Do “Abstinence Only” Treatments Work?

Medically reviewed by

Dr. Gerardo Sison

March 29, 2019

What Are Abstinence-Only Programs?

Currently, it is estimated that about 95% of treatment programs are abstinence-based. Abstinence-only programs revolve around the theory that true recovery consists of a constant state of sobriety. These programs derived themselves most notably from the Minnesota module, which includes:

• Protocol that is commonly based around the twelve steps to encourage people to unlearn destructive behaviors.
• The requirement of complete abstinence including fierce opposition to moderation—it is believed that people cannot progress through recovery if they consume drugs or alcohol in any form.
• The belief that addiction is a disease and inherently incurable as individuals have no control over their behavior or physical dependence.
• Adherence to the tenet that recovery occurs from the constant accountability and admission of your illness which is furthered by attending meetings and relying on your peers.
• The stance that the primary illness is the addiction and that this must be treated before any other concern.
• The belief that recovery is a spiritual practice.

How Opinions Vary

Low Tolerance: Some abstinence-only programs leave little room for the individual and can be streamlined to negate circumstances that could prove to be either useful or detrimental to a person’s recovery. Research suggests that this “stripping away” can actually make some people more susceptible to relapse as they lose their sense of responsibility for their actions. There are some programs that have little to no tolerance for relapse and may release a person from treatment for it.

Critics of abstinence-only programs believe that it can be exceedingly detrimental to kick an individual out of treatment for relapsing, leaving them stranded without the help they need at such a crucial moment. They also argue that this defies the traditional and basic precept of this practice—that addiction is a disease you have for life—by this theory, if it is a lifelong struggle, then relapse is a viable concern that should not dictate your treatment or be wholly indicative of your commitment to wellness.

The National Institute On Drug Abuse (NIDA) acknowledges this, stating that “relapses to drug abuse can occur and should signal a need for treatment to be reinstated or adjusted. Because individuals often leave treatment prematurely, programs should include strategies to engage and keep patients in treatment.”

A Sense Of Powerlessness: Some may struggle with the concept of admitting that they are powerless over a substance which may make it easier for them to relapse. Alternative perspectives teach individuals to become empowered with education and treatment about treating their substance abuse and mental and emotional health concerns. Individuals are encouraged to work through adjacent issues within their lives to alleviate stress and triggers and maintain a balanced and fulfilling life.

Abstinence programs sometimes claim that a person’s perceptions and opinions are discounted by their substance abuse problem and this may hinder an individual’s self-exploration and accountability. Some feel that this perspective may be counterproductive, as introspection and self-awareness can be one of the greatest tools toward recovery.

Ethical Concerns: Some feel that these programs infringe on an individual’s well-being, citing that the methods employed are often confrontational. These approaches could potentially be damaging to the elderly or to individuals that have suffered abuse. Additionally, the protocol of these programs follows a strict outline that does not lend itself to individuality—there may be barriers imposed by language or culture that could impede a patient’s ability to succeed within the program.

Spiritual Aspects: Not every individual adheres to the practice or understanding of a Higher Power. Though this concept may be interpreted loosely, it still may detract from a program that adheres to these practices. Additionally, some fear that this admittance of the individual’s powerlessness paired with the reliance on a Higher Power could deter them from seeking the medical help they need to aid in their recovery.

Opposition To Using Drugs Within Treatment Protocol

Some proponents of abstinence-only treatment oppose using medication within the treatment or recovery progress. They consider it to be counterproductive or damaging to subject an individual to yet another chemical or drug while their body and mind are healing.

However, a fair amount of research suggests that utilizing various drugs within a supervised and trained medical context can actually alleviate physical, mental, and emotional strains the person may be contending with during their recovery, including depression and anxiety and to help them to become more successful in their pursuit.

Additionally, when these drugs are administered by a trained medical staff they can succeed in the following ways: managing a person’s system as they detox; reducing illicit drug use; helping prevent relapse; or reversing an overdose.

The Substance Abuse and Mental Health Services Administration (SAMHSA) is a proponent of Medication-Assisted Treatment (MAT) which “is the use of medications, in combination with counseling and behavioral therapies; to provide a “whole-patient” approach to the treatment of substance use disorders. Research shows that a combination of medication and therapy can successfully treat these disorders, and for some people struggling with addiction, MAT can help sustain recovery.”

Recovery Is Multi-Faceted

Today, it is becoming increasingly evident that addiction and abuse are rooted socially, physically, mentally, emotionally, and spiritually within a person’s life. Thus, for a recovery to be wholly successful it must attend to the drug or alcohol abuse and address the following concerns related to substance abuse:

• Their family and/or relationships
• Jobs
• Education
• Mental-health
• Legal concerns
• Any other areas that may have been affected by their substance abuse

The treatment should be continuously evaluated and modified to fit the individual as they progress through recovery, supporting their changing needs and circumstances.

Some feel that abstinence-only programs commonly bypass some of these facets, focus their attention too heavily on addressing the physical and spiritual ramifications of the addiction, and do not spend enough time preparing an individual to contend with the other aspects of their life.

What Are Some Of The Alternatives?

For those that abuse alcohol or drugs, the harm-reduction module may provide a greater and more diverse approach at providing the education, support, and skills needed to recover. Though relatively new within the history of substance abuse treatment, there is research and individuals that suggest this may be a viable option for some.

NIDA explains Motivational Enhancement Therapy (MET) as “a counseling approach that helps individuals resolve their ambivalence about engaging in treatment and stopping their drug use. This approach aims to evoke rapid and internally motivated change, rather than guide the patient step wise through the recovery process.” This therapy has been shown to be exceptionally successful with people that struggle with anger or other emotional issues.

What Program Is Right For Me?

Substance abuse counseling works and it can often be the difference between a failed and successful recovery. The important thing to consider when choosing a recovery facility is to acknowledge that each person struggles with a unique substance abuse problem. For this reason the treatment that serves them best should also be unique.

The NIDA states that “No single treatment is appropriate for everyone. Treatment varies depending on the type of drug and the characteristics of the patients. Matching treatment settings, interventions, and services to an individual’s particular problems and needs is critical to his or her ultimate success in returning to productive functioning in the family, workplace, and society.”

The structure and accountability of abstinence only or 12-step program do work for many people. In fact these programs have been shown to aid individuals that lack an abstinence social support system. By attending the meetings that are at the forefront of these programs, a support network may be established that provides camaraderie, fights loneliness, and provides accountability.

Some people may find that they will better flourish under a program based in a more holistic treatment or a medically-orientated approach. There are multiple programs that cater to various circumstances and needs and these can help you progress through substance abuse and towards a successful recovery.

Considering Life After Treatment

It is important to become as educated as you can be on treatment facilities, including their approaches and perspectives towards treatment and recovery. Take the time to speak to their staff with a list prepared of questions or concerns. This helps ensure that while within treatment you receive the care that will be most successful at addressing the demands of your life and substance abuse.

It is also important to inquire as to how they prepare you for handling life after your treatment, including how they prepare you for the possibility of relapse and how they will handle it if it occurs during treatment.

Find Out What Your Options Are

Though this process can be daunting, don’t let it deter you from finding the help that you or a loved one deserves—we’re here to help. In addition to a wide offering of articles like this one, we at RehabCenter.net have trained professionals that are standing by to listen to your concerns and answer any questions you have to aid you in making the right choice.