Today's question is on if it's a good idea to try and switch your addiction to a less harmful one.
I am curious about substituting one drug for another milder one. I had a bout with cocaine, won it, then did a round with meth and was lucky to just about escape it by going for an early detox. I have a friend who got clean of an early heroin habit (snorting) and now swears that his salvation is pot. He seems to function pretty well. I have another friend who my take is he is addicted to pot and he doesn't function that well at all but that may be him and not the pot. I have still another friend who did coke a lot and now medicates with porn. A woman I know went from smack to ecstasy. (We're all mostly in a music circle, by the way, so drugs are all around us.) I've read about moderation management and it could be that this is their form of moderation management. Me, I think a couple of beers and a toke or so are helpful to me as I no longer seem to crave the heavier stuff. Most of us are now in our mid thirties and have a sense that our habits won't get worse and may taper off with age. So, are we deluding ourselves? Am I deluding myself, or are we on some natural moderation management path and shouldn't worry about it? I am making a living and am functional myself and am not doing any programs. - Ted
John C. Norcross: Dear Curious Ted, here’s what we can say with clinical and scientific certainty: Some folks can successfully moderate their addictions, and some folks cannot, requiring abstinence. Some folks can replace a serious substance addiction with a milder substance and function well, but many others cannot. Most substance addictions do taper off with age, but many addicts never make it to later years because of early deaths and the health ravages of their addictions.
You beautifully capture the dilemma of every substance abuser and treatment professional: In this particular case, is this safe moderation or is this massive rationalization? A natural course of recovery or delusional denial?
Four guidelines can help you differentiate between the two.
1. Level of functioning: Glad to hear that you are making a living and functioning well. Would you function substantially better without those few beers and an occasional toke? For those functioning well, moderation may be the sensible path. But for those who try to moderate and continue to struggle, abstinence is the preferred route.
2. Others’ observations: Addiction robs us of clear thinking and accurate self-awareness, so our appraisals need to be strengthened with observations from other, unbiased people. What would good friends, mental health professionals, and coworkers (not heavily involved in drugs themselves) say about your current use and functioning? Please do not rely entirely on your own analysis; obtain some feedback from trustworthy sources.
3. Intensity of craving and use: This is an obvious defining point. If you hanker constantly for the substance and your life revolves around it, then moderation, at least at this point, is contraindicated. But if the beers are indeed occasional and unnecessary, then moderation is indeed possible.
4. Defensiveness: A cardinal feature of active addiction is defensiveness about the topic, the substances, and their consequences. How openly and honestly one can discuss these topics marks a line between those caught in denial and minimization, on the one hand, and those aware of various healing paths, on the other. I am impressed that you are asking these important questions about addiction and recovery; that’s a favorable sign for moderation management, as long as it does not deteriorate into an intellectual defense.
So, Ted, take a fearless inventory of your functioning, request that trustworthy people offer their observations, gauge the intensity of your cravings, and determine your level of openness. Those answers will assist you in determining whether moderation management can work for you.
John C. Norcross, PhD, is the author of the critically acclaimed book Changeology as well as co-writer or editor of 19 other books. He is Distinguished Professor of Psychology at the University of Scranton and Adjunct Professor of Psychiatry at SUNY Upstate Medical University. His ideas have been incorporated into addiction treatment by many therapists. Full Bio.