Abstinence or controlled drinking a five-year follow-up on Swedish clients reporting positive change after treatment for substance use disorders

However, to date there have been no published empirical trials testing the effectiveness of the approach. 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. We define nonabstinence treatments as those without an explicit goal of abstinence from psychoactive substance use, including treatment aimed at achieving moderation, reductions in use, and/or reductions http://golpr.ru/index.php?start=360 in substance-related harms. 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.

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. https://siliconpower.com/pennsylvania-headquartered-silicon-power-corporation-acquires-new-york-based-applied-pulsed-power/ 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.

Moderation Management: Does Controlled Drinking Work?

Simply put, those who want to learn to drink in moderation are less likely to achieve their goal, while those who set a goal of quitting drinking entirely see greater success. It goes without saying that it’s important to pay attention to drink equivalents. A typical shot equals one 5-ounce glass of wine, which equals one 12-ounce standard beer. If your favorite bartender is pouring your drinks and he knows you are a big tipper who likes to drink, you might need to have a brief conversation with him. Believe me, bartenders are used to these conversations, and they will not hold it against you. In fact, most bartenders will be very respectful and discreet and will keep an eye out for you thereafter.

  • Differentiating these concepts opens up for recovery without necessarily having strong ties with the recovery community and having a life that is not (only) focused on recovery but on life itself.
  • 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).
  • 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).
  • Controlled drinking was less acceptable as an outcome goal for alcohol-dependent drinkers, especially if controlled drinking was their final goal.

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. When we can learn to stop at the “buzz,” we are well on our way to having our relationship with alcohol fully in check.

Controlled drinking: more than just a controversy

Before you consider that to be a SMART Recovery® license to relapse, it is not. The reality for alcohol addictions, for example, is that people have an average of two and a half relapses in their ultimate turn to permanent sobriety. A commitment to sobriety means that http://galactic.org.ua/Prostranstv/pr_narko-3.htm you are committed to a course of action, understanding that it is not an easy task and one that takes a great deal of patience, persistence and practice. We are not perfect beings, we are fallible and breaking a commitment is not the same as giving up on one.

  • In Europe, about half (44–46%) of individuals seeking treatment for AUD have non-abstinence goals (Haug & Schaub, 2016; Heather, Adamson, Raistrick, & Slegg, 2010).
  • 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.
  • This cultural difference in the acceptability of controlled drinking is probably an outgrowth of the dominance of the US disease model of alcoholism, which advocates total abstinence from alcohol for all problem drinkers.
  • A permanent commitment to abstinence means we no longer have to fight a battle with moderation; but rather devote ourselves to sobriety permanently.

When the premise of AA was transformed into the 12-step treatment programme, it was performed in a professional setting. Many clients in the study described that the 12-step programme was the only treatment that they were offered. The context of treatment in a professional setting, and in many cases, the only treatment offered, gives the 12-step philosophy a sense of legitimacy. Despite the growth of the harm reduction movement globally, research and implementation of nonabstinence treatment in the U.S. has lagged.

Is Controlled Drinking Possible for Alcoholics?

After transcribing the interviews, the material was analysed thematically (Braun and Clarke, 2006) by coding the interview passages according to what was brought up both manually and by using NVivo (a software package for qualitative data analysis). After relistening to the interviews and scrutinizing transcripts, the material was categorized and summarized by picking relevant parts from each transcript. By iteratively analysing and compiling these in an increasingly condensed form, themes were created at an aggregated level, following a process of going back and forth between transcripts and the emerging themes as described by Braun and Clarke (op. cit.). In the present article, descriptions of abstinence and CD and views on and use of the AA and the 12-step programme were analysed.

controlled drinking vs abstinence

Experiences of the 12-step programmes and AA meetings were useful for a majority of the clients. Thus, it was not the sobriety goal in itself that created problems, but the strict belief presenting this goal as “the only way”. The results suggest the importance of offering interventions with various treatment goals and that clients choosing CD as part of their sustained recovery would benefit from support in this process, both from peers and from professionals.

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