Expanding the continuum of substance use disorder treatment: Nonabstinence approaches PMC

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). While AUD treatment studies controlled drinking vs abstinence commonly rely on guidelines set by government agencies regarding a “low-risk” or “nonhazardous” level of alcohol consumption (e.g., Enggasser et al., 2015), no such guidelines exist for illicit drug use. Thus, studies will need to emphasize measures of substance-related problems in addition to reporting the degree of substance use (e.g., frequency, quantity).

There has been little research on the goals of non-treatment-seeking individuals; however, research suggests that nonabstinence goals are common even among individuals presenting to SUD treatment. Among those seeking treatment for alcohol use disorder (AUD), studies with large samples have cited rates of nonabstinence goals ranging from 17% (Berglund et al., 2019) to 87% (Enggasser et al., 2015). In Europe, about half (44–46%) of individuals seeking treatment for AUD have non-abstinence goals (Haug & Schaub, 2016; Heather, Adamson, Raistrick, & Slegg, 2010).

Take Advantage of “Getting Back to Normal” to Revisit Your Relationship with Alcohol

Social stability at intake was negatively related in Rychtarik et al. to consumption as a result either of abstinence or of limited intake. Apparently, social stability predicts that alcoholics will succeed better whether they choose abstinence or reduced drinking. But other research indicates that the pool of those who achieve remission can be expanded by having broader treatment goals. Vaillant (1983) labeled abstinence as drinking less than once a month and including a binge lasting less than a week each year.

Conversely, beverages with lower alcohol contents can increase gastric emptying rates. Drinks that have an alcohol content greater than 15 percent have an inhibitory effect on peristalsis. This means that alcohol slows down gastrointestinal motility, which can lead to constipation.

Risk of Bias Within Studies

Do I want to give up completely, or do I want to be able to have a few drinks now and then. If the answer is a few now and then, the next question to ask is am I honestly able to do that? The majority of people I ask this question to will say no, it is never one or two, it always leads onto more.

Additionally, the system is punitive to those who do not achieve abstinence, as exemplified by the widespread practice of involuntary treatment discharge for those who return to use (White, Scott, Dennis, & Boyle, 2005). Despite the reported relationship between severity and CD outcomes, many diagnosed alcoholics do control their drinking. The Rand study quantified the relationship between severity of alcohol dependence and controlled-drinking outcomes, although, overall, the Rand population was a severely alcoholic one in which “virtually all subjects reported symptoms of alcohol dependence” (Polich, Armor, and Braiker, 1981). Alcoholic remission many years after treatment may depend less on treatment than on posttreatment experiences, and in some long-term studies, CD outcomes become more prominent the longer subjects are out of the treatment milieu, because patients unlearn the abstinence prescription that prevails there (Peele, 1987).

Moderate Drinking is About Having More Control Over Your Drinking

Previous studies suggests that these strict views might prevent people from seeking treatment (Keyes et al., 2010; Wallhed Finn et al., 2014). The present study indicates that the strict views in AA also might prevent clients in AA to seek help and support elsewhere, since they percieve that this conflicts with the AA philosophy (Klingemann and Klingemann, 2017). Initially, AA was not intended to offer a professional programme model for treatment (Alcoholics Anonymous, 2011). 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.

• Here we found that a number of factors distinguish non-abstainers from abstainers
  in recovery from AUD, including younger age and lower problem severity.
• Many clients in the study described that the 12-step programme was the only treatment that they were offered.
• 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).
• Successful moderation involves understanding yourself (what factors trigger excessive drinking), planning (how much you are going to drink and how you are going to stop), and taking concrete steps to exit or avoid situations where you won’t be able to moderate.
• According to an article in The Journal of the National Institute on Alcohol and Abuse and Alcoholism, a small study found daily consumption of red wine resulted in increases in compounds that could cause a IBD flare-up.
• By quitting drinking completely, your body can begin to repair the damage caused by alcohol.

When they are offered 12-step treatment, they get exposed to these strict views in a different setting than what was initially intended within AA, namely a self-help group that people join voluntarily. Williams and Mee-Lee (2019) have discussed this shift in the 12-step programme and argue that current 12-step-based treatment settings promote practices that run contrary to the spirit of AA. For example, they point out that the original AA teaching endorses abstinence only for people with severe addiction disorders, which in the 12-step approach has been changed to abstinence for all members. Williams and Mee-Lee (op. cit.) also claim that AA originally taught that it was not the responsibility of group members or counsellors to give medical advice to others while there is a widespread opposition to using medically assisted treatment in the 12-step approach. Further, that the original focus on support has been replaced by a focus on denial and resistance as personality flaws. This pinpoints the conflicting issues experienced by some clients during the recovery process.

1 Non-abstinent recovery from alcohol use disorders

Future research must test the effectiveness of nonabstinence treatments for drug use and address barriers to implementation. Consistent with previous research, behavioral self-control training continues to be the most empirically validated controlled-drinking intervention. Recent research has focused on increasing both the accessibility/availability and efficacy of behavioral self-control training. Moderation-oriented cue exposure is a recent development in behaviorally oriented controlled drinking that yields treatment outcomes comparable to behavioral self-control training.

• Additionally, the preferred interventions are different for improving PDA and change in DDD.
• 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 specifics
  regarding AA involvement; because these factors could impact the recovery process, we will
  include these measures in future studies.
• It’s hard to measure how effectively different programs are treating a condition when the two different programs are entirely different.
• For example, they point out that the original AA teaching endorses abstinence only for people with severe addiction disorders, which in the 12-step approach has been changed to abstinence for all members.

The only way to ascertain for certain whether you are capable of having just one or two drinks is to try it over a period of time, say 6 months. If during that time, you only ever drink the amount you intend to, and no problems arise as a result of the drinking, then you have found the way that works for you. It is important to know when seeking treatment for substance use that there are options.