When the premise of AA was transformed into the 12-step treatment programme, it was performed in a professional setting. Many clients in the study described that the 12-step programme was the only treatment that they were offered. The context of treatment in a professional setting, and in many cases, the only treatment offered, gives the 12-step philosophy a sense of legitimacy. Here controlled drinking vs abstinence we provide a brief review of existing models of nonabstinence psychosocial treatment, with the goal of summarizing the state of the literature and identifying notable gaps and directions for future research. Previous reviews have described nonabstinence pharmacological approaches (e.g., Connery, 2015; Palpacuer et al., 2018), which are outside the scope of the current review.
3 Stepwise regressions: Non-abstinence
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. The goal of a moderation program is to support a person’s journey toward understanding their drinking behavior and create a safe environment for them to explore how to drink moderately. Moderation often requires that you take anti-craving medication for an indefinite period of time. Medication makes it easier to put the brakes on after a drink or two, and sticking to moderation is challenging without it.
Help for Achieving Lasting Recovery
We thank the study authors who provided data and extra information for this review, including the Project MATCH executive committee for providing the Project MATCH public dataset for the secondary analysis. The authors acknowledge that the reported results are, in whole or in part, based on analyses of the Project MATCH Public Data Set. These data were collected as part of a multisite clinical trial of alcoholism treatments supported by a series of grants from the National Institute on Alcohol Abuse and Alcoholism and made available to the authors by the Project MATCH Research Group. This article has not been reviewed or endorsed by the Project MATCH Research Group and does not necessarily represent the opinions of its members, who are not responsible for the contents. The primary outcome measure was dichotomous, ideally extracted as the number of patients who remained abstinent (no alcohol intake) after randomisation, out of the total number of participants randomised. We converted percentages or fractions to whole numbers based on the number of randomised patients, provided an intention-to-treat analysis had been used.
2. Relationship between goal choice and treatment outcomes
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. An additional concern is that the lack of research supporting the efficacy of established interventions for achieving nonabstinence goals presents a barrier to implementation. In prior analyses, there were no differences between the low risk drinking classes (Class 5 and 6) in drinking or psychosocial functioning in the year following treatment (Witkiewitz, Roos, et al., 2017).
Theoretical and empirical rationale for nonabstinence treatment
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.
- Therefore, our programme includes evidence-based therapies such as cognitive behavioural therapy (CBT) or dialectical behaviour therapy (DBT).
- The context of treatment in a professional setting, and in many cases, the only treatment offered, gives the 12-step philosophy a sense of legitimacy.
- Heterogeneity was assessed using the results of the pairwise analyses, and between study variance for the network meta-analyses (τ2).
- On the other hand, some clients in the present study had adopted the 12-step principles, intensified their attendance and made it more or less central in their life.
- Harm reduction may also be well-suited for people with high-risk drug use and severe, treatment-resistant SUDs (Finney & Moos, 2006; Ivsins, Pauly, Brown, & Evans, 2019).
- Of note, other SUD treatment approaches that could be adapted to target nonabstinence goals (e.g., contingency management, behavioral activation) are excluded from the current review due to lack of relevant empirical evidence.
- This approach underestimates the compulsive nature of addiction and the neurological changes that occur with prolonged alcohol abuse.
This means addressing not just the physical symptoms of addiction but also the psychological, emotional, social, and spiritual aspects as well. Such approaches could include cognitive behavioural therapy to address mental health issues that may contribute to excessive drinking; yoga or meditation for stress relief; art therapy for expressing emotions; faith-based support groups for spiritual growth among others. The results suggest that the 12-step philosophy, with abstinence as the only possible choice, might mean that people in the AA community who are ambivalent and/or critical regarding parts of the philosophy must “hide” their perceptions on their own process. Experiences of the 12-step programmes and AA meetings were useful for a majority of the clients. Thus, it was not the sobriety goal in itself that created problems, but the strict belief presenting this goal as “the only way”. 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 from professionals.
Risk of bias within included studies
- In the results, we mention that there were a few IPs that were younger, with a background of diffuse and complex problems characterized by a multi-problem situation.
- 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.
- Non-abstinent goals can improve quality of life (QOL) among individuals withalcohol use disorders (AUD).
- While there is evidence that a subset of individuals who use drugs engage in low-frequency, non-dependent drug use, there is insufficient research on this population to determine the proportion for whom moderation is a feasible treatment goal.
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 https://ecosoberhouse.com/ such as administrative discharge. A number of studies have examined psychosocial risk reduction interventions for individuals with high-risk drug use, especially people who inject drugs. In contrast to the holistic approach of harm reduction psychotherapy, risk reduction interventions are generally designed to target specific HIV risk behaviors (e.g., injection or sexual risk behaviors) without directly addressing mechanisms of SUD, and thus are quite limited in scope.
Repeated Measures Latent Class Models of Weekly Drinking During Treatment
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. In parallel with the view on abstinence as a core criterion for recovery, controlled drinking (CD) has been a recurring concept and in focus from time to time in research on alcohol problems for more than half a century (Davies, 1962; Roizen, 1987; Saladin and Santa Ana, 2004). It caused heated debates, and for a long time, it has had a rather limited impact on professional treatment systems (Coldwell and Heather, 2006).
In the initial interviews, all the clients declared themselves abstinent and stressed that substance use in any form was not an option. Interviews with 40 clients were conducted shortly after them finishing treatment and five years later. All the interviewees had attended treatment programmes based on the 12-step philosophy, and they all described abstinence as crucial to their recovery process in an initial interview. The purpose of this paper is to investigate how clients – five years after completing treatment interventions endorsing abstinence – view abstinence and the role of Alcoholics Anonymous (AA) in their recovery process. At one extreme, Vaillant (1983) found a 95 percent relapse rate among a group of alcoholics followed for 8 years after treatment at a public hospital; and over a 4-year follow-up period, the Rand Corporation found that only 7 percent of a treated alcoholic population abstained completely (Polich, Armor, & Braiker, 1981). At the other extreme, Wallace et al. (1988) reported a 57 percent continuous abstinence rate for private clinic patients who were stably married and had successfully completed detoxification and treatment—but results in this study covered only a 6-month period.
- After relistening to the interviews and scrutinizing transcripts, the material was categorized and summarized by picking relevant parts from each transcript.
- Remember that every person’s journey is unique; there are no one-size-fits-all solutions for managing alcohol intake.
- While some cultures romanticise heavy drinking others promote temperance; being aware of these cultural influences can aid in reshaping your own relationship with alcohol and eliminate harmful drinking patterns.
- We found that outcomes were reported over a wide range of time points between three and 24 months.
After the classes of drinking during treatment were identified, we examined mean differences in three year functioning by latent class membership using a Wald chi-square test via a distal outcomes analysis (the “BCH” method; Asparouhov & Muthén, 2014; Bolck, Croon, & Hagenaars, 2004). Comparisons between classes derived from the RMLCA on 3-year post-treatment outcomes were examined for PDD, PHDD, DDD, DrInC total score, PFI social behavior subscale, and PFI social role subscale. 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.
