Not long ago, Robert F. Kennedy Jr.’s history of heroin addiction alone would likely have disqualified him from being considered for a role like secretary of Health and Human Services. Now, however, numerous successful authors, politicians, executives and celebrities talk openly about past substance use disorders. “Lived experience” even confers additional authority.
But there’s a caveat to this acceptance. 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. 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 — including me — 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.
Still, few people are open about their “non-abstinent” recovery. Many of us fear that if we disclose the occasional weed gummy or sauvignon blanc with friends, we will be viewed as still in active addiction, and face the stigma that comes with that.
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. Research shows that non-abstinent recovery is already far more common than conventional wisdom suggests.
A federal survey that included some 56,000 Americans over 18 found that in 2024, 12 percent of adults reported ever having had a problem with alcohol or other drugs. Fortunately, nearly 75 percent of this group said they had overcome it. But many did so without abstinence and more than half didn’t get treatment. Earlier research from this survey series found that 65 percent of those who say they are in recovery also reported using alcohol or cannabis in the past month, and did not see this as conflicting with their recovery status. Other studies of people who overcome alcohol problems find that around half do so by moderating rather than quitting.
My own recovery included a long period of abstinence, which started on Aug. 4, 1988. The rehab I attended taught that abstinence was essential and could be achieved only via lifelong participation in a 12-step program based on Alcoholics Anonymous — so I engaged enthusiastically. I attended 12-step meetings daily until around 1995. For seven years, I did not use recreational drugs beyond caffeine.
But then, I fell into a deep depression after a book I’d written was rejected — leaving me despairing and in debt. I’d previously resisted psychiatric medications because many 12-steppers derided them as “an easier, softer way” that would interfere with the work of overcoming my “character defects.” At that point, though, I felt I would relapse without additional help.
Via Zoloft, I soon discovered that my baseline state of dread and social anxiety could be relieved by the right drug, without self-destructive behavior. Over time, I began to find 12-step meetings less necessary. Initially, I stayed for social support, but I began to feel uncomfortable since I now disagreed with many of the program’s precepts. Gradually, I stopped attending, but still maintained abstinence until Sept. 11, 2001.
Living in Manhattan and facing the horror of the terrorist attacks, I figured that if there was ever a day for a drink, that was it. By this point, I knew that nonabstinent recovery was common and I no longer believed that drinking or using marijuana would inevitably lead me back to addiction, since I’d never had trouble controlling my use of them before. I drank some wine with my brother that night without incident.
Nowadays, I cautiously use alcohol and cannabis — drinking wine with dinner, for example, or taking a weed gummy for sleep. But because I do not love those drugs in the all-consuming way I loved heroin and cocaine, moderation isn’t difficult. If I have more than around 2.5 drinks, I get the urge to stop — so I do. That never happened with my favorite drugs.
Like me, 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, which has more than 12,000 members on Facebook.
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?”
Of course, not everyone can safely moderate — and swinging from a treatment system that overwhelmingly requires abstinence to one that supports only reducing harmful use would be unwise. But because most people who recover don’t seek total abstinence — or relapse repeatedly before achieving it — it’s critical that addiction programs accept this reality and offer a full spectrum of services. After all, research shows that attempting moderation often still leads to abstinence, since failures at cutting back help people realize they need to quit.
Since I began my recovery journey nearly 40 years ago, we’ve learned an enormous amount about how to help people get better. It would be tragic to turn our backs on this knowledge now, just as overdose deaths are finally starting to fall.
Maia Szalavitz (@maiasz) is a contributing Opinion writer and the author, most recently, of “Undoing Drugs: How Harm Reduction Is Changing the Future of Drugs and Addiction.”
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