“What makes a woman’s right to procreate more important than the right of a child to have a normal life?” Project Prevention founder Barbara Harris told Time magazine in 2010. The question is entirely rhetorical: her self-professed mission in life is to zero out the number of births to parents who abuse illegal drugs, particularly crack cocaine. “Even if these babies are fortunate enough not to have mental or physical disabilities, they’re placed in the foster-care system and moved from home to home,” she says.

Critics of many stripes have piled on. They argue that Harris’ campaign deprives women who are addicted, poor and vulnerable of reproductive choice even as it feeds their drug habit.

Some opponents say that, since the financial incentive is tantamount to giving addicts money to buy drugs, Project Prevention should be illegal.

Others say that if addicted women are viewed as not responsible enough to have a baby, then they should also be viewed as not responsible enough to give informed consent to having a serious medical procedure in exchange for drug money.

Still others say that Harris is stuck in the past by targeting the wrong drugs: these days, more babies are born dependent on Oxy and other legal opiate painkillers than cocaine or heroin, according to a report published just this week in JAMA.

And many opponents say that the payment is a bribe, and some have even called Project Prevention a revival of the eugenics movement.

Harris takes none of these criticisms seriously. The California foster mother, age 59, started the program in 1997, following her failed effort to get the Prenatal Neglect Act through the California state legislature. The bill would have made it a crime for a pregnant woman to use illegal drugs. (Such laws exist in many states: last week’s Sunday New York Times Magazine profiled an Alabama woman named Amanda Kimbrough who is serving 10 years in prison for doing crystal meth while pregnant and giving birth after only 25 weeks to a very underweight baby who died.) Shifting tactics, the homegrown activist then began her campaign for a less punitive, if more final, solution to the “problem” of drug-addicted mothers bringing children into the world: pay them not to procreate.

“We don’t allow dogs to breed. We neuter them. We try to keep them from having unwanted puppies, and yet these women are literally having litters of children,” Barbara Harris says.

Though based in North Carolina, Project Prevention mainly targets the nation’s major cities, especially poor and minority communities —“drug areas,” in Harris’s words. In addition to posting fliers, volunteers do ride-alongs with police; a mobile billboard (see the photo on The Fix homepage) tours the country.

Harris originally offered addicts $300 for sterilization and only $200 for contraception, but the ensuing bad press—mainly charges that the program was incentivizing addicted women to choose an irreversible decision about reproduction—put an end to that practice. In fact, the vast majority of the birth-control procedures come on the government’s dime, via Medicaid. After the procedures, the women send the medical paperwork and a “paper trail” that proves that they are addicts—“usually arrest records”—to Project Prevention to receive their check. That is the extent of the group’s involvement in the women’s lives.

Project Prevention has paid a total of 4,077 people (including 65 men), 987 of whom have been African-Americans, to get a tubal ligation (tube-tying) or an IUD, implanon (a hormonal contraceptive that is implanted in a woman’s arm), Depo-Provera (an injection that lasts three months) or (for men) a vasectomy, Harris says.

Those numbers aren’t overwhelming, given that the project is in its second decade. Yet with its goal to “save our welfare system and the world from the exorbitant cost to the taxpayer for each drug-addicted birth,” Project Prevention has sparked a firestorm of opposition.

The outrage stems as much from what Harris says as from what Project Prevention does. For one thing, in the considerable press she has sparked, Harris typically characterizes her target population less as drug-addicted women than as breeding machines, spitting out a baby a year.

“I became more angry at the system that allows [these drug-addicted women] to drop babies off yearly at the hospital with no consequences,” she told The Fix. “If there’s a scale, and it’s between her never having any more babies and her having five more babies who may be damaged, then what’s more important? For me it’s the children. And if she can’t have any more children, then that’s just the consequence of her actions, like getting AIDS or something.”

Harris says that she relies on the discretion of the doctors not to give birth-control procedures to women who haven’t already had a child, and says—despite the fact that she does not collect this data—that most of the women have had “at least three children, as many as a lot.”

She told the Telegraph, a British paper, ”The last 20 women who underwent sterilization had been pregnant a total of 121 times and had 78 children in foster care.” A 2004 review of the data that Project Prevention collects on its clients (an incomplete and unscientific data set) reveals that their average birth rate was 3.5—above the national average, but not exactly “a lot.”

Another of her favorite comparisons, not surprisingly, is to dogs. “We don’t allow dogs to breed,” she said. “We spay them. We neuter them. We try to keep them from having unwanted puppies, and yet these women are literally having litters of children.” Given the chance to distance herself from this comment on a segment on 60 Minutes II, she doubled down, saying, “It’s the truth—they don’t just have one and two babies, they have litters.”

Her statements only invite charges that her entire campaign is racist, targeting as it does crack-cocaine users. In defense, Harris, who is white, likes to cite the fact that her husband is black and, even more counterintuitively, that they adopted and raised four black children from a crack-addicted Los Angeles mother.

Harris’ politically incorrect bravado may win Project Prevention both media and money, but such statements are unsupported by empirical evidence. No studies have been conducted that reliably measure the fertility rate of drug-using women vs. the general population—there are too many variables: What kinds of drugs? What patterns of use? A study funded by the National Institute on Drug Abuse found that of 120 low-income, drug-using women, “most” “had one or two children and were expecting or had recently given birth to a newborn.

Yet if Project Prevention’s rhetoric and tactics are problematic, its goal of decreasing the number of unintended and unwanted pregnancies among drug addicts is one that many people, including public health officials, support.

Dr. Peter Beilenson, who was then the Baltimore City Health Commissioner, told the Baltimore City Paper in 2003 that his opinion of the organization was “bifurcated.” “While it is rather coercive to pay people to do things, I don’t have much problem with encouraging people to use reversible birth control at a time when they might not be in full possession of their faculties,” he said.

In 2009, Los Angeles Times columnist Sandy Banks wrote glowingly about Harris’ campaign as not only a cost savings for the foster-care system but a benefit for the mothers themselves. “So we can talk about women’s rights or about the privilege of procreation. However we cast the conversation, there is one truth we can’t avoid: We are helping mothers heal when we keep unwanted children from being born.”

Paying poor women who are addicted to drugs to undergo sterilization obviously leads to a thicket of troubling moral issues, even if it falls short of outright eugenics. In addition to the racism accusations, there is criticism that Project Prevention betrays an abuse of women’s right to informed consent. If a person who is addicted to crack cocaine and has few material resources is in no position to assume responsibility for a baby, are they truly capable of making long-term or permanent decisions about their reproductive health?

Both the American Civil Liberties Union and Planned Parenthood say no, and many bioethicists agree. “Rewarding someone for having a surgical procedure, they note, violates a basic principle of medical ethics: Health care decisions should be made by patients, without any form of pressure,” Barry Yeoman wrote in Mother Jones magazine in 2001.

One frequent Harris opponent is National Advocates for Pregnant Women (NAPW). When asked why NAPW has dogged a relatively obscure grassroots group, Executive Director Lynn Paltrow told The Fix, “The greatest harm of Project Prevention is that they are a propaganda machine used against pregnant women to take away their civil and human rights.”

Paltrow charges that Project Prevention perpetuates the racist bugaboo of the “crack baby,” which has served Harris well in winning funds from some high-profile Republican Party extremists. In fact, the generation of “crack babies” that was predicted in the wake of the crack cocaine epidemic in the 1980s never materialized, nor did a “biological underclass” and its ensuing crime wave. That’s not to say that the fear had no realistic basis: In 1991, some 22,000 “boarder babies” were left at hospitals by parents unwilling or unable to care for them, according to a federal study.

“Of all the risks to future children, among the smallest numerically is use of any illegal drug. Compared to poverty, lack of access to prenatal care, obesity, cigarette smoking, we’re talking relatively few women,” Lynn Paltrow says.

While the use of crack cocaine during pregnancy has been found to increase the risk of miscarriage and of low birth weight, the babies rapidly make up for the deficit. According to a scientific review of the research, “Cocaine exposure in utero has not been demonstrated to affect physical growth. It does not appear to independently affect development scores in the first six years. Findings are mixed regarding early motor development, but any effect appears to be transient and may, in fact, reflect tobacco exposure.” Harris’s own adopted daughter is evidence of this; as a proud mother, Harris told The Fix that “she’s on the chancellor’s list at college, she’s brilliant.” Yet by the logic of Harris’s own activism, her daughter never should have been born.

The use of alcohol (11.6 percent) and tobacco (16.4 percent) during pregnancy is far more widespread than the use of any illicit drug (5.2 percent), according to the Department of Health and Human Services. Yet while smoking and drinking while pregnant are viewed as health problems, taking illegal drugs—especially crack cocaine—is widely considered a moral failing, and in some states a crime. Women who do so often lose custody of their children; in the 1990s, at the peak of the “crack baby” craze, a large number were prosecuted and jailed.

For Paltrow, Harris’s emphasis on the effects of drug use on the fetus deflects attention from the myriad more pressing problems facing children born in poverty. “Of all the risks to future children, among the smallest numerically is use of any illegal drug. Compared to poverty, lack of access to prenatal care, obesity, cigarette smoking, we’re talking relatively few women,” she says. Most public health officials agree that poor parenting, family violence, substandard schools, exposure to lead and other poverty-related stressors have more serious and lasting effects on the development of children, but these issues do not spark the same level of public outrage as “crack moms.”

To the charge that her program disproportionately singles out black women, Harris told The Fix, “If you’re a drug addict, we’re looking for you, and I don’t care what color you are, because we don’t even know what color your baby will be, because often these babies come out all different colors, you know what I mean? They’re mixed.”

Be that as it may, Harris also faces criticism that she does not help women access drug treatment services. In fact, the treatment and care of the woman is incidental to Harris’ aim; her compassion, like that of an anti-abortion advocate, seems reserved exclusively for the unborn, leaving flesh-and-blood mothers and children out in the cold. “A lot of people aren’t looking for treatment, and until they are, they’re not going to do it,” Harris says dismissively.

Funds for drug treatment have been slashed over the past two decades, in any case. The main source, the federal Substance Abuse and Mental Health Services Administration, has cut funding for treatment programs for women by almost 40 percent since 1994; programs for pregnant and postpartum women and their children is now less than 10 percent.

Project Prevention ignores other risks facing drug-addicted women, according to Julia Scott, president of the National Black Women’s Health Project: “to focus solely on pregnancy prevention without acknowledgment of the seriousness of HIV/AIDS is callous and life-threatening.”

Other opponents of Project Prevention are more worried about the human rights of the women. Stuart Sorenson, a mental health and addiction worker in London who led a successful campaign in 2010 to shut down Project Prevention soon after it launched in Britain, says, “It’s not up to me to decide who has value. Any organization that thinks it’s OK to decide who has the right to live is arrogant in the extreme.” He also pointed out that the European Convention on Human Rights designed to prevent another Nazi Holocaust makes the activities of Project Prevention illegal in Europe, because it amounts a discriminatory practice against a population of vulnerable adults: “It’s essentially a form of eugenics dressed up in a thin veneer of compassion,” he told The Fix.

In fact, a well-known, century-old slogan of the eugenics movement might be mistaken for a Project Prevention flier, allowing for differences in style. “I must drink alcohol to sustain life. Shall I transfer the craving to others?” Before the Nazis spectacularly ruined the reputation of eugenics, the movement had garnered widespread approval in the U.S., resulting in state laws permitting the forced sterilization of prostitutes, mental patients, criminals, addicts and other stigmatized people.

Opponents also say that the program ignores the potential of these women not only to recover from their addiction but to be good parents—even during their addiction. Typically, Harris doesn’t even bother to pay lip-service to this bleeding-heart sentiment. “What if five years down the line they get clean and they want to have children but they can’t because they were sterilized? Well, to me it’s a gamble. What if they didn’t get off drugs in five years, and in those five years they had five more babies,” she says.

Yet Advocates for Pregnant Women has released a new video claiming that pregnancy can be a motivation for addicted women to seek treatment and recover the full ability to be good mothers. And Sorenson points out that in Britain, there are welfare-state programs that can help addicted parents keep their children. The fact that Project Prevention’s guide for the volunteers who distribute their fliers instructs them to target “AA and NA Meeting Places” suggests that the organization is equally interested in sterilizing recovering and former addicts.

Project Prevention appears to be very well funded, especially given the scope of its work. Harris says that she has never had to fundraise; donations arrive from around the world without being asked. One of her largest longtime donors is the Allegheny Foundation of arch-conservative billionaire Richard Mellon Scaife, dubbed by the Washington Post “the funding father of the right.” Other notable far-right deep pockets include Dr. Laura Schlessinger, the former talk-show host whose homophobia cost her her advertisers, and Jim Woodhill, a Houston venture capitalist and self-proclaimed member of the “Republican Rebel Alliance.”

Woodhill hired Chris Brand, a British psychologist who was fired from his tenured teaching position at Edinburgh University, to export Project Prevention overseas. Among the claims of a self-proclaimed “race realist” are that blacks are intellectually inferior to whites, that “wanton and criminal females” should be sterilized and that sex with children 12 and over should be legal.

Lynn Paltrow says, “Why would someone like Richard Scaife fund them? To promote disinformation for those who believe that all social problems are about bad individuals and have nothing to do with the social and economic circumstances of their lives.”

The organization has had mixed success in establishing a global footprint; the public outcry in Britain forced the group to decamp for the presumably more welcoming environs of Haiti, which is the world’s poorest nation. In 2010, the organization opened a beachhead in Africa with a new campaign in Kenya targeting women with HIV—on the theory that a child with HIV, like a child exposed to drug addiction, is better off not being born. HIV advocates have attacked the program, pointing out that mother-to-child HIV transmission during childbirth is preventable if the mother can access even temporary antiretroviral treatment, not to mention that the disease is no longer a death sentence—again, if treatment is available.

But rather than help pay for such treatment, Project Prevention offers the women $7 to undergo sterilization or long-term contraception, plus another “$40 American to use as they please.” That’s not even the $300 that drug-addicted women in the U.S. receive, but in Kenya, where average-per-capita GDP is $315, $47 can go a long way.

The logic of associating personalities with specific drugs seems natural. A German-British psychologist named Hans Eysenck spent the mid-20th century turning the eye of the scientific community from Freud’s behavior-based theories to individualized psychology—pioneering the science of personality. He considered this pursuit of matching personalities with drugs a pet project.

Eynsenck believed the ways people are inclined to think aren’t always the ways that make us feel best. And because drugs are the easiest way to modify temperament, it’s only natural for us to seek out those substances that keep us on an even keel. For instance, he thought that introverts, whose brains are always chewing at problems, should crave depressants to quiet the incessant mental chatter. Extroverts, easily bored, should chase the rush of stimulants.

His theory condensed individualized drug cravings into an easy, logical framework—but he was wrong. Or at least, he vastly oversimplified the concepts of both “personality” and “drugs.” Worse, his theory wasn’t borne out by research. Study after study showed both introverts and extroverts drinking alcohol (a depressant) to excess. And extroverts didn’t limit themselves to uppers; it seemed they would reach for all kinds of substances.

So where does that leave us? Well, scientists kept trying to tie the two nebulous concepts together. Over the years, as new methods of personality screening emerged, researchers continued to distribute questionnaires to groups of drug addicts. One major breakthrough came when four sets of psychologists independently realized in the 1980s and 1990s that a person’s personality traits—tendencies that are partially genetic and tend to last throughout life—can be pretty reliably described using five factors.

Introversion and extroversion weren’t enough, they thought. We should also consider openness to new experiences (think Bear Grylls), conscientiousness (Haruki Marukami), agreeableness (Mother Theresa) and neuroticism (Woody Allen) when trying to understand why people act the way they do. Thus armed, personality psychologists began fitting the various personality traits they had come up with over the years into what came to be called the “Big Five.” And lo, with a more accurate representation of traits, a connection between personality and drug use began to emerge.

People who tested high on neuroticism (indicating that they tend to be impulsive, emotionally unstable and anxious), low on conscientiousness (tending to be disorganized, unambitious and lazy), and low on agreeableness (tending to be uncooperative, unhelpful or misanthropic), were more likely to have problems with alcohol or drugs than people whose scores were closer to the middle, or reversed. Perhaps more interestingly to the question of whether personality traits led their owners to cocaine over alcohol, or marijuana over mushrooms, higher scores for each risky trait were linked to higher likelihood of using “hard” drugs like heroin, amphetamines or crack.

“There is some evidence that the more ‘bad’ traits you have, the harder the drugs you’re going to use,” says Michigan State Department of Psychology professor Chris Hopwood. “So super, super-impulsive, sensation-seeking, neurotic people might be inclined to use something like heroin, for example, whereas if you’re a little bit less impulsive or have more anxiety about things maybe you wouldn’t. Maybe you would use other drugs but you would be too afraid to use heroin.”

Not all the personality factors that appear in people with drug problems are negative, however:

Sensation-seeking—a facet of openness to experience that’s common among extreme sports athletes, explorers, philanderers and roller coaster-enthusiasts—is almost always associated with drug abuse, but doesn’t necessarily scale with using harder drugs. Marijuana users, for instance, have been shown to be high in sensation-seeking, with closer-to-average levels of neuroticism.

Sensation-seeking seems to be about 60 percent heritable—meaning about 60 percent of the trait comes from your genes—and appears to be related to the brain’s dopamine reward system, the same system that makes most drugs of abuse pleasurable. Sensation-seeking may even be related to where you live, through interactions with neighbors—or, in the case of, say, New York City, through self-selection. A study by Jason Rentfrow, Sam Gosling and Jeff Potter that was analyzed by Richard Florida on the Atlantic’s Atlantic Cities blog showed that Openness to Experience scaled with drug use when compared within states. And which states had the highest levels of both illicit drug use and openness? Colorado, Vermont, Oregon, Washington, Nevada, Massachusetts, New York and California.

Given the personality characteristics that seemed to split “hard” versus “soft” drugs, scientists began to wonder if—even if they couldn’t predict who would take uppers over downers—there was a way to predict who would become an alcoholic and who would abuse illegal drugs. The studies showed some remarkable similarities: One study conducted among veterans suggested that all addicts share interpersonal styles that tend toward loner, rebel and pessimist stereotypes, for example, which surprised no one who has ever seen “Leaving Las Vegas.” But there did appear to be a little something extra that could push a person into hard drug addiction.

People who use illicit drugs often have been shown to have higher rates of both extroversion and susceptibility to boredom, which may drive them into more situations where drugs appear, or simply make them more likely to crave new subjective experiences. And those who are particularly susceptible to boredom have been shown to use opiates more often.

But this is where the studies break down. Most research on the topic of how personality relates to drugs of choice is conducted among people who already have drugs of choice—addicts. And as any addict knows, once you’ve taken a shine to a drug, it can be exceedingly difficult to disentangle the personality factors that came before from the ones that came after. By the time the personality questionnaires are administered, who’s to say what caused the drug use and what the drug use caused?

“It could go either way,” says Hopson. “A person who uses heroin might end up having problems in their life. Perhaps he loses his job, perhaps then he starts stealing things. You could easily tell a story that goes, the heroin started first and then the person started doing all kinds of mean antisocial things. Or you could tell a story that says that the person was sort of a ‘bad’ person, if you’ll forgive the language, and one of the bad things they did was use heroin.”

There are also direct effects of drugs that scientists have to consider. Crack and cocaine abusers, for example, have shown personality traits related to the symptom of paranoia in certain studies, as well as depression and impulsivity and a trait terrifyingly called “psychoticism.” Because long-term crack or cocaine use can cause many of these effects, however, it’s unlikely that those traits cause people to take up stimulants. Rather, it appears that long-term crack or cocaine use might be able to alter the expression of certain traits to create a “stimulant user profile.”

Regardless of the qualms of scientists, however, quiz websites and message boards hoping to connect personality to a particular drug have popped up all over the Internet. Many focus on Myers-Briggs personality types (ENFP, ISTJ, etc.), which are commonly used by career counselors to assess how people prefer to perceive and organize information. Others skip the science altogether, selecting a drug you’re likely to use based on the clothes you wear, the events you attend, where you live, and your perceived flaws.

Will science ever reach that degree of accuracy—explaining just what it is that seems to make neurotic writers more likely to drink than use heroin? It’s certainly possible, says Hopson. “One way to think about personality is in terms of traits, which are stable and heritable. But you can also think about personality dynamics, like how do I react if you insult me, for example. That’s sort of my guess is that which drugs you use depend on the more complicated personality dynamics.”

Assuming you’ve got the traits that push you toward drug use in the first place, what else might lead you to one substance over another? Hopson says factors that play a role include what your parents use, what your friends use, and even simply what’s available where you live. Which perhaps explains Hemingway’s situation better than we could have expected: there sure was a lot of rum in Cuba.

The first time I tried purging, I was on summer vacation, determined to transform myself during the three months between middle and high school. I was fit and strong from years of dancing and running, but hadn’t yet come to terms with basic facts—like that 95 pounds wasn’t a legitimate goal weight when you’re 5’5”. I had just shared an entire batch of lime Jell-O with my childhood best friend when I was struck by the idea of slinking away to the bathroom to expunge it. Sticking my finger into my mouth was the hardest part—it just feels unnatural to have a hand wriggling about your uvula—but once I found the hot spot at the back of my throat, the relief was instantaneous. Neon-green goo swam before me in the toilet bowl and my stomach felt smaller within seconds. It was that easy. I couldn’t understand why everyone didn’t do this to stay thin. It was the perfect weight control method; eat whatever you want and then get rid of it before your body begins to digest the calories. Once I’d committed to ignoring the foul, acrid scent of bile that trailed after my fingers for the rest of the day, I was hooked.

At first, purging was just a handy tool to un-do the moments where I lost the illusion of self-control. Not when I simply regretted eating a slice of pizza, but when I spent $30 at Taco Bell in a ravenous daze. But as I grew older, all the unnecessary calories that active alcoholism required me to drink—beer, wine, vodka, cheap champagne diluted with syrupy orange juice—grew their very own muffin-top. I realized that I could use my gag reflex for getting rid of those calories so I began to starve myself during the day, living off black coffee and egg whites, then follow my wannabe-anorexic diet with nights of drinking, binging, and purging. I would fantasize about the food I was going to eat all day long: bags of potato chips; those greasy, over-processed pastries found only at corner bodegas; children’s cereal; anything that was embarrassing to purchase, really.  While I ate, I obsessed over chewing thoroughly and quickly enough to get it all back up easily before it could be digested. As soon as I purged, I would be famished again and exhausted from the pure physical violence of repeated vomiting. The classy bottles of Carlos Rossi Paisano that I chugged while binging tinged the toilet water red and left me with a nagging paranoia that I might be vomiting up blood without realizing it. This was just another consequence; I was ashamed, but too addicted to give it up.

Using the daytime starvation/nighttime binge routine, I lost 30 pounds in the heyday of my disorder. My hipbones jutted out from the pasty white flesh of my abdomen and air breezed between my thighs. My elbows bumped against my ribs every time I moved my arms and none of my clothes fit. I felt glamorous and beautiful. When my head would spin from the simple act of standing up from a chair, I felt like Nicole Richie, floating through the world as a waif-like, tragic princess. Old pictures tell a different story: my eyes were puffy, my face gaunt, my hair stringy and thin, and my skin deathly white. I looked like Lindsay Lohan in the infamous mugshot taken the night she was arrested for DUI and cocaine possession. And just like Lindsay, my life revolved around my addictions. I would spend my lunch breaks at school snorting lines of Adderall and smoking cigarettes away from campus, avoiding the worry and judgment in my peers’ eyes. Drugs helped not only to numb the shame of what my life had become but also to suppress my ravenous appetite. Before graduating high school, I was hospitalized for a week for bradycardia—medical jargon for a resting heart rate of a mere 39 beats per minute. Or, simply put, being really fucked up and barely alive.

I knew that I was close to death. As with every addiction, what was once fulfilling and exciting had become a vital and taxing part of my daily routine. Post-hospitalization, I ignored the doctor’s suggestion that I get sober and the nutritionist’s that I follow a meal plan. While I began to eat more regularly, I drank and used even more to fill the sickening emptiness inside me, the God-shaped hole that I once filled with orange chicken and Lucky Charms. I filled the hole with mystery concoctions that the Ed Hardy-wearing, beer pong-playing gentlemen at my college frat parties were always so keen to give me. I filled it so thoroughly that I hit my blacked-out bottom standing in a pool of my own urine in the hallway outside of my dorm room.

Publicly defecating and sleeping in cardboard boxes—not because I was homeless, but because I’d drunkenly misplaced my keys—were not only signs of unmanageability but also humiliating and visible. Alcohol didn’t fill the hole anymore—in fact, it deepened it. After passing out in the dorm hall, covered in urine and vomit in front of the other freshmen one too many times, I made the decision to quit drinking and threw myself into the program—attending young peoples’ late-night meetings nightly, 16-oz Red Bull in tow, and immediately starting to work with a sponsor. Staying sober didn’t seem that hard, as long as I had a food stamp card.

By the time I collected my 90-day coin, I was participating in my eating disorder and AA with equal amounts of pink-cloud vigor. Keeping secrets, however, is much harder when you’re suddenly surrounded by people who have spent the majority of their lives lying and manipulating to get by: my new AA friends quickly discovered what I was up to and, though they were more understanding than my high school peers, they didn’t appreciate it when I would order three scones on a coffee date, then suddenly disappear for 10 minutes in the middle of an intense discussion of what it really means to surrender. They didn’t shun me, but they encouraged me to get help by trying Overeaters Anonymous—the most contemptibly named 12-step program of them all. Admitting OA membership is like confessing to a subscription to Cat Fancy magazine on the first date. I went to two meetings and spent both playing games on my phone.

By the time I was one year sober, my eating disorder had progressed until my head felt like a balloon, my pointer finger was scabbed and peeling, and I was completely isolated. I spent all my money on food and all my time eating and purging. Kneeling over the toilet bowl, alone on a Saturday night, choking on Top Ramen noodles—the only binge food I could afford—I felt the same hollow desperation I’d experienced when I first got sober. And later that night, I met my AA sponsor and began working the steps on my bulimia, despite the fact that she had never had an eating disorder. In the OA meetings I’d been to, I hadn’t seen anyone who had what I wanted: all the women were either severely overweight, which I judged, or bone-thin anorexics, which I didn’t understand.

Working with my AA sponsor on this issue worked, for the most part. After months of praying and doing things like writing my grocery lists with my sponsor, I stopped having the compulsion to binge and purge every night. I no longer had to waste my money on Cheetos or brush my teeth six times a day. Yet the thing about an eating disorder is that it’s impossible to ever really be free from it: it can’t be escaped the way drugs and alcohol can since living requires eating multiple times a day. I haven’t made myself throw up for over two years, but does that really mean I am a recovered bulimic? What am I when I cry after mindlessly wolfing an entire pint of Ben & Jerry’s, or when I stand in front of the mirror for 30 minutes, willing the reflection to look more like Christina Aguilera circa 2001, and less like the 2012 version?

These bizarre practices don’t constitute active participation in my eating disorder the way binging and purging did, but they certainly aren’t normal. Putting the plate down and never eating again isn’t an option, so I try to listen to my body—whatever that means—and ignore my bulimic mind. It’s been two years since I got sick of choking on Top Ramen, but I still don’t believe I’m entirely there yet—or that I’ll ever be.