Total Alcohol Abstinence vs Moderation: Which One Wins in the End?

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Multiple theories of motivation for behavior change support the importance of self-selection of goals in SUD treatment (Sobell et al., 1992). For example, Bandura, who developed Social Cognitive Theory, posited that perceived choice is key to goal adherence, and that individuals may feel less motivation when goals are imposed by others (Bandura, 1986). Miller, whose seminal work on motivation and readiness for treatment controlled drinking vs abstinence led to multiple widely used measures of SUD treatment readiness and the development of Motivational Interviewing, also argued for the importance of goal choice in treatment (Miller, 1985). Drawing from Intrinsic Motivation Theory (Deci, 1975) and the controlled drinking literature, Miller (1985) argued that clients benefit most when offered choices, both for drinking goals and intervention approaches.

Theoretical and empirical rationale for nonabstinence treatment

If a trial reported results at multiple time points, we extracted the result at the longest time point within these periods for the main analysis. To enable all studies to be included, in the main analysis we combined results reported at the nearest time point to 12 months from each study. Controlled drinking, also known as “moderate drinking” or “drinking in moderation,” is an approach that involves setting limits around alcohol consumption to ensure that drinking remains safe and doesn’t interfere with one’s health, daily life, or responsibilities.

Reasons Abstinence From Alcohol May Be the Best Choice

• Controlled drinking as well as abstinence is an appropriate goal for the majority of problem drinkers who are not alcohol-dependent.
• For example, among the 2005and 2010 National Alcohol Survey respondents, 18% of current drinkers who identified as“in recovery” from alcohol problems (who do not use drugs) are DSM-IValcohol dependent, and 26% of current drinkers who also use drugs are DSM-IV alcoholdependent.
• For all we know, it might also be an option for people who do meet criteria for alcohol dependence but since the study we’re about to assess didn’t talk about it, we’ll leave that for later.
• 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.

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. 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.

What are legitimate nonabstinent outcomes for alcoholism?

Next, we review other established SUD treatment models that are compatible with non-abstinence goals. We focus our review on two well-studied approaches that were initially conceptualized – and have been frequently discussed in the empirical literature – as client-centered alternatives to abstinence-based treatment. Of note, other SUD treatment approaches that could be adapted to target nonabstinence goals (e.g., contingency management, behavioral activation) are excluded from the current review due to lack of relevant empirical evidence. The harm reduction movement, and the wider shift toward addressing public health impacts of drug use, had both specific and diffuse effects on SUD treatment research. 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).

A program called Moderation Management advocates this alternative to abstinence as a solution for a substance abuse disorder2. This team of researchers undertook to compare self-identified members of Moderation Management with self-identified members of Alcoholics Anonymous (AA). They looked at demographics—who attends AA versus who attends MM—as well as the relative severity of the drinking problems in the two groups. Some strategies and guidelines to consider if you’re aiming to practice controlled drinking include setting limits, eating before drinking, choosing drinks with lower alcohol content, alternatives with non-alcoholic beverages and having abstinent days. Additionally, we offer exceptional continuing care so even after completing your programme; you’re never alone in this fight against alcohol addiction.

• We thank the study authors who provided data and extra information for this review, including the Project MATCH executive committee for providing the Project MATCH public dataset for the secondary analysis.
• Instead, providers claim, holding out such a goal to an alcoholic is detrimental, fostering a continuation of denial and delaying the alcoholic’s need to accept the reality that he or she can never drink in moderation.
• How do thespecifics of AA and other mutual aid group involvement affect long-term recovery?
• Moderation often requires that you take anti-craving medication for an indefinite period of time.

Moderation techniques such as pacing yourself, choosing lower-alcohol options, or having alcohol-free days can be practical tools in this journey. Individuals with greater SUD severity tend to be most receptive to therapist input about goal selection (Sobell, Sobell, Bogardis, Leo, & Skinner, 1992). This suggests that treatment experiences and therapist input can influence participant goals over time, and there is value in engaging patients with non-abstinence https://ecosoberhouse.com/ goals in treatment. Such reductions are very often the goal of treatment and as such, show some possible promise for the treatment of individuals with alcohol abuse problems. Indeed, the participants in the study are what I would consider very heavy drinkers and are likely more representative of common drinking problem behavior than the really severe, chronic, poly-substance dependent patients that often present to residential treatment.

Data synthesis and analyses

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. There is also a need for updated research examining standards of practice in community SUD treatment, including acceptance of non-abstinence goals and facility policies such as administrative discharge. Here we provide a brief review of existing models of nonabstinence psychosocial treatment, with the goal of summarizing the state of the literature and identifying notable gaps and directions for future research. Previous reviews have described nonabstinence pharmacological approaches (e.g., Connery, 2015; Palpacuer et al., 2018), which are outside the scope of the current review. We first describe treatment models with an explicit harm reduction or nonabstinence focus. While there are multiple such intervention approaches for treating AUD with strong empirical support, we highlight a dearth of research testing models of harm reduction treatment for DUD.

How Many Drinks a Day Is Considered an Alcoholic?

“Moderate consumption” is limited to one to two alcoholic drinks per day for healthy men and one alcoholic drink per day for healthy women. One drink is equivalent to 12 ounces of beer, 5 ounces of wine, or 1.5 ounces of distilled spirits. Paper presented at the Third International Conference on the Reduction of Drug-Related Harm.

Strengths and limitations of this review

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