reminding each one how easily recovery can be lost.

To Identify, Not Compare

One of the principal credos of the N.A. fellowship is to 'identify with other addicts, not to compare.' This is derived in part from a passage in the N.A. program statement: "We are not interested in what or how much you used, what you have done in the past, how much or how little you have, but only in what you want to do about your problem and how we can help" (Narcotics Anonymous Handbook, 1988, p. 9). The value expressed by this statement, and reiterated in the credo, is that all addicts share in common the phenomenological experience of their addiction. Each addict knows, regardless of what substances s/he used, no matter how long or under what conditions, irrespective of socioeconomic status, race, age, gender or ethnicity, what it is to be addicted. And it is this existential knowledge that is their common bond. Non-addicts do not, and cannot, possess this knowledge, whereas all addicts do. In existential terms, this is the dasein of addiction: the being there. Addicted consumers, whether in recovery or still active, have all been there.

The credo, to identify not to compare, thus reminds members of the fellowship that their task is to empathize with what other members are sharing with them, and not to assume a critical, judgmental, or evaluative posture. Thus, within the dynamics of group interaction, criticism of what others have said is not permitted. Only supportive or suggestive comments are made. Within the N.A. tradition, it is not deemed appropriate (or functional) for one recovering addicted consumer to judge the thoughts, actions or words of another. It is believed that to do so would inevitably lead to cliques fragmented along drug-of-choice, economic, age, racial or gender lines. (It should be noted that there are some N.A. groups which are all-male or all-female, however, I am aware of none that are segmented along social class or racial lines.)

Clean Versus Dirty

In a phenomenological sense, perhaps the most important dialectic experienced by addicted consumers is clean versus dirty. Recovering addicts are clean; they have rid themselves of the substances, behaviors, attitudes and thoughts that contaminated (e.g., Douglas 1966) them during their addictions. Conversely, consumers who are still active in their addictions are viewed within this ideology as dirty; as profaned and polluted (e.g., Douglas 1966). In the phenomenological consciousness of the recovering addict, the world is full of potentially polluting contexts and substances that must be guarded against vigilantly. The boundaries of the body, in particular, are to be guarded from the entry of polluting substances; but the mind also is seen as a locus where potentially polluting thoughts and desires (termed 'wrong thinking') may enter and cause relapse.

Body Boundaries. There were several instances provided by the recovering addicts to whom I spoke of attempts to control body boundaries. Two (h, f, 27; w, m, 24) refused to permit novocaine injections during dental surgery, preferring to experience pain rather than "have drugs enter my body." Another recovering alcoholic (w, m, 25) is afraid to rinse his mouth with Scope mouthwash, because it contains 13% alcohol: "I'm just afraid that once that alcohol taste gets in my mouth, I'm a goner... I still have dreams where I wake up tasting bourbon in my mouth." Another recovering alcoholic (w, m, 24) reported refusing to eat some spaghetti sauce his mother had made because she had "poured some beer into it to kill the acid taste... She told me the alcohol was all cooked out, but it didn't matter. The beer was in there, and I wasn't eating it." Similarly, another recovering alcoholic (w, m, 29) became very upset when he learned the cake he had eaten at a friend's house was flavored with Amaretto liqueur: "I just don't want alcohol to be in my body ever again." A recovering female addict (b, 27) "hates to get a cold, because when I do I won't take sinus medication. It makes me drowsy and reminds me of when I was using [drugs]."

Mental Boundaries. Just as recovering addicts seek to protect their bodies from polluting substances, they may also attempt to prevent polluting thoughts from entering their consciousness. The type of thinking which causes recovering addicted consumers the most concern is re-entry of the belief that they can control their consumption through willpower, as other (non-addicted) consumers do. One recovering heroin addict (w, m, 26) told me he had been having strong urges recently to "pick-up" (i.e., to use drugs). He kept "having fantasies that if I could just get my life where I wanted it -- a nice house, a great car, some money, a beautiful girlfriend -- then it would be o.k. for me to use again, 'cause I could control it." Sadly, he was not able to resist these thoughts and has now returned to heroin addiction. Another young woman (w, 28) has been clean for a year and is now "beginning to have thoughts that I could handle social drinking again. I see everybody else do it, and I think 'I bet I could do that too'; but I couldn't. When I was drinking I hurt myself very badly."

N.A. as Surrogate Family/Community

Consumers' addictions often originate in dysfunctional family life; and virtually all to whom I spoke had damaged or destroyed interpersonal relationships through their addictive behaviors. Thus, when they begin the process of recovery, many find themselves alone and friendless. N.A. provides them with a surrogate family and community which accepts them as they are, and serves as a source of nurturance, guidance, and support. As noted earlier, the opening and closing rituals, the concept of sharing one's thoughts and feelings, the credo of identifying/not comparing, and the establishment of a common bond through the phenomenological consciousness of addiction all serve to create a communal atmosphere within the group. One's sharing of oneself within the group generates a sense of self-transcendence closely akin to the Durkheimian notion of sacredness (Durkheim ed. 1961; Belk, Wallendorf and Sherry 1989; Csikszentmihalyi and Rochberg-Halton 1981).

However, the N.A. fellowship reverberates with a more religious form of sacredness, as well. Although explicitly non-denominational, it is fundamentally theistic; its textual materials make several references to a Higher Power, construed by many members to represent God. Some members are uncomfortable with these religious trappings (e.g., E.B., N.A. Way, 1990), and choose simply to find solace in the communal aspects of the fellowship, rather than in theism, per se. (In response to the desire of some recovering addicts to attend non-religious support groups, several agnostic recovery networks are now available. Among these are Rational Recovery and the Secular Organization for Sobriety (Gelman 1991).)

Theology aside, an N.A. meeting does rely upon Christian church metaphors and practices to help maintain a sense of sanctity for its mission. Meetings open and close with prayers, the meeting place itself is referred to as "these rooms" in metaphorical reference to a sanctuary, contributions are collected in a straw basket reminiscent of offertory practices in Protestant churches, and members in unison recite texts akin to liturgical passages in a worship service. All of this is in keeping with the central ideology underlying N.A., and indeed, all 12-step programs. That is that addicted consumers suffer from emotional and spiritual inadequacies, often springing from incomplete or absent bonding within their families as children. (One knowledgeable reader commented, "Is it just lack of bonding? What about inadequate experience to enable learning of how to give emotional support to another human being?") Their addictions will only be truly cured when these emotional and spiritual inadequacies are remedied. N.A. seeks to do this by providing a family, a community, and a spiritual outlet to which addicted consumers can belong without fear of rejection or abandonment.

Group Dynamics

The dynamics of the N.A. group are perhaps best understood by example. Partial summaries of group discussions for Steps One, Three, Nine, and Twelve are provided below, together with interpretive commentary.

Step One. This step requires addicted consumers to admit that they were powerless over their addictions, that their lives had become unmanageable. Cathy, a pretty, 25 year old, blonde woman is the first to speak. She states that she is "halfway through" this step. Her sponsor has encouraged her to "write it," and she is doing this. Writing down her experiences about drug use has made her realize how miserable her life was when she was using: "I used to do terrible things to myself, and I let other people do terrible things to me..." Now she feels "better about herself" and wants to regain her sense of self-worth and "do healthy things." She was at a wedding reception recently and her brother, who is still an active addict, tried to get her to do some drugs there. This made her feel very uncomfortable. She also had to watch many of her friends and relatives drink alcohol. She left the reception early, because she couldn't bear to be around so many people who were "using;" she was afraid she would give in to temptation. However, she now feels guilty that she left and was not doing the "socially appropriate thing" by staying.

Barbara (w, 40) comments on what Cathy had to say. She tells Cathy that she did a very healthy thing by leaving the reception and should not feel guilty about it. Her "self-preservation must come first," and "it took a lot of courage to leave and not give in to the social pressure" to conform by drinking. Barbara notes that there are many social occasions where drinking is expected of people -- e.g., weddings, restaurants, cocktail parties -- and that it is made to seem normal, so that people who don't drink are made to feel abnormal. This makes life very difficult for recovering alcoholics. Barbara also states that "any friend who tries to entice a recovering addict to try drugs/drinks is certainly no friend," and Cathy should feel no guilt in refusing them.

Rod (b, 28) shares that he has been clean now for 6 weeks. He has been to N.A. before, but has relapsed each time. He feels much more confident about this attempt to stay clean, because he is now contributing to/and participating in the group. Before when he came to a meeting he would just "sit in the back like a shadow and never share anything... I had lots of good things to share, but I never did. Now, I've learned to speak up."

Another young woman (w, 25) relates how her mother, who was having memory problems, just underwent brain surgery that morning. The woman is very glad she is now sober so that she can deal responsibly with her mother's problems. Now that she is no longer drinking, she is able to feel appropriate emotions. When she was drinking, she was unable to feel -- in fact, she often drank "to escape from having to feel."

A young man (w, 30) has been clean for 16 days. He had been thinking about getting clean for 8 months, and finally entered a detox center. He had a difficult day yesterday. He was moving out of one house (where he had used drugs) to another residence. He had a hard time organizing his thoughts and deciding how to pack and what to take. Then his date for a concert fell through at the last minute. He was unsure if he wanted to go by himself, but he went anyway. A lot of people were drinking beer at the concert, but he was not tempted. He recalled a time a few months earlier when he had returned home from a party about 2 a.m. His roommates were doing lines of cocaine and invited him to have some. He was tired and wanted to sleep, but he did some anyway. By 4 a.m., he "was so wired I felt my heart was going to explode." This scared him and has helped him stay off drugs.

A woman (w, 35) shares that she was a drug abuser for 20 years but kept avoiding acknowledging it. She has been in psychotherapy for 4 years and only now is acknowledging to her therapist that she was an addict. As part of her therapy, he has had her write the story of her drug use in four chronological installments (5 years each). As she has done this, she has "revealed to herself the great extent and depth" of her addiction. Reading this chronicle helps to "keep her honest" about her earlier life on drugs and remain clean.

Michael (w, 50) comments that when he was in rehab, his counselor had him do the same thing. Michael found this very constructive, because when he talked with his counselor he would rely on the term "you know" to cover the undesirable details of his addictive behavior. For example, he would say "I would drink at a party and then... you know." Having to write down the details glossed over by "you know" forced him to confront the most troubling and repressed aspects of his addiction.

Commentary. The themes surfacing in the group seem to revolve around two of the primary concerns among recovering addicted consumers: (1) maintaining abstinence from addictive substances in the face of their widespread availability, and (2) consciously confronting, acknowledging, and learning to accept the self-destructiveness of their earlier addictive behavior. Recovering addicts are often at risk of giving in to their own impulses and social customs to "use." They may feel self-conscious that they cannot have a drink at a celebratory ritual or social gathering like 'normal' people (often termed "normies"). The social awkwardness and emotional anxiety they experience in such situations often places them in the same frame of phenomenological consciousness they experienced during their addiction. Hence, the fear of relapse is very great -- and very real. Sharing these feelings with people who have had similar experiences helps greatly to restore a sense of commonness and normalcy. The recovering addict is reassured that it is better to 'stay clean,' than to give in to the impulse to fit-in socially by 'using.'

Often recovering addicts, even though aware of their earlier status as active addicts, experience difficulty in fully surfacing the extent and depth of their addictions. This is attributed to the remnants of the denial mechanism (e.g., Johnson 1980), which was in force during their active addiction and which, even in recovery, acts to protect them from having to consciously acknowledge the self-destructiveness of their earlier behavior. Many recovering addicts find that externalizing the story of their addiction by writing it down and telling it verbally to another person has an extremely cathartic effect. (These are steps 4 and 5 of the program.)

Step 3. This step states that addicted consumers must make a decision to turn their lives and wills over to God. Doris (b, 30) opens by sharing a story about herself and her cousin, the person who had originally introduced her to drugs (heroin). Her cousin had been in jail for drug-related crimes, during which time Doris had gone into recovery, gotten clean and joined N.A. Her cousin was released from prison last Monday and the first thing she did was call Doris up and ask if she could stay with her. Doris wanted to say no because she feared her cousin's negative impact on her own recovery, but she was afraid her cousin had nowhere else to stay and might end up on the streets. So she said yes.

When her cousin arrived at her house, she was already high on heroin ("noddin"), but Doris let her sleep on her living room couch. Her cousin's presence in the house made Doris nauseous and have diarrhea; she felt "just like I always did when I'd be shooting up the day before, but not have any stuff [heroin] the next day." Doris took this as a sign from her Higher Power that her recovery was at stake and that she must persevere in keeping clean. The next day her cousin left, but Doris is afraid she will return. She wants to tell the cousin no, but is afraid to offend her/not help her. The next night Doris went to bed at 9:30 p.m., so that if her cousin came to her house, she would already be asleep and would not be tempted to get high. She is struggling with the dilemma of how to be supportive of her cousin and still maintain her own recovery.

Stuart, a handsome blonde young man (25), complains that since he has overcome his addiction he has become much more financially successful (he now makes $45,000), but that instead of dealing with his emotional problems he "just throws money at them. If I'm having a bad day I can afford to just go see a movie to forget about it, rather than really working it out."

Tracy (w, 20) comments that she is having trouble with Step 3 because she does not believe in God in a religious sense. She does believe there is a power greater than herself ("than the human species"), but not in a traditional religious sense. She likes N.A., however, because she wants to be part of the group. She feels "comfortable and loved" here. Doris agrees that she too does not believe in God as her Higher Power. Her Higher Power is "the N.A. fellowship... the people who are here; that's who I believe in."

Lorie (w, 25) comments that she has just recently learned to understand what the phrase "one day at a time" means. "It means I only let myself worry about what's happening that day, not the next day, or next week, or next year. I only live this day and I can only do things that are happening this day... My father is having surgery on Friday and I was very worried about it, but I realized it's only Tuesday. My worrying today is not going to have any effect on what happens to my father on Friday. So I'm going to worry Friday about what is happening to my father on Friday... I used to carry the whole world's burdens on my shoulders, but I've learned to only carry one day's worth now."

Finally, Tim (w, 35) comments that he had a bad run-in with someone that day. A man had come down to the factory and yelled at him about something that was not directly his fault. However, although he had gotten in some "good [verbal] punches" back at the man, he did not lose his own temper. "I realized the guy had had a bad day himself, and he was going to tell somebody about it, so I figured it might as well be me." Tim reports that he is also struggling with co-dependency. (Co-dependency refers to a behavioral syndrome in which one person (the codependent) attempts to control the actions and moods of another person by always seeking to please that person and anticipate his/her demands. Spouses of addicts, battered women, and even traditional housewives may exhibit the codependency syndrome (see Beatty 1989).) "In my family, I was always the 'Fixer,' whenever something went wrong, I would always try to fix it. I still always try to fix things for my girlfriend... But a lot of times people resent it; they need to do it themselves."

Commentary. The discussion at a step meeting sometimes follows and sometimes digresses from the topic step. Doris and Stuart are using the meeting to externalize personal concerns and problems, the common subtext of which has to do with self-control and life management. Doris' problem is perhaps the most poignant in that it details vividly the difficulties which recovering addicts from lower SES backgrounds must face in maintaining their recovery. In Doris' social milieu, it is expected that she will provide shelter for her cousin. Yet, her cousin is not only an active addict, but the person who helped initiate Doris' own addiction. Doris' physical discomfort at her cousin's presence -- and her equating of it to her addictive experiences -- demonstrate her emotional upheaval at being placed in such a conflicted situation.

The subtext of Stuart's complaint that he now "just throws money" at his problems surfaces his concern that he is merely substituting a socially acceptable form of compulsive behavior (i.e., spending money) for a negatively sanctioned compulsion, drug addiction. The comments by Lorie and Tim relate more directly to the Step 3 topic, albeit in a somewhat discursive way. Both of these recovering addicts are trying to learn to "just let it go"; that is, to not attempt to exert control over all events/persons/situations that affect their lives. Tim is also still struggling with a tendency to not only attempt to control events in his own life, but also to control the lives of those with whom he has emotional ties. This is termed co-dependency (Beatty 1989; Cermak 1986); and is a dysfunctional psychological syndrome found in a segment of addicts -- most commonly those who had to care for (and attempt to control) substance-dependent parents when they were children.

Finally, as the comments by Tracy and Doris indicate, N.A. members do not necessarily subscribe to the Christian theology found in some N.A. materials. Note that both of these recovering addicts place the locus of the sacred aspects of N.A. within the communality of the group, rather than in a transcendent deity. Thus the bonding they rely upon resides at an interpersonal, not theistic, level.

Step 9. This step requires that the addict go to those people whom s/he has harmed and make amends to them. Maria (h, 30) begins the discussion by sharing that she has been trying to make amends to her sister from whom she is estranged due to her addiction. Her sister recently came by to see her, and Maria tried to be friendly and make amends, but her sister [in Maria's perception] was very rude and critical. This hurt Maria, but she is glad that she at least tried to make amends. Maria also tells us that her mother is opposed to her getting another job in a restaurant, fearing that it will set off her alcoholism again. Maria reluctantly agrees: "For me to work in a restaurant [where there is a bar] is like putting a junkie in a drug store."

Sarah (b, 23) is a graduate student at an Ivy League university. She feels under "extraordinary pressure" to study and do well. She is unhappy in the town in which she is living [to go to school] and seems to have made few friends. She wants to use drugs again. She began taking caffeine pills to study and work harder, and now finds she "can't stop taking them. I just take them to take them."

Barry (w, 22) says that "all this talk about graduate school has really got me worried... I'm still working on my G.E.D." This gets a big laugh from the group. Barry shares that he recently found a capsule of speed on the ground. He picked it up and smelled it. Fortunately, it no longer smelled like speed, for if it had "I'm afraid I would have taken it."

Jon (w, 24) shares that he has been feeling guilty about something. He was the liaison between two people, and he purposely manipulated the flow of information in such a way to serve his own selfish needs and purposes. "I was very manipulative of the situation, and it reminded me of how I acted when I was using [drugs]." He asked his sponsor what to do and the sponsor told him to "give the person you manipulated power back over his own choices." Jon did this and now he feels better.

Natalie (w, 25) is a new mother. She has been having difficulty adjusting to her new responsibilities and restrictions. She shares that her mind "wanders a lot" during the day when she is home alone with the baby. She feels she is not receiving enough appreciation from the baby and her husband, both of whom are at the meeting. The baby requires constant care and she is always anxious that something could go wrong: "In just one minute my baby could drown." She also feels that people [i.e., her husband] do not respect her opinion on things. "They just ask me hoping that I will agree with what they already think. If I don't, they disregard what I say or dispute it."

Ken (w, 25) shares that he is now at a new job. The past week he has been in the training program, but he is "somewhat paranoid" about the training instructor. He believes that the instructor may have found out that he is a former drug addict from his medical forms. "When the guy put on a training film about 'Don't Do Drugs,' he looked right at me... I know he knows I used to be an addict..." Ken says that "all my life most people haven't liked me... The only person that likes me now is my daughter [18 months old]; she's really happy when I go and see her, unless I am gone too long. Then she acts like she doesn't know me..."

Doris (b, 30) shares that her confidence is growing in her ability to advise other friends who are still on drugs, but that she still suffers from self-doubt. "I say to myself, who am I to tell this person how to live their life... I've only got 8 months clean time... But then I say, well, I am in recovery and I am working the program, so maybe I can help."

Commentary. The discussion by the group focuses upon two kinds of amends -- amends to others and amends to oneself. Maria and Jon are both struggling with re-establishing ties to other people. Maria still seems to need to see herself as the victim ("my sister was very rude"), even though she had originally estranged her sister through her addiction. Jon, conversely, fears that his old, manipulative behavior patterns may be resurfacing in his recovery. At a deeper level, he may also fear that this signals the possible return of his active addiction, as well. He is anxious to 'set things right,' again.

Maria, Sarah, and Barry are sharing with the group their anxieties about the ease with which they could return to active addiction. For Maria, this would be signalled by her accepting another job as a restaurant manager. Sarah, who was on amphetamines as an active addict, has already compromised her recovery by consuming caffeine pills, another central nervous system stimulant. Barry's chance encounter with a discarded speed capsule has brought him right to the edge of resuming his addiction. He was "saved" by their lack of the distinctive scent, which served as an olfactory trigger for Barry.

Natalie and Ken are both facing common challenges imposed by the real world on recovering addicts. Natalie must learn to face the often overwhelming and thankless tasks of being a new mother. Now she is responsible not only for her own recovery, but for the well-being of her child, as well. Doubtless, this puts great pressure on her to return to her addiction. Ken fears being found out as a former addict. Now beginning a new career, he is fearful that his past may reach forward and destroy his chance of a normal life. Doris displays the ambivalent mixture of self-doubt and self-confidence that is found in many recovering addicts. She vacillates between feeling she is not even able to care for herself and feeling comfortable with assisting other addicted consumers to begin their own recoveries.

Step 12. The 12th Step deals with spreading word of the N.A. program to 'still-suffering addicts.' Doris (b, 30) opens the discussion by saying that although she is "nowhere near the 12th Step" in her personal program, she has already helped a few other addicts to obtain help by advising them and helping place them in appropriate rehab and detox facilities. This has "helped me feel good about myself." She repeats the N.A. adage: "We can only keep what we have by giving it away to others."

Next, Barbara (w, 40) shares her concern over a close female friend who is a binge drinker and drug user. This friend knows Barbara is in N.A. and has talked to her about addiction. Barbara has advised her to stop using alcohol and drugs completely, since the friend seems to be unable to use either (especially alcohol) in moderation. The friend told Barbara that she has been able to greatly curtail her drinking. However, last month Barbara learned that the friend is again binge drinking, experiencing blackouts, and driving while intoxicated. She is very concerned and conflicted over what to do for her friend. She does not know whether she should call and pressure the friend to begin attending N.A. meetings. She fears for the friend's safety and believes that the friend also might kill/injure someone else.

A newly recovered addict (w, m, 30) advises Barbara to help her friend as much as possible. He says at least four of his friends, plus his mother, had to "keep after him" for six months before he finally went into rehab. He had to be convinced by others that his drinking was abnormal, before he could recognize it himself. He is "very thankful his friends cared enough" about him to keep telling him he needed help; otherwise he believes he would have simply kept denying it to himself and making excuses to not change his behavior. A second man (w, 30) gives just the opposite advice. He fears that any attempt by himself to help a still-active addict might threaten his own recovery. "I've only got enough strength to keep one life preserver afloat and that's mine. I don't want anyone else dragging me down."

A young woman (w, 28) advises Barbara that her friend may resent and resist her efforts to help. This young woman was arrested three times for DWI; each time she would tell the judge that she wasn't an alcoholic, but was only going through a particular crisis which had 'forced' her to drink: e.g., her parents divorced, she broke up with her boyfriend. Finally, on the third drunk driving arrest she was ordered into rehab. Once there, she realized that she was an alcoholic -- that she responded to virtually any problem by drinking. She advises Barbara that the friend must not only need to recover from addiction, but must also want to recover from addiction. Until the friend wants to help herself, Barbara's help will be rejected.

Tracy (w, 20) advises Barbara that it might be constructive not to force her friend to label herself as an addict; Tracy had felt "too weak and vulnerable" earlier to carry such a heavy label.

A final piece of advice comes from Jon (w, 28). He agrees that addicts must want to get better, but notes that they often need a great deal of support to be able to recognize their own addiction. They also can greatly benefit from suggestions as to what treatment alternatives are available and how they can get access to them (e.g., N.A. meetings). He, in essence, advocates what Doris has already been doing, i.e., helping to guide people into appropriate treatments.

Commentary. Perhaps one of the most significant acts a recovering addict can engage in is to assist a still-active addict into recovery. Besides being a socially beneficial behavior, these acts also help to reconfirm in the recovering addict his/her own decision to leave active addiction and lead a clean life. Every act of helping another addict, therefore, becomes a reaffirmation of one's own choice for recovery.

Recovering addicts are, in a phenomenological sense, perhaps the best equipped of the people an active addict comes into contact with to communicate the need for and possibility of recovery from addiction. The advice of friends and family may be dismissed by the active addict as irrelevant, because these people are seen as unknowledgeable about the experience of addiction and, in some cases, may even be viewed by the addicted consumer as causes of his/her addiction. Similarly, the warnings provided by medical and law enforcement personnel may be seen by the addicted consumer as infringements on his/her freedom to choose. Some addicts may see these persons as representing political values contrary to their own and, therefore, purposely attempt to counteract these efforts to curtail their addictive behavior.

However, it is much more difficult for an active addict to dismiss as naive, ignorant or misplaced the concern of the former addict. Phenomenologically, the recovering addict has been where the active addict now is, and chose to leave it. This simple phenomenological fact can be the most convincing piece of evidence to active addicts that they should and can achieve recovery.

CONCLUSIONS

Recovering from addiction, like becoming an addict, is a process that involves a series of personal choices made over an extended period of time. In many ways recovery is like a voyage of discovery that seeks to reintegrate a self that has been in various stages of disintegration -- often for many years. The value of the fellowship of N.A., and other support groups like it, is that it provides both a haven and a testing ground for the reintegrating self. Often upon seeing the anxiety and uncertainty of newcomers to the group one is reminded of oneself earlier in recovery. Often upon hearing some particularly insightful words from an oldtimer one is inspired to keep going forward with one's life -- one day at a time.

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