Addiction Recovery: Abstinence vs. Harm Reduction
A hotly debated topic in recovery communities is abstinence v harm reduction. Some people believe that true recovery means not taking anything that alters the way you think. Others feel that it is okay to take medications like methadone or Subutex, smoke cannabis as part of marijuana maintenance, or take psychedelic drugs to boost their spirituality and improve their connection with God. Some people in recovery believe they can moderate their drinking and using - and sometimes manage to do this. But at what cost?
This article looks at the argument for each of these and will help you clarify whether or not it is a good idea for you to take intoxicating substances when you are in addiction recovery.
What is abstinence?
Before we delve into the various arguments, let’s first examine what abstinence is.
In most recovery groups, abstinence is said to be not taking intoxicating substances. Fortunately, there tends to be exceptions made for people drinking coffee and smoking cigarettes. If this was not the case, there would be far fewer recovery members with significant clean time! The usual rationale for this exception is that, while drinking coffee is arguably harmful and smoking cigarettes certainly is, they are unlikely to cause anyone to relapse onto more problematic substances.
Recovery groups also make exceptions for people on mood-stabilising drugs like antipsychotics and antidepressants, as people with mental health problems may need these drugs to function. Without them, these people may be risking a much higher chance of relapse. That being said, some on these drugs report feeling better once they have stopped taking them. If you are on these drugs and wish to come off them, speak with your doctor and people who have successfully come off them first.
There is also the case of Medication Assisted Treatment (MAT) such as Subutex and Methadone. They are permitted in most recovery groups as they can help some people who would otherwise not be able to stop using drugs to stabilise their lives.
Abstinence v harm reduction: Does moderation work?
Many people on their recovery journey try moderation before they settle on abstinence. Someone addicted to heroin might attempt to take smaller amounts of heroin, switch from heroin to a less powerful opioid, switch from heroin to another downer, etc. These attempts invariably prove futile for many. Being addicted to these substances, there is a realisation that attempting to make changes such as these is a bit like rearranging the deck chairs on the Titanic. From here there is only one solution - complete abstinence.
Dangers of attempting moderation
While recovery groups stress the importance of abstinence, some people recovering from addiction find that after a while, they can take substances again and do not lapse back into addiction; at least for a period. Often these people encounter serious problems further down the line. This is something to consider when weighing up abstinence v harm reduction.
Physical health risks
Some people may manage to moderate for long periods. However, these actions come with dire risks. People in recovery have already damaged their bodies and brain. Because of this, many in recovery are faced with health complications because of their substance abuse and lifestyles. Continuing to take substances risks causing further damage to an already weakened system. People recovering from addiction are more likely to experience illness. Drinking and using again will not help.
Mental health risks
Addiction not only harms the body, but the mind is also impacted. Someone who suffered from depression or another mental illness may easily lapse back into mental illness following attempts at moderation. This is a dangerous place for someone recovering from addiction, as it may lead to a full-blown relapse.
Even if attempts at moderation do not cause acute mental illness, if you go back to drinking or using, you may find that your mind becomes less clear. Isn’t it a shame to lose the clarity of thought that often comes from complete abstinence?
Perhaps the most significant risk is lapsing back into addiction. This happens more often than not when someone in recovery attempts to moderate substance use.
Abstinence v harm reduction: Possible for some people, impossible for others
Some people in substance addiction recovery should absolutely not attempt moderation. If you have a history of intravenous drug use, have experienced many relapses before attaining a long period of sobriety, or have a mental illness like PTSD or Bipolar, the chance of you being able to moderate your substance use following addiction is very low. In most cases, people like this who try and moderate end up falling back into addiction, sometimes with their original substance of choice, sometimes with a different substance.
Once you are back in substance addiction, it can be extremely challenging to get out. Our advice at Recoverlution is not to attempt moderation if you feel like you may relapse into addiction. It simply isn’t worth it. If you are unsure, speak with a few people who have been in recovery for a long time.
Looking at why you want to try moderation
If you are weighing up abstinence v harm reduction, it may be worth asking yourself what is missing from your life. What is it that you want from taking substances?
If the answer is that you want to use to escape a feeling, it might be time to dig in rather than run away from it. This feeling may be something that you can overcome if you tackle it head-on. Have you considered going to therapy or going through a recovery program? These can also help you increase your ability to connect with people, which is another common reason for people to use substances.
Are you missing excitement in your life? People in early recovery sometimes complain that their lives are not as exciting as they used to be. This is normal, and this bored feeling will likely fade naturally given some time in recovery. You can also try activities that can give you back your lust for life. Have you tried any sports? Cold water swimming? Track days at your local race track? Or, even jumping out of planes? These are all activities that can help you scratch the exhilaration itch.
Other substances in addiction recovery
Here are a few substances that fall into the abstinence v harm reduction conundrum.
Medication-Assisted Treatment (MAT) - abstinence v harm reduction
As mentioned above, MAT like Subutex and Methadone are permitted in most recovery groups. However, there are complications from using these substances. While both of these drugs are unlikely to get someone high who has a large tolerance to opioids, they are both opioids and produce effects in the brain that are somewhat similar to street opioids.
This means that if you take these drugs for a prolonged time and then cease use, you will experience withdrawal. As both of these drugs have a long half-life, the withdrawal is actually much longer than other opioids. For this reason, many people report that it can be more challenging to get off MAT than street opioids, even when tapering is taken into account.
As these drugs are opioids, you may feel slightly inebriated when taking them. You may also find it difficult to work on some aspects of recovery while on MAT. As MAT can numb you significantly, working the 12 steps thoroughly may prove difficult, as part of this process is feeling emotions, which may be numbed with MAT drugs.
Addiction is all about trying to fill an empty void inside. Fixing this void involves first being able to feel it, which is not possible when someone is taking MAT. The psychological aspects of addiction stay untreated.
Marijuana maintenance: Abstinence v harm reduction
In recent years, marijuana maintenance has become more popular. Cannabis has become legal for medical and recreational purposes in many parts of the world, and there is evidence that it can reduce symptoms of mental illnesses, including PTSD. It can also help with other ailments like glaucoma, diabetes, Crohn’s disease, and epilepsy.
So there are valid reasons to use cannabis medicinally. The problem for people in addiction recovery is that they tend to overdo things, particularly when they are pleasurable. You may find that smoking cannabis is incredibly effective at treating your chronic pain and decide to smoke half a joint each evening to help you sleep, but soon pick up a psychological dependence which means you need it to get through your day.
There are treatment methods available for all illnesses. Prescription medication, natural medication and lifestyle changes can all play a valid part in reducing symptoms of all of the above, so you can live a happier life without the need for weed.
Psychedelic drugs: Abstinence v harm reduction
Psychedelic drugs have also seen liberalization in some parts of the world, and there is now evidence that the use of these drugs can play a role in healing from mental illnesses like depression and trauma.
People traditionally took psychedelics in doses that would cause them to hallucinate and experience a profoundly altered state of consciousness. More frequently, though, psychedelic users have begun to microdose, which involves taking a small amount of a psychedelic drug once a day or every few days. We will look at each of these cases separately.
Taking psychedelics at traditional doses
People in recovery wishing to take psychedelics at traditional doses do so for a couple of reasons: getting high, or promoting healing of some kind through a realization experienced in an altered state. The first of these cases can be just as problematic as taking anything else to get high. For someone with addictive tendencies, taking anything that gets you high can lead to dependency. Tripping once a month can quickly lead to tripping multiple times a week (or more), in an attempt to escape reality.
People in recovery from substance abuse addiction have benefited from taking psychedelic drugs to heal trauma and having revelations about their lives, but caution should be observed in these cases. If you have a history of trauma, psychedelics can cause this trauma to be reactivated. You can also make certain mental health illnesses worse. There are many examples of people experimenting with psychedelics becoming institutionalised due to psychosis.
And of course, taking any mood-altering substance can cause a relapse. If you still want to try psychedelics for healing, you should only do this under the guidance of professionals. The UK does not currently permit anyone to use psychedelics for this reason.
The most common reason people microdose psychedelics is to reduce symptoms of mental illness. While psychedelics can reduce symptoms of some mental illnesses, they can also increase the symptoms of others. Microdosing can also be seen as a salve for the soul – it works while you are taking the psychedelic, but you are left with the same problems when you stop taking them.
Due to the “more is more” attitude of many people in substance recovery, there is also the danger of taking increasing doses of psychedelics when micro dosing. Someone may start out taking a dose that lifts their depression a little, and a few months down the line, find themselves taking amounts that are causing them to hallucinate for half of the day. Higher doses significantly increase the risk of mental health complications.
Abstinence v harm reduction
There are not many people who can go through a period of severe substance abuse addiction and go on to use in moderation. Recoverlution advises that you do not do this. If you still decide to try moderation, exercise extreme caution.
For many who suffer from addiction, there is a mental obsession to try to moderate. It can be part of the journey into recovery. When realising that moderation is not possible, a person has the opportunity to go completely abstinent, understanding that this is their only real option.
Once abstinent, true and profound healing can then be undertaken in the form of counselling and a recovery program. New coping skills and strategies can be learned and a new way of life and total freedom from substances embraced.