Tag: language

  • AA's "How It Works" for Everyone

    AA's "How It Works" for Everyone

    Women have had to endure a generic “He” for God all these years. I am not rewriting the Big Book. I am simply asking for a moment to honor my God as a She; for a moment of freedom to express my God as I understand God.

    After attending AA meetings for 12 years, I picked up a coin this month celebrating ten years of continuous sobriety. Throughout my sober years, when asked at meetings to read “How it Works” from the AA Big Book, I sometimes replace “He” with “She” for the word “God.” Recently, an old-timer in my AA home group became highly offended when he heard me read my “She” version of “How it Works.” My improvisation became such an issue that it was put on the agenda at our home group’s monthly business meeting. A motion was presented to place wording at the top of “How it Works” stating, “Please read as written, do not make changes.” After much discussion, members of my home group decided not to make this change to our meeting format. Whew! How interesting! 

    As with any issue in recovery, I learned from this experience. I learned that people get offended at meetings! Ha. We can’t please everyone. I mean, I get offended at meetings, but I just accept things and go on. If I do not like the way a meeting is held I move on to another one. “Attraction, not promotion.”

    Thanks to my messing with pronouns, I find that I am no longer asked to read at AA meetings very often. Yes, the whole Big Book is written in He/Him-antiquated-patriarchal-Bible-form and I accept this. I mean, I got sober underlining everything in red that pertained to me as I worked my first step not caring about the gender terms! I simply did what my sponsor asked me to do. The pronouns were not important at that point. What mattered was that I did and do identify with the men who shared their message. Yet still, today, when asked to read at a meeting, I feel it causes no harm to insert She/Her instead of He/Him for my God. Women have had to endure a generic “He” for God all these years. I am not rewriting the Big Book. I am simply asking for a moment to honor my God as a She; for a moment of freedom to express my God as I understand God. That is all.

    Lately I have begun using a gender-neutral term for “God.” Instead of saying “He” or “She,” I simply say “God as we understand God.” For truly, I have experienced God as a spiritual man, as a spiritual woman, and most recently as pure divine spirit, with no gender identity at all. How could GOD be reduced to a He or a She, to a mere sexual form? Hence, my favorite definition of God is “Group Of Drunks.” Namaste: “The Drunk in me greets the Drunk in you” (the sober drunk, of course). I see GOD in all of you at meetings! It is my favorite vision! I love you all so much!

    I have to remember that “love and tolerance is our code.” If an old-timer is offended because I say that I have made a decision to turn “our will and our lives over to the care of God as we understand Her,” umm, hey, imagine what it took for me, a Hindu, and a lesbian, and a woman to read through the patriarchal (with Christian overtones) Big Book of Alcoholics Anonymous! I am so, so grateful that my homies love and tolerate me enough to let me be me and accept me for who I am! As the Third Tradition of AA says, “The only requirement for AA membership is a desire to stop drinking.” And Tradition One calls for UNITY. That means members are given the freedom to think, talk and act. No AA can compel another to do anything. Nobody can be punished or expelled. Our traditions repeatedly say, “we ought,” never “you must.”

    I have to remember that we are evolving. I believe the AA founders, Bill and Bob, left room for change when they wrote on page 164 of the Big Book: “Our book is meant to be suggestive only. We realize we know only a little. God will constantly disclose more to you and to us.”

    Today, there is a new updated version of “How it Works” created by Hillary J and the Sober Agnostics Group. That alternative to the Big Book text is used at their meeting in Vancouver, BC, Canada. There are also two gender-neutral versions of the Big Book available on Amazon: The EZ Big Book of Alcoholics Anonymous Same Message -Simple Language and A Simple Program: A Contemporary Translation of the Book, Alcoholics Anonymous. Neither book was created by AA so neither is designated as “Conference Approved Literature” by the AA General Service Office (GSO). It is important to remember that the term “Conference Approved” has no relation to material not published by GSO. AA does not tell any individual member what they may or may not read. Each group is autonomous and is free to decide what material is read at the group level.

    Offending someone at a meeting drove home the point that I’m a drunk, plain and simple. I just want to get and stay sober, that’s all. I learned that I am not the only one who replaces “He” with “She” when reading AA material. Many other people are doing this and changes are being made to the literature. Someday, we may see changes to the first 164 pages of our Big Book.

    I have learned that God is beyond gender – and it is comfortable to refer to GOD as simply “God” instead of a He or a She. For me, God is pure divine spirit. Close the eyes. Feel GOD now. Pure Divine Love! God is Love! I love loving God, plain and simple. I love feeling Shiva embracing his beloved Devi in divine union. Sigh, bliss. This breath, here, now. 

    I also learned that AA has evolved enough to publish a new pamphlet already approved in British AA called, “The God Word: Agnostics and Atheists in AA.” There is a quote in this pamphlet that Bill W. wrote in 1965 that says: “We have people of nearly every race, culture, and religion. In AA we are supposed to be bound together in the kinship of a common suffering. Consequently, the full individual liberty to practice any creed or principle or therapy whatever should be a first consideration for us all. Let us NOT, therefore, pressure anyone with our individual or even our collective views. Let us instead accord each other the RESPECT and LOVE that is due to every human being as he tries to make his way TOWARD THE LIGHT. Let us always try to be INCLUSIVE rather than EXCLUSIVE; let us remember that each alcoholic among us is a member of AA, so long as he or she declares.”

    I love the program of Alcoholics Anonymous. I love that we keep evolving and changing. I love that we get to ask questions. Here’s one more (ha ha): Why do we close some meetings with the Lord’s Prayer? I’ll have more to say about that topic later. That’s enough for today. Peace and love to one and all.

    View the original article at thefix.com

  • My Journey from AA to NA, with Stops Along the Way

    My Journey from AA to NA, with Stops Along the Way

    While making my own transition from one fellowship to another, I interviewed people with experience in both AA and NA to find out what’s working for them, and what’s not.

    For a long time, I considered myself an alcoholic with drug addict tendencies. This is why, for the most part, I was a member of AA exclusively for the first six years of my sobriety. Besides, where I lived in Connecticut at the time, Narcotics Anonymous meetings were too far and few in between – as is often the case in more rural areas of the country.

    Also, while in AA I’d heard things about that other fellowship.

    Yes, I was fine right where I was, thank you very much. Like my mother and my uncles and my grandfather before me, AA would remain my easier, softer way til death do us part.

    And then I relapsed: a year and a half bender in which my disease had progressed to include cocaine and prescription pills and after which I was detoxing from alcohol and benzos.

    That’s when the rooms of recovery turned strangely uncomfortable.

    I can’t say it was because I was no longer welcome. No, my mutual friends of Bill were there with open arms when I came back from the relapse… As long as I didn’t share openly about the drug problem.

    “I came to an Alcoholics Anonymous meeting,” an old-timer quickly informed me, “because this is where I come to hear about alcohol – not pills!”

    This got me to thinking. (Not about the chapter in AA’s Big Book entitled Acceptance Was the Answer in which an alcoholic physician describes in painstaking detail his struggles with prescription pills. No, why would I think of that? The old-timer certainly wasn’t.) 

    No, I was thinking I ought to give Narcotics Anonymous a try for a while. Not only would I be able to share more candidly about my relapse but I’d have some time to work through the little resentment I’d suddenly copped against AA and its old timers.

    So, I began asking around. I knew the best way to transition between fellowships was to look to the rooms themselves for advice and guidance. I found four people in recovery, each of them knowledgeable about both AA and NA, who were willing to share their experience not only with me – but with you as well.

    About the Personalities:

    “I had been in AA for 11 years and just kept relapsing,” recalled Christy, 45, from the San Francisco Bay Area. Hers was a vicious cycle of diet pills and wine, always using one to offset the other. “I was sure that people were sick of hearing me talk about how I just couldn’t get it. Well I was sick of talking about it, anyway, at least to the same people again and again. It was embarrassing.”

     Taking the advice of her husband – a former amphetamine addict of 15 years – Christy decided to give NA a try.

    The kinship she felt was immediate, not only because she felt able to share more freely in a room full of new faces, but also because “NA’s a little bit ‘roughie-toughie’ and I liked that. NA had more people with missing teeth,” she joked. “There were so many people just totally out of their minds – exactly like me – and everyone seemed ok with it.”

    Three years later, Christy’s bond with NA is stronger than ever.

    “I find myself spiritually connected to that craziness,” she said. “There’s stories of abuse, there’s sharing about the prison time. It helps keep my recovery feel fresh. NA reminds me of how bad it can get out there.”

    For Johnny L., 39, from New England, the NA group in his area had a more adverse effect.

    “Well there I was, a newly clean and sober gay white man in a heavily black, heterosexual, inner city NA meeting,” he laughed. “I really gave it a shot, too, but after about three or four meetings I still wasn’t relating at all.”

    Thankfully Johnny found himself having to move for work to a more rural area within that first year of recovery and along with the change of geography came a new atmosphere within his meetings. Though he considered himself dually addicted (meth and drinking), Johnny ultimately settled into the rooms of AA, finding the comfort of a home group he’s still part of to this day.

    Back in California, Trey S., a 22-year-old addict, compared the members of fellowships like this: “NA is definitely more of a mixed crowd. There’s a lot of diversity, incorporating more experiences with much heavier drugs, and I think there could be stronger personalities in the rooms because of that. This means a lot more opportunities for conflict.”

    As is so often the case with young people with substance use disorders, Trey was introduced to Alcoholics Anonymous through a rehabilitation center at the age of 16. He eventually gravitated towards NA, identifying more strongly with those rooms, particularly young people’s meetings.

    “At the time AA felt more rigorous and less free-flowing. And I think in general NA attracts a younger recovery crowd, which makes sense because of the pill problem these days. I mean, I was on Adderall at 5 years old and I think that’s fairly common for my generation.”

    As for the old-timers, like Red from the West Coast who has been a member of AA for over three decades, it’s often their job to remind us of that tried-and-true adage, principles before personalities, regardless of the fellowship.

    “Whether it’s AA or NA, as long as you’re living your life according to a program of spiritual principles you’ll do okay,” he told me. “It doesn’t matter what gets you into the rooms, but what you do with yourself once you get here.”

    About the Literature

    Of course, changing recovery programs also means a change in the accompanying literature. After six years of study groups, sponsor assignments, and constant references to the Big Book, I had developed a deep appreciation for AA’s “bible” and was hesitant about NA’s basic text as well as the rest of the program’s literary canon. 

    “So many people claim that all the answers are in the Big Book,” said Christy. “But Living Clean – it seems like every time I pick it up, whatever I read feels like it was written just for me.”

    Living Clean is NA’s version of AA’s book, Living Sober, and both address the nitty gritty of living in recovery. Like instruction manuals for the soul and mind of an addict, both publications offer insights on topics such as relationships, aging, failure, and isolation.

    I quickly learned that my AA books had NA counterparts that were just as valuable and respected. 

    According to Trey, “Even though AA’s literature has more program history, it has more character. It actually feels more playful to me – while NA’s stuff strikes me as much more serious.”

    But when Trey does his step work, he combines the books of both fellowships, studying all the information each program has to offer. “They each bring their own material to the table and all of it is important.”

    “But the NA basic text is so much more international,” Johnny told me. “It feels all-inclusive. Through it I get an idea of what it’s like to be an addict in Iran, in Africa, all around the world. It makes the Big Book feel very old. Like an older language.”

    When it comes to step work, Johnny also works with the writings of both fellowships, first reading what the Big Book and Twelve and Twelve lay out and then hitting the NA’s Step Working Guide afterwards.

    This workbook is the most significant difference in program offerings.

    “That thing makes you feel like you’re in a Master Class for sobriety,” Johnny claimed. “It challenges you to think things through more deeply.”

    Finding that the Guide has become such a big part of his recovery, Johnny has begun searching for a new AA sponsor who would be willing to integrate the book and its myriad of intensely provoking questions into his program; a sort of AA/NA fusion.

    Christy felt just as strongly about the Step Working Guide:

    “Going through it reminds me of the kind of effort I put into my recovery at the very beginning,” she said. “My self-awareness is much higher because of it. And I’m sure my recovery is evolving more strongly as well.”

    Like Johnny, Christy found that mixing and matching materials gave her a more balanced and satisfying program. In fact, while Christy’s primary fellowship was NA, she continued to go to one weekly AA meeting.

    As for Johnny, his six meetings a week were equally split between AA and NA (Crystal Meth Anonymous, more specifically).

    Trey was the purist of those I’d talked to, attending only NA meetings.

    At this point in the conversations, I felt ready to start altering my own meeting schedule. Thoroughly advised on what to expect, I was excited to head over to NA and start sharing from the heart again.

    But first I would have to learn how to talk.

    About the Language

    “We are presented with a dilemma; when NA members identify themselves as addicts and alcoholics or talk about living clean and sober, the clarity of the NA message is blurred.”

    From NA’s Clarity Statement, read out loud at a meeting’s start. The gist of the announcement, from what I could gather, was that I was to no longer call myself an alcoholic because: “Our identification as addicts is all-inclusive.”  

    And all I could think was, Here I go again.

    “I was stopped mid-sentence at an NA meeting when I tried talking about the Promises,” said Johnny, referring to AA’s 9th step list of spiritual and material rewards. “I was disappointed in that. It was embarrassing and awkward. I wound up never going back to that particular meeting.”

    Of course, censorship within the rooms goes both ways:

    “I once saw someone completely shut down in AA when he mentioned his struggle with crystal meth,” Trey told me. “The chairperson interrupted him, saying, ‘Sorry, we don’t talk about that here.’”

    That chairperson had been acting in accordance with the Singleness of Purpose, AA’s version of the Clarity Statement: “We ask that when discussing our problems, we confine ourselves to those problems as they relate to alcohol and alcoholism.” Remember the scolding I’d received from the old-timer when talking about the pills?

    “In my first year of sobriety I was going to all the A’s – AA, NA, CA (Cocaine Anonymous),” joked old-timer Red. “I found out real quick that I couldn’t say this or I couldn’t say that, depending on where I went. In NA I couldn’t claim I was an alcoholic, and vice versa in AA and on and on and on. I don’t know about you but in the beginning I just wanted to say what I needed to say in order to get better!”

    Trey agreed. “Sometimes you can feel negativity in the air when the Clarity Statement is read. I worry it stops people from speaking from the heart. I mean, as long as they’re sharing about appropriate behaviors and it’s coming from a loving and caring place, that’s great.”

    About Recovery

    As I compiled all my notes, the quotes and information, I was relieved to find an absence of what I’d feared most. Nowhere in my talks with these four fellow people in recovery did I find any negativity or slander from one fellowship against the other.

    “I’ve always been aware of the contention between AA and NA,” Johnny had told me, “but I’ve been lucky to stay out of it. The groups I go to are small and intimate and I don’t have to hide whatever I may be struggling with, alcohol or drugs. They’re very supportive regardless.”

    Christy agrees: “I can say that both AA and NA are responsible for saving my life and I gladly still participate in both.”

    With Trey, one of the things he’d always admired most about NA is how the program openly acknowledged its roots. “Right on the first page of the introduction of the basic text, Narcotics Anonymous expresses gratitude towards AA for‘showing us the way to a new life.’

    Yes, by the end of my inquiries it was clear that the fellowships of AA and NA can work together well, with a combined effort and goal of unity, service, and recovery.

    View the original article at thefix.com

  • Microaggressions: How Subconscious Biases Affect Recovery

    Microaggressions: How Subconscious Biases Affect Recovery

    An example of a microaggression in the recovery universe: someone from NA asks someone who’s considering Suboxone: “Are you in denial? A drug is a drug is a drug.” No malicious intent is involved, but the fellow member is left feeling disparaged.

    Politics and Religion: we’re encouraged to avoid these conversations, socially. Conviction can escalate to hostility, hurt feelings and polarization, turning a fun-loving conversation into… “Awkward.”

    Has anyone noticed polarization-creep migrating from political intercourse into our addiction/recovery discussion? A diversifying recovery community means different tribes and subcultures with differing views on recovery and addiction. Many Fix readers are members of a mutual-aid group that gives a sense of identity and belonging. Being tribal is human nature; so, what’s the problem? Maybe it’s a hangover from the current political climate but I’m feeling a little microaggression-fatigue. It’s great to cheer hard for the home-team; but does that mean diminishing the other(s)?

    “We tribal humans have a ‘dark side,’ ironically also related to our social relationships: We are as belligerent and brutal as any other animal species,” says author and UC San Diego Professor Emeritus Saul Levine, MD, in “Belonging Is Our Blessing, Tribalism Is Our Burden.” “Our species, homo sapiens, is indeed creative and loving, but it is also destructive and hostile.”

    Levine cautions that for all the psychological good that belonging offers us, “Dangers lurk when there is an absence of Benevolence. Excessive group cohesiveness and feelings of superiority breed mistrust and dislike of others and can prevent or destroy caring relationships. Estrangement can easily beget prejudice, nativism, and extremism. These are the very hallmarks of zealous tribalism which has fueled bloodshed and wars over the millennia.”

    How does “zealous tribalism” present in the recovery community? Abstinence-focused tribes have dearly held views that differ from our harm-reduction fellows. Inside the abstinence-model tribe, it’s not all Kum Ba Yah, either. Refuge Recovery clans, SMART Recovery, Women for Recovery and the 12-step advocates may feel a superiority/inferiority thing that comes out in how we talk about each other. SMART followers may look down on 12-stepping as stubbornly old-fashioned. 12-steppers might see Life Ring or other new tribes as acting overtly precious with their dismissal of tried-and-true methods. Focusing in even more, we see NAs, CAs and AAs each rolling their eyes at each other’s rituals or slogans. In AA, secular members and “our more religious members” finger point at each other about who’s being too rigid and who’s watering down the message. These are examples of what Levine calls “belonging without the benevolence.” Finding “our people” is great. Part of what makes us feel included might also over-emphasize the narcissism of small differences.

    “Meeting makers make it!”
    “That’s not sober; that’s dry. The solution is clearly laid out in the 12 steps—not meetings!”
    “AA’s a cult that harms more people than it helps!”

    These are tribal battle cries—sincerely held feeling based in part on our unique lived experience and in part on an ignorance we’re not conscious of.

    If you love the fight and you don’t care what others think of you, this article might not hold your attention. We’re going to talk about how to get along better. On the other hand, if you see yourself as empathetic and regret falling prey to us vs. them conflicts, let’s talk about cause and corrective measures.

    Recovery professionals curb their own biases through professional practices; we can borrow their best practices to avoid getting defensive or dismissive with people who hold divergent worldviews. If our goal is to connect with others, an increasingly diverse world of others presents challenges.

    “In my early career, I was adamant about abstinence as the only viable solution to alcohol and other drug problems,” recalls William White, author of Recovery Rising: A Retrospective of Addiction Treatment and Recovery. As a historian and treatment mentor, White learned from lived-experience, clinical practice, study and research. His 2017 book advocates for treatment professionals to exercise “professional humility and holding all of our opinions on probation pending new discoveries in the field and new learning experiences. Many parties can be harmed when we mistake a part of the truth for the whole truth.”

    If 100% of my knowledge about harm reduction is from harm reduction failures who tell their story of decline in a 12-step meeting, I could “mistake a part of the truth for the whole truth.” What would I know about harm reduction success stories if I only go to 12-step rooms?

    Treatment professionals are adapting to cultural diversity in their practices. Bound by a Code of Ethics, NAADAC (the Association for Addiction Professionals) has embraced the concept of “cultural humility.” Cultural humility is a fiduciary duty for professionals to be sensitive to client race, creed, sexual orientation, gender identity and physical/mental characteristics when providing healthcare.

    “Cultural humility is other-oriented. Cultural humility is to maintain a willingness to suspend what you know or what you think you know based on generalizations about the client’s culture. Power imbalance between counselor and client have no place in cultural humility. There is an expectation that you understand the population you’re serving and that you take the time to understand them better,” explains Mita Johnson, the Ethics Chair for NAADAC, who teaches cultural humility to addiction/treatment professionals. Dr. Johnson says, “Addiction professionals and providers, bound by ethical practice standards, shall develop an understanding of their own personal, professional and cultural values and beliefs. Providers shall seek supervision and/or consultation to decrease bias, judgement and microaggressions. Microaggressions are often below our level of awareness. We don’t always know we are doing it.”

    Microaggression—today’s buzzword—google it. In The Atlantic’s “Microaggression Matters,” Simba Runyowa elaborates on the insidiousness of this behavior: “Microaggressions are behaviors or statements that do not necessarily reflect malicious intent, but which nevertheless can inflict insult or injury. … microaggressions point out cultural difference in ways that put the recipient’s non-conformity into sharp relief, often causing anxiety and crises of belonging on the part of minorities.”

    Here’s how that might look in our recovery universe: someone from NA, a complete abstinence-based fellowship, asks someone who’s thinking about medication-assisted treatment with Suboxone: “Are you in denial? A drug is a drug is a drug.” No malicious intent is involved but the fellow member is left feeling disparaged. Maybe the well-intended NA had a negative experience with medically assisted treatment (MAT) and has a visceral feeling about it, “Taking drugs to stop drugs isn’t clean.” But NA doesn’t work for everyone. Yours or my anecdotal experience will bias us. Maybe expressing my own personal experience, or just listening without commenting, would be more culturally humble.

    The same is true of the MAT fan who says, “12-steppers are deluded by a faith-healing 80-year-old modality; only five-percent of people get helped from the 12 steps.” These types of arguments are not other-oriented. This is tribalism. 

    A simplistic solution to avoiding lane-drift is to listen more and share in first person. Prescriptive communicating—as opposed to a descriptive narrative—will, inadvertently, engage us in microaggression.

    Just when “Why can’t we all just get along” seemed hard enough, there’s more than one subconscious microaggression we need to be aware of. Derald W. Sue, Ph.D., a psychology professor at Columbia University, describes three microaggressions: micro–assaults, micro–insults and micro–invalidations.

    Micro–assaults are most akin to conventional discrimination. They are explicit derogatory actions, intended to hurt. Here’s an AA example: disparaging a humanist AA in a meeting by quoting Dr. Bob’s 1930s view, “If you think you are an atheist, an agnostic, a skeptic, or have any other form of intellectual pride which keeps you from accepting what is in this book, I feel sorry for you.” No one feels “sorry for” their equal. Inferiority is implied.

    “A micro–insult is an unconscious communication that demeans a person from a minority group,” Dr. Sue reports. Using another 12-step creed-based example, “CA includes everyone; it’s ‘God as you understand Him.” Who is likely to feel demeaned by Judeo/Christian-normative language?

    We could rightfully credit 1930s middle-America Alcoholics Anonymous founders for their progressive—always inclusive, never exclusive—posture; “everybody” in 1939 America meant Protestants, Catholics and Jews. The AA of the 1930s was culturally humble. Today, inadvertently, this same language is less effective at gateway-widening. Today, just 33% of earthlings embrace this interventionist higher power of the early 12-step narrative. According to the Washington Times, globally, 16% of people have no religion and 51% have a non-theistic, polytheistic faith. Sikhs or Muslims may share monotheism, but they worship a genderless deity; no room for “Him” of any understanding. Cultural humility accommodates all worldviews, without asking others to speak in the language of the majority.

    “Minimizing or disregarding the thoughts, feelings or experiences of a person of color is referred to as micro–invalidation.” This is how the American Psychiatric Association rounds out Dr. Sue’s three types of microaggression. “A white person asserting to minorities that ‘They don’t see color’ or that ‘We are all human beings’ are examples.”

    Disregarding or minimizing in our community might be telling someone: “You can participate in your online groups if you like but don’t treat InTheRooms.com like real meetings. Face-to-face is the only way to connect with real people.” If expressed in first person, instead of disregarding the other, the message could relate a personal experience and an informed belief. Have we learned everything about the person we’re talking to? Social anxiety disorder or a dependent partner, parent or child at home could be reasons why the online meeting is the superior option for them.

    To William White’s point, what do I really know about the comparative benefits of online community vs. traditional meetings? Maybe I could consider his informed advice of “holding all of our opinions on probation pending new discoveries in the field and new learning experiences.”

    Mita Johnson identifies a challenge with microaggression—it’s subconscious. How do we correct subconscious behaviors? Dr. Sue authored a couple of books to help combat microaggression at an individual, institutional and societal level: Microaggressions in Everyday Life: Race, Gender and Sexual Orientation and Microaggressions and Marginality. Sue offers five steps to help connect us with more varieties of addicts/alcoholics. “Microaggressions are unconscious manifestations of a worldview of inclusion, exclusion, superiority, inferiority; thus, our main task is to make the invisible, visible.” Here are Dr. Sue’s five practices:

    1. Learn from constant vigilance of your own biases and fears.
    2. Experiential reality is important in interacting with people who differ from you in terms of race, culture, ethnicity.
    3. Don’t be defensive.
    4. Be open to discussing your own attitudes and biases and how they might have hurt others or revealed bias on your part.
    5. Be an ally. Stand personally against all forms of bias and discrimination.

    I gave it a try. Taking inventory—in these five ways—of my prejudices and preconceived ideas helps identify my insensitivities. It helps thinking/acting more other-oriented. Secondly, more than ever, it’s a good time for more active listening and less instruction. Getting defensive, even to microaggression coming my way, escalates the divides. Admitting my assumptions and the faulty conclusions is a version of “promptly admit it” that is so familiar. Finally, how can I “Be an ally?” It’s not hard, today, to stand up for myself when I’m being disrespected. Now will I say something when someone else is being invalidated, insulted or dismissed? Yes, there’s a time to mind my own business but if I’m committed to “be an ally,” can I stay silent when another is being ganged up on by the tyranny of the majority?

    When I’m tempted to be tribal when confronted with other individuals or recovery groups, I try to remember that all people who suffer from process or substance use disorder have been subjected to microaggressions. William White identifies a few of the more cliché slights we all face:

    • “Portrayals of the cause of substance use disorders as personal culpability (bad character) rather than biological, psychological, or environmental vulnerability.
    • Imposed shame, e.g., being explicitly prohibited by one’s supervisor from disclosing one’s recovery status out of the fear it would harm the reputation of the company.
    • Misinterpretation of normal stress responses as signs of impending relapse.”

    In this regard there is no us vs. them. Just “us.”

    Not everyone believes that shining a light on microaggression will solve hostilities towards each other. “There are many problems with studies of microaggressions, technical and conceptual. To start, its advocates are informed by the academic tradition of critical theory,” Althea Nagai argues in “The Pseudo-Science of Microaggressions.” Nagai identifies confirmation bias found in almost all focus groups and the problem of unintended consequences when institutionalizing anti-microaggression policy.

    Nagai’s National Association of Scholars article continues, “There is nothing in the current research to show that such programs work. I suspect most fail to create greater feelings of inclusion. Research suggests they create more alienation and sense of apartness. The recent large-scale quantitative studies suggest that increased focus on ethnic/racial identity exacerbates the problems they are supposed to address. In other words, ‘social justice’ and diversity programs may actually backfire, creating less inclusion, more polarization.”

    Dr. Sue cautions us about weaponizing microaggression; other-oriented cultural humility is to take inventory of my microaggressions—not to fault-find other’s behaviors. Social psychologist Lee Jussim in Psychology Today says keep it personal—not global: “To understand how we can all unintentionally give offense through our own ignorance or insensitivity—thereby increasing our ability to make the same points without being hurtful.”

    “I’d rather step on your toes than walk on your grave,” is a rationalization we hear in the rooms. How do I neither pussy-foot around and avoid being a dick? Beyond intellectualizing, cultural humility is introspective. In “Cultural Humility versus Cultural Competence: A Critical Distinction in Defining Physician Training Outcomes,” cues from professionals show me how to re-frame how I interact with others: “Cultural humility incorporates a lifelong commitment to self-evaluation and self-critique to redressing the power imbalance in the patient-physician dynamic and to developing mutually beneficial and non-paternalistic clinical and advocacy partnerships with communities on behalf of individuals and the defined population.”

    For me, this nails how to stay other-focused: Professionals (or anyone who wants to relate to others better) should “relinquish the role of expert and become the student of the patient with a conviction and explicit expression of the patient’s potential to be a capable and full partner in the therapeutic alliance.”

    I don’t need a course or a degree to “become the student” of others. Instead of acting like I know what’s best for others, I can be a fellow traveler; think about other-focused approaches globally; but act locally.

    View the original article at thefix.com

  • Language Sideways: The Poetry of Addiction

    Language Sideways: The Poetry of Addiction

    In what ways do current poems of addiction represent the minds of addicts in the throes of active disease as well as after the process of recovery’s begun?

    Something poet Sam Sax said in an interview for The Fix has me thinking about poetry and addiction. “Poetry for me,” he told writer Christian Arthur, “is the only medium I’ve found that can accurately mimic how the brain moves.”

    I’ve sensed this ever since I stumbled into poetry in my early 20s, and though I’ve written books of poems and have taught writing for years, Sax’s statement reminds me that poets use language in radically unexpected ways. Rather than communicating directly, poetry sidesteps logic in ways that may enervate or baffle. Because its language may seem sleight-of-hand (or even swindle), poetry is a medium well-suited to embody the multidimensional shifting and meandering that the mind enacts on a regular basis. But what may seem merely perplexing language that distorts reality may also be noted as presenting how the brain actually moves, with dizzying speed from present to past, reality to fantasy, hard fact to symbolic representation, all in a moment or, more likely, a split second.

    Got it, and now we’re good to go back to our double espresso lattes and the latest CNN infuriation, right? But not so fast, for my coffee-charged mind is cycling through thoughts faster than I can process them, and my news-cycle drenched brain—well, never mind the news. The brain on coffee gets us closer to poetry, at least in the sense that I wish to explore here in relation to Sax’s statement. How, I wonder, does poetry fare under the strain of the addictive mind? What are the ways that poems written by recovering addicts mimic the mental circuitry of addictive thinking, that snarled labyrinth of brain moves that torture every addict I’ve known, both before and after sobriety? In what ways do current poems of addiction represent the minds of addicts in the throes of active disease as well as after the process of recovery’s begun?

    * * *

    Since American poetry is presently enjoying what may well be its golden age, I push away a stack of books by familiar poets and take up three recent books by first-time authors. Though Anne Sexton, Robert Lowell, John Berryman, Charles Bukowski, Etheridge Knight, Jean Valentine, Gregory Pardlo, Cynthia Cruz, Nick Flynn, Maggie Anderson, and Joan Larkin—whose poems on alcoholism The Los Angeles Times described as “the finest ever written on the subject”—have much to tell us about how the addictive mind works, I wish to witness the mental machinations of those at the frontlines of sobriety.

    So I turn to the most recent debut poets issue of Poets & Writers magazine, where I find ten first books, at least three of which address the subject of addiction.

    To read Sam Sax’s Madness, William Brewer’s I Know Your Kind (both chosen for the National Poetry Series) and Kaveh Akbar’s Calling a Wolf a Wolf is to enter danger zones in which the only direction we have comes not from GPS, but from eyeballing how close we drive to the edge of a cliff. In these poems, the mind is vertiginous, and in many cases its language sidesteps reductive meaning in order to reproduce, in the reader’s mind, states of mentality pertaining to the addictive impulse. In each of these books, non-linear, sideways-moving language introduces us to harrowing inner worlds. Words swoop down without warning to initiate us in the experience of drug-induced psychosis or to the grief in watching a brother overdose. Lines come at us from around blind corners to ambush us with the minutiae of what detox feels like, from the inside out. Meaning strips us bare then retreats, and words act not as locatable comfort, but as ventriloquized ephemera, cast-off detritus of the unspeakable degradations and mysteries of the addicted mind.

    In its 79 pages, Madness (Penguin 2017) reveals a mind reeling from institutionalization, addiction to alcohol and painkillers, and the initial stages of recovery. Its concision may appear, at first, as imprisonment until you find that Sax’s language is liberating, untethered, and—dare I say it?—downright playful. You read these poems as interior landscapes. Though statements such as “i can only half-blame alcohol for my overdose / the other half is my own hand / that poured the codeine” (“On Alcohol”) occur, by virtue of Sax’s skill with wordplay and cadence, we’re invited to participate in a mind surveying its experience of an addictive trajectory that spans active withdrawal to whispered reprieve.

    The heft of his subject matter—inpatient mental illness, queer identification and sex as painkiller, an uncle’s cancer, and, of course, drug use—may seem weighty enough to crumple the reader into one of Sax’s finely-wrought pages. Yet the writing style renders Sax’s project one of resuscitation and, for this gay reader, affirmation.

    I have to work for it, though, and Sax gives nothing away cheap. Starting with a prefatory block of clinical language from the DSM-1 (1952), words, in and of themselves, cannot be trusted. “[T]his must be the way of things,” Sax writes in one of the four poems titled “Psychotherapy,” “—all signs pointing toward unknowable destinations.” In the mental states of addiction, nothing clear-cut will do. Sax’s speaker opts for a more chaotic approach. “i’ve begun to grow distrustful of sense,” he says in “On Syphilis,” “let there be madness in the text.” Linear meaning oppresses the mind the way disease oppresses the body, until there’s nothing for language to do but to burst out of its skin. That means, in the mind moving in these poems, out and up, into the freedom of wordplay.

    Linguistic play sets the reader on notice as to the liberties this book takes with documenting a mind that refuses to move in acceptably linear ways. Words rub against each other, a form of auditory intrigue. “[A]ll our white blood / cells an oven,” Sax writes in “Fever Therapy, “a coven of bees blushing,” the off-rhyme (eye rhyme) of “oven” and “coven” creating a kind of linguistic harmony. Elsewhere Sax puts into motion a series of two- and three-word morphing patterns—“comets” / “comma” and “boarding” / “boring” and “sickle,” “silk,” “sick” (“Diagnosis”); “ward,” “warden,” “wars” (“Willowbrook”); “city,” “family,” “ancestry” (“On Syphilis”)—chains of sound that please the ear and, in one possible interpretation, mirror the circularity of the speaker’s addictive mind. Rationality is turned on its side, and we are driven over it, roughshod.

    As I read, Sax’s cadence catches my attention as language becomes a percussive instrument drumming out the mind’s anguish. Punctuation, or its lack, emphasizes these poems’ rhythms, as well as their barrage of mental buzz. In Sax’s hands, driving cadences refuse logic while simultaneously giving rise to a clashing sonic beauty that articulates feeling (drowning? enclosure?) better than most narrative can. Take these lines, for instance, from “Transorbital Lobotomy”:

    in the fifties there were tens of thousands performed in the states

    sour mess. sour mash. mash-up. macerate.

    cut a rug. jitterbug. wonder drug. gutter. tug. suture. lacerate.

    erasure. erase. raced. deadened. dead end.

    How can writing about lobotomy sound so, um, appealing? So mentally alive? There’s more than meets the eye: an outpouring of mind that moves toward implying the panic and dis-ease of circular thinking, while simultaneously (and subliminally) encoding that which is sonically recuperative. In one of the main ways that Sax’s poems encode mental activity, sound, in and of itself, simultaneously embodies the horrors of addiction and enacts recovery.

    Recovery’s brain moves happen in William Brewer’s I Know Your Kind (Milkweed 2017), but differently. New York magazine calls Brewer “America’s poet laureate of the opioid crisis,” but even those like myself who have never taken recreational opioids might find familiar ground here. Addiction is addiction, and in “Oxyana,” the place Brewer defines as “[a] nickname given to the town of Oceana, West Virginia, after becoming a capital of OxyContin abuse,” the addictive mind proliferates. But it’s also where I experience a degree of skepticism with regard to Brewer’s poetics, for this statement seems more explicit than what I’ve come to hope for in poetry. My misgiving only increased as I read further: “Following a successful crackdown on prescription painkillers, heroin has now flooded the state. West Virginia has the highest fatal overdose rate in America, nearly three times the national average.” How, I wonder, can this factual language reach a state of epiphany that poetry is primed to offer? Explanation, my thinking goes, kills the spell that lyricism attempts to cast.

    Which is what I expect to happen in I Know Your Kind. Brewer’s emphasis on Oxyana feels narrow, literally confining. And I sense a further problem in Brewer’s first poem, “Oxyana, West Virginia,” which opens with a panoramic view that winds through the Alleghenies and arrives at the town where the action is. Does the addictive mind think this way—in aerial shots panning down from the ethers to land us in an Oxyana? This seems too staged to be a useful representation of the addictive mind in action.

    But in the book’s second poem, “Icarus in Oxyana,” a striking image leads me to the discovery of another way poetry renders how the brain moves: “Someone on the porch / who’d lost both his arms / chain smokes.” This single image–bold, bewildering, painfully true–clarifies the addictive mind at work. It allows me to settle into this book, an eye out for other potent images.

    And I find them: “waking up in an alley with a busted face, // teeth red and penny-sweet, the rain / coming down clear as gin” (“To the Addict Who Mugged Me”); “have held the still hive of his head, / have placed my lips against the shadow // of his mouth, screamed air into his chest” (“The Messenger of Oxyana”). And these, from “Detox Psalm”:

    With the waves’ jade

    coaxing, I heaved my every organ

    through my mouth, then cut a mouth,

    at last, in my abdomen and prayed

    for there to be something more divine

    than the body, and still something

    more divine than that, for a torrent

    of white flies to fly out of me,

    anything, make me in the image

    of the bullet, I begged, release me

    from myself and I will end a life.

    Language moves sideways here by creating literal impossibilities—heaving internal organs through the mouth—that are metaphorically accurate. Detoxing does feel like the body throwing itself out of itself, the skin all wrong. The detoxing body is its own enemy, and glad we would be, at the worst of it, to be our own bullet that ends the body’s dangers. Such is the power of Brewer’s imagery to carry the reader through the stages of addiction, partial recovery, relapse, and finally sustained recovery. Brewer’s images depict the emotional and mental rot at the foundation of addiction, the skewed thinking at the heart of the disease.

    In the work 2018 Pulitzer Prize winning poet Frank Bidart calls “an intensely inventive and original debut,” Kaveh Akbar’s Calling a Wolf a Wolf (Alice James 2017) is alive with images that render shifting mental states at dizzying speeds. Akbar’s poems shunt from one emotional state to another, giving a sense of mental motion more reminiscent of driving too fast on hairpin curves than of logical elucidation. We race to keep up with speakers who pay no heed to safety. In “Portrait of the Alcoholic with Withdrawal,” Akbar offers a description that veers from one image to another: “I can hardly picture any of it now / save the fox I thought / was in the grass but wasn’t // I remember him quiet / as a telescope / tiny as a Plutonian moon.” Dimension derails, and disproportion prevails as the poem’s narrator lurches from fox to telescope to a moon so far in space that we’re granted a sense of how distorted the mind is that’s lining up these improbable—and emotionally accurate—images of DTs. “It’s amazing what you can find / if you just dissect everything,” Akbar writes in another poem, followed by a tumble of images: “Once / I pulled a glowing crystal from my beard / and buried it in the earth. The next day / I went to the spot and dug up a silver trumpet.” These images aren’t locatable in a linear context. They lurch and undulate beneath the skin of sense, advancing a project that, as with both previous poets, incites a sense of skepticism in relation to the body. As such, Akbar’s images wobble, as if they’re about to topple headlong onto bloody pavement. It’s no wonder, given the sidewinder moves the mind in these poems makes, that Akbar admits, “When I wake, I ask God to slide into my head quickly before I do.”

    Because of Akbar’s linguistic bravura, it takes time for me to become aware of his use of topographical space representative of another way the mind moves. In the context of his poetry, empty space is not vacant; it connotes the unsaid, the impossible-to-say, the outer limits of implication. Every silence is an admission of not-knowing, a blow against hubris. Amid the linguistic swerves of Akbar’s poems, ample white space sometimes surrounds words, engulfs lines and whole stanzas in a silence that cordons off a kind of quiet amidst mental chaos. For showing brain moves in his poetry, silence is as meaningful as articulation.

    Akbar offers extra spaces between words (“my whole life I answered every cry for help with a pour   with a turning away” [“Calling a Wolf a Wolf (Inpatient)”], and he occasionally jettisons left-margin conventions in favor of lineage that moves across the page (“Portrait of the Alcoholic with Moths and River,” “The New World,” “Against Hell”). Though the silences of the intake interview embodied in “Drinkaware Self-Report” indicate physical and emotional distance between interviewer and interviewee, the majority of Akbar’s silences are indicative of commonalities. The space between the three-line stanzas that filter across the page of “Learning to Pray,” for instance, are silences of communion, of reaching toward something greater than the addicted self. The white space between the unrhymed couplets found in “Portrait of the Alcoholic with Relapse Fantasy” is tentative with an uncertainty suggesting a fragile state of mind.

    In Akbar’s best work, silence girds understatement, and what remains unsaid gives a sense that within the frantic place of the addictive mind lies a locus of calm. There, the mind doesn’t explain. It doesn’t offer delusion or false comfort. Yet it comforts, perhaps because open space is public space that has the potential to welcome us all. In its meaninglessness, it aspires to greater meaning, the way, say, our parks and canyons and monuments are open to everyone. Language can undercut commonality, but silent space knows no identity other than that of all. Silence is, in a word, collectivity. We is its pronoun, as in we are not alone. No matter how difficult may be the stages of overcoming addiction, Akbar’s silences imply, there are others with us. The silences I see in his poetry of addiction are perhaps the most hopeful of all the mental moves I’ve observed.

    * * *

    Poetry of the caliber of these three debut poets reminds me that the mind is not a linear muscle. How can it be that I so easily forget this? Wasn’t it just last week that a stain in my bathroom sink reminded me of the cigarette burn at the edge of my grandmother’s porcelain tub from forty-five years ago? Didn’t that image trail with it the smell of her Slavak cooking and her devotion, in absurdly equal proportion, to the L.A. Dodgers and As the World Turns? Standing in my apartment a few days ago, at the sight of a mar on my porcelain my mind catapulted back to four years before I took my first drink before ricocheting into a present that contains the seven years (this month) since I’ve had my last. It happened so suddenly that it shocked me.

    Which is frequently how our minds work. What sideways language does is enact this process, so that we can see it in action. It’s the conduit between our current and past selves, making us privy to states of being we might otherwise miss.

    Though the majority of Americans express intimidation and disinterest in poetry, I wonder if in doing so they aren’t inadvertently expressing a fear of language that moves the way the untethered mind does. Sideways language may nudge us to wonder if it’s not linear logic, rather than its sideways counterpart, that enacts distortion. Minds of addicts and non-addicts alike traverse multiple planes of experience simultaneously. Poetry, in enacting the mind in all its vicissitudes and pyrotechnics, its leaps and mental gymnastics, is an art that counters, not codifies, linear distortion. Shouldn’t we honor, rather than disparage, the depiction of mental states as we actually experience them, something that Sam Sax, William Brewer and Kaveh Akbar are teaching us to do?

    View the original article at thefix.com

  • Language Matters: A Recovery Scientist Explains the Impact of Our Words

    Language Matters: A Recovery Scientist Explains the Impact of Our Words

    If a person has internalized the negative stereotypes associated with being “an addict,” are they more likely to have a fixed mindset and believe they cannot improve or change?

    Over 21 million Americans have substance use disorder and fewer than 3.8 million individuals receive treatment each year. 28 percent of the individuals who need treatment, but do not receive it, report stigma as a major barrier to accessing care. If we want to destigmatize addiction — a highly stigmatized disorder — then we need a unified language.

    The words we use have been shown by researchers to not only negatively influence our attitudes toward people in recovery and people who use substances — to the extent of suggesting that a health condition is a moral, social, or criminal issue — but they also impact access to health care and recovery outcomes.

    This article isn’t a mandate for everyone to start policing language, but it was motivated by a genuine desire to look at the evidence: how we speak to someone with substance use disorder matters. In the midst of a public health crisis, we can’t dismiss the use of language as just semantics, trivial, or being overly politically correct. We don’t have that luxury when 64,000 Americans die from drug overdoses each year and over 88,000 die from alcohol-related causes.

    Building upon an already existing foundation of work in this field, recovery scientist and researcher Robert Ashford and colleagues conducted a larger study of the general public measuring both implicit and explicit bias elicited by certain common words and phrases, which was published in June. I was fortunate to speak with him about the study, the impact of language, and how we can apply this information to help fight stigma.

    The Fix: Let’s say you’re among peers in recovery and you refer to yourself by a term which your study has shown to be a derogatory, like “addict,” “alcoholic,” or “substance abuser.” How does that contribute towards the stigma those in recovery face?

    Robert Ashford: This is an interesting question, and one from an evidence perspective, we don’t have exact answers on. Anecdotally, we believe that even though it is probable that this type of language has an impact on things like self-stigma, self-esteem, and a sense of self-worth, it is more important that people have the right to label themselves as they choose, especially as it concerns the recovery community. The fact is that the use of pejorative labels has had a decades-long place in popular mutual-aid programs like AA and trying to tell the mutual aid recovery community what to do isn’t a goal, nor should it be in our minds. At the end of the day though, it is important for people in recovery to understand that the use of such labels may become internalized over time, leading to decreases in self-esteem and such. However, without more evidence, it is merely hypothetical at this point.

    In what ways does it impact their lives? For example: their access to, and quality of, healthcare?

    Generally, the use of terms such as “substance abuser,” “addict,” and others have been found to be highly associated with negative attitudes (i.e. bias) in the general public, among behavioral health professionals, and in medical professionals. These negative associations ultimately lead to all types of stigma (social and professional) and ultimately to very explicit discrimination. On a personal level, we know that just over 25% of individuals with a severe substance use disorder don’t seek treatment each year due to the belief that they will be stigmatized or discriminated against by their friends, neighbors, or employers. Additionally, this type of bias has also been found to decrease the willingness and efficacy of medical services delivered to patients that have a severe substance use disorder. Access and the quality of treatment in the United States has many barriers and enhancing those barriers through the use of language is an easy fix – just by changing the way we talk!

    What would be an alternative, less-stigmatizing term?

    Any term that puts the focus on the individual as a human is bound to be less stigmatizing. For example, individuals are not “addicts” or “substance abusers,” but rather, “people with a severe substance use disorder” or a “person who uses substances.” Language changes constantly, but the one commonality in terms of bias and stigma seems to be that when we can restore or focus on the humanity of an individual through our language, we will be speaking from a better place.

    How might that term be more empowering to the individual, and in what ways?

    As a person in recovery, I can speak personally that when using terms that are rooted in humanity, I get a better sense of myself and the conditions that I have either lived with or am living through. Often times when we are in the midst of a severe substance use disorder, faced with a constant barrage of language that is meant to disempower and dehumanize, we began to internalize those labels. While it is possible in certain settings that these terms are used as a reminder of a previous identity – intending to provide some sense of catharsis in the recovery process, or a mechanism for not returning to a previous state – I think it is equally plausible that we can be reminded and have that benefit by using terms that don’t immediately degrade our very essence as people.

    I’m curious how a growth mindset versus a fixed mindset might inform our choices of words? Corollary, how does each mindset inform how we interpret what we hear from others?

    This an interesting question, especially in applying the growth and fixed mindset theories from childhood development and education to the field of substance use and recovery. The theory suggests that those who believe they can improve or change (growth mindset) are more likely to engage in activities that allow them to grow, and those that believe they cannot improve or change (fixed mindset) or less likely to do so. In the context of recovery and substance use, this has immense potential to inform how language truly does impact individuals in or initiating recovery. If a person has internalized the negative stereotypes associated with being “an addict,” are they more likely to have a fixed mindset? While there are surely myriad reasons for the challenges faced by people with a severe substance use disorder, mindset may indeed be a big part of it.

    You’ve done an incredible amount of work in educating both those in recovery and clinicians about the importance of the language we use. Some of your research features infographics about negative language and presents a positive alternative (below). For those who may need further clarification, what is the difference between pharmacotherapy (or medication to treat substance use disorders) and medication-assisted recovery?

    The infographics we made from our results have sure inspired a lot of conversation – which is exactly what we hoped for as scientists! One of the constant topics has been around “medication-assisted treatment,” “pharmacotherapy,” and “medication-assisted recovery.”

    Pharmacotherapy is the use of medications to treat a disorder/disease/ailment – specific to our field, this would imply treating a substance use disorder with medications. The term had significantly more positive associations than a similar term, “medication-assisted treatment” from our tests and we wanted to make the suggestion to use it instead.

    “Medication-assisted recovery” on the other hand can be considered the use of substance use disorder medications, combined with the use of recovery support services such as MARS recovery meetings, engaging with a peer recovery support specialist, utilizing a recovery community organization, or attending a MAR-friendly 12-step meeting. The biggest difference is that not everyone who uses substance use disorder pharmacotherapy wants, or would consider themselves, in recovery. Keeping the two terms separate gives people an option, and from a research prospective, both terms are associated with the positive and their use isn’t likely to elicit implicit bias among the general public.

    Figure: Suggested Recovery dialects


    View the original article at thefix.com