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. 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). 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. For example, in one study testing the predictive validity of a measure of treatment readiness among non-treatment-seeking people who use drugs, the authors found that the only item in their measure that significantly predicted future treatment entry was motivation to quit using (Neff & Zule, 2002). The study was especially notable because most other treatment readiness measures have been validated on treatment-seeking samples (see Freyer et al., 2004).
- Controlled drinking (CD) is part of the harm reduction approach to alcohol dependency, and also a type of Alcohol Dependence Treatment (ADT).
- This mental clarity also enhances productivity at work or in pursuing personal hobbies because there’s no longer a hangover holding you back.
- Next, we review other established SUD treatment models that are compatible with non-abstinence goals.
- Harm reduction psychotherapies, for example, incorporate multiple modalities that have been most extensively studied as abstinence-focused SUD treatments (e.g., cognitive-behavioral therapy; mindfulness).
Differences between abstinent and non-abstinent individuals in recovery from
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). However, this approach is consistent with the goal of increasing treatment utilization by reaching those who may not otherwise present to treatment. Alternatively, researchers who conduct trials in community-based treatment centers will need to obtain buy-in to test nonabstinence approaches, which may necessitate waiving facility policies regarding drug use during treatment – a significant hurdle. Individuals with greater SUD severity tend to be most receptive to therapist input about goal selection (Sobell, Sobell, Bogardis, Leo, & Skinner, 1992). This suggests that treatment experiences and therapist input can influence participant goals over time, and there is value in engaging patients with non-abstinence goals in treatment. This attachment and overall mindset of a dependent person may conflict with the current position and dominant view of Alcoholics Anonymous, rehabs and treatment professionals in that people with an alcohol dependency should remain totally and permanently abstinent from alcohol (and drugs).
Abstinence Vs. Moderation Management: Success and Outcomes
Though programs like Alcoholics Anonymous and other well-known programs meant to aid in the recovery from alcohol use disorders and alcohol misuse require or encourage full abstinence, these are not the only solutions known to help people quit or control drinking. Recovering from substance use disorder requires commitment and access to recovery experts, staff, and facilities. Ideally, detox and abstinence or medication-assisted treatment is followed with long-term AA or NA participation.
Alcohol Addiction Treatment at CATCH Recovery
Lack of consensus around target outcomes also presents a challenge to evaluating the effectiveness of nonabstinence treatment. Experts generally recommend that SUD treatment studies report substance use as well as related consequences, and select primary outcomes based on the study sample and goals (Donovan et al., 2012; Kiluk et al., 2019). While AUD treatment studies commonly rely on guidelines set by government agencies regarding a “low-risk” or “nonhazardous” level of alcohol consumption (e.g., Enggasser et al., 2015), no such guidelines exist for illicit drug use. Thus, studies will need to emphasize measures of substance-related problems in addition to reporting the degree of substance use (e.g., frequency, quantity). Here 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.
4.2. Negative impact on treatment retention and completion
His work has been published in leading professional journals and popular publications around the globe. 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. It’s not an easy road to lasting recovery, but with the right support and resources, it can definitely be a journey worth taking.
our approach
Nora Volkow, MD, Director of the National Institute on Drug Abuse (NIDA), advocates for recognizing reductions in drug use as meaningful outcomes. “For many people trying to recover from a substance use disorder, perhaps for the majority, abstinence may be the most appropriate treatment objective. But complete abstinence is sometimes not achievable, even in the long-term, and there is a need for new treatment approaches that recognize the clinical value of reduced use,” says Volkow. Controlled drinking, often advocated as a moderation approach for people with alcohol use disorders, can be highly problematic and unsuitable for those who truly suffer from alcohol addiction. Alcoholism is characterised by a loss of control over one’s drinking behaviour and an inability to consistently limit consumption.
In sum, the current body of literature reflects multiple well-studied nonabstinence approaches for http://harvardsquarebookstore.com/book/infinite_jest/ treating AUD and exceedingly little research testing nonabstinence treatments for drug use problems, representing a notable gap in the literature. The past decade has seen the AUD service field increasingly embrace the broadergoal of `recovery’ as its guiding vision. Donovan and colleagues(2005) reviewed 36 studies involving various aspects of QOL in relation to AUDand concluded that heavy episodic drinkers had worse QOL than other drinkers, that reduceddrinking was related to improved QOL among harmful drinkers, and that abstainers hadimproved QOL in treated samples (Donovan et al.2005). However, the NESARC QOL analyses examined transitions across AUD statusesover a three-year period, and thus inherently excluded individuals with more than threeyears of recovery.
Difficulty Maintaining Moderation
Clinical studies and peer reviewed research have demonstrated that controlled drinking is possible, and various moderation-based treatment could be preferred over abstinence-based treatment. Nevertheless, especially in the United States, zero tolerance has remained the treatment approach most popular among the public and professionals. The ability to control drinking varies significantly from person to person and is influenced by a range of factors including genetics, environment, emotional state, and individual psychology. For people suffering from alcohol use disorders, trying to moderate drinking isn’t advised and http://www.thecoalminetour.com/WatchHistory/watches-for-the-first-time total abstinence is always recommended.
Alcohol Moderation Management: Steps To Control Drinking
For example, offering nonabstinence treatment may provide http://www.race-nights.co.uk/BeachNightClubs/night-clubs-in-cocoa-beach-fl 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. 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. AA was established in 1935 as a nonprofessional mutual aid group for people who desire abstinence from alcohol, and its 12 Steps became integrated in SUD treatment programs in the 1940s and 1950s with the emergence of the Minnesota Model of treatment (White & Kurtz, 2008). The Minnesota Model involved inpatient SUD treatment incorporating principles of AA, with a mix of professional and peer support staff (many of whom were members of AA), and a requirement that patients attend AA or NA meetings as part of their treatment (Anderson, McGovern, & DuPont, 1999; McElrath, 1997).