“First Things First”: What is the First Thing?

Abstract

This OP-ED piece comments on the down-side of an otherwise useful 12-step slogan, “First Things First,” which generally refers to staying sober (not drinking or using no matter what). While important, there are environmental, micro-social, psychiatric, and neurobiological considerations that may place other needs at an equal or higher priority than sobriety per se. That is, other changes may be needed to set the stage for, or enhance efforts at sobriety, prior to or concurrent with attempting to quit one's drug of choice. Perhaps slogans should be considered in a broader context and not be taken too literally.

Substance and Behavioral Addictions, and Their Consequences among Vulnerable Populations

“…There may be a need for psychiatric assistance. (See [38,40] regarding means to rebuild recovery capital.) However, one may experience substitute addictions once one abstains from drug misuse (e.g., other drugs such as tobacco, or various behavioral addictions), which could continue to negatively impacting one's QoL (e.g., [27,41]) and depleting recovery capital.…”

A Perspective on Cigarette Smoking During Alcohol and Substance Use Treatment

“…For many decades, the predominant belief guiding substance user treatment approaches was that cigarette smoking should not be addressed in the early phases of treatment for fear that incorporating tobacco cessation into the treatment protocol might overwhelm individuals experiencing withdrawal symptoms from alcohol and drugs (Sussman, Forster, & Grigsby, in press). It was thought that intervening on smoking too early in the recovery process could potentially remove a coping mechanism, or soothing agent, for the anxiety and discomfort associated with withdrawal thereby increasing, rather than decreasing, relapse rates.…”