recoveryblog: a blog for recovery advocates!
Our recovery advocacy blog is produced by individuals in recovery! Here you will find commentary and personal discussions on different aspects of addiction recovery and advocacy.
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On July 20, The Senate Caucus on International Narcotics Control held a hearing on the state of treatment and recovery in the United States, entitled “The Federal Response to the Drug Overdose Epidemic.” Witnesses included federal officials Regina LaBelle (Acting Director of the Office of National Drug Control Policy) and Tom Coderre (Acting Director of the Substance Abuse Mental Health Services Administration.) The role of recovery support services was a central theme of the testimony.
Tom Coderre shared his personal story of recovery and urged lawmakers to see the positive results it has yielded. “True success with substance use disorder also involves enduring efforts, many of which are through recovery supports,” he stated.
Coderre cited that Recovery Support efforts have been part of SAMHSA’s portfolio since the late 1990s. SAMHSA first launched the Recovery Community Support Program, later the Recovery Community Services Program (RCSP) in 1998. This grant helped launch and supported the development and strengthening of recovery community organizations (RCOs). Their focus has been emphasizing the critical importance of as a bi-directional bridge between communities and formal systems, including SUD treatment, and the criminal justice and child welfare systems. Coderre praised RCOs for being peer-led and managed.
Also receiving attention in the hearing were two newer grant initiatives, the RCSP 5-year grant program and the Treatment, Recovery and Workforce Support Grants (Workforce Support). The 5-year RCSP grants build peer recovery support services capacity through recovery community centers, and the Workforce Support grants enhance employment opportunities for individuals in recovery from SUDs by addressing gaps in services and providing opportunities for veterans, homeless individuals, and those reentering the community after incarceration. Coderre mentioned that also of note, SAMHSA developed the targeted capacity expansion-peer to peer (TCE-PTP) grant portfolio forging the path for the extensive ongoing training of peers towards certification and expanding the workforce. This portfolio has provided state recognition for peer support service providers in the workplace and, in some states where allowable, Medicaid reimbursement for their services.
Since 2017, SAMHSA allocated over 60 million dollars to recovery support initiatives, but Coderre urged the Senate to do more to build out the continuum. Following the lead of President Biden’s FY 2022 Budget, he reiterated his call for a 10 percent set aside for recovery support services in the Substance Abuse Prevention and Treatment Block Grant which would provide states with funding to further invest in building out recovery support services.
Acting Director LaBelle reiterated the priorities of the Biden Administration, including a need to expand access to recovery support services, as well as the advancement of recovery-ready workplaces. She recognized that recovery support services are offered in various institutional and community-based settings and include peer support services and engagement, recovery housing, recovery community centers, and recovery programs in high schools and colleges, and increased capacity and infrastructure of these programs will create strong resource networks to equip communities to support recovery for everyone. The required infrastructure includes a safe, reliable, and affordable means of transportation to access recovery support services. She pledged that ONDCP will work with Federal partners, State, local, and Tribal governments, and recovery housing stakeholders to begin developing sustainability protocols for recovery housing, including certification, payment models, evidence-based practices, and technical assistance.
A Historical Summit
by: Bill White
In 2001, more than 130 recovery advocates from more than 30 states gathered in Saint Paul, Minnesota at the invitation of the Johnson Institute’s Alliance Project and with support of the Center for Substance Abuse Treatment’s (CSAT) Recovery Community Support Program (RCSP). That gathering marked the formal launch of a new recovery advocacy movement in the United States. The vision of culturally and politically mobilizing people in recovery and their families and allies was not a new vison, but those of us in St. Paul during those momentous days had an unmistakable feeling that we were participating in something that could reshape the future of addiction recovery. Now, with 20 years of hindsight, we can acknowledge what was so significant about this event.
The 2001 Recovery Summit marked a clarion call to shift the center of the alcohol and other drug problems arena to a focus on the lived solution for individuals, families, and communities. The shift from pathology/clinical paradigms to a “recovery paradigm” exerted pressure for urgent changes in policy, research, treatment, recovery support practice, and service system evaluation. The emergence or elevation of such concepts as recovery management, recovery-oriented systems of care, recovery coaching, recovery support services, recovery capital, recovery cascade (contagion), culture of recovery, community recovery, etc. would be missing from our current landscape without this paradigm shift, as would many recovery-focused research studies.
The 2001 Recovery Summit marked the passing of the recovery advocacy leadership torch from an earlier generation of advocacy organizations, most notably the National Committee for Education on Alcoholism (1944, later the National Council on Alcoholism and Drug Dependence) and the Society of Americans for Recovery (1991). The founding of Faces and Voices of Recovery as an outcome of the Summit set the stage for subsequent efforts, including Young People in Recovery, Facing Addiction, Shatterproof, the Recovery Advocacy Project, Latino Recovery Advocacy, Black Faces Black Voices, the African American Federation of Recovery Organizations, and other national recovery advocacy efforts. Faces and Voices provided the connecting tissue for RCO leaders to gather, communicate, share resources, and speak with a collective voice. The 2001 Recovery Summit set the foundation for the landmark accomplishments of Faces and Voices of Recovery and other recovery advocacy organizations.
The 2001 Recovery Summit marked the coming of age of a new organizational entity—the grassroots recovery community organization (RCO). The emerging RCO was not a recovery mutual aid fellowship, an alcohol/drug problems council, or a prevention or treatment organization, but rather an organization focused exclusively on recovery community mobilization, recovery advocacy, and recovery-focused community development. Subsequently linked through the Association of Recovery Community Organizations, RCOs have been instrumental in supporting further recovery community institution building, e.g., recovery community centers; recovery residences; occupational/workplace recovery programs; recovery high schools and collegiate recovery programs; recovery ministries; recovery-focused health, sports, and adventure programs; and recovery-focused projects in music, theatre, art, and community service.
The 2001 Recovery Summit marked a milestone in multicultural and multiple pathway recovery advocacy. The 2001 Summit was diverse in its representation of women, communities of color, and the LGBTQ community as well as its representation of diverse pathways of addiction recovery. The Summit was historically noteworthy in bringing affected family members into the advocacy movement on an equal footing with those with lived experience of addiction recovery. The Summit marked a milestone: people representing diverse pathways and styles of recovery seeing themselves collectively as “a people” with shared needs and aspirations. That “peoplehood” inspired subsequent calls for authentic and diverse recovery representation at all levels of decision-making within the AOD problems arena.
The 2001 Recovery Summit marked an early vision—the seed—of the integration of primary prevention, harm reduction, early intervention, treatment, and peer recovery support—a process that continues to this day through efforts to delineate roles and responsibilities as well as efforts of coordination and collaboration across this service and support continuum. Prior to the 2001 Recovery Summit, recovery never appeared on the alcohol and other drug service continuum. The emergence of peer recovery support services as a distinct service entity following the Summit constitutes a significant historical milestone.
What the 2001 Recovery Summit did more than anything was weld the personal commitments of individuals and programs into a national recovery advocacy movement. We had a name; a consensus on vision, goals, and tactics; and, most importantly, we had mutually supportive relationships across the country that bound us together in common cause. I look forward to our gathering this October to revision the future of recovery advocacy in the United States.
An Invitation to Return to Saint Paul
by: Philip Rutherford
Even before my arrival at Faces & Voices, I learned about the rich history and significance of the St. Paul summit that happened on October 5, 2001. While working at a Minnesota RCO, I attended an event put on by The Association of Recovery Community Organizations (ARCO) that was modeled after the original summit. At the time, it was called the ARCO Executive Directors Leadership Academy, and it transformed both my personal understanding of the recovery movement, and ultimately the trajectory of my organization. ARCO’s roots are connected to the powerful movement that arose from the St. Paul summit and that continue to propel the work of countless organizations today.
On October 3, 2021, at the River Centre in St. Paul, Minnesota, we will convene another summit to commemorate the passing of the 20th anniversary of that event. We will examine where we are today and look toward the future. The event will have plenary speakers like Bill White, Dr. Nora Volkow, William Moyers Jr. and Dr. Delphin-Rittmon, and will include six different tracks of learning concentrations around Advocacy, Peer Recovery Support Services, Capacity Building, Diversity, Equity, and Inclusion, Family and Youth, and Leadership Development.
Many things have changed about the recovery movement since 2001. At Faces & Voices, we see this event as an opportunity to celebrate the tireless efforts of those who have come before us, honor those in the trenches right now, and help clear a path for anyone who wants to join the journey. Similarly, some things haven’t changed, and we see this event as an opportunity to have frank and open discussions about where change is required.
If 2020 has taught me anything, it is to expect the unexpected, and as such, I’d be remiss if I didn’t mention COVID-19 and the possibility of rates of infection affecting our plans. The COVID-19 Delta and Lambda variants are influencing how the celebration will take place. We are closely monitoring guidelines and restrictions and will make decisions as the situation unfolds.
Unless restrictions prohibit us from gathering, we plan on hosting the conference in-person. We understand some people may be hesitant to attend, due to safety concerns.
If necessary, we will deliver a webinar-based, hybrid option to accommodate more people, so that we can still be together as a community for this important milestone. We will update you as we can. In addition, the River Centre has taken a number of precautions to ensure your safety.
Thank you for your patience and understanding during this time.
To make it a bit clearer, here are three possible scenarios as examples:
Scenario A– All is well. No mandates or city-wide orders in place regarding COVID
*Summit takes place as scheduled. Proof of Vaccine/Negative test results/mask required (with audit during event). We will stream only keynote events.
Scenario B– Positivity rates increase, moderate concern surrounding transmission. No mandates or city-wide orders in place regarding COVID.
*Summit takes place as scheduled. Proof of Vaccine/Negative test results/mask required (with audit during event). Social distancing rules will be enforced, hybrid conference occurs with streaming of each session.
Scenario C-All is not well, mandates or city-wide orders are in place regarding COVID
Summit takes place entirely in virtual space.
Gate: September 1 decision date
Nationwide positivity of >12% Scenario C
Nationwide positivity of 5-12% Scenario B
Nationwide positivity of <5% Scenario A
Regardless of the eventual format, we extend a warm invitation for you to participate. You can register by clicking HERE. Let’s go make some more history.
UPDATE: On September 1, 2021 Faces & Voices of Recovery made the difficult decision to move the event to a completely virtual setting.
When I remember the thousands who died, many whose stories were never recorded in history, I bow my head. And when my wailing is done, I get up and carry on, not in my name, but in theirs….When you know your history, you know your value. You know the price that has been paid for you to be here. You recognize what those who came before you built and sacrificed for you to inhabit the space in which you dwell. –Cicely Tyson (with Michelle Burford), Just as I am
We have not even to risk the adventure alone; for the heroes of all time have gone before us; the labyrinth is thoroughly known; we have only to follow the thread of the hero-path. And where we had thought to find an abomination, we shall find a god; where we had thought to slay another, we shall slay ourselves; where we had thought to travel outward, we shall come to the center of our existence; where we had thought to be alone, we shall be with all the world. –Joseph Campbell, The Hero with a Thousand Faces
Those seeking and in recovery owe a great debt of gratitude to earlier generations of people whose life discoveries opened and charted pathways to addiction recovery and built the recovery support organizations available to us today. Much of my (BW) past work focuses on excavating and celebrating the lost stories of these recovery pioneers.
The stories of many of our recovery ancestors remain publicly shrouded behind a veil of stigma. For generations, others who sought our control or cure spoke on our behalf while our own faces and voices remained hidden and silent. Actually, those who spoke for us spoke their stories—their perceptions of us and their work on our behalf, but authentic, first-person narratives of addiction and recovery remained obscured and sometimes misrepresented by such accounts.
Today, we are rediscovering lost recovery stories and declaring that we can now speak for ourselves. Every stigmatized and oppressed people must liberate their history and take control of their own stories. As the African proverb suggests, “Until the lion learns how to write, every story will glorify the hunter.”
We as a people can assure that the stories of our recovery ancestors are preserved and called forth at critical times to illuminate our present circumstances. Here are few potential possibilities.
*Designating and training archivists and archival skills within recovery-focused organizations
*Creating formal recovery archives for historical preservation and research
*Digitizing historical materials and creating virtual libraries filled with resources on the history of addiction recovery
*Creating and disseminating histories of recovery, recovery mutual aid and advocacy organizations, and key recovery figures via articles, books, films, plays, and photo exhibits.
*Creating and disseminating the history of recovery among special populations, e.g., women, youth, people of color, LGBTQ, etc.
*Preserving iconic historical sites
*Creating forums for communication between people interested in the history of recovery, e.g. AA History Lovers, NA History Lovers
*Creating oral history projects through which the stories of local recovery elders are recorded and preserved
*Hosting symposia on the history of addiction recovery and related organizations, and
*Ancestor consultations: Consulting with local recovery elders and regularly asking ourselves how recovery ancestors responded to challenges and opportunities similar to those we are currently facing.
Our recovery ancestors have provided a body of historical lessons. They have endowed an intellectual and emotional inheritance on how to best navigate the complexities, challenges, and opportunities within the experience of addiction recovery. They have also forged values and traditions that can best guide our collective life within recovery-missioned organizations. We honor our ancestors by letting their lessons inform our current circumstances. We show up to assert our own needs and aspirations, but we also show up to honor the ancestors that make our survival possible.
You cannot know yourself without knowing the history of your people. We bear the scarred wounds of past recovery generations—the emotional memory of objectification, demonization, maltreatment, and mass incarceration, but we also possess within us the inherited capacity to survive and thrive if we draw upon it.
We must all become students of our history as a people. Once we become students of history, the wisdom of our recovery ancestors lives inside us. We can then elicit the voiced guidance of our ancestors when we most need it. We are but one link in this chain of history. What we as a people achieve today are the fulfilled dreams of our ancestors. What we do today in preparing those who will follow us will shape the future of recovery for generations to come.
We must show up and do our part to prevent a break in this historical chain of personal healing and social progress. We do that for ourselves and in payment for our ancestors’ sacrifices. Our ancestors do not die until we last speak their names. In honor of what they have bequeathed to us and as aide to our own survival and health, we must continue to speak their names.
Posts from William White
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.
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.
This final blog in our five-part series concludes our exploration of the portrayal of addiction recovery within 35 American comic books and 9 graphic novels.
The Role of Recovery Mutual Aid Groups
The supportive role of recovery mutual aid groups was limited exclusively to Twelve-Step groups (Alcoholics Anonymous) within American comic books and graphic novels that contained addiction storylines.
Characters seeking recovery through AA include Tony Stark, Carol Danvers, Katina (“Katchoo”) Choovanski, and five characters in the graphic novel Sobriety. Tony Stark and Carol Danvers even go to the same AA meetings in multiple issues. In Iron Man: Resolutions #313, Tony spends New Year’s Eve at an AA meeting reflecting on his early exposure to alcohol as a pre-teen and current struggles with alcoholism. The role of an AA sponsor is portrayed through the character of Dr. Black, who serves as Ruben’s (Buzzkill) sponsor:
“The rest [beyond admitting you have a problem] is going to be tough, but I’ll be here to guide you. I’ve been through this before. It’s not impossible, Man.”
All five characters in the graphic novel Sobriety were involved in a Twelve-Step program. Larry noted his early perceptions of rehab and AA: “Look at rehabs: They’re invested on getting reimbursement from health insurance companies—the very same companies that require a medical treatment. It seems to me that the Twelve Steps are about something else; it’s like a cult!”
Several characters report getting sober through the help of other AA members. The character Matt (Sobriety) describes how the Twelve-Step program works:
“The problem is easy: we have a disease of the body that causes us to lose control when we drink or drug, and an obsession of the mind that causes us to drink and drug. That’s the powerlessness that step one describes…The solution to that irreconcilable dilemma is that the other steps give us a way to restore purpose and meaning to our lives.”
Resistance to Twelve-Step programs was portrayed via the character of Matthew Parker in Larceny in My Blood. At one of his parole hearings, Parker declares: “Well, I’ll tell you what I won’t do. I won’t go to NA meetings, or AA meetings, or any of that other crap.” (He was then paroled based on his honesty). In speaking of a later parole hearing, he recalls: ”I told them what I really thought of their rehabilitation policies and 12-Step programs in particular. I just think it’s all bullshit.”
There were no references to secular, spiritual, or religious recovery mutual aid alternatives to Twelve-Step programs in the comic books and graphic novels we reviewed. Given the national and international growth and diversification of alternative groups such as Women for Sobriety, SMART Recovery, LifeRing Secular Recovery, Celebrate Recovery, and numerous others, it is somewhat surprising that they have yet to appear within comic book and graphic novel addiction storylines.
Portrayal of Addiction Treatment
The representation of addiction treatment in American comic books is limited. Natural recovery is far more common than professional treatment, and comic book storylines offer few details related to the actual nature of treatment beyond medical withdrawal. In spite of the portrayal of opioid addiction in numerous storylines, there is little portrayal of the pharmacotherapy of opioid addiction. Recovery most often involved heroic rescue or was portrayed as an isolated episode that when shaken off allows other storylines to proceed without continued references to a recovery process. Below are the few treatment references we located.
In the Batman series, there are references to Doctor Leslie Thompkins and Tiffany Fox operating addiction treatment programs without reference to what such treatment involved. The DC Fandom Wiki explains, “Doctor Thompkins ran the free Thomas Wayne Memorial Clinic for criminals and drug addicts in Gotham City. While the majority of her patients were repeat offenders, she continued to do her job with great perseverance and determination.” Dr. Thompson later ceased her helping role and became a vigilante.
There are numerous examples over multiple decades of Tony Stark seeking treatment for alcoholism, however they rarely show details of what that treatment entailed. In Iron Man: Deliverance #182, Tony is admitted to a hospital for detoxification and later shown attending AA meetings.
In Vengeance of Bane, the psychiatrist Dr. Flanders, who Bane saw while in prison, is portrayed as empathic and skilled
The character Leslie in Hey Kiddo references going to a clinic after her release from prison and getting involved with another patient there: “He’s getting treatment, just like me….Miguel and I are on this road to recovery together.” She relapses and later dies of a heroin overdose.
Alex (Sobriety) entered a government-sponsored rehab for four weeks following an overdose. He warmly describes his counselor, who introduces him to the Twelve Steps: “David was a guy who listened—really listened—to me. He was in recovery himself. And he let me see the truth of my life: that it had spun out of control and was insane.”
The most detailed of addiction treatment appears in The Abominable Mr. Seabrook.
William Seabrook’s physician admitted him to Doctors Hospital, dried him out with the aid of “prescription booze”, and then discharged him as cured. The images of this episode show Seabrook looking through bars. Following his discharge from Doctors Hospital, he immediately returned to heavy drinking and was subsequently committed to the Bloomingdale Insane Asylum. Seabrook was a challenging patient, often objecting to various rules of the institution. Treatment at Bloomingdale consisted of “cold turkey” withdrawal from alcohol, hydrotherapy (baths and wetpacks), and psychotherapy to address his “addictive personality” and his sexual perversions. Seabrook was discharged after seven months and later detailed his experience there in his book Asylum. At the end of Asylum, he proclaimed himself cured, that he could now drink without excesses of the past and that he had conquered his writer’s block. “I’m now able to take a drink or two without desiring another and I seem to be cured of drunkenness.”
Seabrook’s drinking again raged out of control.
Matthew Parker provides the most detailed account of treatment resistance in his graphic memoir, Larceny in my Blood. Parker describes being ordered into a halfway house by a judge: “I was allowed to go to work and report back to the rehab each night, which made it easy to maintain my habit.” When arrested for failing a drug test, he “played the contrite junkie.” At a later 28-day rehab, he sarcastically describes his superficial compliance: “Oh, yes, I’ve seen the light. Hit rock bottom. I’m powerless over my addiction. I have to give it away to keep it.” Then released to Maverick House, he described feeling like he was “being conned.”
On Addiction Recurrence
Addiction recurrence following a period of recovery is described in several comic book and graphic novel storylines. Carol Danvers experienced a recurrence of drinking at a time she is struggling with writer’s block. Another time, she follows the Avengers into a bar on a mission commenting that she will need to stay vigilant to avoid another recurrence. Tony Stark experienced multiple relapses across his many storylines. Below is scene from Ironman: Demon in the Bottle that offers a typical depiction of the tensions that often precede a recurrence:
“For days, the stalemate rages—until at long last, emotional blocks begin to crack, then crumble—and Tony Stark spills his pent-up pain like milk from a spilt pail. He sighs, he shudders…and he shakes.” The purge helps and he returns to work. He apologizes to Jarvis saying he has “a handle on it now,” and Jarvis responds, “You have an illness. I quite understand.” While he’s at the Avenger’s mansion, Tony knows there’s a bottle in his room but says, “I don’t need the booze…I can handle this on my own without any counterfeit courage at all.” Later back at the mansion, Tony starts to pour a drink and Beth stops him. His face is sweating, eyes are down, he’s frowning, his hands are shaking. It’s described as the “hardest battle of his life.” Beth reminds him of his life’s dream, and shaking he recaps the bottle.
The self-talk that feeds addiction recurrence is vividly displayed in The Abominable Mr. Seabrook. Following treatment and a period of sobriety, Seabrook tires of the sober life and proclaims: “I’m tired of being a cripple. From now on, I’m going to prove that I can take a drink or leave it alone, like any other man.” After losing control over his drinking again, he would pledge sobriety anew but soon became bored and commence his drinking binges. His repeated refrain when talking to himself in the mirror: What do drunkards do? They drink themselves to death.” At a later stage of his story, Seabrook’s lover and third wife-to-be plunged his hands in boiling water to scald the skin so that he would be unable to pick up a drink. Seabrook continues drinking from a liquor bottle using a straw. He was committed to the Hudson State Hospital in mid-1945. A few months later and after his release, Seabrook committed suicide with sleeping pills and whiskey on September 20, 1945.
Brandon Novak (The Brandon Novak Chronicles) re-experienced heroin addiction after publishing his book, Dreamseller, in which he recounted losing his career as a professional skater due to his heroin addiction. In his graphic memoir, he describes coming back from his “insatiable appetite for heroin.”
Addiction, Recovery, and the Family
An area of scant attention in the addictions storylines of American comic books and graphic novels is the effect of addiction upon the family or the involvement of affected families in family support groups or addiction treatment. The few conclusions that can be drawn related to family include the following.
Addiction inflicts repeated episodes of humiliation, helplessness, worry, guilt, anger, and loss on the family (The Abominable Mr. Seabrook; Drinking at the Movies, Hey Kiddo).
Addiction can become so imbedded within the marital relationship that recovery may pose more of a threat to the relationship than continued addiction. Willie Seabrook’s second wife reveals, “I confess, Willie had handled the teetotaling better than I did.”
Sustained family support can play a crucial role in addiction recovery. Jarrett’s grandfather (Hey Kiddo) purchases a house for Leslie when she finishes the release program to support her new sobriety. Matthew Parker in Larceny in my Blood recounts such support:
“But as pissed as she [his mother] was, I always had a place to live. She was too kind and I used her…. At 41 years old and on my fifth trip to prison, she [mother] saw no reason for hope…But my mom never gave up on me—I think because our shared struggles showed how bad it could get….We were still family, not despite but because of all that we had lost.”
Sustained recovery brings indescribable relief to the family. Again, Matthew Parker reflects:
“She [mother] was not convinced of my commitment to kick heroin until a year after my release, during my second semester at SCC….I think that was the first time in 40 years that my mom could relax.”
The portrayal of the role of recovery mutual aid organizations in the process of addiction recovery is limited within the storylines of American comic books and graphic novels to Twelve-Step fellowships. In spite of their recent growth in the U.S. and internationally, the existence of secular, spiritual, and religious mutual aid alternatives have yet to be portrayed. Addiction treatment is briefly referenced within the addiction storylines of American comic books and graphic novels without substantial details related to the nature of such treatment or its degree of effectiveness. Addiction recurrence following an initial recovery attempt is common within the addiction storylines, with trajectories ranging from death to a final re-stabilization of recovery. American comic books and graphic novels have yet to fully portray the effects of addiction on the family and the processes, stages, and long-term effects of family recovery from addiction.
We anticipate a future in which collaborations between addiction professionals, recovery advocates, and the writers and illustrators will produce a new generation of addiction storylines within American comic books and graphic novels that more accurately portray the prevalence, pathways, stages, and styles of long-term addiction 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.
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.”
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 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).
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.”
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.”
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.
Earlier blogs in this series explored the benefits and limitations of public recovery disclosure, the potential risks to multiple parties involved in such disclosure, and the ethics of recovery disclosure. In this final blog in the series, we explore guidelines for individuals and organizations aimed at minimizing risks related to public recovery disclosure.
The Decision to Disclose
Before disclosing our recovery status or details of our addiction/recovery experiences at a public level, we suggest giving careful thought to such questions as:
*Is this the right time in my recovery to share my recovery story at a public level? Will this strengthen my recovery or would it be a diversion from more critically needed recovery activities?
*Are there any negative effects for myself, my family, my community, and organizations within whom I am associated that could result from sharing my story in public or professional settings?
*Could such story sharing subject me to discrimination in housing, education, employment, health care, or social and business opportunities? Could it have any legal ramifications?
*Do I have a support system that could help me manage any such effects if they should arise?
*Will I be sharing my story alone or alongside other people in recovery?
*Do the potential benefits of public disclosure as a community service outweigh the potential personal risks?
*Who is controlling how my disclosure will be used and is there an explicit right for me to have the final edit on what elements of my disclosure are presented?
Purpose of Public Disclosure
Many people in recovery will have shared their recovery story with family and friends, with medical and treatment professionals, and with other people in recovery before the opportunity for public recovery disclosure arises. Public disclosure is different from any of these preceding situations and involves a different purpose and style of storytelling.
Public recovery storytelling is about service to a larger cause than self. It is the use of self and one’s own story as a catalyst for personal and social change. With each story sharing opportunity, we prepare ourselves by asking key questions. What do I want members of this audience to understand, feel, and do? How can I present my story in a way that will achieve those goals? How can what I do today contribute to the larger goals of the recovery advocacy movement?
It is important that addiction treatment and recovery community organizations provide a process of informed consent when inviting individuals to share their stories in public and professional contexts. This involves a clear statement of the potential benefits and risks of public disclosure and screening out individuals for whom such disclosures present an unacceptable level of risk. Asking individuals currently receiving services to participate in public story sharing or marketing activities is coercive and exploitive.
Many of the risks involved in public recovery story sharing can be avoided with adequate orientation and training. Messaging training has been an effective tool used by Faces and Voices of Recovery and other recovery advocacy organizations to prepare people for this unique service ministry. Messaging training spans both the intent and content of public story sharing and the mechanics of effective story sharing (e.g., language, tone, adaptation for different cultural contexts and audiences, etc.). Pursuing these activities within an established recovery community organization helps assure peer and supervisory support for the “ups and downs” of such sharing experiences.
Public Self-disclosure and 12-Step Anonymity
AA, the precursor of all 12-Step programs, promulgated a tradition of personal anonymity at the level of press as both a protective device for AA and as a spiritual principle. Public disclosure of recovery status and sharing one’s recovery story without reference to affiliation with a particular 12-Step program complies with the letter of 12-Step traditions (See Advocacy with Anonymity), but it may not always meet the spirit of the Traditions. This could occur when advocacy is used as a stage for assertion of self (flowing from ego / narcissism / pride and the desire for personal recognition) rather than as a platform for acts of service flowing from remorse, gratitude, humility, and a commitment to service. For members of 12-Step fellowships, adhering to anonymity traditions (in letter AND spirit) in public recovery story sharing is recommended as a protection both for 12-Step programs and for the protection of the recovery advocate.
Timing of Disclosure
Our capacities (energy, abilities, competing needs and demands) for recovery advocacy ebb and flow over time. It is appropriate to ask ourselves if this is the optimal time for public recovery story sharing, whether this is the first time we have such opportunity or whether we need to take a break from such activities during times of personal distress or competing demands that require our focused attention. Warning signs indicating the latter include losing emotional control over the content of our story sharing (via unplanned expressions of frustration, resentment, anger, sorrow) or experiencing boredom or a loss of energy in our public story sharing. Difficult experiences and emotions can be referenced strategically within our talks (once we have emotional control over them), but public and professional meetings are not the appropriate venues to work out unresolved traumas of the past or present. When we drift across that line, it is time to take a break from this public service role.
Scope and Focus of Disclosure
People in addiction recovery have many stories they can share. There is the life preceding the onset of drug use, one’s addiction career, the turning point of recovery initiation, and the story of one’s personal and family life in and beyond recovery. All of these may be touched on in public recovery story sharing, but the emphasis of this story must be on the recovery story and the lessons drawn from it. Great care is required with the media to maintain this focus. There are dangers that others hijack a recovery story intended to lower stigma in a way that fuels stigma, social marginalization, and the criminalization of addiction. We best serve the advocacy movement and protect ourselves by maintaining a focus on the recovery side of our stories and how we escaped the chaos and drama of addiction.
Depth of Disclosure
There exists a continuum of intimacy defining the degree of risk in public recovery story sharing. There are experiences, feelings, and thoughts known only to ourselves that we have not shared with anyone else. There are experiences, feelings, and thoughts we have shared with only within our most trusted relationships. There are the communications we have expressed only within the context of professional counseling, within a sponsorship relationship, or recovery mutual aid meetings. And there are things about ourselves we have shared widely with those we encounter in our daily lives. Such communications range from high emotional risk to low emotional risk. The question is: Where does sharing our recovery story in professional or public meetings, in media interviews, or on social media fit in this continuum?
All recovery story sharing at a public level involves potential risks to ourselves and other parties, but those risks increase in tandem with the level of detail about our experiences contained within those stories. The category “people in recovery” includes highly armored people who are unable to trust others enough to share their real experiences, feelings, and thoughts. Others in this category enter recovery with no armor and no boundaries to facilitate the nuances of self-disclosure and self-protection in different settings and relationships. People existing on the extremes of this continuum from overly guarded to completely unguarded may need greater time in recovery prior to recovery story sharing at a public level. All people on this continuum need guidance and discipline to manage the depth of public recovery disclosure and the discipline to maintain this boundary over time.
Training and supervision related to public recovery disclosure can provide a safe setting in which we can address such questions as the following:
What is the level of risks (who could experience harm and to what degree?) in the following story sharing venues: a social media post; a radio, television or newspaper interview; speaking at a recovery celebration event; speaking to a professional audience; or speaking to a public audience; writing an article or memoir about our recovery experience?
What parts of my story are not appropriate to share publicly? (We want to break no-talk rules related to addiction/recovery, but we want to avoid disclosures that are so intimate in detail that they pose threats to our own emotional health or repel those who hear our story.)
What aspects of my past or present experience remain too emotionally intense to include in my public recovery story? (These are the boundaries we need to define BEFORE we stand before an audience or sit for an interview! Message training and peer supervision can assist this process.)
Have I avoided referencing other people’s stories who might experience harm or discomfort resulting from my disclosure? (It is best to get permission for inclusion of others within our stories, e.g., spouse, family members.)
Have I fully explored why I am sharing my story and sought feedback from other people who know me to understand the nuances and potential unintended consequences of disclosure?
Facing Criticism of Public Disclosure
As a final note, it is not unusual for individuals disclosing their recovery story at a public level to draw criticism for such activities from expected and unexpected quarters. You may be accused of “grandstanding,” “ripping off the program,” violating program traditions,” or be caught in the crossfires of various ideological debates. Some will comment on what you should have or shouldn’t have included in what you shared. Our advice is to have one or more people you are close to who can help you sort such feedback. And to positively use what you can and disregard the rest. Do know that such criticism is inevitable and can help us refine our message and its delivery—even when the criticism is unfounded and prompted by spurious motives.
We have tried in this series of blogs to explore the purpose, contexts, and risks of sharing our recovery stories at a public level and to explore some of the ethical issues involved in recovery story sharing. It is our hope that these discussions and suggested guidelines will serve as a catalyst for discussion and a tool for the training of recovery advocates who choose to join the vanguard of people who are putting a face and voice to the recovery experience.
Our stories have the power to achieve many things, but we must not embrace total responsibility for eliminating addiction/recovery-related stigma. Those individuals and institutions who spawned and perpetuated stigma and discrimination bear that responsibility. What we can do is offer our stories and our larger advocacy activities to offer hope to wounded individuals, families, and communities and do so in a way that protects our own health and safety.
Ethics involves the application of moral principles to promote good and prevent harm. Ethical decision-making within our service and advocacy activities is an assessment of the ratio of potential benefits to potential harms in any course of action—with a particular emphasis on “first do no harm.”
Such decision-making involves asking ourselves three questions. First, what parties could benefit or experience harm in this situation (and what is the degree and duration of such benefit or harm)? In our advocacy roles, it is helpful to assess such potential benefits and harms related to ourselves, our families, organizations with whom we are associated, the recovery advocacy movement, and the community.
Second, are there any laws, policies, or historical practices that offer guidance in this situation? This question illuminates the complexities between law and ethics: actions may be legal and ethical, unethical and illegal, legal but unethical, or illegal but ethical.
Third, what ethical values are most applicable to this situation and what course of action would these values suggest? Self-disclosure as an ethical issue has been explored in both professional and peer recovery support contexts (See HERE and HERE), but little attention has been focused on ethical concerns related to self-disclosure within the context of public recovery advocacy. Several traditional ethical values inform decisions related to disclosure of our personal recovery stories in public or professional settings.
Beneficence is the ethical command to help others and not exploit the service context. It invites us to share our story as a means of helping individuals and families suffering from addiction and commands us to focus that story on those in need rather than as an act of self-aggrandizement or a means of pursuing our own interests.
Nonmaleficence is the ethical command to do no harm. In the context of public recovery storytelling, it forces us to assess the timing and the intended and unintended consequences of our public disclosures on ourselves and other parties.
Honesty demands that the recovery story be a truthful representation of our experience. Honesty and candor challenge us as advocates to speak truth to power even when lacking confidence in the authority of our own voice.
Fidelity calls upon us to keep our promises. It asks us to remain faithful to pledges we have made to individuals and organizations. It asks us not to make promises that we cannot keep and to adhere to commitments made in the context of our story sharing.
Justice requires that we acknowledge disparities in recovery opportunities and resources and calls on us to seek equity in such opportunities and resources.
Discretion calls upon us to protect our own privacy, the privacy of our family, and the privacy of others in the presentation of our story. Public recovery storytelling is an act of public service; it is not public therapy or a platform for airing personal grievances.
Self-protection calls upon us in our service roles to avoid harm to self, family, and others. It is an acknowledgment of the legitimacy of tending to our own safety and health. It is a recognition that risks of harm to self and others exist within the public storytelling arena.
There are also values deeply imbedded within the history of communities of recovery that can inform recovery storytelling within public and professional arenas.
Humility reminds us of the dangers of ego-inflation and that we speak not for ourselves but for the experiences and needs of all people seeking and in recovery. (See earlier blog on distinction between recovery rock stars and recovery custodians)
Gratitude is a call to give credit where it is due and to express our thanks to individuals and organizations that made our story possible. We offer our own story in thanks for the meaning we drew from the stories of others at a time we were most desperate for the hope they offered.
Respect/Tolerance is a recognition of the spirituality of imperfection—that we are all wounded in some way, that through this shared brokenness and healing, we can experience profound connectedness. It is an extension of humility and empathy—seeing ourselves in the lives of others and respecting multiple pathways and styles of recovery.
Service is the call to carry a message of recovery to all those who continue to suffer from addiction and related problems. We do that as an act of altruism and as a perpetual step in our own self-healing.
There are many decisions involved in public recovery storytelling. Filtering these decisions through a model of ethical decision-making and core values of recovery can help minimize risk to self and other parties.
A central goal of public recovery self-disclosure is to challenge myths and misconceptions about addiction and recovery through the elements of our personal stories. Recovery advocates must avoid contributing to false narratives by having selective parts of our stories appropriated while ignoring the central recovery message.
Addiction/treatment/recovery-related social stigma and its untoward consequences rests on old and new misconceptions regarding the sources and solutions to alcohol and other drug problems. Such key pillars of belief about the nature of addiction, addiction treatment, and addiction recovery constitute the structural supports of addiction-related social stigma. Below are examples of such pillars (in the stigmatized language in which they have been historically conveyed) and how our stories can be hijacked to support these false narratives
Addiction is a product of moral turpitude (badness) that is best prevented and discouraged by public shaming and other forms of punishment. Acts flowing from this premise began with American colonies forcing those convicted of public intoxication to wear the letter D (for “Drunkard”) on their clothing or to be set in stock in the town square under a sign reading “Drunkard.” The moral turpitude pillar continues to feed social shunning, serves as grounds for divorce, and provides a rationale for political disenfranchisement and discrimination in housing, employment, education, and medical benefits. Overemphasizing or exaggerating the “bad people” we were in the addiction portion of our stories inadvertently feeds this view.
Addicts pass on their degeneracy (“bad seed”) to their children. This pillar of belief has resulted in the inclusion of addicted people in mandatory sterilization laws, surgical sterilization without consent during institutionalization, and loss of parental custody and related legal rights. It also feeds false narratives that paint the children of addicted parents with the same brush, e.g., false narratives of “crack babies” as a “biological underclass.”
The addict is an infectious agent who must be closely surveilled and isolated from the community. This pillar of belief provided the rationale for inebriate penal colonies, prolonged institutionalization in psychiatric asylums, prolonged surveillance (addict registries, prolonged probation/parole), and fed the modern era of mass incarceration.
Addicts pose the greatest threat to the community when they associate with each other. This belief undergirded laws banning addict fraternization and probation or parole violations for associating with other addicts. “Loitering addict” laws provided for the arrest of known addicts for simply being in the presence of other individuals identified as addicts. Policies that dissuade recovery networking and the inclusion of recovery voices in matters that affect us may well be rooted in earlier biases against addicts being with each other.
Addiction does not discriminate. Actually, it does! It was with the purest of intentions that the tagline of “addiction does not discriminate” became one of the public education mantras in the wake of the “opioid epidemic.” It was a way of saying, “See…it could happen to anyone… and now you should care.” This narrative sought to normalize (AKA Whiten) addiction by projecting the image of “innocent,” (AKA White), middle-class children and their parents deserving of public resources to support their care. Such care was advocated as an alternative to arrest and incarceration for the “deserving” (AKA White people of means), while addiction in communities of color continued to be stigmatized, de-medicalized, and criminalized.
Stating that alcohol and other drug problems cross boundaries of race and class in the United States obscures the inordinate toll addiction and drug policies have long taken and continues to take on communities of color and other historically marginalized populations. The addiction vulnerability of these communities stems from historical trauma; social, economic, and political marginalization; and related disparities in access to prevention, harm reduction, early intervention, treatment, and recovery support services. An ethical framework of public messaging and education would call for equity of policy application and resource allocation across all affected communities. Ideally, recovery storytelling would include the stories of people from diverse backgrounds and living circumstances. It is important that through our stories we convey the reality of recovery, the varieties of recovery experience, and the challenges of recovery across cultural contexts.
Addiction is untreatable (“Once a junkie, always a junkie.”) This pillar of belief feeds personal, public, and professional pessimism about addiction and provides the rational for prolonged institutionalization/incarceration as well as justification for harmful and potentially lethal treatment experiments. In the U.S., the latter have included brain surgeries, indiscriminate use of chemo- and electroconvulsive therapies, toxic drug withdrawal procedures, and other harmful treatment methods. Portraying the role treatment played within our recovery stories and the nature and positive effects of modern treatment challenges this misconception.
Treatment Works! is a counter misconception in that it suggests the presence of a uniform protocol of addiction treatment in the U.S. that achieves consistently positive clinical outcomes. It also ignores widespread addiction treatments that lack empirical evidence of their effectiveness as well as the presence of treatments more focused on financial profit than long-term recovery outcomes. This central marketing slogan of the treatment industry misrepresents the highly variable outcomes of addiction treatment, which span minimal, moderate, and optimal effects, as well as harmful effects. Addiction is a treatable condition, but recovery outcomes depend upon numerous personal, clinical, and environmental factors. Great care must be taken in how our stories are used by the addiction treatment industry. What we are offering as advocates is living proof of long-term recovery, not an advertisement for a particular proprietary approach to addiction treatment. (See HERE for full critique of this slogan.)
Recovery is not possible until an addicted individual “hits bottom.” Actually, most people recover from addiction long before “hitting bottom” (losing everything). Addiction-related loss and pain in the absence of hope is an invitation for continued self-destruction. Recovery initiation is the fruit of addiction-related consequences interacting with sources of hope for a healthier and more meaningful life. The “hit bottom” premise suggests that recovery responsibility rests solely with the individual—that there is little family or community can do until that point of individual awakening arrives. This constitutes an invitation for family and community abandonment of those suffering from addiction. This premise is untrue, is not applied to other medical conditions, and should be forever discarded within the addictions arena. We must not let our story be twisted to support this supposition even if we were one of those who did hit bottom and lost everything.
Addiction recovery is the exception to the rule. Actually, recovery is the norm; individuals who do not achieve sustainable recovery are the exceptions. Those who struggle with recovery stability are distinguished by higher problem severity, co-occurring problems that make recovery initiation and recovery more difficult, and fewer natural recovery supports in the community. Even people with the most severe addiction problems can and do recover with more intense and prolonged recovery support resources. We must repel any effort to cast our recovery as the heroic “exception to the rule” and convey the consistent message that no one need die of addiction. Recovery is far more than possible; it is the probable long-term outcome for those who experience alcohol- and other drug-related problems.
Addiction recovery is a brief episode that allows one to then get on with their life. For people with mild to moderate levels of addiction severity who possess substantial recovery capital, recovery may be just that. However, for those escaping addictions marked by severity, complexity, and chronicity, recovery is a prolonged process comparable to the assertive and sustained management needed for other chronic medical conditions. It is important in our stories to acknowledge variability of addiction severity and recovery support resources. Our recovery story is just that—our personal story; it is not the whole addiction/recovery story.
Media channels frequently tell the story of addiction recovery only as a personal story rather than a larger story of the role of family and community in addiction and recovery. The prevalence and severity of addiction are profoundly influenced by social, economic, and political contexts. The recovery tipping point has as much to do with family and community resources and capacity for resource mobilization as it does what is going on inside the addicted person. We serve best when we present our journey from addiction to recovery within these larger contexts and extoll the role of family and community in the recovery process.
Addiction recovery is only achieved through a particular type of professional treatment, lifelong affiliation with a recovery mutual aid society, and lifelong abstinence from alcohol and illicit drugs. Actually, people recover from substance use disorders with, and without, treatment, and through diverse approaches to treatment and recovery support. People achieve recovery with and without involvement in recovery mutual aid groups. Professional- and peer-supported pathways of recovery constitute particular styles of recovery, not the only pathways to recovery. Those involved in treatment and recovery mutual aid represent more severe and prolonged patterns of addiction. There are secular, spiritual, and religious pathways to alcohol and other drug (AOD) problem resolution, and AOD problems can be resolved through styles of sustained abstinence or through decelerated patterns of drug use (the latter most viable for individuals with less severe AOD problems and greater social supports). Our personal story illustrates one within many pathways and styles through which people resolve AOD problems. We preface our stories with “In my experience…” and “What I have observed is…” We are sharing our experiential knowledge, not universal truths that have stood the tests of science or application across diverse cultural contexts.
The above pillars of belief (and the degrading caricatures that often accompany them) serve the interests of multiple parties. They aim to socially stigmatize and discourage drug use. They disparage groups with whom the drug is, correctly or incorrectly, associated. They justify surveillance and over-policing of marginalized communities. And they feed institutional profit. Collectively, these pillars define us as a people as outsiders–outcasts for whom doors of entry into the human community should remain closed.
Our goals run counter to these interests. Our intent is to elicit what Isabel Wilkerson has christened “radical empathy”—the ability of listeners to emotionally project themselves into our experience to the point that they move beyond tolerance and compassion to actions that include us within the human community. This requires framing our stories to elicit conscious awareness that addiction is only one of many forms of woundedness that can and do touch all of our lives, and that recovery mirrors the promise of healing that can follow. The challenge we face is to assure that our recovery stories serve this higher purpose and not feed false narratives that are part of the problem.
Supervision is a key component in providing peer recovery support services and should be a relationship that nurtures growth, honest skills, and addresses opportunities for growth that support recovery support core competencies.