The first, Medical Management (MM), consisted of nine brief sessions delivered by a licensed health care professional, and was intended to approximate a primary care intervention. The second, Combined Behavioral Intervention (CBI), consisted of up to twenty, 50-minute sessions which integrated aspects of cognitive behavioral therapy, 12-step facilitation, motivational interviewing, and involvement of support systems. This means addressing not just the physical symptoms of addiction but also the psychological, emotional, social, and spiritual aspects as well.
Approaches to Alcoholism Treatment
Booth, Dale, and Ansari (1984), on the other hand, found that patients did achieve their selected goal of abstinence or controlled drinking more often. Miller et al. (in press) found that more dependent drinkers were less likely to achieve CD outcomes but that desired treatment goal and whether one labeled oneself an alcoholic or not independently predicted outcome type. Non-abstinent goals can improve quality of life (QOL) among individuals withalcohol use disorders (AUD). However, prior studies have defined“recovery” based on DSM criteria, and thus may have excluded individualsusing non-abstinent techniques that do not involve reduced drinking.
Katie Witkiewitz
In addition, some might consider abstinence as a necessary part of therecovery process, while others might not. We sought randomised controlled trials that investigated any treatment intervention (drug, psychological, or both) for maintaining abstinence in recently detoxified, alcohol dependent adults. We were interested only in interventions appropriate for primary care settings and only drugs that are available in the UK.
Complete sobriety might not always be a realistic solution for heavy drinkers.
Abstinence benefits extend beyond just physical improvements though; they also encompass mental health improvements. Emotional resilience begins to grow as you learn new ways to cope with stress or anxiety without reaching for a drink. Your sobriety journey is personal, and what works best for you may not work as well for someone else. For instance, abstaining from alcohol can decrease the risk of liver disease, improve cognitive function, and enhance emotional resilience. You’re here because you’ve taken the first brave step in acknowledging that your relationship with alcohol needs a change. You’re not alone, and it’s important to remember that there is no one-size-fits-all solution when it comes to managing alcohol use.
Stephanie S. O’Malley
Future research should assess the dynamic nature of drinking goal in predicting treatment outcomes. Clinicians have long recognized that client’s attitudes and goals towards drinking change throughout the course of treatment. The dynamic nature of drinking goal may be an important clinical variable in its own right (Hodgins, Leigh, Milne, & Gerrish, 1997). The present study was limited to the assessment of drinking goal at the onset of treatment and future studies examining drinking goals over the course of treatment seem warranted. Likewise, further research should consider matching patients’ drinking goals to specific treatment modalities, whether behavioral or pharmacological in nature.
These individuals are considered good candidates for harm reduction interventions because of the severity of substance-related negative consequences, and thus the urgency of reducing these harms. Indeed, this argument has been central to advocacy around harm reduction interventions for people who inject drugs, such as SSPs and safe injection facilities (Barry et al., 2019; Kulikowski & Linder, 2018). It has also been used to advocate for managed alcohol and housing first programs, which represent a harm reduction approach to high-risk drinking among people with severe AUD (Collins et al., 2012; Ivsins et al., 2019). Advocates of managed alcohol programs also note that individuals with severe AUD and structural vulnerabilities often have low interest in and utilization of abstinence-oriented treatment, and that these treatments are less effective for this population (Ivsins et al., 2019), though there is limited research examining these claims. 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).
Thirty-two states now have legally authorized SSPs, a number which has doubled since 2014 (Fernández-Viña et al., 2020). Regarding SUD treatment, there has been a significant increase in availability of medication for opioid use disorder, especially buprenorphine, over the past two decades (opioid agonist therapies including buprenorphine are often placed under the “umbrella” of harm reduction treatments; Alderks, 2013). Nonabstinence goals have become more widely accepted in SUD treatment in much of Europe, and evidence suggests that acceptance of controlled drinking has increased among U.S. treatment providers since the 1980s and 1990s (Rosenberg, Grant, & Davis, 2020). Importantly, there has also been increasing acceptance of non-abstinence outcomes as a metric for assessing treatment effectiveness in SUD research, even at the highest levels of scientific leadership (Volkow, 2020).
Seek skilled guidance from an addiction psychologist to get feedback when selecting goals, assessing progress, and setting appropriate boundaries. The number of drinks consumed per day alone is not a sufficient criterion to use when trying to diagnose someone with an Alcohol Use Disorder (AUD). Alcoholism is a complex issue characterised by a range of behavioural, physical, and psychological factors. At CATCH Recovery, we understand that your journey towards overcoming addiction is deeply personal and unique to you.
Your thoughts, feelings, and behaviours all play a role in how you manage your alcohol consumption. It’s important to acknowledge any emotional ties you might have to alcohol as these could make both moderation and complete abstinence more challenging. Recognise patterns of thought that lead to excessive drinking like stress, boredom or loneliness; addressing these underlying issues is often a key part of cutting down or cutting out alcohol. Given the abstinence focus of many SUD treatment centers, studies may need to recruit using community outreach, which can yield fewer participants compared to recruiting from treatment (Jaffee et al., 2009).
- While multiple harm reduction-focused treatments for AUD have strong empirical support, there is very little research testing models of nonabstinence treatment for drug use.
- For one study,23 we grouped disulfiram (1 mg/day) with the placebo (riboflavin) group because the author used the disulfiram group as a control and indicated no reaction between disulfiram and ethanol at this low dose.
- 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.
- His work has been published in leading professional journals and popular publications around the globe.
- 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.
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. Over the past few decades, research has demonstrated that complete abstinence isn’t always the most effective approach for treating alcohol abuse.
Unfortunately, few quantitative, survey-based studies have included substance use during treatment as a potential reason for treatment noncompletion, representing a significant gap in this body of literature (for a review, see Brorson, Ajo Arnevik, Rand-Hendriksen, & Duckert, 2013). Additionally, no studies identified in this review compared reasons for not completing treatment between abstinence-focused and nonabstinence treatment. 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. There has been little research on the goals of non-treatment-seeking individuals; however, research suggests that nonabstinence goals are common even among individuals presenting to SUD treatment.
A second reviewer (RGE, LAM, SD, AT, or GJM) also independently screened the titles and abstracts identified from the primary source of randomised controlled trials (CENTRAL), comprising more than half of the search results. The main screener missed none of the studies eventually included in the review, indicating a low likelihood that trials were missed in the other sources. The https://rehabliving.net/what-is-commission-pay-and-how-does-it-work/ full texts of potentially eligible references were obtained and screened independently in duplicate (by HC and one of RGE, LAM, SD, AT, or GJM). Some people find it’s still too overwhelming to be around alcohol, and it’s too hard to change their habits. People who have a more severe drinking problem and find moderation difficult to maintain often do better with abstinence.
After the interviews, the clients were asked whether they would allow renewed contact after five years, and they all gave their permission. The majority of those not interviewed were impossible to reach via the contact information available (the five-year-old telephone number did not work, and no number was found in internet searches). Setting up personal guidelines and expectations—and tracking results—can make maintaining moderation easier. Drinking is often a coping strategy subconsciously used to avoid having to deal with uncomfortable or painful issues.
In the broadest sense, harm reduction seeks to reduceproblems related to drinking behaviors and supports any step in the right directionwithout requiring abstinence (Marlatt and Witkiewitz2010). Witkiewitz (2013) has suggestedthat abstinence may be less important than psychiatric, family, social, economic, andhealth outcomes, and that non-consumption measures like psychosocial functioning andquality of life should be goals for AUD research (Witkiewitz 2013). These goals are highly consistent with the growingconceptualization of `recovery’ as a guiding vision of AUD services (The Betty Ford Institute Consensus Panel 2007). Witkiewitz also arguedthat the commonly held belief that abstinence is the only solution may deter someindividuals from seeking help.
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. Conclusions Evidence is lacking for benefit from interventions that could be implemented in primary care settings for alcohol abstinence, other than for acamprosate. More evidence from high quality randomised controlled trials is needed, as are strategies using combined interventions (combinations of drug interventions or drug and psychosocial interventions) to improve treatment of alcohol dependency in primary care. 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).
Clients were recruited via treatment units (outpatient and inpatient) in seven Swedish city areas. Inclusion criteria were drawn up to recruit interviewees able to reflect on their process of change. Therefore, the client should be at the end of or have recently completed post-treatment intervention and be judged by a professional to be in a positive change process regarding their SUD. 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.
The Form 90 (Miller & Del Boca, 1994; Tonigan, Miller, & Brown, 1997) was used to obtain pretreatment measures of drinking and the Time-Line Follow-Back (TLFB) interview (Sobell & Sobell 1992) was used to obtain daily reports of the number of drinks consumed during the 16 week treatment period. Developed https://rehabliving.net/ for Project MATCH, the Form 90 incorporates aspects of TLFB and grid-averaging methodologies in order to accurately assess participants’ alcohol consumption. Percent days abstinent (PDA), drinks per drinking day (DPDD), and days to relapse during treatment were calculated from the TLFB interview data.
A similar approach was used for dropouts, defined as the number of patients who withdrew from the study at reported time points. 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).
Instead, the literature indicates that most people with SUD do not want or need – or are not ready for – what the current treatment system is offering. Polich, Armor, and Braiker found that the most severely dependent alcoholics (11 or more dependence symptoms on admission) were the least likely to achieve nonproblem drinking at 4 years. Furthermore, younger (under 40), single alcoholics were far more likely to relapse if they were abstinent at 18 months than if they were drinking without problems, even if they were highly alcohol-dependent. Thus the Rand study found a strong link between severity and outcome, but a far from ironclad one. Following that logic, it makes a lot of sense to me to include the idea of moderation as another option in the addiction treatment arsenal. This is especially true in light of the fact that moderate drinking might be good for health and intervention research shows us that changing behavior is possible.
