Abstinence versus Harm Reduction Treatments for Substance Abuse

Abstinence versus Harm Reduction Treatments for Substance Abuse

Going “cold turkey,” or going completely without an addictive substance can seem like a terrifying idea for many people with substance dependence. Still, the practice of abstinence is often a key component of a drug or alcohol treatment program and is a cornerstone of traditional 12 Step programs for recovery. Experts continue to debate whether abstinence is possible or even helpful for everyone, and to compare abstinence with gradual reductions of controlled substances for the overall goal of recovery.

The methods for achieving abstinence can vary from person to person, but typically hinge upon removing the source of temptation. This will require a large degree of willpower and the willingness to decline a substance, like an alcoholic drink or a cigarette, even in social settings where others are taking part.

Abstinence can also involve replacing one harmful activity for a helpful one, like replacing smoking with exercise. People working toward abstinence may also have to take very close look at the sources of stress in their lives, and how to remedy those situations before they are tempted to return to the addictive substance as a coping mechanism. In some cases, this could mean establishing an entirely new social circle – a step not all addicts are willing to take.

As an alternative to abstinence, some substance abuse professionals recommend a process called harm reduction. For example, methadone can be administered on a careful schedule under a doctor’s supervision to people recovering from prescription pain medications. Also called gradual reduction, a moderate amount of the addictive substance may be allowed to stabilize the patient and help them take preliminary recovery steps.

In terms of alcoholism, a New York Times article states that moderate use therapy resulted in positive outcomes in clinical trials for nearly 75 percent of alcoholics out of a study group of 1,400. Still, many families of people addicted to substances, as well as people working through recovery themselves, say the moderate use approach may open the door to new destructive addictions.

Abstinence, too, can have its downfalls. A Harvard Medical study points out that for each person with an addiction, the addiction can assume a different level of role and importance in their lives. This makes abstinence seem too risky to some, or a goal that can never be attained for a long period.
Furthermore, University of Washington researchers explain that some counselors will not treat patients until they first reach a point of abstinence, but the patient’s emotional state may be problematic enough that they cannot give up their dependence without professional help.

Contrary to popular understanding, abstinence can mean giving an addict new options for coping – a process that could involve gradually removing the substance at first. For Noreen Oliver, a successfully recovering alcoholic and now globally-recognized authority on abstinence and addiction, the first step in recovery is to bring order to the disorganization and chaos of addiction. For some, Oliver says, this may not mean abstinence right away, but could instead mean giving a prescribed drug to get someone started on recovery.

Whether it means gradual reduction of a substance, or total abstinence, experts do seem to agree that a strong support network must be in place to guide a loved one to recovery from substance abuse.

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