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!