Ask an Expert: Is "A Drug is A Drug is A Drug" True?

By Debra Rothschild PhD 02/22/16

Our expert on whether addicts find all drugs just as addictive.

Ask an Expert: Is "A Drug is A Drug is A Drug" True?

I've asked this before, but not ever seen a substantive answer. I wonder about the meme: "a drug is a drug is a drug" ... since it clearly isn't true on the most basic level (different drugs accomplish different things in different ways), but one hears this in various 12-step rooms and from various recovery professionals... I wonder about the veracity of such a statement. For example, will a heroin addict necessarily be an alcoholic?

Debra Rothschild, PhD:

Dear Reader,

The word that catches my eye in your query is “necessarily” and I believe that is the basis of your very good question. No, it is not true that a heroin addict will necessarily become addicted to alcohol or that anyone addicted to one substance will automatically be addicted to all mood or mind altering substances. The reason so many professionals and 12-step members declare this with such certainty is that some people who are addicted to one substance easily become addicted to others and they feel that overuse or misuse of any substance is so dangerous, they would rather prevent that possibility by warning everyone away from trying anything else than take that risk. There are some people for whom sobriety is so painful any substance that changes how they feel will be compelling and if they stop using one which got them in trouble, they find another and often use that compulsively as well.  

All that said, this is only a subgroup of people who are addicted. Many people can be addicted to one substance and have no difficulty using others moderately and appropriately. I have many such people in my practice. Many people get in trouble with one substance but never drink to excess, either while using that substance or after they’ve stopped. For example, alcohol doesn’t compel them although opiates do. Some others may smoke weed once in a while and their misuse of another drug is completely independent of that. The notion that “a drug is a drug” not only misses the fact that different drugs have different effects, as you point out, but it also misses the very important element that addiction is about the person who is addicted, not about the substance or drug. The substance itself does not cause addiction. What creates overuse is the effect that substance has on the individual, and that effect is a psychological one and different for everyone. Somebody will overuse a drug if it feels so good, it feels right in some way; it helps them function in a way they cannot function without it. Of course, there are also genetic factors that make some people more vulnerable to becoming addicted, certain drugs are physically addicting, and all overuse creates neurological changes that can perpetuate use, but if that were all that mattered, relapse wouldn’t occur as frequently as it does and we wouldn’t have examples of people using in one environment and easily stopping when circumstances change (i.e., Viet Nam veterans and heroin use).   

I am happy you asked your question as I think it is such an important one. Because of the misbelief that anyone addicted to one thing will necessarily be addicted to all, family members and friends often become angry or scared if somebody who was addicted to one drug uses another, even if they use it appropriately. This is true even for people who always drank safely, even when they were using their drug. Such a phenomenon is not uncommon with users of opiates, crystal meth or other substances. In addition, it is hard for such people to find support like that which is offered in AA. They are not welcome in 12-step rooms which are based on a notion of total sobriety and yet they may be struggling to remain sober from the one drug they love best. Moderation Management meetings will accept people who are trying to stop using, say, heroin or cocaine or crystal meth but have never had trouble with alcohol, but the emphasis for most people in that group is moderating use.  There is no support group that I know of that accepts the fact that many people struggle with one substance and are simply not compelled by others. Individual therapists such as myself and many private programs, especially Harm Reduction ones, understand this notion and offer help for people who wish to stop using one substance and continue to use another occasionally, but for those who cannot afford private care, support can be hard to come by.  

I hope you find this answer substantive. The bottom line is, it is not true that heroin addicts necessarily become alcoholics. There are many, many former heroin addicts in the world right now who have been drinking socially and appropriately for years. Their existence is living proof that the meme “a drug is a drug is a drug” is simply not true.   

Debra Rothschild, PhD, is a psychologist and psychoanalyst in New York City. Full bio.

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