Radicalizing Recovery: Addiction, Spirituality, And Politics

Morell C

Soc Work

Vol. 41 No. 3 May.1996


Copyright by Soc Work

RADICALIZING RECOVERY: ADDICTION, SPIRITUALITY, AND POLITICS Treatment centers and self-help recovery programs promote individual solutions to substance abuse through changing dysfunctional behavior and relying on spiritual beliefs and practices. The root problems are understood to be diseases within the person. However, the social conditions implicated in causing the addiction remain unaddressed. Although class, race, and gender do not predict substance abuse, many people entering clinics are from disempowered groups. Can social workers bring recovery and social justice methods together? What can radical social workers in the addiction-recovery industry do? Key words: addiction; politics; radical social work; recovery; spirituality The interdependency of all individuals and organizations makes the elimination of addiction contingent upon basic social change. --Stanton Peele, Love and Addiction In their insightful critiques of therapeutic and spiritual solutions to addiction, feminists and other progressive political groups view such solutions as reformulating social issues ideologically to avoid political analysis and action (Dietz, 1991; Lerner, 1990; Rapping, 1993; Tallen, 1990; Walters, 1990). "Recovery thought," a worldview perpetuated in substance abuse treatment centers and self-help programs, assumes that current social and economic arrangements work for the general good; therefore, the addicted person must change. Social institutions that may cause and sustain substance abuse are not challenged: "The dominant culture is not threatened by sick people meeting together to get well" (Lerner, 1990, p.15). Yet people are entering treatment centers and self-help programs in unprecedented numbers. In the 1980s the concepts of addiction ("the compulsive use of a chemical and its continued use despite adverse consequences," Straussner, 1993, p. 4) and recovery ("the behavioral and emotional change toward health and growth," p. 352) gained popularity. In the 1990s addiction treatment is a rapidly expanding industry, and recovery is the fastest growing social movement in the United States. In fact, many individuals live better lives because of their involvement in these activities. However, if social workers in the addictions field do not want their role limited to what social work pioneer Florence Kelley called "the wrecking crew"--those called in to clean up the damages the economic system perpetrates and perpetuates--politicizing treatment is necessary (Morell, 1987). Although class, race, and gender do not predict addiction, many people entering clinics and joining recovery groups are from disempowered groups: women, people of color, unemployed and underemployed people, and poor people. Tena Okun ( 1992), training director of Grassroots Leadership, articulated the frustration felt by social justice activists: "These should be our people. . . . So what is going on? Why aren't these same people flocking to our movement, to our organizations, to our causes?" (p. 45). I live with this polarization of personal solutions and political explanations as a radical social worker in a hospital-sponsored outpatient chemical dependency clinic. With a foot in each world, I constantly wonder how these apparently opposite approaches might be integrated theoretically and practically. This article seeks answers to the question, What can radical social workers in the addiction-recovery industry do? Definitions The word "radical" may conjure up widely different images and meanings. Because radical people are portrayed negatively in the popular culture, the term may scare or repel some social work practitioners and clients. Because of the stigma associated with the word, a more neutral term, "progressive," has recently gained currency among reformers and social change activists. I am comfortable with both terms and use them interchangeably and in a broad, inclusive way in this article. Radical social workers are not a homogeneous group; they disagree about such matters as how individual and social transformations occur, whether social workers should work inside or outside of society's welfare institutions, and the character of fundamental sources of oppression (Mullaly & Keating, 1991). Progressive social workers are united by their critical view of central social organizations such as capitalism, patriarchy, and institutionalized racism and the unnecessary human suffering they foster (Mullaly & Keating, 1991). These social workers share a vision of collective responsibility for both individual and social well-being and a "commitment to human equality" (Marable, 1993, p. 21). Although both radical and conventional social work attend to the alleviation of individual symptoms, radical social work pays more attention to oppression, that is, to the economic and political causes of personal problems. A Sociospiritual Approach Spiritual and political worldviews offer two vast and profound modes of understanding experience, and each knowledge system contains both empowering and disempowering tendencies. Social workers can blend the liberating aspects of both worldviews to promote individual and social well-being among each other and their clients. Whereas a political view directs attention to the material social organization of human life, a spiritual conviction directs attention to an experience that is before and beyond human social organization. Without a holistic perception that encompasses both the social and existential dimensions of experience, "we are without a sense of ourselves entire" (Rodriguez, 1994, p. 11). The concept of interconnectedness brings together the reformative trends found in these seemingly contradictory approaches. At the center of most great spiritual traditions (not specific religious ideologies) is a belief that human beings are united as expressions or emanations of a central energy or principle--Spirit. Creator. God. Goddess. Divinity, Force, Living Principle, Source, Life, Love. The recognition of humankind's fundamental relatedness motivates progressive political activity. "An injury to one is an injury to all" is a common phase heard among progressive social workers. Conviction about human interconnectedness provides will and courage to go against the grain in a culture that is committed to separating people by class, race and ethnicity, gender, age, and sexual orientation. Divided, people suffer individually and collectively as they experience personal separation and oppression, both of which relate to addictive behavior. Yet substance abuse treatment and 12-step programs acknowledge and deal only with personal separation. Recovery programs such as Alcoholics Anonymous and professionally facilitated skills training and therapy groups break the emotional isolation between people. People in these groups cross diverse cultural and social boundaries and find their common humanity. These groups do not struggle to end exploitation and the social realities that relate to addiction, including unemployment and underemployment, homelessness, and inhumane urban conditions. Workers and clients alike see these problems as so intractable that action in this realm is perceived as a waste of time and energy. Some see the Serenity Prayer ("God, grant me the serenity to accept the things I cannot change. . .") as an injunction against social action. Thus, thorough recovery is derailed because attention is narrowly focused on personal solutions. However, progressive social workers in addiction settings can help redress this imbalance by incorporating political education and opportunities for political action into all their activities. Social workers can change curriculum and counseling strategies to include consciousness-raising tactics that highlight humankind's interconnectedness and the necessity for collective action to change social circumstances hostile to recovery. Social workers can adopt Brazilian educator Paulo Freire's not-so-humble suggestion made at the 1988 World Conference of Social Workers: "The role of the educator, the dream of the educator, is the permanent transformation of the world" (cited in De Maria, 1992, p.146). Working with Groups Without political education, addictive behavior is decontextualized. Historically, consciousness-raising groups provided participants with conextualized experiences. Social workers engaged with oppressed populations in a variety of settings continue to promote this time-honored approach to helping people make connections between personal troubles and social issues (Gutierrez & Ortega, 1991; Home, 1981; Longres & McLeod, 1980; Morell, 1987,1988; Simon, 1990). Popular in the 1960s and 1970s, feminist consciousness-raising groups embodied many of the characteristics of today's self-help groups. While sharing their personal experiences, women obtained psychological help, positively redefined stigma, and increased self-esteem and self-acceptance in an environment that offered support and a nonjudgmental atmosphere (Home, 1981). In the conservative climate of the 1980s and l990s, women's groups took an apolitical turn, introducing skills training as an approach to change. Skills training for both women and men continues today in substance abuse clinics in groups that address issues such as assertiveness, feelings identification, and self-esteem. Groups also offer opportunities to discuss the dynamics of power. However, unless such training explicitly deals with power, political realities are reduced to personal deficits and social relations are diminished to communication styles (Morel!, 1987). once personal issues are seen in light of power differences, skills training is expanded to include building competencies as social change agents. For example, when learning assertion skills, collective role playing is as important as individual role playing. Participants can practice ways to assert their needs as a group at their workplace, perhaps for a drug-free environment, safer working conditions, or more flexible hours. In skills-training groups, social workers also can educate politically through sharing their progressive perspectives. For instance, one substance abuse prevention program I worked with targeted to women working in the home offered feminist-oriented minilectures. one lecture, called "Doing Good and Feeling Bad," summarized the work of feminist psychologist Jean Baker Miller ( 1976), who pointed out that women are assigned the role of giving, which is not recognized as a real activity and is often punished, devalued, and denied, leaving women feeling bad. Helping others develop is seen as not doing anything; working is the only activity that is directly self-enhancing. The progressive value orientation was made clear--everyone, men and women, must be givers and receivers, and ultimately, power must be shared equally. The women in the group not only learned new skills, but also apprehended a possible new self-definition that moved beyond a "woman's proper place." The essence of feminist consciousness is this "apprehension of possibilities" (Bartky, 1977, p.25). Through bibliotherapy social workers can introduce clients to progressive writers of all colors, ages, genders, classes, and sexual orientations; for example, bell hooks's (1993) Sisters of the Yam: Black Women and Self-Recovery provides excellent material for presentation to African American women in treatment. Through these writings, clients may see themselves as "an ensemble of social relations" (tykes, 1985, p. 364) and may think about how their identities are constructed from social experiences, including the dynamic of class, race and ethnicity, and gender. Another way to stimulate thinking about social variables related to addiction is to use "guided inquiry" in group work (see Enns, 1992). Questions about how gender socialization (or social class location or ethnic and racial background) affects present feelings and experiences can be explored by guiding discussion around topical queries. For example, in the blanks in the following questions could be substituted such words as male, female, gay, lesbian, African American, Latino or Latina, poor, working class: "What did it mean to be-----in your family?" "What direct and indirect lessons did you learn about being --------?" "What happened when you deviated from gender role norms?" "How does your drinking or drugging behavior connect to your identity as-------?" "How is your personal pain connected to being--------?" "How is your personal happiness connected to being--------?" Such questions increase awareness of how social inequality and socialization interact with substance abuse problems. Working with Individuals Although social workers live in a world of diagnostic manuals, third-party payments, and medicalized language and practices (Poppendieck, 1992), radical workers can engage in political practice when assessing and counseling clients. Because common assessment procedures tend to locate the source of addiction within the client rather than within the interaction between the person and his or her surrounding context, progressive social workers can use the dialectical method of therapist Marsha T. Linehan (1993) to restore missing parts to the historical formation of addiction: Dialectical assessment requires that the therapist, along with the patient, constantly look for what is missing from individual or personal explanations of current behaviors and events. The question always being asked is "What is being left out here?" The assessment does not stop at the immediate environment or at the historical family or other past learning experiences (although these are not ignored); it also examines social, political, and economic influences on the patient's current behavior. (p. 218) How social workers interact with clients in individual sessions makes a difference. Clients and workers can join together in dialogic relationships in which clients are given choices and share in assessments. Motivational interviewing, a nonauthoritarian approach to helping individuals discover their own motivations and resources to overcome addiction (Miller & Rollnick, 1991), seeks to be democratic in spirit. Rather than labeling clients "resistant" and confronting their denial, Miller and Rollnick used five general principles in their work: express empathy, develop discrepancy, avoid argumentation, roll with resistance, and support self-efficacy. In motivational interviewing worker and client become "co-investigators linking client thoughts, feelings, and behavior to the problem situation" (Carniol, 1992, p. 12). As with Linehan's (1993) dialectical method, motivational interviewing provides opportunities to link the subjective experience of substance-abusing clients with the primary structures of oppression. In their roles as brokers and advocates, social workers can refer clients to community resources for political education. For example, at the University of Buffalo, the Introduction to Women's Studies course is offered through the continuing education department. The class is educational and therapeutic, and others like it could be wonderful resources for some clients. Promoting an Engaged Spirituality Among radicals, the lack of appreciation for the spiritual emphasis in recovery programs is based on connection of the term "spirituality" to organized religion and theology, the understanding that specific religious beliefs exclude many who need help, a sense that "otherworldliness" precludes necessary politicization of this life, and fear of the power of right-wing religious ideology. These are real concerns, but they are not factors inherent in recognizing a spiritual dimension in life. Many recovery programs do not attempt to impose a narrow belief system on people. Whether thought of as God or as the vitality that results from communing with others, spirituality can inspire and sustain people to move beyond external and internalized oppression. Many people in substance abuse treatment are dispirited. Beliefs and experiences that connect them to others and challenge discouragement can be thought of as spiritual; they invigorate and empower people. Although organizations and leaders may exploit religion and use the term "spiritual" for their own enrichment, there is also evidence that people seek a deeper dimension to life. People draw on this dimension for satisfaction, understanding, and comfort. Rather than simply resisting spiritual discourse, progressive social workers can overcome the false separation between politics and spirituality by focusing on interconnectedness. The goodness-of-fit between spiritual and political activities is displayed by the many people who enter the social justice movement because of their religious affiliations and spiritual beliefs. The congeniality of worldviews is also demonstrated in the writings of many people of color for whom spiritual beliefs and activities play a central role in the struggle against racist oppression. With the current emphasis on respecting diversity, social workers must honor the important role that spirituality plays in the lives of people of all cultures (De la Cancela, 1991; Gross, 1993; Gutierrez & ortega, 1991; hooks, 1990; Marable, 1992). African Americans addressing addiction may provide a model for radicalizing recovery. Spirituality, along with African American history and communal values, is an indispensable tool for resisting and overcoming slavery to drugs and genocide. For example, Reverend Cecil Williams (1992), minister of Liberation at Glide Memorial Church in San Francisco, founded an innovative recovery program that combined individual healing and social change. In the late 1980s more than 600 people marched on Valencia Gardens, a troubled housing project in San Francisco, to call gut the good news of recovery to the people addicted to crack cocaine who lived there. Each marcher was committed to absolute, unconditional acceptance of the people they met there. Marchers brought "paintbrushes and gallons of paint. others bore heaping plates of fried chicken and potato salad" (Williams, 1992, p.29). They arrived carrying banners declaring their nonviolent battle cry, "The User Needs Recovery," and "Welcome Home to Recovery," and they sang songs of freedom. Marchers surrounded the project and, using bullhorns, shouted to those inside, "C'mon down. Join us. It's recovery time. We know who you are. You are our sons and daughters. It's time for you to take control of your lives" (p. 29). one by one, as people slowly came out of the projects, they were put on the stage and given a microphone. They talked. They ate homecooked food. They agreed to come to the church. Williams (1992) articulated a new way to think about recovery that involves four steps: (1) recognition (not powerlessness), (2) self-definition (not society's definition), (3) rebirth (facing the pain and telling the truth), and (4) community (moving further into relationship with people of all colors). Political empowerment is the only route to recovery, and this empowerment is braided with spirituality. Social workers in conventional substance abuse programs need to know stories such as this one. At a minimum, social workers can discuss them with colleagues and clients. Those who dare may be inspired to organize similar outreach efforts. Collaborating at the Policy Level he availability of substance abuse treatment for those who need it. The number of facilities has never been adequate, and with the growth of managed care, insurers are reducing benefits, causing clients to be prematurely terminated from treatment. Yet this crisis provides an excellent opportunity for progressive social workers to engage in political struggle on the health care issue. Colleagues or clients who might not ordinarily engage in political action are more likely to become involved by writing letters and signing petitions to government representatives. Workers could attend public hearings and give testimony of their need for a comprehensive continuum of health care services. Workers could talk about this issue in the groups they facilitate and in this way empower the addictions community to effect history. Another policy issue is the question of what constitutes treatment. Part of the hesitancy to fund lengthy treatment is based on the medical model of addiction (Institute of Medicine, l990). Most substance abuse programs provide psychosocial services along with medical care. Health care insurers do not view skills training and psychoeducational groups as medical care and are unlikely to do so unless evidence of their effectiveness is shown. However, some of the most creative programs, like the one at Glide Memorial Church, lack evidence of effectiveness because of the lack of evaluation of treatment processes and outcomes. Radical social workers can advocate for more alternative programming together with funds for research (Institute of Medicine, l990). With empirical data in hand, the collective clout of addiction staff can alter the definition of treatment. Conclusion People's lives are made through both subjective and objective transactions between inner and outer realities that are constantly developing processes rather than static structures (Linehan, 1993). A person is not an isolated individual but an ever-changing "self-social unity" (Lichtenberg & Roman, 1990), both an object of the prevailing social order and a subject able to move beyond it (Mullaly & Keating, 1990). People construct themselves out of social experiences, including the dynamics of class, race, and gender. Such factors may be associated with negative self-understanding related to prejudice and limited opportunity. The personal self is injured by the social world. Self-love requires transcending this injury. Spiritual traditions and practices provide ways to experience self beyond self-hatred, but such practices do not eliminate the external causes of self-loathing. In the sociospiritual approach advocated in this article, addiction is seen as a deficiency in spirit and in power. The medical aspect of addiction is not denied or ignored but is instead understood not to be all encompassing. 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Accepted November 4, 1994 ~~~~~~~~ By Carolyn Morell Carolyn Morell, PhD, is assistant professor, Social Work Program, Niagara University, Niagara University, NY 14109. The author thanks Nancy Smyth and Jan Palya for their assistance with this article. -------------------