It would be helpful in future research to parse out the benefits and drawbacks of each potential pathway to drinking problem resolution and which individuals may be most likely to benefit the most from any given pathway. Based on 8 studies, the research suggests that abstinence may be needed for individuals with harmful How Long Does It Take to Detox from Alcohol Timeline and More 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. The ability to control drinking varies significantly from person to person and is influenced by a range of factors including genetics, environment, emotional state, and individual psychology. For people suffering from alcohol use disorders, trying to moderate drinking isn’t advised and total abstinence is always recommended. It’s important to acknowledge any emotional ties you might have to alcohol as these could make both moderation and complete abstinence more challenging.
3 Statistical analyses
As such, further research may be required before these findings can be generalized to real-world primary care settings. 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 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. The WIR data do not include current dependence diagnoses, which would beuseful for further understanding of those in non-abstinent recovery.
A recent qualitative study found that concern about missing substances was significantly correlated with not completing treatment (Zemore, Ware, Gilbert, & Pinedo, 2021). 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. There has been little research on the goals of non-treatment-seeking individuals; however, research suggests that nonabstinence goals are common even among individuals presenting to SUD treatment.
- The path towards moderation management comes with its unique set of challenges which can include social pressure or dealing with underlying emotional issues that contribute towards excessive drinking habits.
- Questions on main drug and other problematic drug use were followed by the interviewer giving a brief summary of how the interview person (IP) had described their change process five years earlier.
- The goal of a moderation program is to support a person’s journey toward understanding their drinking behavior and create a safe environment for them to explore how to drink moderately.
- Despite the intense controversy, the Sobell’s high-profile research paved the way for additional studies of nonabstinence treatment for AUD in the 1980s and later (Blume, 2012; Sobell & Sobell, 1995).
- Take our free, 5-minute substance use self-assessment below if you think you or someone you love might be struggling with substance use.
- 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.
Apparently, social stability predicts that alcoholics will succeed better whether they choose abstinence or reduced drinking. But other research indicates that the pool of those who achieve remission can be expanded by having broader treatment goals. 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. Comparisons of abstinence versus reduced or controlled drinking (sometimes called “harm reduction”) remains a hot topic in addiction treatment and recovery research.
Theoretical and empirical rationale for nonabstinence treatment
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. Further, analyses revealed several drinking goal × CBI interactions such that the benefit of cognitive behavioral intervention over medical management was not supported for participants whose reported goal was complete abstinence. These findings were evident in two of four outcome measures and some were trend level, which, given the sample size of the present study limits the conclusions that can be drawn about matching of behavioral intervention based on drinking goal. Additionally, type I error correction was not implemented; therefore caution is warranted when interpreting marginally significant interactions. It is, however, an important clinical finding that CBI conferred no advantage over a brief, medically oriented intervention for participants whose drinking goal was complete abstinence. However, while designed to approximate the style of intervention delivered in a primary care setting, the medical management delivered in the COMBINE study was confounded with extensive and state-of-the-art assessment and follow-up.
Expanding the continuum of substance use disorder treatment: Nonabstinence approaches
After transcribing the interviews, the material was analysed thematically (Braun and Clarke, 2006) by coding the interview passages according to what was brought up both manually and by using NVivo (a software package for qualitative data analysis). After relistening to the interviews and scrutinizing transcripts, the material was categorized and summarized by picking relevant parts from each transcript. By iteratively analysing and compiling these in an increasingly condensed form, themes were created at an aggregated level, following a process of going back and forth between transcripts and the emerging themes as described by Braun and Clarke (op. cit.). In the present article, descriptions of abstinence and CD and views on and use of the AA and the 12-step programme were analysed. Exercise is another key factor in recovery due to its numerous benefits such as stress reduction, improvement in mood and sleep patterns in addition to promoting overall wellbeing. Regular physical activity can act as a healthy coping mechanism when dealing with cravings or anxiety related to your efforts towards alcohol moderation management.
To that end, it should be noted that the distribution of clinical outcomes across the three levels of drinking goal (complete abstinence, conditional abstinence, and controlled drinking) provided strong support for the validity of this coding system. Importantly, clinical assessment of drinking goal is a readily accessible clinical variable which, given the results presented herein, is potentially critical to treatment planning and prognosis. 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). These findings were such that participants committed to complete abstinence took longer to slip and longer to relapse, defined as drug use on four or more days in a week. Critically, Hall et al. (1986, 1990) examined participants with an abstinence goal allowing for occasional slips and found that these participants did not fare as well as participants with complete abstinence goals.