Reader Mailbag: What Does it Mean to Be Totally Abstinent from Drugs...

Reader Mailbag: What Does it Mean to Be Totally Abstinent from Drugs and Alcohol?

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A reader writes in and asks:

I think the artical is great in it’s basic message. However, the 100% total abstinence is a bit confusing. I know that alcohol, crack, weed, meth, heroin etc. are all major parts of the zero tolerance policy. But what about caffeine and nicotine? I know a lot old timers who still smoke and drink gallons of coffee and these are mood and mind altering drugs….

Very good point, and potentially very confusing to the newcomer in recovery.

This also brings up the question of whether or not prescription medications are “allowed” in recovery or not.

So let’s take a look at the two implied questions here and see if we can get some clarity.

First question: What does it mean to be 100 percent abstinent from all mood and mind altering substances? What does it mean to be totally clean and sober from all drugs?

Answer: My experience is simply this (and I am sure some will disagree, so take this for what it is worth, just my own personal experience), that mood and mind altering substances generally do NOT include caffeine or nicotine, but does include alcohol, illegal drugs, and any prescriptive drugs that are potentially addictive and/or habit forming.

So the first problem with this explanation is that some people will be outraged at the fact that I do NOT include caffeine and nicotine in my definition of “mood and mind altering substances.” People argue this all the time and they do have a point, because cigarettes kill an awful lot of people and it is certainly an addictive drug. You could also argue that cigarettes do, in fact, medicate our moods.

However, when it comes to alcohol and other addictive drugs such as heroin, cocaine, or prescription painkillers or prescription anxiety medications, my experience is that caffeine and nicotine are not in the same league as more addictive substances.

Why not?

It’s very simple. The reason is because once you have achieved total abstinence, taking a drink of alcohol or getting high on marijuana or cocaine or opiates DOES reactivate your addiction. Those substances send you “off to the races.”

On the other hand, if your drug of choice is alcohol, or say prescription painkillers, and you sober up for a few weeks and then you suddenly drink a big cup of coffee, guess what? Nothing happens! You don’t go crazy and suddenly start craving your drug of choice.

Same thing with cigarettes or nicotine. Take a puff from a cigarette, and guess what? You do NOT suddenly start craving alcohol, opiates, or whatever your real drug of choice happens to be.

Caffeine and nicotine do NOT reactivate your primary addiction. Yes, nicotine can be deadly, potentially more deadly than some of these other, “harsher” drugs. I realize this. I know this. However, smoking a cigarette does not lead you back to alcohol (if that is your drug of choice) or to opiates (if that was your drug of choice).

On the other hand, certain drugs and substances DO lead people back to their drug of choice. These would include substances such as:

* Alcohol.
* Marijuana.
* Cocaine.
* Heroin.
* LSD, mushrooms, and other hallucinogens.
* Opiate drugs such as vicodin, oxycontin, oxycodone, percocet, ultram, tramadol, percodan, lorecet, lortab, morphine, dilaudid, and so on.
* Tranquilizer type drugs, AKA benzodiazepines such as valium, librium, xanax, klonipin, ativan, etc.

This is not a comprehensive list but if you call up a few drug rehabs and ask them for a list of forbidden medications for their detox clients you can get an even more complete list of what to avoid.

Regardless of what your drug of choice is, be it alcohol or other drugs, taking ANY of these substances could potential “reactivate” your addiction, even if you have been clean and sober for a long time.

Notice that caffeine and nicotine, while potentially dangerous, do not actually “reactivate” a drug or alcohol addiction like these other substances can.

So when I talk about someone being “totally abstinent from all drugs and alcohol” what I am generally referring to is this list up above. I am NOT talking about caffeine and nicotine, even though I fully realize that cigarettes can be just as deadly in some cases as other drugs.

I personally smoked cigarettes for the first few years of my recovery and I also used caffeine quite a bit. Since then I have quit cigarettes entirely and have been off of them for several years now. But I continue to use moderate amounts of caffeine, though I have experimented at times with going off of caffeine entirely for up to a year or so, then going back on it. There seems to be debate about how healthy or bad for you caffeine is, there is a lot of evidence lately and studies that back up the idea that the positives for daily caffeine may outweigh any potential negatives. In my opinion this is not a huge issue either way though because caffeine does not lead me back to my drug of choice.

Now this bring us to question number two: Are prescription drugs allowed in recovery?

Answer: This is a very tricky subject because there have been instances in the 12 step program where people in AA or NA meetings have made blanket statements such as “You have to abstain from ALL drugs, period” and people in the meetings who were on prescription medications stopped taking them immediately without consulting their doctors first. In a few extreme cases this had very negative consequences and it has even cost some people their lives.

As such, our first piece of advice regarding prescription medications in recovery is that you need to:

1) Speak openly and honestly with your doctor FIRST, and inform them about your addiction, and ask them if they will help you to find the best medication for your situation, given that you are an addict.

2) Trust medical professionals before you trust individuals in 12 step meetings OR information on the web (including what you read here! Trust professionals rather than us!). Most of all, trust medical professionals who work in drug rehabs. For example, most doctors believe that a drug like Ultram or Tramadol is safe for drug addicts to take. People who work in rehabs KNOW that it is extremely dangerous for addicts and alcoholics, and that some people who come to rehab that is their drug of choice! When in doubt, seek medical professionals who work in the substance abuse field!

3) Always seek additional professional help if you feel that a doctor is not taking your addiction into account.

The fact is that there are some doctors out there who know NOTHING about drug and alcohol addiction. Seriously, you need to be aware that doctors do not have to be fully knowledgeable about drug addiction. They may actually be hurting you rather than helping you. And they may think you are crazy when you tell them that you are addicted to vicodin and you would like to explore alternatives like Torodol or Flexeril or whatever.

If this is the case then your doctor may actually be part of the problem. This is not to say that you should not trust doctors, because in the vast majority of cases you should seek professional advice and follow it as best you can. But if your doctor is prescribing ADDICTIVE medications and refuses to explore alternatives, then you might want to seek another professional opinion.

Manipulating doctors

Part of the problem in some cases is the idea that any medications that doctors prescribe for us are obviously OK for us, right?

So long as the doctor says we should have it, then we are free to take such drugs, right?


Doctors are not infallible, and patients can be manipulative. In fact, drug addicts and alcoholics in particular can “manufacture” pain and anxiety where no real pain or anxiety actually exists.

We addicts can do this almost subconsciously in order to manipulate doctors to prescribe us stronger medications. We manufacture pain and/or anxiety because we are actually drug-seeking.

Therefore, just because a doctor has prescribed us medicine does not mean that we should actually be taking that medication. Again, trust your medical professional before you trust a website, but at the same time, BE HONEST WITH YOURSELF. If you have manipulated the doctors and manufactured pain or anxiety then they are likely giving you more medication than what you should be getting.

What this means is that in the end we are our own doctors…..we are the ones who give the information to our doctors and then they try to do their best to help us.

For example, the doctor asks you “What is your pain like on a scale of one to ten?”

What do you think a heroin addict who is fiending for opiates is going to say to this question? I have asked that question to over a hundred different heroin addicts who were in withdrawal (in a detox center where I was a nurse aid) and they almost answer something like:

* “My pain is a ten! A ten I say!”
* “My pain? It’s an eleven.”
* “I’m hurting so bad I can’t think about numbers, I’m sorry.”

So you can see what the problem is. Drug addicts who self medicate with heroin or opiate drugs tend to manufacture pain, and alcoholics and other drug addicts tend to manufacture anxiety. This is how many alcoholics end up on dangerous anxiety medications such as Xanax or Klonipin. Their doctors ask them when they are in between bad bouts of drinking how they feel, and of course the alcoholic is anxious because they are not currently drinking or drunk at that moment while in the doctor’s office. So the doc tries to help as best he can and he prescribes anxiety medication such as valium or librium or ativan or whatever.

Then the alcoholic ends up taking these anxiety medications and eventually combining them WITH alcohol, which really does a dangerous number on their system. Then the person does the unthinkable and they stop drinking and they run out of their anxiety medication all at the same time, and their adrenaline system jumps into overdrive as they go into massive withdrawal and experience seizures.

This all comes about because the alcoholic is manufacturing anxiety, telling the medical professional that they are really nervous, when in fact they are just strung out on withdrawal because they had to get sober enough for a doctor visit.

So are addictive prescription medications EVER alright to take in recovery?

There are people in recovery who are going through extremely serious amounts of real pain. There are also some medical situations and procedures that simply have to involve certain amounts of powerful drugs or medications.

In other words, there is no way that EVERY recovering addict and alcoholic in this world can avoid addictive medications at all times during their recovery.

So yes, there are a few select instances when a person in recovery might have to take an addictive drug under the order of a medical professional.

However, this does not mean that you have a blanket excuse to go try to get your hands on any prescription drugs that you can and just go nuts. This is a sure path to relapse.

Instead, what you have to do is to be honest. Really honest. You have to be honest with the doctors and you have to be honest with yourself.

If the medical professionals are suggesting addictive medications for you, then you need to make sure that you communicate effectively and make sure that they know that you are a drug addict. Even if your addiction is to alcohol, you must realize that ALCOHOL IS A DRUG and that you are very much a drug addict (alcohol just happens to be your drug of choice).

I had a friend once who is an alcoholic and they said that they had to go on Vicodin at one point in order to medicate an injury. They sort of joked with me and said “I was not addicted to Vicodin, I just REALLY REALLY LIKED IT!”

Come on now, folks! I think the writing is on the wall for anyone who is in this sort of situation. A drug is a drug and alcohol is a drug and if we want to be vigilant in our recovery then we have to be extremely careful when it comes to prescription medications.

Another good example is from my days of attending AA and NA meetings. A long time sober dude from AA wandered into an NA meeting one day and said “I am starting over. I have been sober in AA for over fifteen years but I got hooked on painkillers recently and I realize now that this is real drug addiction.”

They have a saying in recovery: “A drug is a drug is a drug.”

Alcohol is a drug.

There are other substances and chemicals that could lead you astray in your recovery.

When in doubt, do not put it into your body.

When in doubt, consult medical professionals who WORK IN THE SUBSTANCE ABUSE INDUSTRY. So call up a drug rehab and ask to speak to their medical staff, say that you have a question for them. Generally such people will be glad to give you advice. If you are uncertain about a prescription drug then seek advice before you put it into your body. If they refuse to answer your question then simply call up a different rehab or addiction counseling center.

Ultimately what you put in your body is always up to you as the final decision can therefore YOU are your own doctor in the end, and you always have the final say.

As such, it is YOUR responsibility to find out what substances and chemicals are dangerous for addicts to ingest and which chemicals are safe.

If you have an extreme condition which requires addictive medications then you had better be very, very honest with the people who are prescribing the medicine, and you had also better be very sure that the doctor who is prescribing you addictive drugs has exhausted every alternative and is very aware of all the risks involved with you being a real drug addict or alcoholic.


If anyone has any other questions for the reader mailbag please feel free to email me via the contact tab up at the top of the page. We do not publish full names or email addresses so any questions are basically anonymous. We will do our best to answer any questions and to help you in any way that we can. Thanks!