Can recovering drug addicts drink safely?

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CA Alcohol reading

Alcohol Card © Cocaine Anonymous 2014

In Narcotics Anonymous and Cocaine Anonymous meetings up and down the country tonight, members will read out literature warning those attending that drinking alcohol is a risk to their recoveries. This is not based on scientific study, but on the experience across decades of those following the 12-step programme.

When considered in the light of the neurobiological, learning and genetic evidence on addiction, this makes sense and those of us working with clients in recovery-oriented settings will have seen people become abstinent only to relapse to their drug of choice through alcohol or to go on to develop an alcohol problem. So can recovering drug addicts drink alcohol safely?

Opiates & Alcohol

In opioid replacement therapy populations between one in three and one in four patients are drinking more than safe limits, which has all of the negative health consequences, but is clearly also dangerous because of the risks inherent in mixing depressant drugs. For some folk abstinent from all opiates, there seems to be an ability to drink in recovery without getting into bother, but we don’t know anything about this group.

So we have experience, we have anecdote and we have a theoretical basis. What about evidence? Well, this is where we struggle to find guidance.

William White looks elsewhere to give some pointers on this in an old article from Counselor Magazine. As he says:

History promises us important lessons if we sit at her feet and listen carefully to her stories.

History the teacher

SynanonHe details the start of the Therapeutic Community movement (Synanon) when clients in treatment (generally recovering heroin addicts) could gain ‘drinking privileges’. It wasn’t that long ago in Scotland that a therapeutic community here did the same. So what?

The early policy of alcohol abstinence within Synanon was influenced by the history of its charismatic founder, Chuck Dederich. Dederich had used Alcoholics Anonymous (AA) to initiate his recovery from alcohol and Benzedrine addiction in the two years that preceded his split from AA and the creation of Synanon. Synanon maintained an alcohol abstinence policy until 1978 at which time alcohol was experimentally introduced first for board members and senior staff and then to others within the Synanon community.

Sounds progressive. So how did it go?

Alcohol problems grew within Synanon in the 1980s and contributed to Charles Dederich’s fall from grace and Synanon’s eventual implosion as an organization.

Okay, not so well then, but what about other organisations?

White reports the experiences in ‘Daytop’ a New York therapeutic community. This time there were safeguards: drinking was only permitted for those with no prior history of alcohol problems. They reasonably assumed that in this group the risk of dependence would be about the same in the general population (6-10%). They also had a policy of non-acceptance of intoxication.

So how did that go?

The first signs of problems with the alcohol policy within Daytop and other TCs followed a predictable two-stage pattern. The first stage was the appearance of drinking at social events within the TC community (e.g., staff parties) and at outside professional conferences that exceeded the bounds of social drinking and sparked other inappropriate behaviors. The second was the development of severe alcohol problems (or relapse back to heroin and other drugs while under the influence of alcohol) among some TC staff and graduates.

Estimates of risk

The prevalence of cross-addiction in the history of the TC is unknown. TC old-timer estimates of how many “ex-addicts” later got into trouble with alcohol range from the majority to less than 10%, but all of the TC elders interviewed for this article reported tragic stories of alcoholism-related deaths among early TC graduates.

White details some factors reported, but not evidenced, which might predict future problems:

1) A family history of alcohol problems,

2) A history of alcohol problems predating the emergence of another pattern of drug dependence,

3) Co-addiction to alcohol and other drugs prior to entry into treatment,

4) The presence of a co-occurring psychiatric illness,

5) A history of childhood victimization,

6) Later developmental trauma (e.g., loss via death or separation), and

7) Enmeshment in a heavy drinking social network.

When I apply these criteria to the people I typically work with, then there aren’t many left outside the fold.

The dilemma

Perhaps many or most (a question the scientists need to answer for us) people entering addiction treatment possess a lifelong vulnerability for addiction to a broad spectrum of substances (and experiences), while in others that vulnerability is transient or restricted to a particular drug or class of drugs.

So what should we say to clients?

We have a clinical responsibility to share warnings… at the same time, we have the responsibility to honestly acknowledge that there is much we do not know about these varied patterns of vulnerability and resilience. Lacking science, we need to offer explanatory models that help each client make personalized informed choices related to the whole spectrum of psychoactive drug use.

    9 Responses to "Can recovering drug addicts drink safely?"
    1. angusmcfangus says:

      Based on the evidence at the drug & alcohol service that I’m involved with, this cross-over pattern of behaviour affects around 75% of staff in recovery.
      Given these high % numbers it seems the recovery community continues to bury it’s head in the sand over this dilemma.

      • djmac says:

        Not sure I’m following you. You mean that 75% of staff in recovery identify cross addiction to opiates and alcohol as a past issue? Given that in the blog I mention that at least in NA and CA meetings it’s tackled head on, where’s the evidence for burying heads in sand?

        • angusmcfangus says:

          Sorry for not making myself clearer, I meant that around 75% of staff/volunteers and peer mentors within the organisation I’m involved with. Who have previously been addicted to opiates have gone on to experience problems with their alcohol use.
          Which due to the acceptance of social drinking, is not addressed within the organisation. Hence ‘burying their heads in the sand’.

    2. Ted says:

      When you say between one in three to one in four people in ORT drink more than is safe, is this as measured by the ‘hazardous’ scale of more than 3 units for men and 2 for women per day?

      • djmac says:

        In the study of almost 200 methadone patients attending primary care in Ireland, around a third were found to be positive on the AUDIT screening tool. In Taiwan the rate was much the same in 2011. Much earlier, authorities in the US took a look at what the literature said about’alcoholism’ in MMT populations and found the evidence suggested rates varying from 5-49%.

        Here’s a summary from Addiction Treatment Forum, albeit a bit old now:

        Alcohol drinking disorders have been estimated to affect from 50% [1,2,3] up to 70% [4] of all patients in methadone maintenance treatment (MMT) programs. This engenders various behavioral and psychosocial challenges potentially impacting response to treatment.

        1. Chatham L, Rown-Szal G, Joe GW, Brown BS, Simpson DD. Heavy drinking in a population of methadone maintained clients. J Stud Alcohol. 1995;56:417-422.

        2. Stine SM, Kosten TR. Methadone dose in the treatment of opiate dependence. Medscape Mental Health. 1997;2(11). Available online:http:www.medscape.com. Accessed: November 27, 1997.

        3. Methadone maintenance and patients in alcoholism treatment. Alcohol Alert. Washington, DC: National Institute on Alcohol Abuse and Alcoholism. August 1988;1. Available online at: http://www.niaaa.nih.gov/publications/aa01.htm. Accessed February 10, 1998.

        4. Miller S. The Integration of Pharmacological and Nonpharmacological Treatments in Drug/Alcohol Addictions. New York, NY; Haworth Medical Press: 1997.

    3. Dirtdealer says:

      I have worked in the drug and alcohol treatment field for about twenty years.
      I have observed an alarmingly high number of predominately male opiate users, receiving ORT in one form or another, repeatedly develop chronic alcohol use issues.
      I have often suspected that this transition was somehow accepted as ‘inevitable’ by the treatment service.
      The problem I continually saw was the swift removal of the ORT and an even swifter closure of the case.

      For what it’s worth, there ought to be some form of quantitive and qualitative assessment of this group of clients. I doubt that any of them developed their issues overnight, whilst their key worker was sound asleep.

    4. Paul says:

      Alcohol is an addictive substance. Why on earth would people with addiction problems want to use it ? Maybe because it’s legal & socially except able as well as altering a persons mood & feeling. Which is ultimately what addicts want.

      Another question might be – can alcoholics use drugs recreationally ? The other side of the coin, but not so different . They’re legal & socially unacceptable. Any research on that ? Might be interesting. Btw. there is a community rehab in Italy where residents stay for long periods & drink wine with there evening meal. Make an interesting study for this subject.

    5. Keith says:

      Was clean for two years…..threw it away been fucked up for ten-eleven months…..still got the girl I waited my life for to marry me…..she’s fed up ripped up our two month old marriage license last night. It began with a sip..

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