I recall getting sober myself at a time when things seemed simpler for people new in recovery.  The field had a clear message, “you can’t take anything that effects you from the neck up.”  This kind of concrete thinking was easy for me to wrap my head around.  I had spent most of my life, and certainly my life in my active disease, looking for loopholes and technicalities.  I was looking for a way to get around the “rules” or the “guidelines.” What I found when I entered recovery was a very clear message, “If you are going to make it, you can’t take anything.”

Over time our field had to mature around this idea.  While the concrete nature of it made it very easy to concretize what was continuous recovery and what was a relapse, there were some undesirable side effects.  People took this to mean that people taking much need psychiatric medications were not sober at times.  This misinterpretation of an overall good message was exacerbated by a medical profession that often treated alcoholism as a benzodiazepine deficiency, thereby creating a whole new group of addicts.  This was obviously well meaning on the part of most physicians, but it caused mistrust in them from recovering people in the profession.

As time passed and our message evolved, new influences began to shape the recovering community and society at large.  Pharmaceutical companies and their relationships with physicians were finally regulated to remove inspired biases toward certain medications whether they were what was best for a patient or not.  These inspired biases took the form of very expensive trips, gifts, and exclusive memberships to golf resorts. The regulation the occurred was very necessary to protect consumers.  Of course major corporations do not give up their sales methods without a new plan and the new one was direct to consumer advertising which coincided with the explosion of the internet which also had growing access points such as smart phones.  Rather than marketing their drugs to the suppliers of the drugs exclusively, they began to focus on the creation of demand in their consumer bases.  Physicians became the conduits through which the medications were dispensed and the magnetic draw of consumer desire became the energy that drove the sale of these drugs.  This has had some positive effects as well but they aren’t the scope of this post.

Here we are in 2016, with an entirely new generation of recovering people who have grown up in a completely different world and relationship to drugs that come in pill form than my generation of recovering people had (I became abstinent in 1996).  They have been desensitized and the message about what abstinence is has been muddied by the changes in our world and even in our profession.  Our youngest patients do not remember a time before the internet and Generation Z has a much broader and even international perspective on many aspects of life, drugs included.

The cultural shift in perspective has created a problematic bit of confusion for people new to recovery.  For example I have recently run into several patients who have gone with people in recovery to a “Kava Bar.”  Kava is a plant based drug that is made into a tea in these bars or lounges.  The effects on the brain of kava are like those of a mild benzodiazepine.  Users often take it in pill form or as a tea.  There are several countries in Europe that have made it illegal but the US does not currently take a stance on this and it is primarily viewed as a dietary supplement so it is outside the purview of the FDA.  Therefore there is very little quality assurance of the drug, and more importantly for our population-dosage control.

There is a distinct line in time in recovery where this seems to be “okay” vs those who view it as using.  It seems to be between 5-10 years of recovery, but age also seems to play a major factor in it.  There are of course outliers but those outliers tend to be socially involved with younger groups of people regardless of their length of recovery.  There are of course several other drugs that cause a “head change” that are similar to kava in that they seem to be in this gray area of substance abuse.  Stimulant pre-workout formulas for example are often molecularly similar to methamphetamine.  Several of them have been banned in the US but in our day and age most of the manufacturers of these drugs are able to make simple molecular adjustments to the substances that operate as a “go around” for the regulations.  Kratom is another plant based substance often abused by people in early “recovery.”  Kratom seems to be a favorite among former opioid addicts as many of the effects are, while lesser, similar to an opioid effect.  Many of us have heard about synthetic cannabinoids such as “spice” as well as “bath salts.” It seems that every time a person new in recovery turns around there is a new test that they are unsure about and they have to ask themselves questions at a time of life that is confusing for many about whether this is the “technicality” or “loophole to get relief” in recovery or if this is something their sponsor would disapprove of.  Because of the “gray area” attitude about many of these drugs, unfortunately, their sponsor might be the one giving it to them because they too are confused by it and are making poor choices, choices that often lead to relapse on their drug of choice.

I believe it is time for the recovery community, including treatment providers and sober living owners to concretize their stance on these issues.  A couple of guidelines that I like to use with my patients to help them to create a safe boundary that isn’t likely to cause a relapse are the following:

1.  If you can buy it at a head shop you shouldn’t take it.
2.  Talk to a professional in the field before taking a new supplement such as your physician that is boarded in addiction medicine.
3.  Sit down with a sponsor that is active in AA/NA but who has many years of recovery.  What do they think? (I coach them on how to not pick the sickest person in their meeting for this question)
4. “How would you feel sharing about this in a meeting?”  “What kind of feedback would you expect to get?”  If they reveal they would likely get mixed feedback I ask them to stay away from it.  If I happen to know its an inappropriate supplement or drug, and they do not perceive that it would be mixed, I may begin exploring what meetings they are choosing to attend and I may become more directive myself in establishing boundaries.

The fact that has not changed for us is that addiction is a brain disease.  Just as heroin addicts who switch to alcohol end up with alcohol problems or returning to their drug of choice, playing with these supposed “gray area” drugs will also activate the disease in the brain of these addicts as well as delay the healing of their brains.  The psychological consequences will be a significant delay in the development of health coping mechanisms and for those that are in 12-step, the spiritual consequences of these “gray area” drugs will be the delay and/or prevention of the ability to connect with their higher power.  This would be “blocking the channel” as it were.

As another point of clarity, I take things on a case by case basis obviously, but in general, I approach the use of these drugs as a relapse with my patients.  I do this after I know that I have given them a concretized definition of sobriety to work with.  The brain is still malfunctioning considerably in addicts especially in the beginning so concrete boundaries can be very helpful.  With that said, patients who have not been give these guidelines and who are unaware will need some exploration and have to decide for themselves.  I do not want to shame them for going somewhere with several of the “newish” members of their AA/NA group and participating when they didn’t know any better.    No matter how it is handled by a clinician, by a sponsor, or by a provider of services of any kind, it should not be ignored and if you are the new person in recovery reading this, lets be clear about this-this is not a gray area and these supposed “gray area” drugs need to be avoided at all costs to maintain recovery.