The Fix: What is Abstinence-Supported Addiction Treatment (ASAT) and how does it work?Last Door: Many people entering recovery say if they just stop using substances--or the substance that is resulting in negative consequences--then everything will be okay; it’s the alcohol, it’s the heroin, it’s the meth, it’s the food.However it’s never just about treating the acute substance use disorder; it’s helping someone experience an environment that’s conducive to their own recovery and wellness process -- however that looks.When we look at the research and practice-based evidence of what types of environments support recovery, it points to abstinence supported addiction treatment recovery residences. People who are initiating their recovery process are seeking environments that are conducive to their primary goal of abstinence.[The goal is to provide] environmental enrichments like human connection, meeting basic needs so that people feel safe enough to stop using old coping skills like substance use, crime, and unhealthy attachments to people to survive the reality of their lives. This process often includes grieving losses of exiting that culture and transitioning into a culture of recovery.How does ASAT support recovery?People get to a point where they think, okay so I stopped the coping behavior, now what? If just stopping substance use or stopping something that was causing negative effects in my life was adequate, I wouldn’t be thinking about what my New Year’s resolutions were going to be this year. So once you’ve gone through withdrawal management, you’re stabilized, you’re no longer using a substance in a negative way, what does your recovery look like? And that’s where abstinence supported environments come in. You have this period of life where you can practice recovery-based skills and competencies and get the basic life skills of growing up.When you look at group living and treatment or recovery programs [that foster an abstinence-supported environment] you get to experience what recovery feels like, looks like on a day-to-day basis, minute-by-minute, with your peers, preferably being able to engage in the community in which you’re living. Whether it’s short-term or long-term, you get good at practicing those recovery-oriented skills in a supported way.[We know that when] housing is accessible and quality food, quality supports, are implemented into someone’s life and they are able to access them on a consistent basis, that their well-being improves, that their addiction can be arrested at some point and their recovery can be sustained. Dr. Best’s research shows that people who are provided access and utilize supports in their first five years of recovery go on to sustain long-term recovery for well over 20 years.An abstinence-supported environment helps increase quality of life areas by building Recovery Capital. Key recovery capital domains include social support networks, access to material resources (i.e.: housing, food and financial supports), improving a sense of well-being and skill development and cultural values, beliefs, and identities that all help build connection and safety. Life areas such as becoming gainfully employed in employment that allows you to continue on your recovery journey, your physical mental health, your relationships, what your aspirations are, or having enough safety to have hope that a better quality of life is available to you.Can you talk a little bit about ASAT as treatment for non-substance-related disorders? Yes, ASAT is beneficial for a variety of different health disorders. We know, for instance, that when people who have disordered eating issues are provided environments that enhance their well-being and promote health, they are less likely to utilize their old coping skills or be triggered to indulge or binge or purge.What I’ve found through the change process and unpacking the identified problem, whether it’s a person, a substance, or a behavior, is that oftentimes the solution is not linked to the identified problem. The solution is practicing the life skills or the competency or the capability or whatever fosters connection to people in their life.People who enter bed-based addiction services need to have a sense of safety. They’ve often experienced traumatic events, they’ve been the giver or receiver of acts of violence and abuse, they have a history of feeling unsafe and traumatized, and they may have complex health needs both physical and mental.So when you live in the same household with someone [with similar experience], there’s a sense of safety in the shared social norms of a culture of recovery.There’s the art of knowing each other. So, if the identified goal or the cultural norm in a program is to get up and go for a walk every day or write in a journal every night or maintain abstinence, then that’s an identified cultural goal that has developed in that program.What if someone has the goal of not abstaining permanently?As far as being required to abstain for the rest of your life, it’s like telling me I have to eat one specific thing for the rest of my life or else I’m going to die. No amount of negative consequence is going to make me eat that thing for the rest of my life...that’s a decision that we make based on the quality of our life and what our goals are, long-term.Whereas in treatment you may have an experience of being abstinent from things--or some things--in your lifetime and recovery process, it’s yours to own. And some people may decide to resume their identified problem substance or other substances (and when I say resume, I want to be mindful of language, because if we say someone relapses, that’s a judgment). For some people, resuming a behavior has no negative effects in their life, but it’s a choice and it’s a conversation that they have with their peers and significant people. They make a plan and follow through on it. Sometimes it’s a substance, or sometimes it’s a behavior or process.Sometimes people come back to treatment, and they’re like, seemed like a good idea at the time, didn’t go so well. I thought I could start watching porn with my intimate partner, turns out my emotional and physical intimacy went down the drain. I’m not someone who can socially indulge or socially use that thing in my life. Or, I’m no longer going to work overtime because when I do I get obsessed with money, and the thoughts and the triggers start happening, payday happens and I impulsively go on a binge of substance use. So, part of that is really developing and practicing recovery in all areas of our life before those opportunities show up in our life. It’s that gradual return to work, it’s the knowledge that working overtime and picking your kid up from daycare and getting them fed and to bed is a difficult, that amount of stress in your life may cause you to resort to negative coping skills and it’s not going to go well.But when you build a life that’s conducive to your identified goals, whether it’s abstinence or managed use, that’s what can sustain you over time. And that’s not something someone can necessarily make a decision on early in the recovery process, but I think you can have a conversation well in advance of doing it.Rather than talking about where you’re going to land when you’re huffing off from treatment because you had a conflict with your roommate or the staff, you have a conversation ahead of time about where you think you’ll go if the program is not a fit for you.Same goes for substance use. Resuming substance use at a seriously stressful point in your life is going to be a different experience than planning out resumed substance use. From my experience working in a bed-based program, many of our clients have chosen to remain abstinent for substances long term-- there may be times in life showing up where medications become a necessity (injuries, surgeries, mental health, chronic pain). So when we’re looking at abstinence I think that if our residents identify with some mutual support groups, you know, according to the literature, you’re always welcome to attend meetings, but with the personality dynamics found in the rooms of specific meetings, you may feel unwelcome or judged.Part of the responsibility and role of treatment centers is to help people have those difficult conversations about what we really want to have in our lives, our goals, our dreams and our feelings. As a person in recovery, we get to choose who we have or don’t have in our lives. We must choose who is going to be meaningful and a value in our recovery journey.Any final thoughts?It’s quite fascinating to me to find out where we came from as people in recovery, how did our movement evolve into what it is today (Books such as Slaying the Dragon, how did we start researching people in recovery, how did people start recovering out loud in a way that they are key stakeholders with a seat at the table that includes a voice; that there is actual research and science being conducted about the populations in recovery, that it’s not just a one-size-fits-all.When I look at the key messages that are promoted across the world (i.e.: Canada, UK, USA, Australia’s Life in Recovery Surveys), that there are multiple pathways to and in recovery, that recovery is not just possible, it’s probable -- there is science behind those statements, and 20 years ago it just simply wasn’t readily available.There are also a lot of terrible stories and case studies that happen within treatment centers and happen within communities and looking again at the science of abstinence-supported environments, we know that providing meaningful environments for people helps them thrive and carry hope. Last Door Recovery Centre provides abstinence supported, licensed and accredited addiction treatment services for youth, adults, and families in Canada's most vibrant and successful recovery community. For more information, visit lastdoor.org or call 1-855-465-2851.This interview has been edited for length and clarity.
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