Non-abstainers are younger with less time in recovery and less problem severitybut worse QOL than abstainers. Clinically, individuals considering non-abstinent goalsshould be aware that abstinence may be best for optimal QOL in the long run.Furthermore, time in recovery should be accounted for when examining correlates ofrecovery. There is less research examining the extent to which moderation/controlled use goals are feasible for individuals with DUDs. The most recent national survey assessing rates of illicit drug use and SUDs found that among individuals who report illicit drug use in the past year, approximately 15% meet criteria for one or more DUD (SAMHSA, 2019a). About 10% of individuals who report cannabis use in the past year meet criteria for a cannabis use disorder, while this proportion increases to 18%, 19%, 58%, and 65% of those with past year use of cocaine, opioids (misuse), methamphetamine, and heroin, respectively.
1. Nonabstinence treatment effectiveness
Only 50% of those who focused on controlled consumption succeeded in controlling their drinking. Many who practice it find that they are better at understanding how much they are drinking, are able to reduce or eliminate binge drinking, and suffer fewer negative consequences from alcohol abuse. 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. In the present follow-up, the recovery process for clients previously treated for SUD was investigated, focusing on abstinence and CD.
Alcohol Moderation Management: Programs and Steps to Control Drinking
- Lastly, this being a study, it is very possible that participants were better motivated, more informed, and more likely to put in the effort required to use the moderatedrinking.org program.
- All the interviewees had attended treatment programmes following the 12-step philosophy and described abstinence as crucial for their recovery process in the initial interview, five years ago.
- Some people find it’s still too overwhelming to be around alcohol, and it’s too hard to change their habits.
- While there is evidence that a subset of individuals who use drugs engage in low-frequency, non-dependent drug use, there is insufficient research on this population to determine the proportion for whom moderation is a feasible treatment goal.
- Classification precision (defined by relative entropy) was used to evaluate how well the final latent profile solution classified individuals into latent classes and values of entropy greater than .80 were considered good classification precision (Nylund et al., 2007).
- Parameters were estimated using a weighted maximum likelihood function, and all standard errors were computed using a sandwich estimator (i.e., MLR in Mplus; B. O. Muthén & Satorra, 1995).
However, they no longer found themselves in need of this help and did not express ambivalence regarding their decision to stop attending meetings. On the other hand, some clients in the present study had adopted the 12-step principles, intensified their attendance and made it more or less central in their life. Potential correlates of non-abstinent recovery, such as demographics andtreatment history, were based on NESARC results. Additionally, the survey asked about current quality oflife using a 4-point scale as administered by the World Health Organization (The WHOQOL Group 1998).
Purpose of review
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 http://www.mikewohner.com/allegrippis-ramblings.html et al., 2019). 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). Here we found that a number of factors distinguish non-abstainers from abstainersin recovery from AUD, including younger age and lower problem severity.
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. For example, despite being widely cited as a primary rationale for nonabstinence treatment, the extent to which offering nonabstinence options increases treatment utilization (or retention) is unknown. In addition to evaluating nonabstinence treatments specifically, researchers could help move the field forward by increased attention to nonabstinence goals more broadly.
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. We do not know what factors relate to non-abstinent http://www.nnre.ru/zdorove/yetyudy_o_prirode_cheloveka/p1.php vs. abstinent recovery amongindividuals who define themselves as in recovery. In addition, no priorstudy has examined whether quality of life differs among those in abstinent vs.non-abstinent recovery in a sample that includes individuals who have attained longperiods of recovery.
- It is also worthwhile considering the chemical effect of alcohol addiction on the body and the way alcohol withdrawal affects it.
- 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).
- 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.
- 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.
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 goals in treatment. In addition to shaping mainstream addiction treatment, the abstinence-only 12-Step model also had an indelible effect on http://www.all-diet.info/bon-appetit/bon-appetit-str-44.html the field of SUD treatment research. 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).
4 Stepwise regressions: Quality of life (QOL)
This paper presents a narrative review of the literature and a call for increased research attention on the development of empirically supported nonabstinence treatments for SUD to engage and treat more people with SUD. We define nonabstinence treatments as those without an explicit goal of abstinence from psychoactive substance use, including treatment aimed at achieving moderation, reductions in use, and/or reductions in substance-related harms. We first provide an overview of the development of abstinence and nonabstinence approaches within the historical context of SUD treatment in the U.S., followed by an evaluation of literature underlying the theoretical and empirical rationale for nonabstinence treatment approaches. Lastly, we review existing models of nonabstinence psychosocial treatment for SUD among adults, with a special focus on interventions for drug use, to identify gaps in the literature and directions for future research. We identify a clear gap in research examining nonabstinence psychosocial treatment for drug use disorders and suggest that increased research attention on these interventions represents the logical next step for the field.
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.