Peer recovery support service (PRSS) programs require an ethical framework for service delivery. In most cases, simply “importing” a professional code of ethics is not effective. There is a difference between the professional-client relationship and the relationship of the peer leader and the peer being served that warrants an ethical framework specifically tailored to PRSS.

Understanding oneself is incomplete when divorced from the history of one’s people. Those with lived experience of addiction and recovery share such a larger history. Over the course of centuries and across the globe, we have been:

Abandoned  Arrested   Berated   Caned   Castigated   Coerced   Confronted   Condemned   Conned   Defamed  Defrocked   Divorced   Deported   Denied Probation   Denied Pardon   Denied Parenthood   Executed   Electrocuted   Electroshocked   Evicted   Expelled   Exploited   Exiled   Feared   Fired   Forsaken   Hated   Humiliated   Incarcerated   Incapacitated   Kidnapped   Kicked Out   Quarantined   Restrained  Ridiculed   Sedated  Seduced  Shunned   Shamed   Surveilled   Tough Loved   Criticized   Colonized   Commercialized   Criminalized   Delegitimized   Demonized   Depersonalized   Deprioritized   Disenfranchised   Eulogized   Euthanized   Glamorized   Homogenized   Hypnotized   Institutionalized   Lobotomized   Marginalized   Memorialized   Miscategorized   Mischaracterized   Monetized   Mythologized   Objectified  Ostracized   Patronized   Politicized   Proselytized   Publicized   Sensationalized   Stigmatized   Scandalized   Sensualized   Sterilized   Terrorized   Theologized   Traumatized   Tranquilized  Trivialized

More recently, through the efforts of recovery advocates and professional and public allies, we are being:

Applauded   Awakened   Celebrated   Defined   Educated   Elevated   Encouraged   Helped   Healed   Enfranchised   Hired   Informed   Inspired   Motivated  Profiled   Reconstructed   Recruited   Redeemed   Rekindled   Renewed   Restored   Represented   Reunited   Supported   Surveyed   Transformed   Uplifted  Utilized  Valued Vindicated   Actualized   Baptized   Decriminalized   Destigmatized   Diversified   Enfranchised   Hypothesized   Idealized   Legitimized  Medicalized   Mobilized   Organized   Prioritized   Professionalized   Radicalized   Randomized   Recognized   Reconceptualized   Revitalized   Secularized   Sympathized Theorized

Through our shared journeys, recovery is gifting us with:

Accountability   Acceptability   Adaptability   Authenticity   Clarity   Collegiality   Community   Dignity   Employability   Fidelity   Flexibility   Honesty   Humility   Integrity   Longevity   Maturity   Opportunity   Possibility   Predictability   Productivity   Prosperity   Respectability  Responsibility  Sanity   Serenity   Sobriety   Spirituality   Stability  Survivability   Tranquility   Visibility   Wellbriety

Is it any wonder given the complexity of these experiences that we struggle in recovery to answer, “Who am I?” We cannot fully understand the “me story” without the “we story.”  Our personal stories nest within the hands of this larger multigenerational and multinational story. Our present circumstances, our shared needs, our individual aspirations, and our future destinies are inextricably linked to this complex, collective past. We can draw upon that past for resolve and inspiration at the same time we rise above it. Personally and collectively, we have fallen, yet like Lazarus, we rise anew.  Personally and collectively, we are moving from pain to purpose.

To ensure fidelity to the recovery community organization model, Faces & Voices of Recovery, RCOs across the nation, and stakeholders have identified the following as national best practices for recovery community organizations.

I recently discovered a UK-based project that I found so exciting that I solicited the below blog to share with my readers. To me, the Well-Fed Social Supermarket signals a next stage in the evolution of recovery support services: programs that serve those seeking and in recovery while simultaneously benefiting the larger community. For generations, “service work” in the recovery community has reflected the support we provide each other, our mutual aid organizations, and individuals and families seeking recovery. Perhaps the day has arrived when that service ethic will be extended in new and dramatic ways to larger communities and cultures.

–Bill White

Recovery Innovations: The Well-Fed Social Supermarket

Dave Higham, Ged Pickersgill and David Best

Background

Recovery is a process that is characterised through the acronym CHIME – standing for Connectedness (the importance of social engagement); Hope; Identity (the growth of positive personal and social identities); Meaning (engaging in activities that give value to each day) and Empowerment (often experienced as positive self-esteem and self-efficacy).

For recovery community organisations, supporting people to achieve sustainable recovery is often about finding ways to promote CHIME that are personalised to individual aspirations and goals, and the stage of a person’s recovery. This means creating access to positive social and community resources that can nurture recovery capital.

In the UK, there have been a glut of recovery cafes, some of which have succeeded and others failed, but an increasing quest for diverse programmes and social enterprises that can both bolster recovery experiences while also contributing to the growth and wellbeing of the local community. This article provides a brief overview of the Well and then will focus on its innovative contribution to recovery pathways and community wellbeing.

The Well

The Well is a not-for-profit, community interest company (CIC) formed by ex-offender Dave Higham in 2012. Dave left prison for the last time in 2007 having spent over 25 years in addiction and in that time spent more time in prison than he did in the community. Since leaving prison in 2007 he has dedicated his life to supporting others with drug and alcohol addiction through both voluntary and paid employment. Dave set up The Well with his own money and with no blueprint to follow. Instead, he used his experience, vision and determination to create what has now become a leading provider of recovery services in the region.

Dave set up The Well when he recognised a gap in the provision of services during  off-hours and weekends for those people who wanted to achieve or maintain abstinence. The first hub was launched in Lancaster in 2012, and a further four sites quickly followed in Lancashire and Cumbria (in the North-West of England).The majority of staff at The Well have lived experience of substance misuse and offending histories.

The Well has always been shaped, designed and delivered by the people it serves and supplemented by the assumption that both the person and their family need to recover and are thus welcomed. The Well is also open to people with prescription drug histories, mental health issues and trauma, and nearly all the people served have experienced CPTSD (Complex Post Traumatic Stress Disorder). The Well is based on the assumption that ‘Where we serve our community, we become active citizens in the community’.

The Social Supermarket

A Social Supermarket has been designed as a positive way of supporting those on low incomes, tackling poor diet and overcoming health inequalities, through the provision of surplus stock sold at heavily subsidised prices.

Since store’s opening in November 2019, Wellfed Social Supermarket has had a footfall of over 5,000 people and has also resulted in 279 referrals into The Well Communities through various mechanisms of support.  The social supermarket has also facilitated (including but not limited to ) delivery of over 1500 hot meals to marginalised families, issued over 150 food bank vouchers, issued 17 free flu vaccination vouchers, delivered 37 emergency food parcels, delivered 242 sets of ingredients and recipes, and assisted families with welfare signposting in respect of white goods.

Well Fed social supermarket secures high-quality short dated food from retail and manufacture supply chains that would otherwise be sent as waste to landfill but is fit for human consumption. We sell this food to customers at reduced prices, typically an average of one-third of normal retail prices. Marketing is carefully targeted at residents on the lowest incomes and thus at greatest risk of experiencing food poverty and related health issues.

The social supermarket model innovates further by working with local agencies to provide a range of on-site support services. These are tailored to members’ needs and help them overcome multiple barriers to getting out of poverty. On-site support, signposting and assertive linkage may include money advice, debt counselling, and courses on healthy eating and cooking on a budget, as well as employability and vocational skills training. The Well-Fed Social Supermarket is a non-profit organisation with all monies re-invested back into the local community.

The Well Communities Social Supermarket is a model which enables residents in Barrow in Furness to access the retail aspect of the social supermarket and our Fairshare Model Food clubs and to be included in The Well Communities  Building Better Opportunities (BBO) Project  which helps members benefit from the employment and business opportunities that are arising in Barrow in Furness both now and through the longer term delivery of the BBO programme.

This is linked to the Well-fed Food Clubs which provide a sustainable alternative to free food distribution and foodbanks. Through a £3 per week payment, members receive approximately £10 to £15 worth of food each week while reducing food waste by working closely with fareshare North West by collecting the food from the regional Hub in Preston. The Well has built up a very strong membership of marginalised families; most of the postcode areas we serve are listed in the indicies of multiple deprivation. Over 30 tonnes of surplus food has been distributed to date.

The whole model is based on looking upstream and looking behind the actual need for discounted food. Each family has difficulties which mean they need to obtain goods due to some form of financial hardship; the intention is to determine such reasons and help in some way to alleviate these problems. These are then linked to in-house support mechanisms which Include assertive linkage to local statutory and third sector organisations.

Building Recovery and Community Capital                                                                     

The Well identifies people’s recovery capital, identifies their  passions, and works with them to create enterprises. They have had several successful enterprise ideas, the first being The Well itself, but they have also had some failures or learning that were not so successful. To get to the successful Social Supermarket idea we went through a process of ideas and attempts, the first being a catering trailer business, where the Well bought and renovated a trailer and employed a member of our community as he had experience as a chef, got a pitch for the trailer, but the marketing strategy of announcing that we were recovering addicts and alcoholics was the wrong thing to do as in the first year the project  was working at a loss. The lesson was that the most important factor about a food trailer is the pitch, and let this business go but kept the company name Well-Fed and started up foodbanks.

The other successful business, “Well maintained” used the employment capital and experience within the Well membership, including carpenters, electricians, plasterers and so on, and renovated our Dolton Road Hub which is now the location for The Social Supermarket.

Conclusion

There were false first steps on the road to creating the Social Supermarket, but the commitment to the principles of peer empowerment, community engagement and CHIME have resulted in a number of successes that contribute to the growth, wellbeing and inclusiveness of the recovery community as an active and vibrant part of the local, lived community. Not all of these enterprises will succeed, but the skill base, dedication and creativity of the recovery community will ensure a net gain and a positive contribution to individual recovery journeys, family inclusion and community connections and growth.

In an earlier blog posted in 2017, I offered some preliminary observations on mechanisms of change in recovery and the variation in such mechanisms across pathways of recovery, stages of recovery, clinical populations, and cultural contexts. A recent collaboration with Dr. Marc Galanter in designing a study to investigate such mechanisms of change among members of Narcotics Anonymous has stimulated further thinking about the precise catalytic elements that contribute to addiction recovery.

Mechanisms of change involve precise behaviors that when performed over time elicit radical changes in personal character and identity, personal lifestyle, and interpersonal relationships. They involve decisions, actions, and rituals that strengthen motivation for recovery, serve as building blocks of a recovery-centered lifestyle, and elevate the quality of personal and family life in long-term recovery.

Recovery-focused behavioral mechanisms (repeated actions) lead to intermediate processes that enhance recovery stability and the progressive movement towards global health and social functioning. Such intermediate effects include increased hope for recovery, increased self-confidence in achieving recovery, improved decision-making and coping skills, increased family and social support, and spiritual awakening (sudden epiphanies and turning points; clarification of values and life goals; increased life meaning and purpose).

In my earlier blog, I noted the following: “Addiction recovery involves processes of destruction, retrieval, and creation. Destruction entails breaking entrenched patterns of acting, thinking, feeling, and relating. Retrieval involves the reacquisition of lost assets. Creation requires new recovery-nourishing daily rituals, character traits, relationships, and reformulating life meaning and purpose. These recovery processes can be thought of in terms of subtraction, addition, and multiplication.”

Understanding the mechanisms of change in addiction recovery requires 1) identifying a menu of potential actions, 2) investigating which precise actions or combinations/sequences of mechanisms have the greatest potency and 3) determining how the use of these mechanisms varies across the stages of recovery initiation, recovery maintenance, and enhanced the quality and meaningfulness of one’s life in long-term recovery. A menu of potential change mechanisms could include such actions as the following:

• Altering the frequency, intensity, or circumstances of drug use
• Stopping all drug use
• Seeking specialized addiction treatment
• Seeking other counseling
• Seeking treatment for other health conditions
• Using prescribed medication to facilitate withdrawal and to reduce craving and drug-seeking
• Using medication as prescribed to treat conditions that contribute to drug use, e.g., anxiety, depression, pain, etc.
• Participating in face-to-face recovery support meetings
• Choosing a home group / meeting for regular attendance
• Participating in online recovery support meetings
• Attending other recovery-focused events
• Sharing my recovery story
• Celebrating anniversaries of being drug free
• Participating in the service structure of a recovery mutual aid fellowship
• Reducing or ceasing contact with drug-involved friends and family members
• Severing unhealthy, addiction-supportive relationships
• Reconnecting with weakened or lost family and social relationships
• Socializing with other people in recovery and people supportive of recovery
• Reading recovery-focused literature
• Reading other change-inspiring literature
• Choosing and meeting regularly with a recovery sponsor / mentor / coach
• Serving as a recovery sponsor / mentor / coach for others
• “Working” recovery program Steps/principles
• Working to improve coping and communication skills
• Centering activities, e.g., praying, meditating, reflecting, journaling
• Participating in recovery community center activities
• Participation in religious services and practices
• Participating in recovery advocacy and peer recovery support activities
• Pursuing further education or training
• Resuming old pastimes or cultivating new interests, hobbies, and pastimes
• Helping others / acts of volunteer community service
• Improving physical health (e.g., increased exercise, improved nutrition, regular sleeping schedule, smoking cessation)
• Changing living environment
• Relocating to safer and more recovery-supportive environment
• Changing occupation or employment setting

Important research related to such mechanisms of change is progressing. Below are my predictions on what we will ultimately discover from these studies.

Mechanisms of change in addiction recovery include a core of essential mechanisms (without which recovery for most people is not possible) and a larger set of secondary and complementary mechanisms.

Such common factors are widely shared among people with diverse recovery stories, with some differences shaped by age of recovery initiation, gender, ethnicity, sexual orientation, primary drug choice, degree of problem severity, levels of recovery capital, and degree of religious orientation.

Mechanisms of change differ across stages of recovery, with some having greater salience in recovery initiation and others coming into greater play in the transition to recovery maintenance or enhancing quality of life in recovery. We will likely find variations in such effects across cultural contexts, where personal recovery must be integrated into a larger rubric of cultural values and rituals. Differences may also exist in these mechanisms across secular, spiritual, and religious pathways of recovery.

Particular combinations and sequences of actions will be identified that are particularly catalytic in recovery initiation or facilitating the transition from one stage of recovery to another.

The mechanisms of change (actions) in addiction recovery are woven together within two very different processes: story construction and storytelling. Those experiencing addiction, affected family members and friends, and those seeking to offer help all have a need for sense-making. There are numerous theories about the sources and solutions to addiction that become woven into personal and professional narratives that may or may not have anything to do with the actual processes through which such change occurs. The ultimate truth and the best news is that such change is possible and increasingly common. Behavioral prescriptions for recovery initiation, maintenance, and enhancement will become increasingly clear in future research on mechanisms of change. That is cause for considerable optimism and anticipation.

For decades, the United States has meticulously measured the prevalence of alcohol and other drug (AOD) use and related problems. The question of how many U.S. adults have resolved such problems has received far less attention until recently. In 2012, I reviewed published studies of clinical and community populations in the U.S. that reported rates of recovery from such problems, and two recent landmark studies provide the best data yet on recovery prevalence in the U.S.

Answering the basic question, “How many people are in addiction recovery in the United States?” is complicated because of differences in definitions of the problem and the solution. Reported outcomes differ depending on the language used in the surveys. Survey responses vary when questions include references to addiction, substance use disorder, or problem with alcohol or other drugs. They similarly differ depending on the resolution language: abstinence, sobriety, recovery, remission, controlled (moderate) use, or once had but no longer have an AOD problem. Recovery prevalence estimates expand and contract based on expansive or restrictive problem and solution definitions. In spite of such challenges, a series of important studies reveal a surprisingly high prevalence of lifetime AOD problem resolution that challenge the notion that “recovery is the exception to the rule.”

My 2012 review of recent studies concluded that 5.3% to 15.3% of the U.S. adult population are in remission from significant alcohol or other drug problems—a conservative estimate of 25 million people (not including those in remission from nicotine dependence alone). The reviewed surveys included the Epidemiologic Catchment Area Study, National Comorbidity Survey, National Health Interview, National Longitudinal Alcohol Epidemiologic Survey, and the National Epidemiologic Survey on Alcohol and Related Conditions. In community studies published since 2000, 54% of people who met lifetime criteria for a substance use disorder no longer met such criteria at the time of follow-up. Problem resolution strategies spanned complete AOD abstinence and deceleration of AOD use.

In 2017, Kelly and colleagues published the results from the National Recovery Study—a U.S. survey of the course of AOD problems in the adult population. Survey findings revealed that 9.1% (22.35 million) U.S. adults responded in the affirmative to the question, “Did you used to have a problem with drugs or alcohol, but no longer do?” Of those who had resolved an AOD problem, 46% self-identified as being “in recovery.”

In 2020, Jones and colleagues published an analysis of recovery data from the 2018 National Survey on Drug Use and Health. Of the 27.5 million U.S. adults reporting ever having an AOD problem (11% of the adult population), 75% (more than 20.5 million) reported no longer experiencing such problems. Both the Kelly and Jones surveys found both supported and unsupported pathways of recovery, including a substantial portion of people who had achieved recovery without participation in formal treatment or recovery mutual aid groups.

In 2020, Stefanovics and colleagues published a survey of more than 1,200 veterans who had experienced an alcohol use disorder during their lifetimes as part of the National Health and Resilience in Veterans Study. More than three-quarters of U.S. veterans surveyed who reported a lifetime alcohol use disorder (AUD) no longer met diagnostic criteria for AUD at the time of the survey.

In 2001, recovery advocates from across the United States participated in a summit in St. Paul, Minnesota that formally launched a new addiction recovery advocacy movement in the U.S. The kinetic ideas at the core of this movement included: 1) Addiction recovery is a reality in the lives of millions of individuals and families, and 2) There are many pathways to recovery and ALL are cause for celebration. Those core propositions, grounded in the experiential knowledge of people in recovery across the U.S., now have substantial scientific support. Recovery is not just a possible outcome for AOD problems; it is the probable and likely outcome when people have access to formal and informal recovery support resources.

References

Jones, C. M., Noonan, R. K., Compton, W. M. (2020). Prevalence and correlates of ever having a substance use problem and substance use recovery status among adults in the United States, 2018 [Epub ahead of print]. Drug and Alcohol Dependence, 214, 108169. doi: 10.1016/j.drugalcdep.2020.108169

Kelly, J. F., Bergman, B., Hoeppner, B., Vilsaint, C., & White, W. L. (2017) Prevalence, pathways, and predictors of recovery from drug and alcohol problems in the United States Population:  Implications for practice, research, and policy. Drug and Alcohol Dependence, 181, 162-169.

Stefanovics, E. A., Gavriel-Fried, B., Potenza, M. N., & Pietrzak, R. H. (2020). Current drinking patterns in US veterans with a lifetime history of alcohol use disorder: Results from the National Health and Resilience in Veterans Study. The American Journal of Drug and Alcohol Abuse, September. DOI: 10.1080/00952990.2020.1803893

White, W. L. (2012). Recovery/remission from substance use disorders:  An analysis of reported outcomes in 415 scientific studies, 1868-2011. Chicago:  Great Lakes Addiction Technology Transfer Center; Philadelphia Department of Behavioral Health and Developmental disAbilites; Northeast Addiction Technology Transfer Center.

White, W. L. (2007). The new recovery advocacy movement in America. Addiction, 102(5), 696-703.

Earlier blogs in this series have explored how a sample of 35 American comic books and 9 graphic novels portrayed drug use, the causes of addiction, and addiction-related consequences on individuals and families. The present blog explores dominant themes related to the portrayal of addiction recovery.

Limited Portrayal of the Recovery Experience

While addiction is a central thread within many American comic book and graphic novel storylines, the addiction recovery process receives scant attention. For example, Julia Wertz’s graphic memoir, Drinking at the Movies, portrays the evolution of her drinking throughout the book, but devotes only one page at the end to her decision to stop drinking. Hey Kiddo shows Jarrett visiting Leslie in the halfway house, but it isn’t until much later that Leslie describes her recovery to him. There is within the brief recovery storylines a sense of being free and an awakening of previously unrecognized inner strength. Bane, for example, declares, “I am free of Venom. I am truly free for the first time in my life….I didn’t need Venom then. I don’t need it now.”

Recovery as an Incremental Process

American comic books and graphic novels portray addiction recovery as a difficult process often involving multiple efforts before recovery is sustainable. This pattern of repeated recovery attempts is present in the character storylines of Tony Stark(Ironman) , Roy Harper (Green Arrow), Bane, Bruce Wayne (Batman), Katina “Katchoo” Choovanski (Strangers in Paradise), Carol Danvers (Avengers, Ironman), Allan Quartermain (The League of Extraordinary Gentlemen), and Rose Wilson (Teen Titans). Comic book storylines often portray stable recovery preceded by failed promises and resolutions to stop drug use (Matthew Parker) and by experiments in drug substitution. Matthew Parker (Larceny in My Blood) laments, “I’m bent on substituting the slobbering inebriation of alcohol for the nihilism of heroin” before relapsing once again to heroin addiction.

The transition between active addiction and recovery initiation is preceded by elaborate defenses to sustain drug use, e.g., denial, minimization, rationalization, projection of blame, and anger/aggression. These are elaborately detailed over three years (1998-2000) in the sustained storyline of Carol Danvers crossing over from Avengers to Quicksilver and Ironman and eventually ends with Carol going to AA with Tony. Comic book storylines portray the movement towards recovery as a tortured effort to see oneself and the world as they really are. Regarding the distortions that commonly precede recovery, Willie Seabrook’s second wife Marjorie Worthington described Willie’s repetitive lies in his written work and in his life: “Willie always told the truth: His truth.”

Motivation for Recovery

Momentum for addiction recovery as portrayed in American comic books and graphic novels rises in tandem with the erosion of drug effects, escalating consequences, and experiences within active addiction that serve as a catalyst of recovery. Brandon Novak (The Brandon Novak Chronicles) describes the diminishment of drug effects: “But there is one law that every drug fiend is incapable of breaking: The law of diminished returns.”

Other push forces toward recovery include fear of loss of one’s powers (Dr. Cecilia Reyes) and fear of death if they don’t stop and if they do. Willie Seabrook, his drinking at its worst, prophetically writes his publisher, “I think I’ll die if I don’t stop drinking.” Carol Danvers (Iron Man) and Rose Wilson (Teen Titans) are both told by doctors that continued drug or alcohol use will lead to their deaths. Rose Wilson is told, “…You don’t lay off the epinephrine, you’ll be dead” because of the damage to her heart. She’s warned of the effects from prolonged epinephrine use including “migraines, tremors, blurred vision. Oxygen deprivation. Heart failure.”

Comic books and graphic novels also note positive forces within the addiction experience itself that can serve as push factors toward recovery.

“As devious as we have become, junkies are still capable of emotion, compassion, generosity, and charity. And sometimes we depend on each other to extend kindness, and through this selfless act our humanity can be restored, even if only for a few hours.” (The Brandon Novak Chronicles)

There are references in comic books and graphic novels to what today would be called “interventions” (e.g., Batman’s role in the recovery of Martian Manhunter), there is a surprising lack of references to institutions of control that play such a prominent role in the lives of addicted men and women (e.g., law enforcement, courts, prison, and the child welfare system). In one example we noted (Hey Kiddo), Leslie’s sobriety is implicitly tied to her time in prison. When she is released on probation and gets a job, her family worries that if she does not stay clean and keep her job she will return to prison. In another example, Carol Danvers (Avengers) is court martialed after making serious mistakes due to excessive drinking during a mission. The court martial scene is drawn like an intervention with each Avenger giving a statement about the impact her alcohol use has had, but she quits Avengers before they can demote her.

Styles of Recovery Initiation

There are varied styles of recovery initiation portrayed in American comic books and graphic novels. Recovery for most is portrayed as an incremental, stage-dependent process—a progressive accumulation of drug-related consequences. The turning point is often depicted as a “hitting bottom“ experience. The alcoholic character Wilty in the Wash Tubbs comic series proclaims, “I’m through saying I can quit if I have to…I can’t. I don’t drink any more to get a lift, I drink to stay alive….I’m licked.”

An AA member in the graphic novel Sobriety laments, “This is the case for many of us. We don’t want sobriety until it hurts badly enough.” Later, that same AA member notes the varieties of recovery experience: “Different people have different spiritual experiences. A few are sudden and dramatic… A lot of people—in fact, most—have similar experiences [more gradual and prolonged] that come as a result of working the steps.”

Comic book and graphic novel storylines where the change process was portrayed as unplanned, positive, and permanent include the character of Bane.  While imprisoned in solitary confinement, Bane reviews the traumas of his life (e.g., in prison since his birth, subjected to experimental drugs, victimized by other prisoners) and experiences a vision conveying the message that he had “the strength of innocence to overcome the poison [Venom].” That vision marked the beginning of his recovery process. There are also examples of altered states of consciousness or sudden epiphanies that marked recovery initiation. Klaus (The Umbrella Academy) experienced a vision of himself in a stark white desert where he hears God commanding, “Stay off the drugs, Klaus.” Julia Wertz (Drinking at the Movies) experienced a sudden realization that she has been drowning in self-pity and blaming everything but herself for her problems. Matthew Parker, who had resisted NA and AA and varied treatments, had an epiphany in jail that marked his recovery initiation:

“I was totally, irrevocably, utterly in their control and had been for the past 13 years….I wasn’t a thorn in the side of The Man, but rather old meat trapped in his intestines….I therefore decided, right then and there, to quit using. To turn my life around.”

Viewed as a whole, recovery initiation in American comic books and graphic novels is portrayed as an intersection of pain and hope.

The Need for Sustained Vigilance

Even successful recovery, as in the case of Tony Stark (The Invincible Iron Man), is accompanied by the need for sustained vigilance against cravings and impulses to use: “It’s always with me…whispering to me.”  Holly Robinson in Catwoman is constantly reminded of her addiction during the early months of her recovery: “…And I just can’t stop seeing these streets in junkie-vision…Or noticing how easy it would be to give in…”.

The need for sustained vigilance against impulses to use are well illustrated in the Wash Tubbs comic series, as Ben (AA member) describes Wilty’s continued vulnerability during the early days of Wilty’s recovery:

“Let’s get that straight…there is no cure. I’m what we call a permanently arrested case….one of perhaps 50,000 in AA who will never take another drink but we’ll always be alcoholics because we’re still allergic to alcohol. However, we can live normal lives! We’ve quit kidding ourselves that we can ever be social drinkers.”

“Gig’s [Wilty’s] chief danger now is a false sense of security, as he gradually loses his urges to drink.  Unless we help him keep his guard up, an emotional upset…fatigue…an impulse to join friends in a “quick one”…or even a sudden piece of good luck could cause a relapse. ”

An AA speaker in the graphic novel Sobriety shares similar sentiments:

“Addiction isn’t just in our heads—it’s in our bodies and our spirits too. ….As an alcoholic I will always “have it”—but it doesn’t have to have me!”

“There’s no cure as yet—It’s a chronic illness that needs to be managed, like diabetes.  But there’s a spiritual solution in the Twelve Steps.”

Recovery Support Resources

Recovery was often achieved in American comic books and graphic novels through reliance on resources and relationships beyond the self. Examples of this include Batman’s rescue and detoxification by his assistant Alfred, Captain America detoxing with the aid of Black Widow, the support Tony Stark received from his girlfriend and butler, Theresa Cassidy’s (X-Force) recovery with the aid of Warpath, Speedy’s cold turkey withdrawal with aid of Black Canary, and Harry Osborn’s rescue by Spider-Man. In the X-Men series, Dr. Cecelia Reyes achieves recovery after being rescued by the X-Men and through the support of Xavier through her drug withdrawal process. After Carol Danvers achieves sobriety with the aid of Tony Stark, she later helps him when he returns to drinking following revelation of his true identity. After Danvers achieves sobriety, she rejoins the Avengers on the condition that she be supervised and continue her AA involvement.

In the Catwoman series, Holly Robinson’s friends Selena and Karon serve as key support to her recovery. Leslie (Hey Kiddo) describes how she and her boyfriend support each other’s recovery, “He’s getting treatment, just like me.” (p. 229) … “Miguel and I are on this road to recovery together.” (p. 230). All five characters in the graphic novel Sobriety are involved in a Twelve-Step program, and one of the characters (Alex) references living in a recovery residence.

While in France, Willie Seabrook asked the famed author Gertrude Stein for guidance on his drinking problem. Her advice was simple: “stop drinking so much and return to writing….You must stop drinking and you must begin to write again.” Following that advice, Willie wrote his publisher in September 1933 asking for help. His publisher responded by making arrangements for Willie to return to America and be admitted to Doctors Hospital under the care of Dr. Alexander Lambert.

Character Transformation in Recovery

Recovery within American comic books and graphic novels provides an opportunity for the acquisition of new powers and altered qualities of character. Following Bane’s recovery from Venom addiction, he uses this period of isolation to strengthen his body through extreme physical exercise and strengthen his mind through meditation. Many American comic book characters who transitioned from addiction to recovery went on to develop a recovery-focused service ethic. Batman, after his own recovery, was involved in supporting the recoveries of three other characters: Arsenal, Speedy, and The Martian Hunter. Arsenal then goes on to become a drug counselor and law enforcement officer. Batman served as a recovery role model and recovery coach for others. Other examples of such service activities after recovery initiation include Dr. Cecilia Reyes’ volunteer activities at a homeless shelter (X-Men) and Karen Page’s operation of a legal clinic in Hell’s Kitchen (Daredevil).

Wilty, in the Wash Tubbs comic series, reflects on the therapeutic effects of helping others as part of one’s own recovery: “I had to call on Ben (AA member) again last night. He took me with him to see a very pathetic case. I think we helped him, but it helped me even more.” Holly Robinson in the Catwoman series worked undercover to take down drug dealers following her recovery from heroin addiction. Reflecting on this work, she explains, “I can use my life experience to my advantage for a change…And that makes me feel stronger…Prouder.”

In the graphic novel Sobriety, Dan and Alex describe their lives in recovery

“I once had a life that was destroyed by drugs and alcohol…But I got life back because of the Twelve Steps. It’s different than it was before. It isn’t perfect…But it’s full of surprises. And it’s worthwhile… Sobriety is more than the definition we find in a dictionary. It’s a new lifestyle that we embrace. It gives us real existence.”

“Now, I’ve left that life. I’m selling fine automobiles in London. And I’m happier than ever.”

Matthew Parker (Larceny in my Blood) described channeling his propensity for excess into his recovery process, using education as a pathway to recovery: “Being an excellent student also makes it easier to stay clean. I now channel my compulsion into more productive activities. Compared to the hard work involved in being a junkie, becoming an honor student is ridiculously easy.” Describing his experience in college and his writing aspirations, Parker describes the irony of his new circumstances: “Credit [to pay for school] is my new heroin, and debt its walls and razor wire.”

Closing Reflection

While limited in the range and depth of storylines, American comic books and graphic novels have portrayed recovery as part of addiction-related storylines, including the motivations for recovery, styles of recovery initiation, and the potential of recovery as a medium of personal transformation and service to others. In our next and final blog, we will highlight the portrayal of recovery mutual aid groups and addiction treatment in American comic books and graphic novels, as well as portrayed risk factors for addiction recurrence and the paucity of attention to family recovery.

About the Authors: Alisha White, PhD, is an associate professor of English Education at Western Illinois University. Her research focuses on representations of disability and mental health in young adult literature and teaching with arts-based practices. William White, M.A., is Emeritus Senior Research Consultant at Chestnut Health Systems. His research focuses on the history, prevalence, pathways, stages, and styles of long-term addiction recovery.

In the first two blogs in this series, we explored the historical portrayal of drug use and addiction in American comic books and graphics novels as well as the factors related to addiction vulnerability. The present blog examines the portrayal of addiction-related effects on global health and social functioning within 35 American comic books and 9 graphic novels that contained an addiction storyline.

Physical Consequences

Physical deterioration was among the most prominent consequences of addiction conveyed within the comic books and graphic novels reviewed. Physical manifestations of addiction included portrayals of hangovers and morning drinking as an attempted cure (Julia Wertz / Drinking at the Movies; Tony Stark / The Invincible Iron Man), memory blackouts (Ruben / Buzzkill), as well as an overall erosion of self-care and personal hygiene. Addiction was graphically portrayed via images of dirty, ashen skin, unshaven faces, and disheveled clothing. Physical emaciation of addicted characters was common as was self-expressed concerns about physical health (Karen Page / Daredevil; William Seabrook / The Abominable Mr. Seabrook). A typical scene has the central character looking in a mirror and reflecting, “My skin’s a bit green and I pissed blood the other morning. But it’s easier said than done, to kill yourself with booze.” (The Abominable Mr. Seabrook). Physical insults from addiction also included physical injury from accidents while intoxicated (William Seabrook / The Abominable Mr. Seabrook; Larry and Alex /Sobriety), painful drug withdrawal (Bane), and alcohol or other drug overdose and hospitalization (Tony Stark / The Invincible Ironman, Carol Danvers / The Invincible Ironman; Rose Wilson / Teen Titans). Drug-related death by overdose or suicide were also represented (Leslie / Hey Kiddo; Larry and Alex / Sobriety; and William Seabrook / The Abominable Mr. Seabrook).

Psychological Consequences

The comic books and graphic novels reviewed detailed early psychological effects of addiction. Such effects included embarrassment from drinking behaviors–drunk calls/texts/emails/social media posts, and Amazon buying in Julia Wertz / Drinking at the Movies), getting into fights while using (Ruben / Buzzkill), sexual encounters while drunk (Jessica Jones / Alias), the diminishment or loss of superpowers (Rose Wilson / Teen Titans), and cognitive impairment (inability to concentrate, impaired decision-making as illustrated by Tony Stark in The Invincible Ironman: Demon in a Bottle. The accumulation of secrets and shame was a common theme. As Ruben (Buzzkill) reflected:

“Every addict or junkie has their own secrets. Things they’ve done or said. People they’ve hurt… We tell ourselves that the meetings and the journaling will help us to deal with these secrets…What it amounts to is baring every nerve, forcing yourself to face the parts of your story that don’t want to be told. Facing them and making them submit. Dragging them, scrabbling and screaming into the light.”

As addiction progressed within the comic book and graphic novel storylines, early psychological effects were followed by two dominant experiences. The first was radical personality changes while using and overall psychological deterioration marked by hallucinations, paranoia and fear of insanity (Marjane Satrapi / Persepolis; Rose Wilson / Teen Titans; Matt / Sobriety), sometimes requiring psychiatric hospitalization (Klaus / The Umbrella Academy). As William Seabrook’s alcoholism progressed, he vacillated between periods of self-loathing and a grandiose sense of self-importance accompanied by a hyper-criticalness of others. In the Amazing Spider-Man series, the character Freak, while addicted to heroin, breaks into a laboratory and injects himself with loaded syringes he believes to be heroin but contain instead animal stems cells that turns him into a monster—a metaphor for the deforming experience of addiction. A Dr. Jekyll / Mr. Hyde portrayal of addicted characters is common in American comic books and graphic novels, with references to “feral anger” and portrayal of characters with a “monkey on their back” as rabid—wild eyes, sneering mouth, clenched muscles (Ironman). Larry, the Alcoholics Anonymous member in the graphic novel Sobriety explains such transformations: “Put a drop of booze or mood-altering chemical in us and we change, we become that which we never thought we would: manipulative, lying, stealing, self-centered people…only headed to jails, institutions, or death.”

The second dominate experience involves loss of volitional control over drug use decisions and complete domination of one’s life by drug seeking and drug use. Several central characters describe such effects.

Bane: “I was driven by Venom…It controlled me, not the other way around…the Venom weakened my judgment and I lost everything.”

Larry (Sobriety): “And that’s the thing about alcohol use: For a while I thought I was managing it. That’s not really the way it was: It was managing me. I would come to learn that my addiction would, in due course, demand priority over everything, even the woman I married.”

Holly Robinson (Catwoman) “And when you’re a junkie that’s all you do—wait to score, wait to shoot up, wait for it to wear off, wait for the guy who gives you more money to score again, do anything he wants to get it, wait to score, wait to shoot up…And, then when you quit, it’s all waiting–to not see the world in junkie-vision, I guess…I wonder when that starts”

Matthew Parker (Larceny in my Blood): “Heroin was the dictator of my higher brain functions at the time…2 + 2 = heroin. The capital of Thailand is opium. I think, therefore, I am a junkie.” ; “I couldn’t conceive of a world without heroin. I loved it that much.”

Brandon Novak (The Brandon Novak Chronicles): When asked if he believed in true love, Novak responds, “I believe I truly love heroin!” When asked if he would eat poop for a million dollars, Novak responds, “I’d do it for free if you dipped it in heroin!”

Effects on Social Functioning

The physical and psychological effects of addiction as represented in American comic books and graphic novels/biographies/memoirs exacerbated multiple areas of social functioning within the affected characters:

• Dropping out of college: Ruben (Buzzkill)
• Employment challenges (Julia Wertz / Drinking at the Movies); loss of leadership position (Tony Stark / Avengers); court martial (Carol Danvers / Avengers)
• Financial distress (The Abominable Mr. Seabrook),
• Indebtedness (Matthew Parker / Larceny in my Blood),
• Housing instability and homelessness (Matthew Parker / Larceny in my Blood; Matt / Sobriety; Holly Robinson / Catwoman);
• Loss of driving privileges (Ruben / Buzzkill), and
• Drug-related arrests, imprisonment, and revocation of probation or parole (Leslie / Hey Kiddo; Matthew Parker / Larceny in my Blood; Matt and Hannah / Sobriety.)

The addiction-crime link is vividly described in The Brandon Novak Chronicles:

“In the daily life of a Junkie, at any given time there is a crime of the moment….Dope provides the addict with the relentless compulsion to lie, cheat, and steal at every opportunity in order to score, and this transformation robs the dope fiend of his humanity.”

Relationship Effects

American comic books and graphic novels also depict the devastation addiction inflicts on interpersonal relationships. Such effects encompass addiction-related family conflict and family dissolution (Karen Page / Daredevil), intimate and collegial relationship conflict over drug use (Tony Stark / Ironman; Holly Robinson / Catwoman; Jessica Jones / Alias; Carol Danvers / Avengers), parent-child alienation and lost custody of children (Wilty / Wash Tubbs; Debby / Sobriety; Hey Kiddo), and multiple divorces (William Seabrook / The Abominable Mr. Seabrook). The strain on social and intimate relationships is revealed in the storylines of numerous characters.

Matthew Parker (Larceny in my Blood): “I was crazy about Maria. But I was crazy for narcotics first.”

Ruben (Buzzkill): “None of my friends will talk to me anymore. I understand why. I get it, but it’s just hard.”

Brandon Novak (The Brandon Novak Chronicles): “I am a predator and a tortured soul. She [former girlfriend] is my prey and my savior.”

Closing

American comic books and graphic novels have revealed perceived roots and consequences of addiction within their storylines. The depth and texture of such portrayals could increase through collaboration between addiction professionals, recovery advocates, and the authors and illustrators of comic books and graphic novels.

Coming Next: The Portrayal of Addiction Recovery in American Comic Books and Graphic Novels

About the Authors: Alisha White, PhD, is an associate professor of English Education at Western Illinois University. Her research focuses on representations of disability and mental health in young adult literature and teaching with arts-based practices.  William White, M.A., is Emeritus Senior Research Consultant at Chestnut Health Systems. His research focuses on the history, prevalence, pathways, stages, and styles of long-term addiction recovery.

Recovery Community Organizations (RCOs) and other peer programs are more productive as a recovery community and more supportive as a recovery space when they strive to meet folks where they’re at. Begin by creating an environment where participation is natural, enthusiastic, non-threatening — a culture where social roles within a community begin to emerge. We have designed this Tip Sheet specifically for you to understand some of the key characteristics of a participatory process and integrate it into your organization.