One of the hardest things to talk about with patients who have addiction is the fact that all addictive substances are probably off limits. You hear stories from people who stop their drug of choice and change to a different substance and seem to be able to “control” its use, but I argue that if someone can use an addictive substance without compulsive use then they are not an addict.
This is a very important point for me when I am trying to work with patients. I get the line all the time that “marijuana is not addictive.” I totally agree unless you are addicted to marijuana, which many people are. There are plenty of people who drink alcohol who are not alcoholics, do cocaine and are not cocaine addicts and take opiates and are not addicted to opiates.
The point that I am trying to make is that addiction is a definite physiological phenomenon, just like diabetes or other chronic illnesses and either you have it or you don’t. It affects about 10 percent of the population and that is that. If you have the genetic predisposition, you can either abstain from addictive substances or not. If, however, your brain has the dopamine dysregulation of an addicted individual, then addictive substances are not something that you should try to use recreationally. In my experience of working with addicts, trying other addictive substances turns out badly and leads people back to their drug of choice.