This 2021 post from the American Society of Addiction Medicine (ASAM) blog recently came to our attention. Titled Addressing Challenging Issues in Addiction Medicine: “Abstinence Based” Treatment Centers, it reports on answers they received when posting a question from a practitioner who said “I am struggling to accept the abstinence based treatment philosophy.” This is an important statement and goes to the heart of whether or not the idea of multiple pathways to recovery is a valid approach to treatment and recovery.

In their answer, ASAM said: “The language of ‘drug-free’ and ‘abstinence-based’ treatment or condition is confusing, outdated, and inappropriately applied.” The went on to add that, in their view, “Patients appropriately taking a physician prescribed medication are abstinent from their substance of misuse.” This is a controversial statement for many reasons. For one, the diversion and misuse of buprenorphine (the main treatment drug for opioids) is well-documented and on the rise. For another, it seems to invalidate the value of the many other pathways to recovery that exist and are utilized by many people.

Later in the post they state that “Owners of ‘drug-free’ or ‘abstinence-based’ facilities often do not have clinical backgrounds so have personal or ideological perspectives on addiction and its care.” In our view, such individuals often have experience and perspectives that are the essence of peer support for recovery. Further, most states require credentialed clinical staff for the facility to maintain its license, even for ‘drug-free’ or ‘abstinence-based’ facilities.

The posts answered a message from a practitioner who said “I work as the Medical Director at an “abstinent based” facility. I am Board Certified in Psych and ASAM certified… I am struggling to accept the abstinence based treatment philosophy.” In responding to this message, ASAM said (among other statements) that, “Patients appropriately taking a physician prescribed medication are abstinent from their substance of misuse.”