Addiction is a disease, end of discussion . . . right? As practitioners within the field of behavioral health and wellness, we have all heard the message, loud and clear. Many of us subscribe to the concept without question, confident in our convictions that addicts are sick people, not bad people. Some of us have built our careers upon this assertion, while others espouse it personally, within our own lives and family relationships. But when was the last time that we, individually and collectively, paused to view this “addiction is an illness” belief from an alternative viewpoint?
During this past year of unpredictable and unprecedented social dialogue—as our world has been surging with soapbox invitations and water-cooler conversations, all challenging us to “deepen and broaden our perspectives,” to “think again,” and to reevaluate through an equal-yet-opposite social experience—I am feeling bold enough to ask an uncomfortable question: When we say to our clients, “addiction is a disease,” have we considered this statement from all relevant angles, and are we as fully grounded in our position when viewing it through the eyes of addicts’ loved ones?
Consider this story:
Nine years ago, when my husband first started attending Twelve Step meetings, he came home one night with an analogy that made perfect sense. His sponsor (a doctor, incidentally) had suggested that my husband’s sex addiction might be compared to diabetes, a disease that could be managed, but never cured. Ignored and untreated, this sponsor asserted, sex addiction was both progressive and degenerative. Without intervention, this disease would quickly debilitate and eventually destroy my husband’s life from the inside out. But like diabetes, the analogy continued, sex addiction was not an automatic death sentence: if treated with daily attention, consideration, and moderation, both diseases could be survived, resulting in a high degree of fitness and physical function. If my husband took his sex addiction diagnosis seriously, he could live a happy, healthy, sober, and satisfying life. If my husband “gave himself wholly” to his program of recovery, he would experience a daily reprieve from the worst of sex addiction’s collateral damage, driving it into a relative state of passive remission.
When I first heard this analogy, whispered through the words of a woman desperate for answers, I wanted to stand up and cheer for the idea. Once upon a time, I loved the analogy. And to be honest, I still do love it, in certain respects.
But I will be honest about this, too: historically, I have hesitated to purport that analogy in public forums like this one, specifically because I do not love getting sucked into what I call “the great disease debate.” I am keenly aware that, just beyond the realm of traditional recovery models, experts passionately disagree about labeling addiction an “incurable disease.” They argue the pros and cons of comparing addiction to other lifelong and degenerative illnesses, through valuable exchanges that ask (and answer) questions that legitimately should be addressed. Until a few years ago, I stayed out of the fray, declining a hardline alliance to this concept, for one very basic and practical reason: I am not an addict. And because I am not an addict, I do not claim any direct knowledge or conviction about addiction’s impact upon addicts, at least not from any firsthand point of view.
The Scarlet Sisterhood: We Have Skin in the Game
No, I am not an addict, and neither is my average client. But that is not to say I am disinterested, uninformed or uninvested. In my personal life, I am married to an addict. I work my own Twelve Step recovery program—ten years and counting—and I actively sponsor women within that forever nonprofessional role. Career wise, I am a women’s life, relationship, and divorce recovery coach. I am educated, supervised, and certified through The Association of Partners of Sex Addicts Trauma Specialists (APSATS), trained to provide support for women impacted by their intimate partners’ “S” issues, which are infidelity, pornography, secrets, and sex addiction. My husband is a men’s sex addiction recovery coach, and we have had opportunities to work “two-on-two” with other couples and clients. Between these various personal and professional roles, it is fair to say that even though I myself am not an addict, my entire life revolves around issues related to addiction, recovery, and recovering relationships.
In other words, I have skin in the game.
Working in this field, I encounter the “the great disease debate” almost daily. It presents with questions like these:
- Is addiction really an incurable disease?
- Can we compare addiction to illnesses like diabetes, depression, lupus or cancer?
- Is addiction chronic, terminal or both?
- Are addicts born addicts? If not, how did they become addicts?
- Are addicts forever powerless over their drug of choice?
- Can addicts become “recovered,” or will they always be “recovering”?
Until a few years ago, whenever these questions arose, I would ponder them for a moment, then very consciously shift my attention back to the focus of my own practice, experience, and expertise. As immersed as I am in the world of recovery, my primary passion is coaching women through their own unique experiences of their loved ones’ compulsive behaviors, whatever they may be. I certainly do care about a broader range of recovery topics, but women partners will always be my principal point of reference—and my professional point of entry—into conversations like the great disease debate.
Sometime midway through 2015, I finally stopped ducking the great disease debate, choosing instead to face it in a meaningful way, through my instrument of choice—my writing. I stopped resisting my urge to sidestep the issue, choosing instead to jump in. I decided that it was time for me to actively engage the debate from my clients’ side of the aisle, a viewpoint I do passionately and practically represent. That decision gave birth to an antithetical moment, and I was struck by this harmonious personal and professional truism: regardless of how addicts experience addiction, my own experience of addiction is an independent and stand-alone subject. Speaking exclusively from that stand-alone viewpoint, I actually do have an answer to the question, “Can addiction be compared to another disease?”
And my answer—after I second-guess myself for one brief millisecond—is a big, fat, frank, resounding no—not for me, not for us, not for this, not in a million years, not for a million bucks.
Perhaps addicts can compare their addictions to other patients’ diseases, but here is what I do know to be true, an assertion that I am fully qualified to make.
To the world at large, loving addicts does not gain my clients any measure of empathy, acknowledgment or appreciation. In fact, quite the opposite is more often true. Loving addicts emblazons women with a crimson letter of nefarious alliance. It seals them with a ruby-red stamp of embarrassment, isolation, and guilt by association. It inducts them into a scarlet sisterhood, one that is laden with infamous assumptions and inflammatory implications. Not because of anything they themselves have done (or not done)—their socially identifiable “sin” is the act of loving or having once loved the addicts with whom they share their lives.
I understand that women who are partners of addicts are not the focal point for the majority of addiction professionals, so it makes sense that their voices are less commonly addressed within the great disease debate. And yet, for every single addict we treat, counsel or coach, there is at least one more heartbroken soul who is intimately invested and significantly impacted by the damage caused by that person’s addiction. These women are simultaneously victims and survivors; they have earned their spot at the table, and they deserve to have a voice within this evolving dialogue. No, they are not addicts, which simply means they speak from a separate-yet-equal point of view. They may not be the clients who sit in your office, and that is okay, but they too have skin in this recovery game.
As someone who loves an addict and coaches other women who rise to meet a similar fate, I have gained a whole new level of appreciation for Hester, The Scarlet Letter’s signature “woman of scorn.” Hester knew a lot about facing a tough crowd, and some days, I feel like I am right there with her. After all, I am married to a modern-day sex addict and I spend my career with women who carry similar designations of infamy.
Brace Yourself, it is a Jungle Out There
When patients are diagnosed with nonaddiction illnesses (NAI), the world at large is generally compassionate, caring, and concerned, both toward patients and toward patients’ significant others. They champion these patients’ prognoses for recovery, no matter how small the likelihood for success. But when patients are “drunks,” “junkies” or “sex addicts,” the world at large can be judgmental and shaming and blaming—even if it is not politically correct. They often assume the worst outcomes, belittle past successes, and distance themselves from the addicts and their closest loved ones.
When patients are diagnosed with NAIs, nobody is likely to urge their spouses, “Just leave the sicko!” “He is putting you through hell!” “What are you waiting for?” or “You deserve better!” But many people would tell women who are partners of recovering addicts exactly that. For these women, it is obviously painful to hear such comments from the world. But in the face of those hurts, women can always reach out to their close friends and family, seeking comfort from those they know will understand . . . right?
Imagine how much worse it gets when negative assaults are launched and landed closer to home? Imagine patients being met, in their deepest vulnerability, by uncaring coworkers, uncompassionate relatives, and unconcerned members of their faith communities? Imagine their discouragement when undertrained professionals—clergy, counselors, coaches, therapists, doctors, social workers, educators, law enforcement officers—regard their loved one’s addiction as a “moral failure,” an “unfortunate mistake” or a “bad habit.” Imagine how much it hurts when others assume that women who love their addicted partners either caused the problem, enabled the problem or are pathologically addicted to the addict?
Suddenly, in those scenarios, partners of addicts do not experience addiction as a condition that solicits much (if any) understanding, either from the jungle “out there” or from within their own inner-circle networks of support. They are more likely to feel abandoned by those they once trusted, who expect them to somehow “suck it up” and “figure it out” on their own.
Enter Ground Zero: Home is Where the Hurt is
For women who love an addict, it is acutely painful to be alienated from their old inner circles. But in response to that loneliness, they can always bunker down, tune it out, and cling to the one other person beside them in the trenches. Surely they can draw support from the one other human stuck right there with them, the one with whom they actually share this proverbial hellhole? Perhaps nobody “out there” gets what they are facing, but even though their partners caused this mess in the first place, surely the addicted party can appreciate how fiercely these women are digging to get them out of it . . . right?
Imagine these women, already devastated by the effects of their loved one’s addiction, feeling deserted by everyone they assumed would be supportive, only to realize that their two loudest, boldest, most vicious critics are impossible to escape. They are inextricable from the crisis itself, residing at its very epicenter. Perhaps you have seen this happen with a client in session: there is a sickening silence that accompanies the moment she recognizes those two cruel voices: they belong to her addict (bad just got worse) and to herself (worse just got incomprehensible).
When patients are diagnosed with NAIs, very few blame their intimate partners for “making them sick,” “making it worse” or even for somehow “making it all up.” In most cases, NAI patients are neurologically and psychologically clear minded. They do not often project their pain onto the people they love most. They can consciously empathize with their intimate partners, from initial diagnosis through long-term treatment. NAI patients are usually capable of recognizing, respecting, and validating the way their partners experience the disease; they understand that even though the NAI is ravaging their physical bodies, it is simultaneously attacking their shared life as a couple. NAI patients rarely flood their partners with the emotional burdens of their diagnoses. They often accept help from their healthier partners, and they generally do not resist the very treatments that could save their lives. As NAI patients struggle to eradicate their own diseases, they typically do not push away their partners or shut them out from their recovery processes. Their loved ones’ support means everything to most NAI patients, and they rarely treat their partners as adjunct afterthoughts.
For the women who are partners of recovering addicts, this experience is painfully and profoundly different. The addicts’ voices become the first critics these women struggle to escape. Unlike NAI patients, addicts often accuse their partners of imagining, exaggerating or misconstruing symptomatic reality—it is common for addicts to gaslight, dismiss, and deny their partners’ experience of addiction; it is one of the classic mechanisms by which addiction survives and thrives. Recovering addicts often dismiss or deflect their partners’ legitimate pain, projecting their most unbearable emotional issues—shame, anxiety, grief, regret, fear, powerlessness, trauma, withdrawal—onto their loved ones, unaware that their partners are feeling many of the same emotions. Addicts often resist, resent, and reject any outside intervention, even when their lives are hanging in the balance. And sadly, addicts often minimize the value of their partners’ care or commitment, considering it a peripheral (sometimes even counterproductive) influence to their recovery. As a result, partners often feel diminished and demoralized, rejected by the very ones they are trying, against all odds, to love and support.
Remember, I said there were two voices that call Ground Zero “home” for my partner clients. That second voice (their own) resides with them 24/7 as their very own, in-house judge, jury, and executioner. Addiction can wreak havoc on their inner dialogue, using it as catalyst for searing self-doubt and paralyzing confusion. This voice echoes all of the “out there” assumptions, but it also interjects a few choice phrases straight from purgatory: “How stupid are you?” or “This is your fault; I told you not to marry him.” This voice borrows material from these women’s deepest insecurities: “You never lost that baby weight,” “You are just like your mother,” “If you were less needy, he would come home more often.” To complicate an already confused situation, this voice is quick to contradict itself: “You know you do not believe in divorce, but if he does it one more time, then you should definitely leave him.”
The bottom line is this: there is no ammunition this voice will not engage, and there is no source of shame it considers off-limits. When women love addicts, it is easy for them to lose their own emotional bearings, no matter how fully they maintain their sense of self. This “voice-of-reason turned instrument-of-insanity” is one of the paramount reasons why.
Relapse, Remit, Redux
For my last point, I am going to address the transition between remission and relapse. As I watch my clients healing from sexual betrayals, this is the factor that most distinguishes partners’ experiences of addiction from other forms of NAI recovery. Relapse is the bell that often sounds that intractable “death knell,” that final, echoing, agonizing note that declares to my clients (and to me, as their coach) that addiction manifests in ways that cannot be lumped together with other health-related analogies.
Let us break this down: when an NAI returns to patients living in remission, we attribute that resurgence to the NAI itself. When addiction returns to people living in sobriety, we attribute that resurgence to the addicts, not to the addiction. When an NAI “comes back,” we blame the disease, not the patients. But when addiction “comes back,” we blame the addicts; they become the bearers of failure and fault. When NAI patients slip from remission into relapse, that setback rarely involves lying, hiding, betrayal, infidelity, abuse, financial loss or legal complications. By comparison, when addicts slip or relapse, it usually does include all of that. When an NAI returns with renewed vehemence, it is rarely accompanied by acts that undermine patients’ most intimate relationships. When addicts return, however briefly, to their drug of choice, they rip the scabs from their partners’ deepest hurts. The actions of addicts refuel their partners’ most desperate fears and resurrect their most unbridled anxieties. They betray whatever fragile trust these partners have begun to place in recovery, contradicting every sliver of hope they have been holding on to.
Worst of all, when addicts slip or relapse, they induce a complex trauma response (along with other kinds of serious psychological injury) within the life of their recovering partners. Slips and relapses are deeply retraumatizing, and they compromise every ounce of healing partners work incredibly hard to secure for themselves in the first place.
No Fault, Just Default
To be fair, I have known a few addicts who, like most NAI patients, are capable of empathizing with their partners, even in early recovery. But more often, if and/or when addicts do develop empathy for their partners, it is a process that occurs several years into recovery and sobriety, and/or as the direct result of highly skilled coaching or therapy, provided by a trauma-sensitive professional.
Here is an important side note: this commentary is not about fault or blame, and if there is one thing I am definitely not suggesting, it is that addicts deflect or inflict their partners’ pain deliberately. In my experience, very few addicts intend to hurt or harm their partners, motivated by any form of callous maltreatment or malicious resolve. On the contrary: in most cases, deflection and infliction seem to be the automatic, inadvertent, and default dynamic of early recovery. It happens most prolifically while addicts are sincere about recovery, but not yet strong in their sobriety. It happens before addicts are sober-minded enough to manage their emotions in positive, nonmedicated ways. It happens when addicts are legitimately afraid of worsening an already unbearable situation, terrified of pouring more salt into wounds they inflicted in the first place. Some addicts operate from extreme modes of self-protection and self-preservation; they are hyperfocused on maintaining sobriety at any cost, indifferent to the fact that relationships rarely survive that distinctive brand of egoism. Other addicts devolve into naïve forms of traumatizing behavior, operating from the belief that, by doing certain things, they are actually helping, loving, and protecting their grief-stricken partners.
Regardless of their motivation, recovering addicts make many of the same common (albeit unintentional) mistakes: they force emotional distance, withhold pertinent information, censor painful disclosures, control relational narratives, confuse healthy priorities, and withhold emotional intimacy. At some point in recovery, many addicts begin to understand the pain they have caused their intimate partners—and that is a very good thing! But until they learn how to accommodate their partners’ traumas in ways that effectively serve to heal the pain (not to alleviate the guilt), addicts are highly prone to contradict, invalidate or shut partners down entirely, violating their most tenuous emotional vulnerability.
Not Better, Not Worse, Just Decidedly Different
Here is another quick but important disclaimer. Addiction and NAIs are both very personal; there are obvious exceptions and contradictions to every possible generalization. No two patients—even two patients with the same disease—are exactly alike. The same NAI can present itself as “apples” one day, and “oranges” the next, dependent upon a variety of factors that affect its development. Likewise, comparing two different addictions, or even two manifestations of the same addiction, provide an almost unlimited spectrum of variety and specificity. In these equations, there are no absolutes, no clear declarations that defy all potential for irregularity. With respect to that, I have taken care to qualify these comparative dynamics as “typical” or “common,” and I avoid making unconditional conclusions on behalf of anyone but myself.
If there is one other thing I am certainly not saying, it is that addiction is either better or worse than any other NAI. What I am saying is that addiction is definitively different than its comparative NAI counterparts—if not to addicts, then at least when viewed through the eyes of their traumatized partners. For partners, the battle against addiction is unique, distinct, and utterly incomparable in ways that genuinely, legitimately count.
Where Do We Go From Here?
My outlook on my clients’ recovery is predominantly positive, and thanks to an incredible network of colleagues, I know I am not alone in my assessment. In many cases, partners who love (or have loved) addicts go on to lead rich and recovering lives. Partners heal deeply, love passionately, and dream with renewed meaning and hope and confidence, with remarkable capacity for posttraumatic growth. Partners survive whatever crises thrust recovery into motion, and they thrive within lives that are stronger and more resilient as its direct result. And though it may not be obvious from this specific commentary, I dedicate much of my writing to the beauty that is born in the aftermath of addiction’s darkest hours.
As far as I am concerned, the great disease debate is one very important piece of a larger, multifaceted mosaic. In the grand scheme of things, I am striving to communicate so much more than one simple, albeit significant, compare and contrast exercise. Assuming there is a moral, mission or mandate to be drawn from all of this, it is that our world needs more professionals willing to recognize the challenges faced by partners of addicts—these very same partners who, along with our help, courageously battle both external and internal complexities.
In my own life, it is this mosaic that creates synergy between my personal and professional endeavors. I did not begin my life in recovery to sit around and wait for outsiders to work on my marriage; neither did I begin my work as a partners’ coach to sit around and wait for other advocates to pick up my megaphone.
Instead of sitting and waiting impatiently, I am fast becoming energized by diving right in and saying important things. Inspired by the unmet needs I see around me, I have morphed into a woman of editorial activism. I am done sitting by the sidelines and listening to crickets in lieu of a genuine, multilateral dialogue. I am shouting this message from my proverbial rooftop, seeking to advance the presence, purpose, and profiles of my most courageous and inspiring clients. I am transmitting my clients’ cries for help across our virtual health-and-wholeness stratosphere. I will not stop writing on behalf of my clients, this scarlet sisterhood for whom I so passionately advocate—not until my clients’ message is echoed throughout our community of addiction, recovery, and relationship practitioners.
However, here is the tricky thing about mosaics and missions and mandates: they do not materialize into anything through wishing or wanting, and they rarely gain traction when isolated to polite conversation. Without an intentional, communally orchestrated, trauma-sensitive strategy for reorienting conversations like the great disease debate, there is a deafening silence that will roar throughout much of the addiction recovery field. Furthermore, this is where partners of addicts will land in their moments of crises, desperate with needs to hear and be heard, and this is the narrative from which our clients will learn what addiction and recovery are all about.
This is also where you come in. As driven as I am to make a significant difference, there is no way I can do this alone.
Our Tasks: Dialogue, Demystify, Destigmatize, Deconstruct
It is quite practical, if you stop to think about it. As professionals who stand in support of our clients, we are uniquely positioned to influence this dialogue. We are shaping the future of our vocational field (either intentionally or incidentally), steering it toward whichever direction we want to go next. We are also setting the standards (either actively or passively) for our world of behavioral health and wholeness. All of that means that we have the power to begin overhauling this crimson icon of social derision, moral division, and relationally based incrimination.
Fully on board, but not sure where to start? Take a look at these ideas:
- As we circulate within our professional networks, let us dig into the dialogue—not only about this topic, but about whichever topics we find irresistible or irrepressible. In other words, let us start talking, listening, and processing those conversations, as deeply and broadly as possible—and let us stretch ourselves to initiate dialogue with those we know hold a very different viewpoint.
- As we educate our clients about addiction and its impact upon relationships, let us aim to demystify (not dilute) the keys to successful recovery paradigms. In other words, let us refuse to “dumb down” principles of solid recovery work or summarize addiction into pithy soundbites, simplistic similes or too-easy rhetoric.
- As we further social awareness about these issues, let us work to destigmatize the experience of those who love (or once loved) addicts. In other words, let us work to empower our clients to opt out of judgment, indictment, and guilt by association. Let us seek to spare our clients the brunt of popular external recrimination and internal incrimination. Let us seek to honor the unseen heroism of these individuals, knowing that they traverse an intimidating and unforgiving emotional landscape.
- As we disseminate popular truisms (i.e., “addiction is a disease, not a death sentence”), let us be willing to deconstruct those statements, layer by layer, challenging them for accuracy, veracity, and viability. As we seek to reframe topics like the great disease debate, let us frequently pause to clear our own filters (personally and professionally), from the most permeable to the most impenetrable. Let us seek to recalibrate the key applications through which we treat or counsel or coach—first as helping professionals, because we owe that to our clients, and then as human beings, because we owe that to ourselves.
Our New and Improved Scarlet Letter
For those of us who work in an addiction-related field or capacity, we often stand directly upon that invisible line of demarcation, the boundary that clearly separates “ground zero” (our clients’ private experience of recovery) from the “jungle out there” (the rest of the world).
But humor me for a minute, and think about this: What if that line was not so invisible, and what if increased visibility was actually a good thing? What if our clients knew that we were fully invested in their well-being, rallying for their success on both sides of that border as watchers and witnesses? What if we held both sides sacred on our clients’ behalf?
If we are going to make a case for revamping our scarlet symbolism, let us make it stand for something more inspiring than “A” for “addiction.” If we are going to bear a new standard for the whole world to see, let us make it something progressive, profound, and proud. Let us use our new mantle to clarify, amplify, and unify our voices, rising to meet the challenges we will continue to face on behalf of our clients—regardless of how our world continues to shudder and shift.
I can think of a few alternative “A” words—nouns, verbs, and adjectives—titles that might effectively replace our default use of “A” for “addiction.” But in honor of this work (and those of us who do it), I am going to propose a label that seems altogether appropriate: I am reclaiming the scarlet letter “A” for “advocate.”