The concept of abstinence is a contentious one as it means many different things. Read on to learn more about this important topic.
What Is Abstinence From Drugs?
A common institutional definition of abstinence is a determined period of time (i.e. 30 days) of nonuse of any legal and illegal drugs before discharge from a hospital or residential substance use treatment setting.
However, as Paquette et al observed, “… only a small minority of people with Substance Use Disorders (SUDs) receive treatment. A focus on abstinence is pervasive in SUD treatment, defining success in both research and practice, and punitive measures are often imposed on those who do not abstain…
… About 95% of people with SUD say they do not need treatment…only 40% of those make any effort to get it…most people with SUD do not want or need—or are not ready for—what the current treatment system is offering….Universal abstinence goals are at odds with the objectives of many individuals with SUD. Evidence suggests many individuals with SUD desire to reduce or control their substance use rather than eliminate it” [1].
In fact, a majority of those who complete SUD treatment return to use within a year. And most require three to four treatment experiences over about nine years to achieve long-term abstinence. One of the side effects of a focus only on abstinence is that this objective alone may actually increase the probability and severity of relapse, discouraging continued attempts at recovery.
Paquette observes that returns to use are the norm and expecting sustained continuous abstinence is unrealistic for most. With this view, managing returns to substance use are key element of effective treatment. Inflexibility around abstinence can lead to poorer outcomes.
Abstinence Vs Nonabstinence AKA Harm Reduction
Since the 1980s, a newer approach has gained significant traction based on nonabstinence, known as the Harm Reduction approach. It was sparked by research into alternative alcohol treatments such as moderation and controlled drinking, and drug treatments, especially for needle users in the light of the HIV/AIDS epidemic.
Harm reduction incorporates a spectrum of strategies that includes [2]:
- Safer use
- Managed use
- Abstinence
- Meeting people who use drugs “where they are at”
- Addressing conditions of use along with the use itself
This approach is advocated by the International Society of Substance Use Professionals (ISSUP). “The term “abstinence” refers to the state of not using substances and is a contested term”. It can be defined in different ways. Abstinence may include abstaining from the use of [3]:
- Substances that a person has previously used problematically
- Substances that are illegal
- Substances that are psychoactive
- Substances to which a dependence can develop such as caffeine and nicotine
- Some medication
- Prescribed medication
For some people the significance of abstinence is disputed. It may be seen as an end in itself, such as in “achieving abstinence”. For some it helps to define “recovery”. And for others, it may be temporary or permanent but not that significant.
Abstinence vs Recovery
These varying views on what abstinence is also carry over to the term recovery. The different definitions of abstinence can cause issues for those who regard themselves as abstinent and in recovery, but define abstinence in a different way. This then makes the definition of recovery also variable with different interpretations. And it can lead to judgment among those with these different views.
There are also moral arguments. For example, it can’t be assumed that a person who is abstinent is necessarily “better off” or “more well” than someone who is not. Or that someone who has occasional controlled use of substances is less healthy or worse off than someone who is abstinent.[1]
The narrow definition of abstinence suggests that it is only being physically free from substances by personal choice. But this is too limited a view. It doesn’t account for all the elements of recovery: behavioral, emotional, spiritual and mental for the long-term.
Abstinence vs Sobriety
Given the various interpretations of abstinence, sober may take on shades of meaning as well, depending on the type of abstinence. In its most popular usage, sobriety is developed during recovery where you deal with the underlying issues that had either led to your substance abuse in the first place, or emerged as a result of their misuse.
In sobriety we learn again to deal with our emotions and acquire new skills for living. In doing so we relearn to be a good partner, parent, friend or member of the community.
Abstinence vs Moderation
Within one interpretation of abstinence, there is an approach with alcohol treatment known as controlled or moderate drinking. It counters the traditional understanding of addiction as a chronic, incurable disease characterized by total loss of control over substance use, particularly alcohol, manageable only by abstinence. Paquette reported that “decades of research demonstrates that a significant proportion of those with Alcohol Use Disorder can maintain moderate and/or low risk drinking after receiving treatment” [1].
Some distinguish between moderation goals (a level of use with no harm) and harm reduction goals (reducing but not necessarily eliminating harm). Some propose that moderation is an appropriate goal for those with Alcohol Use Disorder and harm reduction for illicit Drug Use Disorder.
Is Abstinence a Good Way to Recover from Addiction?
Given the above, a lot depends on the level of awareness you have about your addiction and available treatments. Abstinence can be a good way to recover, depending on your personal goals. Be aware that usually multiple attempts at recovery are required to achieve long-term abstinence.
What Helps People Maintain Abstinence?
- Appropriate management of withdrawal symptoms [4]
- Efforts to strengthen the person’s sense of self worth, resilience, and life skill
- Motivational interviewing and other forms of psychosocial counseling
- Treatment of any other underlying mental health conditions
- A strong recovery community
- Ongoing long-term supports based on the person’s needs and goals
- Family support
- Social support
What Makes Abstinence More Difficult?
- Environments that perpetuate ongoing substance use (such as unsafe and unstable housing
- Financial instability
- Being around substances
- Being around other people that use substance
- Lack of social support
- Lack of addiction counseling to prevent an individual’s return to substance use
- Lack of healthcare and mental health support
- Stigma and shaming behaviors
Recovery in Los Angeles, California
At the Encino Recovery and Detox Center in Los Angeles we don’t just treat addiction. We nurture the spirit, heal the mind and help you to regain your life. If you or a loved one is seeking a way out of the darkness of substance abuse, private, confidential help is just a call away. Reach out to our Admissions team now.
Sources
[1] Paquette CE et al., 2022.. Expanding the continuum of substance use disorder treatment: Nonabstinence approaches. Clin Psychol Rev. 2022 Feb;91
[2] Principles of Harm Reduction. National Harm Reduction Coalition. harmreduction.org
[3] Abstinence. International Society of Substance Use Professionals. issup.net
[4] Abstinence & Harm Reduction. Alberta Health Services.
