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Psychiatrists and the Twelve Step

Rethinking Abstinence in Addiction Recovery

Abstinence is the state and process of refraining from engaging in a particular pursuit. We commonly hear the word used in sexuality or addiction recovery contexts.

Abstinence is the antithesis of unmitigated pleasure and consummate indulgence. I would brand it as a portmanteau of abstain and continence. The individual has to exercise a great level of self-discipline and abstain from indulging in immediate gratification, consequently yielding to the tenets of the pleasure principle–the psychoanalytic engine behind Sigmund Freud’s id (the repository of instinctual desires).

When threatened or coerced by external, worldly pleasures, abstinence employs self-restraint and willpower as its internal mechanisms, culminating in a show of strength–personified by self-control.

These internal mechanisms are countermeasures of the ego’s dogma: the reality principle, which assesses the risks and rewards, rationalizing situations and deploying delay discounting.

Abstinence secures precarious accommodations, settling on one extreme end of the moral gamut, while surveying the hedonistic landscape. Abstinence’s gaze fixates on the far, distant, and opposite periphery where decadence is perched on a towering pedestal, enshrouded in symbols of indulgence. The gamut sits on an incline as the scale tips and abstinence feels the brute weight and pressure of a society deeply entrenched in patterns of decadence–particularly consumerism as a form of psychological and emotional salvation.

Is Abstinence Sensible?

However, in a world where addictions are prevalent and etch themselves in the human condition, redefining conceptualizations of normalcy, is it enough to simply abstain from addictive pursuits? Is abstinence really the epitome of recovery?

We have to remember that abstinence is still preached in the addiction community. Groups such as Alcoholics Anonymous propagate abstinence as the objective. The brain disease model of addiction points out that certain agents or pursuits (e.g. alcohol, gambling) are inherently addictive, causing changes to neural circuitry in the brain and perpetuating a cycle of cravings and compulsions.

Thus, this model implies that the goal of treatment is complete cessation of drug intake or specific behaviors in order to eradicate addiction. Further, the person must maintain abstinence throughout his or her life. Is this realistic? We live in a world of addictions. We are immersed in a consumerist culture and are constantly barraged by a hyper-reality of sex, food, drugs, alcohol, shopping, gambling, etc.

All these pursuits are branded in a way that appeals to us emotionally and psychologically. We do not engage sexually solely in the confines of an intimate and consensual relationship. Instead, we are flooded with pornography, prostitution, sexy clothing, and dating sites to fulfill our wildest fantasies and more importantly, meet unmet needs and desires such as acceptance, love, and power.

We do not just eat to survive anymore. Instead, we are sucked into over-indulging in salt, sugar, fat, and processed foods–beyond the point of survival or simple sustenance.

In order for abstinence to be a truly liberating component of addiction recovery, our entire socioeconomic and cultural order would need an overhaul. As long as society is entrenched and rooted in this idea of exhuming psychological and emotional needs (i.e. acceptance, love, power, belonging, etc.) via material possessions–sustaining a cycle of mass consumption–abstinence will endure a Sisyphean fate.

Where Does That Leave Abstinence?

Therefore, it is not enough to just abstain from an addiction because abstinence challenges and denies our real, authentic selves. Addiction is a response to our world. Contrary to popular belief and science demonizing addiction and casting it in the realm of abnormality, I think the propensity for human beings to become addicted is a part of us and is rooted in the meddling of biology in sociocultural contexts.

I would argue that it is normal to engage in obsessive, ritualistic, and even pathological behavior (denoting compulsion and obsession in its informal usage)–especially when threatened by deprivation, pain, adversity, or loss.

We tend to love so deeply, form deep loyalties, act habitually, and master certain skills amongst many other activities. Society creates problems, but also provides solutions to our problems. In our current social order, we find relief and deliverance in many kinds of tangible and material possessions.

For example, a new, luxurious handbag may be emotionally branded as instilling confidence and awarding social recognition amongst a cohort. If we are depressed or anxious, our sociocultural context has made it convenient and acceptable to seek relief and assuagement in a myriad of pursuits such as drugs or gambling–taking advantage of the neuroplasticity of our brains and exploiting, as well as compromising, our biology.

We become immersed in a pathological, dependent relationship, anchored in servitude, where objects and material things are the portals to idealized forms of acceptance, belonging, love, power, confidence, respect, and security amongst other intangibles.

We experience not only physical withdrawal symptoms when that symbiotic relationship is threatened or severed, but also undergo a psychological withdrawal as the ego is overwhelmed by anxiety and depression. Unless our pervasive capitalistic virtues are replaced by a new social order that does not require human-object dependency to acquire intangibles, then addiction is most likely here to stay.

Where Do We Go From Here?

Abstinence implies that the individual maintains the addict label and has to endure a lifetime of refrainment from relapse–particularly in the case of drugs and alcohol. Imagine someone who suffered from alcohol use disorder and gained sobriety five years ago. That alcoholic label lingers because the person could relapse at any time.

That person could achieve 20 years of sobriety and suddenly guzzle one drink or 20 drinks. In that instance, no matter the quantity consumed, his alcoholic identity publicly resurfaces.

The amount of alcohol does not appear to matter. So,

if quantity is irrelevant, what truly defines an addiction? I think the barometer for addiction is the negative consequences and physical, social, and personal difficulties that arise. Perhaps addiction is not something to be cured, but something to be understood and moderated. If we can contemplate and embrace the notion that addiction is ingrained in the human condition–existing in a specific sociocultural and historical universe–then we may gain a deeper understanding of it.

Incorporating a harm reduction perspective, I maintain that moderation and balance are the key in life. From ritualistic binge drinking to tireless smoking, moderation matters while still recognizing and appreciating the real, physical dangers of specific addictions, such as to drugs and alcohol, and their potentially deadly effects on the body and the mind (e.g. death).

Once we achieve ways of truly gratifying needs such as love and belonging, we do not need to overindulge in worldly pleasures. How do we achieve this moderation and balance? We find those intangible needs in other social actors. In a nutshell, maintaining strong and meaningful relationships is a key aspect. We cannot find authentic security, love, or respect in money or tangible things, but we can find it in meaningful relationships with other people. It is the significant, purposeful relationships that we build and maintain that will help us truly fulfill our needs.

Resources

Taylor, D.M., Segal, D. (2015). Healing ourselves and healing the world: Consumerism and the culture of addiction. Journal of Futures Studies, 19(3): 77-86. Retrieved from https://bestfutures.org/wp-content/uploads/2018/05/

Taylor-Segal_Healing-Ourselves-and-Healing-the-World.pdf

 

 

 

 

 

Rethinking Abstinence in Addiction Recovery


Psych Central Professional Contributor

Contributors to Psych Central Professional are mental health professionals, psychiatrists, and psychological researchers who add their deep experience and expertise to our voice, sharing diverse opinions and insights into professional topics.

 

APA Reference
Matanda,, W. (2019). Rethinking Abstinence in Addiction Recovery. Psych Central. Retrieved on September 22, 2019, from https://pro.psychcentral.com/rethinking-abstinence-in-addiction-recovery/

 

Scientifically Reviewed
Last updated: 21 Sep 2019
Last reviewed: By John M. Grohol, Psy.D. on 21 Sep 2019
Published on PsychCentral.com. All rights reserved.