Why The Phrase "Once an Addict, Always an Addict" is Dead

By Dr. Adi Jaffe

"Once an Addict, Always an Addict."

I'm Dr. Adi Jaffe and I consider myself an ex-addict. Why? Because I no longer buy into the OAA ideology. Despite the fact that I struggled with meth addiction for years, I have left my addiction far behind me and am no longer "an addict."

Here are a few things I am: a father of three, a doctor of psychology, and an addiction specialist who used to be addicted to meth and struggled with porn addiction.

I am also right-handed. I was actually born using my left hand primarily, but as a child my teachers made me adjust, so I became right-handed. Once left-handed, now right-handed.

Yes, even your dominant hand doesn't necessarily have to stay constant.

Anyone starting to see why the phrase OAA is problematic? It implies that if you were once addicted to meth, food, alcohol, or sex that you will always be addicted.

It implies that there is no way of changing your state.

But the idea that anyone is powerless over any substance or external addictive force, let alone forever, is simply not supported by research. With the right tools, methods and support ANYONE can break free from their addiction—it's not always easy but it's nearly always possible.

Why the "once an addict" phrase is actually harmful to those in recovery

Shame — Think about it: If someone buys into the OAA adage, they will forever have to label themselves an addict, a label that comes with a lot of additional negative weight—"lazy, powerless, hopeless, loser, untrustworthy." Given that stance, they will be less likely to seek help for their problematic drinking, drug use, or porn use for fear of being labeled or shamed by those they love. Dr. John Kelly, a noted addiction expert says that "people who feel more stigmatized are less likely to seek treatment, even if they have the same level of addiction severity," and that "they're also more likely to drop out of treatment if they feel stigmatized and ashamed."

Why?

Because no matter what you accomplish, if you buy into OAA you have a sense that you will always be required to wear this coat of condemnation. Many people don’t even want to try recovery because they don’t want to fail. Those that do will likely relapse, sending them into a pit of shame and blame.

OAA keeps us feeling powerless and small — Because of the condemning rhetoric of AA’s tenets, I not only felt shame about my slip-up but truly believed I was powerless over my addiction. This belief kept me feeling small and stuck long afterwards—even after I started pursuing my graduate degree in psychology. The term "addict" alone contributes to this as shown in a great study by Robert Ashford.

Recovery is not a linear process — While in rehab for my meth addiction, I relapsed. My parents had already spent thousands of dollars on lawyer fees and rehab, and the moment I relapsed, I felt an immense amount of shame. Never mind that I had been sober for a whole month for the first time since I was 14, or that I had managed to finally reconnect with my family after 10 years of near-complete separation. I felt like a failure. These instances of "slip-ups" or relapse are often used as proof that the addiction is as strong as ever. But in fact, they are great learning opportunities much like mistakes are in any other field (see here, here, and here).

Relapse doesn't mean failure or that I am "always an addict." — It means I had more work to do on myself and that there is more to learn. Relapse is a sign you've been trying, not that you are doomed or damaged. It also might mean the current treatment method you are using isn't a good fit. Keep searching for one that does.

Recovery doesn't look the same for everyone — The more we try to shove people into the same recovery box, the fewer people we will actually help. When we measure recovery success as an absence of relapse, we are setting people up for failure. According to The National Institute on Drug Abuse, relapse rates among recovering alcoholics are between 50 and 90 percent in the first four years after rehab. For recovering drug addicts, rates are between 40 and 60 percent. And those are the people who actually complete the program. What does this say about current treatment programs? It says we can do much better and it's time we stop putting the blame on those who struggle for our failures.

Not everyone has the same goal of abstinence — Abstinence is a barrier preventing folks from seeking help because not everyone wants to quit forever, some just want to gain control of their intake. I will occasionally have a glass of wine with dinner or take mushrooms with friends (a 12-step no-no), but abstinence is simply not a goal of mine. Nor is it something I require of my clients who are currently struggling with addiction. Abstinence will quite likely come once the client has worked through their traumas, triggers, and unhealthy coping mechanisms. But aiming for it should never be a requirement for getting help — in fact, my own research shows that for many it is a hurdle to seeking help.

If you believe OAAA, you believe you will be struggling with your addiction, it will be more likely to happen — The first step in AA is admitting that you are powerless over your addiction. This is not helpful. The notion can become self-fulfilling and exacerbates the negative self-talk that is rampant among many who struggle. And self-fulfilling prophecies are not a wives tale... they're just called things like experimenter bias, confirmation bias, expectancy effect, and more...

Addiction is not a lifelong "characteristic" — Believing addiction will last forever places a huge emotional and psychological burden on recovered addicts. Addiction is a spectrum disorder, like depression, and every person is different. While there are plenty of cases where addicts struggle for years to overcome drug addiction, many more cases reveal the opposite—short-term users who manage to put the past behind them and lead normal and productive lives. According to the National Institute on Alcoholism and Alcohol Abuse, 75% of alcoholics recover without treatment.

All drugs are not created equal — If a heroin user replaces his syringes for cannabis, I think we would all agree this would be a good move. If you need to drink coffee every day in order to function, you are by definition an addict (especially if you crave coffee and have ever spent substantial money on it). Does that mean you have an addictive personality and should avoid happy hour after work?

Recovery may actually improve resiliency to new addictions — According to this JAMA study, people who recover from a SUD, have less than half the risk of developing a new SUD. This proves that recovering from one substance does not typically lead to drug substitution, but actually reduces the likelihood of developing a new SUD.

Just because you break your physical addiction doesn't mean you are recovered — Just because someone breaks their physical addiction doesn’t mean their quality of life has improved. There are many more variables that should be accounted for, like daily functioning, criminal involvement, social integration, and more.

What if an unemployed man who drinks seven nights a week and is cut off from his family and arrested regularly is able to cut down his drinking a bit, maintain a job, earn an income and keep a roof over his head while staying out of jail? Shouldn’t that be measured as a success compared to the alternative—a man who is in jail, has no job, money, or home? The answer is a resounding yes.

The authors of this study suggest that factors such as “coping strategies, skills, and motivation of individuals who recover from an SUD may protect them from the onset of a new SUD.” In other words, by making the life-affirming transition from addicted to recovered, we gain a recovery “toolbox” that helps us navigate life’s challenges and stresses in a much healthier way. We learn to connect with people, push our egos aside, and to ask for help if we need it. Thus, when faced with stressful situations that formerly would trigger us to drink or drug, we might respond by exercising or calling a friend, rather than using a substance. As such, we substitute addictions with healthier activities that perform the function that the drink or drug used to, albeit in a much more fulfilling way."

In Summary

For most people, it is their struggles in life—with trauma, environmental pressure and stress, outside influence, and more—that create their addiction. So is the message really that if one is struggling in their life right now, they will always struggle?

Could we imagine telling someone with depression, "Once depressed, always depressed?" Or saying to someone who is struggling financially "Once broke, always broke?" No. We would think such statements as being self-defeating and holding them back. We would want to support their ability to change!

What if we did the same in addiction? What if we flipped the script and stopped labeling those seeking recovery as addicts? What if we stopped telling people they are stuck in this terrible state and instead supported their agency and ability to change?

I've seen thousands of people create meaningful change in their lives and there are millions more, so why not put that message front and center?