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Anne M. Fletcher, M.S., R.D.

Anne M. Fletcher M.S., R.D.


Abstinence—The Only Way to Beat Addiction? Part 1

Often, it’s better to meet people “where they’re at.”

"Attends AA and she limits herself to 1 drink a day"

Why does this keep happening? One of the answers is that many people struggling with drug and alcohol problems have been “scared straight” into believing that abstinence is the only way out of addiction and that, once you are abstinent, a short-lived or even single incident of drinking or drugging again is a relapse. “If you use again,” you’re told, “you’ll pick up right where you left off.” Once “off the wagon,” standard practice with traditional 12-step approaches is to have you start counting abstinent days all over again, and you’re left with a sense that you’ve lost your accrued sober time.

For many, this becomes a self-fulfilling prophecy—“I blew it, so I may as well keep going.” Feelings of shame and remorse result, and the flame is fueled for even more alcohol or drug use to assuage the negative feelings. I don’t know if this was the case for Hoffman, but it was reported that he attended Narcotics Anonymous, a 12-step organization. Certainly, shameful feelings can make you want to crawl into a hole and not reach out for help when you need it the most.

It’s interesting that most professionals in the field as well as lay people who attend 12-step meetings view addiction as “a disease”, when, in fact, addiction is treated so differently from other diseases. Are individuals with diabetes told they “relapsed” if their blood sugar spikes because they went off their food regime temporarily or got off schedule with their medication? Are they told to start counting their “good behavior” time all over again? For people with addiction, moralistic views and messages prevail.

Some who struggle with addiction aren’t ready to commit to abstinence, yet they’re aware of their problem and want help. However, most treatment facilities require abstinence and see it as the only acceptable outcome—in fact, many of them will kick clients out of treatment for the very symptoms of their disorder (that is, using drugs or alcohol while in the facility’s care.) Such abstinence dictates often prevent people from seeking help.

There is an alternative: what’s commonly known as “harm reduction.” As an early advocate for and expert on harm reduction, the late Alan Marlatt, Ph.D. of the University of Washington explained that harm reduction shifts “the focus away from drug use itself to the consequences or effects of addictive behavior.” Any steps in a positive direction to reduce harm caused by use of alcohol or drugs—for instance, getting into fights, mood swings, and engaging in risky sex—are supported and seen as progress. A professional who uses this approach is willing to “meet clients where they’re at”, often helping them use substances less and/or less often. Explaining that someone who’s not ready to quit using when first seeking help will often choose abstinence after a period of time, Dr. Marlatt said, “Moderation is often the pathway to abstinence.”

As a case in point of harm reduction, a 2014 National Public Radio interview shared that 89-year-old actress, Elaine Stritch —who in 2008 declared herself abstinent in a TV interview—now "attends Alcoholics Anonymous and she limits herself to one drink a day.” While fodder for fainting spells among abstinence adherents, who’s to say this is harmful?

Part 2 will explain why some experts like the concept of but dislike the term, “harm reduction.” It will also give examples of how this concept works.

Copyright, Anne M. Fletcher

Photo credit: copyright Buckley,

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