The primary goal in the treatment of alcoholism and addiction is sobriety. I define sobriety as total abstention from whatever drug is dragging you down. The drug that is impossible to stop and has taken control of your life. I know that there are segment of people out there who are multi-addicted, but I am writing to what I see, and what I imagine others see, in a typical middle class private practice. What I usually see is alcohol as the primary substance of choice and the most common problematic. There are different definitions of sobriety for the Alcoholic. I can remember back in the 1980's when many involved in substance abuse treatment were reluctant to accept clients on prescription medication such as Prozac. Smoking marijuana was akin to drinking, and generally any mood altering drug was prohibited. All mood altering substances were lumped in the same bad category. Older AA members felt that the introduction of a mood altering substance might trigger a relapse.The bias against prescription medication changed with the emergence of Dual Diagnoses. One diagnoses dealt with the addictive substance, the other diagnoses dealt with a recognized underlying clinical disorder, such as depression, anxiety, or psychosis. There grew a recognition that for the maintenance of sobriety, these underlying clinical conditions may be in need of medication. Prescription medication, manufactured by Big Pharm, along with
physicians became part of this growing lucrative prescription substance abuse industry. Any drug outside of this circle, in the past, such as Marijuana or Kratom was not accepted. Oxycodone was safer for their patients, then either pot or kratom. More on this later.