The Myth of the ‘Good Addict’ vs. the ‘Bad Addict’
By: Aaron Matthew Laxton
Tags: Mental Health, Health, Addiction, Recovery, Addiction Recovery

The Myth of the ‘Good Addict’ vs. the ‘Bad Addict’

We do people a disservice when we assume their hesitance at the 12 steps is hesitance at recovery

Photo: Linda D/Flickr

Chances are you know something about the 12 steps of recovery. We have seen it in movies or on TV. The church basement, strong coffee, a person standing up and making a public declaration about how they have a problem. For many people, it works and it works really well. It offers support since there is the ability to socialize and be around other people who understand what it is like to use substances, and the desire to no longer use them. For some, however, the 12 steps may be inaccessible due to trauma, mental health, or other complexities that are far too often dismissed.

I am an addiction therapist in St. Louis, Missouri, but as I tell everyone I work with, I have my own journey through addiction. My social work career has been devoted to working with individuals affected in some capacity by substance use. Addiction was something that was modeled for me early in life, and it’s what caused me to be in foster care for 15 years. Both of my parents were substance users, and I lost three members of my family to overdose.

While 12-step programs work for some, they are not for everyone. You might already be saying, “Here he goes: He is going to bash the 12 steps.” The truth is, I have nothing bad to say about 12-step programs. The rooms of recovery have been there at many pivotal times in my life. There are components of the steps I use every day. I am not here to criticize anyone’s pathway to recovery or the tools they use to get there. This piece instead is meant to explore and further a conversation about how we view people’s ability to choose a pathway that is right for them.

The myth of the “good addict” versus the “bad addict”

I use this language very intentionally but recognize the increasing body of knowledge that points to the importance of person-centered language. This work is being led by Robert Ashford, MSW. His idea is that the term “addict” should not be used and should instead be replaced with “person who uses drugs.” Ashford and his team have extensively studied the use of language in reference to the recovery community. I encourage you to check out his research and learn more about the way we speak about substance use.

For the sake of this piece, I will use the term most commonly used to describe the myth of the “good addict” versus the “bad addict.” According to many in society, a good addict is someone who is trying to no longer use substances. That person is doing everything in their power to get sober. They are going to meetings and making their doctor’s appointments. This is a person who is easily given praise and empathy because they are seen as realigning with society.

On the other end of the spectrum is the “bad addict.” The bad addict is someone who is seen as not wanting to stop or simply cannot stop. This is supported by behaviors such as not attending support groups or following up on referrals or other appointments. They might be resistant to start on medication, or if they are on medication, they are not seen as compliant. So for this person, because they are not perceived to be making any progress toward becoming a “functioning member of society,” they are labeled as the “bad addict.”

This myth is problematic on many levels because it simplifies the complex relationships people have with trauma, systems of injustice, and cycles of poverty, just to name a few. Substance use should never be thought of as simply a choice. Substance use is a multifaceted, complex mental health disorder that society sees through a moralistic lens.

Choosing not to utilize the steps can often be seen as “proof” that a person is not in the appropriate stage of change and they are simply “not ready” to quit using.

A shift toward healthier behaviors

When a person is known to be a substance user, society seemingly strips that person of the ability to choose their own treatment, recovery, or access to harm reduction. Instead, these various interventions are boiled down to a one-size-fits-all template. The “this worked for me, so you need to do it the same way” mentality is society’s view of substance users and is bleeding into the recovery community. Many have adopted this attitude of “policing ourselves” in order to gain acceptance by mainstream society. But just as the 12 steps were a personal choice that some have made, it was just that—a personal choice. Choosing not to utilize the steps can often be seen as “proof” that a person is not in the appropriate stage of change and they are simply “not ready” to quit using.

Beyond people being stripped of the ability to define a path that works for them, they are also limited in the choice of medications that are right for them. To be clear, only a handful of medications are used to treat opioid addiction and even fewer for amphetamine or alcohol use disorders. This also includes the ability to taper off the medication. I have heard from folks across the United States who complain about providers not honoring their desire to taper off of medications such as medication-assisted treatment (MAT). For many, the desire to taper is driven by internalized stigma within the various recovery communities. Although the attitude about suboxone, for example, is changing, for many it has not. Personally, I have been to recovery meetings where a person on suboxone is explicitly told not to share that fact in the meeting.

Capability

The 12 steps, as the name suggests, represents 12 individual steps that a person takes to shift away from unhealthy behavior in favor of healthier behavior. This work is typically done with the assistance of a sponsor who has their own lived experience of recovery. For a moment, I would ask that we consider whether all individuals are capable, or even interested, in moving beyond what is going to help them in their current situation. An all-or-nothing mentality that is often applied by some suggests that a person who does not buy into it is simply choosing to continue using. Again, this simplistic view fails to acknowledge the complex relationship people have with trauma and their ability to cope with that trauma.

Disconnect with God

Chances are, if a person has trauma associated with religion, they might find the 12 steps difficult. Mostly, I hear from people that the close association with God or a higher power is really hard for them to get over. It is not uncommon, however, when a person expresses this that it is seen as an excuse. You might even secretly mumble under your breath, “They are not ready to quit.” If you are that cynical, then you need to talk to someone.

The truth is that the LGBTQ communities already have a complicated experience with faith-based communities. To add to that, individuals who use substances as part of their experience are pushed even further into the margins. With that in mind, is it that challenging to see why some individuals might not subscribe to anything that is perceived as having an affiliation with spirituality?

Let us start by acknowledging that the person standing in front of us is the expert of their own life, health, and body. They know their own trauma far better than we will ever know. If they are telling you that it is traumatic for them, believe them. They have been in their bodies their entire life. While they might not use vocabulary that you are accustomed to, if you listen closely, they will tell you everything you need to know. Who are we to tell them that what they are saying won’t work? In your experience, the path you used worked, but that is not necessarily the gold standard. Consequently, it is easy for individuals to fall into black-or-white thinking. The all-or-nothing angle is symptomatic of our own rigidity that fed into our own substance use disorder, and we relay that to the folks with whom we are working.

The problem is that drugs do not get to the core of the matter. Substances only address the immediate symptom relief.

Drugs worked until they didn’t

I am going to let you in on a little secret. Our mental health system in the United States is not working, and that is an understatement. Even if you have health insurance, it is not working. Often, the decision to use drugs as a coping skill is balked at, however, we are cheating the people we are working with when we invalidate their ability to choose how to relieve symptoms of mental health. It is an unhealthy coping skill, but they are methods for relieving pain, stress, and trauma nonetheless. So let’s start with the basic premise, as my friend Fred Rottnek, MD, always says, individuals make the best decision given the tools that they have available. The problem is that drugs do not get to the core of the matter. Substances only address the immediate symptom relief. From a medical and behavioral health standard, there is no medical benefit to using drugs. From a personal standard, however, it helps the person to alleviate an intense pain that can often not be acknowledged or verbalized.

Substance use addresses the symptoms derived from unresolved or unrealized trauma and complicated bereavement such as anxiety or depression and allows a person to escape, if only for a moment. So in a treatment setting, or as a society, we are quick to tell people not to use drugs, but with what are we filling that void? What other tools are we giving to people? At some point, we must start to acknowledge that an individual’s ability to choose, regardless of our own belief, is something that goes to the very core of shifting toward healthier behaviors, to which I believe all people aspire.

Practice makes perfect

Thinking about my own experience and my social work practice, I see that coping is a skill that is built over time. While we can have conversations about genetics, social determinants, cycles of poverty, and systems theory, people learn on an individual level how to treat their symptoms. What I see daily for many people I encounter are people who never learned how to cope; that behavior was not modeled for them. In the absence of learning positive or healthy coping skills, unhealthy patterns emerged to a point that it became pathological.

When we allow people to choose pathways that are right for them, we set them on a journey of discovering recovery and personal growth. Let them define what recovery is rather than parroting a definition that was force-fed to you. Once an individual defines it, walk along with them on their journey as they start to ease into new practices. We ask people who use drugs to change their attitudes and perceptions, but maybe the biggest shift needs to take place in ourselves.