Still, if you want the easiest way to minimize the problems in your life, go for abstinence eventually. It actually is much easier to just give it up entirely than punish yourself trying to moderate or control your addictive behavior. Studies have shown that regardless of the method employed to become sober, the number one factor for sobriety success is a permanent commitment to discontinue use permanently; a commitment to abstinence. Administrative discharge due to substance use is not a necessary practice even within abstinence-focused treatment (Futterman, Lorente, & Silverman, 2004), and is likely linked to the assumption that continued use indicates lack of readiness for treatment, and that abstinence is the sole marker of treatment success.
Thus, studies will need to emphasize measures of substance-related problems in addition to reporting the degree of substance use (e.g., frequency, quantity). 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). Participants with controlled use goals in this center are typically able to achieve less problematic (38%) or non-problematic (32%) use, while a minority achieve abstinence with (8%) or without (6%) incidental relapse (outcomes were not separately assessed for those with AUD vs. DUD; Schippers & Nelissen, 2006). Multiple versions of harm reduction psychotherapy for alcohol and drug use have been described in detail but not yet studied empirically.
Clients were recruited via treatment units (outpatient and inpatient) in seven Swedish city areas. Inclusion criteria were drawn up to recruit interviewees able to reflect on their process of change. Therefore, the client should be at the end of or have recently completed post-treatment intervention and be judged by a professional to be in a positive change process regarding their SUD. In the initial interviews, all the clients declared themselves abstinent and stressed that substance use in any form was not an option. It’s heartbreaking to see loved ones caught in the grip of addiction, but there’s hope – research shows that many people find success with programmes aimed at reducing consumption.
How Successful Are Controlled Drinking Programmes?
Polich, Armor, and Braiker found that the most severely dependent alcoholics (11 or more dependence symptoms on admission) were the least likely to achieve nonproblem drinking at 4 years. However, a quarter or this group who achieved remission did so through nonproblem drinking. 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.
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. 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 for treatment (SAMHSA, 2018, 2019a). Indeed, about 95% of people with SUD say they do not need SUD treatment (SAMHSA, 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.
Sample
Alcohol moderation management programmes are often successful when tailored to an individual’s specific needs and circumstances. The effectiveness of these programmes can greatly vary depending on several factors such how to wean someone off alcohol as treatment duration, individual factors, and programme challenges. It is very important to note that this study specifically excluded people who had previously been admitted to alcohol or drug treatment as well as those who had symptoms of severe alcohol withdrawal at any point in their life (like delirium tremens and such). This means that the participants likely did not include some of the most severe alcoholic cases. Following that logic, it makes a lot of sense to me to include the idea of moderation as another option in the addiction treatment arsenal.
Controlled drinkers
Only a small minority of people with substance use disorders (SUDs) receive treatment. A focus on abstinence is pervasive in SUD treatment, defining success in both research and practice, and punitive measures are often imposed on those who do not abstain. Most adults with SUD do not seek treatment because they do not wish to stop using substances, though many also recognize a need for help.
Individuals with greater SUD severity tend to be most receptive to therapist input about goal selection (Sobell, Sobell, Bogardis, Leo, & Skinner, 1992). This suggests that treatment experiences and therapist input can influence participant goals over time, and there is value in engaging patients with non-abstinence goals in treatment. In the 1980s and 1990s, the HIV/AIDS epidemic prompted recognition of the role of drug use in disease transmission, generating new urgency around the adoption of a public health-focused approach to researching and treating drug use problems (Sobell & Sobell, 1995). The realization that HIV had been spreading widely among people who injected drugs in the mid-1980s led to the first syringe services programs (SSPs) in the U.S. (Des Jarlais, 2017). Early attempts to establish pilot SSPs were met with public outcry and were blocked by politicians (Anderson, 1991).
As a newer iteration of RP, Mindfulness-Based Relapse Prevention (MBRP) has a less extensive research base, though it has been tested in samples with a range of SUDs (e.g., Bowen et al., 2009; Bowen et al., 2014; Witkiewitz et al., 2014). Our team at CATCH strongly believes in holistic healing methods as part of this process. Therefore, our programme includes evidence-based therapies such as cognitive behavioural therapy (CBT) or dialectical behaviour therapy (DBT). This multifaceted approach helps you develop coping mechanisms while fostering healthier habits that can sustain long-term recovery.
- Even moderate drinking can lead to long-term health problems such as liver disease, heart disease, and increased risk of certain cancers.
- It is important to highlight that most of the studies cited above did not provide goal-matched treatment; thus, these outcomes generally reflect differences between individuals with abstinence vs. non-abstinence goals who participated in abstinence-based AUD treatment.
- While AUD treatment studies commonly rely on guidelines set by government agencies regarding a “low-risk” or “nonhazardous” level of alcohol consumption (e.g., Enggasser et al., 2015), no such guidelines exist for illicit drug use.
- In fact, for those who have found total abstinence too difficult, moderation management can be a life-saver—giving them an achievable way to limit alcohol’s negative impacts.
Models of nonabstinence psychosocial treatment for SUD
Thus relying on DSM criteria to define a sample of individuals in recovery mayunintentionally exclude individuals who are engaging in non-abstinent or harm reductiontechniques and making positive changes in their lives. In parallel with the view on abstinence as a core criterion for recovery, controlled drinking (CD) has been a recurring concept and in focus from time to time in research on alcohol problems for more than half a century (Davies, 1962; Roizen, 1987; Saladin and Santa Ana, 2004). It caused heated debates, and for a long time, it has had a rather limited impact on professional treatment systems (Coldwell and Heather, 2006). Recently, in many European countries (Klingemann and Rosenberg, 2009; Klingemann, 2016; Davis et al., 2017) and in the USA (Coldwell, 2005; Davis and Rosenberg, 2013), professionals working with clients with severe problems and clients in inpatient care tend to have abstinence as a treatment goal . However, CD is a widely accepted treatment goal in Australia, Britain and Norway (Luquines et al., 2011). The Swedish treatment system has been dominated by total abstinence as the goal, although treatment with CD as a goal exists (e.g., Agerberg, 2014; Berglund et al., 2019).
His work has been published in leading professional journals and popular publications around the globe. Such was its popularity that SMART Recovery grew from 42 group meetings at the beginning to more than 2000 in North America alone today and now proliferating worldwide in 23 countries and counting. Some interview person (IP) were former polydrug users and alcohol dry eyes altered between AA and NA meetings. Thus, the results may be more relevant for women with similar experiences as the investigated sample. 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). Alcoholism is a complex issue characterised by a range of behavioural, physical, and psychological factors.
In contrast to the holistic approach of harm reduction psychotherapy, risk reduction interventions are generally designed to target specific HIV risk behaviors (e.g., injection or sexual risk behaviors) without directly addressing mechanisms of SUD, and thus are quite limited in scope. However, these interventions also typically lack an abstinence focus and sometimes result in reductions in drug use. Harm reduction may also be well-suited for people with high-risk drug use and severe, treatment-resistant SUDs (Finney & Moos, 2006; Ivsins, Pauly, Brown, & Evans, 2019).
Previous reviews have described nonabstinence pharmacological approaches (e.g., Connery, 2015; Palpacuer et al., 2018), which are outside the scope of the current review. We first describe treatment models with an explicit harm reduction or nonabstinence focus. 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. We focus our how to stop drinking out of boredom 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.
Multivariable stepwise regressions (Table2) show that younger individuals were significantly more likely to benon-abstinent, and movement to the next oldest age category reduced the odds ofnon-abstinence by an average of 27%. Importantly, the confidence intervals were narrow andextremely similar across models, implying that the effect of age was robust to modelspecification. In regard to help-seeking and problem severity, having attended at leastone 12-step meeting and the number of DSM-IV dependence symptoms were both significantlyrelated to non-abstinence. In the fully saturated models, any twelve-step attendancedecreased odds of non-abstinence by 57–76% (Model 4), while each additional DSMsymptom decreased odds of non-abstinence by 73–89% (Model 4).