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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

References

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

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

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

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

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

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

Limited Portrayal of the Recovery Experience

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

Recovery as an Incremental Process

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

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

Motivation for Recovery

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

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

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

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

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

Styles of Recovery Initiation

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

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

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

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

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

The Need for Sustained Vigilance

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

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

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

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

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

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

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

Recovery Support Resources

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

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

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

Character Transformation in Recovery

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

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

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

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

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

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

Closing Reflection

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

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

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

Physical Consequences

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

Psychological Consequences

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

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

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

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

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

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

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

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

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

Effects on Social Functioning

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

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

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

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

Relationship Effects

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

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

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

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

Closing

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

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

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

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

He who shows himself at every place will someday look for a place to hide. –African Proverb

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.

Disclosure Preparation

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.

Closing

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.

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.