Summary
Abstinence refers to refraining from some kind of behavior or substance, as opposed to moderation. In the context of addiction, it means a policy of never using a substance or a process again, usually under the belief that any use will lead to unmanageable consequences.
History and Etymology
In Latin “abstinere” is formed from “ab” as “away from” and “tinere” as “to hold”. Together, it means “to hold away from.” The noun “abstinentia” came to mean “self-restraint” in a way that still could’ve applied to moderation as a type of restraint. “Abstinence” begins to appear in Middle English through Old French.
Through the 18th and 19th centuries, temperance movements in Europe and North America began promoting abstinence as the only strategy to meaningfully deal with alcohol. It wasn’t just for drinkers, but anyone and everyone, as the substance itself was seen as a problem. “Temperance” also originally meant a type of moderation or self-restraint, as in to temper one’s coldness with compassion.
Once Prohibition policies failed and the country moved away from abstinence, groups like Alcoholics Anonymous (AA) kept using the language of “abstinence” for their own members. William Silkworth, an American physician who worked with AA founder William Wilson (Bill W.), wrote in a foreword for the AA Big Book that alcoholism was like an allergy. Just as someone with a peanut allergy wouldn’t think to themselves “eh, just this once” when they know it would lead to a potentially fatal reaction, an alcoholic similarly needed to maintain abstinence to avoid a fatal reaction.
As the medical community began seeing addiction as something treatable, they also began studying “abstinence” as a potential goal of medical interventions or recovery programs. It’s also just easy to measure, as you’re either using a zero or nonzero amount of a substance or process. Measuring something like the percent of days that abstinence is maintained or number of sustained abstinence periods is much harder, and we still struggle with this problem today.
From then onwards, “abstinence” became a widely legitimized term used in clinical, recovery, and public settings.
Commentary
Is it All-or-Nothing?
Historically, the emphasis on abstinence as a metric and an ideal outcome meant clinicians and researchers alike paid less attention to other metrics. While there were researchers like D.L. Davies in the 1960s who reported the existence of alcoholics who had returned to moderate drinking, it was still seen as a remote possibility rather than an outcome that could be reasonably achieved as a result of interventions. Still, it established that abstinence and death were not the only two outcomes for alcoholics.
In the 1970s, Linda and Mark Sobell, a married couple who collaborate often on research, ran a trial with 70 male alcoholics who were assigned to a goal of either controlled drinking or abstinence, and then either a control group or a group receiving Individualized Behavior Therapy (IBT). The results showed that, aside from the IBT group having significantly better functioning across the board, some alcoholics had maintained controlled drinking behavior by the 1 year mark.
This stirred a lot of controversy, and by the 1980s, researchers had produced new evidence and reexamined the Sobells’ original experiment. On a 10 year follow up of the 20 experimental subjects, only 1 had maintained controlled drinking and 6 had become abstinent. 8 continued drinking excessively, 4 died from causes related to their drinking, and 1 went missing after becoming severely disabled as a result of their drinking. The controversy over the experiment led to an investigation into the Sobells, which established they did not falsify their research. The scientific community remained divided as the Sobells pointed out that multiple independent investigations exonerated them.
Nevertheless, valid questions about the methodology used in these studies was raised.