Abstinence-based treatment

• ALSO KNOWN AS: Minnesota model of addiction treatment

DEFINITION: Abstinence-based treatment of substance use disorder is based on addiction as a disease. According to this treatment model, no cure exists for the disease of addiction. Through counseling and continued support, the person experiencing a substance use disorder can recover as long as they maintain lifelong abstinence from drugs and alcohol.

History

Abstinence-based treatment was first developed at Willmar State Hospital and Hazelden Treatment Center in Minnesota in 1949. The treatment was targeted at “hopeless alcoholics" and was based on the principles of Alcoholics Anonymous (AA). Borrowing from the twelve-step meetings of AA, developed in the 1930s, these alcoholic treatment centers added residential treatment that included lectures, open discussions, small group therapy, and peer interaction.

First known as the Willmar or Hazelden model, and then the Minnesota model in the 1970s, abstinence-based treatment centers became the predominant model for treating both alcohol and drug abuse in the 1980s. Private treatment in twenty-eight-day residential treatment centers dominated the treatment landscape but was affected by cost-cutting managed care by the 1990s. Modern-day experts agree, however, that the longer the residential treatment, the greater the chance of success.

Many abstinence-based treatments occur in outpatient settings. Treatment focuses on individualized treatment plans, family involvement, and frequent use of group meetings such as AA, Narcotics Anonymous, and Al-Anon. Studies show that more than 90 percent of drug and alcohol treatment programs in the United States are abstinence-based, and most use the twelve-step program of AA as a core principle.

Basic Principles

The first treatment principle is that all addiction, no matter the substance, is caused by lifelong physiological, social, and psychological disease processes. No cure exists for the disease of addiction, but recovery is possible through peer support and positive change. This principle removes the guilt that is associated with addiction and focuses on the disease instead of the affected person. The person begins by admitting that the disease makes them powerless over drugs and alcohol.

Recovery involves taking responsibility for one's substance use and behaviors and making necessary changes in thinking and behavior. This type of cognitive behavioral therapy may include individual and group therapy. Personal change may include recognizing denial and other self-defeating behaviors and replacing these negative thoughts with gratitude, honesty, forgiveness, and humility. For many people with substance use disorder, key components of successful abstinence include a spiritual awakening, faith in a higher power, and faith in the power of being part of a recovery community. A final principle is that without continued abstinence, addiction is a progressive and ultimately fatal disease.

Basic Components

Diagnosis should begin with a comprehensive evaluation that recognizes that addiction is a social, biological, and psychological disease. The initial phase of treatment may require medically supervised detoxification. Comorbid diseases related to alcohol or drug abuse and dual diagnosis, such as bipolar disorder, attention deficit/hyperactivity disorder (ADHD), or depression, should also be recognized and treated.

Treatment for primary addiction may include the use of control-craving drugs, individual cognitive behavioral therapy, group therapy, family therapy, and relapse prevention therapy. Abstinence-based treatment may be adapted to a long period of residential treatment or may occur through outpatient care. Because this treatment considers addiction a lifelong disease, individuals with substance use disorder are encouraged to attend after-care programs and twelve-step meetings, where they can benefit from the reinforcement of core principles and the support of other recovering people.

Success and Criticism

Abstinence-based treatment is often criticized for having a low success rate, but because relapse is accepted as part of the natural course of the disease of addiction, it is difficult to give much credence to studies that look at one-year or even five-year success rates. Many people with substance use disorder fail initial treatment, have several relapses, and then continue with many years of sustained abstinence. According to the National Institute on Drug Abuse, relapse rates for addictions are similar to those for other chronic diseases, such as diabetes, hypertension, and asthma.

The abstinence-based treatment model is also criticized for being one-size-fits-all; for not allowing other treatment options, such as the harm-reduction model; for not being adaptable to persons who cannot accept the spiritual concept of a higher power; and for encouraging unattainable goals. A 2021 study published in Addiction found that controlled drinking, as opposed to abstinence, appeared to be a more viable option for some individuals, particularly when it is accompanied by psychotherapy. Further supporting this position, according to a 2025 study, over 65 percent of respondents who self-reported as being in recovery stated they used alcohol in the last month, and about 30 percent had used cannabis. With this trend, non-abstinence goals may be beneficial additions to treatment plans for some substance use disorder treatment plans.

Still, most experts agree that abstinence should be the first and primary goal of addiction treatment. In the United States, therefore, abstinence-based treatment remains the treatment of choice for drug and alcohol addiction.

Bibliography

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