The principle that “a drug is a drug” reflects a foundational concept within recovery frameworks,
emphasizing that addiction is a disease process independent of specific substances. While this perspective supports unified approaches to recovery, it does not account for the distinct physiological effects associated with different substances over time. As increasing numbers of individuals enter older adulthood in long-term recovery, it becomes necessary to examine how substance-specific physiological impacts interact with the aging process. This article explores cohort-based differences in substance use across historical periods and analyzes the implications for health outcomes, service delivery, and system design. Understanding both the universality of addiction and the specificity of physiological consequences is essential for developing effective, recovery-informed responses to the growing population aging in recovery.