Episode Rewind | Nonabstinence Among US Adults in Recovery From an Alcohol or Other Drug ProblemEpisode Rewind | Nonabstinence Among US Adults in Recovery From an Alcohol or Other Drug Problem
Addiction Medicine: Beyond the Abstract
Shawn McNeil, MD, talks with Dr Emily Pasman about her research on non‑abstinence among adults in recovery and the limits of abstinence‑only models. Their conversation looks at harm reduction, patient‑defined goals, and how treatment systems might better support people who continue to use substances while seeking recovery.
19:32•11 Jun 2026
Rethinking Recovery: Non‑Abstinence, Harm Reduction, and What the Data Show
Episode Overview
- Abstinence can be a strong option for some, but many people in recovery aim to reduce or moderate use rather than stop completely.
- A treatment system built around 12‑step traditions and abstinence-focused outcomes may exclude people whose goals are different.
- Harm reduction approaches, including safer‑use skills and non‑punitive retention in care, can lower risks even when substance use continues.
- People in recovery who are more religious and attend mutual aid groups are more likely to be abstinent, while lesbian and gay respondents are more likely to be non‑abstinent.
- Reducing stigma toward non‑abstinent recovery and supporting patient‑chosen goals are key steps toward more equitable and effective services.
“Addiction is really the only health condition that we would discontinue treatment when someone is experiencing a flare in symptoms.”
How do people cope with the challenges of staying sober? This conversation gives a frank look at what recovery can look like when it isn’t 100% alcohol- or drug-free. Host Shawn McNeil, MD, sits down with Dr Emily Pasman, a licensed social worker and postdoctoral research fellow at the University of Michigan. Drawing on her lived experience of addiction and her research, Dr Pasman talks through her study on non‑abstinence among US adults who say they’re in recovery.
Right away, she challenges the idea that abstinence is the only acceptable goal, noting that many people “want to reduce their use or moderate their use rather than stop using completely.” The chat walks through how 12‑step traditions shaped US treatment systems, research outcomes, and even provider expectations.
You’ll hear how this abstinence‑first mindset can unintentionally sideline people whose goals are different, and why discharging someone for using substances is, as she points out, something we don’t do with any other health condition. Dr Pasman breaks down practical harm reduction approaches, such as skills for safer use and non‑punitive, longer‑term engagement in care.
She also highlights findings about subgroups in recovery, including more religious people and those attending mutual aid groups being more likely to be abstinent, and lesbian and gay respondents being more likely to be non‑abstinent. Along the way, she shares how working in a methadone clinic forced her to confront her own biases and broaden her idea of what recovery can mean.
For clinicians, researchers, and anyone curious about evidence-based alternatives to strict abstinence, this episode offers a clear, data-grounded look at recovery that makes room for real life. It might leave you asking: what if success in recovery isn’t one-size-fits-all after all?
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