These groups tend to include individuals who use a range of substances and who endorse a range of goals, including reducing substance use and/or substance-related harms, controlled/moderate use, and abstinence (Little, 2006). Additionally, some groups target individuals with co-occurring psychiatric disorders (Little, Hodari, Lavender, & Berg, 2008). Important features common to these groups include low program barriers (e.g., drop-in groups, few rules) and inclusiveness of clients with difficult presentations (Little & Franskoviak, 2010). In the 1970s, the pioneering work of a small number of alcohol researchers began to challenge the existing abstinence-based paradigm in AUD treatment research. They found that their controlled drinking intervention produced significantly better outcomes compared to usual treatment, and that about a quarter of the individuals in this condition maintained controlled drinking for one year post treatment (Sobell & Sobell, 1973). Nordström and Berglund, like Wallace et al. (1988), selected high-prognosis patients who were socially stable.
Alcoholism Abstinence
The person that decides to drink socially or now and then, is going to be consistently re-introducing that substance to the body, therefore always leaving the body craving more. Those who choose abstinence will completely avoid all alcohol, including that in food or in hygiene products such as mouthwash. Before a person can successfully begin their recovery, a vital question to ask is what is my goal? Do I want to give up completely, or do I want to be able to have a few drinks now and then. If the answer is a few now and then, the next question to ask is am I honestly able to do that? The majority of people I ask this question to will say no, it is never one or two, it always leads onto more.
Overview of studies
We do not know whether the WIR sample represents the population of individualsin recovery. The WIR data do not include current dependence diagnoses, which would beuseful for further understanding of those in non-abstinent recovery. In addition, the WIRquality of life measure is based on a single question; future studies could useinstruments that detail various aspects of mental and physical functioning. WIR is alsocross-sectional by design, though it did include questions about lifetime drug and alcoholuse.
- D Defined as nonproblem drinking, with either low quantities of consumption (8%) or some heavy drinking (10%).
- Thus, it was not the sobriety goal in itself that created problems, but the strict belief presenting this goal as “the only way”.
- Individual factors like personal motivation, mental health status, and support system also play a key role in determining how well someone will fare within a programme.
- Overall, increased research attention on nonabstinence treatment is vital to filling gaps in knowledge.
- In studies by McCabe (1986) and Nordström and Berglund (1987), CD outcomes exceeded abstinence during follow-up of patients 15 and more years after treatment (see Table 1).
Quality of evidence evaluation
- Instead, paststudies have equated “recovery” with DSM-IV diagnostic criteria and nationalguidelines for low-risk drinking; these criteria may exclude people who considerthemselves “in recovery.” For example, individuals involved in harmreduction techniques that do not involve changed drinking may consider themselves inrecovery.
- Questions on main drug and other problematic drug use were followed by the interviewer giving a brief summary of how the interview person (IP) had described their change process five years earlier.
- But the less severe problem drinkers uncovered in nonclinical studies are more typical, outnumbering those who “show major symptoms of alcohol dependence” by about four to one (Skinner, 1990).
- However, it is also possible that adaptations will be needed for individuals with nonabstinence goals (e.g., additional support with goal setting and monitoring drug use; ongoing care to support maintenance goals), and currently there is a dearth of research in this area.
Here we found that a number of factors distinguish non-abstainers from abstainersin recovery from AUD, including younger age and lower problem severity. Furthermore, qualityof life appeared significantly better among abstainers than non-abstainers. A betterunderstanding https://ecosoberhouse.com/ of the recovery process and tools utilized by non-abstinent vs. abstinentindividuals would inform clinical practice; for example, is it more important for those inabstinent recovery to have abstinent individuals in their social networks?
However, CD is a widely accepted treatment goal in Australia, Britain and Norway (Luquines et al., 2011). The Swedish treatment system has been dominated by total abstinence as the goal, although treatment with CD as a goal exists (e.g., Agerberg, 2014; Berglund et al., 2019). Given the abstinence focus of many SUD treatment centers, studies may need to recruit using community outreach, which can yield fewer participants compared to recruiting from treatment (Jaffee et al., 2009). However, this approach is consistent with the goal of increasing treatment utilization by reaching those who may not otherwise present to treatment. Alternatively, researchers who conduct trials in community-based treatment centers will need to obtain buy-in to test nonabstinence approaches, which may necessitate waiving facility policies regarding drug use during treatment – a significant hurdle. Harm reduction therapy has also been applied in group format, mirroring the approach and components of individual harm reduction psychotherapy but with added focus on building social support and receiving feedback and advice from peers (Little, 2006; Little & Franskoviak, 2010).
Historical context of nonabstinence approaches
In the initial interviews, all the clients declared themselves abstinent and stressed that substance use in any form was not an option. Abstinence from alcohol and other drugs has historically been a core criterion for recovery, defined by the Betty Ford Institute as a “voluntarily maintained lifestyle characterized by sobriety, personal health, and citizenship” (Betty Ford Institute Consensus Panel, 2007, p. 222). As recovery processes stretch over a long period, it is suggested that stable recovery is obtained after five years at the earliest (Hibbert and Best, 2011).
However, they do not elucidate patterns of non-disordered use over time, nor the likelihood of maintaining drug use without developing a DUD. Rather, when people with SUD are surveyed about reasons they are not in treatment, not being ready to stop using substances is consistently the top reason cited, even among individuals who perceive a need for treatment (SAMHSA, 2018, 2019a). Indeed, about 95% of people with SUD say they do not need SUD treatment (SAMHSA, 2019a). Even among those who do perceive a need for treatment, less than half (40%) make any effort to get it (SAMHSA, 2019a).
A better understanding of the factors related tonon-abstinent recovery will help clinicians advise patients regarding appropriatetreatment goals. Controlled drinking as well as abstinence is an appropriate goal for the majority of problem drinkers who are not alcohol-dependent. In addition, while controlled drinking becomes less likely the more severe the degree of alcoholism, other factors—such as age, values, and beliefs about oneself, one’s drinking, and the possibility of controlled drinking—also play a role, sometimes the dominant role, in determining successful outcome type.
- Simply put, those who want to learn to drink in moderation are less likely to achieve their goal, while those who set a goal of quitting drinking entirely see greater success.
- However, they no longer found themselves in need of this help and did not express ambivalence regarding their decision to stop attending meetings.
- If one drink still leads to several more, attempting moderation isn’t the safest choice.
- The past 20 years has seen growing acceptance of harm reduction, evidenced in U.S. public health policy as well as SUD treatment research.
- A common objection to CD is that most people fail to return to “normal” drinking, and highlighting those able to drink in a controlled way might attract people into relapse, with severe medical and social consequences.
Finally, the WIR survey did not ask about preferential beverage (e.g., beer, wine,spirits), usual quantities of ethanol and other drugs consumed per day, or specificsregarding AA involvement; because these factors could impact the recovery process, we willinclude these measures in future studies. These findings have important implications for clinical practice, as acamprosate was found to be the only intervention with enough high quality evidence controlled drinking vs abstinence for us to conclude that it is better at maintaining alcohol abstinence than placebo. The finding that there is currently little evidence on other interventions, such as disulfiram, for detoxified, alcohol dependent patients in UK primary care settings should lead to the generation of better evidence from high quality pragmatic randomised trials. We grouped different dosages of the same interventions into one node for network meta-analyses.
Controlled-drinking therapy is widely available in Europe, however, and some in the United States argue that controlled drinking is in fact a reasonable and realistic goal. Alcohol moderation management isn’t just about cutting back and reducing your blood alcohol concentration, it’s a deeply personal journey that can empower you to regain control of your life and reconnect with those who matter most. This strategy is not about total abstinence but involves setting moderate drinking goals that are safe and sensible for you, paying attention to social influences that may sway your decisions, and developing self-awareness around your triggers.
