From nihilism to hope: Reframing the concept of addiction

Abstract

The treatment of substance use disorders (SUDs) has been characterised by a focus on the goal of abstinence, fostering a sense of therapeutic nihilism when relapse occurs. This chapter will focus on an overview of the factors that determine individuals’ vulnerability to SUDs, and how it differs between those at high risk and those at lower risk for an SUD. It will also discuss how this conceptual understanding can be used by clinicians to reframe the focus from an abstinence only model (focused solely on halting drug use) to a more nuanced interventional model that combines harm reduction along with interventions that target the underlying risk factors for addictive disorders, with a longer term focus on recovery.