Is abstinence best?

I’m in a time crunch, so no time to write anything about it, but this post from Peapod is a must-read.

5 thoughts on “Is abstinence best?

  1. Addiction recovery is not measurable, nor is it objective. At best "recovery" is collectively subjective. Problems are that defining recovery is a value laden task. We end up boxing people in or out with our definition.Even some measure of global health is infused with values. We don't know enough about the various factors that influence addiction to be able to determine what kind of recovery works for what person. Abstinence is the foundation that my recovery is,and must be, built upon. If someone else does not need abstinence, great. If an an addict of my type is using replacement medication then their ability to self determine is severely impaired and they can't even see it. Again, values come in here. Part of the reason I cant relate to people on MAR is that it is impossible for me to imagine being satiated by any quantity of any drug. If I am conscious then I need more and will do what it takes to get it. The obsession never left when I was on maintenance. Methadone triggered strong urges for crack which made me want more methadone and heroin and benzo's with more crack.It really is all or nothing for me. I am very happy that I figured that out. 12 step programs have norms and values that broadly define recovery. Continuous abstinence is valued, as is maintenance of certain actions and beliefs. Reinforcement of these values is a key aspect of 12 step programs. Without this continuous reinforcement many people, myself included, would probably wither and die. This does not mean that everybody needs to do it this way.I have never met anyone with an addiction who is beyond hope.I have seen many long term opiate addicts get in to abstinence based sobriety and live happy productive lives. I have also seen many die trying. So, is abstinence best? I guess it depends what you values are. Should we be shooting for abstinence in treatment? I think so.


  2. If an individual's experience with 12 step assisted "abstinent" recovery includes endless craving, repeated relapse and inability to focus on getting ahead in life, whereas the same person on medication-assisted recovery is able to maintain abstinence from other drugs, maintain a steady dose of medication without either feeling "high" or craving more, and move on to become a responsible citizen and family member – which "recovery" has more value? If you accept that there are many paths to recovery, then comparing recovery experiences with no individual context order to gauge their respective values seems like comparing apples and oranges. Addiction is often compared to other chronic illnesses such as diabetes and hypertension. If a person is unable to control their diabetes with diet and lifestyle changes or is repeatedly unable to maintain the necessary diet and lifestyle to effectively control their diabetes, but is able to do so with insulin – would that person's insulin-assisted recovery from diabetes be of less "value" than that same person's experience with having out of control diabetes not treated with insulin? If some day that person becomes able to control his or her diabetes without insulin then he or she can move on to that phase of diabetes management; meanwhile for that individual would there be more "value" in having their disease out of control than having it under control with medication?Maybe "successful" recovery is "firmly grounded in abstinence" for the most number of people. Penicillin might be the best drug of choice for the most number of people with strep infections, but some are going to react badly to penicillin. We are not going to tell them, "sorry, penicillin has the most value for the most number of people with your problem" – we're going to accept that what works for the most number of people will not work for that individual. There are people in "abstinent" recovery who can be fairly accurately described as "dry drunks." If recovery experiences are to be compared it might be more meaningful to select individuals who have re-joined their communities and families as contributing citizens instead of looking at individuals who have not. Maybe a big part the problem is that medication-assisted programs so often do not seem to provide people with much help in moving towards recovery and act only as dosing stations. Comparing the success of an individual who has received nothing more than methadone dosing seems like it would be comparable to looking at someone who went through a detox program with no recovery orientation. Both are inadequate.


  3. I agree with BOTH of the views above and that's what makes this so frustrating in that it's a complex issue. The article that sparked off the blog Jason has linked to above is worth reading (follow the links) because it is looking at the evidence.In the UK where the thrust of interventions is harm reduction and maintenance first, second and last, my fear is that there will be no incentive ever to move on resulting in a lifetime of maintenance when there may have been (for some at least) a lifetime of abstinent recovery.


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