The Question of Cross Addiction

By Bradley S. Caldwell, A.S., B.A., CATC II

    In a recent article entitled, Cross Addiction Isn’t Real (And Many Other Myths Your Counselor Told You), Adjunct Professor, Ian McLoone, of the University of Minnesota explains how the notion of cross-addiction has no merit in actual evidenced based research.  Cross Addiction is the belief that if you are addicted to one substance, there is high risk of you developing an addiction to another substance.   McLoone rightly points out that most people in recovery have been told by their counselors, sponsors, and friends that there is no  way a person once addicted to one substance can ever drink alcohol, smoke cannabis, or use narcotic medication safely.  Based upon my own experience as an addiction counselor, this is true.  For example, I know of many professionals in the field of recovery who would immediately consider an alcoholic’s use of an opioid pain medication to be a relapse.   The converse is also true; I have known many that would argue that a recovering heroin addict who drinks a beer to be a relapse.   Thus, the question remains for the person in recovery, is there such a thing as cross addiction or isn’t there?  In this short essay I will try and explore that question and hopefully provide some help to the person seeking to understand the truth of the matter.

  The controversy that sparked McLoone to write his article was the findings of a team of researchers at the Columbia University Medical Center in New York City.  The findings were published in the September 2014 issue of the peer reviewed scientific journal,  JAMA Psychiatry.  According to that research, the following comparison was made:

    “[T]wo groups of people: 1) adults who had a substance use disorder who overcame it and 2) adults who had a substance use disorder who did not overcome it. All participants were interviewed twice, three years apart.  After three years, those who overcame their original substance use disorder were about half as likely to develop a new substance disorder (13 percent developed a new addiction) as those who did not overcome their original substance disorder (27 percent developed a new addiction.)  One of the researchers, Mark Olfson, M.D., MPH, stated, “Because both groups had around three thousand people in them, we are confident in our results. “  Additionally, Olfson claimed, “The results overturn an old idea that when people give up an addiction they are at particularly high risk of picking up a new addiction.(Fletcher, Are You Really At Risk of Cross Addiction?, 2014).  

      Because of these findings, Olfson concluded that cross addiction is less likely in recovered people.  One researcher explained this by saying, “Coping strategies, skills, and motivation of individuals who remit from an SUD (Substance Use Disorder) may also protect them from the onset of a new SUD.  For example, people in recovery may avoid or better handle triggers for use and avoid drug- and alcohol-using peers (and dealers), which often lead to recurrences.”

      McLoone further points out that telling recovering addicts they are susceptible for cross addiction may do more harm than good, “Belief in this myth (i.e. cross-addiction) has kept potentially life-changing medications from being offered to people in recovery, or kept people in unnecessary amounts of pain because of the false belief that people in recovery from alcohol use disorder can’t safely take opioids.”   Interestingly enough, I have a colleague I worked with who was many years in recovery from alcohol abuse.  He had been working very successfully as a counselor at a local rehab here in Southern California.   At one point he severely injured his leg to the point he was in enough pain that his physician prescribed an opiate pain killer.  As luck would have it, the rehab was doing routine urinalysis testing of their employees.  My colleague told his supervisor that his test would be dirty due to his medication.  Regardless, the myth of cross addiction was so deeply embedded in the conscience of the management that my colleague was dismissed from his position.   I am still in touch with that colleague to this day and never did he develop an addiction to his medication.   Fortunately, he found another position soon after and is once again gainfully employed and doing well.

     In spite of there being no real scientific evidence to support the notion of cross-addiction, should counselors, therapists, or sponsors tell their clients to avoid using other substances for fear of cross addiction anyway?  After all, isn’t it better to be safe than sorry?  I would answer; this is not such a good idea.  Medical consumer advocate,  Anne Fletcher, author of, Inside Rehab: The Surprising Truth About Addiction Treatment—And How to Get Help That Works, mentions the story of Sarah H.   “Sarah never had any trouble with alcohol, despite serious problems with illicit drugs. After residential treatment for a crystal meth addiction, she said, “They scared me so much about alcohol that I was afraid to go into grocery stores. My dad had to go with me.” Two and a half years into her recovery she drank some alcohol. She then said to herself, “Oh well, I’ve done it now; I’m using, so I may as well use meth and keep using before they make me stop.” This led to a lengthy return to heavy drug use, including eventual heroin use.” (Fletcher, Ibid, 2014).  

  Based on the above brief analysis, it would seem that cross addiction is not only a myth, but could be a rather dangerous myth at that.  In spite of this, as a counselor, I can’t help but be concerned about the idea of my clients experimenting with other mood altering substances—especially in early recovery.  Intuitively, it just seems like a bad idea!  I agree with McLoone and others, and I believe we should be honest with our clients about the subject of cross addiction.  Nevertheless, I do have some concerns:  I work with a lot of heroin addicts.  Many of them tell me they have never had a problem with alcohol; regardless, I still advise against it.  Why?  Alcohol, by nature, has the effect of lowering the inhibitions of people who are intoxicated.   This is why some men historically have tried to ply women with alcohol in order to have their way with them.  We all know that when people are intoxicated, they will often agree to do things they otherwise wouldn’t in their right minds.  Obviously, for someone in recovery this could be catastrophic.   A person who is intoxicated by alcohol is more vulnerable to temptations they would normally resist.  When drunk, what seems like a bad idea sober can often sound like a great idea in the moment.   Secondly, neither of the two groups in the experiment at Columbia included the types of addicts I think would be the most vulnerable to cross addiction.   As you recall, the first group was people had already acquired the skills necessary to overcome an addiction to one substance.  Such knowledge would indeed provide some resiliency necessary to be cautious about using any other substance, as one of the researchers mentioned above.  But in the second control group, (the ones that were currently addicted and had not been successful overcoming their addiction), it would be unusual for an addict to give up his or her drug of choice in such a way as to become addicted to some other substance.   Addicts tend to stick with their favorite flavor of poison.  What the experiment really needed to demonstrate was whether an addict, deprived of their drug of choice, would not become addicted to some other substance if it were made available.  Without that variable, I do not believe we can dismiss the possibility of cross addiction entirely.

    Furthermore, part of recovery should be learning to cope with moods and emotions without having to rely on substances.  Many people with long term abstinence will tell you that real recovery is learning to ‘live life on life’s terms.’  We are not learning to do that when we are relying on substances to alter our experience of life.   Moreover, there is often much more to the addict’s problem then just their substance abuse, and abstinence alone does not solve these issues.   Many addicts are fraught with co-occurring disorders, dealing with past traumas, losses, etc.…  It can be nearly impossible to effectively address such issues if the client is still using substances that mask their affects.  For these reasons, encourage my clients to avoid using any intoxicating substances in early recovery (unless in absolutely necessary, as in the case of an injury).   In doing so, however, (for all the reasons mentioned above), I do not recommend this advice be given dishonestly.  The truth is we don’t know if cross addiction is actually “a thing”, so to warn them about it can only harm the credibility of our profession and confidence we need our client’s to have in us.  As professional counselors, we must remember the ethical and moral obligations we have to be honest with them.  

  In the end, I think it is clear that cross-addiction needs further investigation before we can dismiss it entirely.   Regardless, wisdom and common sense always need to synthesize with the scientific data.  Denial is still the number one problem people in early recovery are struggling with, and telling them it is no problem for an alcoholic to smoke marijuana, or a heroin addict to drink booze would be irresponsible.  But we need to be honest about how we go about it!

 

Three Important Considerations When Choosing a Drug Rehab

 

By

Bradley S. Caldwell, A.S., B.A., CATC III

Engaging in a program of recovery from substance abuse and addiction can often seem overwhelming to both the one struggling with addiction, and their family members.  Just finding the right help can be fraught with confusion and frustration.  Treatment is often expensive, and knowing just what you can expect from treatment is difficult to understand.  In fact, because the nature of substance abuse and addiction recovery necessarily entails human decision making, and despite whatever claims you may have heard on television or radio ads, there is really never any guarantee that you or your loved one will have the positive outcome you hoped for.  In light of this, what should you reasonably look for in a rehab when considering treatment?  As a California State Certified Addiction Treatment Counselor, I am often asked this question by people I meet.  Thus, to provide a comprehensive answer, I have put together the following list of the three most important components that I believe any effective treatment facility should include:   

  • Qualified counselors and therapists

 

This may seem like a “no-brainer,” but I actually know of clinics where the only people that are directly working with clients are interns.  While these interns may be overseen by licensed therapists or certified counselors, often no direct care is being provided to the client.   Of course, this doesn’t have to mean that the client is receiving poor or ineffective care, but it may mean that the client is not receiving the best care that is available for the money they are spending.  In my experience, good rehab facilities always provide direct care from licensed or certified staff members—even if it is being supplemented by care from interns. Moreover, drug addiction and alcoholism are deadly conditions; not getting competent treatment could have catastrophic consequences far beyond just the money lost on ineffective treatment stays.  Consequently, I always recommend to anyone thinking of going into treatment to make sure, up front, they will be receiving direct care from a licensed or certified professional.

 

  • Detox

 

If you or your loved one is going into treatment for the first time, more than likely a detoxification period will be necessary.  This is a very dangerous time for the alcoholic or addict; for example, sudden alcohol cessation can cause hallucinations, convulsions, and even heart seizure that may result in death. Additionally, the mental anguish of detoxing can lead to self-harm and even suicide.  While many residential rehabs offer medical detox, these facilities (often known as “detox houses”), do not actually have a fully trained medical staff on the property at all times.  Typically, these facilities subcontract to an off property physician that provides remote supervision, and if there is an employed staff nurse, he or she works out of an office that can be miles away from the detox house.  Moreover, such detox houses typically have little in the way of medical equipment and the on-property staff members have only limited medical training.  One facility I worked at actually had a patient go into seizure and pass away one night while waiting for an EMT to arrive!  This being the case, I have always recommended that if you plan to detox at a drug rehab facility, find out whether there is 24-hour medical staff and medical equipment on-sight.  If not, I recommend that your detox be done at a local hospital.  You can always then transfer to a rehab facility once your detox is completed.

 

  • Family Involvement

 

I really cannot over emphasize the importance of the non-using family members being involved in recovery.  It has been my experience, in working with both adolescents and adults, that without treating the enabler it is very unlikely that the user will have any long term success in recovery.  Uniquely, addiction is as much of a social condition as it is a medical and psychological condition.  There have been legions of studies done on the subject of addiction that demonstrate how addiction is, necessarily, a symbiotic social relationship between two or more people.  What this means is that wherever you find a “user” (i.e. someone abusing substances), there is a corresponding “enabler” (one or more people in the user’s life that makes it possible for he or she to continue using).  More often than not, the enabler is completely unaware of how their behavior is helping to perpetuate the user’s substance abuse.  In almost every case, the “enabling” is happening within the family dynamic.  Thus, I highly recommend finding a rehab that provides either private family sessions, or a comprehensive family process group, (or both).  (Note: the family component may be less important if the user is returning to treatment for a second or third time, or in an outpatient setting where family issues have been previously addressed in an in-patient treatment setting.  Regardless, the family members still need to be attending Al-Anon, or some other outside support group, as long as the addict remains a part of their lives.)  

 

Of course, there are many other things that may be considered as well, but in the interest of brevity, I have kept it to the most important three.  Hopefully, this article has been helpful and I invite any comments, questions, or feedback the reader might have.  

 

Overcoming Boredom in Early Recovery

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We all know that a considerable amount of time and energy must be put forth if one expects to maintain their sobriety! Sober Spot encourages everyone to make the absolute most of their time while in the early stages of recovery and we would like to give you our perspective on periods of boredom that, for many, often trigger a relapse. It’s essential to place more value on time and learn ways to making each moment memorable in recovery.

There is plenty to keep a recovering addict occupied during program hours, but what are they doing on their own time? Are they being productive? Are they engaging in healthy activities or are they sitting at home, bored and tired of the routine that they’ve been keeping?

The purpose for being productive in early recovery is not just to keep the recovering addict’s mind off of their drug of choice, but to truly open their minds to new possibilities and showing them that they are capable of living a wholesome life if they were to simply become more willing to experience new things!

Here is an activity guide for those of you who are struggling to fill your time with anything other than a drug. Your recovery depends on the energy you place on time and, of course, the people you surround yourself with as you go. We hope that you find value in this guide and that you try something new everyday! We’d like your feedback on what has worked for you!

Community Service  - There is great mutual benefit in volunteer work! Being of service to other people, and even animals, can make your days more meaningful. So, take your kind and compassionate soul out into the world and find a place where you can share your gifts and pass the time in a positive, uplifting way! It doesn’t take much but an open heart to pick up the phone and call your local animal or homeless shelter, hospital, church/fellowship or nature conservation center, and ask if they are currently accepting volunteers. Be a difference maker!

Gym & Fitness Groups - Find a gym that offers economical membership packages and join! Plenty of gyms not only offer equipment for individual workouts, but they usually have group rooms where a variety of classes are held at no extra charge. You can choose anything from aerobic and strength training to zumba and pilates, and more! Not only are you improving upon your physical health, but you’re doing it in a room full of people and have the perfect opportunity to make new friends.

Bookstores or Libraries - Take time browsing the shelves of your local library or bookstore. It is highly encouraged that you find inspirational literature that will uplift and keep you motivated in recovery. Find books that challenge your belief system and encourage you to explore your innermost self. To get you started, see if you can find a book titled “The Mindful Path to Self-Compassion: Freeing Yourself from Destructive Thoughts and Emotions” by Christopher Germer PhD.

Explore your Creativity - Visit your local craft store and find a DIY project that catches your eye! Use your imagination to draw, paint, or make a gift for someone special. Take a free jewelry class and proudly wear your handmade piece everywhere you go. Try calligraphy and make someone a beautiful birthday card with it or find a Ceramic Studio and see if they teach Raku, which is Japanese Pottery.

To those of you reading this, we wish you all the best in discovering ways to transform the boredom into fulfilling moments of joy, happiness, creativity and fun!


-ERICA B.












 

 


The Choice of Recovery

It is believed that a person cannot be helped unless they are ready, willing and determined to be helped. If you are the close friend or relative of someone with a drug or alcohol problem, you have probably already experienced rejection when you've reached out to help them. Although you have the best of intentions when offering that help, the addicted person may not be receptive to any such offerings until they are ready and willing to surrender their powerlessness over their addiction and start anew.


As a friend or relative, having patience and compassion will be the key to your well-being, as you may find yourself waiting, worrying and wondering if your loved one is going to consent to getting help for their problem. If they are willing to keep an open mind to treatment for their addiction, they have an excellent chance at successfully completing a program and sustaining sobriety. As a loved one, you must keep in mind that sobriety, first and foremost, is for one's own health, happiness and longevity. While in treatment, a person is encouraged to be mindful of their loved ones who may have been involved in their lives during the course of their addiction, but they are first encouraged to be mindful of themselves, their addiction, need for physical, emotional, and spiritual stability, and much more that comes from within.


While in treatment, your loved one is learning how to meet their own basic needs again. Some may be discovering for the first time what it is they truly desire - what they want their lives to really be about - what their plans for the future are, what dreams they have always had but have never taken the time to nurture, or simply couldn't because they were lost in their addiction. It is important to give your loved one enough space from which to grow and cultivate their newfound sobriety.


Recovery from any form of addiction requires a daily practice of self-determination, self-direction, and a lot of courage! Notice how your loved one, when given the space and power to choose, builds up pride in knowing that they are worth more than what they once believed, and that they are beginning to realize just how ready they are for the powerful transformation that comes with seeking help for their addiction.

-Erica Bedier

 

“Guiding Principles of Recovery” with Sober Spot

Each person’s recovery is unique and should be treated as such! SAMHSA (Substance Abuse & Mental Health Administration) defines recovery from alcohol and drug problems as a “process of change through which an individual achieves abstinence and improved health, wellness and quality of life.” They expand on this definition through the 12 Guiding Principles of Recovery.

 

The first principle suggests “there are many pathways to recovery”, to which we couldn’t agree more! As you aspire for long-term sobriety, please keep in mind that there are many wonderful options being made available to you through Sober Spot! We are determined to help you find the path that will best serve your needs while in recovery, and we do so with great enthusiasm and utmost faith in you! You will be encouraged to explore all the facets of your addiction which will ultimately open your mind to new thoughts, ideas and beliefs that will enhance your ability to choose a new path - a path of recovery.   

 

While there are many pathways to recovery, you can’t get to any of them without willingness! Keeping an open mind to different forms of therapy is essential for a successful recovery. Although new experiences generally make us feel uncomfortable, we have a greater chance at expanding our awareness, learning about ourselves and so much more simply because we worked through that discomfort. In order to sustain sobriety, a supportive environment is much needed; one that will foster your growth and praise you for whatever path toward recovery you choose!


 

  1. There are many pathways to recovery.

  2. Recovery is self-directed and empowering.

  3. Recovery involves a personal recognition of the need for change and transformation.

  4. Recovery is holistic.

  5. Recovery has cultural dimensions.

  6. Recovery exists on a continuum of improved health and wellness.

  7. Recovery is supported by peers and allies.

  8. Recovery emerges from hope and gratitude.

  9. Recovery involves a process of healing and self-redefinition.

  10. Recovery involves addressing discrimination and transcending shame and stigma.

  11. Recovery involves (re)joining and (re)building a life in the community.

  12. Recovery is a reality. It can, will, and does happen.

 

-Erica Bedier

Action – A Key to Recovery

Thomas Edison said “The successful person makes a habit of doing what the failing person doesn't like to do.”  Clancy I., an AA speaker with over 50 years of sobriety, boils recovery down to “One addict, talking to another addict to get him (or her) to take ACTIONS which they may not yet believe in.”

 

Recovery is hard work, there is no chapter in the big book titled “Into Thinking”, it is titled “Into Action”.  The steps aren’t called step “thinking” they are called step “WORK”.  And so when you come into the world of recovery, you will need to put forth some effort, to take some action, and … to have some faith.

 

Ahhhh, that word “faith”, for many it can be a scary thing.  Rest assured that it does not have to be.  In its simplest form, faith simply means believing in something you cannot see.  Surely, we all have faith.  We all breathe in air we cannot see, use electricity we cannot see and express and receive love we cannot see.  In recovery, you just will be asked to exercise your “faith muscle” in new ways.  It isn’t hard.  It isn’t going to hurt.  Nobody is going to force anything on you.  You will be given plenty of space and chances to form your own faith.  One that works for you.  Faith can simply be listening to people and doing things you would not have done before to get you out of the situation which brought you into recovery.

 

So, you need Faith and Action; but, sometimes individuals in early recovery can get comfortable, get “stuck”.  For many, they are clean for the first time in a long time with a place to live and a future with healthy prospects.  Action is frightening because it may mean change away from that comfortable spot. Any change may be viewed negatively.  People naturally start to resist action.  This may look like ;not wanting to go to a meeting, or not doing a chore, or not calling a sponsor, or not looking for work, or…….  The good news is, part of treatment in recovery is that you will have people guiding you and showing you what action means….to help you stay moving….to help you NOT get stuck.  Professionals that have been trained to lead you and people that have done it before.  These people are there to help set you on a lifelong journey free from the horrible anxiety, free from the depression, free from the lieing, free from running, free from the demons.

 

If you are contemplating recovery, take that leap.  IF you are willing to put forth the effort you will join the millions of individuals in recovery who have found a life that is TRULY happy, joyous and free.  

 

If you are in recovery and in a place where you find yourself “stuck” or “stagnant” or just dreading taking action, remember “It is easy to let up on the spiritual program of ACTION and rest on our laurels, WE ARE HEADED FOR TROUBLE IF WE DO.”  Get into action.  One small step is all that is needed.  Go for it!!!!

 

-Jim Joy

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“There are risks and costs to a program of action. But they are far less than the long-range risks and costs of comfortable inaction.” – John F. Kennedy

 

Willingness in Recovery

Have you experienced a time when you knew exactly what needed to be done to bring resolution in the midst of conflict? Did you know what to do but were not always willing to do it? More often than not, were you afraid of the outcome? Perhaps you were not willing to make people angry or hurt their feelings. Maybe you were not willing to take the first step, particularly if you wouldn’t see where that step would lead, or if you were afraid of where it might lead. The more entrenched you become in resistance, the further away you become from a state of willingness.

Willingness fosters and builds a courageous character. Willingness strengthens the connection between the physical mind and the divine or spiritual mind. Willingness may not make your life easier, but it just might make it easier for you to move through every experience that may confront you in life. Having the courage to speak your mind and tell the truth from a position of love rather than anger, being open to accept the views of others without feeling threatened, relinquishing the ego’s need to be in control by demonstrating the willingness to do whatever it takes to establish peace - all these types of willingness lead to growth! You grow in mental agility and spiritual fortitude.

While there are many pathways to recovery, it seems that one cannot get to any of them without willingness. In order to maintain successful sobriety, one must always keep an open mind. It is perhaps the only way to grow and make the most of life’s experiences! Enjoy this week’s positive affirmation and make it come true for you! To be WILLING is to be courageous!  

 

-Erica Bedier