Many of the comments could be summarized as, “abstinence is best for some, for other’s it’s not.”
I think this misses the forest for some of the trees.
The real questions is, in general, what goal should the treatment system treat as the ideal, achievable outcome–abstinence or maintenance?
To me, if the choice is between elimination of symptoms or management of symptoms, the choice is clear.
To be fair, a maintenance advocate might reframe the question this way, “which treatment is likely to lead to the most improved quality of life for the most people?”
I think, as Peapod pointed out, Laudet’s research responds to this question:
“We conducted a study among former substance users, the Pathways Project, to examine the question. 289 participants had had a severe history ofDSM-IV dependence to crack or heroin lasting on average 18.7 years, and had not used any illicit drugs for an average (mean) of 31 months when they entered the study. They were asked to select the statement best corresponding to their personal definition of recovery – 86.5% endorsed total abstinence (Laudet, 2007).
Because the treatment system in the US is strongly influenced by 12-step ideology (McElrath, 1997), we repeated the study in Melbourne, Australia, where the approach to substance user services focuses on a harm-minimisation ideology. Australian participants were also people who had experienced a long and severe history of dependence, mostly to heroin, but who had not used any drugs recently. 73.5% of Australian participants endorsed total abstinence from both drugs and alcohol as their personal definition of recovery (Laudet & Storey, 2006).”
Further, whenever I’m confronted with a health question (for myself or a loved one), my first question is this, “what treatment do doctors with this problem receive?”
In the case of addiction, the answer to that question is abstinence oriented treatment, recovery support and monitoring that lasts years. And, the outcomes are outstanding.
Why would we focus on a different goal for other populations?