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

The results of the NMA indicate that no treatment showed a significantly better effect than TAU or TAU plus PLC on the change in DDD (Figure S9Ba–c), and (d)). All of the significant evidence from active intervention comparisons were with low certainty (Figure S11B and Table S12A). A key aspect of abstinence is understanding and navigating through the withdrawal process – a daunting task indeed but necessary for recovery.

The crucial factor here isn’t necessarily which path you choose but having a supportive network around you who respects and understands your decision. A study conducted at the University of Gothenburg, Sweden found that the Reagans of the world are more successful in treatment than the Saras. The parent WIR study and this secondary analysis study were approved by the
Institutional Review Board of the Alcohol Research Group/Public Health Institute, Oakland,
CA. Some interview person (IP) were former polydrug users and altered between AA and NA meetings. I don’t think I have a problem, but I might be someone that could get it [problems] more than anyone else […] (IP30).

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

These results suggest residual long-term “sensitization”of the extrahypothalamic CRF systems in animals with a history of alcohol dependence. Evidence on the efficacy of abstinence-based programs, such as Alcoholics Anonymous, is hard to come by because the nature of these programs involves anonymity. However, thirty percent of MM members end up choosing to move on to abstinence-based programs.

• Cultural perspectives on alcohol also influence our attitudes towards its use and misuse, shaping norms around what constitutes acceptable levels of consumption.
• Psychologically, you might be dealing with a range of emotions from guilt over past incidents to anxiety about future relapses.
• This study on client views on abstinence versus CD after treatment advocating total abstinence can contribute with perspectives on this ongoing discussion.

Together, this suggests a promising degree of alignment between goal selection and probability of success, and it highlights the potential utility of nonabstinence treatment as an “early intervention” approach to prevent SUD escalation. A considerable number of clients reported changed views on the programme, some were still abstinent and some were drinking in a controlled way. Some of the abstainers still attended meetings because of a fear of what might happen if they stopped, although they questioned parts of the philosophy. 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. These results indicate that strict views on abstinence and the nature of alcohol problems in 12-step-based treatment, and AA philosophy may create problems for the recovery process.

Purpose of review

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. Some clients expressed a need for other or complementary support from professionals, whereas others highlighted the importance of leaving the 12-step community to be able to work on other parts of their lives.

Second, this study conducted GRADE evaluations for direct, indirect, and network meta-analyses, which have not been done previously. Remember that every person’s journey is unique; there are no one-size-fits-all solutions for managing alcohol intake. People suffering from alcohol addiction will thrive in absolute abstinence and find solace in sobriety groups like Alcoholics Anonymous, while others will less severe drinking habits will be able to manage their relationship with alcohol through controlled moderation techniques without feeling deprived controlled drinking vs abstinence or isolated socially. The controversial past of controlled drinking is slowly giving way to a hopeful future in which individuals are less likely to be forced into an abstinence-only treatment scenario. The enhanced accessibility of effective controlled-drinking interventions should significantly expand the treatment options of individuals within the full spectrum of alcohol-related problems. While the pandemic seems to have triggered substantial increases in alcohol consumption, and in alcohol abuse, this is true on a macro level.

Fatty liver disease

If you have health problems related to alcohol, it may be unsafe to drink at all, period. By quitting drinking completely, your body can begin to repair the damage caused by alcohol. At the first interview all IPs were abstinent and had a positive view on the 12-step treatment, although a few described a cherry-picking attitude. As the IP had a successful outcome, six months after treatment, their possibilities for CD might be better than for persons with SUD in general. On the other hand, as the group expressed positive views on this specific treatment, they might question the sobriety goal in a lesser extent than other groups. The purpose of this paper is to investigate how clients – five years after completing treatment interventions endorsing abstinence – view abstinence and the role of Alcoholics Anonymous (AA) in their recovery process.

Most scientists who studied SUD treatment believed that abstinence was the only acceptable treatment goal until at least the 1980s (Des Jarlais, 2017). Abstinence rates became the primary outcome for determining SUD treatment effectiveness (Finney, Moyer, & Swearingen, 2003; Kiluk, Fitzmaurice, Strain, & Weiss, 2019; Miller, 1994; Volkow, 2020), a standard which persisted well into the 1990s (Finney et al., 2003). Little attention was given to whether people in abstinence-focused treatments endorsed abstinence goals themselves, or whether treatment could help reduce substance use and related problems for those who did not desire (or were not ready for) abstinence. It is essential to understand what individuals with SUD are rejecting when they say they do not need treatment. In this model, treatment success is defined as achieving and sustaining total abstinence from alcohol and drugs, and readiness for treatment is conflated with commitment to abstinence (e.g., Harrell, Trenz, Scherer, Martins, & Latimer, 2013).

Historical context of nonabstinence approaches

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). Like the Sobells, Marlatt showed that reductions in drinking and harm were achievable in nonabstinence treatments (Marlatt & Witkiewitz, 2002). In the 1970s, the pioneering work of a small number of alcohol researchers began to challenge the existing abstinence-based paradigm in AUD treatment research. They found that their controlled drinking intervention produced significantly better outcomes compared to usual treatment, and that about a quarter of the individuals in this condition maintained controlled drinking for one year post treatment (Sobell & Sobell, 1973).