Does Gradual Reduction of Substances Work?
One of the most contentious areas for debate around the issue of drug addiction is whether people should stop suddenly (going “cold turkey”) or gradually reduce their usage. The main issue is that the withdrawal symptoms caused by stopping abruptly could drive the individual back to the substance. In the past, this was seen as a necessary evil (almost a punishment) for the past addictive behavior. However, many people have recognized that gradual reduction could reduce withdrawal symptoms and help people get clean in the long run. Others argue that addicts will struggle to stick to a pre-designated amount of their chosen substance and therefore relapse is likely. Weighing up the evidence will help you determine whether gradual reduction is effective for addiction or not.
How Does Gradual Reduction Work?
The general theory behind gradual reduction programs is that the process of detoxification is much easier if you’re weaned off the substance incrementally. Most treatment programs use pre-designated dosages over a set time period, but these can be adapted to suit heavier users. The amount of the substance offered is reduced according to a fixed schedule until the individual has stopped using altogether. Instead of putting the body through the shock of complete abstinence after heavy use, this slower approach staves off withdrawal symptoms while still moving in the right direction. It’s like eating less and less food each day to lose weight instead of crash dieting.
What are Some Examples of Gradual Reduction Treatments?
Although people may use this approach at home with illicit drugs, alternative medicines are offered by drug rehabilitation centers for gradual reduction. The most well-known of these is methadone, which is used to help heroin (or other opiate) addicts kick their habit. It has longer-lasting effects that aren’t as strong as heroin, so it provides relief from withdrawal symptoms without having the same potential for abuse. The longer “half life” (duration of effects) of methadone translates into a longer period of withdrawal, but the symptoms aren’t as intense as from heroin, and the gradual reduction also makes this easier.
The most widely used gradual reduction treatments are actually for a legal addiction-smoking. Several nicotine products have entered the market, offering a gum or a patch that provides a small amount of nicotine over a long period. This reduces the cravings for cigarettes and provides a safer method of administering the nicotine (without the tar and myriad chemicals in cigarette smoke). While the withdrawal symptoms of smoking aren’t very severe in comparison to illicit drugs or alcohol, many people still choose to use a reduction program when they quit.
Do They Work?
Reviews of multiple studies into the effectiveness of gradual reduction or maintenance programs can draw more weighty conclusions because of the increased sample size and the ability to choose methodologically sound research. One review looked at six studies that compared methadone maintenance therapy with placebo (sugar pill) maintenance therapy and other non-medical approaches. The randomized studies provide evidence that methadone maintenance helps to retain patients in treatment and reduces heroin use compared to other approaches. It didn’t reduce criminal activity, but it is much more effective for treatment.
A review published by the Cochrane Collaboration compared reduction programs for stopping smoking with the cold-turkey approach. The researchers found that the reduction approach (whether by limiting the amount of cigarettes or using nicotine alternatives) is as effective as stopping abruptly. It’s important to note that both groups always received additional support, whether through informative booklets or counseling. Despite the comparable success rate, reduction is not often advised to people looking to quit smoking.
What is the Best Option for Getting Clean?
Both of the literature reviews provide evidence of the effectiveness of gradual reduction programs in both legal and illicit substances. The reason for this is clearly the aforementioned benefit of reducing withdrawal symptoms, as well as the process of gradually defeating day-to-day triggers rather than tackling them all at once. A smoker might prioritize his after-meal cigarette over the one waiting for the bus when he can only smoke one more cigarette during the day. In the process, the habit of smoking while waiting for the bus is broken. As the amount of the substance gets lower and lower, the specific cues to use are taken apart one by one.
Although reduction programs are effective, some people still prefer the abstinence approach. For most drugs (aside from extreme cases), the cold-turkey approach doesn’t carry significant risks, so it is usually an option. If the individual would prefer to gradually reduce, however, the evidence presents no reason to dissuade them. In cases with severe withdrawal symptoms such as heroin addiction, it actually appears to be better to manage down than to try and stop altogether. This is seemingly because of the sheer level of discomfort presented by the withdrawal symptoms.
There are obvious advantages to managing down if the withdrawal symptoms will be very unpleasant, but the true deciding factor is clearly the individual’s motivation to change. Either method has the potential to be effective as long as you are dedicated to getting clean. You shouldn’t feel mentally “weak” if you choose the manage-down approach, nor should you feel stubborn for deciding to go cold turkey. It is important to remember that there is no honor in enduring withdrawal symptoms, and you aren’t required to suffer extensively because you’ve been addicted or done bad things in the past. Choose the approach which works best for you.