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. 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). 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).

Expanding the continuum of substance use disorder treatment: Nonabstinence approaches

“The interactive approach has definitely brought me a lot, so that when you read something, you tend to digress or forget that you’ve read it, but when you record it as an audio file or write it down and photograph it or whatever, then the learning material simply sticks better and the content simply sticks better”. Three individuals (P01, P09, P10) stated that they found the section for personal motivation particularly helpful, in which they were able to upload a personal photo. One participant (P09) exclaimed that he liked that there were daily exercises how to help an alcoholic in denial he could do and highlighted the emergency plan. Over the past few decades, research has demonstrated that complete abstinence isn’t always the most effective approach for treating alcohol abuse. While total abstinence is necessary in some cases, in other cases people are able to reduce their drinking to moderate levels without needing to abstain totally. For people who have not been able to maintain sobriety through Alcoholics Anonymous (AA) or other 12-step programs, they may wish to consider if moderation may be a more effective path for them to take.

Alcohol Moderation Management Programs

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. Among those seeking treatment for alcohol use disorder (AUD), studies with large samples have cited rates of nonabstinence goals ranging from 17% (Berglund et al., 2019) to 87% (Enggasser et al., 2015). In Europe, about half (44–46%) of individuals seeking treatment for AUD have non-abstinence goals (Haug & Schaub, 2016; Heather, Adamson, Raistrick, & Slegg, 2010). In the U.S., about 25% of patients how does alcohol affect blood pressure seeking treatment for AUD endorsed nonabstinence goals in the early 2010s (Dunn & Strain, 2013), while more recent clinical trials have found between 82 and 91% of those seeking treatment for AUD prefer nonabstinence goals (Falk et al., 2019; Witkiewitz et al., 2019). Alcoholic remission many years after treatment may depend less on treatment than on posttreatment experiences, and in some long-term studies, CD outcomes become more prominent the longer subjects are out of the treatment milieu, because patients unlearn the abstinence prescription that prevails there (Peele, 1987).

1 Non-abstinent recovery from alcohol use disorders

The data generated and/or analysed during the current study are not publicly available due to privacy reasons but are available in pseudonymised form from the corresponding authors on reasonable request. Data is presented per person and additionally by presenting mean (M), standard deviation (SD), median (Mdn), range and interquartile range (IQR) per assessment time point. Abstinence motivation for the coming six months was assessed as well as confidence levels of achieving this abstinence on a rating scale of 1 (not confident at all) to 5 (very confident). Treatment for AUD often revolves around a plan that includes rehabilitation, care from addiction specialists and self-help programs such as Alcoholics Anonymous (AA).

  1. 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).
  2. Take this “getting back to normal” as a chance to rethink your relationship with alcohol.
  3. Additionally, the system is punitive to those who do not achieve abstinence, as exemplified by the widespread practice of involuntary treatment discharge for those who return to use (White, Scott, Dennis, & Boyle, 2005).
  4. However, among individuals with severe SUD and high-risk drug or alcohol use, the urgency of reducing substance-related harms presents a compelling argument for engaging these individuals in harm reduction-oriented treatment and interventions.

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. Finding useful information and resources about addiction or alcoholism can be a minefield. To increase the chance of a successful recovery and life of sobriety it is important to receive guidance from a reliable source. Seek skilled guidance from an addiction psychologist to get feedback when selecting goals, assessing progress, and setting appropriate boundaries. Another possible option is using medications such as naltrexone or disulfiram along with psychotherapy. You may be able to gradually decrease the amount you drink without needing to go for full abstinence from alcohol.

People who have a more severe drinking problem and find moderation difficult to maintain often do better with abstinence. If you don’t consider yourself an alcoholic or don’t feel comfortable labeling yourself one, practicing moderation helps you avoid having that discussion when you’re not in the mood. You don’t have to attend AA meetings and introduce yourself as an alcoholic, and you don’t have to answer questions at parties or social gatherings when people notice you aren’t drinking. At Addictionhelper, we will never tell you “you can’t ever drink again” because that is not our place. We know that in the majority of cases where addiction is present, abstinence is the only option that works, but for us to insist on this route for others means they are unlikely to try and get help. The idea of never drinking again is extremely daunting, even to those not affected by addiction, and so our advice is to take it one day at a time.

Likely, the concept of abstinence would be overwhelming, as alcohol is a major part of our culture. Expecting someone to potentially cut those events out of their lives to reduce the exposure to alcohol is not always realistic. According to research, “Many individuals experiencing problems related to their drinking (e.g., college students) are not interested in changing their drinking behavior and would most likely be characterized in the precontemplative stage of the transtheoretical model. Harm reduction provides a good method for matching these individuals at that stage and providing motivational incentives (e.g., discussing the negative consequences the person is experiencing) to motivate their desire for positive change” (Marlatt & Witkiewitz, 2002). We do not know whether the WIR sample represents the population of individualsin recovery. The WIR data do not include current dependence diagnoses, which would beuseful for further understanding of those in non-abstinent recovery.

Controlled drinking as well as abstinence is an appropriate goal for the majority of problem drinkers who are not alcohol-dependent. In addition, while controlled drinking becomes less likely the more severe the degree of alcoholism, other factors—such as age, values, and beliefs about oneself, one’s drinking, and the possibility of controlled drinking—also play a role, sometimes the dominant role, in determining successful outcome type. Finally, reduced drinking is often the focus of a harm-reduction approach, where the likely alternative is not abstinence but continued alcoholism. Using a mixed-methods approach, ten participants from the intervention group of the randomized controlled trial SmartAssistEntz who returned to alcohol use and recorded this in the app Appstinence, a smartphone application with telephone coaching designed for individuals with AUD, were interviewed about their experiences. For all we know, it might also be an option for people who do meet criteria for alcohol dependence but since the study we're about to assess didn't talk about it, we'll leave that for later. 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.

The study was especially notable because most other treatment readiness measures have been validated on treatment-seeking samples (see Freyer et al., 2004). This finding supplements the numerous studies that identify lack of readiness for abstinence as the top reason for non-engagement in SUD treatment, even among those who recognize a need for treatment (e.g., Chen, Strain, Crum, & Mojtabai, 2013; SAMHSA, 2019a). In the a beginners guide to doing drugs for the first time 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).