Twelve-step sponsorship is so twentieth century—or so The New York Times would have us believe. In an article published last month in the newspaper’s Fashion and Style section, author Marisa Fox made the case that “recovery coaches,” “once consigned to Hollywood entourages to keep celebrities on the straight and narrow,” are currently trending among upper-class women “from the Upper East Side to the beachfront homes of Boca Raton.”
Last weekend, NPR’s All Things Considered followed the trend, offering a more inclusive description of recovery coaches’ clientele (the stock image that accompanied the report was still a view from the beach).
The historical angle adopted by both news outlets was obvious. The old-fashioned practice of sponsorship—defined by Alcoholics Anonymous as the process by which a person “who has made some progress in the recovery program shares that experience on a continuous, individual basis with another alcoholic who is attempting to attain or maintain sobriety”— presents shortcomings in today’s treatment marketplace. The women featured in the Times have the ability to buy their way out of the social awkwardness and fear of exposure that twelve-step meeting attendance invites. The NPR piece notes that people in early recovery don’t always gravitate toward the most adept supporters— coaches, who are trained to provide practical as well as spiritual guidance, can help solve this long-standing problem.
As historian and clinician Bill White explained, coaches are not sponsors (they don’t do voluntary twelve-step work on “paid time”) and they’re not quite counselors (they don’t diagnose or probe underlying psychological issues). They occupy a new niche in the service economy that employs more than 75 percent of today’s American workers. They are “the new Pilates instructors,” one coach told the Times. They are compensated to be both “cheerleaders” and “beacons of hope,” another told NPR.
Like NPR reporter Martha Bebinger, I think coaches can produce tremendous benefits, both for people in recovery and for the treatment system as a whole. But the proper role of recovery coaches in today’s health service sector also deserves a systemic critique—and not the trolling, “New York Times Style Suction” sort.
The positive qualities of peer-based support services are well documented. An investment in the prevention services delivered by recovery coaches shifts the focus away from the acute care provided by residential treatment or emergency room visits; this saves the system money, while sparing sufferers the agony of addiction-related crises. And coaching works: in mental health settings, trained peer supporters have produced impressive results in randomized clinical trials.
Still, my research on treatment paraprofessionals in the 1960s and 1970s gives me pause. Some of the earliest “ex-addict” professionals who emerged in that era made a living wage, but within a few decades, the combined forces of credentialism, wage compression, and emotionally taxing working conditions put community-based addiction treatment workers on a career path for burnout. Researchers and advocates for “recovery oriented systems of care” know that today’s coaches face many of these same challenges.
If peer-based support works so well, and professionalizing it runs the real risk of exploiting peer providers, it’s tempting to consider a return to traditional, twelve-step voluntarism as a possible solution: today’s coaches could take regular, middle-class jobs, and answer twelve-step calls after hours. Or it would be tempting if—as scholars like Arlie Hochschild have argued—the gift economy hadn’t recently collapsed along with the global one. Hochschild has detailed how, like the recovering clients profiled in NPR’s report, we all need to be taught “how to manage our emotions” in order to be successful in business; how the line between work and home, and between compensated and uncompensated labor, has all but vanished; and how our intimate relationships have been delegated to consultants and service workers. The “sponsored self” in the twentieth century may have been over-psychologized; in the twenty-first century, it’s been outsourced.
What did you make of the recovery coach coverage? Let’s get a conversation going in the comments below.
Excellent post. A similar theme I’ve picked up on in recent years is an assault on supposedly “antiquated” or “ineffective” twelve-step programs. This is probably a result of a few factors: as you highlight here, the professionalization and proliferation of individual treatment, the cult of STEM, and disillusionment with the drug war. For example, I noticed in one recent article (http://aeon.co/magazine/being-human/the-aa-is-out-of-step-with-research-on-addiction/) that the author called Alcoholics Anonymous “out of step” with addiction science, yet it yields abstinence rates comparable to other therapies. They also downplay the environmental and, ultimately, choice factors that contribute to addiction. The author is particularly hostile to court-ordered AA, but I think that opinion is propelled by broader opposition to formal drug control policy.
Hi Kyle! Thanks for the link to the Aeon article. We could definitely add a lot of ‘AA is antiquated and outdated’ links to this round-up (or maybe you could do another one on that topic?) I view the AA backlash as cyclical– every couple of years, there will be a spate of books and articles making the same general criticisms (seen most recently in the Aeon piece/ Lance Dodes’s new book/ etc). What is interesting to me (and it sounds like it is to you, as well) is *why* the backlash cycle starts over at a particular moment. “The professionalization and proliferation of individual treatment” is nothing new, although a kind of nostalgia for medical authority and the current disillusionment with the drug war of the late 20th C might be. I’d love to see an analysis about the differences between the AA critique, circa 2014, and the 1980s wave led by writers like Herbert Fingarette, Stanton Peele, and Charles Bufe.
An interesting proposition… One I may look into for my TBA topic one month sometime in the future!
This blog post led me to recall the trilogy published in 1987 by Sage Publications written by sociologist Norman Denzin (of Symbolic Interaction fame). The lead title was “The Alcoholic Self”. The two following that were results of his further immersion into a realm he loved – the realm of Alcoholics Anonymous – “The Recovering Alcoholic”, and “Treating Alcoholism: An Alcoholics Anonymous Approach.” I think Symbolic Interaction is great construct for some understanding of culture via culture clash in our post modern fiber-opticked world.
Is it possible AA is so rooted in religion and Buchman’s groupism of the early 20th century, that AAers will never be able to escape what results in your apt description of “community-based addiction treatment workers on a career path for burnout?” It seems the important AA doctrine of powerlessness without the group shoves symbolic interactive dissonance right into their daily lives as they try to cope with the forces of “credentialism, wage compression, and emotionally taxing working conditions”, things any other student would expect in due course on the way to a career (but not a career suggesting “join me in AA as a way of life” to struggling people).
I don’t know how much Denzin knew of the history of alcohol recovery, but the professors of religion and medicine were always there to first nip at the heels of sudden self-recovery, and if that didn’t work, plant their teeth firmly in the groin of sudden self-recovery and not let go. What’s sudden self recovery? It’s just what we see when someone quits on their own. We don’t see much of the internal debate preceding, but there it is. It’s what the six Washingtonians did and then popularized until it was fairly quickly transformed into something else.
What does coaching mean? Simply, teaching. I think that’s the direction recovery services are moving – towards simple teaching. And I think the best recovery teaching would include leaving not only the addiction in the past, but the recovery in the past as well. I think that most former addicts do learn this. Out of the 100 million teetotalers in this country I wonder how many were formerly identified as substance abusers. 10 %? It must certainly be more than 2 %.
I think the “nostalgia for medical authority” is incorrect. It’s a nostalgia for what the original six Washingtonians did and what they tried to teach. How to take the pledge and make it stick based upon a personal morality. The experience stories were originally fluff around the edge of taking the pledge. They were not a mandated dredging up of an old corpse to revisit a tarnished past ad infinitum until dead.
I think what people may see as a “cycle” of rejection towards the recovery group movement is actually a periodic interest taken by the mass media and does not reflect the consistent and growing rejection in the general population due to advancement in problem solving of all kinds, including how to end an addiction.