History of Alcoholism and the Justice System? How has this group be

Social Work & Christianity, Vol. 46, No. 3 (2019), 51–65 DOI: 10.34043/swc.v46i2.76

Journal of the North American Association of Christians in Social Work

The Christian Social Worker in Recovery: A Personal Reflection on Professional Stigma, Bias and Discrimination

Denise L. Jaillet Keane

As a professional social worker in long-term substance use recovery, I have come face-to-face with stigma, bias and discrimination regarding those who struggle with the disease of addiction. I have made choices regarding when and where and if to disclose that I am a person in recovery. I have listened to colleagues engaging in “us” and “them” conversations, forgetting that I am both them and us, not realizing how offensive and judgmental their language was. Funders overlooked my identity as a person in recovery, as they requested agencies to hire more “peer mentors,” but did not count recovering clinicians or senior management. The result of a qualitative self-interview on the experiences of being a Christian social worker who just happens to be that 1-in-7 (Hafner, 2016) who has faced a substance use disorder, this paper presents a person-centered perspective regarding working as, or with, a social worker in recovery.

B AVID MILLER, LISW, ACSW, DCSW AND PAST NATIONAL CHAIR OF

Social Workers Helping Social Workers, believes that the field of social work is in denial about substance use among its 165,000

NASW members (Miller & Fewell, 2002). Although the organization has been in existence since 1980, Miller reported in 2002 that this organization that directly assists professional social workers with substance use issues had only counted 800 members in total over those 22 years. Christine Fewell, CSW, BCD, CASAC and chair and founding member of the Peer Consultation Committee of the NASW, New York City Chapter’s Addictions Committee, concurs (Miller & Fewell, 2002). Fewell believes

it is a “complicated phenomenon” that involves shame, secrets and… all the feelings that our professional aspirations and training have added about ethical responsibility, control of our feelings and behavior, (and the) defensive need to be the caretaker and helper rather than the one who receives help” (p.102-103). Media stories often feature high-profile personalities who have substance use disorders looking their worst, being arrested, going into treatment. The words used to describe them are often unkind and stigmatizing. The advances in genetics and neurology that have brought us scientific evidence that makes it clear that substance use has biological components that cannot just be willed into submission have not eliminated moral, class, and ethnic stigmas associated with the disease. If Miller and Fewell are accurate in their conclusion that social work is in denial about social workers with substance use disorders, it is not a denial based upon readily available scientific data. The denial is a demonstration of a socially acceptable, ingrained bias that “good” persons do not get addicted to substances, fed by negative media portrayals and perhaps an unconscious desire of social workers to feel they are a step up from their clients.

Kubek (2007) chronicled the story of a social work student in recovery who “feels a bit annoyed whenever she hears fellow classmates . . . make judgmental comments about people who abuse alcohol and other drugs.” The student in recovery felt they should be learning how to convey ac- ceptance, and knew from personal experience that judgmental language is not safe. Without direct confrontation, the negativity towards those with a substance use disorder will continue into the field. It will impact the future social workers’ relationships with clients and co-workers. Social work as a field must not be in denial of this problem – a problem experienced not just by the story noted above, but one I have also experienced.

Lived Experience

Like all persons, my life is a kaleidoscope of relationships and roles. Some know me as the person they see in the gym, as someone they have seen shop in the local food co-op, or as the professor from a course last semester. Others may recognize my name from a political yard sign, from a list of board members of a non-profit organization, or as the clinical director of a behavioral health agency sometimes featured on the local radio show. To others, I am mom, grandma, aunt, sister, partner, and friend. Those closest to me recognize that I am a Christian in recovery.

If asked the common interview question of “How would your co- workers/supervisor describe you?”, I would without hesitation reply, “As an intelligent, creative, dedicated, hard-working and reliable employee.” I identify as a Christian, a social worker, a philosopher, and a person in recovery.

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I have written this paper from an experiential perspective as a multi- faceted, multi-talented, and probably over-extended person, who has embraced life on life’s terms.1 I cannot write from an objective, observer perspective. My lived experience2 has merit in and of itself. I therefore write of my experiences through a lens developed by relationships, roles and experiences too numerous to mention.

The Lens

The overriding paradigm in which I function is that of Christian ide- als. Faith, hope and love guide my life and my clinical and macro practice. These ideals are the foundation from which I respect the dignity of each individual person and fight against oppression at large. My Christianity informs my interactions, both micro and macro, as a social worker. I attempt to model Christian ideals. I discuss religion with my clients and co-workers. I attempt to be a light in the darkness for others, and when feeling unsure or overwhelmed, I stop and pray for guidance and the knowledge of God’s will. I am thankful to have faith, hope and love as my guideposts for social work, as I do not understand how social workers can maintain effective, quality clinical care without them.

The second paradigm for my life is the Alcoholics Anonymous (AA) 12-step philosophy. Although clearly not designed to be a religion, 12-step philosophy perfectly complements my religious practices and the way I live as a Christian. While some persons in AA have embraced G.O.D. as an acronym for “Group of Drunks” or “Good Orderly Direction,” most of my AA friends are also Christians who recognize God as the father of Jesus and the essence of the Holy Spirit. The basic principles of AA – a spiritual awakening, humility, patience, faith, confession, forgiveness, demonstrated love for others, making amends for wrongs done, seeking God’s will through prayer and meditation, and sharing the good news – align perfectly with basic Christian principles. While both paradigms are therefore complemen- tarily directing my lens, the 12-step philosophy is more directly guiding the practice-driven experiences expounded in this paper.

Theoretical Perspective

There are aspects to the participatory and constructivist perspectives that resonate with me and are relevant to this paper. For example, a participatory view is that “validity is found in the ability of the knowledge to become transformative according to the findings of the experiences of the subjects” (Lincoln, et al., 2011, p. 114). Knowledge which has the ability to transform must have such a high level of authenticity that it creates an inherent power; that level of authenticity equates to validity. What can

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be more authentic than a person’s lived experience, documented in their own words? The collaborative nature of the constructivist paradigm in which people are participants in documenting and telling the truth of their experiences, rather than subjects, (Guillemin and Gillam, 2004), minimizes superficial power differentials. It resonates for me as someone who does not want to choose a label – am I the researcher or the researched? Am I the professor or the student? Am I the social worker or the client? The constructivist paradigm amalgamates the interpretations of my multifaceted perspectives regarding my lived experiences so that they have the power to inform; that perspective is “ontologically relative, epistemologically transactional/subjectivist, methodologically hermeneutical and dialectical” (Lincoln, Lyndham, and Guba, 2011, p. 99). “Denise the Christian” joined with “Denise the Social Worker” and “Denise the Person in Recovery” in an integration of the ethics, values, knowledge and experiences of these roles to form the whole of who I am and how I interact with and experience life.

First Professional Interview

One of the first experiences I recall as a social worker in recovery was actually quite positive. After obtaining an undergraduate degree in philosophy and religion, and a Master of Arts degree in education, I felt the distinct call to social work. I started a Master of Social Work program and after the first year, I applied to be the program director of a female gender-specific Department of Correction work release/treatment program in a larger umbrella behavioral health agency that I will call “XYZ.” During my interview for this position, I was asked how I felt about incarcerated women. Knowing that most of the program participants were incarcerated due to substance-related offenses, I honestly answered that if not for some good luck and God’s will, I could just as easily be sitting in their seats in- stead of where I was. This was the first time I publicly acknowledged that I was a person in recovery from a substance addiction. Due to the nature of the work for which I was applying, and knowing that the agency was committed to hiring people in recovery, I felt confident that my disclosure would not be used against me. Not only did I get the job, but I discovered that the two social workers on my clinical team were also Christians and in recovery. What a wonderful experience for us as co-workers and for the vast majority of women who benefitted from that program who were also Christians in recovery.

Classroom Experience

However, at the same time as I was experiencing this freedom of truthfulness, I was not feeling free to have the same level of openness in other areas of my life: my church family, my volunteerism with local

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non-profit organizations, or my MSW program. During my last semester as a MSW student, one of my professors was upset that I used the term “alcoholic” in self-reference during a class discussion. She felt that the terms “alcoholic” and “addict” were too negative; she directed us to use the terminology “a person with an addiction concern.” Instead, I wanted to debate this with her, let her know that it took me a year of attending 12-step meetings and actually receiving my one year coin3 before I had acquired the reality and humility necessary to say, “I’m Denise and I’m an alcoholic.” I wanted to explain to her and the other almost-social workers that those of us with the disease of alcoholism want everyone to be as comfortable with naming the disease for what it is as they are with saying “he has diabetes” or someone announcing “I’m a vegetarian.” By being oh- so-careful with the words, social workers can actually endorse the stigma associated with the name of the disease instead of working to eliminate it. Additionally, social workers can give the message to those who want the freedom to tell their truth that they should not, that saying the name of their disease is like saying the name of “He-who-shall-not-be-named.” The repetitive declaration in AA rooms that I am an alcoholic has been vital in keeping me from the fantasy that I am cured. I wanted to say all of this, but did not. I was not yet confident enough in 2003, after nine years of sobriety, to enter into this needed discussion on the difference between labelling others and self-labelling.

This view of the use of the word “alcoholic” is in stark contrast to my usual testiness at the limitations placed upon persons through labels, catego- ries, and generalizations. I cringe when others attempt to put me into a box that fits within their own narrow window of experience, and I fight for the rights of others to whom this happens. However, I also know the freedom of finding out the name of the disease or disorder with which one is living and facing the realities of that disorder head-on. “Alcoholic,” used as a term for someone with a brain disorder, is liberating to me. It allows me to understand why my body will crave something that is so harmful to me, something that I do not intellectually want, and something that affects my ability to live ac- cording to my Christian ideals. It permits me to give and accept forgiveness for things I have done while under the influence, and to have empathy and understanding for those who are just learning they have a chronic addiction. However, if someone does not understand that alcoholism is an incurable disease and is using the term “alcoholic” to belittle, deride or dismiss, then it becomes a pejorative label that should not be tolerated.

Continuing Education Experience

A few years later, after becoming a licensed clinical social worker, I attended a continuing education course on Cognitive Behavioral Therapy offered by our state’s Department of Mental Health and Addiction Services.

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This was an intensive four-day course taught by a professor whom I knew, as I was a field instructor for some of his interns. Over the course of the four days, he referred to the differences between how “we” (social workers) think and how “they” (substance users) think so many times that I lost count. The message I received was that substance users all have cognitively distorted thinking patterns and social workers do not. At first, I wrote this off as a necessary convenience of speech, but after a while it became more and more irritating. Was he implying that there was no social worker in the class who ever had to reframe their thinking? Was he ever going to mention that persons in recovery work on being aware of, and reframing their thinking daily, so that they actually become quite expert at it? Did he mean to give the message that no one in this class could possibly be both a social worker and in recovery themselves, despite the one in seven statistic (Hafner, 2016) of persons in the U.S. facing a substance use disorder?

Alcoholism, as any disease, knows no boundaries based upon class, ethnicity, gender, religion, or other demographics. The Substance Abuse and Mental Health Services Administration (SAMHSA) website notes that 6.4% of the population of the United States, or approximately 17 million persons, met the criteria for an alcohol disorder in 2013 (SAMHSA, 2018). Bush and Lipari (2015) analyzed statistics from SAMHSA’s 2008-2012 stud- ies and found 8.7% of persons in full-time employment between the ages of 18 and 64 used alcohol “heavily” during the last month. Heavy alcohol use is defined as “drinking five or more drinks on the same occasion (i.e., at the same time or within a couple of hours of each other) on five or more days in the past 30 days.” Given these statistics, the probability that I was not the only person in recovery in that classroom was high. However, again, neither I nor anyone else spoke up. I addressed the issue by going to a 12-step meeting after the last course session where I felt I could safely talk about how offended I felt.

Reflecting upon this experience, I realize I had two primary reasons for not confronting the offensive language head on. First, the instructor was a colleague of mine at my part-time adjunct faculty position in a state university. I had been a field advisor for that university’s BSW program and been invited by this very instructor to join the adjunct team. I was concerned how my being a person in recovery would impact my status in the department that someday I hoped to join full-time. Secondly, I was hoping for someone else to speak up on behalf of social workers in recovery. I still had enough shame and embarrassment associated with being in recovery at that time to be looking for a rescue from being the spokesperson on this issue. I understand now that it is unrealistic to expect those who are not in the same situation to always recognize when apparently common language is offensive to someone else. Each of us is the one and only expert on our own experiences. It is incumbent upon

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those of us who have experienced discrimination or bias to inform others as to the impact of their words or actions.

Professional Behavioral Healthcare Experiences

Over the course of my professional social work career in the behavioral health field, I have become more open about my recovery status–not in all my roles, but with the staff and clients of XYZ, and with people and orga- nizations in which I have a trusted status. Many times my self-disclosure receives a response along the lines of “No way” or “Well, no one would know it.” They are often surprised to hear that I continue to attend as many AA meetings a week as I can (usually 3-4). This is despite the fact that they tell clients with substance use disorders that they will have their disease forever and might want to try to attend AA or Narcotics Anonymous (NA) as an aftercare measure when they are no longer in formal treatment. For some reason, when it comes to a colleague in a senior management position, these same expert clinicians do not stop and think about the fact that I will also always have a need to manage my disorder so that it does not resurface. I know that these colleagues have the academic knowledge that alcoholism is a chronic, progressive disease, sometimes manageable into remission, and cannot be “cured.” I wonder if they understand the “us” and “them” perspective they are portraying by their incredulity that I vigilantly work my recovery every day. These social workers appear to have a need for staff to be different (maybe better?) than the individuals they are assisting. I am thankful that I continue to know that, but for the grace of God, any one of us could be sitting on the other side of the desk.

Perceptions of Relapse

A message I have often heard from colleagues is that “relapse is a part of recovery”. This has been said directly to me; I have overheard from those around me, and it has been reported by clinicians, mentioned by state experts, and believed by clients themselves who heard it from XYZ staff. It has become a common phrase used not just after a relapse, but used by those in the field prior to a person’s recurrence of substance use. However, persons in recovery who remain compliant with the management of their disease through a personalized regimen that can include 12 step meetings, working the program of AA or NA with a sponsor, therapy, medication, or other treatments, may never experience a recurrence or relapse. Relapse has not been part of my recovery, nor has it been part of many of my friends’ recovery stories. I am hopeful that it never will be. Clearly meant to empathetically support those who slip while walking their recovery paths, the “relapse is part of recovery” message is not a positive message for those who do not

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experience such a recurrence of use. I feel the hackles of defensiveness rise in me every time I hear it. An accurate and caring alternative is the message that “relapse is sometimes a part of recovery.” This message can prepare a client if a relapse occurs, but also promotes the hope that relapse need not happen. The reality is that relapse may be a part of recovery, or it may not. The path of recovery is not a straight path, nor is it without its potholes and obstacles. Sometimes a person in recovery will traverse it without slipping despite the trials; sometimes a person may fall down and reach for an old coping strategy. The innate judgmental quality of “relapse is a part of recovery” when presented to or about every person challenging a substance use disorder diagnosis is a message of inevitable failure that should not be sent to a client or a co-worker. It is not an unconditional message of faith, hope or love.

Staff Relapse

During the years that I have worked for the company XYZ, it has ex- perienced the relapse of some of its staff in recovery. These relapses have ranged from a short-term, easily managed with an outpatient treatment program bender, to the death of a staff member from an irrecoverable alcohol overdose. Each time a relapse has occurred, I have witnessed a perceptible change in management’s willingness to hire another person in recovery. Rather than look at the feelings generated by the relapse and what we, as an agency, could do to better support staff with this disease, management diverted the issue in other directions. The ideas that someone who attends 12-step meetings is unable to maintain professional boundaries and that persons in recovery just “don’t get it when it comes to professional ethics” began to be freely floated around in meetings in which I was in attendance. All participants in those discussions knew I was in recovery. My request to stop anecdotally generalizing, to recognize that our staff in recovery were especially effective with our clients, that “you do remember that I am in recovery too,” were all either ignored or dismissed. When I first joined XYZ, 40-50% of staff were in recovery from a substance use disorder, with staff in recovery openly recruited as beneficial to the agency.

At the end of 2017, when after over 10 years of advocacy I finally ob- tained permission to start an in-house 12-step meeting to support staff in recovery, I could only find five other staff in recovery out of a workforce of 110. During those years, the percentage of applicants in recovery remained the same, but the perspective of the hiring managers progressively favored persons not in recovery. Agency oversight of staff in recovery became more intense, with a prevailing attitude that persons in recovery were suitable only as peer mentors for clients, volunteers for leading in-house client sup- port groups, or to manage the recovery houses. The concept of recruiting

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clinical or administrative and management staff in recovery to enhance the diversity of our teams no longer existed. Unfortunately, reinforcement of this attitude is an unintended consequence of state-sponsored initiatives to have agencies hire Recovery Support Specialists and Recovery Coaches — persons in recovery who operate as paraprofessionals.

Staff in Treatment

One staff member who had not yet made his disease public expe- rienced direct discrimination. While one of his co-workers went out on medical leave for several months to deal with a “medical” illness, harsh questioning ensued as to why he needed more than 30 days to attend an inpatient program to treat alcoholism. Senior management questioned the seriousness of his need for treatment because “we’ve never seen any signs that he had a drinking problem at work.” Having overcome the hesitation early in my career to speak too much about my disease, I reminded my co- workers that no one ever knew I was an alcoholic at my previous places of employment, prior to my being in recovery. I let them know that given my past pattern of drinking and still functioning at my job, they would never be able to tell if I relapsed unless I chose to tell them. I reminded them that, as an agency, we know that once someone has reached the point of needing residential treatment, 30 days will only clear the head enough to start in-depth work – that is why XYZ’s residential treatment program has a four-to-eight month stay, dependent on individual needs. Why would we hassle a staff member for wanting to take 60 days to learn to manage his chronic disease? Both the HR manager and the CEO of XYZ were social workers and they continued to be unsupportive of more than 30 days for his treatment, despite a letter from his treatment provider stating the need for a longer stay.

Employment Challenges

Social workers in recovery who choose to work in behavioral healthcare have many employment-based challenges. For example, some agencies have restrictions that include not attending or not sharing at 12- step meetings where agency clients are present, not having enough time during the day to catch a noon-time 12 step meeting and/or missing dinner to participate in a distant evening meeting, not sponsoring clients, and not self-disclosing your recovery status. Staff in recovery couple these stressors associated with maintaining treatment compliance for their chronic disease of addiction with the everyday stressors of interacting with clients who often exhibit the physical signs, smells and behaviors of active addiction and the vicarious traumatization often experienced by behavioral healthcare staff.

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As another example, it is common to find that persons in recovery are only considered for entry level “peer” positions in an agency, rather than professional positions. When state funders requested the presence of persons on XYZ’s boards and committees with lived experience, they did not accept “professional” staff in recovery as fulfilling that request. I cannot speak for others, but this staff-in-recovery is unable to dissociate myself from a person- in-recovery perspective. I live and breathe my recovery, as I do my Christianity. It informs and defines who I am. I recall a state auditor asking how many peer support staff worked within one of XYZ’s programs. When I included myself in the count, the auditor responded, “Well, you don’t count – we are only counting peer support.” This was a perfect example of what Kaplan (2005) called the concept of associating staff in recovery only with para-professionals. I responded that I was a peer support and role model, as the residents of the program knew I was in recovery. The auditor dismissed me with, “but you’re, well, you’re dif- ferent.” Her perspective appeared to be that only persons in recovery who are not also behavioral health professionals count as “peers;” alternatively, it could have been that once you have achieved a professional status, you no longer count as a person in recovery. Either perspective is offensive and discriminatory to those of us who are living a life that merges those roles.

An employment-based role challenge for me is the opposite ways in which some co-workers regard my “Christian” tag as compared to my “person-in-recovery” tag. When religious clients came to our agency, in- take screeners often assigned them to receive services from the few openly “religious” staff (myself included). Other social workers support this move by saying that they are not familiar enough with religion to give quality care – they have not read the religious texts, they do not attend religious services, and they feel inadequate to the task. However, when clients come to our agency to receive help with their substance use disorders, the same social workers do not feel inadequate even if they have not read Alcoholics Anonymous, have not attended 12-step meetings, and do not have a sub- stance use issue themselves. I believe that any social worker can effectively work with any client if they are open to a transactional relationship in which each is learning from the other. What is curious to me is why I am regarded as a go-to social worker for religious clients, but I am no different than any other social worker for clients with substance use issues. I would love to be a resource for co-workers as a person in long-term recovery who can dispel the myths that surround AA, who can teach the AA lingo5 of the rooms,6 who may be able to shed some light on why a client does not appear to be progressing even after “last chance” behavior contracts and ultimatums. Agency staff whom I have supervised continue to utilize the knowledge regarding alcoholism and alcoholics I have acquired through my personal experiences and choose to share with them. However, XYZ

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is uncomfortable in acknowledging that I, or other staff in recovery, may have useful knowledge not found in textbooks.

Despite the prevailing attitude, there have been those staff who have actively sought my help with challenging recovery situations. A former MSW intern of mine hired by XYZ often requested my person-in-recovery perspective, as well as my clinical social worker perspective, in consulta- tion for challenging clinical situations. In addition, one Program Director within XYZ often called upon my insight as a person in recovery to assist with both individual and group situations. I recall a time when a particular 12-step meeting in the wider community requested that the residents of the treatment program she directed not return to the 12-step meeting. She realized that neither she, nor any of her staff, understood the etiquette involved in 12-step rooms and therefore was unsure how to resolve this dilemma. One of the privileges I afforded myself as a senior management team member was the opportunity to take off the “big boss” hat and replace it with the “AA Old-timer”7 hat, as appropriate to the situations. This I did when speaking with the resid