Despite their cross-sectional design that did not assess status changes over time, the authors speculated how individuals in NESARC-III may be expected to progress. Specifically, “high-risk drinkers may be in the path [of] developing more severe AUD or in the transitionary stage toward recovery.” Analyses of the NESARC wave 1 and wave 2 data (Dawson et al., 2007) provided a glimpse at what would likely happen if the NESARC-III sample was followed prospectively. First, consistent with a “sick quitter” effect (i.e., individuals who abstain because their health is too poor to continue drinking; Sarich et al., 2019), Dawson et al. (2007) found that, among abstainers at wave 1, there was a relatively greater loss to follow-up at wave 2 due to death, institutionalization, or incapacitation. They also reported remarkable stability of recovery status and found that it was far more likely for asymptomatic high-risk drinkers to remain asymptomatic (31.3%) or transition to low-risk (21.4%) or abstainer (7.4%) status than to develop AUD (6%) at wave 2. Therefore, we can predict that, over time, the high-risk drinkers in Fan et al. (2019) will be more likely to have positive outcomes than a worsening of AUD symptoms.
Alcohol Moderation Management: Programs and Steps to Control Drinking
- This study suggests that CBI may help participants control their drinking as opposed to simply encouraging abstinence (Gueorguieva et al., 2010).
- These were required because the titles, abstracts, and indexes of many studies do not contain keywords or are poorly indexed.
- Recently, in many European countries (Klingemann and Rosenberg, 2009; Klingemann, 2016; Davis et al., 2017) and in the USA (Coldwell, 2005; Davis and Rosenberg, 2013), professionals working with clients with severe problems and clients in inpatient care tend to have abstinence as a treatment goal .
- However, at present, a comparison of rehabilitation strategies through MET for patients in different periods of AUDs remains to be explored.
- On the other hand, some clients in the present study had adopted the 12-step principles, intensified their attendance and made it more or less central in their life.
The inevitability that two or more psychotherapies are combined better than a certain therapy alone also needs to be further rigorously proven, and the stability of their long-term effects on AUD remains to be determined further. 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).
Reasons Abstinence From Alcohol May Be the Best Choice
- A similar approach was used for dropouts, defined as the number of patients who withdrew from the study at reported time points.
- All of the significant evidence from active intervention comparisons were with low certainty (Figure S11B and Table S12A).
- 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.
- A main strength of our study is the sensitive search strategies and snowballing technique used to retrieve potentially eligible studies.
- For example, at a large outpatient SUD treatment center in Amsterdam, goal-aligned treatment for drug and alcohol use involves a version of harm reduction psychotherapy that integrates MI and CBT approaches, and focuses on motivational enhancement, self-control training, and relapse prevention (Schippers & Nelissen, 2006).
In the United Kingdom, where there is greater acceptance of nonabstinence goals and availability of nonabstinence treatment (Rosenberg et al., 2020; Rosenberg & Melville, 2005), the rate of administrative discharge is much lower than in the U.S. (1.42% vs. 6% of treatment episodes; Newham, Russell, & Davies, 2010; SAMHSA, 2019b). Rather, when people with SUD are surveyed about reasons they are not in treatment, not being ready to stop using substances is consistently the top reason cited, even among https://ecosoberhouse.com/ individuals who perceive a need for treatment (SAMHSA, 2018, 2019a). Even among those who do perceive a need for treatment, less than half (40%) make any effort to get it (SAMHSA, 2019a). Although reducing practical barriers to treatment is essential, evidence suggests that these barriers do not fully account for low rates of treatment utilization. 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.
Study Inclusion Criteria
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). Repeated measures latent class analysis (RMLCA; Collins & Lanza, 2009) was used to identify patterns of drinking across 12 weeks of treatment, as described elsewhere (Witkiewitz, Roos, et al., 2017). RMLCA is a latent variable mixture model in which the indicators of the latent class are repeated measures. 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). Comparisons between classes derived from the RMLCA on 3-year post-treatment outcomes were examined for PDD, PHDD, DDD, DrInC total score, PFI social behavior subscale, and PFI social role subscale. To evaluate this question, it’s important to recognize that alcohol use disorder (AUD) is diagnosed on a spectrum, and can be addressed in different ways depending on the individual.
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 alcohol abstinence vs moderation approach. A common objection to CD is that most people fail to return to “normal” drinking, and highlighting those able to drink in a controlled way might attract people into relapse, with severe medical and social consequences. On the other hand, previous research has reported that a major reason for not seeking treatment among alcohol-dependent people is the perceived requirement of abstinence (Keyes et al., 2010; Wallhed Finn et al., 2014, 2018). In turn, stigma and shame have been reported as a reason for not seeking treatment (Probst et al., 2015).
- An individual may be abstaining from alcohol and not meet DSM-5 criteria for AUD, but be a miserable “dry drunk” (Pattison, 1968) with little or no improvement in functioning or well-being.
- For example, Bandura, who developed Social Cognitive Theory, posited that perceived choice is key to goal adherence, and that individuals may feel less motivation when goals are imposed by others (Bandura, 1986).
- For example, they point out that the original AA teaching endorses abstinence only for people with severe addiction disorders, which in the 12-step approach has been changed to abstinence for all members.
- Earlier research utilizing drug use goals analogous to goals used in the present study found commitment to absolute abstinence, measured at the end of treatment, to predict days to relapse across nicotine, alcohol, and opiate dependence (Hall & Havassy, 1986; Hall, Havassy, & Wasserman, 1990).
- This hypothesis was not supported by the data in that there was no significant drinking goal × naltrexone interaction in any of the outcome measures.
- People who have a more severe drinking problem and find moderation difficult to maintain often do better with abstinence.
These answers will vary from individual to individual, and your choice of moderation vs. abstinence is a personal one. Our program offers expert medical support, recovery coaching, and a variety of tools and resources—all delivered 100 percent virtually. By quitting drinking completely, your body can begin to repair the damage caused by alcohol. Abstinence means giving up alcohol completely, and it’s the foundation of traditional treatment options like AA and most inpatient rehabs.
2. Relationship between goal choice and treatment outcomes
Heterogeneity was assessed using the results of the pairwise analyses, and between study variance for the network meta-analyses (τ2). We used the mean of the distribution of ranks for each intervention to present its relative order of preference based on the network meta-analysis. In sum, research suggests that achieving and sustaining moderate substance use after treatment is feasible for between one-quarter to one-half of individuals with AUD when defining moderation as nonhazardous drinking.
Systematic review registration
- As recovery processes stretch over a long period, it is suggested that stable recovery is obtained after five years at the earliest (Hibbert and Best, 2011).
- Are you someone who likes to ease into things, or do you prefer an all-or-nothing approach to change?
While your relationship with alcohol is entirely personal, reflecting on outside influences can be helpful when considering the relative benefits of sobriety or moderation. These influences may include family dynamics, workplace culture, friendships, strained relationships, and lifestyle elements. A moderation approach may be recommended for those who prefer a gradual approach to progress. Here are additional reflection questions from a therapist to help you understand your own relationship with alcohol, and if moderation meets your needs and preferences. In addition, the compliance of the active interventions also did not show better evidence than TAU in Figure 3 (12 articles included). We would like to know what GOAL you have chosen for yourself about using alcohol at this time…Pick only one of the following goals.