Exit Double Trouble: A Narrative Approach to the Recovery Process from Addiction and Abuse

Lis Bodil Karlsson, Social Work Department, Karlstad University/Social Work Department, Stockholm University

Ulla Rantakeisu, Social Work Department, Karlstad University

Kirsti Kuusela, Social Work Department, Karlstad University


Studying violence and addiction concurrently is a challenge. Perhaps we are reluctant to share in a life where several negative aspects are interwoven or a combination of destructive consequences (see Holmberg, Smirthwaite & Nilsson 2005). It is also likely that experiences of addiction and abuse are mutually and negatively reinforced, thus aggravating the situation for the afflicted women and their chances to get adequate help. There are also deeply rooted perceptions of the bad and lost woman that diverge from the expectations of a true woman, that is, the good mother and wife (Lander 2003). The “bad woman” deviates from the norm through her actions, which through association are equated with having inferior personal qualities compared to others (Lander 2003). Destructive experiences tend therefore to be dismissed on the grounds of addiction, criminality, and asociality, etc. Such illogical and loose associations are remarkable since research has long shown that even if violence and addiction coexist in certain relationships, there is nothing to indicate that drug/alcohol addiction alone can explain or cause violence, or that the violence will end if the partner quits the addiction (Boles & Miotto 2003; Fals-Stewart & Kennedy 2005; Irons & Schneider 1997).

Physically abused women’s situation can, according to Enander (2011), be summarised in three key sentences based on the mental and physical degradation when violence is part and parcel of everyday life:  

The normalisation process leads to the woman’s gradual breakdown and makes it difficult for her to leave the man. Internalisation of violence means that the woman begins to see the violence and her self through the man’s eyes. The traumatic bond between the victim and the abuser is very strong, amongst other, with the help of internalisation (2011, 44, our italics and translation).

Three recurring explanatory models of violence in heterosexual relations can be discerned, according to Klostermann, Kelley, Mognone, Pusateri and Fals-Stewart (2010). From a feminist perspective, violence is explained by male dominance and as an exercise of power and control. The second explanation is the psychopathological perspective, focusing on individual problems, such as alcohol abuse or emotional deregulation. A third perspective, the family violence theory, explains the violence as an extreme result of conflict. Our article adopts the feminist perspective with focus on the consequences of gender structures, i.e. that abused women are seen as subjected to ”male exercise of power” (Holmberg & Enander 2004/2010, 22, our translation). Social workers need to know and understand not only the way into but also the processes out of abused existence, especially since studying and understanding abuse and addiction concurrently present such a challenge. 

The aim of this article is to create understanding of a drug addicted and physically abused woman’s life story and process of recovery. In the life story presented, the narratives of abuse and violence are interwoven even if the experiences to the extent possible are analysed separately. In this article, recovery refers to the process over time from the break with addiction and abuse to recuperation and the final return to work in the substance abuse field. The narrative approach applied here provides the opportunity to explore recovery as a social phenomenon (Fraser 2004).

1           The exit process theory

In the following, the exit process, originally developed by Ebaugh (1988), is described. It is a general model for delineating the course of events involved when people question their life choices and want to or must change their life situation. It is a general model for describing the course of events involved when people query their life choices and want to or must change their life situation. Ebaugh defines the exit process as a social process over time, in which a person dissociates from a role associated with her identity in order to develop a new and different role in the long run: In the first phase, First Doubts, life choices are re-evaluated. Depression and anxiety may mark this phase. The decision is affected by the reactions of other people, positively as well as negatively. The second phase, Seeking Alternatives to one’s roles, which in the present case is an alternative to addiction and abuse, entails a deliberation of advantages and disadvantages of such a life. In the second phase insights into the limited possibilities for action emerge, which, however, can be liberating for the individual. The transition to the third phase, The Turning Point, usually takes place in connection with a critical event when the person leaves an old role in life behind. Being in a marginal situation is emotionally taxing and anxiety-ridden and the person longs for belonging.

The fourth phase, Creating the X-role, involves building a new life and can extend over several years. The person becomes an ex. According to Ebaugh, this phase concerns the person’s ability to successfully present her/his self and how to relate to people’s reactions. The person has to decide whether or not to reveal her/his experiences in social contexts, stop defining herself/himself in terms of being an ex or change dress style etc. The person must thus relate to the stereotypes associated with the role she/he is leaving and to people with ex experience and those without. ”As exes struggle to disidentify with a previous role, others with whom they associate take their previous identities into account and frequently relate to them in terms of who they used to be” (1988, 180). Ebaugh (1988) emphasises the importance that the individual understands the exit process as this will facilitate the processing of experiences. Similarly, the professionals should have knowledge of the process to create the conditions required for each treatment of recovery.

Enander and Holmberg (2008) argue that the exit process for abused women is not one but three processes in order to disentangle a traumatic bond with the abuser: Breaking up, Becoming Free, and Understanding. Breaking up refers to the turning-point of leaving a partner when there is an imminent threat to the woman’s life or to the lives of other people. The second process, Becoming Free, is described as an emotional liberation, which entails cutting all ties with the abusive partner. Becoming Free is considered a processing of different emotional stages: from feelings of love, hate, compassion to indifference. The third process of Understanding is above all cognitive in character as experiences are interpreted in the light of having been abused. The woman can thus move on in life on the basis of knowing that she was abused and is without guilt, essentially because ”women do not leave because they realise they are abused; rather, they realise they are abused because they have left” (Enander & Holmberg 2008, 218). The theoretical model of Enander and Holmberg (2008), recognizes the complexity of the leaving process from a destructive relationship, while Ebaugh’s theory of the exit process both functions as a frame and as a possible theory of interpretation in order to comprehend the course of events towards becoming an ex drug addict, i.e. to leave a certain life behind (Mouzelis 1995).

2           Stories about recovery

In a classic text Cain describes how people who join self-help groups in AA (Alcoholics Anonymous) change through ”telling personal stories” (1991/2009, 210). What happens at AA-meetings is that members tell a personal story to convey a ”process of self-understanding” (1991/2009, 233), thus learning to tell and understand their life experiences in relation to the AA story structure: from the initial perception of themselves as a normal drinker to seeing themselves as a recovering alcoholic. The person’s situation and past are interpreted in the light of  AA’s personal story: ”As the newcomer learns the AA story and identifies with being an AA alcoholic, the cultural model guides both her present actions and self-understanding, and her understanding of her past. As she learns to place the events of her own life in the AA story form, she reinterprets that past” (1991/2009, 233-234). While the person over time internalises an AA-identity, her story will increasingly correspond with the story structure. The AA story functions as a cultural device, affecting the person’s identity, whose whole life is now seen in the light of the drinking and the alcohol addiction. The result is that all relationships are also perceived as influenced by the addiction.

Hydén’s study shows that living in a relationship of abuse threatens to overshadow everything else in life and affect the woman’s identity (Hydén 1999). The strategy to move on must entail more than being subordinated and the object of male dominance, which for Hydén means that abused women’s stories not only of violence and abuse but also of women’s opposition and resistance must be heard. However, Enander and Holmberg (2008) regard abused women’s resistance as part of the process to adapt to the man who beats, which leads to the gradual, mental breakdown of the woman. Researchers are reluctant to consider resistance only as an outward force but see it also as inward: ”This means that an abused woman may resist, but still stay in the relationship and be broken down by it” (2008, 210). The resistance functions initially as a way of showing the man that she will not continue to be subordinated and that the abuser must change his behaviour. At the same time, resistance lulls the woman into a false sense of being in control of her life situation. Combined, this leads to the woman staying in a destructive relationship.   

Women’s descriptions of violence in close relationships may contain a recurring theme of ”determination to overcome the abuse”, according to Boonzaier and de la Rey (2003, 1023). When Jackson (2001, 318) studied the narratives of young women about their experiences of abusive relationships, she found that the women were resistant ”to positioning themselves as passive victims”. Instead, the women maintained that they had ended up in a destructive relationship because of circumstances or that the difficulties could be related to friends or family. As they refused to see themselves as victims, they also avoided calling the boyfriend abuser or labelling the violence as abusive. Jackson emphasises that when women refrain from labelling themselves and victims, they also render the violence non-existent.

Towns and Adams (2000) use the perfect-love discourse in order to understand the stories of women talking about their abusive male partner. One strategy is not telling others about the violence and trying to change the abusive partner. The status quo of male dominance therefore stays intact and the women are held responsible for men’s violence. Researchers argue that abused women should be exonerated of guilt and not having to blame themselves for not having tried enough to make the relationship work. It is possible to conclude that AA provides a culturally sanctioned model of a story of recovery from addiction. In sharp contrast, there are no accepted role model stories for the recovery of abused women. In the culture of AA, telling stories is part of a tradition, while for a person leaving an abusive relationship this is hardly the case, quite the opposite. The lack of culturally sanctioned story telling may cause a blind spot for the researcher, who may not be able to separate the two aspects of double trouble analytically. We have therefore tried to keep up two parallel tracks in the process of analysis.

Earlier research and theory presented in the paragraphs above display the complexity of the phenomena studied. To be an addict is not the same as being abused or vice versa. The complexity of double trouble has to be acknowledged and the distinctions upheld to avoid conflating addiction and abuse. The narrative approach applied here enables us to explore the recovery process from double trouble.

3           Method

This study centres on a person with the fictitious name of Artemis, who is a middle-aged woman working in a rehab centre for women. For nearly four years one of the researchers [LBK] has talked with the woman regularly. The conversations were permeated with a wish to explore Artemis’s and her colleagues’ work with the abused and addictive women, as well as her approach to her recovery. The narrative interviews were explorative and no manual was used for the questions, which were aimed to invite descriptions of concrete events that elucidated her personal breaking up and recovery. Some of the interviews were recorded, others not, and lasted between 10 to 60 minutes.

For the analysis we chose a narrative perspective. The narrative concept has a varied scientific application and there is in other words not just one way of analysing narratives (Lieblich, Tuval-Mashiach & Zilber 1998, Mishler 1995, Riessman 1993, Karlsson, 2009, Karlsson 2015, Karlsson & Malmqvist 2012). Through narration, individuals recreate events and images of themselves and possible explanations for them (Riessman 1993). Through the life story, the individual conveys a picture of whom s/he is and why s/he became this person (Öberg 1997). Interpretations of experiences affect people’s own conceptions and prejudices, according to Denzin (1989). Researchers must therefore be aware of the criteria of truth that apply in a group and thereby structure the individual’s story since everyone learns to narrate in a way that corresponds with the group’s understanding of how a story should be told. All stories exist in many versions and have neither a clear beginning nor ending (Denzin 1989). Stories are thus not as personal as researchers and laymen tend to believe, but are influenced by the prevailing cultural and social climate. They are culturally sanctioned and are expected to match the group’s way of approaching certain experiences (Denzin 1989). As earlier mentioned there are culturally sanctioned stories in AA about recovery from addiction, while stories of abused women are not culturally available or requested in the same sense. The consequences might be more complicated for the person telling about her experiences. Researchers might miss the essence of stories about recovering from abuse, but even worse, the person stuck in it might even be hindered from coping and recovering from her experiences. 

Stories also have a broader meaning and can encompass different sub-stories and told on different occasions (Hydén 1997). This is the case with the narrative presented in this article. Artemis told about her life and experiences in a special context – researchers’ efforts to understand the vulnerability of abused and addicted women and their chances to recover at a rehab centre. In the process it became unavoidable not to talk about Artemis’s personal experiences. In this way, Langellier (1999, 128) claims, ”personal experience stories are made, not found, by either narrators or researchers”. This raises the question of how we should understand Artemis’s narrative, which has been relayed bit by bit over a long time, since the researcher and Artemis have actually, in a sense, performed the narrative together (Langellier 2009). The study of Artemis’s narrative can be considered an opportunity to study changes and turning-points in an individual’s life, but, in particular, the narrative offers a chance to understand other women with similar experiences (Langellier 2013). The narrative, in other words, grew out of the meetings at the rehab, the woman’s workplace, sometimes as an illustration of what people go through in their recovery processes generally speaking. Sometimes the narrative emerged as an expression of conveying unique experiences. The narrative thus originates in the rehab centre context and contains general as well as unique elements. In every conversation people can use different genres to describe themselves and their experiences, and this is what Artemis does; above all she often resorts to the genre of AA story-telling.

In the transcription process our intention was to report what was said as verbatim as possible. When quotations are given, they are, however, edited for readability and for protecting the ”interviewees” identity. The principle of ethical considerations has been informed consent and awareness of the fact that the interviewee still has to process her problematic background even if she is no longer addicted.

The overriding story was not originally presented in chronological order but is the result of the researchers’ organisation of the extensive material. The analysis presented is therefore a construction where shorter stories embedded in a greater narrative of her recovery are presented. The theory of the exit process developed by Ebaugh (1988) is in other words used both as a frame and as a possible theory of interpretation (Mouzelis 1995).

For reasons of space, the different stories in each phase have been shortened. The four phases are presented in four sections and the headings refer to the stories in each phase:

·         The first phase – Considering life choices; Drug free, but abused; Story of violence dismissed

·         The second phase – Mental collapse and self-accusations

·         The third phase – Marginal situation, between two life patterns; Working as a professional; Processing experiences emotionally and cognitively

·         The fourth phase – Living as an ex and creating a new life; The victim status as a transitional phase; Being a victim is being vulnerable

When it comes to generalisations of our findings, we do hope that our results and analysis can be used in order to understand cultural and social conventions concerning women and double trouble. However, we intend in our text to reflect on the possible consequences for social work at a general level. Future studies on the issue are also called for. 

4           Short introduction of the interviewee

Artemis is single, middle-aged, and has a working class background. As she recalls, she has had a bad relationship with her mother and brother since childhood, but reconciled with her father when she became drug free. Artemis started to drink and use drugs in her teens ”to get control” of her life. After two decades of destructive living and imprisonment for drug convictions, she could not cope any more. After one period at rehab with the Minnesota approach, she became sober and drug free. The process of dealing with her experiences of violence began in a second period at a rehab for women, also subscribing to the twelve-step program. Artemis emphasises that she has to work on recovery for the rest of her life by attending the self-help groups Alcoholics Anonymous, AA and Narcotics Anonymous, NA undergoing psychotherapy, engaging in personal development, and getting professional support.

5           The first phase – Considering life choices

After two decades of alcohol and amphetamine addiction, Artemis did not cope anymore and went to a rehab center with a Minnesota profile with the twelve-step program of Alcoholics Anonymous. Even though AA is not a professional organization in the field of social work but a spiritually-oriented association, some rehab centres in Sweden have been inspired by the ideology of AA. The success of this treatment requires that the addict stops denying the abuse and addiction, which is treated as a disease, and instead accepts being powerless in relation to the drug and/or the alcohol (www.alcoholics-anonymous.org.uk). The way out of addiction may seem uncomplicated since Artemis can no longer maintain the energy needed for a life in addiction and criminality. In addition, the police kept her under surveillance. Artemis knew what a lengthy prison term would entail since she had been sentenced earlier on several drug charges. Once at the rehab AA’s first three steps were easy, that is, declaring that she was powerless in her addiction to drugs and alcohol and that she had lost control of her life. Artemis thinks that only a higher power would be able to help on her road to recovery. She would not be able to on her own powers. Artemis remembers the guilt and the shame she felt for her addiction, especially when she processed the fourth and the fifth steps, which involve sorting out all the pain she has caused herself and others because of her abuse.[1] According to Artemis, a person who has been subjected to violence feels even worse from going through such a self-searching activity.  ”I’ve never felt so bad”, Artemis explains, because she felt guilty for what she had afflicted on others but also for being violently abused.

Artemis says that she actually hated her ex live-in partner and often spoke ill of him in the therapy sessions, but admits that if he had only called, she would have terminated her treatment: ”If he had said that I should come home, I would have cleared off”. Artemis explains why. ”He had power over me, and the illusion”. This [a destructive relationship] is just like a drug.” Then she corrects herself; ”stronger than a drug”. She describes the relation to her ex-partner in retrospect as ”a relationship addiction”. She was in other words in every respect emotionally dependent on him, without thinking of herself. Today, Artemis characterises the relationship as physically and psychologically destructive for both parties. The rehab staff avoided talking about the violence and she never got the chance to process her experiences of being exposed to violence. The addiction was exclusively in focus, and all her relationships were considered in the light of addiction. This is the reason, we argue, that in the treatment of women with Artemis’s experiences it is crucial that the addiction and abuse are treated separately and differently. At this stage, Artemis had at any rate stopped drinking and this was lasting. On the basis of Ebaugh’s (1988) theory of the exit process, we can note that Artemis perceived her choices as limited. But she had at least started to find solutions to her problems.

5.1     Drug free but abused

After the rehab Artemis went home “sober and drug free” and continued her personal development based on the AA steps.[2]  But the violence increased. ”After the treatment and the five years that I lived with him sober and drug free, the physical abuse and his power and control needs escalated. The mental abuse was terrible”. When her partner left for some days to take drugs with his friends, Artemis and her stepdaughter were locked inside the flat.

Artemis describes the everyday violence. The constant fights escalated into extreme physical violence and then passionate reconciliation. After a calm period the irritation and fights would intensify and turn into violence in a never-ending evil circle. At the same time she feared that her partner would meet another woman, who would get all that she herself wanted. ”No one would get what I wanted”. The illusion that the relationship would improve again despite all, was difficult to shatter since it had been “him and me – against the world” during their drug years. ”Reason says that I can’t live with him, but emotionally I can’t live without him!” Artemis thinks that she was obsessed by the relationship. It was a strong, consuming fire that she compares to drug taking. Hope, love, and fear pervaded all their connections.

The researchers Irons and Schneider (1997) emphasise that violence and abuse in couple relations have many common denominators related to shame and guilt, affecting both parties’ self-esteem. Even so, it is difficult to break off the relationship. The physically abusive partner can be inclined to ritualise his behaviour. Periodically, the behaviour can escalate to be followed by periods of ”contrition and promises to change and give up the behavior, followed by a time of increasing tension and then a return to behavioral acting out” (1997, 340).

5.2     Story of violence dismissed

During five years after her first treatment, Artemis attended AA’s special meetings for next-of-kins, Al-anon, and learnt that as a former drug addict and sober alcoholic she should insist that her partner should stop abusing drugs and that she was co-dependent. When Artemis tried to talk about the violence at home, she perceived that her story was dismissed. ”Today I know that it is lethal to tell an abused woman to attend Al-anon meetings. There I was and was expected to stop being an enabler and draw lines, but this even triggered more violence”. At the same time, Artemis says that she was convinced that the violence would stop if she only subordinated to her partner and made more efforts. We can see how hard it was at this stage for Artemis to leave her partner since she viewed the violence from his perspective. The process of internalisation tied her to her partner.

The self-help organisation that Artemis was engaged in sanctioned a narrative with a focus on addiction. Talking about physical abuse was actually seen as a deviation from the expected AA story structure. As a result, her behaviour was misinterpreted. At this point it is clear that Artemis lacked the necessary tools to understand being abused, since Al-anon’s narrative frame offered neither understanding nor explanation of being abused. Artemis had, in other words, lost her claim to truth.    

6           The second phase – Mental collapse and self-accusations

In this phase Artemis felt increasingly bad. Finally, she collapsed and was committed to a psychiatric closed ward for six weeks. She now understood that she would have to break with her partner as her life space was decreasing. Artemis says that people round her saw that she had lost foothold in life. ”Whatever I did was wrong. Finally, I ended up in the psycho ward, deeply, deeply depressed”. Artemis thinks that every woman in a similar situation runs the risk of being labelled irrational:

The saddest thing is that everyone around focuses on the deranged woman. She takes the irrational decisions. She acts weirdly. He has complete control. He has! But they continue to focus on the woman. See how dysfunctional she’s become. She has not recovered. /…/ Unfortunately, this is what it looks like, that’s when the woman is committed and diagnosed as depressive and borderline.

Artemis claims that no one in the surroundings takes an addicted and abused woman seriously and that is why there is nowhere to turn but to a psychiatry clinic, which in this way becomes women’s last recourse. However, a person in a destructive relationship is actually so caught up in it as to be rendered incapable of taking care of her self and ”inept of making reasonable decisions”. This is a pattern that Artemis maintains is recurrent among the women she meets daily at the rehab centre. The surrounding tends to dismiss such a woman’s life situation in terms of dysfunction, irrationality, and/or mental disorder. She is defined as a human being who has lost control. Her partner, on the other hand, appears to be in complete control, says Artemis. The destructivity of the relation can continue without any intervention of the surrounding. Violence in a relation is dismissed when addiction is the focus (see Lander 2003).

Artemis wandered through the psychiatric ward corridors repeating the mantra: ”I know it will pass”. There were no visitors, but her therapist rang now and then. In retrospect, Artemis does not know how she managed to get on her feet again. ”I don’t know myself how I got back, how I came to my senses – I was so ill.” The collapse can be understood as a critical point in her recovery. With reference to Holmberg and Enander’s (2004/2010) theory of breaking up, we suggest that Artemis left the relationship physically when she turned to the psychiatric ward. She had to leave him as a consequence of her endurance and being gradually broken down mentally. The bond to her abuser was very strong, though and Artemis had to cut the emotional ties to her abuser in order to become free. In sum, neither AA nor AL-anon nor the psychiatric care had anything to say about the abuse, which in practice meant the abandonment of Artemis as she was trying to overcome the violence.

7           The third phase – Marginal situation, between two life patterns

On her release from the ward, Artemis contacted the social services and requested therapy for her untreated experience of violent abuse even though she had stopped drinking and abusing drugs. This time she wanted to go to a rehab for addicted women to continue the AA step program. Since the addiction and treatment field is not very big, the staff was aware of her background. No one, however, wanted to address the violence. ”Everyone knew that I had been beaten. But when I came to the rehab centre, no one asked the question. They didn’t want to know”.

It takes a long time to break old destructive patterns, according Artemis. She says that giving up abusing alcohol and drugs was one thing, but the process of recovering from breaking out of an abusive relationship and coming to terms with destructive experiences and healing mental wounds is something completely different. It was essential and a turning-point at this time that Artemis gave up the idea of reuniting with her partner, which also meant emotional processing. Holmberg and Enander (2004/2010) describe the process of cutting all ties as an emotional emancipation in order to become free. In retrospect, Artemis can jokingly refer to the relationship as ”a hopeless renovation project”.  The label signals that she has attained emotional distance to the man today.

7.1     Working as a professional

After her second rehab period, Artemis started to work as a drug therapist concurrent with her own psychotherapy. Svensson (2007) points out that it is not uncommon that people with an addiction background start working as drug therapists after treatment. Such a background can be an asset rather than a liability in this context as the personal experience can be perceived as credible and support a professional approach. The person can be a role model, especially if s/he demonstrates that it is possible to live a different life.

Artemis’s narrative shows that she had to continue her processing after leaving the rehab. In her sessions with her own clients, unpleasant memories surface from time to time as she is using her experiences to help these women. Regardless of background, all individuals undergoing therapy have to relate to their own experiences. Therapists with or without a past of addiction, says Artemis, must be aware of their own claims, and she confirms that she often found herself in a conflict. Sometimes she did not understand until afterwards what approach she had taken. Here we would like to emphasise that Artemis was emotionally caught between two life patterns.

Artemis was used to living under exceptional pressure and she thinks that she developed into a Drama Queen, who manipulated others, only to make amends in a later conflict. Seeking negative confirmation and pursuing sensations had become a bad habit. Artemis says that she was suffering from enormous self-contempt. Others were therefore allowed to treat her in any way they liked, as long as they did not abandon her, she confesses. It was better to have bad relations than feeling excluded and lonely. Her existence as an active addict, and as a non-addict, entailed exposing herself and others to extreme stress situations and recurring conflicts:

Oh, Dear God, I was busy. If I started people off emotionally, it was my fault and then I stepped in to sort things out! Then, in the end, I was upset for not being taken seriously, when it really involved me and what I had given.

Although no longer an addict, she retained an emotional approach that was linked to a previous life. Artemis describes the fear of being abandoned, of not being accepted, and self-contempt but also strong feelings of shame and grief. In this phase she liked spectacular conflicts. Since she gave the impression that she did not expect to be questioned, she was left on her own. But when she was made aware of her unsympathetic traits, she understood that she was still emotionally living as an addict, which made her want to change and take responsibility for her actions.

7.2     Processing experiences emotionally and cognitively

We argue that it was not until Artemis started as a drug therapist that she recognised the need to emotionally process the addiction, even though she had been clean for several years. Two crucial insights emerged, firstly, of herself and how she responded to others at the rehab by adopting a destructive attitude; secondly, of the necessity for understanding women in therapy to help them break away from their addiction and vulnerability to violence. In addition to the AA traditional narrative, she must formulate a narrative for processing her experiences of addiction and abuse emotionally and cognitively. Our analysis shows that Enander and Holmberg’s (2008) development of the leaving process is not only applicable to a situation of abuse but also to the understanding of recovery from addiction. The partly overlapping processes of Breaking up, Becoming free and Understanding all recur in Artemis’s addiction recovery narrative.

8           The fourth phase – Living as an ex and creating a new life

It is not possible to pinpoint a clear transition in Artemis narrative to the fourth phase of the exit process and the creating of a new life (Ebaugh 1988). It is rather Artemis’s approach that indicates a change; from having seen herself as others saw her, she started to examine her own experiences of abuse and her own role in destructive behavior in the sessions with the other women. The discovery of own unsympathetic traits offered an opportunity to process addiction and abuse emotionally and cognitively. Being exposed to violence could not, however, either be excused or explained by her personality or behavior. Artemis’s history shows how complicated the recovery process was and how long it actually took. Other researchers show that it is essential to understand that the recovery process from being addicted takes years, while attitudes towards obstacles in life change accordingly (Hecksher 2004). Even though people might refer to specific turning points as being of importance, they still have to work on their recovery continuously over time (Öjesjö 2004).

8.1     The victim status as a transitional phase

In Artemis’s opinion, a woman who leaves an abusive partner can still be defined as a victim on the grounds that she has been the victim of violence. The victim status is, however, a transitional phase in her view. It does not mean that the woman in question is poor or incompetent, only that she has been exposed to and been a victim of a crime. Vulnerability must be expressed without apportioning blame and shame to the woman if it is to be processed. This means never to categorise an abused woman as a deficient human being. Defining oneself as a victim of crime is, however, de-dramatising. The male beater is in practice the perpetrator and guilty of criminal actions, according to Artemis. She does stress that professionals are sometimes cautious of not wanting to stigmatize the male partner as an evil person, especially if he is a drug addict himself. But that does not help the male to start working on for example his own issues of being controlling and abusive, Artemis stresses.

8.2     Being a victim is being vulnerable

Artemis claims that the good intentions of the professionals, for example, conducting conversations with the couple have detrimental consequences since the abused woman is rendered unable to change her behavioural pattern and that the partner, in reality the perpetrator, gets information in the meeting enabling him to control her even more. Couple therapy is bound to exclusively confirm the man’s strength in relation to the woman. Artemis highlights how inadvertently naively professionals can act. Contrary to their good intentions, the professionals strengthen the destructive relationship. Research confirms that if a woman reveals to a professional that she is being abused, it can mean that she puts herself in danger (Green & Ward 2010).

We essentially stress that we should not get stuck in stereotypes. On the other hand, we should never be afraid of naming a situation and addressing the state of affairs, i.e. when a woman is actually the object of a crime and the man the perpetrator. Being a victim of abuse must never be confused with passivity and weak-mindedness. In our opinion, a victim is vulnerable, but this does not mean that there is no capacity to act.

9           The consequences of gender structures

The gender structure gives rise to social norms and expectations of how women and men should relate to each other. Trulsson (2003) observes, for example, that an addicted woman's deliberations are frequently based on the consequences of her actions for the man, which in turn affects her approach to continued treatment. The asymmetry in a relationship is in many respects more apparent when a man and a woman are addicts. Artemis mentions that sometimes it is stressed in rehab settings that the addicted woman is man-dependent. True or not, the formulation is problematic because it conveys a contextually limited view as there is no link to the consequences of the gendered power structure in women’s and men’s lives, which favours men at the expense of women. Destructivity is again explained as the woman’s own fault. The woman’s lack of independence in relation to the man is regarded as a defect in her and/or reduced to her addiction. The Monday woman specimen cannot manage without a man (Hirdman 2001).

The question is if a man stops abusing after completed addiction therapy, i.e., when he is sober and drug free. Another question is if a woman stops living in destructive relationships after completed addiction therapy, i.e., when she is sober and drug free. Artemis thinks that destructive relations are impossible to understand without knowledge and too complicated to break without key insights, which in turn must be processed in therapy. In addition, the need to ”make the women and their subordinate position in the world of addiction visible” is emphasised. Men are described as thieves and drug dealers, but never as a perpetrator, a person abusing another person, as Artemis puts it. We would like to add the need for understanding social gender structures, i.e., the social relation and how a skewed gendered power structure can create a destructive relation between women and men. Moreover, power structures also complicate the chance to process such issues and impact on the situations of individuals. The socially constructed order is not, however, apparent, either professionally or for the double troubled women. Male-dependence is explained by addiction instead of being analytically integrated with gender order theory. Frišaufová (2012) explains the need of viewing every client as someone with specific needs in relation to a societal context. In order to expand our view as social workers/researchers in social work, we do stress the necessity of women with similar experiences of violence should be able to share their experiences with each other, instead of avoiding or rejecting their ordeals. Artemis and women like her are not different from other women; it is just that the oppression becomes so much clearer because the addiction aggravates the vulnerability. Whether under the influence or not, vulnerability to abuse is not in any way the woman’s fault. Holmberg and co-authors (2005) emphasise that addicted women’s experiences of violence do not make them into a different species; ”[b]ut having been sexually abused does not /.../ by far make these women distinct from other women. Abuse also occurs in socially established environments” (Holmberg, Smirthwaite & Nilsson 2005, 146, our translation).

It goes without saying that male addicts also have to live the consequences of gender structures. Men are not by definition evil perpetrators, but the reluctance to mention the gender structure has consequences for men because they are prevented from tackling their own situation as well. In our conversations, Artemis discusses the standard explanation of men’s violence as caused by the presence of drugs/alcohol. In terms of AA’s vocabulary, violence is then a symptom of a present drug abuse, which means that the perpetrator is not held responsible for his actions since he was drunk or under the influence. Rehab clinics must, however, hold the men responsible for their actions or they otherwise will not be able to process the perpetration, says Artemis. Many people who are convicted of abusing women are sentenced to contract treatment for their addiction, but seldom for having abused their partner, according to Artemis. It is clear, then, that the tendency in social work to confuse violence and addiction might be a recurring phenomenon.

Sensing that no one wants to believe your story and being dismissed amount to a violation that must be related to underlying structures. Exclusively interpreting an addicted and abused woman’s story in terms of her addiction inevitably means reproducing her life situation. The attempt to avoid stigmatising an abusive man, thus confirms the asymmetry of power. Women undergoing treatment must, in other words, be given the tools required to relate to their vulnerability. In addition, each women must be offered options as abusive violence in the last analysis is the responsibility of the abusive men and a criminal act irrespective of the women’s addiction or not.

10       Parallel narratives 

Narrative researchers stress that there is no ultimate interpretation of stories told, but ”multiple possibilities for representing stories”, according to Fraser (2004, 195-196). Our analysis of Artemis’s life story and her recovery is hardly conclusive. We must also relate to implicit expectations of a happy ending and focus on changes for improvement (Zilber, Tuval-Mashiach & Lieblich 2008). As researchers we are inexorably included in Artemis’s story through her inside perspective. Several parallel narratives emerge in the encounter with the researcher while the analytical frame of the exit process shows how complicated her story is. One narrative centres on addiction. A second narrative focuses on being a victim of violence and ideas on powerlessness (see Pyles, Katie, Mariame, Suzette & DeChiro 2012). These two narratives refer to a situation of being a victim of a power that is perceived as bigger as and stronger than her; a dependency illness and male violence respectively. The attraction to the partner is in the first exit phase compared to an emotional dependency of being subordinated to his will. But an abusive partner is a perpetrator, committing a criminal act. This is tantamount to declaring zero tolerance of violence against women and absolving them of guilt. Self-accusations are preposterous in the context. Associating victims with passivity means that women have to defend themselves since they are deprived of ability to act.

A third narrative discernable in the analysis is the story of Artemis, the drug therapist, which we see as corresponding to the third phase of the exit process. In this narration Artemis is balancing between the wise, aware therapist processing her own experiences and the manipulative, unsympathetic and demanding therapist who wants to win everyone’s love, a Drama Queen, who gets a kick out of (self) destruction. The drug therapist also tries to understand the women through her self, and vice versa in this story. When she becomes aware of her unprocessed emotions and how these are manifested in the therapy sessions, then she can move on to the fourth phase, that is, she starts to be an ex.

But how do we want to interpret Artemis’s narrative? Langellier (1999) emphasises the difference between a narrative observed from a modernist and a postmodern perspective respectively. Modernist stories have a linear plot about discovering the veritable truth about oneself focusing on ”suffering, coming out, survival” (1999,139). From a modernist perspective Artemis’s storytelling is about dealing with suffering in a quest for self through reaching an understanding of how her addiction can be explained. This is perhaps the most expected narrative and it is really identical with the AA narrative frame. The main character does everything in her power to belong to a we instead of a them. At the same time she diverges from the frame by questioning the AA story and by wanting to view the violence in terms of a different narrative frame, namely male power and control. A further narrative is the story about the addict who becomes a therapist, thus illustrating the transformation from the unaware to the aware therapist and how she affects and is affected by other persons in vulnerable situations and with a background similar to hers.

In contrast to the modernist story, the postmodern story, according to Langellier (1999), is marked by fragmentation and the deconstruction of the grand narrative. Postmodern stories depict multiple selves without presenting a simple, uniform, and given truth and yet, paradoxically, it is the truth that is emphasised (Langellier 1999). If we consider Artemis’s narrative from a postmodern perspective the interpretation is changed. The question is then: Who is the "I" of the story? Who is suffering and where are the lines between her and the women in therapy with similar experiences? The lines are in fact blurred.

The narrative of recovery can be said to diverge from the culturally sanctioned norm of AA (see Denzin 1989). In the third phase, the main character starts seeing the women and herself through different eyes. Artemis describes a process in which she stopped looking at herself through the man’s eyes and saw instead a Drama Queen – in a sense a quite uncomfortable discovery. Recovering from addiction appears initially to go faster than recovering from physical abuse, but this is ostensible. Not until her meetings with women undergoing treatment do some aspects catch up with her and she finally acknowledged that she had adopted a self-destructive attitude to addiction. Concurrent with her treatment of the women, her recovery escalates. Artemis processes the difficulties of having been vulnerable and abused to rising to the challenges involved in working as a therapist. While working with her clients she was forced to transform the knowledge of herself in relation to them to contribute to their recovery. Artemis’s narrative adds something by not merely focusing on the relation between women but also by viewing other women in relation to her own experiences. But she also starts to see herself as a person with similar experiences as other abused women.

11       Conclusion

The life story presented in this article illustrates the complexity of recovery. The recovery process can be prolonged if professionals do not understand or are unable to analytically separate the drug/alcohol abuse from being a victim of physical abuse and instead solely consider the violence as a consequence of the drug and alcohol abuse. The woman in question still needed to work on earlier destructive and unprocessed experiences because these surfaced and affected her work when she started as a drug therapist. The recovery from physical abuse and surprisingly enough also from addiction can be understood in terms of Enander and Holmberg’s (2008) discussion of three processes of breaking up. For the main character of the story processes involved first breaking a pattern of alcohol and drug abuse, as she could no longer maintain the lifestyle of an addict. The process of emotional emancipation entailed an emotional processing of previous addiction for her. The cognitive process centred on interpreting her personal experiences in relation to her therapy clients. The cognitive processing of addiction did not take place until she noticed that she responded to her clients as if she was still actively abusing drugs. We suggest, however, that it is not necessary to consider the course of events as three distinct processes but as determinant dimensions during the course of the exit process.

It can be hard to distinguish between drug/alcohol abuse (addiction) and physical abuse, especially since the person can continue to use drugs in order to cope with the trauma of being exposed to violence. Self-destructive life patterns and experiences are interwoven and entwined. But our analysis indicates that addiction and abuse should reasonably be treated separately, that is, in different programs with different approaches. As an alternative, the opportunity to process experiences of both addiction and abuse in the same treatment should be given providing that neither experience is reduced. In addition, it is crucial to keep in mind that violence and destructive experiences are related to gender and power, and therefore also present in the drug scene and in the professional culture supporting women’s recovery.


Finally we wish to thank our reviewers for constructive comments, which helped to make our text more concise and analytical.



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Alcoholics Anonymous Great Britain (Retrieved September 2015): http:// www.alcoholics-anonymous.org.uk.



Author´s Address:
Lis Bodil Karlsson,
Ph.D. Associate professor Social work
Social Work Department
Karlstad University
SE 651 88 Karlstad, Sweden
/Social Work Department
Stockholm University
SE 106 91 Stockholm, Sweden

Ulla Rantakeisu
Ph.D., Associate professor Social work
Social Work Department
Karlstad University
SE 651 88 Karlstad, Sweden

Kirsti Kuusela
Social Work Department
Karlstad University
SE 651 88 Karlstad, Sweden


[1] The fourth and the fifth steps; 4. Made a searching and fearless moral inventory of ourselves. 5. Admitted to God, to ourselves, and to another human being the exact nature of our wrongs. (www.alcoholics-anonymous.org.uk)

[2] The sixth and the twelfth steps: 6. Were entirely ready to have God remove all these defects of character. 7. Humbly asked Him to remove our shortcomings. 8. Made a list of all persons we had harmed, and became willing to make amends to them all. 9. Made directs amends to such people wherever possible except when to do so would injure them or others. 10. Continued to take personal inventory and when we were wrong promptly admitted it. 11. Sought through prayer and meditation to improve our conscious contact with God as we understood Him, praying only for knowledge of His will for us and the power to carry that out. 12. Having had a spiritual awakening as the result of these steps, we tried to carry this message to alcoholics, and to practice these principles in all our affairs. (www.alcoholics-anonymous.org.uk).