Does addiction last a lifetime?

Peter Grinspoon, MD

Contributing Editor

I am now 11 years into recovery from my battle with opiate addiction, and I have always been fascinated with two related questions: is there truly such a thing as an “addictive personality,” and do people substitute addictions?

The myth of the addictive personality

The recently deceased writer and television personality Anthony Bourdain was criticized by some for recreationally using alcohol and cannabis, in what was seemingly a very controlled and responsible manner, decades after he quit heroin and cocaine. Was this a valid criticism? Can a person who was addicted to drugs or alcohol in their teens safely have a glass of wine with dinner in their middle age?

It depends on which model of addiction and recovery you subscribe to. If you are a traditionalist who believes that addictions last a lifetime, that people readily substitute addictions, and that people have ingrained “addictive personalities,” the answer is: absolutely not. This would be playing with fire.

During my 90 days in rehab, it was forcefully impressed upon me that addictions are routinely substituted, and that if one is ever addicted to any substance, then lifelong abstinence from all potentially addictive substances is one’s only hope of salvation. This seemed to make sense, as a person would have the same lifelong predispositions to an addiction: genetic makeup, childhood traumas, diagnoses of anxiety or depression — all of which could plausibly set them up to become addicted to, say, alcohol, once they have put in the hard work to get their heroin addiction under control. In medical terms, the concern is that different addictions can have a common final pathway in the mesolimbic dopamine system (the reward system of our brain), so it is logical that the body might try to find a second pathway to satisfy these hungry neurotransmitters if the first one is blocked, a “cross-addiction.”

I learned early in my own recovery how critical it is to apply logic and evidence to the field of addiction, and that just because things make sense, and because we have thought about them in a certain way for an extended period of time, that doesn’t mean that they are necessarily true. While in rehab, I was actually told a lot of other things that turned out to have no basis in scientific evidence. For example, I was told on a daily basis that “a drug is a drug is a drug.” This mentality doesn’t allow for there being a difference between, for example, the powerful opiate fentanyl, which kills thousands of people every year, and buprenorphene (Suboxone) which is a widely-accepted treatment for opioid use disorder.

I have come to believe that an uncompromising “abstinence-only” model is a holdover from the very beginnings of the recovery movement, almost 100 years ago, and our understanding has greatly evolved since then. The concepts of addiction and recovery that made sense in 1935, when Alcoholics Anonymous was founded, and which have been carried on by tradition, might not still hold true in the modern age of neurochemistry and functional MRIs. That said, mutual help groups today do have a place in some people’s recovery and they can encourage the work of changing and maintaining change.

Recovery may improve resiliency to new addictions

It seems as if no one definitively knows the answer about whether people substitute addictions. According to the National Institute on Drug Abuse in response to a request for comment from the website Tonic: “A previous substance use disorder is a risk factor for future development of substance use disorder (SUD),” but “It is also possible that someone who once had an SUD but doesn’t currently have one has a balance of risk and protective genetic and environmental factors that could allow for alcohol consumption without developing an AUD [alcohol use disorder].”

One study published in JAMA in 2014 showed that, “As compared with those who do not recover from an SUD, people who recover have less than half the risk of developing a new SUD. Contrary to clinical lore, achieving remission does not typically lead to drug substitution, but rather is associated with a lower risk of new SUD onset.”

The authors of this study suggest that factors such as “coping strategies, skills, and motivation of individuals who recover from an SUD may protect them from the onset of a new SUD.” In other words, by making the life-affirming transition from addicted to recovered, we gain a recovery “toolbox” that helps us navigate life’s challenges and stresses in a much healthier way. We learn to connect with people, push our egos aside, and to ask for help if we need it. Thus, when faced with stressful situations that formerly would trigger us to drink or drug, we might respond by exercising or calling a friend, rather than using a substance. As such, we substitute addictions with healthier activities that perform the function that the drink or drug used to, albeit in a much more fulfilling way.

This issue is also, partly, a question of semantics, and of how narrowly or widely we define addictions. Many hold that an addiction can be to either a substance or a process: gambling, eating, video game playing, Internet use, sex, work, religion, exercise, or compulsive spending. Lots of people gain weight when they quit smoking. Is that a case of substituting an addiction? I like to joke that, in my observations, the only reliable outcome from a stay at rehab was a nicotine addiction, because many people, in an attempt to cope with the trauma and dislocation of being sent away to rehab, pick up cigarettes.

People grow and change

Personally, I am skeptical that many people substitute addictions. In my experience, people who are addicted tend to have a particular affinity for a particular class of drug, not for all drugs and alcohol. This is probably based on some combination of their neurochemistry and their psychological makeup. I was addicted to opiates, but didn’t have difficulties with substances in other classes. I have seen this to mostly be the case with thousands of my brothers and sisters in recovery who I have had the honor to interact with. People continue to add to their coping skills toolbox throughout life, so the unhappy 18-year-old who is struggling is not the well-adjusted 50-year-old who has worked through many of their problems, or who has improved their life circumstances. Vulnerabilities can improve over time. People aren’t static, which is what reminds us to never give up hope when dealing with an addicted loved one, no matter how dire the circumstances appear to be.

Comments:

  1. Lance Watson

    I found this article extremely relevant to my circumstances and personal experience. I live in the UK and am finally in a stable recovery following a nightmare 27 year heroin addiction.
    The UK, in my opinion, has a completely inadequate and outdated model for recovery. There is just one treatment centre that uses an alternative to the 12 step program and even this I believe uses an ineffective program. The statistics speak for themselves as the percentage for a successful recovery is painfully low.
    I spent many years desperately looking for help, spending a fortune of my families money in the process. Sadly the help on offer and the help i received often provoked my addiction as opposed to helping it.
    Reflecting on my experience and the advice I received is now totally mind blowing and I’m surprised I’m alive to write this post.
    I finally managed to get clean doing a fairly rapid brupenorphine detox which I followed with a 9 month ONeil Naltrexone Implant. This without doubt saved my life. With the safety of the implant I was able to focus on CBT and to slowly integrate back into society.
    I have tried NA and A.A. and although it does seem to work for some people I found that those people actually became dependant on the fellowship. They would become distant from the world beyond the fellowship and even started to speak a language only used within the fellowship. The fellowship I believe almost brainwashes you into believing that once an addict always an addict and that complete abstinence in the only path to recovery. I was told within NA that if I did not adhere to the guidelines of the fellowship that I would relapse and only those who follow the program 100% would find recovery. To me that is a fear based program.
    I cannot speak for the USA but the whole system within the UK needs a massive overhaul. You can no longer get a Naltrexone implant in the UK and addicts are being forced to travel to Eastern Europe. I myself became victim to a £10,000.00 Naltrexone scam in Belgrade where they inserted a fake implant which I still have in my belly today.
    I am hoping to become involved in setting up clinics within the UK and would welcome any feedback, thoughts and comments.

  2. Sharan Binning

    Thanks Peter for your wonderful insight. I have met many people who were addicted to alcohol when they were young but they do not go close to it in their old age days, maybe cause they’re afraid they’ll be addicted to it again.
    There are some changes going on even in the legal system, for example the recent legalization of Marijuana in Canada.

  3. Nicolas Ruf

    “. I was addicted to opiates, but didn’t have difficulties with substances in other classes. I have seen this to mostly be the case with thousands of my brothers and sisters in recovery who I have had the honor to interact with.” Do you mean that these thousands who have been addicted to one class of drug are now using, and have been using for an extended period of time, another class nonproblematically?
    Where on the continuum of addiction were they? I mean if we’re talking about a bunch of party boys/girls in their twenties who would probably meet DSM criteria for a SUD and who have ‘matured out’ and now drink socially, maybe. But if they’ve crossed the line (which I would define as having used against one’s will), I doubt it.
    Also, there is some research suggesting that some genes can code for vulnerability to certain drugs while others can be more general (addictive personality types).
    And also, if addiction begins with self-medication, then whatever fills the bill works, at least at first.

  4. José Nieto

    I recently read the article “The Opioid Diaries” on Time Magazine. I am an eye doctor from Spain who did some training in the US. I injured my knee while living in the States and had surgery. I had absolutely no pain during my recovery, but still, I was given a prescription for Oxycodone. I can understand how opioid adiction can grow from pills to heroin injection in some individuals.
    It is not easy and very uncommon to get a prescription for these drugs in Europe. I think changes in that respect in the US could help the next generation.

    J.Nieto
    Barcelona

  5. Drew Edwards

    From beginning this piece you were citing the power of non scientific folklore and tradition and you transition to end with personal opinion. The new science studying phenotypical changes genetic transcription errors and neuroadaptation that usurp the brain’s reward and anti reward system reward system. Plus the discovery that inhibition of the N methyl D aspartate system mediate depression, plus, central hormonal deficits e.g., Oxytocin, are opening a new broader understanding of reward deficiency, including addictive disease, hedonic overeating, depression, PTSD, ADHD, and the finding that up to 30% of US adults are dopamine deficient. Why? Unknot, polymorphisms occur at greater frequency than previously thought. And, yes I have seen and treated the “Accidental Addict” who managed to get through High School and College, experimenting with alcohol and MJ and left it alone, only to have her 1st Percocet from an injury at age 37 and became addicted almost instantly. Patent Centered, Individualized Care is where we should be going, Until then, we can only do what the best available evidence tells us and what works for most–not outliers

  6. Drew Edwards

    It’ important to not use the term “Cannabis” generically when describing the benefits or risk associated with THC or CBD. Why? Δ⁹-tetrahydrocannabinol (THC)—is the most commonly used psychoactive drug (behind alcohol). And should be called marijuana, not cannabis because Cannabis Sativa also contains Cannabidiol (CBD). an abundant but not psychoactive constituent. The endocanabinoid system (EC) includes CB1 and CB2 receptors. THC primarily exerts it’s effect CB-1 receptors which are most prevalent in the prefrontal cortex, left ventral striatum, hippocampus, amygdala, basal ganglia, and cerebellum. These brain regions undergo prominent developmental changes throughout childhood and myelination during adolescence, and thus may be particularly susceptible to the adverse cognitive effects of marijuana. Adolescents who use marijuana regularly have increased volumes in the cerebellum, possibly from failure to prune synapses effectively. These adolescent marijuana users also show increased brain processing effort on fMRI during an inhibition tasks and task performance, even after 28 days of abstinence. Now loss of 6-8 points of IQ has been established. Taken together, there is compelling evidence that chronic increases in stimulation of the brain’s cannabinoid system can lead to morphologic and physiologic changes especially during adolescence. So stating that cannabis offers neuroprotection or is a treatment for epilepsy is misleading the public. Head to head-double blind placebo controlled studies comparing to THC and CBD, are needed. Epolidex is a CBD product with no THC, yet I hear weekly that Cannabis is proven to treat seizures, assuming that means marijuana. Thank you for your posts.

    • Peter Grinspoon, MD

      Much of what you stated in your post is contested. For example, the study that purported to show a 6-8 point IQ drop was roundly debunked as this drop was entirely explained by socioeconomic factors that the authors neglected to factor in.

  7. Bob

    If a person is abusing and the abusing is leading to negative outcomes then abstinence will form part of the solution. But if the person is no longer abusing and is therefore not producing any negative outcomes then does abstinence still form part of the solution? That seems to be the 6 million dollar question that individuals must answer for themselves based on their ability to predict outcomes. This has been a very honest and stretching discussion and makes me think of a person who walks along a brick fence 2 feet wide with a half mile drop off the side. If you do this walk you will need to possess confidence and knowledge before hand. Very enjoyable read. Thank you.

  8. RG

    Although the bulk of your article has no relevance to my situation, the last sentence was the one that struck me most “……never give up hope when dealing with an addicted loved one, no matter how dire the circumstances appear to be”.
    We are parents of an alcoholic son who is a serial relapser (20+ times) and has been in numerous rehabs (15+) in various countries with different approaches to recovery, but none of them have managed to get him to surrender himself to the basic fact of his alcoholism. Regardless of the suggestions for recovery he maintains a resistance to proven methods, as if to leave the door to relapse available, and opens it frequently, with ever worsening results. After 13 years of this its hard to maintain hope when no avenues appear to remain. It seems from where we are looking that addiction DOES last a lifetime.

    • Ali

      I’m so sorry for your pain. As an addict not using, let me just say that he will not respond to any treatment until he is ready to do so. Period. No matter how many times you put him in rehab, it simply will not work. He will need to hit bottom and then figure out who he is and what he wants to do about it! Keep loving him, but stop the rehab!

      • Rosemary Marchitell

        I have worked in the field of addictions for 30 years and we used to think a person had to reach bottom but research and practical application tells us otherwise. Interventions do work, calling in a professional interventionist can make the world of difference. In the past an individual’s bottom was often prison or death and through evidence based programing we recognize that paradigm change. One does not have to hit bottom. Good Luck. Rosemary

    • Peter Grinspoon, MD

      I’m sorry to hear of your struggles, and those of your son. Don’t give up on him! Have you tried medications? Vivitrol? A modern scientific team with recovery coaches, therapists, doctors who are up to date on the latest research? That might be a lot more effective than rehab…

    • Bob

      You might want to look at this area of investigation to see what is going on in the brain at a physiological and chemical level. I understand that this group gets good results and long term outcomes including recommendations for the carer.

      http://pnpcenter.com/

    • Patrick Doyle

      I don’t see mention of any support/professional help for the parents. While supportive families are known to be a powerful ally and assist to a loved one with SUD, they are seldom helped or brought in to help the treatment team. Families receiving professional guidance/support with Family Opioid Coaching report a great deal of benefit; promoting recoveries for both the Family as well as the Identified Patient. Either way; get support for yourself as well as your son. Recovery is possible.

  9. Thomas E. Camfield

    I partially agree with Dr. Grinspoon on having an affinity for one class of drug. Switching addictions is the common term thrown around addiction/recovery circles. I myself have abused every substance that alters a persons perception of reality. Hopping from one substance to another is not necessarily the brain looking for the ultimate high but could be explained as simply no longer having access to a particular substance or diminishing returns from a growing tolerance. The Dr. is correct in that there is no one size fits all recovery template. Every person is in a constant state of change and every drug is not the same and has different effects on people through there lifetime. My brother asked me a question that if i had the answer it would be the epiphany of epiphanies. He asked “ Why do you Always have to be on something?”’ Maybe this should be the starting point in any recovery program. I have heard an old saying that the body craves what it needs , so if this holds true for the body then it must for the brain. I agree with the Dr. that the old model of addictive personality is woefully inadequate to adress addictions . My thinking is that people are treating themselves for a reason. Finding the reason incorporates every aspect of the patient. I am just wondering if the chemical structure of the brain is altered during traumatic experiences to the point where the individual requires a substance to alleviate the imbalance.

  10. Maletta Pfeiffer

    I agree with Philip Bettin. I have been sober for almost 30 years.However I do not feel it warrants any congratulations since that seems to miss the point. For me the reward of sobriety is that I now have a meaningful life that I carefully guard.
    I can understand the frustration among the professional experts on how to fix addiction since relapse is the hallmark of SUD. I do question the motive when a medical doctor who is himself in recovery uses his professional authority to claim it may be safe to return to drink or use again. Are you completely honest with yourself?
    I have met enough people who were sober for over two decades only to die withing a short span of time after relapsing. Why risk it when
    the stakes are so high? As a friend o mine said, ” even if I could safely
    return to drink I love my sober life ” .

    • Jeff t.

      Thank you…

    • Peter Grinspoon, MD

      The point of the article was, at least in part, about asking hard questions, and examining whether there actually is ANY basis for doing what we have been doing for almost 100 years, and whether things can be improved. There is so much folklore and misinformation in the recovery treatment world that it is essential for all of us to question our assumptions. I’ve seen the misinformation kill people e.g. around medication assisted treatment for opioid use disorder. If a definitive study came out that showed that people who practice abstinence for life lived longer and did better, I’d be thrilled to have this complex issue resolved.

      • Peter Barclay

        An interesting subject! I’ve been sober for over 32 years and sometimes I have wondered why alcohol became my drug of choice and not say marijuana or something harder. I know that pills were never an option for me because my mother died of emphysema. By the end of her life she was taking a huge array of pills and if she got them wrong all hell would break loose. I know she had emphysema but I believe, from a young age, it became established in my mind that pills equaled death, so I wouldn’t touch them. It’s often said that the AA program is ‘a simple program for complicated people’. In academic circles at least it might be easy to dismiss its sayings and methods as kinda folksy maybe or a little twee at times. The point I want to make here is that, the program comes with a kind of inverse logic that seems to trap minds like mine into accepting what is screamingly obvious to others. I think its a great thing that psychologists and medical minds keeping working in this field so, Dr Grinspoon, I say keep hunting. As for me you may have noticed that I’ve tried to avoid the real issue of SUD’s although, in my roundabout way, I hope I’ve touched on it. You know, until Netflix came along, I never knew there was anything else I could become addicted to!

      • Peter Grinspoon, MD

        Thanks for your thoughts! Good luck with the Netflix addiction!

  11. Alice Pastorius

    I am in my 41st year of recovery from alcohol. Other substances aren’t a problem, because I didn’t use them. Why would I? I knew I was addicted to alcohol for 10 years before I joined a fellowship of recovering alcoholics where I got sober. At the time that was all that was available. Treatment centers only opened when insurance companies were required to pay for treatment.
    As for substitute addictions…you betcha…sugar and shopping both of which I seem to have modulated. I quit smoking 22 years ago.
    The only mind altering substance I’ve taken was muscle relaxers for a bad back, and I don’t plan on taking anything else. Why would I? Why would I risk my recovery for something that means nothing to me today.

  12. Rick

    Call your sponsor you are in the middle of a relapse!

    • Peter Grinspoon, MD

      What sponsor?? I’ve literally never had a sponsor except when I was forced to have a temporary sponsor during my 90 days of forced rehab in a 12-step program!! (I’m not a 12-step person, though I have lots of friends who are who I support and respect…). The beauty of it is that there are many different paths to recovery.

  13. Dianne McKay

    I am interested in knowing what the author thinks about a genetic relationship to alcohol or drug addiction. I’ve met people who excuse a relative’s addiction on family genetics, e.g., he didn’t have a chance with alcoholism on both sides of the family.

    • Peter Grinspoon, MD

      There is definitely a large genetic component to addiction, though that doesn’t “excuse” or not excuse an addiction, as it is a disease, and not a moral failing, and it doesn’t deserves or trigger blame. Perhaps it partially EXPLAINS a vulnerability to addiction, along with other factors such as anxiety or depression, or childhood trauma…

      • Barbara Lesko

        You wrote: “The point of the article was, at least in part, about asking hard questions, and examining whether there actually is ANY basis for doing what we have been doing for almost 100 years”. You seem to present the following statement as an unquestionable fact: “addiction is a disease, and not a moral failing”. I am wondering if this an opinion, and if it too is subject to hard questions. Or has it been proven scientifically and does it have universal acceptance of the scientific community?

      • Peter Grinspoon, MD

        I don’t think that ANYTHING has universal acceptance in the scientific community but, yes, virtually all addiction specialists, scientists and doctors, who are trained in modern science, and up to date on the literature, understand that much of addiction has to do with changes in the reward system of the brain of a chemical nature. That is not to say that other factors such as anxiety, depression, childhood trauma, etc., aren’t critical as well, but, just as we understand diabetes to be a medical disease, we also understand addiction to be a medical disease.

  14. Barbie

    I have been in recovery for 24 years, abstinent from all drugs and alcohol. I am a proud member of A.A. and also have worked in the field of substance abuse for the last 15 years as a substance abuse counselor. I personally would not encourage anyone to substitute. I like to use the analogy that substituting one drug for another is like changing seats on the titanic. More than likely you are going down sooner or later. Addiction is not something to be played with. I always encourage total abstinence.

    • Peter Grinspoon, MD

      That is a point of view that many, many people share. Others would counter that drugs are very different, and that people grow and change over time, and can shed some/much of their vulnerability. Addictions are known to resolve without any treatment at all in a large percentage of people, these are just not the cases we hear about.

  15. guitarsandmore805

    I remember quite specifically when the Vietnam war ended there was no longer a reason for me to be angry, no longer a reason to protest. I stopped smoking pot, put down the wine, went back to college and got a degree. I stayed sober for about 12 years and fell off the wagon once when I fell in love with a beautiful, smart, well educated, fun woman who had the same interests as me. Her only fault was she snorted cocaine every day. Dating her for two years was fun but damaged my life severely and so I gave up the woman and the cocaine. It CAN be done. I have no cravings today 30 years later.

  16. David L Kaus

    I have been working in the arena of addictions for 30 years as a CAP& LMHC. Was raised by an alcoholic Father & my first wife was the same. This is a question I hear often from the user as well as the family members . My best answer is each person must HONESTLY decide if it must be total abstinence or a return to social use. Cocaiane & other drugs are not for recreational use. If you can live without than do so. And go to meetings of some kind.
    Truly a good article, thank you.

    • Peter Grinspoon, MD

      Thank you for connecting and sharing your thoughts. (One qualm: people have been using “cocaine and other drugs” for recreational use since the dawn of human history, literally, whatever humans could get their hands on, often alcohol, in virtually every society that we know about, so many argue that altering our consciousness is part of our nature…)

  17. Jocelyn Allgood

    Having over 27 years if sobriety from alcohol, marijuana, cocaine and shrooms. Through one 21 day rehab stay. Holding two master degrees pre sober and post sober, I understand your points. I do believe I have an addictive personality and have substituted healthier options for that bring me the same focus and mind quietness that came from alcohol and drugs. Not sure about different classes of drugs not bothering me as much as those of choice..(mostly all) I have seen many changes in views in AA and do not agree that an alcoholic can ever use alcohol safely. As a progressive disorder, all those who tell me they picked up after years of sobriety go way over the edge and are lucky to return having not killed themselves or anyone else.

    If it works, don’t fix it is my motto!

  18. Karen

    My ex husband was an alcoholic who would stay sober for a year or nine months and then decide it was ok to drink again, because he was able to stop for the long period of time. It turns out he could have a drink and another and another and make me crazy. He should never have another drink again in his life, but he will, he can’t help it. The good news is I don’t have to watch. We’re divorced because of his certainty that he could control his drinking.

  19. Sophia

    As the mother of a recovering addict, I have seen the relapses that come with addiction. Been to too many of his peers funerals. My son went to a good rehab with addiction specialist medical doctors. The mid brain defect that predisposes one to addiction will always be there. I think this opinion of yours may work for you, but is very dangerous public advice.

    • Peter Grinspoon, MD

      Thank you for sharing your thoughts. I wasn’t giving advice as much as starting a discussion. I’m just not sure that it’s true that “the mid brain defect that predisposes one to addiction will always be there.” For six months– definitely. Five years — probably. But, thirty years later? I just don’t think we know, because a lot of our addiction science is brand new…

  20. Bill

    Dr. Pete – great article! My dad (a 3 pack a day guy) did the same thing as “Bob’s” father (wow what willpower! – I unfortunately am still a casual smoker – is there such a thing?) after a long battle with opiate use for pain control I’ve been a methadone user for years for the same reason – addicted… I hate that word -dependent certainly (because of other medical issues I would have to do a hospital supervised stay to quit) – but very controlled – same level dosage for many years and it does help control my pain – I’m way beyond any “buzz” or risks of getting “high” – my wish is that there would be more research for chronic pain folks and the govt/politicians would remember there are legitimate people with real pain issue for which these types of medication do work – don’t throw the baby out with the bath water – help those that get addicted but remember us that are beyond “addiction” we are dependent on these medications to lead fulfilling, productive lives. I work, I own businesses, I pay my taxes….. please remember me and the thousands of others in this same spot!

    • Peter Grinspoon, MD

      Agree! It is a complex discussion, addicted vs. dependent, and it’s true that if our government creates a crisis in untreated chronic pain by over-aggressively hounding doctors to not prescribe opiates, then they have just traded one crisis for another…

  21. T. Gulbransen

    Self-esteem very often seems [to my layperson view] to be the genesis of addictions. The thread above helps separate the lifelong role of self-esteem from substances’ physiochemical properties. Self-esteem may create the initial demand for mood-altering substances. The substance’s physiochemical properties then act in synergy with self-esteem. They can alter mood it in a healthy, albeit addictive way, e.g. endorphins from exercise or other public service altruism. Or substances can overtake one’s physiochemical controls. I agree with Dr Grinspoon that, while there may be lifelong behavior patterns, they alone do not indicate that all substances will be overwhelmingly addictive. Thank God for those who found clearer choices for how to alter moods.

  22. james stepsr

    One requirement for sustained and expanded healing from recovery for the individual addict is subjective possession of self-knowledge about the prospect of one day returning to an ability to use intoxicants ‘recreationally.’ Hard won wisdom on that point is readily available, especially to anyone with legitimate experience in the recovery community.

    • Peter Grinspoon, MD

      Thank you! (Our society is steeped in drugs and alcohol and, yes, anyone in recovery has to reckon with this difficult issue…)

      • james stepsr

        From a scientific perspective, methodological fallibilism is not usefully open for consideration, aside from its pedagogical utility. i.e. no scientific proposition is immune to revisions.
        But from a recovery community perspective, this question is not at all open for debate, which any serious look at its vast body of democratically approved, experientially established literature would show, much less any query of 5-10 addicts with more than two years clean who regularly participate in their recovery with other addicts.
        This isn’t the forum, obviously, but I concur the author sounds like they are sort of ‘intellectualizing some cravings’, plain and simple.
        Sincerely apologize for being abrupt. I recommend discussing this confidentially with a few people who’s judgment you trust that have more clean time than you, and who maintains and grow their recovery.
        love, wisdom, quietude and courage be with you; this moment, today and in coming days

      • Peter Grinspoon, MD

        This would represent one end of the spectrum I described in the article; we are trying to make the field of addiction more evidence-based than “query of 5-10 addicts”! Though, I greatly appreciate your input and opinion.

  23. Eric B

    While the thought of using something you may have been addicted to or using it’s a close cousin to increase a happy moment, take the edge off or relax in normal life sounds appealing I think the risk outweighs the benefit if you’ve had a problem with addiction to anything. Furthermore, and the real topic and what a 12 Step program is about is that if you’ve tapped into a personal, conscious contact with a spiritual power and have helped others along your journey and enlarged our spiritual capacity and capacity to love, why would you want to risk it or quit participating in a 12 step program. I think people that have found a way out of the destruction of addiction and now that it’s better to think the program is no longer appealing are short on sight. Lack of logic with a sub-conscious agenda; blind spots exist for everyone. Tune into the frequency of the God of your choice; the God/spirit that is within and you will find your truth if you are truly seeking the truth. Much easier said than done but a pathway to true and lasting peace of mind; which what every human seeks. We are spiritual beings having a spiritual experience. To deny this is a rough path for sure.
    Good luck to all.

  24. Lorie Eber

    I think this is a very interesting subject and definitely worth exploring. I know people who struggle forever, but others who seem to get past it. My guess is that the ones who substitute or revert are those who have not gotten to the underlying issue that causes the behavior. I agree with you, we should not just assume everyone is addicted forever.

  25. Monty Johnston

    Strange lack of distinction here between other-direction and inner-direction.

    Behaviors such as gambling, over- or under-eating, video game playing, Internet use, sex, work, religion, exercise, compulsive spending, etc., when done other-directedly, may well, for recoverING addicts, morph into bingeing, hang-overs, regret, failed swearing-off, increased tolerance, relationship damage, etc. Here we have weight training for chemical addiction.

    To not caution that other-directed “abstinence” can safely include addictogenic behaviors in someone with no serious inner-directed experience is dangerous and irresponsible.

    Sow, what?, is eveything “with no basis in scientific evidence” false? This article is a risky opinion piece.

    • Peter Grinspoon, MD

      Thank you for your interesting comments. I appreciate your concern and your opinion though I do believe that the addiction and recovery field has suffered incalculably form a lack of treatment “with no basis in scientific evidence” and am eager to see modern life saving treatments used uniformly in the addiction treatment industry and community.

      • Ger

        I could not agree more. Whilst I know many people in the recovery community, and once was a member of AA myself, I do not like the fact that it is unscientific. I was encouraged to label myself “an alcoholic” when actually there is no scientific definition. I have abused alcohol. I am fond of a few drinks. These days, I really enjoy max 6 units ( equivalent of 3 pints of 4.5% beer or half a bottle of up to 13.5% wine) in one 24 hr period. Mostly, once a week, sometimes in holiday periods, up to 3 times a week. My average consumption is about 2 drinks a week. Far cry from being “an alcoholic” and it really does help me enjoy a good social life with my friends – which is very important for overall health.

      • Peter Grinspoon, MD

        Thank you for your comment. I tend to agree with you, and think that our conceptualization of addiction needs to evolve. But, I have lots of smart friends that are on the other side of the fence, and I don’t think that any of us has cornered the marked on these complex issues!

      • Peter Grinspoon, MD

        Yours is not an uncommon experience…thanks for sharing your thoughts. Sometimes addictions “burn themselves out.” And, as I suggested in my article, the “abstinence for eternity” model is by no means scientifically proven.

      • Rick Fulton

        AA is not treatment it is self help. I have worked in the addiction field for 27 years. I have ran across people who moderated their drinking from previous exssive use. However I belive that is the exception and not the rule. I have been in AA for 32 years but by no means believe that AA is the only path to recovery.

      • Peter Grinspoon, MD

        Thank you for sharing your ideas; I agree that people have to find what works for them. The scientific data for AA is spotty at best, but many, many people swear by it…

  26. Terry Goldman

    Back around 1910, a physician wrote a book about narcotics, alcohol and smoking addictions. He found smoking to be a dangerous addiction leading to lung cancer. He also claimed that some people “aged out” of heroin addiction. If correct, this suggests an even more positive conclusion than presented here — the neurochemistry can change to get past the addictive condition. Now if we could only figure out how to actively change it, we would have real ‘cures’.

  27. David C Arndt, M.D.

    As a surgeon and long-time methamphetamine addict who is now in my 15th year of recovery, I found Dr. Grinspoon’s editorial to be of considerable interest.
    My use of “recreational” and mood-altering substances had catastrophic effects on my life and the lives of those around me. I cannot imagine a circumstance where I would find it prudent to use any mood-altering substance again.
    I suppose my question to Dr Grinspoon is: “Why would using anything after having struggled with a SUD be desirable?”. If dinner without a glass of wine feels difficult, perhaps this is a sign that one’s recovery is not a solid as one might have thought. If this is the case, perhaps the solution is not to find a way to justify drinking the wine…

    • Holly Attutis

      I agree with everything you are saying…

    • Carla

      Thanks for the comment, Dr. Arndt. My brother started at a young age with drinking, went through rehab for alcoholism but fell later for cocaine and opiods, a wide range of drugs. Multiple rehabs did not help. Only at 50 when his underlying dual diagnosis was treated and he had a stay in jail has he been able to stay sober. He says it is not worth the risk, and “denial is not just a river in Egypt.”

    • Etta elliott

      I am now 83 years old! I have had an anxiety disorder most of my life, which the Drs treated with zanex for many years. Then they changed it to clonipen years ago, and now generic brand called clonazepam 1mg. which works well. But I don’t like the idea of being addicted to anything. I kicked my addiction to pain meds years ago which I was given for arthritis. I did not know for a long time that the pain meds, or the zanex was addictive. The dr. Writes my prescription for 3per day of clonazepam now, however, I have never taken but one half pill nightly. Recently I decided to quit that, but easier said than done. I have been cutting back for some time and making one third of one pill do me each night. I can’t seem to completely quit it!! Could you someone please suggest something off that I can replace the clonazepam with? Thanks!

      • A N

        Dear Etta,

        I have experienced similar problems as you, but on a smaller scale. Last year, I started meditating twice a day, with the help of a trained teacher. I also see a therapist. I also signed up for yoga and fitness classes. A few months ago, I was able to let go of the anxiety meds. It was not easy, and I have had some bad days in terms of how I feel. Overall, I feel less lost. Good luck!

    • Ger

      It is not that dinner without a glass of wine is difficult. For some of us, we have dinner maybe 5 nights a week without a glass of wine. But we may like to enjoy a glass or two over a special occasion dinner, without going over the top with it! I am so glad I tried that again, many years into my so called “recovery”. It makes life more enjoyable for me.

    • Peter Grinspoon, MD

      Hi David! (our fathers were classmates in medial school…). That’s the whole point: some people find it difficult to enjoy that glass of wine, and others don’t. Obviously, if you have any difficulty, you should avoid it like the plague. But, in fact, many (most?) people don’t have trouble, decades later, using, say, a drug that is much less addictive than meth (e.g. cannabis) in an entirely different class of substances. The people in this category wouldn’t necessarily need to fall into the “abstinence for eternity” category. In rehab, they teach that “a drug is a drug is a drug” but, as you know, that is mindless nonsense…in any case, congrats on your recovery!!!

    • Peter Grinspoon, MD

      Hi David! (our fathers were classmates in medial school…). Thanks for your comments. That’s the whole point: some people will find it difficult to enjoy that glass of wine, and others won’t. Obviously, if you have any difficulty, you should avoid it like the plague. But, in fact, many (most?) people don’t have trouble, decades later, using, say, a drug that is much less addictive than meth (e.g. cannabis) in an entirely different class of substances (e.g broadly speaking, a downer vs. an upper). The people in this category wouldn’t necessarily need to fall into the “abstinence for eternity” category. I believe that concept was never evidence-based in the first place, came from AA in the 1930’s, and may well be out-dated. In rehab, they teach that “a drug is a drug is a drug” but, as you know, that is mindless nonsense. In any case, congrats on your recovery!! I’m really happy for you.

  28. Bob Shoemaker

    I have but one experience and that was my father. He was heavily addicted to tobacco all of his adult life. Sometimes 3 packs or more per day. When he was in his early 60s he was at Mayo clinic He was told that he needed to cut down his smoking. He and my mother were driving home. As they crossed a bridge over the Mississippi River he opened the car window and through a cigarette butt out. He said, “I cannot ‘cut down’ but I can quit”. He did. That was the last butt he ever had to dispose of. Returning home “No smoking” signs went up in the front hall of their house and in his car. Never having smoked my self I took that cue and posted “no smoking” signs in my office. Dad quit –period. Sadly it was a little late. He died as a result of lung cancer about ten years later. My children, his grandchildren, are non-smokers as are their families.

    • Peter Grinspoon, MD

      That’s a fantastic story; thanks’s for sharing. A lot of people find it easier to just quit than to just cut down…

    • David

      I quit smoking as a 40 year old after smoking for 25 years. The interesting part of my story was I quit smoking during my time as a marketing representative of a leading tobacco firm. Considering I had free cigarettes/tobacco at my disposal, tells me anyone can do it particularly today with the cost associated with smoking. I resigned from the company some 6 months later as I couldn’t promote something I never believed in myself. I just wish weight loss was as easy!

  29. Stephen C Row

    I lost three family members to addiction – my mother to alcohol, one sister to alcohol and cigarettes (She died from COPD) and another from a combination of pills and alcohol. I stopped drinking 33 years ago, nine months after my mother died. I stopped relatively early – as a young child (8 – 15 years old), watching my mother go through DT’s (three times), hallucinations, convulsions, and physical and emotional abuse of all of us children and my father – I didn’t need to experience these things to know that my own drinking, if I continued, would probably lead to these terrible extremes. Of course I never talked about this while a student at Harvard. I also found rowing – a very healthy “addiction” – helped me overcome my own depression, hypomania and ADHD. For me, the question has never entered whether I can imbibe in a glass of wine now and then. I don’t even want to consider it. I too often watched my mom try a glass of wine at a family celebration only to relapse into full-blown alcoholism and be carted off on Christmas eve to detox, wake up in the morning as a child to a house filled with shattered dishes, blood, Christmas trees in the front yard, neighbors gossiping about mom’s running half naked through their yard, etc., etc. I am not religious about this abstinence; it’s just a risk I choose not to take. And for what? Is the pleasure of a glass of wine worth the hassle and risk? For me, NO!

    • Peter Grinspoon, MD

      Congrats on your recovery! I can see how, if it runs so deeply in your family, that it makes sense to not even consider opening Pandora’s box!

    • Ger

      You sound like an immensely strong person, and you are ver definite in your decision not to risk addiction. I completely understand why and would agree with that – the risk would be so horrendous I cannot imagine enjoying any substance you feel would take you down that very sad and difficult road. Well done on your choices – they make perfect sense.

    • Peter Grinspoon, MD

      Sounds like you’ve figured out what works for you, which is what is most important of all!

  30. phillip Bettin

    If you have a primary SUD with certain drug, why would anybody want to role the dice that they won’t develop an addiction to another one, or that use of another drug won’t lead then back to their “drug of choice”. It would seem prudent to refrain from all mood altering chemicals. I’m sober over 36 years. Headed for a12 step meeting right now. Phil 😊

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