Background
Materials and methods
Participants and sampling
Data collection
Participant | Gender | Age | Race | Addictive behaviors | Time in recovery | Received treatment (outpatient/ residential) | Substitutes since entering recovery |
---|---|---|---|---|---|---|---|
1 | F | 50 | White | Alcohol, cannabis, cocaine | 4 years | No | Sex/relationships |
2 | F | 36 | Colored | Alcohol, ecstasy, Mandrax, cannabis, Crystal Methamphetamine, over-the-counter medication | 10 years | Yes | Shopping; food; work; cigarettes; coffee |
3 | F | 43 | Colored | Cannabis, Mandrax, Crystal Methamphetamine, alcohol | 16 years | Yes | Cigarettes; food |
4 | M | 38 | White | Heroin, Crystal Methamphetamine, pornography, video games | 1 year and 8 months | Yes | Do not believe they substituted |
5 | M | 55 | Colored | Alcohol, heroin | 9 years and 6 months | Yes | Cigarettes; sex/relationships, pornography; binge-watching |
6 | M | 44 | Colored | Crack cocaine, Crystal Methamphetamine, alcohol | 8 years | Yes | Cigarettes |
7 | M | 26 | White | Prescription medication (Zolpidem, Ritalin®), crack cocaine, Crystal Methamphetamine, alcohol | 3 months | Yes | Cigarettes; exercise |
8 | M | 51 | White | Sex cannabis, alcohol, cocaine | 8 years and 11 months | Yes | Food |
9 | F | 37 | Colored | Crystal methamphetamine, cannabis | 4 months | Yes | Food; shopping; cigarettes |
10 | F | 52 | White | Alcohol, caffeine, nicotine, crack together with Mandrax, sleeping pills | 9 years | Yes | Exercise; cigarettes; coffee; work |
11 | M | 39 | White | Alcohol, cannabis | 5 years and 2 months | Yes | Do not believe they substituted |
12 | M | 31 | Black | Alcohol, cocaine | 3 years and 6 months | Yes | Do not believe they substituted |
13 | F | 33 | Colored | Drugs, alcohol, sex, and love addiction, food | 7 years | Yes | Food |
14 | M | 30 | Colored | Heroin | 4 years | Yes | Exercise; pornography; food |
15 | M | 44 | White | Crystal Methamphetamine | 6 months | Yes | Cigarettes; coffee; pornography; food |
16 | F | 26 | Colored | Crystal Methamphetamine | 2 years | No | Food; gambling; cigarettes; binge watching |
17 | M | 30 | White | Heroin and crack cocaine | 3 months | Yes | Exercise |
18 | F | 51 | Colored | Cannabis, crack, cocaine, alcohol, hallucinogenics, cigarettes, ‘reckless spending’ | 14 years | No | Food |
19 | M | 22 | White | ‘Anything I can get my hands on’, cannabis, alcohol, cocaine, ecstasy | 3 years and 6 months | Yes | Stealing |
20 | M | 34 | Colored | Crystal Methamphetamine, Mandrax/cannabis | 4 years | No | Work; sex (escorts, pornography) |
21 | M | 40 | Colored | Crystal Methamphetamine, sex, masturbation, and food | 3 years | Yes | Exercise; food; vaping; pornography |
22 | M | 46 | Colored | Crack, Mandrax, alcohol | 13 years | Yes | Do not believe they substituted |
23 | F | 46 | Colored | Alcohol and drugs | 5 years | Yes | Cigarettes/ vaping; binge watching |
Data analysis
Results
Substance-to-substance substitution
Two years clean and I stopped using cigarettes […]. So, I didn't smoke even in active addiction, but in recovery, when I was in treatment they said like “I think you probably need to smoke” […]. I started smoking a bit more. Participant 5.
Escalation in cigarette use
I smoked more in the year after I stopped using. So, it was like a comfort and it was also when I was anxious and so it was just all the time […]. I used to smoke maybe five-six cigarettes a day in active (addiction). I was smoking 20 a day (in recovery). Participant 10.
Vaping, tapering off and quitting
Cigarettes is one thing I’ve managed to cut down. I vape. […] And […] maybe six cigarettes a week […] I’d love to quit it completely, everything. And that’s what I’m working for, towards […] But I also don’t see smoking as a bad thing considering all the stuff I’ve dropped. Participant 12.I quit for three years and then I started again and then I quit for 18 months and then I started again. So, I think my biggest problem is smoking cigarettes. Participant 3.
Drinking too much coffee doesn’t make you push a trolley (become homeless) […], smoking cigarettes doesn’t ruin all your relationships […]. The hard drugs that do that. But get out there and swap it for all the other ones, uhm, to manage it. So then, are you actually really clean? […] A drug is a mood- or mind-altering substance […]. That cigarette alters my mood and my mind. Are we all in denial? […] 7 to 10-min smoke breaks at NA meetings? We go and smoke drugs. Participant 15.
Coffee (abstaining, maintaining, or increasing)
I smoke cigarettes and drink a lot of coffee. They also think that's addiction but I'm not too hard on myself for that. Yes, one day I'm going to put it down; it's going to happen, […] but not now (laughs). Participant 2.
Substance-to-behavior substitution
Food: binge eating and overeating
I work on long binge-purge cycles, gain a lot of weight, eat very unhealthily, and then I lose it and I gain it again […]. The real problem behavior at the moment is food […]. I've got this picture of a blanky […]. I think a lot of ‘addicts’ have taken on a series of blankets. […] Our inability to connect with our true feelings […] something to pull over ourselves when we’re afraid […] nervous, […] uncomfortable, […] don’t want to deal with feelings. Participant 8.
Because I've now stopped my other addictions, it's progressed much faster and it's starting to bother me […]. A month ago, I ate so much that I […] had to vomit […] I don't wait until I get hungry. I just eat because it's the next thing—if I'm not smoking […] if I’ve got nothing to do, I'm eating. Which is terrible! […] It's one of the reasons […] I loved using tik (crystal methamphetamine), because it stopped me from compulsive eating […]. It made me thin […]. Gave me self-esteem, but also took everything else away from me […]. I kept using it, because I didn't want to end up like this […]. It's that horrible feeling inside that's killing me. Participant 9.
I’m eating everything I see […]. You’re not smoking anymore so you’re eating […]. Gas cooldrinks. […] That is the biggest problem I have. Since I stopped smoking, oh my goodness. […] I had gastro now a few times; ulcer […]. Maybe three (2-L) Jive (soft drink brand) cooldrinks, alone […]. There must be a cooldrink in front of my bed. If I wake up in the night because I’m thirsty to drink, gas drink […]. This chocolate […] it’s almost like a drug to me now. Participant 16.
I had a nine-page bank statement for the month […]. I found that I went to KFC for 54 swipes that month. Now, that excludes the amount I paid cash […]. More than twice a day, obviously sometimes three or four times a day […]. That’s ludicrous. […] I’ve got a very very toxic relationship with food. Participant 13.
Exercise, sport and physical activity
Going bungee jumping and then wanting to do it a second, third, fourth, fifth, sixth time […]. I never did that in addiction. It's a natural high […]. It’s something that could get very addictive. […] The endorphins. […] Is better than any drugs. You'll build confidence […]. You'll feel great, you smile […]. I think it's so important for me in recovery […]. I'm not overdoing it. It's calculated. It's rewarding. My exercise isn't damaging to myself. Participant 4.
I found myself very big, very big, very fat. Because I wanted to eat everybody’s plate finished (laughs) […]. And then I started exercising and then […] over-exercising and then I messed up my back. So yes, I always go overboard, with everything […]. I haven’t actually been to the gym, […] this whole year […]. I would probably still be gymming […]. To be out of my head man […]. So, I don’t have to think about my, my reality. Yes. Participant 14.
I got back into MMA. Very quickly I was like beating myself up for not going six times a week. I was close to within the first month accepting an amateur fight. […] I haven't trained in ages and […] I switched […] I found out about my placement at (hospital) and […] then had a purpose. […] I was just in recovery […] I was latching onto anything. […] I can […] get worth there. […] That was probably about three weeks. Participant 7.
I'm training for the Argus (Cycle Tour) I've entered twice before and haven't finished. […] I've also joined a running program […]. It was six weeks I did it six times a week and that's too much. […] I was sick. Sick, sick, sick […] and my husband said to me: […] ‘You cycled and ran today. You haven't had a day off, you're working 10 h at work. You are doing too much.’ […] And […] my sponsor […] said ‘You look terrible, why are you so tired? What's going on?’ […] ‘Wednesdays off, Fridays off. That's it’. Participant 10.
The month and a half after that, I was really obsessing about going to the gym. […] I wanted to be like before […], I played basketball on a national level. […] I still go to the gym sometimes but not every day anymore because […] it was really obsessive behavior. […] In that period, I also had an injury […] I had to rest for six weeks and after two weeks I was already in the gym. Participant 17.
Pornography, sex and relationships
My sex addiction, it's private. […] My sponsor suggested that I go to SAA (Sex Addicts Anonymous) meetings […]. I went there, and […] thought […] I'm not as sick as this mense (people) […] but […] ek is (I am), […] I can't go back there, because I'm not ready to admit to my wife […]. She thinks it's only porn […], but then […] I am involved with other things. And, I know it’s a matter of time before it takes me back to my first addiction. And for a long time now I haven't gone to houses, […] but it will never stop. […] It stops for one week […]. You can’t pray and you feel overwhelmed […]. I know it's gonna fuck up my whole life […]. You are now probably the first person that I really—like, even the people in NA […] don't know, […] one of the reasons I, I'm not […] connected anymore […] (it) takes me to dodgy places sometimes, and I'm putting my life at risk. Participant 20.
A hole, there was like a part missing. I still have that feeling. And she kinda filled that part. She made me feel I meant something. […] I was obsessing about her every day […] I was checking if she was online […] because she didn’t answer I felt rejected, and then I got angry, so I see my cycle now […]. I’m still struggling, but it’s not bad. […] I realize it when I’m going in that behavior. […] I give my phone to […] my friend, or put it in my room […] or do something else. Participant 17.
Yes, I probably picked my partners because of the availability of sex […]. It was just like how can I distract myself and that was probably the best way to do it. […] Yes, in early recovery I got into a lot of relationships. […] I've been without a relationship for […] two and a half years. […] I'm trying to be comfortable with myself and to find out that I'm enough. […] I struggle with intimacy. Participant 5.
Binge-watching series or pornography
If I'm angry and I want to isolate I can watch a whole series […], the entire weekend […], I'll call in take out, I won't even cook. I will just stay there in my room just watching […]. To avoid people. […] When I had really bad time or when my daughter emigrated, and I didn't want to deal with that pain. And I just started a whole lot of series because then I don't have to think. So, it is a way of escape. Participant 10.
Excessive time spent working
I was working extensive hours […] 47 h overtime […] I still carry that title […] ‘Overtime King’. (laughs). […] Though I was performing at work, at home I just want to sleep […]. I am tired… nasty […]. My family started suspecting me of using because the behavior is the same […]. They made me permanent at work […]. It scaled down a bit, but […] didn’t change […]. From 7 ‘o clock the morning ‘till 11 ‘o clock at night. […] People […] say I’m trying to impress the boss, but […] my substitute addiction still makes my life unmanageable. Participant 20.
Buying and shopping
I'd go to the shopping, you know, with money that I don't have […] and I could see it progressing […]. I knew it wasn't a positive effect in my life. […] I try to fill a void with something then I go shopping […] and I think to myself:’Why do you need that specific thing? What is going on inside here?’ […] ‘Is it anxiety? Is it fear? Is it, is it loss of something?’ […]. Over 20 grand—I maxed it out within a month […]. It was so easy. Participant 2.
It's a coping mechanism that allows you to feel better about yourself. […] But the urge just to spend money it’s crazy. It's unmanageable. Completely. […] It wasn't always me that had to benefit from all the shopping. […] I wanted to make everybody else happy. […] Now that I'm not inclined to go buy drugs, I will buy sweets […]. The money will burn holes in my pocket. […] That feeling that I get rid of when I spend money or when I get rid of the money. […] It's much more rewarding. Participant 9.
Substitute behaviors and harm (reduction)
If it becomes compulsive behavior […] ruins things that you applied in recovery. […] Becomes aggressive and you forget about other things within yourself […]. That’s the thing for relapse. Participant 2.You can’t stop yourself […] you are obsessing […] which makes your life unmanageable. […] resentful, angry […] ashamed, anything that’s gonna make you feel like less. That is, you are still acting out on your addiction. Participant 18.
I mean if you had the choice between being a heroin ‘addict’ or a Comrades (marathon) runner, I’d rather go for a Comrades (marathon) runner […]. You are so used to having your soul, your identity’s consumed by being an ‘addict’. You take that out, what's left? Sometimes the easiest way out is to give that person something. ‘Okay you can't have heroin but here, have a cup of coffee’. So, I don't think it's always (harmful), but I mean the majority of the time, yes. […] There are some guys pursuing all kinds of weird things to keep them clean. Participant 4.
I think excess is always harmful. I mean even if it's something healthy like exercise. […] I can't think of a single example where substituting with a substance would be a good idea. […] The behaviors […] you can convince yourself a lot easier that it's healthy. Participant 7.
Anything excessive could harm you. So, even if it's exercise. You’re literally not dealing with the fact that you can't handle your emotions and your well-being on a level that's balanced. […] I do believe that in excess anything could kill you. Anything. Even denial. Participant 9.
Addiction is addiction […] it’s the disease of more. […] Sometimes it changes, uhm but it’s the behavior that needs to be focused on. […] When I become obsessed, does my thinking follow a pattern? […] Make a start recognizing this pattern. […] If you can deal with the disease itself, there shouldn’t be several addictions. […] A lot of the time […] people came to replace their active addictions with healthier things […], with exercise […] family life […] raising children […] it doesn’t necessarily have to be toxic. Participant 13.
Gambling is going to strip you of everything as the drugs did. […] still going to eat your money too because you're not always going to win. So, it can be harmful because you can lose your home […] your family […] everything. Participant 16.It takes me back to that feeling of how I felt when I was in active. […] (I) stop being honest with myself. […] Definitely, it doesn't work. […] I don't think it really matters […] what the addiction is […]. It's harmful to me because I’ll get to a point where I'll say to myself it's okay? Participant 23.
Support needs to manage and resolve substitute behaviors
If an ‘addict’ doesn't stay in the program and find daily relief […] they will cross-addict […] manipulate, lie […] cover up […] another addiction. […] Rationalize to themselves and to everyone else […] that they are not addicted. It might start off slowly, quickly […] progress. Participant 11.
When it comes to process addictions […] what's carried over, what has changed from the past? […] Education […] needs to […] become bit more practical in recovery. What is a good amount of time to exercise? […] What is a healthy meal plan? […] What is a healthy exercise routine? […] What entails a healthy sexual life? […] What’s normal? […] We have no comprehension of what normal is. Participant 4.
You must fight the underlying emotional state […]. It doesn't matter what you are addicted to. […] It's about what you’re trying to hide. It's what you’re trying not to see […]. Teaching […] how to emotionally capacitate themselves rather than trying to push down an addiction […]. Why they wanted something as a substance to use in the first place. Participant 9.Addiction for me is coping with pain […]. ‘Addicts’ […] need to learn the, the normal way of coping. […] The thing about NA […] if they tell me something out of their experience, maybe it works for me. […] Sometimes if someone like my psychologist […] would say: […] ‘try that’ […] What do you know? […] You don’t know how my mind works. Participant 17.
If someone says they’re engaging in a behavior but the behavior isn’t so serious […]. Encourage the person to really work on that thing […]. Because that's the next thing that he’s gonna focus on […]. I have this porn addiction […] I spoke to my counselor about it, but for me it was, you’re here for this (drugs) – ‘let’s now just focus on this’. But, actually, we needed to focus on that other thing also […] and try to get balance on it […] that thing is going to grow. Participant 20.