Addiction Treatment Culture

From Hillbilly Elegy: A Memoir of a Family and Culture in Crisis, by J. D. Vance (Harper, 2016), pp. 114-117:

On designated weekdays and weekends, we visited our mother at the CAT [Center for Addiction Treatment] house. Between the hills of Kentucky, Mamaw and her guns, and Mom's outbursts, I thought I had seen it all. but Mom's newest problem exposed me to the underworld of American addiction. Wednesdays were always dedicated to a group activity—some type of training for the family. All of the addicts and their families sat in a large room with each family assigned to an individual table, engaged in some discussion meant to teach us about addiction and its triggers. In one session, Mom explained that she used drugs to escape the stress of paying bills and to dull the pain of Papaw's death. In another, Lindsay and I learned that standard sibling conflict made it more difficult for Mom to resist temptation.

These sessions provoked little more than arguments and raw emotion, which I suppose was their purpose. On the nights when we sat in that giant hall with other families—all of whom were either black or Southern-accented whites like us—we heard screaming and fighting, children telling their parents that they hated them, sobbing parents begging forgiveness in one breath and then blaming their families in the next. It was there that I first heard Lindsay tell Mom how she resented having to play the caretaker in the wake of Papaw's death instead of grieving for him, how she hated watching me grow attached to some boyfriend of Mom's only to see him walk out on us. Perhaps it was the setting, or perhaps it was the fact that Lindsay was almost eighteen, but as my sister confronted my mother, I began to see my sister as the real adult. And our routine at home only enhanced her stature.

Mom's rehab proceeded apace, and her condition apparently improved with time. Sundays were designated as unstructured family time. We couldn't take Mom off-site, but we were able to eat and watch TV and talk as normal. Sundays were usually happy, though Mom did angrily chide us during one visit because our relationship with Mamaw had grown too close. "I'm your mother, not her," she told us. I realized that Mom had begun to regret the seeds she'd sown with Lindsay and me.

When Mom came home a few months later, she brought a new vocabulary along with her. She regularly recited the Serenity Prayer, a staple of addiction circles in which the faithful ask God for the "serenity to accept the things [they] cannot change." Drug addiction was a disease, and just as I wouldn't judge a cancer patient for a tumor, so I shouldn't judge a narcotics addict for her behavior. At thirteen, I found this patently absurd, and Mom and I often argued over whether her newfound wisdom was scientific truth or an excuse for people whose decisions destroyed a family. Oddly enough, it's probably both. Research does reveal a genetic disposition to substance abuse, but those who believe their addiction is a disease show less of an inclination to resist it. Mom was telling herself the truth, but the truth was not setting her free.

I didn't believe any of the slogans or sentiments, but I did believe she was trying. Addiction treatment seemed to give Mom a sense of purpose, and it gave us something to bond over. I read what I could on her "disease" and even made a habit of attending some of her Narcotics Anonymous meetings, which proceeded precisely as you'd expect: a depressing conference room, a dozen or so chairs, and a bunch of strangers sitting in a circle, introducing themselves as "Bob, and I'm an addict." I thought that if I participated, she might actually get better.

At one meeting, a man walked in a few minutes late, smelling like a garbage can. His matted hair and dirty clothes evidenced a life on the streets, a truth he confirmed as soon as he opened his mouth. "My kids won't speak to me, no one will," he told us. "I scrounge together what money I can and spend it on smack. Tonight I couldn't find any money or any smack, so I came in here because it looked warm." The organizer asked if he'd be willing to try giving up the drugs for more than one night, and the man answered with admirable candor. "I could say yes, but honestly, probably not. I'll probably be back at it tomorrow night."

I never saw that man again. Before he left, someone did ask him where he was from. "Well, I've lived her in Hamilton for most of my life. But I was born down in eastern Kentucky, Owsley County." At the time, I didn't know enough about Kentucky geography to tell the man that he had been born no more than twenty miles from my grandparents' childhood home.