“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, microsocial, 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.

Keywords:

• “First things First” slogans
• treatment needs

GLOSSARY

• Concurrent addiction: Two or more behaviors that one is addicted to at the same time.

• Recovery: Lifestyle balance, generally described by abstinence from alcohol and other drugs, and obtaining a positive and conscientious perspective on living.

• Recovery slogan: Words, phrases, or sentences that assist one in obtaining recovery.

• Substitute addiction: When one addiction, which serves a similar function, takes the place of another addiction that has been halted.

Notes

¹ Although there is no consensualized definition by a range of involved deliverers of care and services for its targeted populations recent definitions include: (1) In the U.S., recovery from substance dependence is a voluntarily maintained lifestyle characterized by sobriety, personal health, and citizenship. Sobriety refers to abstinence from alcohol and all other nonprescribed drugs. The Betty Ford Institute Consensus Panel, Journal of Substance Abuse Treatment 33 (2007) 221–228; and (2) the UK Drug Policy Commission: “Recovery is a process, characterized by voluntarily maintained control over substance use, leading towards health and well-being and participation in the responsibilities and benefits of society” The UK Drug Policy Commission, Recovery Consensus Group Policy Report, July 2008; www.ukpc.org.uk. “Recovery” is most often associated with abstinence. Its dimensions, and the necessary internal and external, micro- and macro-level conditions for its achievement and sustainment, and the person's necessary enabling resources, as well as interfering flaws and limitations, have yet to be delineated in treatment ideologies such as harm reduction, quality-of-life, and conflict resolution. Editor's note.

² Almost all (not all) persons with serious substance use problems as adults are unable to become “controlled” drinkers or users (Sussman & Ames, 2008).

Additional information

Notes on contributors

Steve Sussman

Steve Sussman, US, Ph.D., FAAHB, FAPA,US, received his doctorate in social-clinical psychology from the University of Illinois at Chicago in 1984. He is a professor of preventive medicine, psychology, and social work at the University of Southern California (USC), and he has been at USC for 30 years. He studies etiology, prevention, and cessation within the addictions arena, broadly defined. He has over 460 publications. His programs include Project Towards No Tobacco Use, Project Towards No Drug Abuse, and Project EX, which are considered model youth prevention or cessation programs at numerous agencies (i.e. CDC, NIDA, NCI, OJJDP, SAMSHA, CSAP, Colorado and Maryland Blueprints, Health Canada, U.S. DOE and various State Departments of Education). He received the honor of Research Laureate for the American Academy of Health Behavior in 2005, and he was President there (2007–2008). Also, as of 2007, he received the honor of Fellow of the American Psychological Association (Division 50, Addictions). He is the current Editor of Evaluation & the Health Professions (SAGE Publications).

Myriam Forster

Myriam Forster, US, MPH, is a doctoral student in Preventive Medicine at the University of Southern California, Keck School of Medicine. The focus of her research is the etiology of interpersonal violence and violence-related behaviors. She has a particular interest in translational research that can improve prevention strategies in community-level care settings.

Timothy Grigsby

Timothy Grigsby, US, B.A., is a doctoral student in Preventive Medicine at the University of Southern California, Keck School of Medicine. His research focuses on adolescent and young adult health behaviors with an emphasis on the conceptualization, measurement and determinants of problem alcohol/drug use.