What Does Being “Clean” Mean?
By John Steinberg, MD – Medical Director, The Bergand Group
This would seem to be a simple idea at first glance. But, as with many supposedly simple concepts, it apparently doesn’t mean the same thing to everyone. As a physician treating addicts and from the perspective of being in recovery myself, the simplest version I can offer is that “clean” refers to using NO intoxicating substances of any type other than medications as prescribed and as directed.
Both NA and AA literature seem to support this. An addict recovering in NA who is treated for ADHD with amphetamines- and who takes the medication exactly as directed and ONLY for the purpose for which it was prescribed, is, in this author’s opinion, “clean.” An addict using appropriately prescribed medication, according to NA World Service Literature (2007), may also be considered to be “clean.” The decision as to what role such NA members may play is deferred to each individual NA group. Unfortunately, many patients with dual diagnoses are occasionally stigmatized for using some medications. It is important for the addict in recovery to find both sponsors and groups who understand and can help such addicts to get through their own personal concerns in such situations. I have treated many addicts who suffer needlessly either from untreated disorders or who, in accepting such treatment, feel a sense of shame as being less than truly in recovery. Each individual addict, working with his or her prescribing physician, sponsor, and support network should strive to find the right balance between proper treatment and recovery in a 12-Step Fellowship. Not every recovering addict is so fortunate as to be entirely free of dually diagnosed disorders that require such treatment.
Yet, NA explicitly notes that NA is a program of abstinence from all drugs, especially in referring to alcohol. This applies as well to synthetic marijuana and other intoxicants. The use of any substance specifically to self-medicate feelings, to achieve euphoria, or to escape bad feelings is a perilous path for an addict to take. There are few who would consider a person doing so to be “clean.” Some professionals in the field of substance abuse disorders consider modification of use, reduction of use, or use of non-primary intoxicating, addictive substances to be within acceptable limits of the term “clean.” This author is NOT among them. The Bergand Group encourages addicts to engage in abstinent model recovery and participation in 12-Step recovery programs. While cognizant of the need to use controlled substances in treatment of disorders when properly diagnosed, we feel that if our patients were able to successfully control their use of self-selected and self-administered intoxicants, they wouldn’t have required treatment in the first place.
The bottom line is:
- If a patient has a co-occurring disorder (e.g. depression) in addition to a substance abuse problem, both illnesses must be treated at the same time.
- And both illnesses may require medications, some of which may be, in fact, controlled substances
- If a patient follows his or her doctor’s recommendations exactly, taking medicines only as and when prescribed and remains completely abstinent from all non-prescribed substances;
Then the patient can be considered “clean” and in recovery.
Empathy and understanding are what we at the Bergand Group employ in helping every addict seeking treatment and recovery to enjoy the fullest measure of personal recovery and growth possible.
John R. Steinberg, MD
Medical Director, Co-Founder
The Bergand Group