Controlled drinking: more than just a controversy : Current Opinion in Psychiatry

In sum, research suggests that achieving and sustaining moderate substance use after treatment is feasible for between one-quarter to one-half of individuals with AUD when defining moderation as nonhazardous drinking. 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. However, among individuals with severe SUD and high-risk drug or alcohol use, the urgency of reducing substance-related harms presents a compelling argument for engaging these individuals in harm reduction-oriented treatment and interventions.

Helpful and hindering factors of the intervention regarding abstinence motivation

For example, an algorithm for task sequence based on individual needs could fulfill the need for a tighter guidance. Fourth, the use of approach goals before and after the return to alcohol use might 3 ways to stop taking wellbutrin be of advantage, which also needs to be explored regarding AUD treatment. These adaptations may lead to more motivation and adherence and thereby drive conversion into AUD-related behavior change.

  1. At Addictionhelper, we will never tell you “you can’t ever drink again” because that is not our place.
  2. After transcribing the interviews, the material was analysed thematically (Braun and Clarke, 2006) by coding the interview passages according to what was brought up both manually and by using NVivo (a software package for qualitative data analysis).
  3. First, interventions should focus more on motivation by incorporating the aspects that were perceived as supporting after the return to alcohol use.
  4. Do I want to give up completely, or do I want to be able to have a few drinks now and then.

Study design

Adi Jaffe, Ph.D., is a lecturer at UCLA and the CEO of IGNTD, an online company that produces podcasts and educational programs on mental health and addiction. The sample size used in the study also leaves something to be desired and I would hope that further research would examine these effects with a bigger cohort and a more variable participant group. There was no inpatient treatment component, just use of the MM website alone, or in conjunction with the new interactive web application. Take our short alcohol quiz to learn where you fall on the drinking spectrum and if you might benefit from quitting or cutting back on alcohol.

2. Relationship between goal choice and treatment outcomes

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. 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.

3. The harm reduction movement

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. If the 12-step philosophy and AA were one option among others, the clients could make an informed choice and seek options based on their own situation and needs. This would probably reduce the risk of negative effects while still offering the positive support experienced by the majority of the clients in the study.

I don’t think I have a problem, but I might be someone that could get it [problems] more than anyone else […] (IP30). All procedures involving human subjects were reviewed and approved by the PublicHealth Institute’s Institutional Review Board.

Furthermore, younger (under 40), single alcoholics were far more likely to relapse if they were abstinent at 18 months than if they were drinking without problems, even if they were highly alcohol-dependent. Thus the Rand study found a strong link between severity and outcome, but a far from ironclad one. In other studies of private treatment, Walsh et al. (1991) found that only 23 percent of alcohol-abusing workers reported abstaining throughout a 2-year follow-up, although the figure was 37 percent for those assigned to a hospital program. According to Finney and Moos (1991), 37 percent of patients reported they were abstinent at all follow-up years 4 through 10 after treatment.

Interviews with 40 clients were conducted shortly after them finishing treatment and five years later. All the interviewees had attended treatment programmes based on the 12-step philosophy, and they all described abstinence as crucial to their recovery process in an initial interview. Multivariable stepwise regressions (Table2) show 9 healthy things that happen to your body when you stop drinking for 30 days or more that younger individuals were significantly more likely to benon-abstinent, and movement to the next oldest age category reduced the odds ofnon-abstinence by an average of 27%. Importantly, the confidence intervals were narrow andextremely similar across models, implying that the effect of age was robust to modelspecification.

Limiting the amount of alcohol you drink, or taking breaks from drinking alcohol, are ways to get your alcohol problem under control while providing space for you to address the issues that power your drinking. Several said that starting drinking was preceded by concerns about whether an uncontrolled craving would occur. After the interviews, the clients were asked whether they would allow renewed contact after five years, and they all gave their permission. The majority of those not treatment and recovery national institute on drug abuse nida 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). Take our free, 5-minute substance use self-assessment below if you think you or someone you love might be struggling with substance use. The evaluation consists of 11 yes or no questions that are intended to be used as an informational tool to assess the severity and probability of a substance use disorder.

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 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.

Witkiewitz also arguedthat the commonly held belief that abstinence is the only solution may deter someindividuals from seeking help. Multiple versions of harm reduction psychotherapy for alcohol and drug use have been described in detail but not yet studied empirically. Consistent with the philosophy of harm reduction as described by Marlatt et al. (2001), harm reduction psychotherapy is accepting of a wide range of client goals, including risk reduction, moderation, and abstinence (of note, abstinence is conceptualized as consistent with harm reduction when it is a goal chosen by the client). However, to date there have been no published empirical trials testing the effectiveness of the approach. Individuals with fewer years of addiction and lower severity SUDs generally have the highest likelihood of achieving moderate, low-consequence substance use after treatment (Öjehagen & Berglund, 1989; Witkiewitz, 2008).

Furthermore, our assessment of the explored change in motivation was retrospective, which could have influenced the findings. Recent work used an empirical approach to deriving subgroups of individuals based on probability of endorsing abstinence, low risk drinking (less than 4/5 drinks for women/men), and heavy drinking (4/5 or more drinks for women/men) (Witkiewitz, Pearson, et al., 2017; Witkiewitz, Roos, et al., 2017). This approach allows for exceeding the cutoff on some occasions and still provides guidance about overall patterns of drinking over time.

This suggests that individuals with non-abstinence goals are retained as well as, if not better than, those working toward abstinence, though additional research is needed to confirm these results and examine the effect of goal-matching on retention. 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). To date, however, there has been little empirical research directly testing this hypothesis. 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).