Treating Methadone Addicts with Heroin


Last week my colleague, Bill Owen, and I gave a presentation at the annual conference of the CCAPP, (The CaliforniaConsortium of Addiction Programs and Professionals.) The topic of our talk was: Sex and Pornography Addiction in early Substance Use Recovery.

Newly sober addicts tend to rediscover sex, and enjoy it in a way they never had while they were using.

Here's an anecdote about Wynn C, an early AA member:

Wynn stood on our front steps one bright Christmas morning enthusiastically kissing a different handsome AA swain as others crowded past them, pushing inside to a party, where they would drink tomato juice and laugh like banshees, delirious with joy. They had found God (as they understood Him), and as long as they stayed away from booze and aspirin, they were okay; they were in the clear. They weren't ashamed of sex; they gloried in it.
"MY NAME IS BILL", Carolyn See, The Washington Post, February 27, 2004, page C02.

Bill Wilson himself , according to many accounts, struggled with inappropriate sexual behavior.

Treating methadone addicts with heroin.

As the AA office staff expanded in the 1940s, Bill seemed to take an active part in its recruitment efforts. One longtime AA member told me that at first she didn't know why in 1946 Bill hired her and another young woman AA member. "Neither of us could type or take dictation," she told me. Then, one night soon after they were hired, Bill took both women to an AA meeting. He sat between them and, all during the meeting, he had a hand on one leg of each of the women.
Bill W., A Biography of Alcoholics Anonymous Co-Founder Bill Wilson, Francis Hartigan, page172.

Back then they couldn't identify what we have come to know as the “Whackamole” problem in addiction. Put down one drug and you'll find another to take its place. Those early AA meetings, in addition to being hook-up central, were so filled with cigarette smoke, it was hard to see. The focus then was on the substance, not the underlying condition. Many sober addicts took to gambling, sky diving, spiritualism, religiosity, overeating, compulsive exercise, workaholism... Anything to self-soothe and feel OK. Addiction is a disease of escape. Take away his drug of choice, and he'll quickly find another. A good addict will always find a way to escape.

Now, some 80 years after AA began, we have a lot of information we did not have then. For starters, we have the cases of the millions of people who have been able to tame their addictions through the 12-Step process. We also have numerous therapeutic techniques that were developed in the intervening years. We have some understanding that some are genetically predisposed to addiction, and well documented evidence that childhood trauma and neglect play a part in the development of addictions.

We also have increased understanding of how the brain operates. The neurochemistry of the brain, it turns out, is a key component in addiction. Substance addictions and process addictions are merely different ways of manipulating this chemistry to effect a change in mood. Behavioral addictions and substance use can actually carve new neural pathways over time, so the brain ends up in a new “normal” state, dependent on the addiction to remain regulated. To the brain, it doesn't matter if you're using porn or cocaine. To the pleasure centers of the brain, it's all the same.

The good news is that this process can be reversed. The brain chemistry, over time, can essentially reset itself. New neural pathways can form, allowing the addicted individual to feel OK without the need to alter their mood artificially. This is what recovery is, a new “normal”, which is what the old normal should have been, but was hijacked along the way.

Terence Gorski, known in addiction treatment as the Relapse Prevention Guru, puts it this way:

Sobriety = Abstinence from addictive drugs +

Abstinence from compulsive behaviors +

Improvements in bio/psycho/social health.

In 1958 Bill Wilson wrote that “Emotional Sobriety” was the next frontier. He was referring to what Gorski put into words years later.

People don't like the term Sex Addiction. Some say it's not a real addiction. Some say that it is just an excuse for bad behavior. They come up with all kinds of names for it: Sexual Compulsivity, Compulsive Sexual Behavior, Impulse Control Disorder, Hypersexuality, Out-of-control Sexuality, Problematic Sexual Behavior, Intimacy Disorder, Sexual Disorder (Not otherwise specified)

But when you look at the characteristics: preoccupation, tolerance, withdrawal, cravings, denial, continuance despite negative consequences, what you see is addiction, pure and simple. Pat Carnes defines addiction as “A pathological relationship with a mood altering experience.”

The relationship is pathological when choice is gone. The sex addict does not choose his behavior any more than a heroin addict chooses to shoot up. The choice is gone. The compulsion is in charge.

Sure, sex in recovery can be great, but an addicted person always needs to examine why you're doing it. If it is primarily to escape or run from feelings, then it's important to look at that. Replacing one addiction with another can bring the whole recovery process to a grinding halt, and have you scratching your head, wondering what went wrong.

© Tim 2015