The Problem with Abstinence

My last post considered the benefits and controversy over “harm reduction.” In short, harm reduction seeks to minimize the damage done to the addict and those around them resulting from their drug use, but doesn’t seek to actually stop drug use. This has led to criticism that harm reduction actually promotes drug use by making it easier and safer for addicts to use. In other words, opponents believe that drug addicts should be motivated by consequences to quit. But that rarely happens. Addiction has such a powerful hold on the addict that he or she will continue to use regardless of any potential consequences. So “harm reduction” simply brings a level of human decency that is already found in most affluent nations. Portugal’s approach, emphasizing public health over public order, is a great example.

But the question remains: Why isn’t abstinence the goal of our nation’s government? The answer is twofold.

First, our government doesn’t know how to foster abstinence. National policy is confused. It treats drug addiction as either a choice or a medical disease. The former approach incarcerates hundreds of thousands of nonviolent drug offenders under the theory that locking them up will cause them to give up using. (It doesn’t.) The latter is equally problematic: If drug addiction is a medical disease, then there should be a medical solution. But there isn’t. The best answer medicine has is Medication Assisted Treatment (MAT), which simply substitutes a long-lasting opiate for a short-acting one. And the replacement is even harder to get off! MAT is not so much a treatment as a substitute–another method of harm reduction.

Abstinence requires more than replacement with another drug. The needs of the addict that are met with drugs have to be met in some other way. That doesn’t sound so hard, right?

Which brings us to the second poart of the problem: The government can’t promote abstinence because it is prevented by law from supporting what works. Here’s why:

In my book The Soul of an Addict, I argue that addiction fills certain specific human needs for the addict. These include identity, life purpose, life structure, community, and moral code. And these needs are exactly what religion provides in its sociological sense. In other words, drug addicts are caught in the grip of a false and destructiuve religion. In order to changem they need to get these needs met in a healthy way– through a real religion. And our government is barred from getting involved in religion. It’s called separation of church and state.

Now religion in the sense needed for an addict to recover is very broad. The Twelve Step progams, which claim not to be religious, provide these needs. So can the various mainstream religions, from Christianity to Buddhism, although most churches, temples, and mosques don’t know how to apply their religion in a way that addicts need.

However, the ban on government supporting religion is also very broad, and includes Twelve Step programs. So the very thing that could promote abstinence from drugs cannot be included in government policy. So we cannot look to our government for help. They can’t provide it.

This leads to a strange situation, but one with which addicts are hardly unfamiliar: addiction exists outside the purview of government policy. The government will continue to lock up or medicate the addict. It has no other recourse. Or more accurately, there is another recourse but our government is prevented by law from exercising it.

Sadly, this means that the effort to help addicts find an abstinent recovery falls outside govertnment policy. It is up to nongovernmental agencies–and individuals–to promote true recovery. Those most capable of doing so are addicts who have already found recovery. Which, ironically enough, makes the recovering addict more powerful than our government in addressing the scourge of addiction sweeping our nation.

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