Previous reviews have described nonabstinence pharmacological approaches (e.g., Connery, 2015; Palpacuer et al., 2018), which are outside the scope of the current review. We first describe treatment models with an explicit harm reduction or nonabstinence focus. While there are multiple such intervention approaches for treating AUD with strong empirical support, we highlight a dearth of research testing models of harm reduction treatment for DUD. Next, we review other established SUD treatment models that are compatible with non-abstinence goals.
Sensitivity Analyses
This study investigated what factors are related to choosing a non-abstinent path, and whether these individuals have better or worse overall quality of life. Multivariable stepwise regressions estimating the probability of non-abstinentrecovery and average quality of life. Seeking professional treatment is recommended at any time, whether you are engaging in binge drinking or have an alcohol use disorder. There is no wrong time to seek help, which can mean many different things depending on your personal needs and preferences. The Centers for Disease Control and Prevention (CDC) defines moderate drinking as no more than two drinks daily for men and one drink daily for women. Moderate drinking may reduce the risk of experiencing adverse health effects, but it does not eliminate them fully.
- In addition to issues with administrative discharge, abstinence-only treatment may contribute to high rates of individuals not completing SUD treatment.
- Controlled drinking as well as abstinence is an appropriate goal for the majority of problem drinkers who are not alcohol-dependent.
- Even if you could choose to stop using drugs and alcohol on your own, you could end up with dry drunk syndrome or potentially relapse.
- This approach reduces the painfulness of withdrawal syndrome, which former alcoholics can develop even with controlled alcohol use.
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).
Is Drinking in Moderation Possible for Alcoholics? – Verywell Mind
- From a broader public health perspective, increasing access to effective SUD interventions and recovery support services is likely to enhance their overall impact (Glasgow et al., 2003).
- The current aims are to identify correlates ofnon-abstinent recovery and examine differences in QOL between abstainers andnon-abstainers accounting for length of time in recovery.
- You may have found yourself in a place where you cannot choose how much or how little you drink or use drugs because of your physical dependence and the power of craving.
- It could also be that chronic use of AOD begins to culminate in greater incidence of medical problems (e.g., through toxicity-related impacts) and continued use may exacerbate these medical issues or interfere with effective treatment for them (Eddie et al., 2019), again, promoting motivation to abstain or reduce use.
- Harm reduction programs are important when considering treatment options for substance use disorders.
- The RP model has been studied among individuals with both AUD and DUD (especially Cocaine Use Disorder, e.g., Carroll, Rounsaville, & Gawin, 1991); with the largest effect sizes identified in the treatment of AUD (Irvin, Bowers, Dunn, & Wang, 1999).
In addition, some might consider abstinence as a necessary part of therecovery process, while others might not. The controlled drinking approach is based on the idea that not all problem drinkers require complete abstinence to improve their health and well-being. For some individuals, learning to moderate their alcohol consumption can be an effective way to reduce alcohol-related harm while maintaining a level of social drinking. It’s heartbreaking to see loved ones caught in the grip of addiction, but there’s hope – research shows that many people find success with programmes aimed at reducing consumption.
Who Might Benefit from Moderation Management?
Instead, providers claim, holding out such a goal to an alcoholic is detrimental, fostering a continuation of denial and delaying the alcoholic’s need to accept the reality that he or she can never drink in moderation. While working with a clinician is the best way to determine what goals and treatment approach is appropriate for you and your medical history, here are some useful pointers to consider when reflecting on the question of abstinence vs. drinking in moderation. The capacity to sustain abstinence prior to treatment significantly decreased the likelihood of heavy drinking. Two weeks of abstinence was the optimal split in COMBINE which is consistent with prior work by Stout (2000).
Learn more about our whole-person healing philosophy by consulting a member of our admissions team today. By understanding the key differences between these paths, you or someone you love can make informed decisions that align with goals and needs, whether aiming for harm reduction or complete recovery. Abstinence is the preferred medical recommendation for achieving lasting sobriety if you or someone you love has a genetic predisposition to AUD or SUD. Research indicates that 40–60 percent of risk factors are biological, so many family members choose to abstain if they know their background. Zero tolerance is also recommended for people with a history of SUD or AUD if moderate consumption poses considerable risks. This concept is about finding a balance where alcohol can be enjoyed in a controlled, responsible manner without negative impacts such as impaired judgment, health issues, or dependence.
To date, research examining associations among abstinent and non-abstinent substance use status and well-being, has focused primarily on treatment-seeking individuals with alcohol use disorder. Subsequently, the authors found that abstinence in this sample at three years did not predict better psychological functioning at ten years controlled drinking vs abstinence addiction recovery (Witkiewitz et al., 2020). Although this research adds to growing evidence that distinct longer term recovery profiles can be identified based on both alcohol-related outcomes and functioning indicators, important questions remain about whether these profiles forecast sustained positive outcomes over longer intervals. For example, do the individuals in the high functioning profiles—including those engaging in heavy drinking—maintain this level of functioning in subsequent years?
Regardless of your path, working with a physician and therapist can provide answers, reassurance, and guidance throughout the process. You also don’t need to have a clear understanding of your goal to start making progress. Get therapy and medical care—just $25 with insurance, no hidden fees— for alcohol recovery, depression, everyday illnesses, and more. This section collects any data citations, data availability statements, or supplementary materials included in this article. Having overcome it, a person with addiction is unable to listen to the arguments of reason. Unfortunately, the very program that Kishline created was one that worked for others but not for herself.
WHAT DID THIS STUDY FIND?
Moderation can also make individuals feel as though they can control their substance use, giving them a false sense of wellness. Abstinence may not be the easiest addiction treatment approach, but it is the most effective. MM may help some people moderate their drinking, but this program is not the answer for those who are truly alcoholics.
Edwards et al. (1983) reported that controlled drinking is more unstable than abstinence for alcoholics over time, but recent studies have found that controlled drinking increases over longer follow-up periods. Finney and Moos (1991) reported a 17 percent “social or moderate drinking” rate at 6 years and a 24 percent rate at 10 years. In studies by McCabe (1986) and Nordström and Berglund (1987), CD outcomes exceeded abstinence during follow-up of patients 15 and more years after treatment.
Quality of life / Functioning
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, 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. To date there has been limited research on retention rates in nonabstinence treatment.
This suggests that individuals with non-abstinence goals are retained as well as, if not better than, those working toward abstinence, though additional research is needed to confirm these results and examine the effect of goal-matching on retention. Researchers have long posited that offering goal choice (i.e., non-abstinence and abstinence treatment options) may be key to engaging more individuals in SUD treatment, including those earlier in their addictions (Bujarski et al., 2013; Mann et al., 2017; Marlatt, Blume, & Parks, 2001; Sobell & Sobell, 1995). To date, however, there has been little empirical research directly testing this hypothesis. Advocates of nonabstinence approaches often point to indirect evidence, including research examining reasons people with SUD do and do not enter treatment. This literature – most of which has been conducted in the U.S. – suggests a strong link between abstinence goals and treatment entry.
The debate between controlled drinking and abstinence approaches continues in the addiction treatment field. While abstinence is generally considered the safest option, especially for those with severe AUD, controlled drinking may be a viable alternative for some individuals. 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. But the less severe problem drinkers uncovered in nonclinical studies are more typical, outnumbering those who “show major symptoms of alcohol dependence” by about four to one (Skinner, 1990).