This post had been sitting patiently in my brain since before the blog even started, and I’m finally getting to it. I’ve been working on it for a few weeks now. It’s a shorter post than when it started (I can hear the collective sigh of relief; don’t: It’s still a long one). I wanted to make sure I got this right. Addiction is a serious problem. But I think it is often misunderstood due to the not-even-once propaganda that surrounds discussions about substance use.
Fear mongering and abstinence-only education doesn’t work. It doesn’t stop teen pregnancies. It doesn’t stop the use of illegal substances. Instead, there should be a focus on teaching harm reduction, but that requires understanding that harmful factors can be reduced. Substance use is not a binary system in which someone is either clean or an addict. Responsible recreational use is possible.
The first thing we need to do is define addiction. Because of course we need to define things! Have you read this blog before?
Oh, you haven’t? Then that collective-sigh-of-relief joke was probably confusing for you.
I’m verbose.
Before we dive into this topic, a few points to get out of the way upfront.
Addiction Is Real and It Is Damaging
I want to be clear upfront that I am in no way suggesting that addiction isn’t real or that it isn’t life destroying. I have known people who have struggled with addiction. Two of them lost their lives to it. Others are currently successfully managing their addictions.
This is not a topic I take lightly.
But it is one I feel needs to be looked at logically and rationally, which we don’t often do in the United States. Our drug policies criminalize and demonize people with addictions rather than promoting empathy and pathway to actual recovery. Even our addiction-recovery policies and practices are awful and even predatory, as John Oliver covered on his Last Week Tonight segment about rehab.
Having an Addiction Versus Being an Addict
I’m very specifically using phrasing like “have an addiction” rather than calling someone an addict. Deficit language isn’t useful.
An addiction is a problem that potentially can be overcome. It is not a person’s identity.
I’m Not a Doctor nor an Addiction Expert
I’m someone who’s learned about a topic as it pertains to some other points of interest. As with many of my posts, I’m trying to reconcile what I’ve been told all my life against what I have experienced personally and learned on my own. Nothing in this post should be taken as medical advice.
Psychedelics and Addiction
Before we go any further, let me address psychedelics. Despite being listed as Schedule 1 (no currently accepted medical use and a high potential for abuse), psychedelics like LSD show no signs of having any addictive qualities. To quote this report, psychedelics “are generally considered physiologically safe and do not lead to dependence or addiction.”
Nor is there a known lethal dose.
In fact, psychedelics are sometimes called anti-addiction substances because people have gotten over addictions to other substances through the use of psychedelics like psilocybin, ibogaine, and ketamine. In fact, Bill Wilson, a cofounder of Alcoholics Anonymous, thought that LSD should be included in the AA program. But others in the AA program leadership didn’t like the idea of taking a substance to get over another substance.
This idea—that once you are addicted to one substance you need to avoid all other ones—persists today. I don’t agree with this concept, but I can’t get into my reasons in this post.
More research needs to be done on psychedelics as a treatment for addiction, and fortunately, MAPS is on it.
Now that psychedelics are covered (not addictive, and in fact could help cure addictions to other substances), from here on in, I’m not referring to them at all.
What Is Addiction?
This might surprise you, but today I am not turning to my beloved Merriam-Webster for a definition. I recently spent a lot of time running. While doing so, I listened to hours of the Duncan Trussell Family Hour with guests Jason Louv, Hamilton Morris, and Dr. Drew, all of whom helped inform some of the ideas herein. In fact, the definition I’m using is from Episode 133 with Dr. Drew who defines addiction around the 37:10 mark.
First, he says it is a spectrum disorder, from incipient to mild to severe to advanced to fatal.
Then he says, “It’s a biological disorder with a genetic basis. The hallmark is progressive use in the face of consequence—and by consequence it’s got to affect important sphere of the life: work, or school, finance, health, relationships, or legal status. And then denial. There has to be some degree of denial.”
(The Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition, [DSM 5] uses the term substance use disorders, which has different criteria to the above definition.)
This seems rather comprehensive. But it leaves out what I think is an important distinction to consider: There’s a difference between physical dependence on an exogenous substance and normal desire for an altered state, which in turn can develop into a psychological dependence.
Physical Dependence
Physical dependence occurs when the body adapts to a substance. This can lead to someone developing a tolerance to the substance and thus needing a larger dose to get the desired effect. It can also result in changes of internal chemical profiles and hormone production. If someone with a physical dependence stops taking the substance, they will experience withdrawal symptoms.
Any number of antianxiety meds or antidepressants (all prescription drugs, mind you) fit this bill. Getting off these drugs can require stepping down the dose across weeks. Without that step down, the withdrawal symptoms can be fatal.
Alcohol and opioid withdrawal can also be fatal, but that’s not common.
Not that fatal withdrawal symptoms are a requirement of being physically dependent on a substance. A good number of people have a solid caffeine dependence and soothe that craving daily, if not more so.
Psychological Dependence
Other substances, like MDMA and cocaine, show no sign of creating a physical dependence. Rather, these substances create a state that people find pleasurable. Humans, being the pleasure-seeking creatures we are, often gravitate toward wanting to be in pleasurable states.
Many of these substances have a subsequent crash either immediately after the experience (AKA the “comedown”) or the days that follow (which I refer to as the hangover)—or both!
Erin and I find hangovers are worse the deeper and harder we go in the experience, just like with alcohol. Keep the dosage on the light side, and it is completely avoidable for us. Have an all-night rager, and it’s going to hurt the next day.
To stave off the comedown, some people will feel compelled to take more of whatever substance they are on. Given the short high of cocaine, this could mean doing lines every 30 to 45 minutes throughout an evening.
And it doesn’t have to stop at one evening. Some drug binges can go on for days.
These experiences can cause shifts in brain chemistry, rewiring the dopamine receptors that are responsible for pleasure responses. Basically, the substances hijack your brain’s reward center to make the high a more rewarding stimuli than just about everything else.
Obviously, that’s bad.
Even though there is no physical dependency on a substance, there is psychological one because things that were rewarding before (food, sex, working out, checking things off a to-do list, etc.) no longer provoke enough of a dopamine response to feel rewarding.
The Double Whammy
Some substances do both. The substance itself creates a positive experience for the user, be it extra energy, a feeling of productivity and mental acumen, or actual pleasurable euphoria. The positive experience leads to continued use which develops into physical dependency and the psychological reconditioning.
But Neither Are Addictions
It’s worth noting that neither physical nor psychological dependence constitute an addiction. Remember that addiction is defined by progressive use in the face of consequence.
Wanting to purge the negativity of a shitty day by going out and having a few drinks doesn’t suggest an addiction to alcohol. Rather it points to understanding how to use an intoxicant to help unburden emotional distress.
Similarly, a desire to take a substance like MDMA to relax and enjoy time with friends does not indicate an addiction.
It might be possible for some people to self-monitor their own use of substances to avoid developing either dependence. This would require both setting time/dosage limits on each experience and taking sufficient time between experiences to return to a baseline.
What those time limits and gaps in experience need to be will vary from person to person. I’m sure there are people who don’t want to do the research nor risk the results of the research going poorly. I’m certainly not pushing that people try.
I take a cautious approach to trying new substances. I research threshold doses and side effects. We start low, go slow, and don’t take more than was planned beforehand. There isn’t a lot of information out there about the toxicity or addictive qualities of substances, but I learn what I can to mitigate any comedown effects and plan out time between experiments.
It at least feels like we’re being careful.
Can You Get Addicted From One Use?
Despite the propaganda, it seems rare for someone to become addicted or even dependent from a single experience. Even though this article starts out with the “all it takes is one time” fear mongering about heroin, note the two examples they use.
The first story is about a guy who was already addicted to prescription opioids before trying heroin. Of course he instantly switched to heroin. It’s an opioid. A cheaper and more potent one than the prescription pills to which he was already addicted.
In the second example, the “party girl” tries heroin, likes it, and it “becomes a regular thing.” She even says she was not mindful about her use to avoid addiction. By the time she realizes she has a physical dependency, it’s too late. She already has psychological dependency and cannot easily stop. But she didn’t become addicted or even develop her dependencies from one time. She became a regular user before self-assessing.
Even the article that one links to, the one they say is heavy on the biological details states the following:
“Many factors, both individual and environmental, influence whether a particular person who experiments with opioid drugs will continue taking them long enough to become dependent or addicted. For individuals who do continue, the opioids’ ability to provide intense feelings of pleasure is a critical reason.” [Emphasis added]
Right there in the science journal it says people need to continue to take opioids long enough to become dependent or addicted. So why would you start an article with “all it takes is one time” if that’s not what the science suggests?
Because of those “many factors, both individual and environmental [that] influence whether a person will continue to take them.”
Hooked but not Dependent
If someone is in a state where their normal life is full of fear, anxiety, or pain, the relief that one dose of a substance brings might be seductive. Our friend D who developed an addiction to prescription opioids was dealing with fear, shame, and anxiety around her sexuality due to her religious upbringing.
Her first exposure to opioids didn’t create a dependency. Rather it revealed that there was a substance she could take that would soothe her pain for a time, which developed into both a psychological and physical dependency, and over time, that became an addiction.
If she had no underlying desire to want the floaty numbness of opioids, would she have continued to seek out prescriptions? We’ll never know.
Hamilton Morris, the creator and director of the television series Hamilton’s Pharmacopeia, said in an interview on the Joe Rogan Experience podcast (Episode 1136, 55:04) that he’s tried heroin and doesn’t find it that interesting. I had a similar experience with Vicodin that I was prescribed years ago after I had surgery.
Despite how much I have enjoyed several substances, so far I’ve never had an experience that was so amazing that I immediately wanted to return to it (or continue in it for an extended time). And if Erin and I had such an experience, that would make us even more cautious about using that substance again.
Being able to self-regulate is paramount.
Set and Setting: Not Just for Psychedelics
I’m currently reading the book Getting Higher: The Manual of Psychedelic Ceremony by Julian Vayne, and I liked how these are defined:
“‘Set’ includes everything ‘within’ the (mind) set of the individual, their mood, expectations and memories of previous experiences. ‘Setting’ includes everything ‘without,’ from the immediate environment of the trip, the presence or not of other people, through to the broader cultural backdrop (which of course folds back into the ‘set’) of the experience.” (pg 11)
Psychedelic experiences feed off set and setting in a way not easily understood by someone who’s never had the experience. Substances like MDMA can create a mood that is pleasurable regardless of set and setting (although this isn’t always the case). As such, someone might not consider critically whether they are in a headspace that is conducive to taking a substance that will make them feel good. In fact, that could be the reason they want the experience in the first place.
And there is nothing wrong with that. As I said before, whether it’s alcohol or some other substance, desiring the experience is not indicative of unhealthy behavior.
However, someone who isn’t in a great space mentally or emotionally could be more susceptible to the seductive, potentially insidious, pleasurable quality of a particular drug experience.
I don’t mean just having a bad day. I mean someone who is suffering from depression or anxiety or going through a traumatic experience like a divource or the loss of a loved one.
Does Shane Have an Addiction?
Let’s break things down by the definition:
Genetic Basis—I can’t know this without specific genetic tests, but I don’t have a history of addiction in my family.
Progressive Use—We’ve added more substances to our repertoire over the years, mainly because every time we try something new, we’re shocked at how benign it is for us. That’s what we were warned against? But overall, our use of any single substance hasn’t progressed much.
In the Face of Consequences—I would have more money in my bank account if I weren’t buying illegal substances.
Or would I? LSD is a 16+ hour experience for $6 a tab. An entire evening of MDMA is about the cost of a movie ticket per person. The price of dinner at a high-end steak shop hooks me up with several months’ worth of cannabis. The way we use substances, it’s cheaper than going out.
And given the pandemic going on, it’s safer than going out, too.
The big risk I’m taking is legal. The smaller risk is health, but I test all my substances and study the research (as much research as there is) to avoid any potential health risk factors.
But it’s not a perfect world. I can’t control for everything. There are risks.
Denial—This one confounds me. Technically I’m denying I have an addiction, so yes, I have denial…. But I’m trying to prove it objectively…so is it denial? And, if I came to the conclusion that I have an addiction, I’m no longer in denial about it…so that means I don’t have an addiction?
Circular logic is circular.
Recreational Use, Not Addiction
I don’t believe Erin and I are addicted to any substance.
MDMA is our most regularly used illegal substance. We usually wait at least three weeks between experiences and sometimes go longer either for the purpose of letting ourselves recover more, because we can’t schedule the event and recovery time, or simply because we don’t think to do it.
We know what kind of experience we want (a light roll versus a heavy one), and we usually decide that together beforehand based on our mood or how connected we’re feeling. We’re experienced enough to decide in the moment if we need a little more to get to the right place. Our usage is fairly consistent. We haven’t developed a significant tolerance, and therefore we don’t need to keep adding progressively more.
We look forward to these experiences because they help us connect as a couple. As such, we often schedule rolls to coincide with other events like birthdays, Valentines, and our anniversary. For us, MDMA experiences are a form of date night. But instead of going out to a fancy restaurant, we stay home and cuddle.
Sometimes a planned MDMA roll falls through. Like the one we were supposed to have a few days ago. We went away to a cabin-in-the-woods vacation. We had the time and great setting for it. However, the crystals I got from my vendor are not MDMA (which is why you should always test your substances! I’ve ordered from this guy several times, and he’s always been spot on.), and the new supply didn’t arrive in time.
It was a little disappointing but no big deal. We’ll have other opportunities in the future. Neither of us are desperate for an MDMA experience. Because we don’t get desperate for these experiences.
The Addictive Personality
I don’t believe I have an addiction to any substances, but I have many of the traits of an addictive personality—but that list is pretty broad.
As an Enneagram Seven, I’m all about letting the good times roll. I’m always willing to escalate an evening. Give me a drink, I’m always down for another. Want to do MDMA? Absolutely! Let me get the drug box. Already rolling and you want to add ketamine? Sure, let’s give that a try!
Fortunately these are impulses I can manage by focusing on the “scientific” results of experimenting. I know better.
I also easily get obsessed with things. Enneagram-wise, this is in part due to Sevens (and me being an ADHD Seven at that!) always seeking out new stimulations. My Path of Integration is to Five, which means when I get interested in a thing I want to learn all about the thing.
Combine those two traits, and you have someone who throws all his time and effort into something, but potentially for only a short burst before moving onto something else to become obsessed over.
This is likely due to me getting a huge rush of dopamine from starting new things. The rush is so powerful, I am suddenly fully invested in whatever this new obsession is. But that dopamine response quickly fizzles, the new thing becomes boring, and so I seek something else to provoke another dopamine rush.
My brain is always seeking new thrills (AKA more dopamine).
And yet, so far, this hasn’t been a problem.
Is It Worth the Risk?
First off, for there to be worth, there must be a reward. Is there a reward to taking a substance?
Yes. For the most part, many substances create a pleasurable feeling for the user at the very least. Effects beyond that depend on the substance but can include better communication with loved ones and really enjoying music and neon colors at a level you never imagined.
Thought exercise: Think of a substance that is legal in the United States that has the sole purpose of being pleasurable. The only two I could come up with are alcohol and tobacco—I’ll argue that caffeine is also taken for productivity (and I’m not the only one)—and these are terrible for our health. And not even close to as pleasurable as any other substance I’ve tried.
Really hammers home the notion that substances are illegal not because of health risk but because the Puritanical Moral Authority doesn’t want us indulging in states of euphoria. How dare we enjoy our time on this bountiful and beautiful planet?
Anyway, enough of that. Onward!
Second, this question implies there is a risk. Or at least a significant risk. And to evaluate risk, we need to look at two things:
- How bad are the consequences?
- How likely are the consequences to happen?
I’ll address each in turn.
How Bad Is Addiction?
The consequences becoming addicted to a substance can be devastating. Addictions are fatal, and along the way, someone with an addiction can hurt many people around them, friends, family, and complete strangers.
However, addiction is progressive and usually forms after dependency and tolerance. By being mindful and allowing for days and weeks between experiences, I can self-assess if there is a physical or psychological dependency building.
Addiction being a progressive disease makes the consequences less severe than, say, unprotected sex, in which can result in STIs or a baby. Those are binary consequences. You can’t have a little chlamydia or be sort of pregnant. You’re all in on those.
How Likely Is Addiction?
We don’t know. It’s possible that my system of having weeks if not months between experiences makes becoming dependent and addicted impossible.
But it’s hard to find such information because research or anecdotes that don’t fit the “drugs patently and without exception have no value” and “you can get addicted from one use and ruin your life” narrative are viewed as reckless.
That even this blog post is justifying someone’s desire to take substances and will lead to an increase in addiction. And it will be my fault because I challenged the abstinence-only story.
It’s the same thing with abstinence-only sex policies: Those who promote it will outright lie about birth control methods and give ridiculous emotional and sexual health reasons as to why it’s bad to have multiple sex partners all to scare people into conforming to their mindset.
Or to use a more adult-oriented argument, people who cling to monogamy as a relationship style will bash consensual nonmonogamy with absurd statements about nonmonogamy being selfish, childish, and dangerous, leading to disease and divorce.
Do some couples who try consensual nonmonogamy end up getting divorced? Sure. There is a risk. But those stories shouldn’t be the only ones we hear about and judge the lifestyle on. With mindfulness and communication, those risks can be mitigated as is evidenced by the all of the amazing lifestyle podcasts and blogs out there.
That said, there are many people who are not, and will never be, in a good mental or emotional set and setting to have substance experiences without getting hooked to the pleasurable state substances can create and falling into a pattern that leads to dependence and addiction. Just as there are people who should never try nonmonogamy.
The Harm of Abstinence-Only Substance Education
As I said in the intro, this post is me trying to reconcile my experience and things I’ve learned against the bullshit that I was “taught” as a child.
I didn’t try cannabis until I was in my mid-20s. I only smoked it a few times throughout my 20s because I don’t find it that impressive a feeling. Which made me think, “This is what I was being warned against? I’m going to get addicted to feeling like this and get into more potent drugs to chase the high?” Bullshit!
That led me to question all the other info I had received about drugs, and as I experimented, I learned the rest of it was bullshit, too. So many of these substances have value even if that value is simply to have a pleasant, fun, relaxing evening.
Self-care matters! We’re allowed to have fun! Pleasure isn’t evil!
But therein lies the danger of abstinence-only policies: Once the lie is exposed, it can be easy to go down the rabbit hole. I was very methodical and cautious with my experimenting. Others might not be so careful.
Which is also the problem of the “one time and your addicted” lie: If someone tries a substance like heroin and doesn’t become dependent after a few uses, they might think they are immune or that the addictive nature of the substance was a lie. Without caution and mindfulness, dependencies can creep up and by the time they are noticed, it can be hard to get over them.
If You Have a Substance Dependence or an Addiction, Seek Help!
Substance dependence and addiction are progressive diseases and potentially fatal. The longer they go unchecked, the harder it will be to overcome them.
If you are a recreational substance user, add periods downtime of total sobriety and be mindful of how you feel during them. I even go off caffeine at times just to check myself. If you know you have a dependence on a substance, be cautious about your use. Monitor your dosage and note any developing tolerances.
Listen to your friends, family, and loved ones if they show concern over your usage. Be honest with yourself and others (those you can trust) about habits and usage. I have a friend who knows of my usage but rarely indulges with me so he’s not going to give me a pass on my usage because he’s in the same boat. He checks in on me, and I’ve promised that if he ever comes to me with concerns, I will take those concerns very seriously.
And if you decide you need help, find a reputable source. Sadly, treating addiction can be a money-making scheme, and there are a lot of people willing to prey off those who are in desperate need of help.
Stay safe and healthy, friends!