Non-abstainers are younger with less time in recovery and less problem severitybut worse QOL than abstainers. Clinically, individuals considering non-abstinent goalsshould be aware that abstinence may be best for optimal QOL in the long run.Furthermore, time in recovery should be accounted for when examining correlates ofrecovery. Controlled drinking, also known as “moderate drinking” or “drinking in moderation,” is an approach that involves setting limits around alcohol consumption to ensure that drinking remains safe and doesn’t interfere with one’s health, daily life, or responsibilities. The results suggest the importance of offering interventions with various treatment goals and that clients choosing CD as part of their sustained recovery would benefit from support in this process, both from peers and professionals.
Effectiveness: maintaining abstinence up to 12 months versus placebo
Finally, reduced drinking is often the focus of a harm-reduction approach, where the likely alternative is not abstinence but continued alcoholism. To determine interventions that are applicable to primary care,8 three content experts (DK, ALH, and MH) examined the interventions. Interventions that involved frequent, repeated intravenous infusions, uncommon equipment in primary care, illicit drugs, experimental chemicals, and drugs unlicensed in the UK were not included in the review (see list in supplement 3). We excluded studies on pregnant women, participants with chronic liver disease, participants with HIV/AIDS, and patients with liver transplant owing to the specific clinical considerations of these populations. Should it be complete and total abstinence from alcohol, or can an alcoholic learn to use alcohol in moderate, controlled ways? 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.
1 Sample demographics, help-seeking and problem severity
In addition to shaping mainstream addiction treatment, the abstinence-only 12-Step model also had an indelible effect on the field of SUD treatment research. Most scientists who studied SUD treatment believed that abstinence was the only acceptable treatment goal until at least the 1980s controlled drinking vs abstinence (Des Jarlais, 2017). Abstinence rates became the primary outcome for determining SUD treatment effectiveness (Finney, Moyer, & Swearingen, 2003; Kiluk, Fitzmaurice, Strain, & Weiss, 2019; Miller, 1994; Volkow, 2020), a standard which persisted well into the 1990s (Finney et al., 2003).
Risk of bias assessment
For example, among the 2005and 2010 National Alcohol Survey respondents, 18% of current drinkers who identified as“in recovery” from alcohol problems (who do not use drugs) are DSM-IValcohol dependent, and 26% of current drinkers who also use drugs are DSM-IV alcoholdependent. Thus relying on DSM criteria to define a sample of individuals in recovery mayunintentionally exclude individuals who are engaging in non-abstinent or harm reductiontechniques and making positive changes in their lives. Some clients expressed a need for other or complementary support from professionals, whereas others highlighted the importance of leaving the 12-step community to be able to work on other parts of their lives.
- These data suggest that non-disordered drug use is possible, even for a substantial portion of individuals who use drugs such as heroin (about 45%).
- This multifaceted approach helps you develop coping mechanisms while fostering healthier habits that can sustain long-term recovery.
- For these clients, the recovery process, aiming to reach sustained recovery in the broader sense covering parts of their lives other than the SUD, was in part at odds with the ongoing participation in AA.
- WIR is alsocross-sectional by design, though it did include questions about lifetime drug and alcoholuse.
- Social stability at intake was negatively related in Rychtarik et al. to consumption as a result either of abstinence or of limited intake.
Unfortunately, there has been little empirical research evaluating this approach among individuals with DUD; evidence of effectiveness comes primarily from observational research. For example, at a large outpatient SUD treatment center in Amsterdam, goal-aligned treatment for drug and alcohol use involves a version of harm reduction psychotherapy that integrates MI and CBT approaches, and focuses on motivational enhancement, self-control training, and relapse prevention (Schippers & Nelissen, 2006). Participants with controlled use goals in this center are typically able to achieve less problematic (38%) or non-problematic (32%) use, while a minority achieve abstinence with (8%) or without (6%) incidental relapse (outcomes were not separately assessed for those with AUD vs. DUD; Schippers & Nelissen, 2006). This paper presents a narrative review of the literature and a call for increased research attention on the development of empirically supported nonabstinence treatments for SUD to engage and treat more people with SUD. We define nonabstinence treatments as those without an explicit goal of abstinence from psychoactive substance use, including treatment aimed at achieving moderation, reductions in use, and/or reductions in substance-related harms.
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. Donovan and colleagues(2005) reviewed 36 studies involving various aspects of QOL in relation to AUDand concluded that heavy episodic drinkers had worse QOL than other drinkers, that reduceddrinking was related to improved QOL among harmful drinkers, and that abstainers hadimproved QOL in treated samples (Donovan et al.2005). 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. Therefore, knowledge about whether and how QOL differs betweennon-abstinent vs. abstinent recovery remains limited.
Alcoholism: Abstinence Versus Controlled Drinking
- In the fully saturated models, any twelve-step attendancedecreased odds of non-abstinence by 57–76% (Model 4), while each additional DSMsymptom decreased odds of non-abstinence by 73–89% (Model 4).
- Some clients expressed a need for other or complementary support from professionals, whereas others highlighted the importance of leaving the 12-step community to be able to work on other parts of their lives.
- If you don’t consider yourself an alcoholic or don’t feel comfortable labeling yourself one, practicing moderation helps you avoid having that discussion when you’re not in the mood.
- The ability to control drinking varies significantly from person to person and is influenced by a range of factors including genetics, environment, emotional state, and individual psychology.
- The study was especially notable because most other treatment readiness measures have been validated on treatment-seeking samples (see Freyer et al., 2004).
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. The current review highlights multiple important directions for future research related to nonabstinence SUD treatment. 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 more broadly.
- Abstinence is not the only solution for recovering from alcohol use disorders, but it is one of the most studied and successful methods for recovering from alcohol use disorders.
- If you want to resolve problem drinking without medication, abstinence may be a better choice for you.
- To date, however, there has been little empirical research directly testing this hypothesis.
- It is important to highlight that most of the studies cited above did not provide goal-matched treatment; thus, these outcomes generally reflect differences between individuals with abstinence vs. non-abstinence goals who participated in abstinence-based AUD treatment.
- Abstinence means giving up alcohol completely, and it’s the foundation of traditional treatment options like AA and most inpatient rehabs.
It’s not an easy road to lasting recovery, but with the right support and resources, it can definitely be a journey worth taking. The crucial factor here isn’t necessarily which path you choose but having a supportive network around you who respects and understands your decision. Some interview person (IP) were former polydrug users and altered between AA and NA meetings. I don’t think I have a problem, https://ecosoberhouse.com/ but I might be someone that could get it [problems] more than anyone else […] (IP30). Take our free, 5-minute substance use self-assessment below if you think you or someone you love might be struggling with substance use. The evaluation consists of 11 yes or no questions that are intended to be used as an informational tool to assess the severity and probability of a substance use disorder.
Total Alcohol Abstinence vs. Moderation: Which One Wins in the End?
Further, the aftercare sample, which was more severe at baseline was not followed for the three year follow-up assessment. It is also important to note that Project MATCH included individuals who met DSM-III-R criteria for alcohol abuse (4.6%) or dependence (95.4%), and it is unclear whether the small proportion of individuals with alcohol abuse would meet DSM-5 criteria for AUD. Finally, the measure of psychosocial functioning was not specific to alcohol use and only captured social behavior and roles.
This literature – most of which has been conducted in the U.S. – suggests a strong link between abstinence goals and treatment entry. For example, in one study testing the predictive validity of a measure of treatment readiness among non-treatment-seeking people who use drugs, the authors found that the only item in their measure that significantly predicted future treatment entry was motivation to quit using (Neff & Zule, 2002). The study was especially notable because most other treatment readiness measures have been validated on treatment-seeking samples (see Freyer et al., 2004). This finding supplements the numerous studies that identify lack of readiness for abstinence as the top reason for non-engagement in SUD treatment, even among those who recognize a need for treatment (e.g., Chen, Strain, Crum, & Mojtabai, 2013; SAMHSA, 2019a). Rychtarik et al. found that treatment aimed at abstinence or controlled drinking was not related to patients’ ultimate remission type.