The results of the Sobell’s studies challenged the prevailing understanding of abstinence as the only acceptable outcome for SUD treatment and raised a number of conceptual and methodological issues (e.g., the Sobell’s liberal definition of controlled drinking; see McCrady, 1985). A “controlled drinking controversy” followed, in which the Sobells as well as those who supported them were publicly criticized due to their claims about controlled drinking, and the validity of their research called into question (Blume, 2012; Pendery, Maltzman, & West, 1982). Despite the intense controversy, the Sobell’s high-profile research paved the way for additional studies of nonabstinence treatment for AUD in the 1980s and later (Blume, 2012; Sobell & Sobell, 1995). Marlatt, in particular, became well known for developing nonabstinence treatments, such as BASICS for college drinking (Marlatt et al., 1998) and Relapse Prevention (Marlatt & Gordon, 1985). Like the Sobells, Marlatt showed that reductions in drinking and harm were achievable in nonabstinence treatments (Marlatt & Witkiewitz, 2002).
3. The harm reduction movement
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. On the other hand, previous research has reported that a https://ecosoberhouse.com/article/recommended-vitamins-for-recovering-alcoholics/ major reason for not seeking treatment among alcohol-dependent people is the perceived requirement of abstinence (Keyes et al., 2010; Wallhed Finn et al., 2014, 2018). In turn, stigma and shame have been reported as a reason for not seeking treatment (Probst et al., 2015).
Why Moderation May Be a Better Choice Than Abstinence
Most of the information collected was self-reported by the participants, which is known to be somewhat problematic, so the researchers also contacted significant others who were used to corroborate the drinking behavior reported by the participants. The thing is that the amount of alcohol or drug use per se is not a part of the definition of addiction or abuse (other than in the “using more than intended” factor but even there an absolute amount isn’t introduced) and I don’t think it should be a necessary part of the solution either. Data extraction Outcomes of interest were continuous abstinence from alcohol (effectiveness) and all cause dropouts (as a proxy for acceptability) at least 12 weeks after start of intervention. Some of the abstainers reported experience of professional contacts, such as therapists or psychologists. These contacts had often complemented the support from AA but in some cases also complicated it as the IPs found that their previous SUD was related to other things that were not in line with the approach to addiction as a disease (e.g. IP19). When your goal is only one drink instead of no drinks at all, the temptation to stray can become less powerful and you can more often enjoy positive reinforcement from your successes.
Take Advantage of “Getting Back to Normal” to Revisit Your Relationship with Alcohol
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. We first provide an overview of the development of abstinence and nonabstinence approaches within the historical context of SUD treatment in the U.S., followed by an evaluation of literature underlying the theoretical controlled drinking vs abstinence and empirical rationale for nonabstinence treatment approaches. Lastly, we review existing models of nonabstinence psychosocial treatment for SUD among adults, with a special focus on interventions for drug use, to identify gaps in the literature and directions for future research. We identify a clear gap in research examining nonabstinence psychosocial treatment for drug use disorders and suggest that increased research attention on these interventions represents the logical next step for the field. A considerable number of clients reported changed views on the programme, some were still abstinent and some were drinking in a controlled way.
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. Moderation techniques such as pacing yourself, choosing lower-alcohol options, or having alcohol-free days can be practical tools in this journey. In addition to issues with administrative discharge, abstinence-only treatment may contribute to high rates of individuals not completing SUD treatment. About 26% of all U.S. treatment episodes end by individuals leaving the treatment program prior to treatment completion (SAMHSA, 2019b).
- “Harm reduction” strategies, on theother hand, set more flexible goals in line with patient motivation; these differ greatlyfrom person to person, and range from total abstinence to reduced consumption and reducedalcohol-related problems without changes in actual use (e.g., no longer driving drunkafter having received a DUI).
- Many clients in the study described that the 12-step programme was the only treatment that they were offered.
- In sum, research suggests that achieving and sustaining moderate substance use after treatment is feasible for between one-quarter to one-half of individuals with AUD when defining moderation as nonhazardous drinking.
- It is essential to understand what individuals with SUD are rejecting when they say they do not need treatment.
- Given low treatment engagement and high rates of health-related harms among individuals who use drugs, combined with evidence of nonabstinence goals among a substantial portion of treatment-seekers, testing nonabstinence treatment for drug use is a clear next step for the field.
Individuals who received MET were more likely to be in the heavy and low risk drinking classes (Classes 3 and 5) and those who received CBT were less likely to be in the abstinent and heavy drinking class (Class 3). I’m a big supporter of the idea that improvements in quality of life, in addition to or instead of measures of abstinence, need to be incorporated broadly into addiction treatment research. The way I see it, our goal in treating addiction is to help a client improve their functioning, which is often being hampered by substance abuse but that is not necessarily completely dependent on it.
Data synthesis and analyses
While abstinence refers to behaviour, sobriety goes deeper and concerns the roots of the problem (addiction) and thereby refers to mental and emotional aspects. Differentiating these concepts opens up for recovery without necessarily having strong ties with the recovery community and having a life that is not (only) focused on recovery but on life itself. Also, defining sobriety as a further/deeper step in the recovery process offers a potential for 12-step participants to focus on new goals and getting involved in new groups, not primarily bound by recovery goals. Further, describing recovery as a process also implies paying attention to contributing factors outside the treatment context, such as the importance of work, family and friends.
Individuals who were mostly abstinent, even with occasions of heavier drinking (Class 6 and 7), had the best outcomes. Individuals who engaged in persistent heavy drinking (Class 1) had worse outcomes than all other classes, including those classes with other patterns of heavy drinking. Thus, it may be important for clinicians to assess for patterns of drinking and to encourage at least some abstinent days, even among those clients with low risk drinking goals.
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