Expanding the continuum of substance use disorder treatment: Nonabstinence approaches

In the U.S., about 25% of patients seeking treatment for AUD endorsed nonabstinence goals in the early 2010s (Dunn & Strain, 2013), while more recent clinical trials have found between 82 and 91% of those seeking treatment for AUD prefer nonabstinence goals (Falk et al., 2019; Witkiewitz et al., 2019). The results of the Sobell’s studies challenged the prevailing understanding of abstinence as the only acceptable outcome for SUD treatment and raised a number of conceptual and methodological issues (e.g., the Sobell’s liberal definition of controlled drinking; see McCrady, 1985). A “controlled drinking controversy” followed, in which the Sobells as well as those who supported them were publicly criticized due to their claims about controlled drinking, and the validity of their research called into question (Blume, 2012; Pendery, Maltzman, & West, 1982). Despite the intense http://www.socioclub.org/others/1243/1.htm controversy, the Sobell’s high-profile research paved the way for additional studies of nonabstinence treatment for AUD in the 1980s and later (Blume, 2012; Sobell & Sobell, 1995). Marlatt, in particular, became well known for developing nonabstinence treatments, such as BASICS for college drinking (Marlatt et al., 1998) and Relapse Prevention (Marlatt & Gordon, 1985).

• A recent meta-analysis of CBT for substance use disorders found support for a modest benefit of CBT over treatment as usual (Magill & Ray, 2009).
• 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).
• For example, all studies with SUD populations could include brief questionnaires assessing short-and long-term substance use goals, and treatment researchers could report the extent to which nonabstinence goals are honored or permitted in their study interventions and contexts, regardless of treatment type.

1. Review aims

Empirical support for a broader conceptualization of recovery has been reviewed in recent work16–18 and also expressed by individuals who self-identify as being in recovery19–21. It is well known to both clinicians and researchers in the addiction field that patients in alcoholism treatment vary dramatically with respect to their alcohol use goals. Patients differ on the continuum between not wanting to change their drinking at all to seeking complete and long-term abstinence from alcohol.

How Many Drinks a Day Is Considered an Alcoholic?

• Our two case reports illustrate how disulfiram, initially intended to enforce abstinence, was repurposed to support reduced drinking.
• Assessment of patients’ drinking goals may also help match patients to interventions best suited to address their goals and clinical needs.
• People suffering from alcoholism typically experience a physical and psychological dependence on alcohol, making it extremely challenging to maintain moderation.
• Lack of consensus around target outcomes also presents a challenge to evaluating the effectiveness of nonabstinence treatment.
• With these qualifications, the present study adds to evidence that non-abstinent AUD recovery is possible and can be maintained for up to 10 years following treatment.

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. However, these interventions also typically lack an abstinence focus and sometimes result in reductions in drug use. It is also important to note that profile 4 (high functioning, infrequent non-heavy drinking at year 3) had the best overall outcomes at year 10, despite the fact that some individuals in profile 4 had returned to some heavy drinking (average percent heavy drinking days of 10%) at year 10. 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.

Alcohol Moderation Management: Programs and Steps to Control Drinking

• For these clients, the recovery process, aiming to reach sustained recovery in the broader sense covering parts of their lives other than the SUD, was in part at odds with the ongoing participation in AA.
• In the present article, clients treated in 12-step programmes were reinterviewed five years after treatment.
• Overall, increased research attention on nonabstinence treatment is vital to filling gaps in knowledge.
• 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.
• Multivariable stepwise regressions estimating the probability of non-abstinentrecovery and average quality of life.

The analytical strategy for the present study was consistent with the primary COMBINE report (Anton et al., 2006). Thus, PDA was tested using a mixed effects general linear model (PROC MIXED), relapse and DPDD were tested using a proportional hazards model (PROC PHREG), and GCO was analyzed using a https://thespice.net/we-take-care-of-the-eyes-correctly.html logistic regression model (PROC LOGISTIC)1. Analysis accommodated the clustering of observations by site through the estimation of a random intercept term.

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. It’s heartbreaking to see loved ones caught in the grip of addiction, but there’s hope – research shows that many people find success with programmes aimed at reducing consumption.

2 Quality of life and recovery from AUD

Controlled drinking, often advocated as a moderation approach for people with alcohol use disorders, can http://kosino-uhtomski.ru/index.php?id=939&pid=8 be highly problematic and unsuitable for those who truly suffer from alcohol addiction. Alcoholism is characterised by a loss of control over one’s drinking behaviour and an inability to consistently limit consumption. Attempting controlled drinking in such cases often reinforces the addictive cycle rather than breaking it.