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Does Recovery Require Abstinence From Abusive Substances?

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Recovery means something a little different to everyone. For some, it may mean abstinence from all drugs and alcohol. For others, it may mean abstinence from only certain substances. Others don’t define recovery according to drug use (or non-use) at all. In fact, after conducting studies and interviews, the American Society of Addiction Medicine uses over 39 “recover elements” to define addiction. Clearly the definition of recovery isn’t as simple as abstinence. So what role, if any, does abstinence play?

What Is Abstinence?

Recovery isn’t only about abstinence. And even if it were, abstinence isn’t all that easy to define, either. The European Monitoring Centre for Drugs and Drug Addiction explains that the definition of abstinence can vary. Some people believe it means not using a primary drug of choice. Others believe it means not using any substances at all. So is there one “right” definition of abstinence? Is abstinence no drugs, just not certain drugs, or something else entirely?

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Recovery, Abstinence and Medically Maintained Recovery

Part of the reason for confusion about abstinence and recovery springs from the use of medication assisted treatment (MAT) or maintenance drugs. Time explains that maintenance therapy is different from only using medication during detox. Some individuals use medications like naltrexone and buprenorphine to help in the early stages of detox and treatment. Others will need these medications to support their long-term health. These medications are potentially addictive or problematic, but they can also make the difference between a good life and one of active addiction. This poses some questions:

  • Is someone using medications during detox or inpatient treatment “recovering?”
  • Can someone making progress while using MAT be “in recovery?”
  • Are these individuals abstinent because they aren’t using their drug of choice, or are they not?
  • And does it matter, if they are achieving their goals of moving towards a better, healthier and more balanced life?

Recovery, Abstinence and Behavioral Addictions

Behavioral or process addictions should also be considered when deciding if recovery requires abstinence. Obviously, someone struggling with an issue like food addiction can’t abstain. Someone with an Internet addiction may not be able to avoid this useful tool. Individuals who struggle with a shopping addiction still have to buy groceries, basic clothing and supplies. If they can’t abstain, are they never in recovery? The goal in these cases is management and moderation. This may be true for some people with substance abuse issues, as well. It comes down to the individual situation and the individual person.

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Abstinence Doesn’t Define Success

Another reason abstinence cannot be relied on to define recovery is because a person can be abstinent and not in recovery. AA calls this being a “dry drunk.” Psychology Today defines a dry drunk as “one that abstains from alcohol, but is still grappling with the emotional and psychological maladies that may have fueled their addiction to begin with.” Even if individuals are no longer drinking, they may be struggling with alcoholism. They may be frustrated that they can no longer drink or jealous or angry toward those who can. They may still be anxious or afraid of approaching life without alcohol. They may not have made any of the other changes that make recovery a positive, lasting and enjoyable way to live. So, if there can be abstinence without recovery, can there be recovery without abstinence? As with everything related to addiction, the answer comes down to personal experience.

Recovery Is Personal

No two addictions (or recoveries) are the same because no two individuals are the same. The important thing to remember is that recovery is personal. This is why there is no one path to recovery, no one treatment method that works for everyone and no one definition of success. Treatment must be personalized. And it is ultimately up to an individual to determine if he or she is in recovery. It is up to the person and his or her team of peers, family and professionals to determine if recovery requires abstinence. And this requirement may change depending on where a person is in life.

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Recovery Is a Journey, Not a Destination

Keep in mind that recovery is a journey. It is not a destination. Addiction is a chronic disease, so life in recovery is always about moving forward but never about being “cured.” This is why the Substance Abuse and Mental Health Services Administration’s (SAMHSA) definition of recovery may be one of the most helpful, explaining that recovery is “person driven:”

“Self-determination and self-direction are the foundations for recovery as individuals define their own life goals and design their unique path(s) towards those goals. Individuals optimize their autonomy and independence to the greatest extent possible by leading, controlling, and exercising choice over the services and supports that assist their recovery and resilience. In so doing, they are empowered and provided the resources to make informed decisions, initiate recovery, build on their strengths, and gain or regain control over their lives.”

Recovery takes both inner strength and learning to rely on external sources of support. It involves living a person’s best life, however that “best” may be defined. It involves using any tools, resources and practices that “best” may require. And the first, easiest tool available? Simple access to treatment options. WeRecover connects patients to the right treatment for them, whatever that treatment may look like now, later and long into the future.

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References

  1. Kaskutas, LeeAnn. “What Is Recovery?” American Society of Addiction Medicine. https://www.asam.org/resources/publications/magazine/read/article/2015/04/10/what-is-recovery. 1o Apr. 2015. Accessed 1 May 2018.
  2. Dale-Perrerra, Annette. “Recovery, Reintegration, Abstinence, Harm Reduction: The Role of Different Goals Within Drug Treatment in the European Context.” http://www.emcdda.europa.eu/system/files/attachments/6322/EuropeanResponsesGuide2017_BackgroundPaper-Recovery-Reintegration-Abstinence-Harm-reduction.pdf. European Monitoring Centre for Drugs and Drug Addiction. 2017.Accessed 1 May 2018.
  3. Szalavitz, Maia. “Hazelden Introduces Antiaddiction Medications into Recovery for First Time.” http://healthland.time.com/2012/11/05/hazelden-introduces-antiaddiction-medications-in-recovery-for-first-time/. Time. 5 Nov. 2012. Accessed 2 May 2018.
  4. Bennett, Carole. “Is There a Dry Drunk in Your Life?” Psychology Today. https://www.psychologytoday.com/us/blog/heartache-hope/201105/is-there-dry-drunk-in-your-life. 14 May 2011. Accessed 1 May 2018.
  5. Vecchio, Paolo del. “SAMHSA’s Working Definition of Recovery Updated.” Substance Abuse and Mental Health Services Administration. https://blog.samhsa.gov/2012/03/23/defintion-of-recovery-updated/#.WuuXb5e1vid. 23 Mar. 2012. Accessed 2 May 2018.
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