HAMS: Harm Reduction for Alcohol

The Truth About Cross-Addiction And Cross-Tolerance

If you have ever been through a twelve step chemical dependency treatment program then it is almost certain that you have been taught the myth that "if you are addicted to one drug then that automatically makes you addicted to all drugs and therefore you must never use any mood altering substance again as long as you live or you will immediately become addicted again." Perhaps you were even shown the Hazelden-made scare video "Cross Addiction: The Back Door to Relapse" in an attempt to scare you out of ever using any mood altering substance (except for nicotine and caffeine) ever again. The simple fact is that this is a total made up scare story intended to scare you into going to 12 step meetings which has no more truth or scientific validity to it than the movie "Reefer Madness" which tried to scare kids in the 1930s away from marijuana by telling them that weed would turn them into homicidal maniacs.

Will the neo-prohibitionists and the blue-nose moralists never learn that trying to scare people--particularly young people--into acting a certain way by telling them a pack of lies always backfires? Once kids catch you n a lie then--since kids are very black and white thinkers--they automatically assume that everything you have told them is false. When kids find out that you lied to them about marijuana, which is relatively harmless, then they figure that you lied to them about heroin as well, which is a lot less harmless than weed.

And then we really have to ask as well--why are nicotine and caffeine somehow excepted by the 12 step treatment gurus as somehow different than other drugs or alcohol? Is it something in their chemical nature? In the way they affect the brain? No--caffeine and nicotine are not really neurochemically different than any other mood altering, addictive drug of abuse. The simple fact is that AA founder and holy man William Wilson refused to give up his addiction to coffee and cigarettes until the cigarettes actually killed him. Since good old Bill W smoked and drank coffee this somehow gave caffeine and nicotine the status of holy drugs which were exempt from the proscription against other addictive drugs--or even medication like antidepressants.

The real truth is that many people are highly successful at stepping down from a drug which causes them great harm to another drug which causes them much less harm. In fact the success rate of substituting a less harmful drug is man. Many times more successful than a twelve step Hazelden type approach which demands perfect abstinence from everything. Why? Because when people are forced to give up everything that they like then they become very miserable and very apt to fly off the handle and use drugs wildly. If they have been brainwashed into believing that they are powerless and out of control then they are extremely likely to run amok and use ore and worse drugs than they ever did before. Many people go through the following pattern: marijuana → 12 step treatment → cocaine → 12 step treatment → heroin → 12 step treatment → death.

Many ex-heroin addicts become social drinkers who never have a problem with alcohol. Many ex-alcoholics substitute marijuana for alcohol and never have a case of the DTs again--we call this marijuana maintenance.

Any sane treatment program would tell you that moving from a very harmful drug to a less harmful drug is a step in the right direction. Any sane treatment program would teach people that this is a good harm reduction strategy. 12 step treatment programs are not sane and are not concerned with the well-being of their clients--rather they are only concerned with providing more warm bodies to fill 12 step meetings with. And I swear if I ever had to sit through another 12 step meeting again I would go out and shoot some heroin myself!

Cross-addiction is a total myth and a scare story--being addicted to one drug DOES NOT make you addicted to other unrelated drugs. Using an unrelated drug DOES NOT automatically make you go back to your drug of choice--if this were true then every drug and alcohol counselor who ever puffed a cigarette or had a sip of coffee or cola would immediately be back to shooting heroin and quaffing liters of vodka again.

That being said--if using one drug tempts you to go back to the old drug that caused you problems then perhaps you should avoid it. Some ex-junkies become social drinkers--others get tempted to shoot smack if they get intoxicated and hence choose to avoid alcohol. Only YOU can choose which strategy will work the best for you.

Even though cross-addiction is nothing but a myth and a made up horror story, there is a phenomenon called cross-tolerance that exists and that people who practice harm reduction should be aware of.

Cross-tolerance means that when you develop a tolerance to a drug you will also have a tolerance to closely related drugs--but not to totally dissimilar drugs. The more closely related the two drugs are the stronger the cross tolerance effect will be. For example, Valium, Librium, Xanax, Ativan and Klonopin are all closely related drugs which belong to the benzodiazepine family of drugs. These drugs all affect the GABA receptors in your brain. If you become addicted to any one of these benzodiazepines then you can substitute any other because there is cross-tolerance. Since alcohol also affects GABA receptors there is some cross-tolerance with alcohol but not as much with each other since alcohol affects many different receptors. However you cannot substitute heroin for Valium because heroin does not affect the GABA receptor. There is no cross tolerance between heroin and Valium.

Heroin, morphine, codeine, methadone, etc. are all opiates and they all affect the brain's opioid receptors. If a person is addicted to heroin then that person can use another opiate such as codeine or methadone to prevent withdrawal because these drugs all belong to the same family and have cross tolerance with each other. However an opiate like heroin does not have cross tolerance with a benzodiazepine like Valium. The opiates may have a limited cross-tolerance with alcohol which affects many receptors--but if this is the case then it is a rather limited cross-tolerance.

Many other drugs are still under study but it appears that there may be some cross-tolerance between nicotine, caffeine, crystal meth, Ritalin (methylphenidate), and amphetamine.

So beware! Shooting crystal meth might just lead to coffee drinking!!

It is nothing short of ironic that even though Ritalin and crystal meth are nearly identical in action and effect--we are giving the one to grade-schoolers and locking up adults in prisons for the use of the other. Why didn't the pharmaceutical companies give grade school kids crystal meth instead of Ritalin for their ADHD? Because the patent on crystal meth had expired and they couldn't make money off of it--that is all.


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PubMed Abstract

Jain R, Holtzman SG. (2005). Caffeine induces differential cross tolerance to the amphetamine-like discriminative stimulus effects of dopaminergic agonists. Brain Res Bull. 65(5), 415-21.
PubMed Abstract

Leith NJ, Barrett RJ. (1981). Self-stimulation and amphetamine: tolerance to d and l isomers and cross tolerance to cocaine and methylphenidate. Psychopharmacology (Berl). 74(1), 23-8.
PubMed Abstract

Wooters TE, Neugebauer NM, Rush CR, Bardo MT. (2008). Methylphenidate enhances the abuse-related behavioral effects of nicotine in rats: intravenous self-administration, drug discrimination, and locomotor cross-sensitization. Neuropsychopharmacology. 33(5), 1137-48.
PubMed Abstract
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