Addiction Essentialism

Addiction Essentialism
The 2 of Swords: Rigid or binary thinking by someone who is not stupid. (Rider-Waite-Smith tarot deck)

This post is first in a series on how we talk about addiction.

Stigma and stereotypes are never helpful. While perhaps this should go without saying, a strong contingent in the public mistakenly believes that stigma (shaming, shunning, exclusion, judgment) discourages substance use. In fact, transnational comparative research shows that stigma on substance use is highest in those societies where it is most common. Similarly, on the local level, communities and neighborhoods with higher prevalence of substance use also show stronger stigma attaching to it compared to areas with lower rates of substance use.

These findings are important because too often, anti-stigma campaigns presume stigma is born of ignorance. “Educating” the public and “humanizing” people with addictions is supposed to lead to greater acceptance. But what if these attitudes come from people who are already intimately familiar with addiction? Including those drawing from their own lived experience? These folks know of what they speak, and are often deeply invested for personal reasons. So we need a way to challenge negative generalizations without pretending they are baseless or uncaring.

Rather than “stigma” or “stereotypes,” I’m thinking about addiction essentialism. Essentialism is the belief that members of a certain group—in this case, people with addictions—all share a set of inherent, immutable traits that set them apart from everyone else. The “essential addict/alcoholic” is:

·       Disorganized

·       Impulsive

·       Thinking only in the short term

·       Unreliable, irresponsible

·       Dishonest

·       Lacking in self-insight

…and we could go on.

People in recovery who talk this way are describing their former selves. By getting sober (or at least reducing their substance use significantly) they were able to change course, and in recovery they remain vigilant to these essential tendencies. Who are you to say this is wrong? Some clients tell me they lack supportive relationships because most of their family and friends are addicted and fit this profile. Others tell me they currently fit this profile, and warn me against ever expecting different from them. None of the above need a lecture about stigma and stereotyping.

The problem is not that these descriptors are false; the problem comes with assuming they are true for everyone who has a substance use problem, all the time. Calling this attitude essentialism, rather than stigma or stereotyping, leaves room to validate people’s sad and traumatic first- or secondhand experiences while also acknowledging the risks of generalization and of giving up hope.

Another group prone to addiction essentialism: people who work in substance use treatment. Many staff come to this field through personal experience, but even for the rest of us, again, the problem is not lack of contact or information. In treatment circles, I believe essentialism comes from:

1.       Bias in who we see. Most people who struggle with substance use resolve it permanently on their own, without any outside help. By definition, then, this majority never shows up in treatment. We may think of ourselves as “addiction experts,” but in fact our expertise is only in the situations that lead people to formal treatment. Which brings us to the next factor…

2.       Treatment Mandates. Most people end up in professional treatment for substance use by legal force, or because their unhappy employer, partner or family gave them an ultimatum. Those who enter without any outside pressure are most likely to drop out before completion. In a high-stakes process intended to reform people against their will, it should not be surprising if their reactions look like the list above.

Not all providers and staff have good intentions. Sometimes addiction essentialism really comes down to contempt. But I have found that many people in this profession, as in the general public, can become more flexible in their thinking if approached with respect for what they do know.

Coming up: More pitfalls in the ways we talk about addiction: Pity and Respectability.  

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