“Harm reduction” strategies, on theother hand, set more flexible goals in line with patient motivation; these differ greatlyfrom person to person, and range from total abstinence to reduced consumption and reducedalcohol-related problems without changes in actual use (e.g., no longer driving drunkafter having received a DUI). In the broadest sense, harm reduction seeks to reduceproblems related to drinking behaviors and supports any step in the right directionwithout requiring abstinence (Marlatt and Witkiewitz2010). Witkiewitz (2013) has suggestedthat abstinence may be less important than psychiatric, family, social, economic, andhealth outcomes, and that non-consumption measures like psychosocial functioning andquality of life should be goals for AUD research (Witkiewitz 2013). These goals are highly consistent with the growingconceptualization of `recovery’ as a guiding vision of AUD services (The Betty Ford Institute Consensus Panel 2007). Witkiewitz also arguedthat the commonly held belief that abstinence is the only solution may deter someindividuals from seeking help. This includes those managing liver disease, bipolar disorder, abnormal heart rhythms, or chronic pain.
Katie Witkiewitz
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 lead authors (DK and MH) affirm that the manuscript https://ecosoberhouse.com/ is an honest, accurate, and transparent account of the study being reported; that no important aspects of the study have been omitted; and that any discrepancies from the study as planned (and, if relevant, registered) have been explained. 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).
1 Non-abstinent recovery from alcohol use disorders
- 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.
- Proactively cutting back on drinking can start to illuminate how drinking less can give you more, and create the mental clarity to identify your goals and values.
- Together, these analyses seek to further elucidate the predictive utility of drinking goal as well as to identify specific treatment approaches that may be better suited for patients whose goals are abstinence versus non-abstinence oriented.
- We found that outcomes were reported over a wide range of time points between three and 24 months.
Notably, these individuals are also most likely to endorse nonabstinence goals (Berglund et al., 2019; Dunn & Strain, 2013; Lozano et al., 2006; Lozano et al., 2015; Mowbray et al., 2013). In contrast, individuals with greater SUD severity, who are more likely to have abstinence goals, generally have the best outcomes when working toward abstinence (Witkiewitz, 2008). 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. Traditional alcohol use disorder (AUD) treatment programs most often prescribeabstinence as clients’ ultimate goal.
Preliminary Analyses
The second, Combined Behavioral Intervention (CBI), consisted of up to twenty, 50-minute sessions which integrated aspects of cognitive behavioral therapy, 12-step facilitation, motivational interviewing, and involvement of support systems. It is well known to clinicians and researchers in the field of alcoholism that patients vary with respect to drinking goal. The objective of this study is to elucidate the contribution of drinking goal to treatment outcome in the context of specific behavioral and pharmacological interventions. Some no longer attended meetings but remained abstinent with a positive view of the 12-step programme. However, they no longer found themselves in need of this help and did not express ambivalence regarding their decision to stop attending meetings. On the other hand, some clients in the present study had adopted the 12-step principles, intensified their attendance and made it more or less central in their life.
- Additionally, TAU+SP was more efficacious than TAU for changing DDD in the high-quality direct comparison, although they had no other connection in the evidence network.
- This resistance to nonabstinence treatment persists despite strong theoretical and empirical arguments in favor of harm reduction approaches.
- Here we discuss exploratory analyses of differences between abstinentand nonabstinent individuals who defined themselves as “in recovery” fromAUDs.
- Briefly, as the Supplementary File presents, 14.71% of the included trials were considered low risk, 66.67% were considered unclear risk, and 20.59% were considered high risk (Figure S6A).
- Finney and Moos (1991) reported a 17 percent “social or moderate drinking” rate at 6 years and a 24 percent rate at 10 years.
2 Quality of life and recovery from AUD
If the 12-step philosophy and AA were one option among others, the clients could make an informed choice and seek options based on their own situation and needs. This would probably reduce the risk of negative effects while still offering alcohol abstinence vs moderation the positive support experienced by the majority of the clients in the study. A final limitation of the Fan et al. study (2019) is the reliance on cross-sectional data to characterize a dynamic process of behavior change.
What is Controlled Drinking or Alcohol Moderation Management?
Evidence is lacking for benefit from interventions that could be implemented in primary care settings for alcohol abstinence, other than for acamprosate. Unfortunately, there has been little empirical research evaluating this approach among individuals with DUD; evidence of effectiveness comes primarily from observational research. For example, at a large outpatient SUD treatment center in Amsterdam, goal-aligned treatment for drug and alcohol use involves a version of harm reduction psychotherapy that integrates MI and CBT approaches, and focuses on motivational enhancement, self-control training, and relapse prevention (Schippers & Nelissen, 2006).
Reasons Abstinence From Alcohol May Be the Best Choice
GRADE Quality Assessment of Evidence
- The protocol followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA), and was registered on the International Prospective Register of Systematic Reviews (PROSPERO).
- As such, further research may be required before these findings can be generalized to real-world primary care settings.
- Alcoholics Anonymous (AA; 1939) advanced the seminal definition of recovery as a spiritual journey to overcome the effects of uncontrollable alcohol use and to rebuild one’s inner and outer life, a lifelong journey for which abstinence was necessary, but not sufficient to effect this life-altering transformation.
- By 1989, treatment center referrals accounted for 40% of new AA memberships (Mäkelä et al., 1996).
- Only 18 percent of 500 recovered alcohol abusers in the survey achieved remission through treatment.