Rightly or wrongly, society wants people with substance use disorders to abstain.
Many factors interfere with abstaining from substances.
Addiction is a brain condition, not a moral or criminal one. What an individual is supposed to do with his or her brain to abstain right here, right now, is unknowable. For most individuals and scientists alike, the brain is a black box of mystery.
Substances serve purposes. When the substances are absent, the purposes aren’t served. This absence is experienced as stress, distress, and suffering.
Humans need social connection to survive and thrive. Due to the brain’s automaticity with regard to environmental cues, abstaining usually requires cutting oneself off from anyone or anything that may trigger a return to use. Isolation is experienced as pain.
The brain has evolved to withdraw the being it inhabits from pain. Abstinence requires fighting the brain’s automatic function to relieve pain by returning to substances.
Negative consequences don’t work. Punishing an individual with negative consequences for returning to use – or an individual on his or her own trying to fear negative consequences to prevent a return to use – doesn’t work. That’s because the primary symptom of addiction is the brain’s drive to return to use despite negative consequences.
Addiction is a chronic illness. Who wants to chronically treat a chronic illness? Most people with chronic illnesses drop out of treatment, even quit filling their prescriptions for meds, and their symptoms return.
Humans naturally, normally, wondrously seek pleasure and avoid pain. Denying oneself substances can feel like self-inhumanity.
In sum, for people with acute substance use disorders, abstaining is nearly impossible, especially long-term. Relapse rates can be are high, similar to those for other chronic conditions. People with substance use disorders can be considered to be at risk for 5 years.
(Note that I didn’t even mention physical withdrawal from substance dependence. A mere annoyance compared to the anguish of the other factors.)
What tools can be helpful to people who need or want to abstain?
- Stop putting energy into things that, according to research, don’t work for most people, most of the time, better than other treatments, better than no treatment.
- Other than some medications for some substance use disorders, shrug your shoulders and accept that what directly results in abstinence is unknown. Indirect, imperfect means are all we know to try.
- Use periods of successful abstinence to attempt to identify, personally and individually, what did work for you.
- Jettison this punishing mindset: “I must make myself not use.” Research suggests that direct attempts are very unlikely to work, even help.
- Adopt this generous mindset: “I can help myself not use.” Research offers a bounty of possibilities for practices that can, however indirectly and imperfectly, help people not use.
- Learn additional methods and practices that help people abstain, experiment, and find the ones that work for you.
Art by Jesi Pace-Berkeley
This post is part of a series on evidence-informed self-care for addiction. Self-care is NOT an evidence-based treatment for addiction. The introduction and table of contents are here and posts are published in the category entitled Guide.
The views expressed are mine alone and do not necessarily reflect the positions of my employers, co-workers, clients, family members or friends. This content is for informational purposes only and is not a substitute for medical or professional advice. Consult a qualified health care professional for personalized medical and professional advice.
