It was also hypothesized that, given naltrexone’s effect on hedonic response to alcohol (King et al., 1997; McCaul et al., 2001; Ray et al., 2010), naltrexone would be more effective among those with a controlled drinking goal versus those with an abstinence oriented goal. This hypothesis was not supported by the data in that there was no significant drinking goal × naltrexone interaction in any of the outcome measures. This may be due to the fact that the vast majority of participants (78%) consumed alcohol during the trial, such that the drinking mediated effects of naltrexone were not restricted to patients with controlled drinking goals. 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.
What is Alcohol Moderation Management?
Cognitive behavioral therapy (CBT) for alcoholism has received empirical support since the 1980s (Marlatt & Gordon, 1985). 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). The ultimate goal of CBT is to provide the skills that can prevent a relapse and maintain drinking goals, whether they be abstinence or controlled drinking (Marlatt & Gordon, 1985; Marlatt & Witkiewitz, 2005).
In turn, stigma and shame have been reported as a reason for not seeking treatment (Probst et al., 2015). Although research indicates that CD may be a possible option for sustained recovery, at least for certain groups and at least later in the recovery process, it seems as if the dominating approach of treatment systems is still abstinence. The 12-step approach is widely adopted by alcohol treatment facilities (Galanter, 2016) endorsing total abstinence as the treatment goal. In the present article, clients treated in 12-step programmes were reinterviewed five years after treatment. All the interviewed clients reported a successful treatment outcome, i.e. total abstinence six months after treatment. The aim is to investigate how these clients view abstinence and the role of AA1 in their recovery process during the past five years.
Whether it’s through continued counselling or group meetings within the community -we’ll be there every step of the way- supporting you as much as needed so that recovery becomes less daunting and more hopeful. A key aspect of abstinence is understanding and navigating through the withdrawal process – a daunting task indeed but necessary for recovery. The severity of these symptoms can vary widely depending on how much you are drinking, how frequently, and your overall physical health. The analytical strategy for the present study was consistent with the primary COMBINE report (Anton et al., 2006). Thus, PDA was tested using a mixed effects general linear model (PROC MIXED), relapse and DPDD were tested using a proportional hazards model (PROC PHREG), and GCO was analyzed using a logistic regression model (PROC LOGISTIC)1. Analysis accommodated the clustering of observations by site through the estimation of a random intercept term.
Sensitivity Analyses
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). Little attention was given to whether people in abstinence-focused treatments endorsed abstinence goals themselves, or whether treatment could help reduce substance use and related problems for those who did not desire (or were not ready for) abstinence. When they are offered 12-step treatment, they get exposed to these strict views in a different setting than what was initially intended within AA, namely a self-help group that people join voluntarily.
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). 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). 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 (Des Jarlais, 2017).
With this as a starting point, the IP was asked to describe the past five years in terms of potential so-called relapse and retention and/or resumption of positive change. The interview guide also dealt with questions on treatment contacts during the follow-up period (frequency, extent and type), the view of their own and others’ alcohol consumption and important factors to continue or resume positive change. 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). 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. Some strategies and guidelines to consider if you’re aiming to practice controlled drinking include setting limits, eating before drinking, choosing drinks with lower alcohol content, alternatives with non-alcoholic beverages and having abstinent days.
- The interview guide also dealt with questions on treatment contacts during the follow-up period (frequency, extent and type), the view of their own and others’ alcohol consumption and important factors to continue or resume positive change.
- This would probably reduce the risk of negative effects while still offering the positive support experienced by the majority of the clients in the study.
- However, to date there have been no published empirical trials testing the effectiveness of the approach.
- This mental clarity also enhances productivity at work or in pursuing personal hobbies because there’s no longer a hangover holding you back.
- The aim is to investigate how these clients view abstinence and the role of AA1 in their recovery process during the past five years.
Latent Profiles at the 3-Year Follow-Up
Nonabstinence approaches to SUD treatment have a complex and contentious history, and significant social and political barriers have impeded research and implementation of alternatives to abstinence-focused treatment. We summarize historical factors relevant to non-abstinence treatment development to illuminate reasons these approaches are understudied. However, the extent of their problems according to ICD-10 (International Statistical Classification of Diseases and Related Health Problems, 10th edition) or DSM 5 (Diagnostic and Statistical Manual of mental disorders, 5th edition) was not measured. At the first interview all IPs were abstinent and had a positive view on the 12-step treatment, although a few described a cherry-picking attitude. As the IP had a successful outcome, six months after treatment, their possibilities for CD might be better than for persons with SUD in general.
Here we found that a number of factors distinguish non-abstainers from abstainersin recovery from AUD, including younger age and lower problem severity. A betterunderstanding 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? Finally, we hope tofurther investigate the overlap between “remission” and“recovery” from AUD, especially in the context of harm reduction. In addition, Helzer et al. identified a sizable group (12%) of former alcoholics who drank a threshold of 7 drinks 4 times in a single month over Can You Smoke Shrooms Read This Before You Do the previous 3 years but who reported no adverse consequences or symptoms of alcohol dependence and for whom no such problems were uncovered from collateral records.
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. Despite the reported relationship between severity and CD outcomes, many diagnosed alcoholics do control their drinking. The Rand study quantified the relationship between severity of alcohol dependence and controlled-drinking outcomes, although, overall, the Rand population was a severely alcoholic one in which “virtually all subjects reported symptoms of alcohol dependence” (Polich, Armor, and Braiker, 1981). Severity of alcoholism is the most generally accepted clinical indicator of the appropriateness of CD therapy (Rosenberg, 1993). Untreated alcohol abusers probably have less severe drinking problems than clinical populations of alcoholics, which may explain their higher levels of controlled drinking.
Multivariable stepwise regressions (Table2) show that younger individuals were significantly more likely to benon-abstinent, and movement to the next oldest age category reduced the odds ofnon-abstinence by an average of 27%. Importantly, the confidence intervals were narrow andextremely similar across models, implying that the effect of age was robust to modelspecification. In regard to help-seeking and problem severity, having attended at leastone 12-step meeting and the number of DSM-IV dependence symptoms were both significantlyrelated to non-abstinence. 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).