Definition of Abstinence in Addiction Treatment

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There are times when no alcohol is the best choice. Image © Kriss Szkurlatowski, Freeimages

Definition of Abstinence

Abstinence is a term used in the addictions field to describe the process of abstaining -- meaning avoiding, or not engaging in -- certain potentially addictive substances or behaviors. If an individual does not engage in the addictive behavior at all, either indefinitely or for a short period of time, that person is said to be abstinent or abstaining, for example, "He was abstinent from alcohol for 6 months."

Abstinence can also be a goal, for example, "She intends to abstain from sexual activity until she is married," or a philosophy, for example, "AA is an abstinence-based approach to recovery from alcoholism."

Controversy About Abstinence

Alcoholics Anonymous (AA) was the first program focused specifically on treating addiction, and complete abstinence from alcohol was the cornerstone of the approach. Therefore, abstinence has a long history of being an entrenched concept required for recovery. Those who developed the AA 12 step program genuinely believed that alcoholism was a disease people were born with, not that it develops in response to exposure to alcohol, and therefore, that any drinking was  a complete failure on the part of the "alcoholic."

Abstinence is a rigid, all-or-nothing approach, so much so, that it is considered by some factions of the addictions field to be unworkable for many people who want to overcome addictive behavior.

Some also believe it to be unnecessary, and some people are able to go from drinking excessively to drinking in moderation. This has set up a dichotomy between approaches to treatment that require abstinence, and those that do not. People working in the field, and people who seek help with addictive behaviors, are often pressured to take sides, and state whether they believe in abstinence or harm reduction as if the approaches are mutually exclusive.

For example, 12-step programs require abstinence, whereas motivational interviewing does not. Abstinence from alcohol involves completely avoiding intake of any alcohol, and contrasts with controlled drinking that might help an alcohol addict to become a moderate and non-problematic drinker. This also means that for someone to overcome a problem with drinking too much, they have to go through alcohol withdrawal, which can range from unpleasant to life-threatening. In contrast, a harm reduction approach allows people to gradually reduce the number of drinks they consume each day, without requiring the withdrawal syndrome.

Similarly, methadone maintenance treatment may or may not require abstinence from heroin or other opiate drugs, but as an opiate drug itself, people on methadone are often perceived not to be abstinent, and may therefore find themselves excluded from abstinence based programs. This can be very frustrating for people who have tried multiple times to withdraw from heroin, but have relapsed. These are the people most likely to be stabilized on methadone prior to going into psychological treatment.

Some professional have a more balanced and evidence-informed approach to treatment.

Harm reduction approaches may be most effective for many people, yet for those whose health has been severely compromised through alcohol and drug use, abstinence may be advisable, as further exposure to alcohol or drugs could be life threatening, or abstinence may half progression of a condition that may become life-threatening if the person consumes alcohol or drugs. In these circumstances, the decision to become abstinent is individual and evidence-based, not a dogmatic one-size-fits-all philosophy.

Problems With Abstinence From "Normal" Behaviors

With the growing recognition of behavioral addictions, abstinence-based approaches are increasingly seen as unworkable.

For example, everyone needs to eat, so abstinence from food is not possible -- although some who are particularly attached to abstinence-based approaches hold that certain foods should be completely avoided. Exercise addiction, sex addiction, and shopping addiction are very difficult to treat with abstinence-based approaches.

However, even among advocates of moderation and controlled approaches, it is acknowledged that abstinence has its place for certain people who are prone to relapse, for whom any addictive behavior would be harmful, or for certain stages in the process of recovery. And some addictive behaviors, such as sexually abusive behavior or the use of inhalants, are so harmful that controlled behavior is not possible or advisable under any circumstances, and complete abstinence is necessary.

 

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