Can You Use Crack ‘Socially?’ Addiction Myth Watch: Charlie Sheen Edition

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The subject of addiction swirls with myths and misinformation. It doesn’t help that so many people seem to believe that their own struggle with addiction — or a few drop-ins to Alcoholics Anonymous meetings — make them unquestionable experts on the topic. As the latest news about Charlie Sheen’s escapades show, sometimes the seemingly crazy statements of an apparently active addict can be more accurate than those of people who have spent years in recovery and even some “addiction experts” — if you go by the science, that is. (More on New Hope For An Anti-Cocaine Vaccine)

Myth One: Everyone Who Takes Crack Is An Addict

On Monday, during a radio interview with the sports-talk “Dan Patrick Show,” Sheen mentioned that some crack users can “manage it socially.” (He said his own attempts to be a social crack user “kind of blew up in my face. Like an exploding crack pipe, Dan.”)

Although crack cocaine is indeed one of the most addictive drugs, Sheen’s statement about social use is true of most people who have tried the drug, if by “social” you mean use that does not qualify you for a diagnosis of substance dependence. Far from being universally addictive, crack is actually unattractive to the majority of people who’ve tried it: only about 15%-20% of initial users become hooked. (More on Bonus: 4 Tips for Staying on the Wagon)

Indeed, according to data from the National Survey on Drug Use and Health, about 75.6% of those who tried crack between 2004 and 2006 were not using it at all two years later. Another 15% were still hitting the pipe occasionally, but not at levels that would qualify them as addicts. About 9.2% were addicted.

So, although Sheen’s terminology may be inexact, he’s correct about the existence of non-addicted crack users. He’s also correct to note that drinking chocolate milk is much, much safer.

Myth Two: Residential Treatment Works Better than Outpatient Treatment, and Must Be Done in Groups

People magazine recently reported that Sheen would go into treatment for substance abuse for the third time, this time at home: “Surrounded by a team of professionals, the Two and Half Men star will attend no meetings with other patients, check into no center. He could do it all at home or in some other private setting.” (More on Does Suffering From Withdrawal Really Mean You’re Addicted?)

Commenting on Sheen’s rehab plan, Dr. Drew told the magazine that “treatment of addiction is a group process when done properly — not an individual thing at all.” Yet actual addiction research shows this is not the case. For example, the largest study ever done on alcoholism treatment, Project Match, was conducted mainly through individual therapy sessions (though one arm did focus on improving 12-step group participation):  its aim was not to compare individual to group treatment, but overall, it found individual treatment just as successful.

Further, studies that have directly compared inpatient treatment to outpatient therapy have found that there is little difference in outcomes for most addicts, except for very severe cases, particularly amongst the homeless and jobless — these people lack social and family support, or other important goals to work toward, things that have been found to aid recovery. For employed professionals — like Sheen — outpatient and inpatient treatment tend to be equally effective. (More on ‘i-Dosing’: Can You Download a Drug High?)

Myth Three: 12-Step Programs are Required for Recovery

Although celebrities, including Sheen’s own father, swear by them, 12-step programs like Alcoholics Anonymous are not the only way to recover from addiction. Project Match, in fact, found that on most measures, cognitive behavioral therapy and motivational enhancement therapy were as effective as 12-step facilitation (TSF), a program that worked to enhance 12-step attendance. When patients received these therapies as after-care following inpatient treatment, all three groups did equally well. However, in outpatient-treated addicts, those in the TSF group had slightly better rates of complete abstinence in the year following treatment. (More on Study: Do Energy Drinks Lead to Alcohol Abuse?)

So, although Sheen may not exactly be a model citizen — or rehab patient — his distaste for 12-step programs does not mean that he’s untreatable. Maybe he just needs to find a rehab or addiction “professional” who is familiar with the scientific literature.