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Abstinence, moderation management or harm reduction as a recovery choice.
Dr Gabor Maté, a leading expert on addiction and trauma, uses three criteria in his definition of addiction:
Craving the addictive substance or behaviour.
Engaging in the addictive substance or behaviour to experience pleasure or temporary relief from some kind of pain.
The inability to give the substance or behaviour up.
Addiction is an attempt to solve a problem. It is the symptom of a deeper malaise, in many cases, trauma. It's when bad things happened, or simply when good things that should have happened didn’t, like when children didn’t get their needs met and were neglected, this can lead to addiction. His most important question is “Not why the addiction but why the pain?”. To heal addiction, we need to look at the underlying trauma. Dr Maté believes that ALL addiction has its roots in some kind of trauma, but not all trauma leads to addiction. Though addressing trauma is an extremely important part of healing, this post is going to address the different ways people choose to manage their substance use disorders.
Recovery from addiction refers to the process of overcoming substance abuse or behavioral addictions and working towards a healthier, balanced, and substance-free life. It is a journey of personal growth, healing, and transformation. Recovery involves addressing the physical, psychological, and emotional aspects of addiction and developing strategies for long-term sobriety and well-being.
It is important as a person in recovery, or maybe as someone considering recovery, for you to decide what recovery means to you. It’s a personal process that requires an enormous amount of internal motivation and commitment. It is about recovering what we have lost in our active addiction and reconnecting to ourselves, families, friends, communities, careers, and passions.
Although the numbers vary, depending on the research and where it was conducted, it is estimated that as much as 75% of people with addictions and substance use disorders achieve recovery. This is according to a study published by the Centre for Disease Control (CDC) and the National Institute on Drug Abuse in 2020 found 3 out of 4 people who experience addiction eventually recover. The Recovery Research Institute, states that compared to many other medical and psychiatric illnesses, substance use disorder is a disorder with a good prognosis. It is estimated that between 42% - 66% of people with substance use disorder achieve full remission, although it can take time, and more than a single attempt, to reach that point. These are USA figures, but it's countries like America who have the resources and the organisations to run these types of studies.
So, as you can see the numbers vary considerably. The important point of focus is that people do recover and probably more people recover than you may think. Recovery does not always mean abstinence and there are multiple pathways to recovery, and not all of them are based on abstinence from all habit-forming and mind-altering substances. A lot of the research does show that people who choose abstinence find it much easier to manage their SUDs and mental health, but the choice is, and always will be, yours to make, even when faced with far-reaching consequences and depending on the nature of your addiction.
Abstinence:
Abstinence needs to be a choice that makes sense in terms of your recovery and nature of your addiction and substance use disorder. A focus on abstinence in defining recovery from an alcohol or other substance use problems has a long history in the field of addiction. More recently, however, efforts have been made to broaden the definition of recovery so as to align more closely with the variety of actions one can take toward health and wellness for those with substance use disorder.
The expansion of the definition has primarily concentrated on integrating measures of functioning and well-being, which are highly significant for individuals with an SUD, whether within or outside the treatment setting. Nonetheless, a study conducted by the Recovery Research Institute in the USA revealed that individuals opting for abstinence achieved superior psychological and functional results. This encompassed enhanced quality of life, reduced depressive symptoms, and fewer alcohol-related issues.
Recent research indicates that individuals might benefit from abstaining from certain substances and behaviours. This aligns with the idea that those who choose abstinence-focused recovery tend to have fewer distractions and greater capacity to focus on creating a fulfilling life that does not involve engaging in risky substance use. Abstaining individuals may also experience health advantages linked to avoiding alcohol consumption.
With the benefits of reduced drinking compared to non-reduced drinking in mind, it is probable that involving as many people as possible in treatment through supporting non-abstinent recovery paths will result in an overall positive outcome. While these individuals may not achieve the same level of improvement in psychological well-being and functioning on average, not including them in treatment altogether would be a less favorable option.
There are clinical, non-clinical, and self-management pathways to recovery.
Clinical pathways are recovery processes aided by the services of a healthcare provider, clinician, or other credentialed professionals:
Clinical addiction treatment and care.
Pharmacology and medication-assisted treatment.
Holistic-based recovery services.
Acceptance and commitment therapy (ACT).
Cognitive behavioural approaches (CBT).
Mindfulness-based relapse prevention.
12-Step facilitation.
Non-clinical pathways are recovery processes that do not involve a trained clinician but are often community-based and utilise peer support:
Recovery residences.
Recovery community centres.
Peer-based recovery support.
Education-based recovery services.
Faith-based recovery support.
Self-management pathways are recovery processes that involve no formal services, sometimes referred to as “natural recovery.” This is a common recovery pathway in which remission from substance use disorder is achieved without the support or services of professional or non-professional intervention.
Moderation Management:
Some people may choose to follow a programme of moderation in terms of their use of alcohol or other habit-forming substances. Often moderation is more suitable for people who are not heavily dependent on their substances either psychologically or physically. This would ordinarily be initiated by a period of 30 to 90 days of abstinence, followed by the moderate use of alcohol. Moderation management is a form of harm reduction, which means that negative consequences associated with risky behaviours are managed, leading to positive behavioural change instead of stopping these actions altogether.
After the period of abstinence, a person may slowly add moderate drinking back into their life. Some people may remain abstinent for longer after a period of not drinking, some may decide to enter into an abstinence-based recovery program, and others may be able to drink on occasion without incident. Individuals participating in a moderation approach need to continue to assess their drinking, or use of other substances. If a relapse occurs, individuals may need to reevaluate their consumption levels, return to a 30-day abstinent period, or enter into an abstinence-based programme.
These choices are personal, and I encourage you to be honest and open with yourself and anyone involved in your recovery so that they can support you with the correct information about your recovery choices. Again, recovery is a personal choice, and you need to decide if the amount you are using warrants full abstinence or whether you think you can control or moderate your use.
Harm Reduction:
Harm reduction is the policies, programmes, and practices that aim to reduce the harms associated with the use of alcohol or other drugs.
Harm reduction is an approach that promotes health in a way that meets people where they are at, accepting that not everyone is ready or capable of stopping their substance use at a given time. Instead of making judgments about where individuals suffering from addiction should be with regards to their health and behaviour, harm reduction focuses on promoting evidence-based methods for reducing associated health risks in the current moment (e.g., preventing HIV and Hepatitis transmission).
The defining features of harm reduction include a focus on the prevention of harm, rather than on the prevention of substance use itself. Harm reduction initiatives run the gamut from medical care and disease prevention to education and linkage to addiction treatment. Not everyone supports the idea of harm reduction, but my personal belief is that if we are to treat people with addiction disorders as unwell then they needn't be penalised and punished for their choices, but rather supported in maintaining the best level of possible health regardless of their substance use choices and dependencies.
Principles of Harm Reduction:
A non-judgmental approach that meets people where they are at.
Treating all individuals with dignity, compassion, and respect.
Opposition to the stigmatization of substance use disorder.
Use of evidence-based policy and practice.
Accepting behavior change as an incremental process. Small gains for many people have more benefit for a community than large heroic gains achieved for a select few. People are much more likely to take multiple tiny steps, rather than one or two huge steps.
Inclusion of individuals in active addiction, in recovery, and within the community to shape policies and practices.
Focus on quality life improvements over abstinence.
Commitment to universal human rights.
Empowerment of the individual as the primary agent responsible for reducing the harms related to their substance use.
There are other areas where harm reduction has decreased the risks associated with the use of certain substances and everyday items in our lives.
At the end of the day, no one can keep you well and in a state of recovery except you. There is no coach, programme, partner, system or other external scenario that will keep you on track if you are not fully committed to the process. Only know where you are in terms of your addiction and it's long-term manageability. The face of recovery, and what that means, is changing. Treatment modalities are evolving. Pharmacological interventions are emerging. And these are not all aligned with the historical idea that only abstinence off everything is really recovery. As an adult, you need to decided the best way for you to manage your recovery and health that is sustainable and supportive of holistic wellbeing.
If you choose either of these three approaches then it is your responsibility to manage your recovery and wellness. You need to consider how progressive your substance use is and the level of consequences you are experiencing as a result. Based on this you need to make a decision that is workable and sustainable for you. The intention of this post is not to give you permission to try moderation if you know that you have crossed that invisible line at some point. But it may give you some information on harm reduction if you are looking for ways to take better care of yourself.
There are wonderful support systems, resources, professionals and programmes to support you in getting well. You don't need to go it alone. If you are unsure of which approach is a better fit for you, reach out to me and we can chat about your choices in an informative and non-judgmental way, so that you can make an informed decision.
Just remember that addicts are not bad people trying to be good. Addicts are ill people trying to get well.
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