Here’s a joke.

Question: How do you know an addict is lying?

Answer: His lips are moving.

Ha ha ha ha ha ha ha ha ha ha ha ha!

That was a fake laugh, a lie, if you will. In fact, I don’t think this joke is at all funny, though I laughed at it more than once back when I was in treatment. Why did I laugh? Was I acknowledging, with a carefully calibrated blend of amusement and regret, the truth beneath the joke: that addiction made me a pathological liar? Well, I wasn’t one, so no. Was I acknowledging that, though I may not have lied very much myself, I undoubtedly would have lied, had I kept drinking and using? That isn’t true either, so no. Instead my laughter acknowledged that the people around me did think that all addicts lie, if not actually then potentially.

Why do people think that? First, let’s dispense with the obvious answer: many people with addictions lie about those addictions to conceal either their existence or their extent. A smoker sneaks a cigarette break by claiming the dog needs an outing, and a binge eater runs to the store for cheesecake under cover of a milk emergency. What’s different with drug addicts, including alcoholics, is that strategic lying about the addiction is generalized to global dishonesty: lying as a habit or reflex. It’s as though the addiction is a kind of ethical toxin that would make an addict say to Kate Moss, “Yes, Kate, those pants do make you look fat.”

One reason for this perception is that, as addicts, we’re all supposed to be on the same road to the same destination. Male or female, rich or poor, black or white, the only difference between us is how far down that road we have traveled. To this way of thinking, it doesn’t matter that I may not have uttered actual falsehoods. Given a bit more time using, lies would swarm from my mouth like bats from a cave because addicts lie. We just do. Not to admit it is to be in denial of my true nature and the destiny that awaits me outside the tender care of the recovery industry. I laughed at that stupid joke because I didn’t want to look like I was in denial. Or humorless, but that’s a whole ‘nother issue.

The “we’re all on the same road” idea is perhaps most clearly expressed in one of the recovery industry’s foundational documents: the Jellinek Curve. The curve is a U-shaped diagram of the downward progress of alcoholism and the upward progress of recovery. Like much recovery “science,” it’s based on research done generations ago on a tiny sample of men who were all in A.A. In its day, it was vaguely innovative. Jellinek was (among many other things) a biostatistician who applied quantitative methods to the study of alcoholism and argued that it was a disease, rather than a symptom of moral bankruptcy. His research, conducted in the 1940s and 1950s, is justifiably regarded as groundbreaking.[1]

As Jellinek himself recognized, his curve should have been superseded by better, more rigorous models. But the original curve is still going strong more than 70 years after its debut. In many treatment programs, a photocopy of it is one of the first handouts given to patients. As they distribute it, clinicians may apologize for the dated language of the Curve, but they nonetheless accept its central premises:

• that the progress of addiction is uniform and inevitable and steadily downward toward a “bottom.”
• that, after a dramatic conversion, recovery is equally uniform and upward.[2]
• that addiction involves predictable social, ethical, and mental degradation.
• that recovery involves predictable social, ethical, and mental restoration beyond what was possible before the onset of the disease.
• that the progress of addiction and recovery corresponds exactly with the scheme outlined in Alcoholics Anonymous, otherwise known as the Big Book.

When patients receive their copy of the Jellinek Curve, they are told to plot correspondences between their own histories and milestones on the Curve. They are praised for finding many correspondences and helped to find more if their tallies seem low. Some of the milestones are legitimately predictable physical symptoms, such as blackouts and morning shakes. Most are not. Among the latter milestones are:

• loss of ordinary will power
• grandiose and aggressive behavior
• unreasonable resentments
• moral deterioration
• drinking with inferiors

And of course:

• complete dishonesty

The idea that all addicts lie is confirmed outside the treatment industry as well. It’s a frequent theme in Al-Anon discussion groups, and it’s repeated by professionals such as the Guardian’s agony aunt Mariella Frostrup and relationship coach Dr. Neill Neill. Writers who are otherwise careful to avoid damning generalizations about large groups of people feel no compunction about claiming that all addicts lie, cheat, steal, manipulate other people, think only of themselves, and leave a broad swath of physical, financial, and emotional wreckage in their wake. If you wonder why some of us don’t embrace the designations “alcoholic” and “addict,” you need look no further than the behavior we’re expected to own, whether we actually did any of it or not.

I can’t believe that I actually have to say this, but addicts differ from one another as much as any other group of people. Some of us lie, steal, drive drunk and high, cheat on our spouses, hit our children, and produce all manner of mayhem. Some of us don’t. Serial killers Ted Bundy and John Wayne Gacy were raging alcoholics, but so were Betty Ford, Chögyam Trungpa, and Winston Churchill. Just because drugs such as alcohol have some predictable (though by no means universal) physical effects does not mean they have equally predictable effects on a person’s character. Alcohol is disinhibiting, yes, but what impulses are disinhibited? With one person, it may be violent rage; with another it may be karaoke.

Why does it matter? After all, people have to endure pejorative stereotypes for all sorts of things over which they have no control. First, it matters because it affects policy. There are deep contradictions in the way we think about addiction at the best of times. No matter how much researchers discover about genetics, neuroscience, and the role of trauma, there’s always an atavistic moralism bubbling right beneath the surface of any debate about addiction. It keeps research funding low; it keeps treatment scarce and ineffective; it keeps the alcohol and pharmaceutical industries free of responsibility for promoting the abuse of their products. Every time someone says “All addicts lie” without being challenged, that moralism is reinforced.

The second problem is the one I mentioned: that it discourages people from acknowledging a problem that carries with it such a large burden of shame. If they do get into treatment anyway, it can still affect that treatment so profoundly as to render it ineffective. Let me give you one small example from my experience.

A few years ago, I endured 21 days of inpatient treatment at a facility called Sundown M Ranch in Yakima, Washington. The treatment philosophy at Sundown M is explicitly confrontational. Patients are assumed to be in denial of their problems, denial that must be challenged and broken down so that they can then construct a new sober identity. The counselors at Sundown M all benefited from this technique themselves and practice it with gusto.

Here’s an example of how it works. After you’ve been there a few days, you receive a long, detailed questionnaire in which you’re supposed to write down everything you’ve lost or destroyed as a result of your addictions—along with the dollar value of those losses. When you finish the questionnaire, you read your responses out loud to your counselor and the patients in your therapy group. After that comes the confrontation, because unless your tally is long and horrific (and really expensive), your fellow patients accuse you of lying. If they don’t, then the counselor goads them until they do—or makes the accusation herself.

Had I known the drill, I would have lied, absolutely. I would have fabricated six-figure expenditures on drugs and alcohol plus three times that much on hospital bills, bail, lawyers’ fees, crashed cars, trashed homes, and therapy for my traumatized children, and I would not let inconvenient facts, such as my childlessness, limit my imagination. Instead, I tried to tell the truth, which was that I had been sober most of my adult life but had lately resumed occasional solitary binges that simply didn’t produce TV-movie-worthy wreckage, though they alarmed me and my family plenty. I wasn’t in denial; I was baffled and scared, and the very last treatment I needed was a professional counselor jabbing her finger at me and shouting “denial” because my history didn’t look like hers or conform to the Jellinek Curve.

That’s what I got, though. In fact, my counselor was so sure I was in denial that, on the day I was to read out my tally, she brought in ringers, people from another therapy group who had shown special enthusiasm for confrontation.[3] As I listened to the accusations of these strangers, I felt like I was on a really bad reality TV show. The experience was unpleasant, but I was aware throughout that it didn’t have anything to do with my life. At the same time, I realized how shattered I would have been twenty years earlier. I thought of all the young addicts, particularly survivors of abuse, and wondered how being called liars would affect them as they tried to cope without the drugs that kept their self-loathing at manageable levels. Given the huge percentage of addicts who have experienced childhood trauma—a percentage that has been recognized for a generation and confirmed many times by independent research—I have trouble believing that confrontation is still considered a legitimate therapeutic method.[4]

Which is why, when politicians promise “more money for treatment,” I can manage only a weak smile. Given the current state of addiction treatment in the US, I’m not sure more of it is a good idea.

But, since there’s nothing else available to most of us, I’ll continue to encourage people in active addiction to seek treatment. The deception won’t bother me a bit–all addicts lie, remember?

[1] According to sociologist Ron Roizen, Jellinek was a bit of a charlatan with no scientific training and only a single honorary degree. See his article “E.M. Jellinek and All That! A Brief Look Back at the Origins of Post-Repeal Alcohol Sciences in the United States.”

[2] A loop at the bottom of the Jellinek Curve indicates that conversion may require multiple tries to get underway.

[3] These sessions are normally conducted within therapy groups, the idea being that group members take turns being vulnerable. Bringing in outsiders to confront one person is therapeutically unsound. For starters.

[4] I’ll write a piece on trauma and addiction at some point. For now, see these two useful articles by Donna Bevan-Lee, “Childhood Trauma and Addiction” and “Childhood Trauma and Addiction Treatment.” If you’re just looking for numbers, recent research shows that 55.1 percent of alcoholics and 66 percent of opioid addicts have a history of childhood trauma. See Ming-Chyi Huang, Melanie L. Schwanndt, Vijay A. Ramchandani. David T. George, and Marcus Heilig, “Impact of multiple Types of Childhood Trauma Exposure on Risk of Psychiatric Comorbidity Among Alcoholic Inpatients, Alcoholism: Clinical and Experimental Research, 2012, 36(6), 1099-1107 and Maia Szalavitz, “Opioid Addiction Is a Huge Problem, but Pain Prescriptions Are Not the Cause,” Scientific American, May 10, 2016.