The ecology of addiction in a multicultural society requires us, as family therapists and addiction counselors, to re-examine two core ideas that have historically guided our treatment of addiction in the United States: power and powerlessness. Pride, false pride, and shame are closely related concepts and must also be viewed in a multicultural context.
Power and powerlessness are concepts laden with multiple meanings. Understanding the ecology of addiction as it relates to a particular individual or group requires us to first think about these concepts in a generic way and to then particularize them to the individual or group. The founders of Alcoholics Anonymous and family systems thinkers like Gregory Bateson based their beliefs about the nature of addiction on the Western European view, which is primarily "power over." I will address the concept of "power over" at some length, because traditional addiction treatment in the United States, often wedded to a twelve-step approach, evolved from this Western European view. It is in the context of this view that addicts are asked to embrace the idea of powerlessness over their addiction. Only then, we tell them, can they regain power over their life. The first step in recovery in Alcoholics Anonymous, the dominant paradigm for most addiction treatment in the United States, occurs when addicts recite, "[We] admitted we were powerless over alcohol, that our lives have become unmanageable." This admission of powerlessness that AA insists on is key to the shift in the addict's belief system and crucial to dismantling what Karen Horney (1937) calls "neurotic pride." In his concept of the symmetrical structure of "alcoholic pride" Gregory Bateson (1972) too recognized the necessity for addicts to shift their stance from one that asserts domination over the self, others, and the environment to one that accepts the reality of limitation, a concept that is foreign to our Western culture.
It is necessary to broaden our thinking about what it means to have power or to be powerless and examine what it is about these prevailing views of power that can set the stage for addiction.
Kinds of Power
In her book Understanding Race, Ethnicity, and Power, Pinderhughes(1989) wrote:
People experience the presence or absence of power in many areas of life. For power is a systemic phenomenon, a key factor in functioning....Internal power is manifest in the individual's sense of mastery or competence. The power relationships between people determine whether their interactions are characterized by dominance-subordination or equality. These styles of interaction are, in turn, affected by the status and roles assigned within the group or the larger society.
There are four related kinds of power:
Let us first deconstruct these kinds of power and posit how addicts think of each of them. I believe that addicts, in their addiction, identify with the dominant discourse of "power over" and that they must learn to view this discourse as "power to" if they are to recover from their addictions.
Individual "power to" is synonymous with empowerment and includes feelings of self-control, subjectivity, and the ability to define one's own life. It is the power to choose. For example, although we have no say about the family of origin we are born to, we can learn to make choices about family relationships that empower rather than victimize us. For the addict, "power to" is the power to surrender, a paradox I examine later in this chapter.
Individual "power over" may extend to total control of one's feelings or to the illusion of total control over one's life. Gender-linked messages about the control of feelings, such as the suppression of male vulnerability or of female anger, teach people that they have individual power over their feelings, thereby constricting normal emotional behavior. Individual "power over" denies the need to act in a context with others. Those who insist on having this kind of power will have difficulty submitting to authority. Any absence of control is viewed by them as being controlled and therefore out of control. For example, being a member of the crew on a sailboat rather than the captain may be experienced as being powerless, rather than simply as being a team player. The individual who must have "power over" will have difficulty relinquishing control when cooperation is needed. For example, the addict says, "I can control my habit. I have power over my addiction."
Interpersonal "power to" is the power to be heard in a group, perhaps to become the leader. It is the power to make choices and take positions about what one will or will not do, rather than just react to situations in relationships. For the addict, "power to" means the ability to leave bar friends and go to an AA meeting. It empowers addicts to exercise a healthy choice, such as to amend their relationships in sobriety.
However, interpersonal "power to" can lead to "power over." One's power to enlist in a cause may become institutionalized leadership, a legitimized form of "power over." Although "power over" may start benignly, it is vulnerable to becoming a power over others that denies equality and becomes exploitative, unjust, and even violent. There can be no "power over" without relative inequality (Sebastian, 1992). Our institutionalized "power over" that emanated from the Eurocentric subjugation of what became these United States is White, male, Protestant, and heterosexual.
The addict, desperate to hold on to "power over," says, "I will overpower your efforts to control my chemical use. I will control you." The addict's expression of "power over" might be annoying manipulative behavior or actual physical coercion.
Culture, like power, is a systemic rather than a static process. Falicov (conversation with author, 1998) points out that it is a dialogical process, with certain cultural attributes being highlighted in interaction with others.
Sociocultural power is group power. For a group, "power to" may mean a centralized position (rather than marginalization), access to resources, or political power. That is, "power to" is the right to define the rules, control the discourse, select the language. For the addict, sociocultural "power to" means becoming part of a reference group that values sobriety.
Sociocultural "power over" is power that privileges certain groups at the expense of others, as demonstrated by race and class discrimination. A group that exerts "power over" creates inequality among groups. For example, immigrants come to the United States to find the "good life" portrayed in the media, but their success often depends on which race or class they belong to. It is clear that success and power in the United States are synonymous with material comfort. Immigrants of color are frequently denied access to the better-paying jobs. These people may be highly skilled, well-educated individuals who were relatively well compensated for their work in their country of origin. It is a shock for them to come in search of the "good lif
Addiction, Family Therapy, and Multicultural Treatment
Bridges to Recovery
Addiction, Family Therapy, and Multicultural Treatment
Bridges to Recovery is the first book to bring together experts from three major fields within psychotherapy -- family therapy, addiction counseling and multicultural treatment -- to provide a practical and flexible framework for working with families within their individual cultural contexts. Drawing upon case studies, clinical anecdotes and proven treatment methods, Bridges to Recovery provides practitioners with a unique insight into the individual cultural nuances that make addiction recovery a very personal journey.
Jo-Ann Krestan, co-author of the classic book The Responsibility Trap: A Blueprint for Treating the Alcoholic Family, and her contributors integrate the latest ideas and research to offer a foundation for addiction treatment that brings to the forefront the cultural thinking that affects alcohol and drug use/abuse among Native Americans, Jewish Americans, African Americans, West Indians, Asian Americans, Mexican Americans, Puerto Ricans and groups of European origin. This book will be an invaluable asset to teachers and students in clinical social work, psychology and substance abuse counseling programs, setting the standard for education and treatment at the beginning of the 21st century.