Is Abstinence Best for Addiction?
Lately, there have been many different approaches to treating substance use and behavioral addictions. Harm Reduction, moderation, SMART recovery, medication-assisted treatment (MAT), and 12 Step groups are several popular modalities–but what works best?
Addiction is a disease of brain reward, motivation, and related circuitry according to the American Society of Addiction Medicine. When someone engages with a behavior or substance that they have a proclivity to addiction to a neurochemical cascade of dopamine and norepinephrine. Depending on the drug or behavior, an intense feeling is produced and the addicted person pursues this feeling ad infinitum.
Can’t I just cut back?
Good question. Can you? Have you tried? How did it go? Certainly, most people are able to consume moderate amounts of drugs, alcohol, or pornography without consequence. However for some people, moderation is not an option. They are seemingly unable to stop consuming substances or behavior despite ongoing and increasing consequences.
Exposure to even one drink, drug, or pornographic image sets off the “I need more” obsession. Addicted people often report that they have honest intentions of having “just one”, and later find themselves in a situation that they did plan on.
Here a test to help you determine if you have problematic use:
Try some controlled use; drugs, pornography, gambling, alcohol. Take in a moderate amount (1-2 drinks, 1 hit/line, 1 video).
Be sure to stop after the controlled use. Do not consume any more of your substance.
How do you feel?
Do you find yourself thinking about using more? Maybe even obsessing a bit?
Did you find yourself rationalizing your next use or pursuing more?
Were you unable to stop for the rest of the day?
If you answered yes to any of the 3 questions, you should seek help.
Repeat this experiment often. Track your results. Seek help if you are unable to moderate.
What about withdrawal?
When someone stops using substances, they may experience withdrawal symptoms. Most are familiar with the dramatic acute withdrawal symptoms seen in the media today, but did you know that there are others?
Post-acute withdrawal syndrome (PAWS) is far more common than acute withdrawals. PAWS include insomnia, irritability, cravings, fatigue, and mood swings. There are many factors that contribute to PAWS intensity and duration including substance used, amount, frequency, metabolic factors, and route of administration. PAWS can occur with most substances (yes, even marijuana) and can last up to 2 years.
If you are stopping substances, please contact your doctor. Acute withdrawal can be fatal. PhaseZero is happy to provide referrals to providers that can help you quit safely.
Why abstain?
Safety: Fentanyl, which is 100 times stronger than morphine, has been ravaging the nation. Because of it’s strength, the overdose rate has climbed astronomically. From April 2020-April 2021, drugs took over 75,000 American lives with fentanyl being responsible for two-thirds of them. For some perspective, 58,000 Americans died during the entirety of the Vietnam war. Fentanyl has been showing up in methamphetamine, heroin, cocaine, and even marijuana. It’s terrifying, and many people are overdosing and dying due to the wide availability of this dangerous substance.
Effectiveness: Abstaining is effective. As any addict will tell you, it’s not the sixth drink/drug/video that gets them in trouble, it’s the first one. If the addicted person does not start using, the cycle doesn’t begin. Of course, this is easier said than done–the obsession of the mind that drives the addict to use is powerful and not easily controlled or managed.
Where do I start?
If you are using drugs or alcohol, you may want to consider treatment. There are varying levels of treatment and finding the right place for you is a daunting task. We have experience at all different levels of care of treatment and will happily help you find an appropriate place at no charge. Please speak with a doctor prior to stopping use of substances as the risk of significant consequence and death is very real with acute withdrawal.
People with porn, sex, or behavioral addictions can also benefit from treatment although there are far less services available. Please contact us and we may be able to help. Our services, or similar ones, may be appropriate.
