Is Drinking in Moderation Possible for Alcoholics?

Successful moderation involves understanding yourself (what factors trigger excessive drinking), planning (how much you are going to drink and how you are going to stop), and taking concrete steps to exit or avoid situations where you won’t be able to moderate. Limited social drinking is a realistic goal for some people who struggle with alcohol, and should definitely be considered by people who have not been able to successfully adhere to abstinence. We intend to provide clinicians and clinical scientists with an overview of developments in the controlled-drinking literature, primarily since 2000. A brief description of the controversy surrounding controlled drinking provides a context for a discussion of various approaches to controlled drinking intervention as well as relevant clinical research. In the present follow-up, the recovery process for clients previously treated for SUD was investigated, focusing on abstinence and CD.

Tools and Support for Moderation

• 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).
• Although reducing practical barriers to treatment is essential, evidence suggests that these barriers do not fully account for low rates of treatment utilization.
• However, the results show that the view on abstinence and CD can change during the recovery process.
• In the present follow-up, the recovery process for clients previously treated for SUD was investigated, focusing on abstinence and CD.

This could mean that the neurobiological underpinnings of addiction may take root well before an individual or their loved ones suspect a problem with alcohol. All of these stages of drinking, from the enjoyment of alcohol to withdrawal to the cycles of craving, continuously alter the brain and its communication pathways. Alcohol can affect several dozen neurotransmitters and receptors, making understanding its mechanism of action in the brain complicated.

Drinking Goal Item of the Treatment Experiences and Expectations questionnaire

Additionally, while early studies of SUD treatment used abstinence as the single measure of treatment effectiveness, by the late 1980s and early 1990s researchers were increasingly incorporating psychosocial, health, and quality of life measures (Miller, 1994). In the 1970s, the pioneering work of a small number of alcohol researchers began to challenge the existing abstinence-based paradigm in AUD treatment controlled drinking vs abstinence 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). Vaillant (1983) labeled abstinence as drinking less than once a month and including a binge lasting less than a week each year.

• By 1989, treatment center referrals accounted for 40% of new AA memberships (Mäkelä et al., 1996).
• Clients reporting CD in the present study only met one of these criteria – an initial period of abstinence (Booth, 2006; Coldwell and Heather, 2006).
• For people who have not been able to maintain sobriety through Alcoholics Anonymous (AA) or other 12-step programs, they may wish to consider if moderation may be a more effective path for them to take.
• Therefore, knowledge about whether and how QOL differs betweennon-abstinent vs. abstinent recovery remains limited.

1 What Is Recovery? study

Despite compatibility with harm reduction in established SUD treatment models such as MI and RP, there is a dearth of evidence testing these as standalone treatments for helping patients achieve nonabstinence goals; this is especially true regarding DUD (vs. AUD). In sum, the current body of literature reflects multiple well-studied nonabstinence approaches for treating AUD and exceedingly little research testing nonabstinence treatments for drug use problems, representing a notable gap in the literature. Traditional alcohol use disorder (AUD) treatment programs most often prescribeabstinence as clients‘ ultimate goal.

Summary of the COMBINE Study

Although abstainers had the best outcomes, this study suggests that moderate drinking may be considered a viable drinking goal option for some individuals who may not be willing or able to abstain completely. It was hypothesized that patients whose drinking goals were oriented towards complete abstinence would have better treatment outcomes as indexed by a greater percentage of days abstinent, longer period until relapse, and an overall higher global clinical outcome. These hypotheses were supported by the present study, such that participants with a self-reported goal of complete abstinence had better overall clinical outcomes following 16 weeks of alcohol dependence treatment.

Abstinence continues to be the dominant approach to alcohol treatment in the United States, while non-abstinent approaches tend to be more acceptable abroad (Klingemann & Rosenberg, 2009; Luquiens, Reynaud, & Aubin, 2011). The debate between abstinence and non-abstinence approaches, specifically controlled drinking (CD), has remained a controversial topic in the alcoholism field since the 1960s (Davies, 1962; Miller & Caddy, 1977). As far as treatment outcomes are considered, there is no universally accepted definition of what constitutes successful CD. It has been suggested that CD, and more specifically a reduction in heavy drinking, has a number of clinical benefits that should be taken into consideration when discussing drinking goals (Gastfriend, Garbutt, Pettinati, & Forman, 2007).

These results suggest that drinking goal represents a highly predictive clinical variable and should be an integral part of the clinical assessment of patients with alcohol dependence. Assessment of patients‘ drinking goals may also help match patients to interventions best suited to address their goals and clinical needs. It is well known to clinicians and researchers in the field of alcoholism that patients vary with respect to drinking goal.

Sobell et al. (1992) found that many patients entering an outpatient treatment facility for alcohol problems preferred self-selection of treatment goals, versus adoption of the goals selected by the therapist. Treatment programs that allow for and encourage patient-driven treatment goals may be more https://ecosoberhouse.com/ appealing, and may lead to greater treatment utilization and engagement. This is particularly important in light of the overall low treatment seeking rates for alcoholism, with only 27.8% of alcohol dependence cases seeking treatment in the past year (Cohen, Feinn, Arias, & Kranzler, 2007).