The Deserving and Underserving Paradox

This has been fantastic and immensely beneficial, especially for educating the general public and policy makers about the reality of recovery being possible, for shining light on the fact that investing in treatment works, and in voicing the importance of embedding ongoing recovery support services in local communities. However, have we ever stopped to consider the collateral damage incurred by the ways in which we push the recovering narrative forward, by the ways in which we tell our personal recovery stories?

With the mainstream recovery advocacy movement having grown to be largely White-centered, some of us who are White have rightfully acknowledged the privilege afforded us that made accessing treatment, recovery supports, and decreased social distance in our communities that much easier. Unfortunately, many of us have also made statements about how “addiction affects everybody now; we may not be what you typically think of when you think addiction…we came from good families, we were loved, we had homes…”  This is an important point as substance use disorders do impact all walks of life with impunity; however, these statements fail to account for the reality that access to the resources, privileges and social supports which foster recovery are anything but equitable. This also reinforces the stereotype that those who use drugs or develop a severe substance use disorder are more often the exact opposite of these things – that is, more often people of color, poor people, those who came from non-traditional families, those who experience homelessness or live in impoverished conditions, etc.

As mentioned, the public profile of individuals in recovery has been magnified as those in recovery come out of the shadows and choose to become “faces and voices of recovery.” Various privileges, however, still determine who can and cannot “come out” and be a public face and voice of recovery. Is your individual recovery pathway abstinence-based? Do you have a criminal justice background? Are you a professional that doesn’t stand to lose your job or your license based on your past? Are your family and friends aware of and supportive of your recovery status?  Simply being able to speak out is a perfect storm of privilege and identities that not everyone has; as such, the stories we so often hear are unique but share common threads that render other recovery trajectories, pathways, experiences, identities and realities essentially invisible to the world.

We believe this inadvertent positioning of the recovery story has had, and continues to have, dire consequences on our communities at large. Within this hierarchy of “redeemed” and “non-redeemed” people who use substances, we are reminded of a similar dichotomy often used in the halls of congress to support or refute social assistance programs – the deserving and undeserving poor.

This paradox of the “undeserving” and “deserving” identity is an unintended consequence of anti-stigma efforts of the recovery movement and it should force us to take closer look at our strategies, messaging, and intent. As we lift up the stories of recovery and redemption, even educating others that substance use disorder affects all walks of life (i.e., the well-to-do, White, suburban teenager), we reinforce negative perceptions of others that “of course are addicted” (i.e., impoverished individuals experiencing homelessness, often people of color, poor people, etc.) and further moralize addiction. No true stigma reduction effort should ever oppress one population as it lifts up another – this is not stigma reduction, it is the oppressed becoming the oppressor. As we make ourselves seemingly more palpable to the general public, we further stigmatize those who have not yet begun the recovery process, or those who use substances and do not need or want total abstinence or recovery in the first place. Theories of oppression tell us that the oppressed often seek to be in good favor of the oppressor.  For those of us who have lived with a substance use disorder and experienced oppression as a result, exemplifying redemption via demonstrating sustained abstinence from substance use is at its core more about demonstrating that we are no longer “that unworthy person” and in turn should be listened to, supported and valued by society.

Stories of recovery absolutely should be told, and individuals should be proud of their efforts and feel good about their healing, but not at the expense of further marginalizing others – after all, those of us in recovery were in fact these “undeserving” souls at one point in our lives. We do ourselves, all of us in fact, a grave disservice by creating an artificial boundary between those who use drugs and those who no longer do – restoring humanity on one side of this line, and further taking away the humanity on the other side.  While many readers may react to our words initially with the sentiment that the telling of their recovery as a redemption story is about spreading hope that recovery is possible, we encourage readers to rigorously explore within themselves if this is in fact the sole reason and personal social benefit of doing so.

Collectively, we need to look at how stigma internalized as shame plays a part in positioning recovery as a redemption story – the further we are removed from being “that bad person doing bad things,” the less shame we feel. This may be helpful, even cathartic, but again, we ask at what expense and if there is perhaps a better way? A more inclusive way even, one that does not alienate others who are just as human, just as worthy, as all of us.

One immediate thing we can all do, including those not in recovery but in other positions of political means and leadership, is to begin including the voices and stories of those who use drugs and who currently live with substance use disorders at the figurative and literal table. It is more common today that an individual in recovery is seated at this table, a long fought and hard won privilege for our communities. However, if the goal is to seek solutions and empower those who are most impacted by substance use and the systems which prop up systemic oppression, then only including the abstinence-based, overwhelmingly White recovery voice is a form of tokenization – a tokenization that our community shouldn’t be complicit in, settle for, or be happy with.

Unfortunately, we still have more questions than answers. To find answers, we must come together as a community – a community of those who use drugs and those who previously used drugs but no longer do – all of us, no matter the identity we hold today. We do know that for the two of us and an emerging group of others, we cannot continue to empower ourselves as redeemed while at the same time contributing to the oppression, marginalization, discrimination and stigma placed on others who share our prior substance use experiences.  We cannot continue to elevate the ‘recovery as redemption from a prior state’ story at the expense of those who are currently in that prior state and who society still stigmatizes and outcasts as undeserving until achieving redemption. We cannot continue to be grateful for decreased social distancing and a seat at the table by virtue of our recovery and other privileges at the expense of others who remain woefully excluded and deemed unworthy. While we don’t have the answers to how exactly this will or can be done, we are striving to find a better way to drastically change the conversation and public perception surrounding substance use and recovery in this country – and we hope you’ll join us on that journey.