The term ‘abstinence’ refers to the state of not using substances and is a contested term for several reasons.

Abstinence can be defined in several different ways. For example, abstinence may include abstaining from the use of

  • substances that a person has previously used problematically
  • substances that are illegal
  • substances that are psychoactive
  • substances to which a dependence can develop such as caffeine and nicotine and
  • some medication
  • prescribed medication

Even when a definition is agreed, the significance of abstinence is disputed. For some people, abstinence is an end in itself. This leads to phrases like ‘achieving abstinence’. For some people abstinence defines, or helps to define, ‘recovery’. (see recovery)

In other circumstances, or for other people, abstinence is simply a state of being which may be temporary or permanent but does not necessarily have particular significance.

For people who use abstinence to define recovery, different definitions of abstinence can cause issues if people who regard themselves as abstinent and in recovery compare and judge others who regard themselves as abstinent and in recovery but define abstinence in a different way. While peer pressure can be helpful and support people in making progress in their lives, it can also be destructive and divisive.

Some common inferences about abstinence are not borne out in experience. For example, it cannot be assumed that a person who is abstinent is necessarily ‘better off’ or ‘more well’ than someone who is not. (see ‘better than well’) For example, when they stop using drugs, a person who has been self-medicating for mental health issues associated with trauma may find that their mental health symptoms become more apparent and severe and may seem overwhelming. (see self-medicating) Also, it is hard to sustain a case that someone involved in occasional controlled use of substances is by definition less healthy or ‘worse off’ than someone who is abstinent. (see recreational use)

Abstinence is an unusual human state. The evidence is that all through human history back to the beginning of recorded history and across human geography the use of substances is common. Substance use has been shaped by religious and legal strictures and different forms of taboo and stigma have developed within societies. (see stigma) However, examples of the complete elimination of substance use in societies are limited and have always been temporary.

It is commonly stated that people who present at treatment services or who have a drug problem want to be abstinent. If evidence is cited for this, it is usually a 2004 paper by Neil McKeganey (citation below) However, it should be noted that Joanne Neale, a co-author of that paper, later wrote to effectively dispute both the methodology of the research and the interpretation of the data.(see citation below).

The claim that ‘people want abstinence’ is heavily contested and unhelpful if it is used to imply that people in treatment who are on OST, for example, are in this treatment against their will or that their treatment does not support them in addressing at least some of the issues they face.

McKeganey, N. et al (2004) What are drug users looking for when they contact drug services: abstinence or harm reduction? Drugs: Education, Prevention, and Policy Vol 11 pp 423-43
Neale, J et al (2011) What is the role of harm reduction when drug users say they want abstinence? International Journal of Drug Policy Vol 2.3 pp 189-193
Explore further:

Norman E Zinberg Drug Set and Setting

‘What Do Patients Want?’ Drug & Alcohol Findings 2016