Addiction, Spirituality, And Politics

·期刊原文
Radicalizing Recovery: Addiction, Spirituality, And Politics

Morell C
Soc Work

Vol. 41 No. 3 May.1996

Pp.306-312

Copyright by Soc Work

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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.
Substance abuse is a condition that needs liberation (release from
domination by a foreign power suet as a substance, a psychological
condition, or a social order), a process that requires both a change in
consciousness and a change in circumstance.

Despite the millions of dollars spent on drug interdiction, prisons,
treatment centers, and self-help books, addiction continues to expand as a
personal and social tragedy. Society must do more and do it better. The
self-help movement teaches the power of bringing individuals together and
emphasizing spiritual values. The feminist, African American, and other
progressive movements teach the power of politics and social structure.
Social workers need to bring recovery and social justice methods together.
A sociospiritual approach to addiction--with its emphasis on
interconnectedness--offers this opportunity.
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Accepted November 4, 1994

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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.
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