Abstinence versus Controlled Drinking as a Treatment Goal Alcohol, Other Drugs, and Health: Current Evidence

Therefore, knowledge about whether and how QOL differs betweennon-abstinent vs. abstinent recovery remains limited. Multiple versions of harm reduction psychotherapy for alcohol and drug use have been described in detail but not yet studied empirically. Consistent with the philosophy of harm reduction as described by Marlatt et al. (2001), harm reduction psychotherapy is accepting of a wide range of client goals, including risk reduction, moderation, and abstinence (of note, abstinence is conceptualized as consistent with harm reduction when it is a goal chosen by the client). However, to date there have been no published empirical trials testing the effectiveness of the approach. 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.

Models of nonabstinence psychosocial treatment for SUD

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. 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”.

Like the Sobells, Marlatt showed that reductions in drinking and harm were achievable in nonabstinence treatments (Marlatt & Witkiewitz, 2002). Some clients expressed a need for other or complementary support from professionals, whereas others highlighted the importance of leaving the 12-step community to be able to work on other parts of their lives. The descriptions on how the tools from treatment were initially used to deal with SUD and were later used to deal with other problems in the lives of IPs can be put in relation to the differentiation between abstinence and sobriety suggested by Helm (2019). While abstinence refers to behaviour, sobriety goes deeper and concerns the roots of the problem (addiction) and thereby refers to mental and emotional aspects. Differentiating these concepts opens up for recovery without necessarily having strong ties with the recovery community and having a life that is not (only) focused on recovery but on life itself. 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.

Is Controlled Drinking Possible for Alcoholics?

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. The prevailing view that alcoholics lack willpower and that is why they drink so much is a total myth. As a mother, I could use my willpower to stop drinking each time I became pregnant and during my pregnancies I did not drink. Essentials mission is to renew lives impacted by addiction through personalized and complete behavioral healthcare.

1.3. Harm reduction integrated in SUD treatment

The Haynes Clinic offers residential treatment for dependency on alcohol, drugs and prescription medication. Looked at like that, the answer to the question of controlled drinking versus abstinence is obvious. The same would be the case if an alcoholic decided to cut down for the rest of his or her life. There’s a risk that attempts at controlled drinking may lead to a return to problematic drinking patterns. Clearly, most research agrees that most alcoholism patients drink at some point following treatment.

• Although controversial controlled drinking is a strategy which helps a person to reduce their alcohol consumption to a moderate level.
• This literature – most of which has been conducted in the U.S. – suggests a strong link between abstinence goals and treatment entry.
• 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).
• Thus, while it is vital to empirically test nonabstinence treatments, implementation research examining strategies to obtain buy-in from agency leadership may be just as impactful.

Controlled Drinking vs Abstinence Addiction Recovery

Previous reviews have described nonabstinence pharmacological approaches (e.g., Connery, 2015; Palpacuer et al., 2018), which are outside the scope of the current review. While there are multiple such intervention approaches for treating AUD with strong empirical support, we what is Oxford House 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. We focus our review on two well-studied approaches that were initially conceptualized – and have been frequently discussed in the empirical literature – as client-centered alternatives to abstinence-based treatment. 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.

Practicing Stress Management for a Healthy Recovery

If a person tells themselves this every day, the number of days without a drink will soon add up. However, the extent of their problems according to ICD-10 (International Statistical Classification of Diseases and Related Health Problems, 10th edition) or DSM 5 (Diagnostic and Statistical Manual of mental disorders, 5th edition) was not measured. Some of the abstainers reported experience of professional contacts, such as therapists or psychologists. These contacts had often complemented the support from AA but in some cases also complicated it as the IPs found that their previous SUD was related to other things that were not in line with the approach to addiction as a disease (e.g. IP19).

• After transcribing the interviews, the material was analysed thematically (Braun and Clarke, 2006) by coding the interview passages according to what was brought up both manually and by using NVivo (a software package for qualitative data analysis).
• If a person tells themselves this every day, the number of days without a drink will soon add up.
• When the premise of AA was transformed into the 12-step treatment programme, it was performed in a professional setting.
• Although research indicates that CD may be a possible option for sustained recovery, at least for certain groups and at least later in the recovery process, it seems as if the dominating approach of treatment systems is still abstinence.
• 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).
• A betterunderstanding of the recovery process and tools utilized by non-abstinent vs. abstinentindividuals would inform clinical practice; for example, is it more important for those inabstinent recovery to have abstinent individuals in their social networks?

He adopted the language and framework of harm reduction in his own research, and in 1998 published a seminal book on harm reduction strategies for a range of substances and behaviors (Marlatt, 1998). Marlatt’s work inspired the development of multiple nonabstinence treatment models, including harm reduction psychotherapy (Blume, 2012; Denning, 2000; Tatarsky, 2002). Additionally, while early studies of SUD treatment used abstinence as the single measure of treatment effectiveness, by the late 1980s and early 1990s researchers were increasingly incorporating psychosocial, health, and quality of life measures (Miller, 1994). 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).

Controlled drinking (CD) is part of the harm reduction approach to alcohol dependency, and also a type of Alcohol Dependence Treatment (ADT). However, even with repeated studies, the treatment has endured a controversial history among therapists, popular media, and in the research literature. It is also worthwhile considering the chemical effect of alcohol addiction on the body and the way alcohol withdrawal affects it. The person that decides to drink socially or now and then, is going to be consistently re-introducing that substance to the body, therefore always leaving the body craving more.

Future research must test the effectiveness of nonabstinence treatments for drug use and address barriers to implementation. Individuals with fewer years of addiction and lower severity SUDs generally have the highest likelihood of achieving moderate, low-consequence substance use after treatment (Öjehagen & Berglund, 1989; Witkiewitz, 2008). Notably, these individuals are also most likely to endorse nonabstinence goals (Berglund et al., 2019; Dunn & Strain, 2013; Lozano et al., 2006; Lozano et al., 2015; Mowbray et al., 2013).

In several clinics, controlled drinking has become an alternative treatment approach when the patient does not wish to, or feels they cannot be, completely abstinent. Although controversial controlled drinking is a strategy which helps a person to reduce their alcohol consumption to a moderate level. Set over a period of time, often between 6 and 8 months, the idea is that by lowering the consumption of alcohol, the consequences produced by dependency can be addressed and minimized. We do not know what factors relate to non-abstinent vs. abstinent recovery amongindividuals who define themselves as in recovery.