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, Sober House behavioral activation) are excluded from the current review due to lack of relevant empirical evidence. This paper presents a narrative review of the literature and a call for increased research attention on the development of empirically supported nonabstinence treatments for SUD to engage and treat more people with SUD.
- In 1990, Marlatt was introduced to the philosophy of harm reduction during a trip to the Netherlands (Marlatt, 1998).
- Furthermore, one report using a trajectory analysis of the COMBINE study data found the Combined Behavioral Intervention (CBI), which is principally grounded in CBT, to reduce the risk of being in an “increasing to nearly daily drinking” trajectory.
- A common objection to CD is that most people fail to return to “normal” drinking, and highlighting those able to drink in a controlled way might attract people into relapse, with severe medical and social consequences.
- Moderated drinking could give you the space to address those issues you’ve been pushing aside.
Percent Days Abstinent
While the pandemic seems to have triggered substantial increases in alcohol consumption, and in alcohol abuse, this is true on a macro level. More time at home may have contributed to less peer pressure to drink, less time in a “wet” culture, and lifestyle changes that might support a shift towards moderation. You might find yourself constantly preoccupied with thoughts about when you’ll have your next drink or whether you’re staying within your limits – this constant monitoring can create stress and mental exhaustion over time. Moreover, in committing to a moderate drinking plan, it’s essential to recognise that slip-ups can happen and these instances should not discourage you from continuing on your path towards moderation management, but rather serve as reminders of why moderation is necessary in the first place. Your thoughts, feelings, and behaviours all play a role in how you manage your alcohol consumption.
Moderation vs. Abstinence: Should You Cut Back or Quit Drinking Completely?
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).
Levels of Care in Drug and Alcohol Rehab Programs
- There is less research examining the extent to which moderation/controlled use goals are feasible for individuals with DUDs.
- Such findings would aid in refining AUD treatment and would provide more information for clinicians to improve clinical decision-making.
- In order to be included in that original study, an individual had to be diagnosed with an alcohol use disorder, report a minimum average weekly drinking of 16+ drinks for women and 25+ for men, and express interest in a moderation approach to changing their drinking.
- 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.
- According to Finney and Moos (1991), 37 percent of patients reported they were abstinent at all follow-up years 4 through 10 after treatment.
- Finally, reduced drinking is often the focus of a harm-reduction approach, where the likely alternative is not abstinence but continued alcoholism.
We identify a clear gap in research examining nonabstinence psychosocial treatment for drug use disorders and suggest that increased research attention on these interventions represents the logical next step for the field. A number of studies have examined psychosocial risk reduction interventions for individuals with high-risk drug use, especially people who inject drugs. 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.
Alcohol Moderation Management: Programs and Steps to Control Drinking
The current study was a secondary data analysis and was limited by the measures assessed in the original Project MATCH study. Most notably, there were no measures of drinking goals and all of the Project MATCH treatments were delivered under the assumption of an abstinence goal. It is unclear whether the same patterns of drinking would be found among clients with low risk drinking goals. Correspondence between an individual’s drinking goal and the approach of the treatment program can affect long term outcome, so this is an important limitation (Berglund, Svensson, Berggren, Balldin, & Fahlke, 2016). Further, the aftercare sample, which was more severe at baseline was not followed for the three year follow-up assessment. It is also important to note that Project MATCH included individuals who met DSM-III-R criteria for alcohol abuse (4.6%) or dependence (95.4%), and it is unclear whether the small proportion of individuals with alcohol abuse would meet DSM-5 criteria for AUD.
Approaches to Alcoholism Treatment
A significant LRT and BLRT indicates a significantly better fit for a k profile model (e.g., 3 profiles) versus a k-1 profile model (e.g., 2 profiles), and a non-significant LRT and BLRT indicates that adding an additional profile does not significantly improve model fit (Nylund, Asparouhov, & Muthen, 2007). In addition, lower BIC and aBIC indicates a better fitting model (Nylund et al., 2007) and the smallest class of any class-solution should not contain less than 5% of the sample (Nagin, 2005). Classification precision (defined by relative entropy) was used to evaluate how well the final latent profile solution classified individuals into latent classes and values of entropy greater than .80 were considered good classification precision (Nylund et al., 2007). Our approach is not one-size-fits-all; instead, it’s grounded in empathy, respect for your individuality, and a deep understanding of how alcohol abuse impacts different people in different ways. That’s why our approach involves taking time to know you better, identify your triggers, and help chart a path forward that aligns with your life goals. In the present follow-up, the recovery process for clients previously treated for SUD was investigated, focusing on abstinence and CD.
- Individual factors like personal motivation, mental health status, and support system also play a key role in determining how well someone will fare within a programme.
- Experiences of the 12-step programmes and AA meetings were useful for a majority of the clients.
- When it comes to choosing between total abstinence or limiting your intake, the answer isn’t black and white.
- 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.
- All of these stages of drinking, from the enjoyment of alcohol to withdrawal to the cycles of craving, continuously alter the brain and its communication pathways.
- Drawing from Intrinsic Motivation Theory (Deci, 1975) and the controlled drinking literature, Miller (1985) argued that clients benefit most when offered choices, both for drinking goals and intervention approaches.
Abstinence from alcohol and other drugs has historically been a core criterion for recovery, defined by the Betty Ford Institute as a “voluntarily maintained lifestyle characterized by sobriety, personal health, and citizenship” (Betty Ford Institute Consensus Panel, 2007, p. https://thetennesseedigest.com/top-5-advantages-of-staying-in-a-sober-living-house/ 222). As recovery processes stretch over a long period, it is suggested that stable recovery is obtained after five years at the earliest (Hibbert and Best, 2011). Non-abstainers are younger with less time in recovery and less problem severitybut worse QOL than abstainers.
Take Advantage of «Getting Back to Normal» to Revisit Your Relationship with Alcohol
Drinking is often a coping strategy subconsciously used to avoid having to deal with uncomfortable or painful issues. Moderated drinking could give you the space to address those issues you’ve been pushing aside. At CATCH Recovery, we understand that your journey towards overcoming addiction is deeply personal and unique to you. We believe in the power of personalised therapy, where our experts tailor a recovery plan suited to your needs and circumstances. It’s not an easy road to lasting recovery, but with the right support and resources, it can definitely be a journey worth taking.