Should addicts and alcoholics remain anonymous about their recovery? Eighteen years ago this month, I wrote my first op-ed for the Washington Post‘s Sunday Outlook section, arguing against that idea. It was headlined “Addicted to Anonymity; It’s Time for Recovering Users to Join the Drug Debate.”
This past Sunday, the New York Times‘ Fashion & Style section included a first-person piece making a similar case. It reasoned that in the age of tell-all addiction memoirs, reality TV and Facebook, the “Anonymous” in Alcoholics Anonymous may have outlived its usefulness.
(More on TIME.com: ‘Wet Houses’ Allow Alcoholics to Drink, With Surprising Results)
Writes David Colman:
More and more, anonymity is seeming like an anachronistic vestige of the Great Depression, when A.A. got its start and when alcoholism was seen as not just a weakness but a disgrace.
Colman quotes Pat Taylor, executive director of Faces and Voices of Recovery, or FAVOR, an advocacy group for people recovering from addictions, who clarifies that there’s a difference between speaking publicly about addiction and revealing one’s membership in a 12-step program:
“I remember growing up, if you saw someone on TV who was in recovery, you couldn’t see their face or their voice was disembodied. … But there’s nothing that prohibits people from talking about recovery as long as they don’t mention their actual support group. And the other thing is that there are so many ways that people are getting into recovery and sustaining it. It’s not just one path.”
That’s crucial: research shows that the majority of people who recover from alcoholism and other addictions actually do so without treatment or participation in 12-step self-help groups. Millions of others recover through the use of medications like methadone, buprenorphine or naltrexone, through talk therapy, other kinds of self-help groups and a wide variety of other methods.
(More on TIME.com: Drugs In Portugal: Did Decriminalization Work?)
One of the downsides of maintaining anonymity is that it allows harmful myths about addiction to persist — the belief, for instance, that if 12-step programs don’t work for you, you have little hope of getting better. More than 90% of addiction and alcoholism treatment programs in the U.S. focus on getting patients to attend 12-step groups, even though research shows that treatments like cognitive behavioral therapy and motivational enhancement therapy work equally well; for opioid addictions, maintenance treatments are often superior to 12-step programs when it comes to saving lives.
But the cloak of anonymity makes it hard for people who are seeking treatment to get the lowdown on rehab programs; it’s often hard to determine, for instance, if a program is run by 12-step group members who believe that their way is the only way. Preserving anonymity has also been used as a reason not to conduct research on the effectiveness of 12-step programs — even though research participants in all studies remain anonymous anyway.
(More on TIME.com: The Addiction Files: How Do We Define Recovery?)
Yet even while many people in recovery nominally agree to remain anonymous, Colman reports that they are also increasingly posting photos on Facebook taken at AA meetings or otherwise outing themselves on other social-networking platforms and among fellow people in recovery. He quotes Susan Cheever, biographer of AA founder Bill Wilson (and herself an AA member), about how members signal their shared experiences to others:
“I am increasingly uncomfortable with this level of dishonesty. … This dancing around and hedging, figuring out ways of saying it that aren’t really saying it, so that people in recovery know what I am talking about — all the code words. I am sure this is not what Bill intended.”
Certainly, there’s a good reason for anonymity: it helps people just starting their recovery and, as with confidentiality in other forms of mental health treatment, it should be preserved when people seek help.
But I believe that when people are in positions of power related to addictions — treatment providers, policy makers, etc. — it’s imperative that they be transparent about their associations and connections. It’s fine to be anonymous about your own path to recovery when you are the only one being affected, but it’s not appropriate when you seek to influence public health or policy.
(More on TIME.com: Using Heroin to Treat Heroin Addiction)
As I wrote in the Washington Post (sorry, the op-ed is now behind a pay wall) in 1993:
People don’t think of addicts like me when they imagine intravenous drug users. I’m a white woman who works as a producer for a national PBS talk show. Five years ago I was shooting cocaine and heroin up to 40 times a day.
When Americans picture a heavy drug user, they see an ignorant, immoral, undisciplined criminal: the worst caricature of the racist view of minorities. But because addicts are in the closet, no one banishes that image. And this lets addiction and AIDS continue to kill us. If we want to fight those diseases, recovering addicts had better come out and organize. There’s no other constituency for the change we need.
Now, I should add, I have been free of heroin and cocaine for 23 years.