The current findings align with recent proposals to move beyond relying on alcohol consumption as a central defining feature of AUD recovery. The analytical strategy for the present study was consistent with the primary COMBINE report (Anton et al., 2006). Thus, PDA was tested using a mixed effects general linear model (PROC MIXED), relapse and DPDD were tested using a proportional hazards model (PROC PHREG), and GCO was analyzed using a logistic regression model (PROC LOGISTIC)1. Analysis accommodated the clustering of observations by site through the estimation of a random intercept term. In the present follow-up, the recovery process for clients previously treated for SUD was investigated, focusing on abstinence and CD.

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. Cognitive behavioral therapy (CBT) for alcoholism has received empirical support since the 1980s (Marlatt & Gordon, 1985). CBT for alcohol use disorders is grounded in social-cognitive theory (Bandura, 1986) and employs skills training in order to help patients cope more effectively with substance use triggers, including life stressors (Longabaugh & Morgenstern, 1999; Morgenstern & Longabaugh, 2000).

5. Feasibility of nonabstinence goals

How the risks of drinking balance out this potential benefit, if it is found to be causal, for those with Type II diabetes is not yet clear. sunrock strain leafly Much can be learned from research that investigates how reducing or quitting alcohol provides benefits in terms of individuals’ day-to-day lives. In this study, Charlet and colleagues conducted a large review of 59 studies that addressed these important issues, providing key information on whether and to what extent changing drinking is beneficial.

Traditional alcohol use disorder (AUD) treatment programs most often prescribeabstinence as clients’ ultimate goal. “Harm reduction” strategies, on theother hand, set more flexible goals in line with patient motivation; these differ greatlyfrom person to person, and range from total abstinence to reduced consumption and reducedalcohol-related problems without changes in actual use (e.g., no longer driving drunkafter having received a DUI). In the broadest sense, harm reduction seeks to reduceproblems related to drinking behaviors and supports any step in the right directionwithout requiring abstinence (Marlatt and Witkiewitz2010). Witkiewitz (2013) has suggestedthat abstinence may be less important than psychiatric, family, social, economic, andhealth outcomes, and that non-consumption measures like psychosocial functioning andquality of life should be goals for AUD research (Witkiewitz 2013). These goals are highly consistent with the growingconceptualization of `recovery’ as a guiding vision of AUD services (The Betty Ford Institute Consensus Panel 2007).

1. The majority of those not interviewed were impossible to reach via the contact information available (the five-year-old telephone number did not work, and no number was found in internet searches).
2. Despite benefits of reducing drinking, abstinence seems to be the safest and most impactful strategy.
3. As such, further research may be required before these findings can be generalized to real-world primary care settings.
4. The context of treatment in a professional setting, and in many cases, the only treatment offered, gives the 12-step philosophy a sense of legitimacy.
5. Thus, PDA was tested using a mixed effects general linear model (PROC MIXED), relapse and DPDD were tested using a proportional hazards model (PROC PHREG), and GCO was analyzed using a logistic regression model (PROC LOGISTIC)1.
6. Early attempts to establish pilot SSPs were met with public outcry and were blocked by politicians (Anderson, 1991).

2. Established treatment models compatible with nonabstinence goals

Indeed, a prominent harm reduction psychotherapist and researcher, Rothschild, argues that the harm reduction approach represents a “third wave of addiction treatment” which follows, and is replacing, the moral and disease models (Rothschild, 2015a). While patients with goals of complete abstinence did succeed in drinking less frequently and taking longer to relapse to heavy drinking than participants with controlled drinking or conditional abstinence goals, they drank more per drinking day, on average. This finding is consistent with an abstinence violation effect wherein abstinence oriented participants are more likely to engage in heavy drinking following an initial lapse (Marlatt & Gordon, 1985). While CBI should theoretically reduce the impact of the abstinence violation effect by providing the opportunity to accurately process a lapse, the results presented herein did not support this effect (i.e., no goal × CBI interaction was observed).

Additionally, no studies identified in this review compared reasons for not completing treatment between abstinence-focused and nonabstinence treatment. 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). In the U.S., about 25% of patients seeking treatment for AUD endorsed nonabstinence goals in the early 2010s (Dunn & Strain, 2013), while more recent clinical trials have found between 82 and 91% of those seeking treatment for AUD prefer nonabstinence goals (Falk et al., 2019; Witkiewitz et al., 2019). 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).

Quitting alcohol for good is a life-changing decision with countless benefits that will make you wonder why you didn’t quit sooner. Your liver will start to recover and function better, your skin can become clearer, and your risk of serious diseases such as heart disease and certain types of cancer can significantly decrease. Your sobriety journey is personal, and what works best for you may not work as well for someone else. For instance, abstaining from alcohol can decrease the risk of liver disease, improve cognitive function, and enhance emotional resilience. Simply put, those who want to learn to drink in moderation are less likely to achieve their goal, while those who set a goal of quitting drinking entirely see greater success. When out for a nice dinner or attending a get-together, she still wanted the freedom of having a drink or two.

Controlled drinkers

In particular, medically oriented treatments emphasizing abstinence appear to be an effective and cost efficient treatment modality for patients whose goals are oriented toward complete abstinence. Conversely, more intensive behavioral interventions may be particularly beneficial for patients whose goals are conditional abstinence or controlled drinking. On balance, this study is one of the few to empirically examine the effect of drinking goal on treatment outcome, and in particular, matching treatment options to drinking goals. If supported in future studies, these results could be used to inform treatment planning for patients with alcoholism. To that end, an important feature of this study is the accessibility and clinical appeal of the drinking goal measure, which can be readily applied to a wide variety of treatment settings.

Researchers have long posited that offering goal choice (i.e., non-abstinence and abstinence treatment options) may be key to engaging more individuals in SUD treatment, including those earlier in their addictions (Bujarski et al., 2013; Mann et al., 2017; Marlatt, Blume, & Parks, 2001; Sobell & Sobell, 1995). Advocates of nonabstinence approaches often point to indirect evidence, including research examining reasons people with SUD do and do not enter treatment. This literature – most of which has been conducted in the U.S. – suggests a strong link between abstinence goals and treatment entry. For example, in one study testing the predictive validity of a measure of treatment readiness among non-treatment-seeking people who use drugs, the authors found that the only item in their measure that significantly predicted future treatment entry was motivation to quit using (Neff & Zule, 2002). The study was especially notable because most other treatment readiness measures have been validated on treatment-seeking samples (see Freyer et al., 2004).

It would be helpful in future research to parse out the benefits and drawbacks of each potential pathway to drinking problem resolution and which individuals may be most likely to benefit the most from any given pathway. Some no longer attended meetings but remained abstinent with a positive view of the 12-step programme. However, they no longer found themselves in need of this help and did not express ambivalence regarding their decision to stop attending meetings.

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. In previous research, several indicators of whether CD is possible are mentioned (Klingemann and Rosenberg, 2009; Klingemann, 2016; Davis et al., 2017; Luquiens et al., 2011; Berglund et al., 2019). Clients reporting CD in the present study only met one of these criteria – an initial period of abstinence (Booth, 2006; Coldwell and Heather, 2006). 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 professionals.