he 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?<\/p>\n
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 \u201caddictive personalities,\u201d the answer is: absolutely not. This would be playing with fire.<\/p>\n
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\u2019s 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 \u2014 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 \u201ccross-addiction.\u201d<\/p>\n
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\u2019t 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 \u201ca drug is a drug is a drug.\u201d This mentality doesn\u2019t allow for there being a difference between, for example, the powerful opiate fentanyl, which kills thousands of people every year, and buprenorphine (Suboxone).<\/p>\n
I have come to believe that an uncompromising \u201cabstinence-only\u201d 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\u2019s recovery .<\/p>\n
It seems as if no one definitively knows the answer about whether people substitute addictions. According to the\u00a0National Institute on Drug Abuse<\/a>\u00a0in response to a request for comment from the website Tonic: \u201cA previous substance use disorder is a risk factor for future development of substance use disorder (SUD),\u201d but \u201cIt is also possible that someone who once had a SUD but doesn\u2019t 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].\u201d<\/p>\n