Latest developments in causes and treatments



The Movement Away From Abstinence and Toward Addiction Resistance

Millions of people every year have their lives improved and extended by successfully completing substance abuse treatment programs. However, the goal of total abstinence is elusive, with an estimated 85% of people treated for substance use disorder (SUD) relapsing within a year of completing treatment, and two-thirds returning to drug use within weeks.

A study comparing the effectiveness of inpatient vs. outpatient drug treatment programs in the U.K. found a 10% lower relapse rate for inpatient treatment (55% vs. 45%). The authors state emphatically that “relapse was associated with rural residency,” and go on to explain other related factors:

  • low monthly income
  • frequently subjected to insufficient food
  • substandard housing
  • high levels of violence
  • poor mental health

“[All these factors] may encourage them to use illicit drugs and engage in dangerous behaviors,” the authors state.

Recently, drug addiction treatment professionals are trying a different approach. Rather than pushing complete abstinence, they are focused on harm reduction and resilience leading to sustainable life situations. Author, clinical psychologist and psychology professor Dr. Kelly E. Green, writes in Psychology Today about the need to shift childhood education about substance abuse away from slogans such as “Just Say No” to realistic, scientific explanations of what addiction does to body, brain and psyche. 

Dr. Green stresses the importance of equipping young people with better tools for keeping substance abuse to moderate levels. For example, kids need to know that… 

[G]enetic predisposition accounts for 50 percent of the chance of developing addiction [and the children of addicts] are 10 times more likely to develop addiction than their friends without a family history of addiction.

Children should be taught how binge drinking and drug abuse can impair their judgment and make them much more susceptible to accidental injury. If they are impaired, they should seek assistance and avoid dangerous or risky behavior. They should know that because their brains are still maturing, an alcohol or drug problem could lead to lifelong difficulty controlling substance abuse. To quote Dr. Green:

Building addiction resistance gives [kids] the best chance to navigate the hellscape of adolescence with healthy coping skills instead of turning to alcohol and drugs to self-medicate, tolerate distressing thoughts or feelings, or foster a sense of belonging with their peers.

Dr. Green has started a YouTube channel to help caregivers teach kids to be resilient and addiction-resistant. The method of using simplistic slogans that leave no room for failure (“Users Are Losers”) results not in resilience but in stigma and shame. That stigma increases the chance substance abusers will hide the problem rather than seek help. 

Dr. Green laments:

We’ve made so much progress destigmatizing mental health struggles like depression, anxiety, autism, and posttraumatic stress disorder, yet we continue to perpetuate the Us vs. Them mentality when it comes to substance use and addiction.

We have covered the approach of harm reduction before on AddictionNews. It involves treating the whole person, not just the emergency of the moment. In addition to assisting with the immediate need to preserve life and relieve pain, there is a need to assess and remove factors causing stressful life situations. Withdrawal combined with cognitive behavioral therapy seems to work best at allowing people to deal realistically with drug problems and build resilience and addiction resistance that lasts a lifetime.

Written by Steve O’Keefe. First published May 15, 2024.


“Assessment of addiction management program and predictors of relapse among inpatients of the Psychiatric Institute at Ain Shams University Hospital,” Middle East Current Psychiatry, October 2022.

“We Need to Stop Trying to Raise ‘Drug-Free’ Kids,” Psychology Today, May 13, 2024.

“Treatment and Recovery,” National Institute on Drug Abuse (NIDA), retrieved May 13, 2024.

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