“Recovery is still largely viewed as lifelong abstinence — not just forever avoiding the specific substances someone once relied on, but also typically steering clear of all nonmedical drug use besides caffeine and nicotine. Most public recovery stories — like Mr. [Robert F] Kennedy’s — are tales of total abstinence, often propelled by participation in 12-step programs like Alcoholics Anonymous.
In reality, most people who resolve addictions [..] do not reject all substance use forever. For example, though I am in recovery from heroin and cocaine addiction, I still occasionally drink alcohol and use marijuana without issue. Though definitions vary, many experts now agree: If substance use no longer interferes with your ability to live a productive and loving life, then recovery has been achieved, with or without abstinence. [..]
The scarcity of recovery stories like mine distorts drug policy. It bolsters the continued dominance of abstinence-only rehabs and recovery housing, which deters many people who could benefit from seeking help. It enables most residential treatment and recovery homes to reject long-term use of the addiction medications like buprenorphine and methadone — the only treatments proven to cut opioid overdose deaths in half — based on the mistaken idea that taking them means a person isn’t really sober or in recovery.
A recent executive order from the Trump administration makes recognizing non-abstinent recovery more urgent than ever. It proposes defunding a wide range of harm reduction programs that help people use drugs more safely without requiring abstinence, including efforts that provide clean needles or supervised places to use drugs. It also promotes compulsory rehab, which overwhelmingly demands total abstinence.
To end the overdose crisis, we need more recovery options, not fewer. We need to acknowledge that there’s not one “right” approach.
[..] many people in non-abstinent recovery still avoid their preferred drugs. Those who successfully moderate tend to start with significant periods of abstinence, to break the habit aspect of addiction. For example, a period of abstinence of months to years is one of the “17 elements” recommended by the support group Harm Reduction, Abstinence and Moderation Support or HAMS [..].
Another key to recovery is discovering the purpose that excessive drug use serves for you, and finding healthier ways to achieve it. I used drugs primarily because I felt unlovable. In recovery, I learned that sensory and emotional overload were behind my difficulties connecting with people, and that antidepressant medication and cognitive techniques could relieve my discomfort. Now, social support, music and exercise ease stress for me, enabling me to live a meaningful life without anesthesia.
Specific techniques for moderation, like alternating alcoholic and nonalcoholic drinks at a party or counting drinks or using medications like naltrexone that can reduce cravings, vary in their usefulness from person to person. But without discovering what drives excessive use, recovery is rarely achievable. The question is “‘What are you using it for?’” says Edward Wilson, a psychologist in Pennsylvania who has helped hundreds of clients attain non-abstinent recovery, “And then what is going to be a more satisfactory replacement?””
Full editorial, M Szalavitz, New York Times, 2025.8.14