Use of Addictive Substances by Those in Alcoholism and Drug Addiction Recovery

I am going to briefly introduce a subject I have referred to here before, namely, use of substances with addiction potential (alcohol and other drugs) by those in recovery from alcoholism and those in recovery from drug addiction and hopefully others will chime in on this complicated and, at times, controversial topic. I will not address (except as mentioned in AA's position on Drug Use and Sobriety, copied below) an even more difficult topic for those in recovery, namely, use of physician prescribed substances that affect the central nervous system in ways similar to drugs of abuse, including alcohol. So, I'll just pose a few questions to open the discussion. Should an individual who has an alcohol addiction (alcoholism) and is seeking recovery, and who has no history of a problem with any other drug of abuse (for ex., marijuana), use such a drug of abuse? Should a drug addict, say with an addiction to heroin or amphetamines, and who is seeking recovery, and who has no history of a problem with alcohol, use alcohol?

Hopefully, most would agree that an individual who is an alcoholic and also has a (another) drug addiction, should, in order to maintain recovery and abstinence from either addiction, abstain from use of alcohol and all other drugs. As soon as I wrote this, I started thinking about some individuals I know in recovery from both a drug and alcohol addiction who would not consider marijuana as an addictive substance that they need to avoid, but that is another subject. I also think it is fairly well established that a drug addict, that is, an individual who has crossed the line into addiction (pattern of use in the face of adverse consequences and loss of control, with or without, physical dependence), no matter what the substance, who values his/her recovery, should not use any type of addictive drug. However, the question of the use of alcohol by a recovering drug addict without alcoholism has been enough of an issue for Narcotics Anonymous to issue a position on the matter:

"The only way to keep from returning to active addiction is not to take that first drug. If you are like us you know that one is too many and a thousand never enough. We put great emphasis on this, for we know that when we use drugs in any form, or substitute one for another, we release our addiction all over again. Thinking of alcohol as different from other drugs has caused a great many addicts to relapse. Before we came to NA, many of us viewed alcohol separately, but we cannot afford to be confused about this. Alcohol is a drug. We are people with the disease of addiction who must abstain from all drugs in order to recover (NA White Booklet, Narcotics Anonymous. Copyright © 1976, 1983, 1986 by Narcotics Anonymous World Services, Inc. )."

Here is AA's position on Drug Use and Sobriety, including use of physician prescribed medication:

"Some A.A. members must take prescribed medication for serious medical problems. However, it is generally accepted that the misuse of prescription medication and other drugs can threaten the achievement and maintenance of sobriety. *** From the earliest days of Alcoholics Anonymous it has been clear that many alcoholics have a tendency to become dependent on drugs other than alcohol. There have been tragic incidents of alcoholics who have struggled to achieve sobriety only to develop a serious problem with a different drug. Time and time again, A.A. members have described frightening and sobriety-threatening episodes that could be related to the misuse of medication or other drugs. Experience suggests that while some prescribed medications may be safe for most non-alcoholics when taken according to a doctor’s instructions, it is possible that they may affect the alcoholic in a different way. It is often true that these substances create dependence as devastating as dependence on alcohol. It is well known that many sedatives have an action in the body similar to the action of alcohol. When these drugs are used without medical supervision, dependence can readily develop. "Many A.A.s who have taken over-the-counter, nonprescription drugs have discovered the alcoholic’s tendency to misuse. Those A.A.s who have used street drugs, ranging from marijuana to heroin, have discovered the alcoholic’s tendency to become dependent on other drugs. The list goes on and will lengthen as new drugs are developed (The A.A. Member-—Medications and Other Drugs (Revised 2011), Copyright © 1984, 2011. Alcoholics Anonymous World Services, Inc. Pages 4-5)."

A final point--I have had individuals in recovery from alcoholism or another drug addiction, wonder why, if they have had no history of a problem with another substance, cannot they use that substance and still maintain their abstinence/recovery from their drug or alcohol addiction? One answer can be phrased as a question: Does an alcoholic or addict need to try every drug of abuse now or hereafter developed to see if he/she can use the drug without developing an addiction or relapsing into use of their original drug of choice? Here are some reasons I have for taking the position, as I do, and as does NA, that complete abstinence from all psychoactive substances is necessary for ongoing recovery from addiction:

1. Use of any drug will result in impaired judgment (may lead back to drug of choice (DOC)).

2. Substitution—the person may develop a new addiction.

3. Use of any drug will have an adverse effect on already damaged neurotransmitter systems in the reward pathway of the brain.

4. The resulting high from the new substance will not be the effect of the person’s DOC (not the high desired).

5. Recovery is an all or nothing proposition; either you’re sober or clean or you’re not.

As always, comments are invited. Jan Edward Williams, 06/28/2013.