Differences between abstinent and non-abstinent individuals in recovery from alcohol use disorders PMC

controlled drinking vs abstinence

The Minnesota Model involved inpatient SUD treatment incorporating principles of AA, with a mix of professional and peer support staff (many of whom were members of AA), and a requirement that patients attend AA or NA meetings as part of their treatment (Anderson, McGovern, & DuPont, 1999; McElrath, 1997). This model both accelerated the spread of AA and NA and helped establish the abstinence-focused 12-Step program at the core of mainstream addiction treatment. By 1989, treatment center referrals accounted for 40% of new AA memberships (Mäkelä et al., 1996). This standard persisted in SUD treatment even as strong evidence emerged that a minority of individuals who receive 12-Step treatment achieve and maintain long-term abstinence (e.g., Project MATCH Research Group, 1998). Rychtarik et al. found that treatment aimed at abstinence or controlled drinking was not related to patients’ ultimate remission type. Booth, Dale, and Ansari (1984), on the other hand, found that patients did achieve their selected goal of abstinence or controlled drinking more often.

  • Finally, reduced drinking is often the focus of a harm-reduction approach, where the likely alternative is not abstinence but continued alcoholism.
  • In its original form, RP aims to reduce risk of relapse by teaching participants cognitive and behavioral skills for coping in high-risk situations (Marlatt & Gordon, 1985).
  • Even though she would later wind up admitting straightforwardly that balance didn’t turn out for her, she still completely upheld it as a possibility for other people, and from that point forward many have committed and made fruitful turnarounds in their lives with the moderation management program.
  • In contrast, individuals with greater SUD severity, who are more likely to have abstinence goals, generally have the best outcomes when working toward abstinence (Witkiewitz, 2008).
  • You will feel stressed and wishing your life away until you can have the next ‘fix’.
  • It’s during this period that peer support becomes invaluable; it helps to know that others are experiencing similar struggles or have overcome them already.

Expanding the continuum of substance use disorder treatment: Nonabstinence approaches

Additionally, individuals are most likely to achieve the outcomes that are consistent with their goals (i.e., moderation vs. abstinence), based on studies of both controlled drinking and drug use (Adamson, Heather, Morton, & Raistrick, 2010; Booth, Dale, & Ansari, 1984; Lozano et al., 2006; Schippers & Nelissen, 2006). The past decade has seen the AUD service field increasingly embrace the broadergoal of `recovery’ as its guiding vision. However, the NESARC QOL analyses examined transitions across AUD statusesover a three-year period, and thus inherently excluded individuals with more than threeyears of recovery. In addition, previous QOL analyses have not accounted for length oftime in recovery. Therefore, knowledge about whether and how QOL differs betweennon-abstinent vs. abstinent recovery remains limited. Cognitive behavioral therapy (CBT) for alcoholism has received empirical support since the 1980s (Marlatt & Gordon, 1985).

controlled drinking vs abstinence

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controlled drinking vs abstinence

If you are just starting your moderation management program, you might need controlled drinking vs abstinence to invest some time trying to come up with a decision on a commitment to abstain from substance abuse before it becoming solid in your heart. Choosing something truly important to you does not mean simply wanting to do something. Results from the 1989 Canadian National Alcohol and Drug Survey confirmed that those who resolve a drinking problem without treatment are more likely to become controlled drinkers.

Historical context of nonabstinence approaches

Overall, increased research attention on nonabstinence treatment is vital to filling gaps in knowledge. For example, despite being widely cited as a primary rationale for nonabstinence treatment, the extent to which offering nonabstinence options increases treatment utilization (or retention) is unknown. In addition to evaluating nonabstinence treatments specifically, researchers could help move the field forward by increased attention to nonabstinence goals https://ecosoberhouse.com/ more broadly. For example, all studies with SUD populations could include brief questionnaires assessing short-and long-term substance use goals, and treatment researchers could report the extent to which nonabstinence goals are honored or permitted in their study interventions and contexts, regardless of treatment type. There is also a need for updated research examining standards of practice in community SUD treatment, including acceptance of non-abstinence goals and facility policies such as administrative discharge. For example, offering nonabstinence treatment may provide a clearer path forward for those who are ambivalent about or unable to achieve abstinence, while such individuals would be more likely to drop out of abstinence-focused treatment.

controlled drinking vs abstinence

3. Summary of the state of the literature

controlled drinking vs abstinence

Multiple versions of harm reduction psychotherapy for alcohol and drug use have been described in detail but not yet studied empirically. However, to date there have been no published empirical trials testing the effectiveness of the approach. Traditional alcohol use disorder (AUD) treatment programs most often prescribeabstinence as clients’ ultimate goal. In the broadest sense, harm reduction seeks to reduceproblems related to drinking behaviors and supports any step in the right directionwithout requiring abstinence (Marlatt and Witkiewitz2010). Witkiewitz (2013) has suggestedthat abstinence may be less important than psychiatric, family, social, economic, andhealth outcomes, and that non-consumption measures like psychosocial functioning andquality of life should be goals for AUD research (Witkiewitz 2013). These goals are highly consistent with the growingconceptualization of `recovery’ as a guiding vision of AUD services (The Betty Ford Institute Consensus Panel 2007).

Models of nonabstinence psychosocial treatment for SUD

  • Next, we review other established SUD treatment models that are compatible with non-abstinence goals.
  • However, this approach is consistent with the goal of increasing treatment utilization by reaching those who may not otherwise present to treatment.
  • Nonabstinence goals have become more widely accepted in SUD treatment in much of Europe, and evidence suggests that acceptance of controlled drinking has increased among U.S. treatment providers since the 1980s and 1990s (Rosenberg, Grant, & Davis, 2020).
  • Although abstainers had the best outcomes, this study suggests that moderate drinking may be considered a viable drinking goal option for some individuals who may not be willing or able to abstain completely.
  • CBT for alcohol use disorders is grounded in social-cognitive theory (Bandura, 1986) and employs skills training in order to help patients cope more effectively with substance use triggers, including life stressors (Longabaugh & Morgenstern, 1999; Morgenstern & Longabaugh, 2000).

A better understanding of the factors related tonon-abstinent recovery will help clinicians advise patients regarding appropriatetreatment goals. It is well known to clinicians and researchers in the field of alcoholism that patients vary with respect to drinking goal. The objective of this study is to elucidate the contribution of drinking goal to treatment outcome in the context of specific behavioral and pharmacological interventions.

  • The Alcoholics Anonymous organization states that the goal of treatment for those who are dependent on alcohol must be total, complete, and permanent abstinence from alcohol.
  • Some people cannot get past step one, which is admitting that one is powerless over alcohol.
  • These results suggest that drinking goal represents a highly predictive clinical variable and should be an integral part of the clinical assessment of patients with alcohol dependence.
  • It frequently helps in fighting off worries from others in their life, as well.
  • His work has been published in leading professional journals and popular publications around the globe.