Congrats on Your 12 Steps, But What About People with Addiction Who Don’t Get Sober?

In her new memoir, How to Murder Your Life, writer (and former VICE columnist) Cat Marnell describes the melange of addictions she struggled with during her rise to fame as beauty editor of the recently shuttered women's website xoJane.com. There, Marnell's writing, even when discussing mundanities like eyeliner, was both gritty and profound, palpably steeped in the drug abuse and eating disorders that eventually, well, "murdered her life."

Her work at xoJane earned her legions of fans, partly because of her unique voice (sample article title: "PILLHEAD BEAUTY: The Product I Learned About From My Shrink Dad That I Don't Even Talk To Anymore") and partly because she was refreshingly unapologetic about her addiction to angel dust, Adderall, benzos, and more. As she told a New York magazine reporter in 2012, "Why am I not talking about drugs if I'm taking them every day? … That's when I go back to the idea of shame, especially for girls. Why do I have to clean up?"

Though Marnell's new memoir is compelling in a grimy, voyeuristic way, the most striking thing about it is the ending. Or, perhaps, its lack thereof. Unlike most popular addiction memoirs (Sarah Hepola's Blackout, David Carr's Night of the Gun, Lisa F. Smith's Girl Walks Out of a Bar, and Caroline Knapp's classic Drinking: A Love Story, to name a few), Marnell's book doesn't wrap up tidily with rote espousals of a hazy newfound freedom found through God, rehab, or a 12-step program. She doesn't claim to be fixed, or "happy, joyous, and free." No, at the end of Marnell's book, the author writes that though she is healthier and more lucid than she was a few years ago, she's still using. Indeed, she's still doctor-shopping, still "a little lonely," and still seeing her "Chinese night pharmacist more than [her] pregnant sister."

Marnell credits her $500,000 book deal, not a higher power or the Big Book, with forcing her to straighten up (somewhat). But her refusal, or perhaps her inability, to adhere to the neat, tidy ending typically found in these sorts of memoirs raises questions: Why is it so unusual to see this messier type of narrative in the first place? Why do so many addiction memoirs end the same way, when statistically speaking, most addicts don't maintain 100 percent lifelong abstinence? What nuances and truths might we be missing when we insist on lifelong abstinence as the only "happy ending" for addicts?

As journalist and author Maia Szalavitz writes in her recent book, Unbroken Brain: A Revolutionary New Way of Understanding Addiction, part of the problem is that commonly, "addiction is viewed as both a sin and a disease." The rise of 12-step programs as the gold standard for substance abuse treatment has irrevocably colored people's everyday dialogue around addiction: It's seen not as a medical issue, but as a "spiritual malady" with physical consequences. If left untreated, 12-step literature claims, addicts and alcoholics will find themselves on a choose-your-own-adventure with just three conceivable outcomes: "jails, institutions, or death."

In 12-step parlance, to be effectively treated for alcoholism and addiction requires not only accepting the notion that addiction is an emotional disease, but finding the willingness to turn one's life over to a higher power. It also requires working the steps with a sponsor, attending regular meetings, and atoning for one's "character defects." Most people don't stick with this rigid regimen for the long haul, even when it's forced upon them via drug court or rehab. In fact, AA has a 5 to 10 percent success rate.

This isn't to say that 12-step programs don't help keep people sober. The support derived from being part of a group of people facing similar demons is immensely powerful for thousands of recovering addicts and alcoholics. But just as there is no "typical" addict, there's no one-size-fits all treatment for addiction. This is something you wouldn't know from most addiction memoirs, or from the fact that, as Szalavitz writes, at least 80 percent of American treatment programs rely on the 12-step model.

Hence, most folks believe that 100 percent abstinence is the only "successful" outcome for addicts, and the publishing industry keeps releasing highly hyped, often-bestselling memoirs by the same people: the white, intellectual, upper-middle-class few who do manage to find their own sanitized resolution in the rooms of AA. We saw it in Burroughs' Dry, which ends with the author telling a 12-step newbie to just "go to a meeting," even if they "feel stupid." We saw it in Hepola's Blackout, which concludes with the author commiserating with a crying newcomer in a meeting: "I was in the exact same place … I was lost for a very long time." Drinking: A Love Story—a book I've long called a favorite—also wraps with Knapp cozily ensconced in a meeting, feeling overcome with "affection for [her fellow alcoholics'] humanity" (there's also a 12-step-centered appendix titled "Where to Get Help"). Even James Frey's disgraced faux-memoir, A Million Little Pieces, ends with the narrator confessing his wrongs to a priest, then abstaining from drinking a shot of whiskey in a bar because after a stint in rehab and some divine intervention, he's all better now.

It makes sense that these kinds of stories sell, even if they don't accurately reflect the experience of most addicts. As Szalavitz says, "The tale of sin and redemption is a siren for writers. It sells well. People like it."

When I inquired about this on my Facebook wall, a New York literary agent concurred with Szalavitz, noting that both editors and readers appreciate a "Hollywood ending." But for most addicts, and most people in general, real life and Tinseltown have very little to do with each other. Many addicts relapse. Many flit in and out of recovery for years. And a surprisingly high number of people "outgrow" their addictions as they age, as Szalavitz, herself a former heroin addict, discusses in Unbroken Brain. She tells me, "If you look at the largest epidemiological surveys of psychiatric and mental health in the United States, they show quite clearly that the vast majority of people with addictions to alcohol or other drugs recover—and they recover without treatment or the 12 steps." (Note that "recover" doesn't always mean to accomplish permanent sobriety; for some, it means learning how to moderate, to a point that no longer qualifies them as having a substance use disorder. She notes, also, that the people who recover without treatment tend to have more resources and social capital at their disposal, but that doesn't mean their addictions are less severe.)

There are various evidence-based approaches for treating addiction—harm reduction, behavioral therapies, plus support groups like Moderation Management, SMART Recovery, and Women for Sobriety—but you'd never know that from the bulk of the addiction memoirs on shelves. And that's a problem. "By not having more diverse literature in this area, we are telling people who are actively addicted that there is only one way to recover. This is the only narrative arc you can have, and if you don't have that narrative, you're doomed to fail," Szalavitz says. "That is a horrible message."

Which is why books like How to Murder Your Life are more necessary than ever. Not surprisingly, the media coverage around Marnell's memoir narrows her tempestuous journey down to a trite before-and-after story (think "notorious downtown party girl goes good"—or, as the New York Post delicately put it: "NYC's hottest mess survives to tell her tale of hard-core addiction").

And Marnell's "before" was, indeed, messy. Though she'd been addicted to Adderall since her psychiatrist father started prescribing the drug to her in her teens, Marnell's drug use escalated when she began working at high-profile magazines like Lucky. By the time she landed at xoJane in 2012, her substance use and eating disorders were running the show, and at times she could barely string a few words together.

After crashing and burning at xoJane, Marnell began writing her memoir the same day it was due, from rehab in Thailand. The structure was good for her, and she returned to New York in a healthier headspace, a new devotee of meditation, exercise, and, yes, prayer. As with many other addiction memoirs, Marnell's writing starts to feel hollower toward the end of the book, like she's trying to stuff the loose ends of her life into a palatable package ("I don't go to nightclubs anymore. … I take long walks underneath the FDR Drive, listening to Louise Hay's affirmations"). One senses that she's trying, hard, to reconcile the parts of herself that have long been at war: the addictive personality that veers toward crusty self-isolation, and the ambitious achiever who wants to be healthy, successful, and loved (in a recent Sunday Times feature, Marnell says she wants a partner "so badly, but I'm too weird, man"). She's upfront about continuing to struggle with drugs; in the book's final pages, she confesses, "There's a bottle of Adderall right next to me … as I sit writing this."

But again, why would Marnell be sober? For most addicts, "recovery" is a winding and deeply individualistic road. Success looks different for everyone, and the everyday realities of most people's lives are far from neat or tidy, addicts or not.

I hope Marnell is closer to finding her own own happy ending, whatever that looks like. I also hope that more addicts and former addicts of varying ages, races, and socioeconomic backgrounds are given the space, in both literature and in their regular lives, to share their unvarnished truths: the chaotic endings, the contradictory endings, the gleeful endings, and everything in between.