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When your drinking is under control, you may have the internal bandwidth to accept the professional psychological support that can help you develop healthier ways of coping. You could also get help to better manage your emotions, address past trauma, and understand how anxiety, depression, or other emotional difficulties have powered your alcohol abuse. The Alcohol Dependence Scale (ADS; Skinner & Allen, 1982) was used to assess severity of alcohol dependence. This 25-item scale measures alcohol dependence symptoms over the past 12-months and has been shown to contain items outpatient rehab for alcohol that are very relevant for alcohol dependent drinkers (Kahler, Strong, Stuart, Moore, & Ramsey, 2003), such as the ones recruited in the present study. The first, Medical Management (MM), consisted of nine brief sessions delivered by a licensed health care professional, and was intended to approximate a primary care intervention. 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.
Expanding the continuum of substance use disorder treatment: Nonabstinence approaches
Seek skilled guidance from an addiction psychologist to get feedback when selecting goals, assessing progress, and setting appropriate boundaries. Dr. Stanton Peele, recognized as one of the world’s leading addiction experts, developed the Life Process Program after decades of research, writing, and treatment about and for people with addictions. His work has been published in leading professional journals and popular publications around the globe. The parent WIR study and this secondary analysis study were approved by theInstitutional Review Board of the Alcohol Research Group/Public Health Institute, Oakland,CA. Liver transient elastography was used to identify and diagnose liver steatosis and fibrosis. Fecal samples (collected at study initiation and again at final follow-up) were used for microbiome and metabolome analyses, the former of which was conducted via 16S rRNA sequencing.
Analytic Approach
By extension, for all those treated for alcohol abuse, including those with no dependence symptoms, moderation of drinking (termed controlled drinking or CD) as a goal of treatment is rejected (Peele, 1992). Instead, providers claim, holding out such a goal to an alcoholic is detrimental, fostering a continuation of denial and delaying the alcoholic’s need to accept the reality that he or she can never drink in moderation. Here we found that a number of factors distinguish non-abstainers from abstainersin recovery from AUD, including younger age and lower problem severity. Furthermore, qualityof life appeared significantly better among abstainers than non-abstainers. A betterunderstanding of the recovery process and tools utilized by non-abstinent vs. abstinentindividuals would inform clinical practice; for example, is it more important for those inabstinent recovery to have abstinent individuals in their social networks? Finally, we hope tofurther investigate the overlap between “remission” and“recovery” from AUD, especially in the context of harm reduction.
What is Controlled Drinking or Alcohol Moderation Management?
Some strategies and guidelines to consider if you’re aiming to practice controlled drinking include setting limits, eating before drinking, choosing drinks with lower alcohol content, alternatives with non-alcoholic beverages and having abstinent days. Controlled drinking, also known as “moderate drinking” or “drinking in moderation,” is an approach that involves setting limits around alcohol consumption to ensure that drinking remains safe and doesn’t interfere with one’s health, daily life, or responsibilities. This means addressing not just the physical symptoms of addiction but also the psychological, emotional, social, and spiritual aspects as well. Such approaches could include cognitive behavioural therapy to address mental health issues that may contribute to excessive drinking; yoga or meditation for stress relief; art therapy for expressing emotions; faith-based support groups for spiritual growth among others.
- Drinking is often a coping strategy subconsciously used to avoid having to deal with uncomfortable or painful issues.
- Also, defining sobriety as a further/deeper step in the recovery process offers a potential for 12-step participants to focus on new goals and getting involved in new groups, not primarily bound by recovery goals.
- At the other extreme, Wallace et al. (1988) reported a 57 percent continuous abstinence rate for private clinic patients who were stably married and had successfully completed detoxification and treatment—but results in this study covered only a 6-month period.
- Vaillant (1983) labeled abstinence as drinking less than once a month and including a binge lasting less than a week each year.
- Additionally, we offer exceptional continuing care so even after completing your programme; you’re never alone in this fight against alcohol addiction.
1. Nonabstinence psychosocial treatment models
Consistent with the philosophy of harm reduction as described by Marlatt et al. (2001), harm reduction psychotherapy is accepting of a wide range of client goals, including risk reduction, moderation, and abstinence (of note, abstinence is conceptualized as consistent with harm reduction when it is a goal chosen by the client). Publications about harm reduction psychotherapy have included numerous case studies and client examples that highlight the utility of the approach for helping clients achieve reductions in drug and alcohol use and related problems, moderate/controlled use, and abstinence (Rothschild, 2015b; Tatarsky, 2002; Tatarsky alcohol and the brain & Kellogg, 2010). However, to date there have been no published empirical trials testing the effectiveness of the approach. Despite the growth of the harm reduction movement globally, research and implementation of nonabstinence treatment in the U.S. has lagged. Furthermore, abstinence remains a gold standard treatment outcome in pharmacotherapy research for drug use disorders, even after numerous calls for alternative metrics of success (Volkow, 2020). Models of nonabstinence psychosocial treatment for drug use have been developed and promoted by practitioners, but little empirical research has tested their effectiveness.
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. People suffering from alcoholism typically experience a physical and psychological dependence on alcohol, making it extremely challenging to maintain moderation. This approach underestimates the compulsive nature of addiction and the neurological changes that occur with prolonged alcohol abuse. For individuals with severe alcohol dependence, abstinence remains the most effective and safe strategy to avoid the devastating consequences of alcohol-related health issues, social disruption, and the potential for relapse. Your thoughts, feelings, and behaviours all play a role in how you manage your alcohol consumption.
These data suggest that non-disordered drug use is possible, even for a substantial portion of individuals who use drugs such as heroin (about 45%). However, they do not elucidate patterns of non-disordered use over time, nor the likelihood of maintaining drug use without developing a DUD. 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.
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). For individuals with alcohol use disorder who make an effort to get treatment but do not end up receiving it, 25% say the reason was that they were not ready to stop drinking or using drugs.
Untreated alcohol abusers probably have less severe drinking problems than clinical populations of alcoholics, which may explain their higher levels of controlled drinking. But the less severe problem drinkers uncovered in nonclinical studies are more the difference between alcohol and ethanol typical, outnumbering those who “show major symptoms of alcohol dependence” by about four to one (Skinner, 1990). In Britain and other European and Commonwealth countries, controlled-drinking therapy is widely available (Rosenberg et al., 1992).
This resistance to nonabstinence treatment persists despite strong theoretical and empirical arguments in favor of harm reduction approaches. Additionally, given the nature of the COMBINE study, the effects of a medically oriented intervention (i.e., MM) without a pharmacological component could not be investigated. Furthermore, it should be noted that the literature does not offer consensus on the operational definition of drinking goal (Luquiens et al., 2011). Instead, the authors categorized responses to the Commitment to Abstinence item based largely on clinical judgment and prior research using this measure. 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.
You don’t have to attend AA meetings and introduce yourself as an alcoholic, and you don’t have to answer questions at parties or social gatherings when people notice you aren’t drinking. Abstinence means giving up alcohol completely, and it’s the foundation of traditional treatment options like AA and most inpatient rehabs. In three Swedish projects, on recovery from SUD, 56 clients treated in 12-step programmes were interviewed approximately six months after treatment (Skogens and von Greiff, 2014, 2016; von Greiff and Skogens, 2014, 2017; Skogens et al., 2017).
This finding supplements the numerous studies that identify lack of readiness for abstinence as the top reason for non-engagement in SUD treatment, even among those who recognize a need for treatment (e.g., Chen, Strain, Crum, & Mojtabai, 2013; SAMHSA, 2019a). Multiple theories of motivation for behavior change support the importance of self-selection of goals in SUD treatment (Sobell et al., 1992). For example, Bandura, who developed Social Cognitive Theory, posited that perceived choice is key to goal adherence, and that individuals may feel less motivation when goals are imposed by others (Bandura, 1986). Miller, whose seminal work on motivation and readiness for treatment led to multiple widely used measures of SUD treatment readiness and the development of Motivational Interviewing, also argued for the importance of goal choice in treatment (Miller, 1985). 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. A key point in Miller’s theory is that motivation for change is “action-specific”; he argues that no one is “unmotivated,” but that people are motivated to specific actions or goals (Miller, 2006).
In prior analyses, there were no differences between the low risk drinking classes (Class 5 and 6) in drinking or psychosocial functioning in the year following treatment (Witkiewitz, Roos, et al., 2017). However, the current study showed that Class 6 had better drinking outcomes at three years following treatment than Class 5. Individuals with expected membership in Class 5 (low risk and heavy drinking) had a low probability of abstinence days during treatment, whereas individuals in Class 6 (abstinence and low risk drinking) had a higher probability of abstinence days throughout treatment. Some days of abstinence during treatment may be important for longer term functioning among those engaging in low risk drinking during treatment. Those with greater dependence severity were unlikely to be classified as low risk drinkers during treatment and clinicians may consider assessing dependence severity in developing intervention strategies and collaborating with patients regarding the selection of abstinence or low risk drinking goals. 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.
