Interview: Co-Occurring Disorders & AA
“I think there’s still a prevailing idea that recovery is very black and white. I think there are very few things in life that are that cut and dry.”
CONTENT WARNING: This interview contains explicit, graphic discussions of self harm, alcohol use, and other mental health related topics that may be triggering for some readers. Please proceed with caution.
It is not uncommon for a person to deal with both a substance use disorder (SUD) and a mental illness. In fact, they sometimes go hand in hand. Studies have shown addiction has become a means of coping with emotional stress. According to the Substance Abuse and Mental Health Service Association (SAMHSA), 20% of individuals with a severe mental health disorder will develop a substance use disorder during their lifetime. But, of these individuals, only 7.4% receive treatment for both disorders, and 55% receive no treatment at all (SAMHSA, 2015). Individuals with both a SUD and one or more mental illnesses experience what is known as a co-occurring disorder (COD).
It’s no secret that mental healthcare in America is lacking. Unfortunately, most treatment centers and hospitals approach folks in recovery with one or the other — if a person uses substances, they can expect to be referred to Alcoholics Anonymous, a deeply religious and strictly abstinence-based program. Five of the twelve tenets of AA mention God, and the program offers only an all-or-nothing approach to sobriety. By nature, AA is extremely difficult to examine, as there is no concrete data on how successful folks who attend it are, and no records kept on attendance. A 2012 report by the National Center on Addiction and Substance Abuse at Columbia University, which compared the current state of addiction medicine to general medicine in the early 1900s, stated, “The vast majority of people in need of addiction treatment do not receive anything that approximates evidence-based care.” No wonder why the overwhelming majority of folks struggling with CODs don’t go or “succeed” in traditional treatment.
I talked to a good friend of mine — who we’re going to refer to here as Elizabeth (she/her) — about her experience as a recovering alcoholic who has utilized Intensive Outpatient Programs (IOP,) AA, and other similar groups to cope with her SUD. She also holds her Bachelor’s degree in Social Work. She offers her perspective on living with CODs and her experience attending AA as a requirement for her treatment plan.
Can you take some time to share some of your lived experiences that brought you to recovery/working in the field?
So my decision to enter the human services field occurred before my recovery, kind of. That decision was around 22 years old or so, and spurred by my experiences as a client of emergency mental health services and my experiences in attempting to get sober. I think my first symptoms of my mental illness began around puberty, when I began cutting myself , around 12 years old or so. And that continued, and then later I began introducing substances which pretty significantly impacted the severity with which I was injuring myself. I was around 20 the first time I needed to go to an ER for psychiatric reasons related to self injury. They set me up with a therapist and that was all well and good. Unfortunately, that was rarely my experience in emergency rooms following that first encounter.
I also was also hooked up with a local IOP after that to try and address my drinking. Following that first ER visit, I was in the ER at least once a month. But my experiences got increasingly worse, I was often ignored for hours, was treated pretty poorly by a lot of doctors and even the people coming in to do the psych evals. It was awful about 85% of the time. For several years I actively avoided seeking medical attention even when I definitely needed it because of my experiences with staffing at the emergency rooms.
I’ve learned a lot more about myself and sort of the state of things since starting my BSW several years ago, so that has changed slightly, but I think the basic premise of that decision has remained the same- I don’t want people to have to deal with what I did (or worse). My personal recovery has been very bumpy, which is par for the course I think.
Where are traditional groups like 12 Steps and AA failing? What have been some of the most frustrating parts of receiving services?
So, I generally refrain from speaking negatively about AA depending on who I’m with. Especially, especially when I have been in treatment. My experiences are my own, and even still it’s probably where I would direct someone first if they were questioning whether they had an issue with use.
With that said, one of the biggest problems, especially in the beginning was getting providers to believe that my problems were both psych and substance abuse. Like, yes, my self injury was very much tied to my drinking in terms of like…at that point I was only injuring myself while intoxicated. But their response to that issue would be: “well, stop drinking then.” But that was the problem- I couldn’t. I needed that addressed as well, but it wasn’t for a long time.
This seems to be pretty standard practice at many drug/alcohol treatment facilities — they are very heavily influenced by the tenets of Alcoholics Anonymous, and I absolutely agree that it can be beneficial for people. However, not everyone. Except I never heard that discussed, and I feel that’s incredibly harmful. And I think spending a lot of time in AA (I was in and out for about 6 or 7 years) was incredibly damaging for me, because it just never “clicked.” The steps, the spirituality, whatever. Nothing.
It’s frustrating because I would raise these concerns, or concerns about other things, and it’s kind of dismissed in terms of like, “you didn’t go to the right meetings,” or something to that effect. I don’t accept that response anymore. I know myself enough that that was not the way I was meant to recover. I also experienced trauma at the hands of people I was supposed to/told to trust in the program.
The steps and program don’t work for everyone, and that is okay — more people need to know that that is okay and there are other ways to recover from drugs and alcohol.
Another thing I would hear a lot was: “Chase a meeting as hard as you chased a drug,” or things to that effect- “needing” a meeting, or hearing about people well into their recovery going to meetings every day still — that wasn’t something I wanted. I wanted to move away from that aspect of my life; my mental illness and alcoholism had already taken up so much of my life, I didn’t want to spend the rest of my life in recovery making that my primary focus as well. It’s important, of course, but I don’t want it to feel like that’s all I am.
I think there’s still a prevailing idea that recovery is very black and white. I think there are very few things in life that are that cut and dry. To me, the program kind of oversimplifies the incredibly complex issue of addiction and everything that factors into a person’s desire to continue or stop use, like mental illness, socio-economic factors, etc.
The spiritual aspect of the program was always a big thing I couldn’t get past either, but that’s a struggle for a lot of people I think. Agnostic/Atheist folks have been successful in AA, I’m just not one of them. I don’t have any religious or spiritual beliefs (not really), and I felt like that was pushed on me a lot more than was helpful.
How have you been able to advocate for yourself, your needs, and what works for you in recovery?
When I got sober two years ago — the first program I was in, at the aforementioned hospital, required I attend meetings, so I attended them until I finished that and then transitioned down to IOP. I was given the freedom to explore what worked for me while still having the safety and accountability of being in treatment. So I’ve found what’s worked for me, and at two-ish years sober now, I can say being given more options and support from a less black and white system is to thank for that. I think that having unconditional support has been a big part of me learning how to advocate for myself. I’ve been given the freedom and space and safety to explore my “chosen” path. The counselors I have worked with for the last two years gave me the confidence to be able to develop and/or rework, if necessary, the way I am choosing to recover with absolutely zero shame or judgement
I also have support from many other people who I know deeply care for me and my well being which has been instrumental in me learning how to care about myself.
My recovery has been a collaboration and I think that’s the best thing I could have asked for. I’m driving it, I saved my own life, but it was definitely made more possible by being given the space to decide what I wanted.I think shame drives a lot of these behaviors and relying on a system that continues to produce shame just…don’t make sense to me. That shame for me was removed by giving me a choice.
What would you say to others who may be reading this and finding they identify with some or all of your experiences?
Recovery isn’t linear and looks different for everyone. If something doesn’t work, try something else. But don’t do nothing. It’s a long and hard process, and things don’t magically get better but it’s possible to learn how to deal with things in a healthier and safer way.
There are still days that I don’t see the point in being sober or self harm free, but I have learned how to navigate that stuff in healthier and safer ways even if it’s begrudgingly. It really is so much better on “this side.”
