Treatment of addiction: from abstinence programs to abstinence-supported treatment

Abstract

During decades abstinence has been the only major treatment goal in addiction treatment; the efficacy of addiction clinics in general and treatment programs in particular usually has been evaluated with the aid of abstinence rates: the higher the number of abstainers, the better the treatment program. But for many of the patients suffering from addiction abstinence is not a very attractive treatment goal, for some of them not even an unattainable one. For many of our patients abstinence means weakness, handicap, stigmatization, a feeling of restraint, declining, inhibition, not being accepted, suppression, tension, being ill, social withdrawal, no fun, no relaxation anymore, isolation, etc.. In any case the term abstinence is strongly connected with abstention from, loosening of and distance to something. In this way a quite unattractive form of the nothing becomes the final goal of addiction treatment. Among others, this could be considered as one of the reasons of poor patient adherence in abstinence-oriented treatment programs. A way-out of this highly unsatisfactory situation for both, the patients as well as the therapists, could be a change of paradigms to abstinence-supported treatment. In abstinence-supported programs, abstinence is no longer the final goal but one of the important steps in order to reach other treatment goals according to an autonomous and mostly joyful life: on the basis of dimensional diagnostics, which are in contrast to classical categorical diagnostics not disease-oriented but phenomenology-, pathogenesis- and process-oriented, the patient and the therapist plan in dialogue accessible treatment goals according to the patient's deficiencies and resources; in this perspective abstinence is not the final aim but offers the patient a chance for transformation.