Addiction and Therapy


Does anyone know from personal experience or study why abstinence is a must for starting therapy?

To me this sounds contradiction like you should be sober to become sober. It sounds to me like your cancer has to be in remission to get treatment. I am not assuming here addiction is disease or not just using this as analogy. It is sort of obvious I am quite not educated about this topic.

Even though I do understand the real complications of being state of addiction and lacking the ability to conduct or commit or relate to healing/therapy etc. I still feel the precondition to be state of normalcy (if such a thing) and abstinence is counterintuitive. Maybe this is why therapy often fails for addiction related cause clients are put in opportunities to lie about their real state of mind or may hide if they relapse or feel failure or shame cause the deal is you have to stay sober/abstinence. But if the deal is come as you are, then shame is already being dealt with...I may be simplifying this cause my experience is extremely limited.

My feeling is that a person should be accepted at any state even at their lowest point for treatment and experience the patience in others until they feel differently or emulate or leave treatment altogether but the precondition may communicate not accepting that part (that needs help the most), as long as there is no violence (which I do not believe comes with most addictions anyways).

I am trying to understand how this abstinence at admission has become popular and if anyone with real life experience can help me if this worked for them or they wished different ways or such.

Just looking for insight and ways to relate to others who have addiction in their lives.

Are there treatments that do not ask for this condition of abstinence at admission in US or Canada?

ps. I do not have addiction but I have a lot of family members who do and trying to understand it for myself. I can clarify if I am not making sense here.
Thank you,
I've never heard that abstinence is a must for starting therapy! Far from it, therapy can absolutely assist people on getting a handle on their substance use disorders. To require people to be abstinent before starting therapy seems completely misguided.


I'm an alcoholic but haven't drunk or smoked for over a year. I was still drinking and smoking when I started counselling with my current counsellor. One person at a drug and alcohol clinic said to me that he thinks people should be clean and sober for a year before having therapy. I think that's bullshit. I stopped drinking and smoking because I nearly died from a heart attack. Whether your still using or not, therapy is still very useful and effective and can be very useful in helping you to stop using aswell as other problems.


Before starting therapy… or before starting TRAUMA therapy?

Because those are massively different things, and the precursor for trauma therapy is “stabilization”. Which does not require sobriety, but does require control. And addiction …is durn near the opposite of control. So it would be criminally reckless to embark on trauma therapy with someone in active addiction, the same way it would be to start trauma therapy with someone who is cutting, suicidal, in psychosis, or out of control / wildly unstable in any other way.

THERAPY, on the other hand, is how one often gets someone TO BE in control/stabilized.

Are there exceptions to stabilize before (destabilizing) trauma therapy? Sure. But they require 24/7 supervision, and even then? The GOAL is stabilize, first. That’s why most inpatient trauma units aren’t actually focusing on trauma therapy, but on stabilization. Teaching the skills -in a controlled environment- to get stable, or be stable. First by providing the stability of food/shelter/safety, then by teaching skills (or skills + meds) to manage the most destabilising aspects. To get a person able to maintain that on their own.

Don’t get me wrong… I fought against this, for years. It was just like…Dude. If I were stable? I wouldn’t need therapy. It’s the trauma itself that’s making me UNstable. So can we sort this shit, now, please???

But, at least in my experience, there aren’t shortcuts with trauma therapy. Because it’s destabilizing by nature, the end result of destabilizing an unstable person further? Are “duh” predicitble. Madness & death. (Rapid decompemsation, psychosis, suicide.). Stabilize FIRST. Trauma therapy second.
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I should probably mention… I know therapists with differently held beliefs abound stabilization & medicating -v- self medicating.

Some are perfectly fine with self medicating (as long as there’s 6+ months of well understood & consistent use, without abuse), others don’t accept any kind of self medication (coffee, cigarettes, alcohol, or illegal drugs) as being stabilized. So there’s a giant subjective factor involved.

Some are conditionally okay with self medicating, or with supervised medicating.

Some are not okay with any kind of medicating or self medicating.

So there’s a preeeeeetty broad spectrum on the “what constitutes stabilization in regards to psychoactive substances” front. But the unifying factor is still? Stabilization first, trauma therapy second


Oh wow!
Thanks everyone. I am glad to see my assumption is wrong and that sobriety is not a pre-condition to treatment in some areas.
I understand 100% @Friday that the difference of stabilization for processing trauma versus life skills and getting to the stabilization phase.

I need to digest this further so I truly thank you so much for giving me some real information.


every therepist i ever worked with as a kid demanded sobriety from me before we started the real work. so i never did the real work. my current therepist is aware that i drink (but that i am trying to become sober, and my periods of drinking are actually patterns of like, normal drinking these days.) she does not demand sobriety from me (but will refuse to do therepy if i am under the influence). we are doing the work.
but will refuse to do therepy if i am under the influence
This is a good point. I don't know ANY therapist who will do work with a client who's currently under the influence.

... Um, except mine. We attempted to do EMDR while I was pretty buzzed on MJ. Unsurprisingly it didn't work.


Thank you @grief. I can see this might be more for the therapists' safety and ethics than about the client...even though the client's safety is also part of it.
I do appreciate you have a therapist that allows you to figure it out rather than demand you fit a preconceived state of mind. I was thinking it would be almost impossible to have full sobriety for some addictions like eating is complicated.