Originally published on The Fix.
When abstinence is prioritized as the truest form of recovery, we lose sight of the fact that recovery is a diverse, personalized and evolving process.
In March, I took psychedelics for the first time in over five years. While that may not be the most shocking revelation to admit, a substantial community of peers would be quick to designate this as a relapse. That’s because I’m a member of Narcotics Anonymous. But six months later, I don’t feel like I’ve relapsed, and I still consider myself a person in recovery.
So do, presumably, many people who qualify at some point in their lives for a Substance Use Disorder (SUD) that go on to moderately partake in some form of socially acceptable, tolerated, or medically approved drug use. For members of 12-step fellowships, non-medical use of any drug is indiscriminately designated as a relapse, whether or not the person returns to the same level of addictive behavior they sought help for in the first place. But recovery is achievable without sustained abstinence, and that, too, must be celebrated.
Rock bottom, or one size fits all?
As a mid-twenties college dropout living with my parents, I was introduced to recovery from an encouragement to go to inpatient rehab when I was arrested and charged with a felony in 2010. The 12-step program has a near ubiquitous influence on the dominant abstinence-based treatment model, but, like many clients in treatment, I was reluctant to jump on the 12-step bandwagon despite what I viewed as a choice between abstinence or a potential jail sentence. At the time, recovery seemed like an all-or-nothing proposal, and within weeks of returning home I picked up right where I left off.
While relapse is certainly a hallmark of early recovery, if not an expectation, there is growing attention to alternatives to abstinence. Andrew Tatarsky, PhD, psychologist and pioneer in the integrated harm reduction psychotherapy approach to addiction treatment, presented the case of a woman with no interest in abstinence. Instead of setting the terms of treatment as beginning with abstinence, Dr. Tatarsky focused on establishing a therapeutic alliance with the woman, accepting her active substance use in the context of a complex interplay with prior trauma, self-medicating symptoms of depression and suicidality, and interpersonal difficulties.
Coming to believe…
Unlike Tatarsky’s client, I went untreated and sunk further into dependent, isolated use. But in July of 2011, as I nearly rounded out my first full year as an IV heroin addict, I asked for help during a soft and compassionate intervention by my mother, and went to detox. Despite this sincere surrender I was still facing charges, but I was surprised when, after my treatment, my objection to all-or-nothing abstinence that was being sold to me at rehab the year before—and now the drug treatment court program—seemed slightly less terrible.
I spent my first year in 12-step recovery the same way the many people I met did—living in a halfway house, taking the first job to hire me, and attending lots of NA meetings. I got a sponsor to guide me through the 12 steps, all while counting passing days as I accumulated “clean time.”
Nearly a year after treatment, and following seven months in a halfway house, I decided that I was stable enough to move back and return to finish college. Over the next few years I finished my undergraduate degree in neuroscience, spent a year each working full-time for a mental health agency and a peer-reviewed science journal, and I remained as active in NA as I had in my first year. Three times I celebrated the coveted annual milestone recognizing the anniversary of my “clean date,” while sponsoring a few other members to guide them through the 12 steps, and cycling through a couple of times myself.
Like addiction, recovery exists across a spectrum.
Initially, the attachment to clean time was an objective measure that reinforced my ego with marked recognition at 30, 60, and 90 days, six months, and so on. I would later feel that the foundation of abstinence seemed more and more like a kind of hierarchical scheme that separated those of us “in recovery” from others still “sick and suffering.” NA is explicit that people receiving medication-assisted treatment (MAT) are at a lower hierarchy.
Jenifer Talley, PhD, psychologist and integrated harm reduction practitioner with Dr. Tatarsky, raises strong opposition to this stance. She tells The Fix, “There is an inherent value judgement if we only recognize total abstinence as true recovery, which may lead to more harm if people feel they can’t attain it or don’t wish to pursue it for a variety of reasons. When abstinence is prioritized as the truest form of recovery, we lose sight of the fact that recovery is a diverse, personalized and evolving process.”
I understand addiction as a learned pattern of habitual and self-reinforcing behavior manifesting over time for different reasons and in numerous ways from person to person, but its pathology is most universally and succinctly defined as perpetuating in spite of consequences. For this very reason, Dr. Talley posits, “Just as there are many paths that lead one to develop a problematic relationship with substances, recovery itself should be recognized as encompassing a range of outcomes.”
My decision to take psychedelics again was not made in haste—in fact, I became aware of the opportunity to participate in a group session over a year before it took place. Initially, I confided in a few close friends, including my girlfriend and my NA sponsor. Understandably they each raised concerns, mostly regarding consequences that my action may cause. However, Dr. Talley’s words resonated strongly with my own experience: “People also have different relationships with certain substances and may choose abstinence from one substance but may be able to use another safely and in a non-problematic way. Does that mean that person is not truly in recovery then?”
As an NA member, I self-identify as an addict and certainly feel I qualify. In the months since my decision to use, I’ve had to ask myself several questions if I was to choose to open up to the people in my life: How would my membership in NA change? Would I lose any trust in my relationships with family and friends? And perhaps of the most relevant: Would this “one-time use” return to an uncontrollable and destructive pattern of drug use?
Having had an empirical awakening…
Eventually I became less and less able to reconcile my background in neuroscience and my understanding of addiction with many of the basic ideology of 12-step fellowships. Maia Szalavitz, neuroscience writer and author of the book Unbroken Brain: A Revolutionary New Way of Understanding Addiction was also a former addict who initially embraced abstinence through membership in 12-step groups. But ultimately, Maia writes, “My personal break with 12-step programs began when I learned about harm reduction and what the science really shows about addiction.”
Like Maia, my awakening came when I embraced principles of harm reduction, and acknowledged the research indicating how many people with SUDs achieve some form of recovery through little or no intervention, or how MAT patients are at far lower risk of overdose than those seeking recovery in 12-step programs.
At just under five years “clean,” I felt my own approach to recovery lacked something personally meaningful and significant—integrating profound psychedelic experiences. Fortunately, last winter a small group of people I had met were all apparently experiencing something similar in their desire to approach intentional psychedelic use in a recovery oriented context. Most of us were members of 12-step fellowships, and we each had a nuanced appreciation for the ongoing role the steps play in our lives. Some either had already had a recovery-integrated psychedelic sessionand others used psychedelics occasionally throughout the year, finding an accentuation in their approach to the steps. We all recognized that social support is perhaps the biggest strength with 12-step, but we wanted a venue to share our experiences that may be too controversial to discuss “in the rooms.”
Through our newly formed Psychedelics in Recovery group, I found a safe and accepting space where, rather than condoning or encouraging my decision to participate in a psychedelic session, I could voice the concerns going into an experience, and process it through the group afterward. Sadly, due to the stigma I perceive from members of 12-step groups toward attempts at moderation, I have chosen to remain anonymous with the majority of members I am not as close with, as well as my family.
As Dr. Talley poignantly states, “Each person has the right to define what recovery means for them. For many people, establishing safer and less risky relationships with substances while also working to optimize other areas of functioning is the essence of recovery.”
Less than a month ago, the next stage in my journey began with the start of my first semester in a graduate psychology program. As fortunate as I have been with my path in recovery, my hope in my own progress pales in comparison to the hope needed for people in all stages. Let’s celebrate them.