Recovery = Abstinence… Or not

The Substance Abuse and Mental Health Services Administration (SAMHSA) just release a new definition of “recovery” from mental health and addiction:

A process of change through which individuals improve their health and wellness, live a self-directed life, and strive to reach their full potential.

I’ll give you 10 seconds to find a key missing ingredient in this definition of recovery without peeking at our title. Hey! No Looking!!!

The definition calls recovery a process the provides improvements in well-being and that allows people to gain control of their life. It seems that abstinence is simply nowhere to be found in this new SAMHSA definition.

I have no doubt that some people will be upset about the decision not to include abstinence in the definition of recovery, but I won’t be one of them. I’ve been saying that we should be moving to a different definition, one that focuses on improvement in quality of life, as the basis for whether someone is in recovery or not. You see as far as I’m concerned it doesn’t matter whether a person is using any substances – all I care about is the impact of such use on their well being, their “quality of life.”

We’ve already written a few article on All About Addiction making this exact point (see here and here for some examples) and there have been some addiction researchers calling for the same when measuring success in addiction treatment research (see here and here).

Most addiction treatment research simply measures abstinence when individuals finish treatment (especially outpatient treatment) and then maybe 6 or 12 months later. But as the research I linked to earlier shows, there are a whole slew of people who are not abstinent a year after their release from addiction treatment but are without a doubt involved in recovery: Their substance use is either fully under control or is at least producing much less of a problem than it had before. As far as I’m concerned that is a success, and if the use begins being troublesome again, then it is possible that more treatment, and perhaps complete abstinence, is necessary.

This whole thought process can easily lead us right down the harm reduction, substitution therapy, and legalization argument rabbit hole, and I’m all for that discussion. I’m also sure that I will once again get some more hate-mail from readers who think I’m being irresponsible by suggesting that people who have at one point had trouble with substance abuse may be able to use anything (even substances that were not their drug of choice) ever again. They’ll accuse me of being responsible for those who decide to try such methods and fail while taking absolutely no responsibility for the countless who try their approach and relapse. Fortunately for me I’ve learned to ignore those emails.

Addiction stories – LSD addiction: AN LSD trip down the wrong path

An LSD trip may be fun for a bit, but LSD addiction doesn't sound like any fun at all.**DISCLAIMER: This post has been changed since its original content. Since I Believe the submitted story was fake, I’ve now made this a post about the possibility of developing LSD dependence**

Many of my readers claim that LSD addiction does not exist. Well, They’re simply wrong. LSD dependence (the clinical term for addiction) is certainly out there, though its no doubt rare. To understand why I can make that claim, let’s cover the specifics of what a psychological assessment of dependence requires:

The official definition of addiction

As far as the DSM-IV (the psychological assessment manual) is concerned, dependence on any drug require at least three of the following to occur within a year:

  1. Tolerance, as defined by either of the following:
    • a need for markedly increased amounts of the substance to achieve intoxication or desired effect
    • markedly diminished effect with continued use of the same amount of substance
  2. Withdrawal, as manifested by either of the following:
    • the characteristic withdrawal syndrome for the substance
    • the same (or a closely related) substance is taken to relieve or avoid withdrawal symptoms
  3. The substance is often taken in larger amounts or over a longer period than was intended
  4. There is a persistent desire or unsuccessful efforts to cut down or control substance use
  5. A great deal of time is spent in activities to obtain the substance, use the substance, or recover from its effects
  6. Important social, occupational or recreational activities are given up or reduced because of substance use
  7. The substance use is continued despite knowledge of having a persistent or recurrent physical or psychological problem that is likely to have been caused or exacerbated by the substance (e.g., continued drinking despite recognition that an ulcer was made worse by alcohol consumption)

Now, I’ve taken more than my share of LSD trips before. Actually, I used to sell acid, among many other drugs in my former life. I knew many people who loved acid, mushrooms, and other hallucinogens (including me) but a few cases stand out in particular.

LSD addiction – Hypotheticals and examples

Given the above definition of substance dependence, any number of combinations of symptoms could qualify someone as being dependent on LSD.

  1. Tolerance buildup for the drug is quick and significant. As anyone who’s ever tried to follow one trip with another knows, the second time requires a lot more acid, and any additional trips increase the amount of LSD needed greatly. Tolerance – Check!
  2. Withdrawal from LSD, especially in the wake of repeated exposures (the multiple trips I was talking about before), includes disorientation, difficulty thinking, fatigue, and sometimes perceptual difficulties (problems with hearing, vision). I’ve experienced this myself, but the best example I’ve seen is of a friend who tried to trip continuously for as long as possible – After about a week and a half, she was eating literally a sheet of acid to feel anything (her boyfriend was a dealer, talk about tolerance). When she stopped because her boyfriend cut her off, she had the hardest time finishing sentences, completing thoughts, or following conversations for nearly three months! Withdrawal – Check!
  3. With the above 2 out of the way, any of the other 5 symptoms can serve to complete the LSD dependence picture. Still, though I’ve never met anyone who tried to stop but couldn’t, I have:
    1. Known people who spent a lot of their time and resources (money) chasing down good acid, paying for it, or preparing for and getting involved in activities that involved LSD.
    2. Many of the people I knew began slacking off at work, sometimes being fired, getting far more lax at school, and neglecting any relationships they had with people who were not involved in their LSD use.
    3. Quite a few of the hard-core LSD users I knew told me time and again that they know their LSD use is causing them difficulties (mostly psychological difficulties) but that fact seemed unable to deter them from buying more acid and continuing down the same path.

So does LSD addiction exist?

Obviously, I believe that LSD dependence exists, though it is no doubt rare. As I’ve stated time and again, I am NOT against the use of drugs. However, I think that drug users’ naive approach to many of these issues, including their constant desire to ignore all signs of the negative consequences of drug abuse, is a big part of the problem here. Ingesting drugs is harmful, but knowing that, I believe people should have the choice to harm themselves, though not others. People with drug problems need help, not jails. Still, to make this a reality, we need to do a much better job of educating ourselves about the true effects of drugs.

I’ve seen LSD destroy lives that took years to rebuild. I’m not talking about people locked away in mental institutions thinking they’re an orange (we’ve all heard that story). But I had friends who became completely unable to live and function in society who gave up friends, significant others, and family for a drug that eventually made them crazy. Some of them are back, some aren’t.

All I’m saying is be careful.