Whether 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. After five years, the majority remained abstinent and described SUD in line with the views in the 12-step programme. For some, attending was just a routine, whereas others stressed that meetings were crucial to them for remaining abstinent and maintaining their recovery process. Family involvement plays an integral role in our treatment process because we understand that addiction does not occur in isolation – it affects everyone who cares about you too. Through family counselling sessions and support groups, loved ones can learn more about addiction and how best to support you on this journey towards sobriety.
Alcohol moderation management programmes are often successful when tailored to an individual’s specific needs and circumstances. The effectiveness of these programmes can greatly vary depending on several factors such as treatment duration, individual factors, and programme challenges. In the present follow-up, the recovery process for clients previously treated for SUD was investigated, focusing on abstinence and CD.
Abstainers
With this as a starting point, the IP was asked to describe the past five years in terms of potential so-called relapse and retention and/or resumption of positive change. The interview guide also dealt with questions on treatment contacts during the follow-up period (frequency, extent and type), the view of their own and others’ alcohol consumption and important factors to continue or resume positive change. 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). Therefore, the client should be at the end of or have recently completed post-treatment intervention and be judged by a professional to be in a positive change process regarding their SUD. In the initial interviews, all the clients declared themselves abstinent and stressed that substance use in any form was not an option. Abstinence from alcohol and other drugs has historically been a core criterion for recovery, defined by the Betty Ford Institute as a “voluntarily maintained lifestyle characterized by sobriety, personal health, and citizenship” (Betty Ford Institute Consensus Panel, 2007, p. 222).
4. Current status of nonabstinence SUD treatment
This strategy is not about total abstinence but involves setting moderate drinking goals that are safe and sensible for you, paying attention to social influences that may sway your decisions, and developing self-awareness around your triggers. 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.
Additional research should examine whether remission how much did steve harwell drink from AUD diagnostic symptoms, which were not examined in the current study, are useful in defining recovery or whether focusing on well-being and psychological functioning is sufficient to characterize recovery from AUD. Thus, while it is vital to empirically test nonabstinence treatments, implementation research examining strategies to obtain buy-in from agency leadership may be just as impactful. 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). These individuals are considered good candidates for harm reduction interventions because of the severity of substance-related negative consequences, and thus the urgency of reducing these harms. Indeed, this argument has been central to advocacy around harm reduction interventions for people who inject drugs, such as SSPs and safe injection facilities (Barry et al., 2019; Kulikowski & Linder, 2018). It has also been used to advocate for managed alcohol and housing first programs, which represent a harm reduction approach to high-risk drinking among people with severe AUD (Collins et al., 2012; Ivsins et al., 2019).
1. Nonabstinence treatment effectiveness
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). The WIR data do not include current dependence diagnoses, which would beuseful for further understanding of those in non-abstinent recovery. In addition, the WIRquality of life measure is based on a single question; future studies could useinstruments that detail various aspects of mental and physical functioning. WIR is alsocross-sectional by design, though it did include questions about lifetime drug and alcoholuse. 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. The dearth of data regarding individuals in long-term recovery highlights theneed to examine a sample that includes individuals with several years of recoveryexperience.
Most U.S. treatment providers still utilize abstinence-focused approaches such as 12 Step Facilitation and AA/NA groups as a mandatory aspect of treatment (SAMHSA, 2017), and while providers demonstrate growing acceptance of controlled drinking, acceptance of nonabstinence outcomes for drug use remains very low (Rosenberg et al., 2020). 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. This resistance to nonabstinence treatment persists despite strong theoretical and empirical arguments in favor of harm reduction approaches. The current review highlights multiple important directions for future research related to nonabstinence SUD treatment. Overall, increased research attention on nonabstinence treatment is vital to filling gaps in knowledge.
- A systematic review means authors start with specific search terms in databases that contain hundreds of thousands of scientific articles, and criteria that needed to be met for the studies to be included in the review.
- About 26% of all U.S. treatment episodes end by individuals leaving the treatment program prior to treatment completion (SAMHSA, 2019b).
- Polich, Armor, and Braiker found that the most severely dependent alcoholics (11 or more dependence symptoms on admission) were the least likely to achieve nonproblem drinking at 4 years.
- Importantly, the only published study that asked individuals in recovery (fromcrack or heroin dependence in this particular study) how they defined the term revealedthat less than half responded in terms of substance use; the other definitions were moregeneral, such as a process of working on oneself (Laudet2007).
- 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.
- For example, in one study, reducing one’s weekly drinking by about 30% (in total volume) was related to fewer injuries and 44% fewer sick days over a 2-year period.
In 1990, Marlatt was introduced to the philosophy of harm reduction during a trip to the Netherlands (Marlatt, 1998). He adopted the language and framework of harm reduction in his own research, and in 1998 published a seminal book on harm reduction strategies for a range of substances and behaviors (Marlatt, 1998). Marlatt’s work inspired the development of multiple nonabstinence treatment models, including harm reduction psychotherapy (Blume, 2012; Denning, 2000; Tatarsky, 2002). Additionally, while early studies of SUD treatment used abstinence as the single measure of treatment effectiveness, by the late 1980s and early 1990s researchers were increasingly incorporating psychosocial, health, and quality of life measures (Miller, 1994).
I don’t think I have a problem, but I might be someone that could get it problems more than anyone else … (IP30). Several said that starting drinking was preceded by concerns about whether an uncontrolled craving would occur. This section collects any data citations, data availability statements, or supplementary materials included in this article. Preparation of this manuscript was supported in part by grants from the National Institute on Alcohol Abuse and Alcoholism (R01 AA022328, 2K05 AA016928, K01 AA024796, K01 AA023233, and T32 AA018108). Different measures from the original Project MATCH study were assessed at the 10-year follow-up assessment, and only the Form-90 and DrInC were administered at both 3-year and 10-year follow-ups.
The severity of these symptoms can vary widely depending on how much you are drinking, how frequently, and your overall physical health. Cultural perspectives on alcohol also influence our attitudes towards its use and misuse, shaping norms around what constitutes acceptable levels of consumption. While some cultures romanticise heavy drinking others promote temperance; being aware of these cultural influences can aid in reshaping your own relationship with alcohol and eliminate harmful drinking patterns.
One of the most commonly studied issues in alcohol research is the effect of drinking on cardiovascular functioning. Generally, except in the most mild drinkers (less than 1 drink per day on average), drinking reductions are related to better cardio outcomes. In one study with moderate drinkers who were drinking 3-6 drinks daily, reducing drinking by 67% was related to improved (i.e., reduced) blood pressure, an average of a reduction by 3 systolic points over 2 diastolic points. In the United States, for example, there are 14 grams of ethanol in a standard drink (1 beer, 1 glass of wine, or one shot of liquor) whereas in other countries like Australia a standard drink contains 10 grams of pure ethanol. Also if the study included individuals that received an intervention (i.e., intended to help people reduce or quit drinking), the intervention had to be psychosocial, meaning patients did not receive medication. They could also follow a group of drinkers over time, called a prospective cohort study, or even simply assess them at one single point, called a cross-sectional study.
