Is Abstinence The Only Way?
In addiction treatment circles, abstinence is used to describe the ongoing act of avoiding or not partaking in specific behaviors or substances. Thus, if someone has not consumed drugs or alcohol for a period of time, they could be described as abstinent or abstaining.
Abstinence can also be used to describe treatment approaches or goals i.e. “Alcoholics Anonymous and Narcotics Anonymous endorse abstinence-only treatment models.”
What Does Abstinence from Substances Involve?
Abstinence, at its most simple, is refraining from one’s substance of choice. Of course, in practice, this can be extremely difficult. A substance use disorder (SUD) will cause affected individuals to experience extremely strong cravings that are difficult to resist. To help recovering individuals with this, classic 12-Step programs like AA and NA will harness the power of groups.
Participation in regular thrice-weekly group meetings that follow AA and NA models has been demonstrated to greatly improve the chances of achieving long-term abstinence. Even participating just once a week has been shown to have some benefits.
Additionally, recovering individuals could go with psychotherapy and supplemental therapies like meditation and exercise. Psychotherapy and cognitive-behavioral therapy, in particular, is particularly effective at addressing cravings as well as symptoms of common co-occurring mental health conditions.
Are Abstinence-Only Goals Realistic?
Abstinence is held by many laypersons and some mental health clinicians to be the ideal goal for individuals recovering from SUD. However, reaching this goal within a short period (less than a year) is widely known to be exceedingly difficult for individuals with moderate to severe SUD.
This could be further complicated if the individual has a dual diagnosis (one or more co-occurring mental health conditions in addition to SUD) or has serious financial constraints that make a sustainable recovery more difficult.
However, abstinence-only programs continue to be the most widespread throughout the United States. Most of these follow the model endorsed by AA and NA or have some kind of religious connection to them. These programs do have their share of self-reported successes. However, a growing number of mental health clinicians consider the “all-or-nothing” approach endorsed by these groups to be outdated or mostly unworkable.
Criticisms of Abstinence-only Treatment Models
Common criticisms of abstinence-only treatment and rehabilitation include the following:
1.) May Be Outdated
Alcoholics Anonymous’s treatment model was developed before developments that led to the current understanding of the human brain and behavioral science.
For instance, the AA founders believed that so-called “alcoholics” or people with alcohol use disorder were born with their condition. They also did not yet know that repeated exposure to certain addictive substances like alcohol changes the brain works, presenting an extraordinarily complex barrier to a full recovery.
2.) Tends to Have a Specific Moral Approach
While not universal to all abstinence-only programs, the dominant rehabilitation model endorsed by AA and NA explicitly includes a spiritual aspect that is heavily Judeo-Christian. In the right circumstances, this spirituality can serve to further strengthen one’s commitment to recovery.
While this spiritual approach is a positive for many Americans, it can be isolating for a few others, making it less useful for them as a recovery framework. This focus on morality and spirituality is also often considered to be in opposition to “evidence-based treatment” models.
3.) Potentially Dangerous
Abstinence-only treatments can be dangerous for people with severe SUD. Withdrawing from some substances like alcohol or opioids can have extremely uncomfortable withdrawal symptoms, usually requiring drug substitution therapy or dosage tapering to safely stabilize the patient.
Many supporters of abstinence-only programs oppose these types of therapeutic interventions, particularly when it needs to be long-term, as is often the case with severe opioid use disorders.
4.) Early Recovery is Extremely Difficult
Even when less dangerous addictive substances are concerned, abstinence-only approaches generally make withdrawals and early recovery extremely challenging. Without gradually tapering the dosages or substituting drugs, recovering individuals may find it close to impossible to avoid relapses. This tends to reduce the effectiveness of these types of treatment models for people with severe SUD.
Find The SUD Treatment You Need Today
Abstinence-only treatments are highly accessible and work remarkably well for recovering individuals with mild to moderate SUD. However, it’s worth noting that they are no longer the only options available out there. Alternatives like SMART Recovery that lean heavily into evidence-based treatments are also well worth exploring.
If you’re in the Dallas-Fort Worth area, Dallas Drug Treatment Centers gives you access to programs that meet your unique recovery needs. Call +1(214) 935-2287 to discuss your options.
Resources:
- Subbaraman, M. S., & Witbrodt, J. (2014). Differences between abstinent and non-abstinent individuals in recovery from alcohol use disorders. Addictive behaviors, 39(12), 1730-1735.
- Krentzman, A. R., Robinson, E. A., Moore, B. C., Kelly, J. F., Laudet, A. B., White, W. L., … & Strobbe, S. (2011). How alcoholics anonymous (AA) and narcotics anonymous (NA) work: Cross-disciplinary perspectives. Alcoholism treatment quarterly, 29(1), 75-84.
- Fernandez, D. P., Kuss, D. J., & Griffiths, M. D. (2020). Short-term abstinence effects across potential behavioral addictions: A systematic review. Clinical psychology review, 76, 101828.
- Gottheil, E. (1976). Advantages and disadvantages of the abstinence goal in alcoholism. The American journal of drug and alcohol abuse, 3(1), 13-23.