Here we discuss exploratory analyses of differences between abstinentand nonabstinent individuals who defined themselves as “in recovery” fromAUDs. A better understanding of the factors related tonon-abstinent recovery will help clinicians advise patients regarding appropriatetreatment goals. Personal factors such as the severity of addiction, the presence of co-occurring mental health disorders, and individual resilience play a significant role in shaping the recovery experience.
- Models of nonabstinence psychosocial treatment for drug use have been developed and promoted by practitioners, but little empirical research has tested their effectiveness.
- Additionally, no studies identified in this review compared reasons for not completing treatment between abstinence-focused and nonabstinence treatment.
- However, for those in environments where moderate drinking is accepted, the pressure to conform might make total abstinence seem extreme or unnecessary.
- Ultimately, the decision of moderation vs abstinence depends on your medical history, health, and goals now that you know what moderation and what abstinence in alcohol use are.
- However, this approach can be exclusionary, as it may not account for the complexities of individual circumstances, such as cultural attitudes toward alcohol or personal readiness for complete sobriety.
- Instead, providers claim, holding out such a goal to an alcoholic is detrimental, fostering a continuation of denial and delaying the alcoholic’s need to accept the reality that he or she can never drink in moderation.
Perhaps the most notable gap identified by this review is the dearth of research empirically evaluating the effectiveness of nonabstinence approaches for DUD treatment. Given low treatment engagement and high rates of health-related harms among individuals who use drugs, combined with evidence of nonabstinence goals among a substantial portion of treatment-seekers, testing nonabstinence treatment for drug use is a clear next step for the field. This could include further evaluating established intervention models (e.g., MI and RP) among individuals with DUD who have nonabstinence goals, adapting existing abstinence-focused treatments (e.g., Contingency Management) to nonabstinence applications, and testing the efficacy of newer models (e.g., harm reduction psychotherapy). 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).
2.2. Relapse prevention
This standard persisted in SUD treatment even as strong evidence emerged that a minority of individuals who receive 12-Step treatment achieve and maintain long-term abstinence (e.g., Project MATCH Research Group, 1998). In some European countries, such as France and Italy, cultural attitudes toward alcohol are more integrated into daily life, with moderate consumption often viewed as a normal and even healthy practice. These societies tend to focus on harm reduction rather than absolute abstinence, reflecting a belief that individuals can learn to manage their drinking without complete cessation.
Additionally, we offer exceptional continuing care so even after completing your programme; you’re never alone in this fight against alcohol addiction. Whether it’s through continued counselling or group meetings within the community -we’ll be there every step of the way- supporting you as much as needed so that recovery becomes less daunting and more hopeful. For instance, abstaining from alcohol can decrease the risk of liver disease, controlled drinking vs abstinence addiction recovery improve cognitive function, and enhance emotional resilience. Cultural perspectives on alcohol also influence our attitudes towards its use and misuse, shaping norms around what constitutes acceptable levels of consumption. While some cultures romanticise heavy drinking others promote temperance; being aware of these cultural influences can aid in reshaping your own relationship with alcohol and eliminate harmful drinking patterns. Virtually the entire sample met diagnostic criteria for alcohol dependence, about half were female, most were above age 35, and half had a college education or greater.
Expanding the continuum of substance use disorder treatment: Nonabstinence approaches
Just for your information, a standard drink is typically standard drink is typically 12 ounces of beer, 5 ounces of wine, and 1.5 ounces of distilled spirits such as rum or vodka. Please read on to understand moderation vs abstinence, and how you can decide which one is the better option for you. At CATCH Recovery, we understand that your journey towards overcoming addiction is deeply personal and unique to you. We believe in the power of personalised therapy, where our experts tailor a recovery plan suited to your needs and circumstances. It’s not an easy road to lasting recovery, but with the right support and resources, it can definitely be a journey worth taking. Regardless of how one defines recovery, non-abstinent routes to problem resolution are more common than abstinent pathways.
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. The debate over total abstinence versus moderation often hinges on the strength of the psychological dependency. For many alcoholics, the psychological grip of alcohol is so strong that even one drink can reignite cravings and lead to relapse. This is why programs like Alcoholics Anonymous (AA) emphasize abstinence as the cornerstone of recovery, focusing on breaking both the physical and psychological chains of addiction.
- This paper presents a narrative review of the literature and a call for increased research attention on the development of empirically supported nonabstinence treatments for SUD to engage and treat more people with SUD.
- Nonabstinence approaches to SUD treatment have a complex and contentious history, and significant social and political barriers have impeded research and implementation of alternatives to abstinence-focused treatment.
- Marlatt’s work inspired the development of multiple nonabstinence treatment models, including harm reduction psychotherapy (Blume, 2012; Denning, 2000; Tatarsky, 2002).
- Additionally, some groups target individuals with co-occurring psychiatric disorders (Little, Hodari, Lavender, & Berg, 2008).
- For people suffering from alcohol use disorders, trying to moderate drinking isn’t advised and total abstinence is always recommended.
- This strategy is primarily targeted at individuals who have experienced problems related to their drinking but do not meet the criteria for severe alcohol use disorder (AUD).
However, it is essential to recognize that moderation is not a one-size-fits-all solution, and its effectiveness depends on various factors, including the individual’s level of dependence and personal commitment. As the field of addiction treatment evolves, offering a range of evidence-based options, including moderation management, can provide more tailored and accessible support to those struggling with alcohol-related problems. The question of whether total abstinence is the only viable path for individuals struggling with alcoholism has sparked considerable debate, with moderation programs emerging as an alternative approach. These programs aim to help individuals reduce their alcohol consumption to non-harmful levels rather than advocating for complete sobriety. The effectiveness of such programs is a critical aspect to explore, as it challenges the traditional abstinence-based treatment models.
These spiritual perspectives can deeply influence an individual’s approach to recovery, making it essential to consider them when discussing whether total abstinence is the only choice. For instance, a person whose faith promotes moderation might find harm reduction strategies more compatible with their beliefs than strict abstinence. The dearth of data regarding individuals in long-term recovery highlights theneed to examine a sample that includes individuals with several years of recoveryexperience. Moreover, although previous studies have examined treated, non-treated andgeneral population samples, none has focused on individuals who identifythemselves as “in recovery” from alcohol problems. Instead, paststudies have equated “recovery” with DSM-IV diagnostic criteria and nationalguidelines for low-risk drinking; these criteria may exclude people who considerthemselves “in recovery.” For example, individuals involved in harmreduction techniques that do not involve changed drinking may consider themselves inrecovery. Importantly, the only published study that asked individuals in recovery (fromcrack or heroin dependence in this particular study) how they defined the term revealedthat less than half responded in terms of substance use; the other definitions were moregeneral, such as a process of working on oneself (Laudet2007).
One Glass a Day? The Impact of Low Volume Drinking on Mortality Risk
The Rand study quantified the relationship between severity of alcohol dependence and controlled-drinking outcomes, although, overall, the Rand population was a severely alcoholic one in which “virtually all subjects reported symptoms of alcohol dependence” (Polich, Armor, and Braiker, 1981). 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). By the same token, controlled drinking may be the more common outcome for untreated remission, since many alcohol abusers may reject treatment because they are unwilling to abstain. Ultimately, the decision of moderation vs abstinence depends on your medical history, health, and goals now that you know what moderation and what abstinence in alcohol use are. In a nutshell, if your drinking has not yet led to any major concerns of abuse or dependence, or other health complications, then moderation with strict limits can be good for you.
3 Rationale for current study and study aims
The role of moderation in recovery also extends to addressing the underlying issues related to alcohol use. It encourages individuals to explore the reasons behind their drinking habits and make positive lifestyle changes. This may involve developing healthier coping mechanisms, improving stress management skills, and building a supportive social network. By focusing on moderation, individuals can learn to identify triggers, manage cravings, and make informed choices about their alcohol consumption.
In addition, some might consider abstinence as a necessary part of therecovery process, while others might not. One of the key criticisms of harm reduction is the concern that it may inadvertently normalize or encourage alcohol use, particularly in individuals who could benefit from abstinence. Critics argue that promoting controlled drinking could lead to ambivalence about recovery or serve as a gateway to heavier use. However, research suggests that harm reduction does not necessarily lead to increased consumption for most individuals and can serve as a stepping stone toward abstinence for those who choose it. Moreover, harm reduction aligns with a public health perspective that prioritizes pragmatic, evidence-based solutions over ideological purity.
What Is Controlled Drinking or Moderation?
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. 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. Social influences also impact the recovery process, particularly through peer groups, family dynamics, and community expectations.
Age of first and last substance use
A subset of individuals—mostly those with lower SUD severity—resolve their substance use problem (Kelly et al., 2017) and experience improved health and well-being despite ongoing substance use (Stea et al., 2015, Witkiewitz and Tucker, 2020). Such ongoing substance use may mean moderating use of a primary problem substance or abstaining from one or more substances while continuing the use of others (e.g., abstaining from opioids while consuming cannabis). In the context of “harm reduction,” individuals may make positivechanges in their lives that do not include reduced alcohol use and may consider themselves“in recovery” even though their AUD status remains unchanged (Denning and Little 2012).
Healthcare professionals, including therapists and counselors, can offer evidence-based treatments such as cognitive-behavioral therapy, which has been shown to be effective in helping individuals change their drinking behavior. These professionals can work with the individual to set personalized goals, which may include moderation or abstinence, depending on what is most suitable for the person’s unique circumstances. Based on this, for the fully adjusted models controlling for demographic and individual factors pertaining to substance use history and clinical severity, race/ethnicity, number of years since AOD problem resolution, and number of psychiatric diagnoses were included in all models. Sex was included only in the self-esteem and quality of life/functioning models, and primary substance used was included only in the psychological distress model. Here we found that a number of factors distinguish non-abstainers from abstainersin recovery from AUD, including younger age and lower problem severity. 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?