The study, led by researchers examining the experiences and opinions of adolescents and young adults who do not consume alcohol in Switzerland, is part of a broader qualitative investigation into alcohol non-consumption among youth. Rather than relying on surveys or statistical modeling, the team turned to focus groups, a method designed to surface the nuances of language, identity, and social perception that quantitative approaches often miss. The result is a rare, detailed portrait of how young people themselves interpret the vocabulary that researchers, clinicians, and educators have long applied to them.

Between 14 and 20 years of age, 63 participants took part in twelve focus groups, with 36 females and 27 males. The researchers deliberately structured the groups along three axes: gender, age, and drinking status. Age categories were based on Swiss alcohol laws, which distinguish between different levels of access to alcohol depending on age, while drinking status separated non-drinkers from drinkers. This design allowed the team to compare how the same terminology landed across different social and legal contexts, and crucially, to hear from both those who do not drink and those who do, ensuring that the perceptions of non-drinkers were not examined in isolation from the broader peer culture in which they are embedded.

Each focus group lasted roughly an hour and was recorded and transcribed for analysis. The discussions were anonymized, with any identifying details removed before transcription was finalized. The researchers then applied thematic content analysis, a qualitative technique that involves systematically reading through transcripts to identify, code, and categorize recurring themes. This method is particularly well suited to questions of language and perception because it preserves the participants’ own words and reasoning, allowing patterns to emerge from the data rather than being imposed by predefined hypotheses. The central question put to participants was deceptively simple: what do you think of when you hear the term abstinence in the context of alcohol?

The answer, across nearly every group, was that the term felt wrong. Participants consistently judged abstinence, abstainer, and abstention to be unsuitable descriptors for young people who do not drink, regardless of whether the person being asked was a drinker or a non-drinker. This consensus across drinking status is one of the most striking findings of the study, because it indicates that the rejection of the term is not merely a defensive reaction from those being labeled. Even young people who drink alcohol recognized that the vocabulary used for non-drinkers carried connotations that were out of step with how their peers actually experience the choice not to drink.

So what did the word actually evoke? The connotations participants reported were overwhelmingly negative and, perhaps most surprisingly, rarely connected to alcohol at all. For many, abstinence immediately suggested religion. One 16-year-old female participant explained that the word made her think of priests who abstain, of abstaining from all sins, and that it did not necessarily make her think immediately of alcohol. Others connected the term to people who refrain from drinking to honor their religious beliefs, reinforcing the sense that abstinence belongs to a moral and spiritual register rather than a health-related one. A second major connotation was sexual, with participants associating the term with abstinence from sexual activity, a usage common in educational and religious contexts. The third and most consequential association was with adults who have stopped drinking because of alcohol-related problems, positioning abstinence as a term for recovery rather than for the ordinary, everyday choice of a teenager who simply does not drink.

Beyond these specific associations, participants identified a deeper structural problem with the term: it normalizes alcohol consumption by making non-drinkers appear as the deviant group. Because no special term exists for people who drink alcohol, the existence of a label like abstainer implicitly frames drinking as the default and not drinking as the exception requiring explanation. One 19-year-old female non-drinker argued that it should not be those who do not drink alcohol who are called abstainers, but rather those who drink who should be called consumers, adding that the term somehow labels people who do not drink. This insight, articulated by a teenager, mirrors a long-standing critique in sociolinguistics: that naming practices reveal which behaviors a culture treats as normative and which it treats as requiring justification. In a context where alcohol consumption is widespread among adults and increasingly common among older adolescents, the term abstainer effectively marks non-drinking as an act of deviance rather than a legitimate personal choice.

The study also revealed interesting variation across age groups. Younger participants, aged 14 to 16, often struggled to connect the term to alcohol at all, reflecting the fact that abstinence is not part of their everyday vocabulary in this context. Older participants, particularly those aged 18 to 20, were more likely to have encountered the term in health education or literature, and some could articulate a more nuanced position. A 20-year-old male non-drinker acknowledged that the term works in a limited sense, because there is a sort of not giving in to temptation, capturing the self-restraint dimension that the word carries. Yet even this participant, who could see the logic behind the term, ultimately recognized that it imposed a framework of temptation and resistance that did not match his own experience of not drinking. For most non-drinkers in the study, the choice not to consume alcohol was not experienced as a constant battle against desire but as a simple preference, and the vocabulary of temptation and resistance felt alien to that experience.

This disconnect between the lived experience of non-drinking and the language used to describe it has practical implications for prevention and education. The researchers argue that continuing to use abstinence in scientific literature and prevention campaigns to describe young people who do not drink may be actively harmful, because it reinforces the marginalization of a group that already feels out of the norm. Participants themselves offered alternatives: terms such as non-drinking, non-drinkers, or alcohol non-consumption were preferred, particularly because they describe the behavior without imposing a moral or medical framework. These terms, participants suggested, would better integrate non-drinking youths into prevention initiatives and positively highlight their choices rather than framing them as acts of self-denial. The distinction may seem subtle, but it reflects a broader principle in public health communication: that the language used to describe a behavior shapes how individuals understand their own choices and how peers perceive those choices.

The researchers are careful to note that the term abstinence is not inherently problematic in all contexts. For adults who have stopped drinking due to alcohol-related issues, the term remains appropriate and widely understood within clinical and recovery communities. The problem, they argue, is specifically the application of recovery-oriented vocabulary to young people for whom not drinking is not a recovery but a preference. This distinction matters because the growing number of adolescents and young adults who choose not to drink alcohol represents a significant public health trend, one that prevention initiatives should support rather than stigmatize. By adopting terminology that reflects the actual experiences of young people, researchers and educators can create initiatives that resonate with their audiences rather than alienating them.

The study’s findings arrive at a moment when alcohol non-consumption among youth is rising across many high-income countries, driven by a combination of health consciousness, changing social norms, and the growing visibility of alcohol-free lifestyles. In Switzerland, as elsewhere, the cultural context remains one in which alcohol consumption is deeply embedded in social life, making the choice not to drink a socially salient act that requires navigation. The language used to describe that choice, the study suggests, is not a trivial matter of semantics but a factor that shapes identity, peer perception, and engagement with prevention. As the researchers conclude, moving away from abstinence toward terms that young people themselves prefer is a small change with potentially large consequences for how the next generation understands and discusses the choice not to drink.

Subject of Research: Perceptions of the term “abstinence” among adolescents and young adults: a qualitative study on alcohol non-consumption in Switzerland

Article Title: Perceptions of the term “abstinence” among adolescents and young adults: a qualitative study on alcohol non-consumption in Switzerland

Article References: Fernandes Palhares, D., Chok, L., Suris, J.-C., & Barrense-Dias, Y. (2025). Perceptions of the term “abstinence” among adolescents and young adults: a qualitative study on alcohol non-consumption in Switzerland. Advances in Drug and Alcohol Research, 5, Article 13969. https://doi.org/10.3389/adar.2025.13969

Image Credits: AI Generated

DOI: 10.3389/adar.2025.13969

Keywords: Perceptions, term, abstinence, adolescents, young, adults, qualitative, alcohol, non-consumption, Switzerland, scientific research

Metacognition is often described as “thinking about thinking.” It is the mental faculty that allows a person to sense when they are unsure of an answer, to judge the accuracy of a memory before acting on it, and to adjust behavior accordingly. In laboratory settings, metacognition is typically measured by asking participants to perform a perceptual or cognitive task and then to rate their confidence in each decision. Researchers then compute a metric known as metacognitive sensitivity — essentially, how well a person’s confidence ratings track their actual accuracy. A person with strong metacognitive sensitivity is confident when correct and doubtful when wrong; a person with impaired metacognition loses this correspondence, becoming unable to distinguish reliable internal signals from unreliable ones.

This capacity matters enormously in everyday life and, according to a growing body of addiction research, it may matter especially in the cycle of substance dependence. The predominant neurocognitive models of addiction hold that chronic drug use degrades the neural systems responsible for self-regulation, tipping the balance toward habitual, compulsive drug-seeking at the expense of deliberate, goal-directed behavior. If metacognitive monitoring is part of that self-regulatory architecture, then deficits in it could help explain one of the most perplexing features of addiction: the persistence of drug use despite obvious and repeated negative consequences. A person who cannot accurately appraise their own cognitive state may also be less equipped to appraise the mounting costs of their behavior, or to trust their own resolve when attempting abstinence.

Earlier studies in the field had reported reduced metacognitive accuracy in individuals with cocaine use disorder, but the reliability of those findings remained an open question. Small sample sizes, heterogeneous participant groups, and inconsistent methods for quantifying metacognition all left room for doubt about whether the observed deficits were genuine features of the disorder or artifacts of particular experiments. The new study was designed specifically to address this uncertainty through a confirmatory approach, meaning that it set out to test the previously reported association under carefully controlled and preregistered analytical conditions, using refined behavioral metrics that separate metacognitive sensitivity from the underlying task performance itself.

The research team assessed participants with cocaine use disorder alongside well-matched comparison participants, evaluating metacognition across cognitive tasks while also gathering detailed information about recent patterns of cocaine consumption. This dual focus proved crucial. The results indicated that metacognitive impairment was not simply a fixed trait of the disorder but was dynamically linked to the recency and intensity of drug use. Participants whose recent cocaine consumption was higher showed more pronounced deficits in their ability to monitor the accuracy of their own decisions, while those with longer periods of reduced use displayed comparatively better metacognitive performance. In other words, the internal compass that tells us how much to trust our own minds appears to be dulled by recent exposure to the drug and may partially recover as use declines.

Technically, the study relied on signal-detection-theoretic frameworks to disentangle the components of metacognitive performance. Simple accuracy on a task and confidence in one’s answers can be confounded — a participant who performs poorly on everything might also report uniformly low confidence, without any true metacognitive deficit. Modern metrics such as meta-d, which estimates metacognitive sensitivity relative to task performance, allow researchers to ask whether an individual’s confidence judgments are informative above and beyond their raw accuracy. By applying such analyses in a confirmatory framework, the researchers could demonstrate that the impairment in cocaine use disorder specifically involves the monitoring layer of cognition rather than a generalized cognitive slowdown or lack of engagement with the tasks. This distinction carries theoretical weight, because it points to disruption in neural circuits — often implicating the prefrontal cortex and its connections to parietal and limbic regions — that are thought to support self-directed evaluation.

The prefrontal cortex has long been identified as a region vulnerable to the effects of chronic cocaine exposure. Neuroimaging and neuropsychological studies have repeatedly documented alterations in prefrontal gray matter volume, white matter integrity, and metabolic activity in people with cocaine use disorder. Because these same frontal networks are central to metacognitive processing in healthy individuals, the convergence of evidence is striking: the brain systems that generate our sense of confidence and uncertainty are precisely those most affected by prolonged stimulant use. Recent drug use, by modulating dopaminergic signaling and prefrontal function acutely as well as chronically, may therefore exert a double burden — degrading the machinery of self-monitoring at the moment when recovering individuals most need it.

The clinical implications of this work are potentially far-reaching. Addiction treatment typically depends on the patient’s ability to recognize lapses in control, anticipate high-risk situations, and honestly evaluate progress. Metacognitive impairment could undermine each of these processes, explaining why some individuals struggle with self-reported insight into their condition — a phenomenon sometimes described clinically as impaired awareness of illness in addiction. If recent drug use exacerbates these monitoring deficits, then treatment programs might benefit from incorporating strategies that scaffold self-assessment: structured feedback, external monitoring tools, and therapeutic techniques such as metacognitive training or mindfulness-based relapse prevention, which explicitly aim to strengthen awareness of one’s own cognitive and emotional states. Conversely, the observed link between reduced recent use and better metacognition offers a hopeful message: the capacity for accurate self-reflection may be at least partially restorable during abstinence or sustained reduction in use.

At the same time, the researchers are careful to frame the findings within their limits. Confirmatory evidence strengthens confidence in the association between recent cocaine use and metacognitive impairment, but longitudinal studies remain essential to determine the direction of causality. It is plausible that impaired metacognition predisposes individuals to heavier use — poor self-monitoring could erode the brakes on consumption — while acute and chronic drug effects, in turn, deepen the impairment, creating a self-reinforcing loop. Disentangling these pathways will require repeated-measures designs that track metacognitive performance and drug use over time within the same individuals. Future research may also extend the paradigm to other substance use disorders to determine whether metacognitive dysfunction is a shared mechanism of addiction or a distinctive signature of stimulant dependence.

What the study already establishes, however, is a meaningful step forward for the cognitive neuroscience of addiction. By confirming, with methodological rigor, that cocaine use disorder involves a genuine and use-dependent impairment of metacognition, the work reframes the disorder not merely as a failure of willpower or reward processing, but as a disruption of the mind’s ability to audit itself. This perspective resonates with the lived experience of many people with addiction, who often describe acting on autopilot, surprised by their own behavior after the fact. Understanding that surprise itself — the failure to foresee and monitor one’s own lapses — has a measurable cognitive basis could reduce stigma and inform more compassionate, biologically grounded approaches to treatment. As research continues, the internal gauge of confidence and doubt may prove to be a promising therapeutic target, one whose recovery could mark a turning point in the journey out of dependence.

Subject of Research: Metacognitive impairment in cocaine use disorder and its relationship to recent drug use

Article Title: Metacognitive impairment in cocaine use disorder: confirmatory evidence for the effects of recent drug use

Article References: Moeller, S. J., McClain, N., Abeykoon, S., Alia-Klein, N., & Goldstein, R. Z. (2026). Metacognitive impairment in cocaine use disorder: confirmatory evidence for the effects of recent drug use. Translational Psychiatry. https://doi.org/10.1038/s41398-026-04406-7

Image Credits: AI Generated

DOI: 10.1038/s41398-026-04406-7

Keywords: cocaine use disorder, metacognition, substance abuse, prefrontal cortex, self-monitoring, Translational Psychiatry, addiction neuroscience, relapse prevention, cognitive impairment, dopamine, confidence judgments, abstinence