Abstinence-Based, “Durable Recovery” Is the Gold Standard in Behavioral Health.
by Jim O'Connor, CADC | February 10, 2026
For people with severe substance use disorder and housing or employment instability, sustained abstinence is the lowest-risk condition for rebuilding health, stability, and independence.
Harm reduction prevents immediate crisis, but abstinence-based recovery creates the conditions for durable outcomes and better returns on public investment. Public systems should protect the investment already made in treatment by funding recovery housing and workforce supports that reinforce long-term recovery.
Abstinence-based, “durable recovery” is the gold standard in behavioral health. Public health has always known this. In addiction treatment and recovery work, precision matters—especially when we’re talking about outcomes rather than intentions.
For individuals diagnosed with Severe Substance Use Disorder, particularly those experiencing functional poverty—housing instability, unemployment, and fractured relationships—sustained abstinence from drugs and alcohol is the lowest-risk health condition to maintain in order to repair the material, neurological, and relational losses associated with the disorder.
This is not an ideological claim. It is a risk-management one—both clinically and systemically.
Severe Substance Use Disorder is characterized by impaired control, compromised executive function, and repeated harm despite consequences. When psychoactive substances remain in active use—even intermittently—the risks to health, housing stability, employment, and relationships remain elevated. Progress may occur, but it is fragile and easily reversed, often pulling individuals back into crisis-driven systems of care.
Abstinence-based Recovery reduces those risks across multiple domains simultaneously. It stabilizes cognition, improves emotional regulation, restores reliability, and allows supports—housing, employment, family relationships, and community participation—to actually hold over time rather than requiring constant intervention.
Smoking cessation, seatbelt use, and vaccination are all examples of public-health interventions grounded in information, encouragement, and individual agency. None eliminate risk, and all involve personal choice and imperfect adherence. Importantly, however, we do not lower the standard because adherence is difficult. We continue to name the safest and most effective course because doing otherwise would mislead patients, distort policy, and lead to worse long-term outcomes.
Abstinence-based Recovery—or, Recovery— functions the same way for people with severe addiction and functional poverty. It establishes the lowest-risk baseline from which health, stability, and independence can be rebuilt—and from which public investments in housing, workforce, and care are most likely to produce durable returns rather than recurring cost.
No licensed clinician, public-health professional, or healthcare advocate can credibly argue that for severely addicted individuals living in instability, continued substance use—
however “managed”—offers better long-term health, social, or economic outcomes than sustained Recovery, nested in community and supported by recovery infrastructure.
Harm reduction has an important role in preventing immediate catastrophe. That work matters.
But reducing harm and restoring health are not the same intervention. One keeps people alive in crisis.
Recovery allows people to rebuild a life—and ultimately reduce reliance on publicly funded systems.
William White is one of the most influential historians, theorists, and system-level thinkers in the modern addiction recovery field. White describes ‘Durable Recovery” as long-term, stable remission from substance use disorder that is sustained by meaningful changes in identity, behavior, relationships and community connection—not just the absence of substance use for a short period.
Durable recovery must be the health condition publicly messaged by agencies and funders because systems optimize for what they define as success—and only a durable recovery standard aligns incentives toward long-term stability, functional independence, and reduced reliance on public services.
Finally, we should acknowledge something that often goes unsaid.
Medicaid eligible people who seek inpatient or residential treatment for Substance Use Disorder have made a meaningful investment in their health and recovery. That decision reflects a time commitment, effort, and risk taken in pursuit of a better future. And it’s a positive step towards behavior change. And taxpayers pay for that intervention.
Public systems should recognize and protect that investment—not dilute it—by ensuring that housing, workforce, and recovery infrastructure are designed to help that investment compound over time, rather than cycling people back through high-cost, low-durability interventions.
Particularly, systems funders need to fund recovery homes—supportive sober living environments for people re-entering after residential SUD treatment. In Illinois people experiencing housing instability who have admitted to a residential SUD treatment facility are excluded from the largest publicly funded housing developments, Housing First PSH.
If we want durable outcomes, we have to support the conditions that make recovery durable.
Abstinence is not the only condition required—but without it, the others rarely hold.
In a follow-up, I’ll look more closely at how public housing investments shape recovery trajectories—specifically the difference between low-barrier, harm-reduction housing and post-treatment recovery infrastructure.
Both approaches serve distinct purposes. The challenge arises when we stop naming those differences and begin funding them as if they produce the same outcomes.
Return on investment—and the intentional design of supported exits from public subsidy— should occupy a more prominent place in how states think about and fund their housing portfolios.
