Written by: Angela Smith-Sullivan, Boston, MA Journalism Graduate

The prospect of giving up drugs or alcohol entirely is too daunting for many people affected by substance use disorder. For that reason, many are often reluctant to seek help or accept treatment. They are aware of the withdrawal symptoms that will follow after they have ceased using. Moreover, many people simply cannot fathom never using drugs or drinking alcohol again, making the whole idea overwhelming. The finality of abstinence is scary for many individuals, which results in them delaying the treatment. However, although it is quite drastic and definitive, the role of abstinence in addiction treatment is more than significant – it is the most effective approach to substance abuse treatment.

Understanding abstinence

Abstinence is an approach that requires a person in recovery to give up all drugs, alcohol, or any other harmful behavior completely. It has been considered the goal of substance use disorder treatment. It implies not using any substances or engaging in any actions that may be addictive. The abstinent recovery process also involves counseling and behavioral therapy, which support recovering individuals on the road to positive changes. 

The controversy

The first program that focused on addiction treatment was Alcoholics Anonymous (AA), and abstinence was the foundation of the approach. The AA 12-step program developers truly believed that addiction is an inherent disease rather than a consequence of alcohol exposure. With this in mind, we can perceive alcoholism or other addictions as a symptom. Therefore, if a person in recovery has a drink, it is considered a complete failure. Perhaps, here lies one of the biggest cliches that are not only true but also relevant - strive for progress, not perfection. 

Many programs deem abstinence a goal, and any deviation from it may result in discharge. If we look at addiction as an illness and using or drinking as a symptom, how would that relate to other illnesses? Will a person who coughs due to tuberculosis would get discharged from the hospital? How about a patient suffering from schizophrenia who experiences hallucinations? 

Abstinence vs. moderation

Moderation, or harm reduction, is an alternative approach to addiction treatment. It implies that a person gradually reduces the amount of alcohol or drugs they consume, rather than ceasing to use altogether. Many individuals have implemented it without even knowing it as a way to control their substance abuse. For a person in recovery, moderation is a slippery slope that can easily lead to dependency on mind-altering substances again. It is, therefore, ill-advised.

What is more, data shows that extended abstinence is prognostic of sustained recovery. The National Institute on Drug Abuse published an article in 2008, stating that 34% of individuals who were abstinent for one to three years will relapse, while the percentage drops to 14% if they remain abstinent for five years. So, the chances of success increase with active participation. 

It appears that moderation is only a way to enable individuals affected by substance use disorder to continue with harmful behaviors. Moreover, people who have proved they cannot control their drinking should police their own addiction. If they were unable to do so before, why would anything change now? Also, self-reporting is not a reliable way to determine how much someone is drinking. Finally, there is no reliable way to measure success in harm reduction treatment. What is considered success?

Besides, how much sense the application of moderation to drug abuse has is more than questionable. There really is no acceptable level of drug abuse, while there is a tolerable amount of alcohol one can consume. It is not okay to allow an occasional heroin shot, knowing that each incident can lead to overdose. 

The effectiveness of abstinence in addiction treatment

We have already mentioned that abstinence is the most effective approach to addiction treatment. While moderation may be an option for those who are not physically addicted, for those dealing with addiction to illegal, mind-altering substances, abstinence is a much more effective mechanism. In other words, drug or alcohol addiction is chemical dependency, not a harmful habit that one can break with enough determination. It is a chronic disease, and abstinence is a common part of their recovery process. 

Individuals dealing with substance abuse disorders are at constant risk of relapsing. Studies have shown that embracing abstinence as an approach to addiction treatment is the most effective way to be prepared for the continual challenges that sobriety brings. It is important to remember that recovery is attainable with professional help and abstaining from all mood-altering substances. 

The importance of abstinence in addiction treatment

Although experts sometimes disagree about what abstinence means, many recognize it as a prerequisite for recovering individuals. It is because a chemically dependent person cannot always control the need for a substance. Allowing the smallest amount in can quickly lead to constant using. Moreover, mood-altering substances, alcohol included, can often alter a person's ability to think, feel, and respond, making it harder not to use. Finally, drug and alcohol abuse can cause inappropriate behaviors that can endanger both the user and other people. 

Relapse avoidance

Abstinence is a way to avoid relapse after the treatment. Alcohol and drug rehabilitation programs help people develop and adopt mechanisms necessary for coping with addiction. They teach them to recognize triggers causing substance abuse so they can employ these coping skills and avoid relapse. In addition, the adoption of a generally healthier lifestyle is essential. For instance, regular exercise is proven to be beneficial for abstinent people. 

Conclusion

The role of abstinence in addiction treatment is considerable, as it is often a requirement for long-term success. Abstaining from all substances is hard, and many individuals in recovery relapse within the first year. However, the necessary professional help and extended refraining from use increase the chances of success. Also, although a viable alternative for some, harm reduction is a slippery slope that can potentially lead to unwanted behavior. Although many consider abstinence unrealistic due to its somewhat rigid, all or nothing, nature, it is still the most effective approach. 

Written by: Angela Smith-Sullivan, Boston, MA Journalism Graduate