Why Is Abstinence the Best Choice for Addiction?
And why is shaming people with addiction the only way to help them?
Posted May 28, 2019
"We admitted we were powerless over alcohol—that our lives had become unmanageable." —Step 1 of 12, Alcoholics Anonymous
“Hi my name is Adi and I’m an alcoholic.” Most of us are familiar with this phrase thanks to Hollywood movies, and I was lucky enough to utter those words nearly daily in Alcoholics Anonymous meetings for years. The AA program has become synonymous in our culture with addiction recovery.
Since 1935, AA claims to have helped 2 million “problem drinkers” recover from alcohol addiction. And regardless of whether you think 2 million is a "fuzzy number" or "fake news," there is a reason why 12-step programs have a monopoly in the recovery sphere—they work, plain and simple.
Therefore, there is no other need for any other recovery options, nor do we need to implement other principles like harm reduction or medication assisted treatment because once everyone is 100 percent abstinent, there will be nothing left to cause harm.
In addition, this program came about 80 years ago. Why should we give people more options for recovery, when the old ways work so well? I mean, all addicts are the same. People definitely don’t need more options when what we have works just fine. So, let’s look at some of the reasons why traditional treatment programs (especially those that rely primarily on 12-step work) are simply the best (now and forever):
1. Adults currently struggling with addiction are like toddlers and therefore need to be told what's best for them.
While one person's goal may be to cut back on their daily consumption to improve their relationships another person's recovery goal may be to simply lose weight. Just because goals are individualized, "success" in recovery should only be measured one way, and one way only, abstinent or not. Telling people what to do ("you must be 100 percent abstinent forever") is the perfect way to inspire those who want to quit because it ensures that they are afraid of and feel shame if/when they relapse. Shame = Good.
Even though it’s been scientifically proven that giving people a choice in goal-setting makes them more likely to be committed to the goal, we still prefer the strict 100 percent abstinent goal found in our traditional approaches. This is only a hypothesis that has been tried and tested in both laboratory and field-based research settings (Erez, Early, & Hulin, 1985). Groups in the study that were allowed to establish their own goals exhibited higher goal commitment relative to groups there were assigned goals. Essentially, if a person has input into a goal then they are more invested in trying to attain that it. Ever heard of the IGNTD recovery program where participants choose their own goal? It’s up to the individual to decide whether they are willing to commit to full abstinence, a period of abstinence or a reduction of drug or alcohol use. I can’t believe programs like this exist. What a bunch of hogwash (anyone who tells an addict they can have a choice of what to do must be liar and a cheat—like all those rehab owners who keep getting caught embezzling money, defrauding insurance companies or sexually harassing or assaulting their clients).
2. Abstinence is the only realistic treatment goal for everyone
Celebrities such as Anne Hathaway, Lena Dunham, and Russell Brand have all made their abstinence recovery journeys public. And if they can do it than anyone should be able to. If/when people relapse it's their fault for being sick and weak and we should double down on pushing them. It definitely doesn’t mean there's anything that requires changing in the current approach.
It’s Darwinian selection at it’s best. Let them learn on their own.
Abstinence programs work long-term for most folks. Pay no mind to the numbers below, they’re just there to show you how ridiculous “statistics” can be.
According to the National Institute on Alcohol Abuse and Alcoholism, evidence shows that roughly 90 percent of people with an alcohol use disorder relapse within four years after completing treatment.
Some studies have shown that people who receive treatment have a short-term remission (they get better) rate between 20 percent and 50 percent. Unfortunately, between 20 percent - 80 percent of those same people are estimated to relapse in the long-term. What’s more, between 40 to 60 percent of people who've been treated for an alcohol use disorder relapse within a year, according to a 2014 study in JAMA. Regardless of the high relapse rate, 12-step programs are the most popular for a reason.
3. They don't allow MAT, which everyone knows is just replacing one habit for another.
If Medication Assisted Treatment keeps people alive long enough so they can seek help and gives the person struggling with addiction a moment to pause and think about literally anything other than the substance they are addicted to, why shouldn't it be a viable tool in recovery?
Because it’s a drug.
And don’t you dare compare MATs (herbal or non-herbal) to caffeine or sugar. Next thing you know, you’ll be telling us that coffee and cookies should be banned at AA meetings because they might become replacements for those things we’re addicted to. Everyone knows it’s impossible to become addicted to sugar or caffeine. Sure, MATs might work when they are used in conjunction with other behavioral therapy because they reduce the social consequences of an alcohol or drug addiction (access, risky behavior, chance of overdose) and gives the individual a chance to get to the root of the problem, but that’s all just hearsay. If you use MAT and therapy as a tool to help you throughout your recovery, you’re basically cheating.
And we don’t like cheaters, even if they’re alive because of it. We did it the hard way, so you have to also.
4. You are forever branded an addict, which helps internalize the shame you feel.
Shame prevents people from getting the help they need BEFORE they ever hit rock bottom and then it helps trap you when you relapse, because you're afraid to admit you failed. For anyone who has ever been in recovery, you know how helpful it is to embody shame and keep adding to it whenever possible. Go ahead and set goals for yourself (especially unrealistic ones like being abstinent), relapse, and then run to your nearest AA meeting so you can repeat the cycle of shame and repentance.
After you’ve repeated that cycle enough times (and hopefully made it back alive every time), you’ll be so used to the shame that you’ll start wearing it like a badge of honor. And assuming you did make it back, that’s when the winning starts.
Shame is actually the sober person's secret to success.
5. Recovery is rigidly defined: You are either 100 percent abstinent or you are not.
Obviously, abstinence is the best path toward recovery because that leaves no gray area. And we all know that all the solutions to life's problems are always black and white.
How many times have you committed to something like losing weight, cutting back on spending or eating less chocolate—and had a slip-up? Does that mean you are an utter failure? Yes, of course it does.
Recovery is not on a spectrum; you are either in recovery or you aren’t. Even if you’ve been a heavy drinker for 30 years (drinking 6+ drinks/day) and manage to cut back to 1-2 drinks per day, that doesn’t mean you should earn a gold sober star. It means you should keep going to meetings until that 1-2 drinks a day becomes zero. Otherwise, you’re a failure and a disaster waiting to happen.
According to the AA website, addicts only have one primary purpose: to stay sober and help other alcoholics to achieve sobriety. Some people think that’s a problem because it doesn't consider the person's relationships, work/life balance, or happiness levels. But I happen to think it’s a great philosophy. If someone has reduced their alcohol consumption and has improved their relationships and overall functioning, that’s great for them, but that can’t happen, so it doesn’t matter.
In conclusion: The ongoing addiction debate
Here’s the thing everyone, and I assume I’ll get some flack for this: I’m certainly not condemning AA or 12 step or abstinence-only programs because I know they do work for some people. But when we have them as the only option it leaves a lot of people in the dark. Some people don't want to quit completely. Some people don't want to be branded an addict forever. We need to broaden the definition of recovery so that it's more inclusive and we need to continue to ensure that people have options and choice in their method of recovery.
Because people are dying and we’re losing this war.
Just because you're 100 percent abstinent doesn't guarantee that your quality of life has improved. Maybe you are abstinent but maybe you also isolate yourself from others, for fear of being triggered and relapsing. Does that mean you are cured? Shouldn't we be working toward improving quality of life? That's why I am advocating redefining measurements of success in recovery.
Let’s look at the quote we began with, “We admitted we were powerless over alcohol—that our lives had become unmanageable.”
This is simply not true. You are not powerless over alcohol. Nor are you powerless over any other addiction.
I mean, isn’t the act of going to a meeting and going to see a therapist and calling your sponsor literally an act of exerting power over your addiction?
Again, this doesn't mean you're all powerful either—this isn't a Superman movie (and even he had Kryptonite).
I believe that with the right tools and support, you (and all of us) can create new healthier habits that will help you overcome your addiction and live a more fulfilling life. Because there is no direct path to addiction, there is no one size fits all path to recovery.
Erez, M., Earley, P.C., & Hulin, C.L. (1985). The impact of participation on goal acceptance and performance: A two-step model. Academy of Management Journal, 28 (1), pp 50-66. Sourced from: https://ie.technion.ac.il/~merez/papers/erezearley.pdf