Parents' experiences of substance use problems,parenthood,and recovery within the 12-step movement

12-step movement

Because the parents interviewed in this study have been engaged in Alcoholics Anonymous as well as Narcotics Anonymous and Cocaine Anonymous, throughout the article I use the term 12-step, which includes all these movements. 12-step programmes exist both within the frame of professional substance use care, and as self-help groups, and are a common form of continuing care after formal treatment. As 12-step self-help groups are accessible and free to participate in, they have been found to play an important part in the recovery of many substance users (Donovan, Ingalsbe, Benbow, & Daley, 2013). Studies on effectiveness have also shown that taking part in a 12-step programme is at least as helpful as participating in any other type of intervention (Bøg, Filges, Brännström, Klint Jørgensen, & Karrman Fredrikkson, 2017; Kelly, Magill, & Stout, 2009).

Cain (1991) compares the 12-step movement to a subcultural system, as it holds a set of certain beliefs and assumptions, and in this sense can be seen to constitute a specific meaning system within the larger Western culture. Most of the beliefs and principles of the movement are formulated in the 12 Steps Towards Recovery, which constitutes the basic programme for each individual member’s work towards sobriety. One of the most important principles is the definition of a substance use problem as a progressive and incurable disease (Cain, 1991). This view is formulated in the first step, in which the participant is asked to acknowledge his or her powerlessness over the alcohol or other drug. Acquiring the insight and view that substance use problems are a disease is described as a fundamental part of the 12-step recovery process (Hänninen & Koski-Jännes, 1999). Furthermore, this disease is viewed as something originating in the individual’s self and emotions. People with substance use problems, from a 12-step perspective, are therefore by definition emotionally ill (Denzin, 1993).

Several of the following steps emphasise the importance of spirituality, and individuals are said to gain control over their substance use problems by surrendering this control to God or a Higher Power (Swora, 2004). The definition of spirituality has, however, broadened over time, from the purely religious to the include the individual’s own ability to think, feel, and do things he or she is not able to do through mere will power alone (Kelly, 2016). Other steps include admitting one’s wrongs and defects of character. For example, the fourth step calls for a fearless moral self-inventory that, as pointed out by Swora (2004, p. 196), serves the purpose of creating “a new past in the present”. The eighth and ninth steps focus on making amends to people one may have harmed during one’s time with active substance use problems, and in this way serve the purpose of changing the way one acts in the social world and relates to other people (Swora, 2004). Finally, the 12th step requests that the 12-step member should carry the message of the movement on to other people who may need it. Through the process of working with the steps, an identity transformation is expected to take place, as the individual is not only supposed to become abstinent, but also to develop spiritually, and become more humble, caring, and open-minded (Humphreys, 2000; Swora, 2004).

Aim of the study

The aim of the study was to explore how parents who self-define as active members of the 12-step movement speak about their experiences of becoming and being parents. How do the participants narrate their experiences of parenthood within the narrative framework of the classic 12-step storyline? How do they conform to or oppose this storyline? And how do these narratives relate to culturally established values of parenthood? That is, how do the interviewees present themselves as parents in their recovery narratives? The study contributes to existing narrative research on recovery within the 12-step movement by incorporating the dimension of parenthood, thus analysing 12-step stories from a novel perspective.

Theoretical approach to storytelling

The data were analysed within a narrative theoretical framework that positions storytelling as the basic way that human beings make sense of their lives (Somers, 1994). When telling stories, we both construct and communicate our views of ourselves, of other people, and of the world we live in. Through storytelling, chaotic experiences can be structured and ordered, and fragments can be moulded into a coherent entirety (Johansson, 2005). Narratives thus serve the function of structuring experience and memory (Bruner, 2004). This theoretical standpoint implies that I view my data (the interviews) as narratives actively constructed by the study participants, rather than just information about the participants’ experiences. The goal of the analysis will thus be to explore in which ways the participants construct their parent identity and structure their experiences of having children in relation to the narrative frames set up by the classic 12-step storyline. The analysis will consequently pay attention both to what the participants say and how they say it (see, e.g., Silverman, 2013).

Data and analysis

The data consist of eight interviews with parents (of children up to 10 years old) who said that participating in the 12-step movement had been an essential part of their recovery. To find potential interviewees, professionals at several social agencies and substance use care units were contacted in Stockholm and other Swedish cities. This, however, turned out to be quite an unsuccessful way to recruit. In the end, only one out of eight interviewees was found this way, while the others were recruited through “snowball sampling”, a form of network sampling in which new interviewees are found through the recommendations of existing participants. The use of snowball sampling is common in studies of hard-to-reach populations (such as minority groups, sex workers, or people with substance use problems), as random samples are often too difficult to obtain (Goodman, 2011; Handcock & Gile, 2011). The participants in this study had no active substance use problems at the time of the interviews. However, it is likely that speaking of children and parenthood in relation to one’s earlier substance use problems raises a taboo that makes this population harder to reach than if the subject of the interviews had been more neutral. As pointed out by Crosby, Salazar, DiClemente, and Lang (2010), a range of obstacles often makes it difficult to achieve rigour in studies involving hard-to-reach populations. And although snowball sampling may not be the best strategy, there is always a need to “…strike a balance between the need for rigour and the realities of working with populations that may be less than amenable to engaging in research” (Crosby et al., 2010, p. 2).

Results

Below, the interviewed parents’ narratives of substance use problems, recovery, and parenthood are described and analysed under the headings Negative consequences as motivation for change, Substance use problems and heredity, and “Now” compared with “then”.

Discussion

The process of identity transformation connected with taking part in a 12-step programme has been explored by several researchers who describe the 12-step programme as a way of life, rather than just a type of substance use rehabilitation (Humphreys, 2000; Swora, 2004). Sobriety is, from a 12-step perspective, not only abstinence from drinking or taking drugs, but also a state of humility, less self-centredness, and more openness to change and spiritual growth than during the times both before and during substance use (Swora, 2004). In the narratives of this study’s participants, this identity transformation was mainly manifested through descriptions of how one has changed and become able to live a richer and more harmonious life through learning to accept and come to terms with one’s feelings. Through the 12-step recovery process, earlier experiences are described to have been transformed into strengths rather than weaknesses, and these strengths are also described as important resources in parenthood. The tendency to define former substance use problems and recovery this way has been described in earlier research. For example, Swora (2004) states that 12-step members often see their substance use problems as meaningful in that they led them, through the 12-step recovery process, to more fulfilling lives.

Throughout their narratives, the participants in this study are doing active identity work, presenting themselves as parents. Among those participants who had recovered by the time they had their first child, self-presentation as a parent often emphasised how their work with the 12 steps had made them more emotionally present and in touch with their feelings than the average person or parent. Among the participants who had children during a time of active substance use problems, the positioning of oneself as a (nowadays) well-functioning parent was accomplished by comparing the former self with the present recovered self. The narratives in these cases centred on descriptions of having felt an emotional numbness towards the child, and these experiences were contrasted to how one nowadays is more emotionally present. The criticism of the parent one earlier was thus served to emphasise the improvements made. The quite harsh condemnations of how one functioned as a parent during the time of active substance use problems can also be seen in the light of how an important part of working with the 12 steps is to admit one’s wrongs and defects of character. Earlier research has shown that parents with active substance use problems (who are not involved in the 12-step movement) can negotiate culturally held values of parenthood and present themselves as capable parents despite their ongoing substance use (e.g., Baker & Carson, 1999). This kind of negotiation, presenting one’s former, substance-using self as a “good enough” parent, would probably be difficult within the narrative framework set up by a 12-step understanding.

Research has underlined pregnancy as well as parenthood as important motivators for women to seek help for substance use problems (Fraser, McIntyre, & Manby, 2009; Schultz, Teyra, Breiler, Evans-Campbell, & Pearson, 2018). Research on whether these factors are also motivators for men is very limited, but a study by McMahon, Winkel, Suchman, and Rounsaville (2007) showed that men in substance abuse treatment, to a high extent, were motivated to work with improving their parent capacities. Furthermore, parenthood is, from a general perspective, often mentioned as one of the most important turning points in an adult’s life (Rönkä, Orvala, & Pulkkinen, 2003). In light of this, it is noteworthy that none of the participants credited becoming a parent (or wishing for children in the future) with the same strong potential for personal change as the process of working towards sobriety within the 12-step movement. With only one exception, none of the parents interviewed mentioned parenthood, children, or a wish for future children as major factors in their decision to start working towards recovery. Instead, the turning points in the narratives were almost always experiences of hitting rock bottom, indicating just how strong the notion of “hitting rock bottom” is within 12-step discourse. As Humphreys pointed out (2000), stories of hitting rock bottom often include dramatic events such as psychotic breakdowns, arrests, divorces, or suicide attempts. The lack of focus on children in the participants’ narratives is thus logical, as hitting rock bottom refers to negative consequences of the substance use problems, rather than wishes for a better future (that may include becoming a parent or improving relations to the children one already has). The one exception in the data, when parenthood is mentioned within the telling of a hitting rock bottom experience, also is clearly negatively framed, as the parent in question describes her fear of having her child removed by the social authorities.

In several of the participants’ narratives, the disease model of problematic alcohol and drug use was connected to an understanding of these problems as genetically hereditable. However, several of the parents described feeling prepared to meet their children’s possible future problems with the knowledge and competence gained through their own recovery. Thus, they considered it possible to compensate for potential genetic vulnerability, and several hoped to be more competent and better prepared than the average parent for their children’s possible future interactions with alcohol and drugs. One parent, however, expressed some scepticism about letting his own 12-step experiences guide his reactions to his children’s future contacts with alcohol or drugs, and he emphasised the importance of taking a laid-back position in this respect. All participants, however, shared the view of substance use problems as a disease that some people are susceptible to, while others are not.

This study focused on whether and how participants related their experiences of parenthood to the principles and beliefs of 12-step programmes, and how they conformed to or opposed the classic 12-step storyline when narrating these experiences. Since the study had a small sample, recruited through snowballing, there are certain limitations in the generalisability of the results. Another potential limitation could be the fairly long time since the interviewed parents had active substance use problems. However, life stories are shaped in retrospect. For example, which life events are assigned meaning as turning points in relation to a substance use problem is often clearer when constructing one’s life story later and at some distance (Teruya & Hser, 2010).

To summarise, the results show several interesting tendencies. The study confirms earlier research (e.g., Andersen, 2015; Carr, 2011) that has shown the importance of treatment context in how recovery narratives are created and new non-substance-abusing identities are formed. The participants’ narratives, on the whole, conformed to the classic 12-step storyline. The lack of reference to children (or future children) as a motivating factor towards recovery is a striking example of how the classic 12-step story was an organising narrative structure in the participants’ retellings of their parenting experiences. The participants’ decisions to start working towards sobriety were all connected to hitting rock bottom experiences rather than to any particular incentive, including present or future children. An interesting question for future research would be whether the idea of having children is considered a turning point in the stories of parents who have recovered from substance use problems through methods other than 12-step programmes. The most salient result of this study, however, is that all participants described their work with the 12 steps as leading them to personal change through allowing them to become more in touch with, and better able to handle, their feelings. They also emphasised how this improved their parenting capacity and promoted the well-being of their children, in both the short and the long term. Through their narratives of substance use problems and recovery, they were able to present themselves as (nowadays) competent and well-functioning parents. The 12-step storyline thus allowed for integrating experiences of substance use problems into the parent identity in a way that made these experiences empowering rather than stigmatising.