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When It Comes to Addiction, Abstinence Is Key — Or Is It?

“Hi, my name is ____, and I’m an alcoholic.” 

When conjuring up images of those suffering from substance abuse disorders, the phrase above is one most people first think of. This greeting of sorts is deeply entwined with the alcohol recovery group, Alcoholics Anonymous, an organization that in the majority of cases promotes abstinence, or in other words a complete removal of alcohol from one’s life. 

This approach of complete and permanent rejection of alcohol has garnered much attention and success, and has become over the years the forefront of substance abuse treatment, leaving many unaware of other approaches. 

But Is There a Better Way? 

One of the bigger components that the abstinence method seems to forget is the individuality of people. 

A National Household Survey on Drug Use and Health found that around 20.6 million people required alcohol and substance abuse treatment but never received it, with over a quarter claiming that was because they were not interested in abstinence. 

Although there may be many similarities in the situations of those going through substance abuse problems, a one size fits all approach severely limits options for treatment and success. If a person either is not ready for or can’t physically handle a complete removal of their substance right away, they may be left feeling discouraged and unwilling to keep trying.

This is where the Harm Reduction Model comes in and offers a different approach.

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What is Harm Reduction? 

Harm reduction, as defined by the Harm Reduction Coalition, is a “set of practical strategies and ideas aimed at reducing negative consequences associated with drug use.” 

The keyword in that sentence is “reducing”, as the end goal is not always to completely abstain from alcohol or other substances. Instead, harm reduction acknowledges that substances, such as alcohol and drugs, are a part of life and works to both accept that fact, while also lessening the negative consequences from it.

This model does not minimize the overall harm of these substances in any way, but recognizes that if they can’t be avoided, then certain ways of doing them are safer than others and supports any steps in the right direction.

For example, if an individual with a drinking problem typically consumes eight drinks per day, and after seeking treatment consumes four drinks per day, a traditional abstinence program would see this as a failure. Harm reduction, however, would view this a step in the right direction.

Would it be considered a success though? That would be based on the wishes of the individual. If abstinence is the end goal then there is still work to do, but if moderating the amount of drinks to a certain level is the goal then this may be considered a success. From then on, maintenance, or keeping this level steady would be the new goal.

Does it work?

Studies have shown that yes, this method has been effective in both the long and short term in different populations of people. 

College Students

One of the largest populations to be studied has been that of college students, a group that continues to show a very high rate of alcohol abuse. To counter this, a Harm Reduction program aimed at reducing drinking called the Alcohol Skills Training Program, which consists of therapeutic tactics such as Cognitive Behavioral Therapy was tested. After multiple sessions, participants on average had a 40-50% decrease in both alcohol intake and negative consequences, with the average baseline of drinks per week decreasing from 14.8 to 6.6. These results were still accurate even at a two-year follow up, showing long term success.

Workforce

Workplace initiatives have also been looked at, as it has been shown that about 70% of heavy drinkers have full-time employment. In one instance, a brief intervention was included in an employee assistance program and found that the number of drinks on occasion decreased from 7.56 to 4.78 upon completion. Interactive websites have also been introduced, with a pilot project called CopingMatters showing a significant decrease in drinking binges over a three month period.

Homeless

Along with student bodies and the workforce, one of the greatest populations to report substance abuse is that of the homeless, which has become a target population for harm reduction practices. 

It has been found that among the homeless who suffer from alcohol abuse, only 15-28% start any sort of treatment, and out of that number only 2.5-33% ever complete their treatment. These numbers decrease even further with programs where abstinence is the goal, meaning that the idea of abstinence can act as a barrier to getting proper help. 

Although some may say that this is because those who are homeless do not care much for their health, research has shown otherwise. In fact, when homeless in treatment are asked to set goals for themselves, improving physical and mental health are among the most popular goals, surpassing those of even basic needs. 

This strategy of goal setting when used in harm reduction can act as a powerful motivator, enhancing an individual’s feelings of self-efficacy and self-confidence, motivating them to continue. Setting these different goals also makes the treatment a more holistic approach, focusing on every aspect of the individual’s life rather than just their substance abuse. 

Also, a huge barrier to the success of many homeless with alcohol dependency is that of finding housing. This is made even harder when many housing programs have strict abstinence rules, where if broken, you can be kicked out. Housing programs without this requirement, however, lead to an increase in stable housing and maintenance which has been shown to directly result in decreased drinking and intoxication as well as a saved amount of $2,449 per person in medical and social services bills monthly.

Despite clear evidence for its effectiveness, the Harm Reduction Model is still viewed by some as a controversial method and is resisted, leaving those who need it at risk and out of options. Nevertheless, whether your goal is abstinence or reduction, recovery is always possible.

References:

Collins, S. E., Grazioli, V. S., Torres, N. I., Taylor, E. M., Jones, C. B., Hoffman, G. E., Haelsig, L., Zhu, M. D., Hatsukami, A. S., Koker, M. J., Herndon, P., Greenleaf, S. M., & Dean, P. E. (2015). Qualitatively and quantitatively evaluating harm-reduction goal setting among chronically homeless individuals with alcohol dependence. Addictive behaviors, 45, 184–190. https://doi.org/10.1016/j.addbeh.2015.02.001

Logan, Diane E., and G.Alan Marlatt. “Harm Reduction Therapy: A Practice-Friendly Review of Research.” Journal of Clinical Psychology, vol. 66, no. 2, Feb. 2010, pp. 201–214. EBSCOhost, doi:10.1002/jclp.20669. Principles of Harm Reduction. (n.d.). Retrieved April 6, 2020, from https://harmreduction.org/about-us/principles-of-harm-reduction/

When It Comes to Addiction, Abstinence Is Key — Or Is It?


Carly Heyn

Carly Heyn is a freelance health and wellness writer with a B.S. in psychology from San Diego State University. As a writer, she is passionate about breaking mental health stigmas and loves to help people become the healthiest and happiest versions of themselves. You can learn more about her on her website.

APA Reference
Heyn, C. (2020). When It Comes to Addiction, Abstinence Is Key — Or Is It?. Psych Central. Retrieved on August 15, 2020, from https://psychcentral.com/lib/when-it-comes-to-addiction-abstinence-is-key-or-is-it/
Scientifically Reviewed
Last updated: 17 Apr 2020 (Originally: 18 Apr 2020)
Last reviewed: By a member of our scientific advisory board on 17 Apr 2020
Published on Psych Central.com. All rights reserved.