Increasingly the addiction treatment field is recognizing the benefits associated with non-abstinent substance use disorder remission pathways. At this same time, this study, and others like it suggest individuals pursuing abstinence-based recovery may experience more psychological and functional gains.

Abstinence was associated with generally better psychological and functional outcomes.

For complete research 

The aim of this study was to better understand the role of social networks in maintaining recovery from opioid use disorder (OUD). Researchers completed longitudinal surveys (2 surveys, 3 months apart) with 106 adults receiving medications for OUD in Delaware who planned to disclose their substance use, treatment, or recovery to a person in their life. Surveys assessed the degree of social support provided, and closeness to—and history of shared substance use with—the person to whom they disclosed.

• Participants who disclosed to someone with whom they felt close had increased commitment to recovery. This was stronger among individuals whose close contacts provided higher social support.
  
• Disclosure to someone with whom participants had previously used substances was associated with decreased commitment to recovery.
  

Comments: Social networks and relationships can influence recovery. This study demonstrates that disclosing substance use, treatment, or recovery to a highly supportive and close person—without a shared substance use history—may be beneficial to recovery.

Elizabeth A. Samuels, MD, MPH, MHS Reference: Brousseau NM, Karpyn A, Laurenceau JP, et al. The impacts of social support and relationship characteristics on commitment to sobriety among people in opioid use disorder recovery. J Stud Alcohol Drugs. 2022 Sep;83(5):646–652.

It is against this backdrop that two further (linked) debates continue to haunt drug policy and in particular the implementation of recovery models:

1.       harm reduction versus recovery
2.       professional versus peer roles in supporting recovery pathways.

The two debates overlap and are laid out here as choices or dichotomies although there is no reason that they have to be seen as such. In Scotland, the transition from the Road to Recovery (Scottish Government, 2008) to Rights, Respect and Recovery (Scottish Government, 2018) is seen as the pendulum swinging back in the direction of harm reduction in response to drug-related deaths and several of our key informants felt the same was the case for the 2017 UK drug strategy (HM Government, 2017) – seen as a ‘balancing’ of recovery and harm reduction.
But who makes those decisions, particularly the ones about implementation? When we did the research it was very hard – particularly in England – to identify or speak to those who were responsible for shaping and implementing drug policy. Yet this leads to a real concern that power (and money) remains in the hands of vested interests including a small cabal of treatment providers, a cosy network of ‘experts’ and the hegemonic influences of their disciplinary backgrounds and the continuing shadow of the pharmaceutical industry.
Conclusion
The shared concern in both the US and the UK is that increased investment and increased public concern and attention have not led to new ways of thinking but have largely ended up in doing more of the same. More treatment workers, more treatment services and very little of the crucial lessons from recovery – jobs, houses and pathways to community capital and resources. In Scotland, McGarvey (2018) has referred to this as the self-preservation of the ‘poverty industry’
Recovery policies are very hard to implement effectively yet there are great examples from the US outlined in John Kelly and William White’s 2011 book “Addiction Recovery Management”. While there are always opportunities (and needs) to improve treatment, the commitment to meaningful recovery-oriented systems of care is essential if short-term gains are to be translated into lasting and meaningful changes in communities and families.  It is notable that almost no funding has been allocated to researching recovery-oriented systems of care in the US or UK in the last decade.

For more Recovery in Policy and Practice on Both Sides of the Atlantic — (rec-path.org)

(The Dalgarno Institute has for over a decade now, argued in a similar fashion that Harm Reduction ONLY ideologies that should lead to drug use exiting recovery, have not. Instead, it appears a cynical strategy has been in play that has seen Harm Reduction hijacked by certain ‘gate-keepers’ of drug policy to simply sustain a ‘damage management’ model that takes a non-accountability stance toward self and community harming drug use.
Even though ‘right’ words are often used and the Australian National Drug Strategy has put Demand Reduction as the priority pillar, we still see interpretation of policy and the continued relentless promotion of harm reduction principles used to enable, equip, and even endorse ongoing drug use, rather that actively facilitating reduction, remediation, and recovery from drug use.
This is not a secret; however, it is entrenched bureaucracy that continues to guard the ‘poverty industry’ mentioned in this article.   Political will and a removing of the strangle-hold of pro-drug advocates on policy interpretation is what is needed to see a genuine change, in not only policy direction, but the positive health benefits it brings.)

Also see

• Contingency Management for Abstinence as a Recovery Tool?
  
• Abstinence: Not the only option, but clearly the best one for your well-being
  
• Overcoming the pains of recovery
  
• Maintaining Hope and Health During Drug Abuse Recovery (Of course, the irony is that all the following factors are also key in the #Prevention and #DemandReduction space.
  

Quitting the Booze or At Least Slowing Down? Check out these offerings.

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After nine years as a homeless drug addict in Los Angeles, Jared Klickstein finally checked himself into a drug treatment center. Unlike the program he had gone to six years before, which had hot tubs, acupuncture, and trips to the beach, this one, in North Hollywood, was deadly serious about personal responsibility. Clients kept a strict schedule. They did chores. They scrubbed toilets. “No hot tubs,” Klickstein said.
Most important, they couldn’t use drugs. “If you use, they kick you out,” he said. “There’s consequences.”
It took him two attempts, but Klickstein, now 33, finally got clean. Four and a half years later, he’s independent, employed, and emotionally stable. “I was a person that you would see on one of these videos, screaming with blood and shit all over them,” he said. “And now I’m not.”
Klickstein attributes his success to the North Hollywood program’s emphasis on sobriety and accountability. “Without sobriety, there is no mental or emotional stability for me and most other drug addicts, meaning homelessness was inevitable,” he said. “Half measures and coddling do not work. Period.”
But tough-love centers like the one that turned Klickstein’s life around are becoming harder to come by. The idea that you have to quit drugs to recover from addiction has become old-fashioned, and treatment centers that insist on abstinence are disappearing. In California, changes in state law have made it virtually impossible for any program that accepts public funds to push clients to quit using.
... and before he got himself cleaned up. “Half measures and coddling do not work," Klickstein says. "Period.”
“You cannot intervene or even speak to someone regarding their alcohol and drug use,” said Reverend Andy Bales, who has worked in drug recovery in Los Angeles for decades. As a result, most homeless services and housing providers in the city allow, in his words, “a free flow of alcohol and hard drugs.” This permissive approach, Bales believes, is why California has more people living on the street than any other state in the country.
The repudiation of abstinence-based treatment in California and many other states represents the broad embrace of an approach called “harm reduction.” Instead of seeing addiction as a serious illness whose treatment ultimately requires addicts to stop using drugs, it casts addiction as a risky health condition to be managed, and insists that different people benefit from different management strategies, not all of which require abstinence.
But as the addiction crisis has deepened across the country, with the highly toxic and addictive opioid fentanyl killing addicts at record rates, homelessness exploding in California and throughout the West Coast, and drug cartels operating in the open in cities like San Francisco, the ascendance of a particularly dogmatic form of harm reduction may be exacerbating the crisis instead of mitigating it. By normalizing drug use, eschewing intervention, and shutting down abstinence-based treatment programs, critics of this radical harm reduction philosophy believe it’s keeping people trapped in addiction.
“It’s just going to end up with more death,” said Klickstein.

For complete story

Also see
The inevitable outcome of ever permissive drug policy interpretations and
The Disastrous Californian Cannabis Legalization Experiment – More than promises ‘Up in Smoke’!