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Sobriety: A Complete Abstinence from Any Substance?

Sobriety and Substance Abstinence Illustration

Episode 35: Does Sobriety Mean Complete Abstinence from Using Any Substance?

Today’s question is an old one in the world of addiction. Does an individual need to abstain from all substances for recovery success? Are addictions to all substances connected, and is there some universal definition for “recovery” and staying “clean”?
Clare Waismann, RAS/SUDCC and David Livingston, LMFT discuss these questions, addressing the importance of understanding the dangers of labeling and stigmatizing when we talk about addiction and substance use.

Dwight Hurst, CMHC: Welcome back to a podcast to answer your questions on addiction recovery and mental health, by Waismann Method Opioid Treatment Specialists. I’m your co-host Dwight Hurst, and I’m joined, as always by Clare Waismann and David Livingston. I think this is going to be a really interesting discussion to have our question that we’re addressing today is do I need to abstain from all addictive substances to be clean? This would include what sometimes I’ve seen people call these soft addictions, which is an interesting we probably need to get into what that is. But things like use of caffeine or smoking is oftentimes what people are talking about when they say this, if I’m getting off of drugs or if an alcohol problem. Do I also need to be cleaned from other things? Or if I had a problem with painkillers, should I automatically assume that I should abstain from alcohol to be healthy and sober? This question comes up a lot, and there’s such a there’re very strong opinions and feelings people have on it. And so I, yeah, I’m excited to talk about it today and see what you guys think.

Clare Waismann, RAS/SUDCC: Well, I will start with the term to be clean, I think. That’s not a good term at all to be used. Um, and I think that’s where, you know, a lot of the confusion lies, um, because you are using a mood-altering substance doesn’t mean you’re a dirty person.

Dwight Hurst, CMHC: Aha. That’s a good point.

Clare Waismann, RAS/SUDCC: One of the major issues of the question is the word or the term “to be clean”. I think when somebody using a substance does not mean they’re dirty. It just means they’re using the substance. So the other issue that I see is when people use substances is what they’re using that for. What’s the goal? And it’s really important to understand that because when they come off that substance and they are fully detoxed, if they use other alternating substance, what is the reason they’re using it, then I think in life it’s really important, not what we do, but the reasons why we’re doing it. I think that’s much more important than the act itself. So if they are using, you know, mode alternating substance to, you know, self-medicate negative emotions, now there’s an issue. Yeah. And so, um again, it’s important to understand why they started using that substance in the first place and why they are using the other ones as well. But with that said, I’m going to let David get deep into it.

David Livingston, LMFT: Or before I go. Dwight, what are your thoughts on it?

Dwight Hurst, CMHC: I really like the clarification of terms. When we talk about that, I think that becomes a big problem. There almost becomes something so vague about the concept of clean versus. And I like what you say there, does that mean because we use the term “dirty”? Then if someone has that sounds like someone who’s taking a like a, you know, urinalysis test or something? Well, you were dirty, so you’re in trouble. So right away, we set up that paradigm, right? So I really like sort of looking at that. And saying, what is it about this term, there’s no such thing as like a magic status of clean or, for that matter, sober. We have to know what we’re talking about. I mean, I worked in a treatment facility once where my boss actually he even cautioned us about the term recovery. He said when people talk about being in recovery, he’s like, We need to make sure that everybody knows what they mean for their own healing from their own condition. And because once again, sometimes that became just an idea of Are you in recovery? Are you really in recovery? And is your recovery as good as my recovery? And it would get thrown around sometimes that we’d forget to stop and say, What the hell does “recovery” mean? What does that mean? You know, what are we? What is our goal for our health? And sometimes?

Clare Waismann, RAS/SUDCC: Well, that’s the whole point. Wouldn’t it be great if everybody could say, you know, I am proceeding with a healthier lifestyle, then saying, I’m in recovery? Such negative connections to those words, there’s such stigma to those words, you know, there are such expectations. So if people are just healthier and living a healthier style based on their specific needs instead of, you know, having to fall into this bubble, that doesn’t fit everybody. I think it would be easier for people to seek help and B to sustain it.

David Livingston, LMFT: It’s easy for any of us to overestimate or underestimate things. And I think that. You know, the evolution of treatment has been, in some ways, to get people’s attention. I also think there’s been generally a I think because maybe the way it first began to evolve through AA long time ago, there was a lot of denial and it wasn’t really talked about and written about. And so there was a kind of a confronting process that was initially meant to kind of push people out of the idea that everything was OK and, you know, and help them sort of really think about what was healthy or not healthy for them and strong words like addict and recovery and clean and so forth were brought into. And, you know, and sometimes being strong and confronted is what people need because they are, you know, they’re leaning to whatever ambivalence they have is leaning too far in one direction or another. And so and while there’s always ambivalence, right, there are people like things and don’t like things, often simultaneously, including whatever substance they might be struggling with, it’s far better to get to know both sides of it. And then really begin to sort of understand what is possible and what works. And and in my experience, people will tell you, like, have you ever had a problem with alcohol? No, I don’t really like it that much.

David Livingston, LMFT: I’ve, you know, I’ll have a beer and half the time I can’t even I don’t even finish the beer. And so no, but opioids, I can’t ever do. And I’m like, Yeah, you can’t ever do that again. But you know what, if you want to sit down and have a beer, you’ve never had a problem with it that ever led you to anything else or doing anything that you’re not comfortable with now. I don’t even like it that much, but every once in a while with a friend, I actually I’ll sit down and have one. I’m like, Then that’s fine. So it’s you really have to just people will tend to tell you if they’re, you know if they’re working on themselves legitimately, they’ll tell you what’s possible and what’s not. And they tend to know themselves pretty well. Usually, it is better to be cautious. I think in general, when because there are some gray areas as you move forward. But I agree, you know, I don’t like the terminology and like we talk about a lot on this podcast, everything. All of this has to get past far, far more than it does.

Dwight Hurst, CMHC: Yeah, it’s the discussion that you’re talking about. It popped in my head, as you were saying that people will tell you what they need. And I wonder how much of when we make a blanket statement about, Oh, you know, you need to cut every psychoactive substance out of your life. You need to, you know, if you ever had this problem, you that means you’ll eventually have this problem and you can’t ever drink a beer if you’ve ever had this problem for everyone. And when we try to paint with a broad brush, do you think that comes from the assumption that someone going through addiction treatment is like up to something or that they’re like trying to get away with something? I mean, I feel like sometimes it’s like we’re trying to assume that the person isn’t telling us the truth when they say what they want to work on.

Clare Waismann, RAS/SUDCC: And that’s something I think that’s part of why people think I’m sorry. I think that’s part of the stigma, you know, that, uh, those words and those terms are scary. And that’s why it’s so important for us to get away from them is they know there’s an assumption that a person that uses, you know, a mood-altering substance is a dishonest person. He’s going to lie is going to manipulate. I mean, there are so many things that come with it. And I believe also if there is a rule for keeping your sobriety that doesn’t fit somebody’s needs, you’re completely disregarding the person as a person. So she becomes just a condition and not a person anymore. And that’s a horrible place to be. And I think most people that we see and treat feel that way. They feel unheard, they feel unseen. Um, you know, in all people, when they look at them, they see the condition, Oh, he is an addict. He is suffering from addiction. But I think for us to get to a productive, you know, point in the addiction world, we’re going to have to start. Looking at the individual and, you know, making instead of assumptions, making rules that will fit and not even rules, you know, expecting what should be expected from that individual and not from a set of rules that was written by somebody, you know, 20 years ago.

David Livingston, LMFT: That understanding is the way to go like the whole idea of addictive thinking. Right? So when I think about it, I try to look what part of that is true. Ok, so someone is in a really compulsive place. You could say that they are in a state of addictive thinking because when people are in a really compulsive high anxiety kind of fight or flight reflex, they are in a compulsive state and then they are going to not be able to necessarily have context and executive functioning, working at the way they would be when they’re not in a compulsive state. So if that’s true for everybody, by the way, whether you, whether you suffer with substances or not, I mean, that’s true with sleep deprivation and other things that move people into that fight or flight state. So it’s a condition of the brain. But so so when you’re trying to figure out what’s healthy for somebody moving them into a place of understanding where they start to really begin to understand themselves and then then the what you want them to be able to feel is more relaxed.

David Livingston, LMFT: So the more compassionate, the easier they are on themselves in one way helps them relax and the less chance they’re going to go into an anxiety state. So if you push people and kind of tell them what to do or create while the idea is you’re creating a floor of sobriety and a floor that’s going to support them. That’s only true at times and only true to a certain extent. Ok. If it goes too far, it will have the opposite effect. So, so in. You know, in treatment, you’re constantly going back and forth, Oh, you slept well, OK, do more tonight or exercise more today. Oh, you didn’t sleep at all. Back off, don’t push yourself too much. So it’s this constant movement back and forth, and then this gets internalized by people. And so over time. So they then know how to treat themselves better and ultimately keep themselves in a healthier state, which is why the kind of black and white thinking is has some some validity at times, but is also really untrue at other times. Hmm.

Dwight Hurst, CMHC: Yeah, it’s interesting because by nature, a problem that has to do with compulsion and impulse control and addiction is a problem that sometimes our judgment is thrown off. And so that’s where I think there’s the old, the black and white thinking would be, don’t trust yourself because you have this problem and you can’t judge your own use of anything. And so it’s useful to get an outside perspective. But then on the other hand, that is not great advice because you have to ultimately trust yourself to some extent because you are the one that’s living your own life. And so it’s this fine line between don’t get cocky, kind of. I just want to hear you saying, like, don’t just say I can do whatever I want because you have had the person has been going through a problem, a health problem related to impulse control and related to addiction. So don’t over trust that I got this. But on the other hand, you do need to trust yourself to know what you need. So I guess, I mean, having a support system and real treatment professionals in your life, according to your needs is probably a pretty big part of this of evaluating this question for a person, right?

Clare Waismann, RAS/SUDCC: I think so as well. Uh, I I think absolutely, but it is really important to look at the issue as know, no physiological issue. What David was talking about the, you know, brain chemistry and not personality. So where the patient is or where the person is at that point on, you know, of stabilizing their brain chemistry also makes a difference of, you know, how able they are to make a decision of having a beer or you know how fragile they are of not being able to have something that will create or mimic that numbing device of the other substance. So different times in our lives, we are able to sustain a lot more than others. So, you know, we also see patients that at a moment that they had oral surgery and they start taking opioids was the same time as they were having, you know, they were going through a divorce and or they lost somebody. So that medication at that time became harmful for them, where if they took it in another time in their lives, you wouldn’t have been an issue they would have taken for their oral surgery and just, you know, put that behind them. So I think when we discussed, you know, can somebody that just came off a drug use another substance? It’s really important to know, you know, where they are physiologically and you know how strong they are or how able they are to make those decisions, you know, and being able to limit themselves if needed.

Dwight Hurst, CMHC: The old school way of looking at it in, like a lot of communities about recovery was to say get off alcohol, get off drugs. But you know, smoking was always kind of winked at kind of like, well, you know, you can’t get off of everything all at once. Does a soft addiction or whatever you want to call it? Is that just something society has said, Hey, this isn’t illegal, you know, or you’re not going to crash a car if you’re smoking too much? So. So somehow it’s OK, I guess, you know, what are what the determination for that? What do we think of the concept of a soft addiction?

Clare Waismann, RAS/SUDCC: I, I think I think mostly as society see it. I think, uh, when you smoke a cigaret or you have coffee, it doesn’t really compromise your ability to think or make decisions where if you drink a lot or if you have, you know, a lot of cocaine or opiates, it really. Enables you to make, you know, at least safe decisions for yourself. It puts you in a riskier space. You and everybody else around you. So I think that’s how, you know, society views it in, you know, select the softer directions in not so soft. It’s truly the ability to, um, make decisions, make healthy decisions.

David Livingston, LMFT: Yeah, it’s it’s I mean, we’re always putting chemicals in our body. We’re always, you know, even water is a chemical. It’s it’s so. Like you’re like you’re saying, I mean. You know, we all know the potential harmful effects of smoking, and for some people, coffee isn’t a big deal at all, and for other people, it can raise anxiety and other things and their body doesn’t do well with it. So and and and you know, in terms of some of the studies I’ve read about, some of the softer addictions is what they found with smoking. They used to think that don’t quit smoking when you’re if you’re coming off something else because it’s too much. But in the longer run, what they found and that could be true like in the short term. But in the longer run, what they found was that actually, if somebody quit smoking along with another substance, maybe they did much better overall because what happens is that the better we take care of ourselves, the more we want to continue to take care of ourselves. It creates a positive momentum. I think that positive sense of “I’m healthier and I want to stay healthier”, “I’m exercising, I’m doing these things.” It creates a sense of well-being and intends to sort of drive people in a healthier direction. And I think that’s the goal overall. You know? Look, and the other thing is, and this gets tricky because when you suggest this, people can take this way too far. But I talk to patients about this because often they when you talk about giving things up, they just look like I’ve been bad. And so I got to do this, I got to do that. 

David Livingston, LMFT: But but you have to have something that changes your consciousness, that shifts how you feel. At times you need things to look forward to. And I think one of the problems with addictions in part is that people just get too lazy and I don’t know a better way to put it. And rather than going to a concert going, you know, you know, whatever you like to do with your friends, you’re going to a sporting event or going to a, you know, dinner with your family or whatever it is that you enjoy doing all of those things shift your consciousness when you’re around new people and maybe you take a road trip in your car with a friend, these things all have a similar effect. And so we need things to look forward to. We can’t just live in the same routine. It’s we’re meant to shift our consciousness in different ways. But when you just habituate to anything, you know, a substance you, you tend to lose that drive for those other things. And ultimately, you know, it’s funny because when you talk to someone who comes who was sober and then they got on to substance, they will almost inevitably tell me that was the better time in my life that was so much better. Right. But it’s but, you know, it’s some for one reason or another, they didn’t sustain it, but that’s why they’re in treatment. They want to get back to that because it is better. It’s better to have varied experiences.

Dwight Hurst, CMHC: It’s interesting how you put that the laziness of our own instincts because if we get into an addictive cycle and it’s like I, I can ingest something, I can go and pour a drink a little quicker and easier. Maybe then I could organize my friends together for a game night, or then I could take, take, get my kid and run to the park and do something or go for a jog. Or those things take some coordination. But you’re talking about opening up and diversifying how we adjust our consciousness to make life more rich. And yeah,

David Livingston, LMFT: That’s it, that the goal is a more creative life or those needs are getting met in a more varied way. It’s not because the fear is that every so I’m just going to be, I’m going to be a good boy or a good girl. I’m going to do the right things. But underneath that is the part of of all of us. That’s like, I want to do what I want to do. I don’t want anybody telling me what to do. I want to, you know, there’s a wild man and a wild woman in everyone, and there should be. But you have to tame it. You have to understand there’s limits to that part of you so that you don’t, you know, mess up everything you’ve built and you know, and but and and the goal to that is a more creative life. Like you’re saying at first, it’s more work. But once you get in the routine of doing those things, it’s actually just much better.

Dwight Hurst, CMHC: Clare, what were you going to say? 

Clare Waismann, RAS/SUDCC: No, no, no. I thought I lost you guys.

Dwight Hurst, CMHC: Oh, no, no, we’re here.

Clare Waismann, RAS/SUDCC: No, I think I think the only thing that you know again, I go back to terms is the word laziness. You know, I, I think, is more. Instead of laziness, it’s trying to escape life. And I think that’s one of the reasons why, you know, a lot of people choose to instead of going out to concerts and being with their friends to stay in a room doing drugs is they can’t handle whatever is out there and they are truly using. Whatever drug or substance to escape life, so it’s I don’t know if it’s easier to do what they’re doing than to go out there and have fun. But it’s just what they’re capable of and that minute.

David Livingston, LMFT: And you know what? You make a good correction because it often is. Sometimes it can be about that. But mostly it isn’t. And sometimes people don’t know what to do. And and maybe they’re lonely. They don’t feel like they have friends to go and do. Some of the things we’re talking about or things in their life are sort of fallen apart. So or they’re struggling with resources to kind of do the things we’re talking about. So it’s far, far more complex, you know, but worth building towards, you know, and step by step. But you’re right, it’s the reasons for it are really varied.

Clare Waismann, RAS/SUDCC: Hmm. And again, as is what we started the whole conversation in the first place, you know, putting things in “recovery” or, you know, uh, now they have here, “California sober”. Is it good? Is it bad? You know, it’s uh, you can’t put everybody in the box and, you know, have an answer for every issue is looking at. The person is instead of being in recovery or staying clean is. Working for your health, you know, working and staying healthy physically and emotionally, whatever it is that you need to do, and everybody is different. And I think we hear a lot of that question from parents, should they go after detox to rehab, should they stay at a sober living? You know, what are the steps and. It’s first understanding the patient is hearing the person is understanding where they’re coming from to have an idea, what’s the best step forward? So I think especially in today’s society and I don’t want to go there because that’s a whole big can of worms. Um, everybody’s being put in a, you know? Where you are this or you are that. And if you’re this, we don’t accept you and if you’re that, we accept you. So I think we got to get away from labeling people as much as we can and understand A people change, B our expectations might not be the right one for that other person. So what works for me? It might not work for somebody else. And the reasons why they’re doing something, maybe I don’t understand. So we need to get out of these boxes and, you know, be more accepting and understanding of people without so many, um, you know, exact terms and expectations.

Dwight Hurst, CMHC: Yeah, it seems like the real first step to answering a question like this for one’s self. And I guess that’s the real answer to start with. You know, if someone was to say, Do I personally, that’s the first thing is don’t ask, does everyone need to do? I personally need to cut out intoxicants from my life completely if I’ve had a problem with one form of addiction or one method of addiction? If someone’s really trying to answer that for themselves, they need to have a really what it sounds like as a is a good, honest conversation with themselves and maybe someone who knows them and cares about them and their doctor or therapist or some professional like start talking about it is really the first thing to do. And that and as I think you know, something you mentioned, David, I think that’s coming out here is that it’s always good to be cautious. But I think there’s a there’s a right. It’s always good to be cautious when we’ve had a previous preexisting condition of any kind. But I hope that what we’re saying to people, I think, is that you should be conscious and cautious of a preexisting condition of addiction just the same way you would as any other preexisting condition. If I’ve been pre-diabetic, I probably need to be cautious about what I eat, even if I’m not pre-diabetic anymore, or if I’ve skated that or or whatever, you know, that’s a great example. But you know, if I had a heart attack, I need to question my activities a little bit differently or in my diet a little bit differently. And this is really the same thing, which is I know I have a preexisting condition where I had opiate dependence problem. And so I probably should think hard about how I approach alcohol. That’s it’s way different than saying, Oh, you know, I’m this kind of person. So therefore I just can’t even really think for myself about stuff.

David Livingston, LMFT: So that’s right, and just to complicate it further, which is one of my favorite things to do. But it’s also true there are people who are really, really capable of putting the brakes on and some people who are less capable of putting the brakes on. And and and so you have to keep that vulnerability, you know, you know, you have to assess for that as well, and they’ll tell you, right, no, I can’t do that because if I do, this happens. This happens, this happens. It’s always happened. And right, so OK. So know, and there are other people who would. It’s, you know, their problems or more driven situationally, rather than the fact that their repression barrier, which is really our ability to put the brakes on, isn’t as strong as it is in other people. Ok, so they just tend to have trouble, you know, pushing things down once they have a substance in them, you know that that piece of them just isn’t is strong. So, you know, so that’s just I mean, this is why you shouldn’t walk in when you’re talking with people with a lot of predetermined ideas. You should really walk in and listen and, you know, get to know them and spend some time. And, you know, and if they trust you and they feel like you’re not judging them and you really want to understand and help them, and there’s a feeling of that type of rapport and authenticity and both people, they will tell you and you’ll get to know what’s possible and what’s not. And then you can begin to really, you know, get a get an accurate picture.

Dwight Hurst, CMHC: And that will do us for today. Thank you again for listening. As always, this podcast is here to answer your questions on addiction. And you always can join the conversation. You can follow us on Twitter @opiates or send us an email info at opiates. Also, please use the #StopTheSilence to help to spread the word about the opioid overdose epidemic and all the tragedy that is happening with that in the U.S. and other places. Please tag us @opiates when you do so. If you’d like to share your stories or if you’d like to share your questions, it’s another good way to do it. This show, as always, is brought to you by Waismann Method Opioid Treatment Specialists and is produced by Popped Collar Productions. Our music is the song Medical by Clean Mind Sounds for Clare Waismann and David Livingston. I’ve been Dwight Hurst. Thank you for sharing your questions and listening to us. Remember, keep asking questions when you ask questions, you get answers, and when you can find answers, you can find hope. But before today, we’ll be back again soon.