Is it okay to take prescription pain medication when you're a recovering alcoholic or addict? Does getting sober mean you can never take a drug of any kind for the rest of your life?

On a warm October day, I hurried to to class, maneuvering around groups of slower-moving students. I checked my phone - fifteen minutes before class started, enough time to pop into the mini mart and buy some iced tea or soda. Approaching the entrance, I smelled the faint scent of fresh cigarette smoke from a passerby. Then my eyes caught the posters featuring cigarette brands on the mini mart door. All of the sudden, pleasurable memories wafted over me. I could feel the cigarette between my fingers and taste the hot smoke. I was experiencing a smoking craving.

In addiction treatment, one of the concepts that gets tossed around a lot is that of the "lizard" or "reptilian" brain. It comes from the triune brain model set forth in the 1960s by American neuroscientist Paul MacLean. According to this model, human brains comprise the most advanced product (thus far) in mammalian evolution, sharing some properties with our evolutionary ancestors. We have essentially three parts: The reptilian complex (basal ganglia) The paleomammalian complex (limbic system) The neomammalian complex (neocortex) As it relates to addiction, the idea is that addicts are engaged in a struggle between their reasoning (neocortex) on the one hand and their instinctual, compulsive reptilian brain on the other.

Early in recovery, a young woman who had gotten sober several years before me gave me some good advice. She said that when I felt like drinking, I should make a list of possible actions I could pursue and rank them in order from least destructive to most destructive. Actions such as praying or taking a bath would probably rank high on the list, while drinking and suicide would come in last. In the middle, I might list such things as shirking responsibilities to watch TV all day or going on a reasonable shopping spree. (I should mention, I have not struggled with shopping addiction.) When I felt the urge to drink or use, I was to start at the top of the list and work my way down.

The most recent Diagnostic and Statistical Manual of Mental Disorders (DSM-5), published in 2013, changed the criteria for evaluating substance abuse problems and problems involving compulsive behavior, such as gambling. The DSM-5 includes the word "addiction" for the first time, in reference to pathological gambling, which the manual lists as a "behavioral addiction."

An old saying, often dubiously attributed to Martin Luther, warns: "Who loves not wine, women and song/remains a fool his whole life long." The phrase has hedonistic implications (which is why I find the Luther attribution puzzling) and its modern equivalent is "sex, drugs and rock-and-roll." Whether it really was Luther who said it, or whether it was Johann Heinrich Voss, as Bartlett's Familiar Quotations has it, the hendiatris is an old one. Even if Bartlett made it up himself, it would still date to at least 1855.  That means that for a long, long time, people have lumped substances, sex and music into the same category of mood-altering temptations. Reflecting on this fact made me wonder, is there a difference between addiction to mind-altering substances and mind-altering behaviors or experiences?

One of my biggest regrets from my drinking days is that I wasn't a support for my grandfather when he was dying.  We were very close throughout my childhood and adolescence, but when he experienced a recurrence of cancer I was totally immersed in my alcoholism. My mother and I lived with my grandparents for some of his last months, but I was more harm than help. He died a few months before I got sober and for years, my wreaking havoc on my family during this difficult time pained me. For the last seven years I have experienced troubling recurring dreams involving my grandparents and their home, which was a happy and magical place for me growing up.

A few days ago a good friend of mine, Leah, asked for my opinion on a situation she was having with a friend of hers, Sarah. Leah was struggling to stay clean and sober, but recently, she recommitted to substance abuse recovery. Leah wanted to help her friend with a history of drug abuse, who is on methadone, so she has been driving Sarah to the methadone clinic three days a week. Unfortunately, Sarah recently started using drugs again and is pressuring Leah for drug contacts and even to drive her to drug deals. Leah decided she needed space from Sarah and asked if I thought seeking temporary distance was okay. My response -- of course! As long as Sarah is overwhelmed by her drug-seeking behavior, she is not capable of being a good friend.

People with substance abuse issues are at higher risk for suicide than those who do not abuse substances. Research suggests that individuals with substance use disorder are nearly six times more likely than others to report having attempted suicide at some time.

I took my last drink of alcohol (hopefully for good) on February 19, 2007. I smoked my last cigarette (also hopefully for good) on December 31, 2010. In contrast, my friend quit street drugs and alcohol years ago, but she doesn't know the exact dates. 12-step programs emphasize dates. Alcoholics Anonymous, Narcotics Anonymous and Overeaters Anonymous all celebrate sobriety dates, clean dates and abstinence dates, respectively. For me, my sobriety date is extremely important. It commemorates a miraculous day when I was given another chance to live. The day I quit smoking is important to me too, but I might not remember it if it didn't coincide with New Year's. Perhaps I care more about my sobriety date because my struggle with alcohol was much harder. Even so, for the clean and sober folks I know who do not commemorate a specific clean date, (mind you, this is the minority of clean and sober folks I know) it is not because their sobriety isn't important to them.