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. Earlier research utilizing drug use goals analogous to goals used in the present study found commitment to absolute abstinence, measured at the end of treatment, to predict days to relapse across nicotine, alcohol, and opiate dependence (Hall & Havassy, 1986; Hall, Havassy, & Wasserman, 1990). These findings were such that participants committed to complete abstinence took longer to slip and longer to relapse, defined as drug use on four or more days in a week. Critically, Hall et al. (1986, 1990) examined participants with an abstinence goal allowing for occasional slips and found that these participants did not fare as well as participants with complete abstinence goals.
Alcohol Moderation Management: Steps To Control Drinking
An observational study of individuals with AUD surveyed participants about their drinking practices, psychosocial functioning, and life contexts at baseline and 1, 3, 8, and 16 years later. Regardless of whether they had recently sought help or achieved abstinence, many participants showed improvement in alcohol-related functioning, life contexts, and coping26. Taken together, these studies may inform a longstanding debate in the field concerning the risks and stability of non-abstinent recovery9 and the utility of broader conceptualizations of recovery that emphasize improvements in biopsychosocial functioning16,17. 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. Given the widespread recognition of individual differences in drinking goals for alcoholism treatment, as well as the accessible nature of this clinical variable to treatment providers, the potential clinical utility of such findings is high. Perhaps the most notable gap identified by this review is the dearth of research empirically evaluating the effectiveness of nonabstinence approaches for DUD treatment.
How Many Drinks a Day Is Considered an Alcoholic?
Whether addiction recovery group activities you’re considering moderation or complete abstinence, this article will provide information about how to begin an Alcohol Moderation Management (AMM), its effectiveness, potential drawbacks, and its applicability to people dealing with alcoholism. Recent research in this field has shown that our previous understanding of how much we can drink without negatively impacting our health was incorrect. Some studies indicate that drinking more than 100 grams of alcohol (approximately seven standard glasses of beer or wine) per week increases the risk of death in all alcohol-related causes. As MM rules allow men to drink up to 14 alcoholic beverages per week, there is growing evidence that these may be dangerous guidelines.
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 ability to control drinking varies significantly from person to person and is influenced by a range of factors including genetics, environment, emotional state, and individual psychology.
Moderation is an Option
- The harm reduction movement, and the wider shift toward addressing public health impacts of drug use, had both specific and diffuse effects on SUD treatment research.
- For example, among the 2005and 2010 National Alcohol Survey respondents, 18% of current drinkers who identified as“in recovery” from alcohol problems (who do not use drugs) are DSM-IValcohol dependent, and 26% of current drinkers who also use drugs are DSM-IV alcoholdependent.
- Moderation techniques such as pacing yourself, choosing lower-alcohol options, or having alcohol-free days can be practical tools in this journey.
Given the abstinence focus of many SUD treatment centers, studies may need to recruit using community outreach, which can yield fewer participants compared to recruiting from treatment (Jaffee et al., 2009). However, this approach is consistent with the goal of increasing treatment utilization by reaching those who may not otherwise present to treatment. Alternatively, researchers who conduct trials in community-based treatment centers will need to obtain buy-in to test nonabstinence approaches, which may necessitate waiving facility policies regarding drug use during treatment – a significant hurdle. In addition to shaping mainstream addiction treatment, the abstinence-only 12-Step model also had an indelible effect on the field of SUD treatment research. Most scientists who studied SUD treatment believed that abstinence was the only acceptable treatment goal until at least the 1980s (Des Jarlais, 2017). Abstinence rates became the primary outcome for determining SUD treatment effectiveness (Finney, Moyer, & Swearingen, 2003; Kiluk, Fitzmaurice, Strain, & Weiss, 2019; Miller, 1994; Volkow, 2020), a standard which persisted well into the 1990s (Finney et al., 2003).
Drinking Goals in Alcoholism Treatment
We first provide an overview of the development of abstinence and nonabstinence approaches within the historical context of SUD treatment in the U.S., followed by an evaluation of literature underlying the theoretical and empirical rationale for nonabstinence treatment approaches. Lastly, we review existing models of nonabstinence psychosocial treatment for SUD among adults, with a special focus on interventions for drug use, to identify gaps in the literature and directions for future research. 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. It was also hypothesized that, given naltrexone’s effect on hedonic response to alcohol (King et al., 1997; McCaul et al., 2001; Ray et al., 2010), naltrexone would be more effective among those with a controlled drinking goal versus those with an abstinence oriented 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. In the context of “harm reduction,” individuals may make positivechanges in their lives that do not include reduced alcohol use and aetna momentum program may consider themselves“in recovery” even though their AUD status remains unchanged (Denning and Little 2012). For example, among the 2005and 2010 National Alcohol Survey respondents, 18% of current drinkers who identified as“in recovery” from alcohol problems (who do not use drugs) are DSM-IValcohol dependent, and 26% of current drinkers who also use drugs are DSM-IV alcoholdependent. 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.
Profile 4 had significantly lower anger, depression, and alcohol-related consequences, and greater purpose in life than profiles 1 and 2 and did not differ significantly from profile 3 on two important functioning outcomes at year 10 (i.e., depression and purpose in life). While individuals who achieved both high functioning and abstinence/non-heavy drinking (profile 4) at three years had optimal long-term outcomes as a whole, individuals who have a combination of high functioning and more frequent heavy drinking (profile 3) also showed favorable long-term outcomes in psychosocial functioning. Regarding pharmacological interventions for alcohol use disorders, recent laboratory studies of naltrexone have elucidated its mechanisms of action. Importantly, one study examined the effects of naltrexone on alcohol non-abstainers and found that participants who drank regularly during the treatment period benefited more from naltrexone relative to placebo (Ray, Krull, & Leggio, 2010). Together, these findings suggest that naltrexone may be better suited to a controlled drinking approach and thus liberty cap effects may be more effective among patients with controlled drinking goals. A considerable number of clients reported changed views on the programme, some were still abstinent and some were drinking in a controlled way.
