Addiction Masterclass: What is Abstinence?

Just like not all professionals or individuals agree on what addiction is, the same goes for how we address the problem. There are two major camps of how people address addiction, and that is through abstinence, no use whatsoever, or something that falls under the harm reduction umbrella, which may be a little bit broader and may be more permissive of people using. But which one is better? Which camp is correct? I'm Evan. I'm your resident addiction and mental health therapist. This is my addiction masterclass.

And today we're going to break down one of those interventions, and that is abstinence. Once again, in these topics of controversy, I fall in the middle. I find both abstinence and harm reduction have their place, but it just depends on the individual walking in. We must match the intervention based on the type of addiction or the circumstances of every individual client. So let's go ahead. Start off with abstinence, which means no use whatsoever. Meaning if I have a client coming to me with addiction, we are working together on the goal that they no longer use any mind or mood altering substances.

Now, this makes a lot of sense, because if someone comes to me and they've had years, let's say, of struggling with an addiction that's chronically relapsing, that they've tried to manage to control their use through all sorts of different methods. They've tried switching. Maybe they go from vodka to beer, or they go from heroin to weed, or they try these different ways to keep substances in their life, yet it doesn't work, and they continue to have consequences. Now, it makes sense to work towards that goal of not using whatsoever.

It is just too risky. Any mind or mood altering substance affects that same part of the brain, the midbrain, the one that releases dopamine, that is associated with addiction. Therefore, a lot of people fall into cross addictions, especially early on in recovery. And that is the overall rationale, the justification for why abstinence is such a strong approach, why it's tried and true and been around from the beginning of addiction treatment. Very early, drug and alcohol treatment was geared towards people who had more of a severe addiction that fell more under the disease model, and that is why abstinence was promoted.

And this was in line with the movement of Alcoholics Anonymous. Now, Alcoholics Anonymous and many other twelve step programs are based in abstinence, that you don't use alcohol in any form or any other mind and mood altering substance. For that reason, it often leads to relapse, especially for those who are severe. So at one time, that community based approach of the twelve steps and treatment were intertwined. Basically, treatment was a way of integrating the twelve steps and getting people into that community.

They were one in the same thing. Now, there's still a lot of people who go to addiction treatment who are resistant to twelve step models or abstinence in general. However, there are different levels of care which we'll break down in another video, but not everyone who comes to me, I believe is appropriate for an abstinence based approach. Of course, that worked for me. I have a bias towards abstinence based. Most people coming to my office on as an outpatient therapist who does one on one individual therapy are in need of inpatient treatment.

So even though I believe abstinence is a great tool, it's one of the best. It's the gold standard for severe addiction treatment. I don't think it's appropriate for everyone. In fact, even though abstinence works so well for me, the people who come to my office for therapy, I don't recommend it quite as often as you think. I don't recommend it quite as often as I thought going into the field. And that is because a lot of the people that first come for help are not in that stage of severe addiction.

They're in those earlier stages. They're more often in the abuse stage. And the approach for them is going to be a little bit different. I find that if someone is in the abuse stage and you push them too hard to those more extreme elements like twelve step or abstinence, that could push them away. This may be an individual who will continue to struggle, that their addiction may be progressive and eventually they would be more appropriate. And if you push them too early, they may be more resistant when they need it.

Well, I hope you found that topic interesting and illuminating. And in the next video, we're going to break down the other side of addiction treatment, which is the umbrella of harm reduction. It is newer, more progressive. It is fascinating and I believe has a really strong place in the comprehensive approach we take to treating addictions. So don't miss it.