Dear Sober Lady,
After reading about someone with a sex addiction, I wanted to write in to ask if you take non-substance-related “addictions” less seriously than substance-related addictions. As someone who has been addicted to cocaine, it’s hard for me to imagine having that compulsion around anything other than a drug. But I recently had an experience that made me wonder if I’m being too judgmental about others’ addictions.
I’m five years clean from cocaine, but I still drink and smoke weed on occasion; I never felt like either of those was out of control for me, so despite advice from early NA meetings, I didn’t feel the need to quit. While out with a friend for drinks, I mentioned that I was sleepy and wanted to go home, and she said, “You know what’s good for that?” and mimicked snorting cocaine. I told her, “You know that I’ve been clean for 5 years,” and despite her being a nurse and a friend who I thought knew better, she said my problem wasn’t that big of a deal. I asked her why she thought that, and she said that if it was, I’d stop drinking too.
I went home immediately out of frustration. This isn’t the first time someone took my addiction lightly, but it is since I’ve gotten clean. Is there any truth to the idea that a “real” cocaine addiction also requires quitting drinking? What’s the best way to respond to these situations? And are all addictions equally serious?
Best,
Judged
Hi Judged,
Thanks for the question(s); I’m going to address your specific scenario as well as your broader question about the seriousness of other addictions, because both are important. Let’s start with the one about your friend’s assessment of your past cocaine use. No, there is no truth to the idea that having a cocaine addiction inherently means you also have a drinking problem or otherwise need to quit drinking. Put another way, just because you can use alcohol in moderation doesn’t mean that you can also use cocaine in moderation, as it sounds like you know from personal experience.
Do many people who develop one substance use disorder often quit using other substances because they’re worried about misusing them as well? Yes, all the time. Do some people with an addiction to one substance also have an addiction to another substance? You betcha. But none of this happens automatically or in the same way for everyone. Most importantly, you are not obligated to prove anything to anyone.
As for the best way to respond to these situations, I’m really tempted to say stop hanging out with people who minimize your past cocaine use and subsequent recovery by making casual “jokes” about how you should use again. But I don’t know your history with this person, and I’m sure your relationship is characterized by more than this one incident.
It’s up to you how you respond, but it’s crucial to understand that neither her nor anyone else’s opinion matters when it comes to the “seriousness” of your past cocaine use. You don’t need anyone’s permission to stop using a substance. If saving money or wanting to be less annoying at parties were your reasons, that would be good enough.
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You clearly got to a point where you feel like you needed to stop, and kudos to you for doing so. I don’t know what’s going on with your nurse friend, but I know she’s wrong from both a medical and a being-a-good-friend perspective. “I don’t want to” is all you should need to say. “I don’t do that anymore” also works.
Regarding your first question, I think you’re asking if compulsive behaviors that people often frame as addictions, like sex, food, shopping, video game use, and social media, are addictions in the same way that alcohol or cocaine addiction is.
It’s a fair question that requires a definition of addiction. We often think of addiction as a binary thing, something like cancer that you either have or don’t, and of which there can be different types and subtypes. That’s not true, and it’s why clinicians have moved from using words like “alcoholism” to alcohol use disorder. How a person uses a substance and the consequences of that use on their life are much better indicators of severity than just the specific substance or behavior in question. (For the sake of clarity, I call severe substance use disorders ‘addiction’ because using four words when I could use one is a bummer.)
Typically, substance addiction is characterized by chronic, compulsive use of a substance despite repeated negative consequences in one’s life. It’s not about the quantity of alcohol you put away, or even how often you drink. It’s about how preoccupied you are with drinking, if you want to stop drinking but can’t, if you prioritize drinking over important responsibilities, if you lie about your drinking for fear someone will suggest you stop, the list goes on.
These are exceedingly useful criteria and an excellent barometer for judging one’s relationship to many behaviors. From a strictly medical standpoint, the only behavioral addiction in the DSM-5— the manual clinicians use to diagnose mental health disorders—is gambling disorder. But things take a long time to find their way into the DSM. Years of study, debate, and academic jousting are required for a new condition to make it into this psychiatry bible. Nonetheless, the criteria it uses to diagnose substance use disorders and gambling disorder can be useful in understanding one’s relationship to behaviors that haven’t yet made the DSM cut.
Addiction severity isn’t determined by the substance used or behavior; it’s determined by the effect it’s having on a person’s life. If Bob routinely drinks more than intended and sometimes craves alcohol but doesn’t meet any of the other DSM criteria, he’s probably in a less serious situation than Jane, whose compulsive video game use resulted in being fired from her work, the loss of important personal relationships, and growing debt.
It doesn’t matter to me if the medical establishment formally calls something an “addiction”— doctors and, more likely, insurance companies can worry about that. But if using a substance or engaging in a certain behavior results in a person being plagued by obsessive thoughts, fighting debilitating cravings, abandoning loved ones and responsibilities, and an inability to stop, it is obviously harmful and requires help. Whether or not the world views a compulsion as a “real addiction” isn’t relevant; the impact it has on one’s life is.
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I love seeing a nuanced take on this - thank you, Katie. I feel like there are lots of people who, like me and this letter writer, had a capital-P problem with one substance (for me, it was opiates, today I am over 10 years clean!) but are able to take or leave the rest. Others cannot. There's no "right" way - only what helps the individual get and stay healthy and alive.
I’m recovering from a cocaine addiction. I realized after many relapses that I needed to stop using alcohol because when I drank it lowered my inhibitions which always led me back to cocaine. This confirms the statement that it doesn’t matter how often you drink or the quantity you drink but rather the consequences of your drinking. The consequences for me were cocaine relapses. The relapses ceased when I eliminated alcohol. I am now 33 years clean and sober