Life Meaning and Purpose in Addiction Recovery

Once you have no hope, no goals or no dreams, you're just waitin' to die.

God gives you the means to get clean; now what you gonna do with that life?

—Voices of recovering addicts in New York City

In the transition from addiction to recovery, each client must find ways to draw life meaning and purpose from the addiction and recovery experiences, forge new prescriptions for daily living, and generate hope for the future. To understand more deeply the role of meaning and purpose in the recovery process, the authors conducted 354 semi-structured interviews and 50 in-depth qualitative life history interviews with New York City residents in recovery. The semi-structured interviews are being repeated annually over four years.

Most of those interviewed have prolonged histories of multiple drug dependence (predominantly crack cocaine, heroin, and alcohol) and numerous collateral problems (including homelessness, HIV, and co-occurring psychiatric illness).1 This article highlights some of the key findings of this study, illustrates those findings using excerpts from the interviews, and discusses the potential implications for addiction counseling practice.

Sense making in recovery

There is a growing diversity of religious, spiritual, and secular frameworks of addiction recovery.2 While individuals representing these varieties of recovery experience are often juxtaposed against one another as part of an acrimonious debate, these frameworks of recovery share much in common. All help their members answer, albeit in very different ways, five recovery-crucial questions:

1. Why and how did this happen? (Why me?)

2. What does it mean to have this problem? (How has this problem changed me and my most important relationships and activities?)

3. How did I come to escape this problem? (Why have I survived when others have not? Where does my recovery story begin?)

4. What actions do I need to take today to sustain my recovery?

5. How does this problem affect the future direction of my life? (What is my personal destiny as a person in recovery?)

Such questions are a normal process of constructing meaning and redefining self and the self-world relationship in the face of serious illness.3 Answering these questions provides a way to escape self-censure and social stigma and a means of positively coping with the loss of personal power and control. Whether framed in religious, spiritual, or secular terms, these answers constitute the building blocks of recovery and can be collectively framed within the rubric of life meaning and purpose (LMP).

LMP's role in recovery

LMP links past, present, and future. Meaning focuses on rendering our past coherent and giving value to our present, and purpose provides a framework for linking present activities to a desired future. Recent studies of addiction recovery suggest that LMP plays an important role in the recovery process.4 Some of these studies' clinically significant findings and tentative observations include the following:

• LMP in addiction recovery is often defined in the context of multiple conditions (e.g., developmental trauma/loss, co-occurring medical or psychiatric illness, poverty, homelessness).

• The development of LMP in recovery often occurs in the context of catalytic metaphors (through which previously inexplicable struggles become understandable), empowering relationships, and the experience of connection to community.5,6

• LMP can serve as a catalyst of recovery initiation, an anchor for recovery maintenance, and a source of recovery enrichment.7

• LMP significantly enhances the likelihood of successful recovery maintenance.8

• Recovery-inciting LMP can be experienced suddenly in a transformative revelation that is unplanned, positive, and permanent, or through an extended process of self-awakening.9

• LMP can occur in the context of self-surrender and self-transcendence (connection with resources outside the self) or through a process of self-assertion (discovery of hidden resources inside the self and acts of personal resistance/defiance).

• LMP evolves across the stages of recovery and across the developmental stages of life. The LMP that anchors early recovery might have to be redefined in later stages of recovery.

• Life meaning and life purpose are forms of recovery capital (internal and external assets that mediate long-term recovery outcomes); LMP can be increased through the guidance of addiction professionals and recovery support specialists.

Asking those in recovery about the importance new LMP played in their recovery generated responses such as:

I need to have a reason to stay sober. … I asked myself the question, “Why am I here? Just to drink?” No, a sense of purpose gives me something to work with. Everybody don't go to meetings or to church or believe in a higher power. You've got to have a purpose, something that you believe in.

You have to hold on to something that gives you purpose for taking another breath.

One of our respondents drew meaning from having fallen and broken his leg in the panic that followed the attacks on the World Trade Center on Sept. 11, 2001:

That particular day I was there for a purpose—maybe for me to go through this metal thing with my leg, so that I could be here and maybe learn things about myself. There's gotta be a purpose; I know I haven't gone through all of this pain for nothing.

Sources of meaning and purpose

In our interviews with people recovering from addiction in New York City, LMP was described within explicitly religious, spiritual, and secular terms. We found four primary sources of LMP shared across these recovery frameworks: survival, self-reclamation, service to others, and connection to community.

Those we interviewed shared a mixture of awe, wonder, gratitude, and indebtedness regarding their own survival. They came to understand that survival in terms of a greater purpose and personal destiny:

Look at them. They're all dead. If it's not the virus, it's an overdose. … Why do you think I'm alive? You have to talk to God about that, but it must be for a purpose.

God didn't abandon me; I still had his grace. I understood that I was chosen and that I have a purpose. Helping somebody, that's my purpose. All that I went through wasn't in vain.

One participant described being shot and then immediately experiencing the incongruity between escaping death and continuing to waste his life as an addict:

God, he must have a purpose for me because he saved me that day they shot me. And I looked at me—what I'm doing with the life that he gave me back, using drugs and walking around the street like a bum. … I knew that I should be doing something more positive and constructive than using drugs and beating myself up in the street, killing myself.

Another person in recovery found purpose in transcending his own efforts at self-destruction:

I always wondered, “Why am I still here?” I tried to kill myself … and I'm still alive. I felt so low that I injected myself with battery acid and didn't call 911 or tell a friend or anybody. I wanted to die, but I didn't. I woke up and said, “Why am I here?” Now I know. My message will get across, one way or another, but I'd rather speak it than deliver it in a casket.

A central theme in the addiction stories we heard was that of loss of self. The counter-theme in recovery was a reclamation or reconstruction of self.

I was able to open my eyes and see that I needed help. I had to get myself back together and continue to be sober and get my life straightened out.

I got to live for myself. I ain't ready to die. My mother and my mother's sister died in their 30s. And I don't wanna die in my 30s. You know what I'm saying? … I wanna see 40. Or 50.

Part of the act of self-reclamation in recovery is the identification of excesses of character (e.g., self-centeredness, grandiosity, resentfulness, intolerance) and the cultivation of new recovery-based personal values (e.g., self-honesty, humility, patience).

Many of those we interviewed drew meaning from new values and new personal goals that emerged early in the recovery process:

I write and it's not like any other writing in this world. It's the kind of writing that touches people. God put the words in my mouth to put 'em on paper so it'll touch and better the lives of many. … That's when life becomes meaningful. I ain't got no kids, so that's my legacy.

Two other frequently mentioned dimensions of self-reclamation were the experiences of hope and gratitude:

What gets me out of bed in the morning? Hope. Hope for what my life could be like. … The disease of addiction doesn't want me to have any hope, wants me to think that I'll never be anything. When I go to meetings, I hear a story and meet other people who've finished school, started a family, or got their family back. That gives me hope.

I don't know why God gave me this calling. A lot of my friends have died. I used the same drugs they did, even more, and was out there for 35 years. Some of them haven't even been out there for five years and they're dead. I consider myself very fortunate and blessed. It's up to me to try to bring others back because it's sick out there.

People in recovery often develop a conscious orientation toward the needs of others. Those in our studies demonstrated service to others in three distinct ways. The first was through service to those injured or neglected through the addiction experience (parents, siblings, children, friends). Tales of broken and estranged relationships were often followed in recovery by stories of reconnection, restitution, and reconciliation. Many of those we interviewed talked about the meaning they drew from now living their lives for people whom they had injured in their addiction years.

My direction is getting myself to the top shape physically, mentally, and emotionally to show my children, “I'm back you all; I'm back!” That's my main purpose on this planet—to help my kids. Then I can say, “God, I'm finished.”

Another client dedicated his recovery to his partner who had been murdered.

So, that just gonna make me stronger, it's gonna make me stronger to do the right thing, ‘cause I know that's what'd she want.

A second category of service involved pursuit of the “wounded healer” tradition—service to those still suffering from addiction and those seeking recovery:

I feel that my purpose is to help somebody else, to give this message that there's hope. I'm living proof that life can get better.

One interesting aspect of service to other addicts was that the meaning is in the offering of that service and not contingent upon the nature of the response to it:

… it's like God's come to you and he's saying something through you to me. And if I'm not whipped enough or if I'm not open enough, I reject it. So your purpose was for God using you just to say it. That was your job, just to say it.

Others in recovery pursue acts of service to the larger community. Such acts came most frequently through volunteer service work:

You know, I'm part of a business meeting with the church once a month. It's worked out well. It's given me a purpose—it means I'm doing something. I'm important. I'm needed now and I'm loved. People look up to me to do certain things.

A final source of LMP noted by those we interviewed was their connection or reconnection to a larger community. This occurred in two ways: identification with a particular recovery community and identification with the larger group of people or all humanity.

But the basic thing is I am part of Narcotics Anonymous and I wanna stay part of the fellowship because that's the defining moment of where I fit in. I stay with that; that's my purpose.

With drugs, you can hardly look people in the eye because you just feel so disgusted with yourself. So your purpose should be to be able to look somebody in the eye and feel good about yourself. You can't do that being addicted to drugs. You just can't.

You have an obligation that you have to be something positive in the building you live in, the job you go to, your neighborhood, your society, your country, the world. You are an individual and you fit in because there's nobody else like you. Nobody was like you before, nobody's going to be like you afterwards, so you fit in. So, you have to do your part.

There is in all of this a stage in which addiction/recovery paradoxically shifts from the status of a stigmatized curse to that of a gift that opens new horizons of experience, a new sense of self, new and renewed relationships, and a new depth of living. Deep gratitude for this gift often generates feelings of indebtedness that spawn the compulsion to reach out to others in a spirit of acceptance and service.

Implications for professionals

The early findings that are emerging from the study of LMP suggest the following ten prescriptions for addiction service professionals:

1. Raise questions related to LMP to open windows of opportunity for recovery initiation and to strengthen existing commitments to the recovery process.

2. Use hope-based methods of intervention (motivational enhancement, exposure to recovery role models) as an alternative or adjunct to pain-based interventions (coercion and confrontation).

3. Become fluent in the diverse languages of meaning reflected in religious, spiritual, and secular pathways of recovery.

4. Offer clients a broad menu of meaning-making metaphors and help each client forge personally and culturally meaningful answers to the five recovery-crucial questions.

5. Help each client construct a recovery-enhancing life story using his or her answers to those questions. (We found this rewriting of one's narrative life story to be one of the key functions of participation in 12-Step recovery fellowships.)

6. Help each client set personal goals for his/her future in recovery.

7. Assertively link clients to communities of recovery whose members can offer mutual support in the exploration of recovery-based LMP.

8. Link clients to opportunities for community restitution and service.

9. Help relapsed clients reformulate LMP when the past source of meaning and purpose that supported recovery has been lost (e.g., loss of a catalytic relationship).

10. Recognize the potential for LMP to take both salugenic/vital (health/ wholeness promoting) and pathogenic/malevolent forms.10,11

Many people proselytize particular answers to life meaning and purpose. What distinguishes addiction professionals in their work with LMP is their tolerance of multiple frameworks of meaning and their ability to work across these frameworks (rather than within a single framework) to help each client achieve a meaningful and purposeful recovery that fits his/her worldview and belief system.

The addiction professional's focus is not on which framework is true, but on which framework can ignite, sustain, and enrich the addiction recovery process. There is a growing list of pharmacologic adjuncts that can quiet the cellular demand for intoxicants, but those medications cannot answer the meaning and purpose of life in recovery. The addiction counselor can play a vital role in helping those seeking recovery to find such answers.

William L. White, MA, works within the addictions research division of Chestnut Health Systems in Bloomington, Illinois. He coauthored the cover article on how frontline professionals can become the next generation of addiction field leaders in the January/February 2006 issue.
Alexandre B. Laudet, PhD, work within the Center for the Study of Addictions and Recovery at the National Development and Research Institutes, Inc. (NDRI).
Jeffrey B. Becker, MSW, MPH, work within the Center for the Study of Addictions and Recovery at the National Development and Research Institutes, Inc. (NDRI).
The authors acknowledge that the study highlighted in this article was funded by National Institute on Drug Abuse Grant R01 DA014409 and by the Peter McManus Charitable Trust.

References

1. White W, Laudet A. Life meaning as a potential mediator of 12-Step participation benefits on stable recovery from polysubstance use. Presented at 68th Annual Scientific Meeting of the College on Problems of Drug Dependence, June 2006.
2. White W Kurtz E. The Varieties of Recovery Experience. Chicago:Great Lakes Addiction Technology Transfer Center; 2005.
3. Fife B. The conceptualization of meaning in illness. Soc Sci Med 1994; 38:309-16.
4. Carroll S. Spirituality and purpose in life in alcoholism recovery. J Stud Alcohol 1993; 54:297-301.
5. White W. Transformational change: A historical review. J Clin Psychol 2004; 60:461-70.
6. White W, Sanders M. Recovery management and people of color: Redesigning addiction treatment for historically disempowered communities. Unpublished 2004 paper retrieved from Behavioral Health Recovery Management Web site (www.bhrm.org).
7. Laudet A, Morgen K, White W. The role of social supports, spirituality, religiousness, life meaning and affiliation with 12-Step fellowships in quality of life satisfaction among individuals in recovery from alcohol and drug use. Alcohol Treat Q 2006; 24:33-74.
8. Laudet A, White W, Storey G. Recovery capital as prospective predictor of sustained recovery, life satisfaction and stress among former poly-substance users. Substance Use Misuse. In press.
9. Miller WR, C'de Baca J. Quantum Change: When Epiphanies and Sudden Insights Transform Ordinary Lives. New York:The Guilford Press; 2001.
10. Clinebell H. Understanding and Counseling the Alcoholic. New York:Abingdon Press; 1956.
11. Johnson RA, Sandler KR, Griffin-Shelley E. Spirituality and the regulation of self-esteem. Alcohol Treat Q 1987; 4:1-12.