Expanding the continuum of substance use disorder treatment: Nonabstinence approaches

Clients reporting CD in the present study only met one of these criteria – an initial period of abstinence (Booth, 2006; Coldwell and Heather, 2006). These answers will vary from individual to individual, and your choice controlled drinking vs abstinence addiction recovery 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.

But 61 percent of those who achieved remission without treatment continued drinking. In Britain and other European and Commonwealth countries, controlled-drinking therapy is widely available (Rosenberg et al., 1992). The following six questions explore the value, prevalence, and clinical impact of controlled drinking vs. abstinence outcomes in alcoholism treatment; they are intended to argue the case for controlled drinking as a reasonable and realistic goal.

• Our main purpose is to provide services and education to the client and family that will support long lasting recovery of mind, body, and spirit.
• However, prior studies have defined“recovery” based on DSM criteria, and thus may have excluded individualsusing non-abstinent techniques that do not involve reduced drinking.
• Nonabstinence goals have become more widely accepted in SUD treatment in much of Europe, and evidence suggests that acceptance of controlled drinking has increased among U.S. treatment providers since the 1980s and 1990s (Rosenberg, Grant, & Davis, 2020).
• Having overcome it, a person with addiction is unable to listen to the arguments of reason.

If you lean towards gradualism, moderation may be a more comfortable place to start. If alcohol is playing a central role in your life, you might find more success exploring sobriety. You know yourself and your drinking habits better than anyone, and putting thought into the decision can reveal powerful insights. It’s also important to remember that it’s not a permanent line between “moderate drinkers” and “abstainers.” You can always reevaluate your relationship with alcohol and revisit your goals. The moderation approach to addiction recovery believes that people can recover from addiction by slowly reducing the amount of alcohol or drugs they consume.

What Is Moderation Management?

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. Non-abstinent goals can improve quality of life (QOL) among individuals withalcohol use disorders (AUD).

What proportion of treated alcoholics abstain completely following treatment?

• If you went through rehab and after some time you started thinking about drinking in moderation, then you are in the first stage of relapse.
• Harmful drinking and alcohol use disorder are among our nation’s most challenging public health problems.
• Stopping the usage of drugs or alcohol is easy, but doing the work to heal the part of yourself that craved drugs or alcohol as a coping mechanism is an entirely different journey.
• Abstinence helps maintain stability and reduces the risk of relapse, and is also advised when someone has SUD, as there’s a tendency to simply substitute one chemical for another.
• Early attempts to establish pilot SSPs were met with public outcry and were blocked by politicians (Anderson, 1991).
• Results from the 1989 Canadian National Alcohol and Drug Survey confirmed that those who resolve a drinking problem without treatment are more likely to become controlled drinkers.

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. 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.

The Moderation Management Program

Join our global mission of connecting patients with addiction and mental health treatment. There are no long-term studies that can provide concrete insights into the program’s success. But walk into any MM meeting and you’ll find people who boast that it’s the answer to their problems. Recent research in this field has shown that our previous understanding of how much we can drink without negatively impacting our health was incorrect.

For example, a person who has one glass of wine every night may think they’re okay, but under MM, they’re breaking the rules. It’s crucial that people give their body a break from alcohol every few days, and the MM rules generally encourage this. Also, those without a history of treatment were 37% more likely, those without Alcoholics Anonymous exposure 67% more likely, and those without lifetime alcohol dependence 83% more likely, to be in the non-abstinent group. There are also therapeutic tools and techniques available to help you learn how to identify and avoid triggers, as well as stay motivated in recovery. If you find yourself wondering if your drinking habits are normal or if you’re drinking too much, it might be time to examine your drinking patterns.

Moderation: Can Controlled Consumption Work?

Also if the study included individuals that received an intervention (i.e., intended to help people reduce or quit drinking), the intervention had to be psychosocial, meaning patients did not receive medication. They could also follow a group of drinkers over time, called a prospective cohort study, or even simply assess them at one single point, called a cross-sectional study. The association between greater time since problem resolution and lower risk substance use status possibly reflects an aging out of substance use (Heyman, 2010), or some individuals struggling to moderate their use and eventually gravitating toward abstinence. ‘Ageing out’ itself may consist of substance use becoming less compatible with individuals’ lifestyles and developmental contexts as they grow older. It could also be that chronic use of AOD begins to culminate in greater incidence of medical problems (e.g., through toxicity-related impacts) and continued use may exacerbate these medical issues or interfere with effective treatment for them (Eddie et al., 2019), again, promoting motivation to abstain or reduce use.

. Correlates of substance use status

Alcohol misuse is consuming alcohol in such a way that it puts you or someone else in harm’s way, such as driving while intoxicated. Some people see abstinence as temporary, while others consider it a lifelong decision. For most, abstinence means no longer using alcohol to maintain sobriety long-term. Even if you could choose to stop using drugs and alcohol on your own, you could end up with dry drunk syndrome or potentially relapse.

Stephen A Maisto, PhD

Recovering from addiction requires a series of lifestyle changes that help individuals regain control of their lives. One of the biggest changes is a commitment to abstain or avoid drugs and alcohol entirely. Abstinence doesn’t address the behaviors, emotions, and mental health conditions that contribute to substance use, but being free of addictive substances can help individuals realize the extent of their addiction. Additionally, abstaining from drugs and alcohol can also help individuals strengthen their impulse control, think sensibly, and better regulate their emotions. Even though sobriety encompasses much more than avoiding drugs and alcohol, individuals practicing active sobriety do abstain from substances that can alter the mind.

Strategies to Overcome Urges and Maintain Sobriety

The simple fact is that if you’re considering any program at all, a part of you likely knows that your drinking is uncontrollable. If you’ve been unable to moderate your drinking on your own, many would ask why you think this program will be any different. By comparison, whether someone attended treatment, and the severity of their alcohol problem were not significantly related to quality of life. This study was a secondary analysis of data from the “What is Recovery” study, highlighted in a prior Bulletin.