This blog was written by an Anonymous SafeLink Alberta Staff Member. Editing by Oluwaseun Ayodeji Osowobi and Alisha Ostberg.
Substance use disorders are a complex and multifaceted public health issue affecting millions globally. In response to this growing crisis, two primary models have emerged in addressing substance use: the abstinence-only model and harm reduction. While abstinence-only approaches have been dominant for decades, increasing evidence shows that this model alone falls short in addressing the needs of diverse populations struggling with substance use. However, harm reduction is not opposed to recovery—it offers a more holistic and practical approach that can work alongside abstinence, supporting individuals at every stage of their journey. This blog post explores the abstinence-only model’s limitations and the harm reduction’s complementary potential.
Table of Contents
What is an abstinence-only model?
Abstinence-only programs emphasize that avoiding all use of any substances is the only acceptable way to prevent or recover from substance use disorder and any other adverse effects. Abstinence-only models often focus on the dangers of substance use and the moral or personal reasons for avoiding these behaviours. However, they usually provide little information about risk reduction and practical coping strategies.
What are the limitations?
Abstinence-only models are a narrow, rigid approach.
The abstinence-only model is built on the premise that people with substance use disorders should completely stop using drugs or alcohol, with sobriety viewed as the only acceptable outcome. This approach is often used in traditional recovery programs, like 12-step programs, where abstinence is equated with success. However, this model is inherently rigid and fails to account for the varied experiences and needs of those dealing with substance use. Not everyone is ready or able to stop using substances entirely, and some may find complete abstinence to be unrealistic or even counterproductive to their overall recovery journey.
Abstinence-only models don’t teach practical coping skills.
Research indicates that abstinence-only approaches often lead to lower treatment retention and higher rates of relapse. According to a study published in the Journal of Social Work Values and Ethics, people who do not or cannot follow strict abstinence are often stigmatized, which can result in feelings of failure and disengagement from treatment altogether. Moreover, this approach fails to provide individuals with the tools they need to navigate real-world situations where substances are present, increasing the risk of overdose upon relapse.
Abstinence-only models exclude ways to reduce harm.
One of the critical limitations of the abstinence-only model is its exclusion of harm reduction strategies, which are crucial in supporting people who are not ready or willing to stop using substances completely. Harm reduction aims to minimize the negative consequences of substance use rather than focus solely on the elimination of use. This approach includes practical measures like needle exchange programs, supervised injection sites, and access to naloxone to prevent opioid overdoses.
By contrast, the abstinence-only model often rejects harm reduction because it is assumed to enable substance use. However, research from the Canadian Mental Health Association (CMHA) shows that harm reduction does not encourage drug use but instead helps people manage their consumption in safer ways, ultimately leading to better health outcomes. Harm reduction meets people where they are, providing support in a nonjudgmental manner and often serving as a bridge to more intensive treatment options when individuals are ready.
Abstinence-only models overlook the Social Determinants of Health.
The abstinence-only model also neglects the broader social, economic, and cultural factors that contribute to substance use. Issues such as poverty, trauma, and mental health disorders often underlie addiction, and addressing these root causes is essential for effective recovery. Indigenous communities, for example, have unique experiences with substance use stemming from historical trauma, systemic marginalization, and colonialism. Harm reduction frameworks tailored to Indigenous populations have shown promise in addressing these specific needs. The abstinence-only model fails to account for these complexities and can further alienate marginalized communities that may not relate to its one-size-fits-all approach.
Abstinence-only models have unrealistic expectations and can cause potential harm.
One of the most significant flaws of abstinence-only models is the unrealistic expectation that people can immediately quit substance use without relapsing. Relapse is often seen as a moral failure rather than an expected part of recovery. This perception not only contributes to shame but can also be dangerous. After a period of abstinence, an individual’s tolerance to a substance decreases. If they relapse and use their previous dose, they are at a much higher risk of overdose, which is a well-documented consequence of abstinence-only treatment models.
By focusing just on abstinence, treatment programs often fail to equip people with relapse prevention strategies or harm reduction education. In contrast, harm reduction acknowledges that relapses may occur and emphasizes education on how to reduce the risk of overdose, such as by using smaller doses or not using alone. This approach allows for a more compassionate, practical response to relapse.
Abstinence-only models lack inclusivity.
The abstinence-only model also lacks inclusivity for people who may not define success in terms of complete sobriety. Many people with substance use disorders do not necessarily want to quit all substance use but instead aim for more controlled, safer use. The abstinence-only framework often excludes these individuals from receiving treatment because it defines success too narrowly. Harm reduction, on the other hand, offers a more flexible and inclusive approach, recognizing that people’s goals for recovery vary and may change over time.
Furthermore, abstinence-only programs often prioritize long-term, highly structured residential treatment settings, which may not be accessible or culturally appropriate for all populations. Harm reduction, by comparison, provides more accessible entry points to care, allowing people to engage in treatment on their own terms. This is especially important in rural or underserved communities, where access to long-term treatment may be limited.
The Need for Paradigm Shift
While the abstinence-only model has long been the dominant framework for addressing substance use, it is increasingly evident that it has significant limitations. Its rigid, one-size-fits-all approach fails to meet the needs of many individuals, overlooks essential social determinants of health, and can even contribute to harmful outcomes such as relapse and overdose. With its inclusive, flexible, and pragmatic approach, harm reduction offers a more effective and compassionate alternative.
As more research and real-world experience continue to show, it is time for a paradigm shift toward harm reduction. By embracing a model that meets people where they are, supports safer substance use practices, and addresses the underlying causes of addiction, we can create a more inclusive, effective, and humane approach to substance use treatment. Harm reduction does not discourage recovery or choosing to use a substance no longer—but it does use a more inclusive approach to reach those that an abstinence-only model can not.
In a world where substance use remains a universal issue, we cannot afford to continue with outdated models that alienate and stigmatize those who need support. Harm reduction is not about endorsing drug use; it is about valuing human lives and recognizing that recovery is not a one-size-fits-all journey.
At SafeLink Alberta, we embrace innovation.
SafeLink Alberta combines evidence-based public health strategies with a strong focus on innovation to address the evolving needs of our communities. We recognize that complex social factors—like poverty, racism, and trauma—shape health outcomes, and we use creative, adaptive approaches to meet people where they are. By turning bold ideas into practical solutions, we offer resources, education, and support to help individuals make informed decisions and reduce harm. Innovation drives our work, allowing us to empower communities and promote lasting change.
Need Additional Support?
SafeLink Alberta supports people who use substances. We provide drop-in support, system navigation, peer support, referrals to treatment, housing and more. Our offices are located in Calgary and Medicine Hat Alberta. You can contact us here.
References
- Provider views of harm reduction versus abstinence policies within homeless services for dually diagnosed adults
- Abstinence and Harm Reduction – Alberta Health Services
- Principles of Harm Reduction – Harm Reduction Coalition
- Harm Reduction – Canadian Mental Health Association
- Journal of Social Work Values and Ethics
- FHE Health
- Pyramid Healthcare
- Expanding the continuum of substance use disorder treatment: Nonabstinence approaches
- Harm reduction and abstinence-based models for treatment of substance use disorders during the COVID-19 pandemic: a global perspective
- Rock Recovery Center
- Indigenous Harm Reduction Policy Brief
- Interior Health
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