The results suggest the importance of offering interventions with various treatment goals and that clients choosing CD as part of their sustained recovery would benefit from support in this process, both from peers and from professionals. People suffering from alcoholism typically experience a physical and psychological dependence on alcohol, making it extremely challenging to maintain moderation. This approach underestimates the compulsive nature of addiction and the neurological changes that occur with prolonged alcohol misuse. For individuals with severe alcohol dependence, abstinence remains the most effective and safe strategy to avoid the devastating consequences of alcohol-related health issues, social disruption, and the potential for relapse. 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.
This is consistent with another important study showing there is a greater likelihood that alcohol use disorder symptoms will resurface and that there will be a complete return of alcohol use disorder for individuals in remission who are drinking versus those who are completely abstinent. Even the body of studies finding that very mild drinking could have cardio-protective effects appear to be somewhat in doubt. In a previous Bulletin, we reviewed a study that took a look closer at this issue, which concluded that abstinence is still likely to be the safest strategy when it comes to mortality risk over time. Based on 8 studies, the research suggests that abstinence may be needed sun rocks marijuana for individuals with harmful drinking – defined in this review as drinking at least 3-4 drinks on average per day in men and 2-3 in women depending on the study – or alcohol use disorder, to achieve social benefits. For example, in three separate randomized trials, reduced drinking did not lead to changes in anxiety or life satisfaction. In addition, while studies tend not to find helpful effects of drinking reduction on health care utilization, abstinence, on the other hand, tends to be related to less health care utilization.
1. Nonabstinence treatment effectiveness
This finding supplements the numerous studies that identify lack of readiness for abstinence as the top reason for non-engagement in SUD treatment, even among those who recognize a need for treatment (e.g., Chen, Strain, Crum, & Mojtabai, 2013; SAMHSA, 2019a). The harm reduction movement, and the wider shift toward addressing public health impacts of drug use, had both specific and diffuse effects on SUD treatment research. In 1990, Marlatt was introduced to the philosophy of harm reduction during a trip to the Netherlands (Marlatt, 1998). 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).
3 Stepwise regressions: Non-abstinence
- This is consistent with another important study showing there is a greater likelihood that alcohol use disorder symptoms will resurface and that there will be a complete return of alcohol use disorder for individuals in remission who are drinking versus those who are completely abstinent.
- Multiple versions of harm reduction psychotherapy for alcohol and drug use have been described in detail but not yet studied empirically.
- The findings support recent proposals to move beyond viewing abstinence as a central defining feature of AUD recovery and relying heavily on quantity-frequency measures of drinking practices as the primary outcome indicator.
- Despite significant empirical support for nonabstinence alcohol interventions, there is a clear gap in research examining nonabstinence psychosocial treatment for drug use disorders.
Attempting controlled drinking in such cases often reinforces the addictive cycle rather than breaking it. It’s important to acknowledge any emotional ties you might have to alcohol as these could make both moderation and complete abstinence more challenging. 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. Potential correlates of non-abstinent recovery, such as demographics andtreatment history, were based on NESARC results.
2 Quality of life and recovery from AUD
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). Additionally, given the nature of the COMBINE study, the effects of a medically oriented intervention (i.e., MM) without a pharmacological component could not be investigated.
A better understanding of the factors related tonon-abstinent recovery will help clinicians advise patients regarding appropriatetreatment goals. 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. While there is evidence that a subset of individuals who use drugs engage in low-frequency, non-dependent drug use, there is insufficient research on this population to determine the proportion for whom moderation is a feasible treatment goal. However, among individuals with severe SUD and high-risk drug or alcohol use, the urgency of reducing substance-related harms presents a compelling argument for engaging these individuals in harm reduction-oriented treatment and interventions. Individuals with greater SUD severity tend to be most receptive to therapist input about goal selection (Sobell, Sobell, Bogardis, Leo, & Skinner, 1992).
Developed for Project MATCH, the Form 90 incorporates aspects of TLFB and grid-averaging methodologies in order to accurately assess participants’ alcohol consumption. Percent days abstinent (PDA), drinks per drinking day (DPDD), and days to relapse during treatment were calculated from the TLFB interview data. Here we found that a number of factors distinguish non-abstainers from abstainersin recovery from AUD, including younger age and lower problem severity.