Additionally, drinking goal was initially analyzed as a five-level variable keeping all possible self-report responses separate. Visual inspection of these results supported our classification system (i.e., controlled drinking, conditional abstinence, and complete abstinence) in that the two possible responses for both controlled drinking and conditional abstinence clustered together across outcomes. Since drinking goal is a three-level variable, following the omnibus test, planned analyses were conducted to test differences between the three drinking goal groups for effects observed on all outcome variables. The current review highlights multiple important directions for future research related to nonabstinence SUD treatment. Overall, increased research attention on nonabstinence treatment is vital to filling gaps in knowledge.
Mental Health, Quality of Life & Social Functioning:
- 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.
- Untreated alcohol abusers probably have less severe drinking problems than clinical populations of alcoholics, which may explain their higher levels of controlled drinking.
- 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).
While complete abstinence often requires you to avoid any circumstances or people that might tempt you to drink, moderation allows you to still participate in work functions and social events while empowering you to have more control over when and how much you drink. Rather, when people with SUD are surveyed about reasons they are not in treatment, not being ready to stop using substances is consistently the top reason cited, even among individuals who perceive a need salvia extent of use, effects, and risks for treatment (SAMHSA, 2018, 2019a). 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.
The Effects of Drinking Goal on Treatment Outcome for Alcoholism
The WIR data do not include current dependence diagnoses, which would beuseful for further understanding of those in non-abstinent recovery. In addition, the WIRquality of life measure is based on a single question; future studies could useinstruments that detail various aspects of mental and physical functioning. WIR is alsocross-sectional by design, though i need help dealing with my angry and alcoholic mother it did include questions about lifetime drug and alcoholuse. Finally, the WIR survey did not ask about preferential beverage (e.g., beer, wine,spirits), usual quantities of ethanol and other drugs consumed per day, or specificsregarding AA involvement; because these factors could impact the recovery process, we willinclude these measures in future studies.
Historical context of nonabstinence approaches
Furthermore, younger (under 40), single alcoholics were far more likely to relapse if they were abstinent at 18 months than if they were drinking without problems, even if they were highly alcohol-dependent. Thus the Rand study found a strong link between severity and outcome, but a far from ironclad one. In other studies of private treatment, Walsh et al. (1991) found that only 23 percent of alcohol-abusing workers reported abstaining throughout a 2-year follow-up, although the figure was 37 percent for those assigned to a hospital program.
Low Risk Drinking Outcomes and Longer Term Functioning
For example, while interventions that emphasize or allow for drinking reduction rather than abstinence may attract more individuals with alcohol problems – and thus have potentially greater reach – they may possibly have a smaller positive impact on health and wellness. In the results, we mention that there were a few IPs that were younger, with a background of diffuse and complex problems characterized by a multi-problem situation. Research on young adults, including people in their thirties (Magaraggia and Benasso, 2019), stresses that young adults leaving care tend to have complex problems and struggle with problems such as poor health, poor school performance and crime (Courtney and Dworsky, 2006; Berlin et al., 2011; Vinnerljung and Sallnäs, 2008). Thus, this is interesting to analyse further although the younger IPs in this article, with experience of 12-step treatment, are too few to allow for a separate analysis.
Reasons Abstinence From Alcohol May Be the Best Choice
The 12-step approach is widely adopted by alcohol treatment facilities (Galanter, 2016) endorsing total abstinence as the treatment goal. In the present article, clients treated in 12-step programmes were reinterviewed five years after treatment. All the interviewed clients reported a successful treatment outcome, i.e. total abstinence six months after treatment. The aim is to investigate how these clients view abstinence and the role of AA[1] in their recovery process during the past five years. There are heterogeneous views on the possibilities of CD after recovery from substance use disorder both in research and in treatment systems. This study on client views on abstinence versus CD after treatment advocating total abstinence can contribute with perspectives on this ongoing discussion.
Are You Addicted to Alcohol?
Patients differ on the continuum between not wanting to change their drinking at all to seeking complete and long-term abstinence from alcohol. While drinking goal represents an important clinical variable, the literature is relatively limited as to the specific influence of drinking goal on treatment outcomes for alcoholism. Likewise, the clinical implications of drinking goal on treatment matching are largely unknown. Given data demonstrating a clear link between abstinence goals and treatment engagement in a primarily abstinence-based SUD treatment system, it is reasonable to hypothesize that offering nonabstinence treatment would increase overall engagement by appealing to those with nonabstinence goals.
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 a complete guide to ketamine withdrawal & addiction 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.
Here we provide a brief review of existing models of nonabstinence psychosocial treatment, with the goal of summarizing the state of the literature and identifying notable gaps and directions for future research. Previous reviews have described nonabstinence pharmacological approaches (e.g., Connery, 2015; Palpacuer et al., 2018), which are outside the scope of the current review. While there are multiple such intervention approaches for treating AUD with strong empirical support, we highlight a dearth of research testing models of harm reduction treatment for DUD. Next, we review other established SUD treatment models that are compatible with non-abstinence goals.
The dearth of data regarding individuals in long-term recovery highlights theneed to examine a sample that includes individuals with several years of recoveryexperience. Moreover, although previous studies have examined treated, non-treated andgeneral population samples, none has focused on individuals who identifythemselves as “in recovery” from alcohol problems. Instead, paststudies have equated “recovery” with DSM-IV diagnostic criteria and nationalguidelines for low-risk drinking; these criteria may exclude people who considerthemselves “in recovery.” For example, individuals involved in harmreduction techniques that do not involve changed drinking may consider themselves inrecovery. Importantly, the only published study that asked individuals in recovery (fromcrack or heroin dependence in this particular study) how they defined the term revealedthat less than half responded in terms of substance use; the other definitions were moregeneral, such as a process of working on oneself (Laudet2007).