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controlled drinking vs abstinence

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). Little attention was given to whether people in abstinence-focused treatments endorsed abstinence goals themselves, or whether treatment could help reduce substance use and related problems for those who did not desire (or were not ready for) abstinence. 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.

Stephen A. Maisto

controlled drinking vs abstinence

For example in one study of alcohol use disorder treatment patients, across 16 years of follow-up, 73% of individuals who relapsed died while only 30% of abstainers died – primarily from heart attack or heart failure (more on this in “Why is this study important” below). In parallel with the view on abstinence as a core criterion for recovery, controlled drinking (CD) has been a recurring concept and in focus from time to time in research on alcohol problems for more than half a century (Davies, ecstasy addiction and abuse 1962; Roizen, 1987; Saladin and Santa Ana, 2004). It caused heated debates, and for a long time, it has had a rather limited impact on professional treatment systems (Coldwell and Heather, 2006). 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 .

Behavioral Addictions: Are They More or Less Stigmatized than Alcohol & Drug Addictions?

The context of treatment in a professional setting, and in many cases, the only treatment offered, gives the 12-step philosophy a sense of legitimacy. The rationale and methods of the COMBINE study have been described in detail elsewhere (aCOMBINE Study Research Group, 2003a, COMBINE Study Research Group, 2003b). In brief, the COMBINE study was a large multi-site treatment study of two pharmacotherapies (i.e., naltrexone and acamprosate), and cognitive the twelve steps alcoholics anonymous behavioral intervention for alcoholism. Exclusion criteria were any serious mental illnesses or unstable medical conditions, current abuse or dependence on any drug other than nicotine or marijuana, and taking or requiring any medication that interfered with the study medications, including any current opioid use. Multiple versions of harm reduction psychotherapy for alcohol and drug use have been described in detail but not yet studied empirically.

3. The harm reduction movement

controlled drinking vs abstinence

For example, among the 2005and 2010 National Alcohol Survey respondents, 18% of current drinkers who identified as“in recovery” from alcohol problems (who do not use drugs) are DSM-IValcohol dependent, and 26% of current drinkers who also use drugs are DSM-IV alcoholdependent. 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 a recent study published in the journal PLoS ONE, researchers investigated the effects of alcohol consumption and short-term abstinence on gut dysbiosis in individuals with Alcohol Use Disorder (AUD). Their case-control study evaluated the gut microbiota and metabolome of three cohorts comprising newly abstinent, currently drinking, and BMI-matched healthy controls.

Help for Achieving Lasting Recovery

These findings were conceptualized in the context of the abstinence violation effect, whereby an initial lapse triggers heavier within-episode drinking among abstinence-oriented individuals (Marlatt & Gordon, 1985). Perhaps the most notable gap identified by this review is the dearth of research empirically evaluating the effectiveness eye color may be linked to alcohol dependence 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.

  1. According to Finney and Moos (1991), 37 percent of patients reported they were abstinent at all follow-up years 4 through 10 after treatment.
  2. Like the Sobells, Marlatt showed that reductions in drinking and harm were achievable in nonabstinence treatments (Marlatt & Witkiewitz, 2002).
  3. After five years, the majority remained abstinent and described SUD in line with the views in the 12-step programme.
  4. In parallel with the view on abstinence as a core criterion for recovery, controlled drinking (CD) has been a recurring concept and in focus from time to time in research on alcohol problems for more than half a century (Davies, 1962; Roizen, 1987; Saladin and Santa Ana, 2004).
  5. 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).

Together, this suggests a promising degree of alignment between goal selection and probability of success, and it highlights the potential utility of nonabstinence treatment as an “early intervention” approach to prevent SUD escalation. 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. Therefore, knowledge about whether and how QOL differs betweennon-abstinent vs. abstinent recovery remains limited.

controlled drinking vs abstinence

Alcoholism is characterised by a loss of control over one’s drinking behaviour and an inability to consistently limit consumption. Attempting controlled drinking in such cases often reinforces the addictive cycle rather than breaking it. 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).

You might find yourself constantly preoccupied with thoughts about when you’ll have your next drink or whether you’re staying within your limits – this constant monitoring can create stress and mental exhaustion over time. Moreover, in committing to a moderate drinking plan, it’s essential to recognise that slip-ups can happen and these instances should not discourage you from continuing on your path towards moderation management, but rather serve as reminders of why moderation is necessary in the first place. While you may see the appeal in a programme that allows for some level of drink intake, it’s crucial to consider the potential drawbacks that could come with this approach. Even moderate drinking can lead to long-term health problems such as liver disease, heart disease, and increased risk of certain cancers.

Importantly, there has also been increasing acceptance of non-abstinence outcomes as a metric for assessing treatment effectiveness in SUD research, even at the highest levels of scientific leadership (Volkow, 2020). Many advocates of harm reduction believe the SUD treatment field is at a turning point in acceptance of nonabstinence approaches. Indeed, a prominent harm reduction psychotherapist and researcher, Rothschild, argues that the harm reduction approach represents a “third wave of addiction treatment” which follows, and is replacing, the moral and disease models (Rothschild, 2015a).

Results from this study support the need for a broader conceptualization of the clinical course of AUD (Maisto, Witkiewitz, Moskal, & Wilson, 2016) that does not rely solely on binary cutoffs to determine treatment success (e.g., abstinence). Research is needed to explore time-varying predictors of low risk drinking and alternative definitions of reduction outcomes (e.g., World Health Organization risk levels; Witkiewitz, Hallgren, et al., 2017) that may promote beneficial longer term functioning. Such findings would aid in refining AUD treatment and would provide more information for clinicians to improve clinical decision-making. Demographics, baseline dependence severity (as measured by the Alcohol Dependence Scale (Skinner & Horn, 1984)), and treatment condition by latent classes are presented in Table 3. Individuals in the low risk drinking classes (Classes 5 and 6) had lower dependence severity than those in the mixed heavy drinking classes (Classes 2 and 4).

Analysis accommodated the clustering of observations by site through the estimation of a random intercept term. If you believe that harm reduction therapy may help, you may be interested in our alcohol addiction program. “…we hypothesized gut microbiome/metabolome similarities between healthy controls and newly abstinent individuals with AUD, while the CD group was going to be different than the other two groups. By contrast, it was the AB group to separate itself, from a gut microbiome/metabolome standpoint, from the other two groups.”

Individuals who were mostly abstinent, even with occasions of heavier drinking (Class 6 and 7), had the best outcomes. Individuals who engaged in persistent heavy drinking (Class 1) had worse outcomes than all other classes, including those classes with other patterns of heavy drinking. Thus, it may be important for clinicians to assess for patterns of drinking and to encourage at least some abstinent days, even among those clients with low risk drinking goals.

In the fully saturated models, any twelve-step attendancedecreased odds of non-abstinence by 57–76% (Model 4), while each additional DSMsymptom decreased odds of non-abstinence by 73–89% (Model 4). They’re able to enjoy an occasional drink while still avoiding negative drinking behaviors and consequences. For individuals with Type II diabetes, reduced drinking provides no benefit in insulin; there even seems to be some data suggesting moderate drinking (up to 2 drinks per day) could help improve insulin sensitivity. How the risks of drinking balance out this potential benefit, if it is found to be causal, for those with Type II diabetes is not yet clear.

Our approach is not one-size-fits-all; instead, it’s grounded in empathy, respect for your individuality, and a deep understanding of how alcohol abuse impacts different people in different ways. That’s why our approach involves taking time to know you better, identify your triggers, and help chart a path forward that aligns with your life goals. When it comes to choosing between total abstinence or limiting your intake, the answer isn’t black and white.

However, CD is a widely accepted treatment goal in Australia, Britain and Norway (Luquines et al., 2011). The Swedish treatment system has been dominated by total abstinence as the goal, although treatment with CD as a goal exists (e.g., Agerberg, 2014; Berglund et al., 2019). 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).

Take our short alcohol quiz to learn where you fall on the drinking spectrum and if you might benefit from quitting or cutting back on alcohol. After the interviews, the clients were asked whether they would allow renewed contact after five years, and they all gave their permission. The majority of those not interviewed were impossible to reach via the contact information available (the five-year-old telephone number did not work, and no number was found in internet searches). 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 during this period that peer support becomes invaluable; it helps to know that others are experiencing similar struggles or have overcome them already.

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). 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). This model both accelerated the spread of AA and NA and helped establish the abstinence-focused 12-Step program at the core of mainstream addiction treatment.