In its original form, RP aims to reduce risk of relapse by teaching participants cognitive and behavioral skills for coping in high-risk situations (Marlatt & Gordon, 1985). More recent versions of RP have included mindfulness-based techniques (Bowen, Chawla, & Marlatt, 2010; Witkiewitz et al., 2014). The RP model has been studied among individuals with both AUD and DUD (especially Cocaine Use Disorder, e.g., Carroll, Rounsaville, & Gawin, 1991); with the largest effect sizes identified in the treatment of AUD (Irvin, Bowers, Dunn, & Wang, 1999).
Success rates of abstinence programs
Alternatives such as moderation management, harm reduction, medication-assisted treatment, and holistic approaches provide flexible and personalized pathways to recovery. These methods recognize the complexity of alcohol use disorder and offer diverse strategies to help individuals achieve their goals, whether that means complete sobriety or a healthier relationship with alcohol. The key is to find an approach that aligns with the individual’s needs, preferences, and stage of readiness for change.
Treatment and mutual-help measures
Empirical evidence supports the effectiveness of abstinence-based treatment, particularly when combined with comprehensive care. Studies have shown that individuals who engage in abstinence-oriented programs, such as inpatient rehabilitation or intensive outpatient therapy, often experience significant reductions in alcohol consumption and related problems. The success of these programs is often attributed to their holistic approach, which addresses not only the physical aspects of addiction but also the psychological, social, and spiritual dimensions. Peer support, a common feature of abstinence-based programs, has been identified as a critical factor in maintaining sobriety, as it provides individuals with a sense of belonging and shared purpose.
While you may see the appeal in a programme that allows for some level of drink intake, it’s crucial to consider the potential drawbacks that could come with this approach. Even moderate drinking can lead to long-term health problems such as liver disease, heart disease, and increased risk of certain cancers. Besides, alcohol affects your sleep quality and mental health too; it’s not uncommon for people who drink regularly to struggle with anxiety or depression. There is less research examining the extent to which moderation/controlled use goals are feasible for individuals with DUDs. The most recent national survey assessing rates of illicit drug use and SUDs found that among individuals who report illicit drug use in the past year, approximately 15% meet criteria for one or more DUD (SAMHSA, 2019a).
This underscores the importance of tailoring recovery strategies to fit the social and cultural realities of the individual. Non-abstinent recovery, marked by drinking or drug use that is no longer problematic, became a “hot topic” in the 1970s and has continued to receive much attention in the scientific literature, particularly for alcohol-related interventions during the past 15 years. In fact, for individuals in remission from a severe alcohol use disorder, 65% are drinking alcohol in some form.
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- Psychologically, you might be dealing with a range of emotions from guilt over past incidents to anxiety about future relapses.
- For alcoholics in such environments, moderation might be a more culturally aligned and feasible goal, provided it is carefully monitored and supported.
- Despite compatibility with harm reduction in established SUD treatment models such as MI and RP, there is a dearth of evidence testing these as standalone treatments for helping patients achieve nonabstinence goals; this is especially true regarding DUD (vs. AUD).
Finally, mindfulness-based interventions and holistic approaches offer alternatives to traditional abstinence-based recovery. Practices such as mindfulness meditation, yoga, and acupuncture can help individuals develop greater self-awareness and coping mechanisms to manage cravings and stress. These methods focus on healing the mind, body, and spirit, providing a comprehensive approach to recovery. While not explicitly focused on abstinence, these practices can empower individuals to make healthier choices and reduce their reliance on alcohol. Abstinence-based models of addiction recovery dominated the substance use disorder (SUD) treatment landscape for most of the 20th Century and continue to dominate today (SAMHSA, 2013).
MAT allows individuals to focus on recovery without the immediate pressure of complete abstinence, providing a bridge to long-term sobriety. This method is often used in conjunction with therapy and support groups to address the psychological and social aspects of addiction. Finally, the role of media and public health messaging cannot be overlooked in shaping cultural and social attitudes toward alcoholism.
A one-size-fits-all approach is unlikely to be effective in treating AUD, a condition that varies widely in severity, context, and underlying causes. Integrative models that combine elements of both approaches—such as offering harm reduction strategies while also supporting abstinence for those who seek it—may provide the most comprehensive and compassionate care. The goal of alcohol treatment should be to improve health, well-being, and functioning, and this can be achieved through multiple pathways, whether abstinence is the ultimate goal or not. The controlled drinking approach is based on the idea that not all problem drinkers require complete abstinence to improve their health and well-being.
Is Controlled Drinking Possible for Alcoholics?
This mental clarity also enhances productivity at work or in pursuing personal hobbies because there’s no longer a hangover holding you back. It’s during this period that peer support becomes invaluable; it helps to know that others are experiencing similar struggles or have overcome them already. You’re here because you’ve taken the first brave step in acknowledging that your relationship with alcohol needs a change.
- In some European countries, such as France and Italy, cultural attitudes toward alcohol are more integrated into daily life, with moderate consumption often viewed as a normal and even healthy practice.
- This response rate is similar to other nationally representative surveys (Grant et al., 2015, Center for Behavioral Health Statistics and Quality, 2016, Centers for Disease Control and Prevention, 2013).
- Social influences also impact the recovery process, particularly through peer groups, family dynamics, and community expectations.
- In the context of alcohol treatment, moderation management programs aim to teach individuals how to control their drinking, set limits, and develop healthier relationships with alcohol.
- If you are struggling with alcohol use and are ready for change, moderation or abstinence are not easy to come by.
However, it is also possible that adaptations will be needed for individuals with nonabstinence goals (e.g., additional support with goal setting and monitoring drug use; ongoing care to support maintenance goals), and currently there is a dearth of research in this area. An additional concern is that the lack of research supporting the efficacy of established interventions for achieving nonabstinence goals presents a barrier to implementation. Lack of consensus around target outcomes also presents a challenge to evaluating the effectiveness of nonabstinence treatment. Experts generally recommend that SUD treatment studies report substance use as well as related consequences, and select primary outcomes based on the study sample and goals (Donovan et al., 2012; Kiluk et al., 2019).
1 What Is Recovery? study
Nonabstinence goals have become more widely accepted in SUD treatment in much of Europe, and evidence suggests that acceptance of controlled drinking has increased among U.S. treatment providers since the 1980s and 1990s (Rosenberg, Grant, & Davis, 2020). Importantly, there has also been increasing acceptance of non-abstinence outcomes as a metric for assessing treatment effectiveness in SUD research, even at the highest levels of scientific leadership (Volkow, 2020). Many advocates of harm reduction believe the SUD treatment field is at a turning point in acceptance controlled drinking vs abstinence addiction recovery of nonabstinence approaches. Indeed, a prominent harm reduction psychotherapist and researcher, Rothschild, argues that the harm reduction approach represents a “third wave of addiction treatment” which follows, and is replacing, the moral and disease models (Rothschild, 2015a).
NEXT STEPS
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). The past 20 years has seen growing acceptance of harm reduction, evidenced in U.S. public health policy as well as SUD treatment research. Thirty-two states now have legally authorized SSPs, a number which has doubled since 2014 (Fernández-Viña et al., 2020). Regarding SUD treatment, there has been a significant increase in availability of medication for opioid use disorder, especially buprenorphine, over the past two decades (opioid agonist therapies including buprenorphine are often placed under the “umbrella” of harm reduction treatments; Alderks, 2013).
Finally, the WIR survey did not ask about preferential beverage (e.g., beer, wine,spirits), usual quantities of ethanol and other drugs consumed per day, or specificsregarding AA involvement; because these factors could impact the recovery process, we willinclude these measures in future studies. Abstinence-based models have strong evidence supporting their effectiveness for many individuals, particularly those with severe AUD. They provide a clear goal, structured support systems, and a community of peers who share the same objective.
Moderation techniques such as pacing yourself, choosing lower-alcohol options, or having alcohol-free days can be practical tools in this journey. 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. In the United Kingdom, where there is greater acceptance of nonabstinence goals and availability of nonabstinence treatment (Rosenberg et al., 2020; Rosenberg & Melville, 2005), the rate of administrative discharge is much lower than in the U.S. (1.42% vs. 6% of treatment episodes; Newham, Russell, & Davies, 2010; SAMHSA, 2019b).
