In addition to issues with administrative discharge, abstinence-only treatment may contribute to high rates of individuals not completing SUD treatment. About 26% of all U.S. treatment episodes end by individuals leaving the treatment program prior to treatment completion (SAMHSA, 2019b). Studies which have interviewed participants and staff of SUD treatment centers have cited ambivalence about abstinence as among the top reasons for premature treatment termination (Ball, Carroll, Canning-Ball, & Rounsaville, controlled drinking vs abstinence 2006; Palmer, Murphy, Piselli, & Ball, 2009; Wagner, Acier, & Dietlin, 2018). One study found that among those who did not complete an abstinence-based (12-Step) SUD treatment program, ongoing/relapse to substance use was the most frequently-endorsed reason for leaving treatment early (Laudet, Stanick, & Sands, 2009). A recent qualitative study found that concern about missing substances was significantly correlated with not completing treatment (Zemore, Ware, Gilbert, & Pinedo, 2021).

So what does this mean for drinkers?

• If you’re aiming to moderate your drinking, you may be asked to keep a “drinking diary”.
• 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.

Perhaps the most notable gap identified by this review is the dearth of research empirically evaluating the effectiveness of nonabstinence approaches for DUD treatment. Given low treatment engagement and high rates of health-related harms among individuals who use drugs, combined with evidence of nonabstinence goals among a substantial portion of treatment-seekers, testing nonabstinence treatment for drug use is a clear next step for the field. Ultimately, nonabstinence treatments may overlap significantly with https://ecosoberhouse.com/ abstinence-focused treatment models. Harm reduction psychotherapies, for example, incorporate multiple modalities that have been most extensively studied as abstinence-focused SUD treatments (e.g., cognitive-behavioral therapy; mindfulness). However, it is also possible that adaptations will be needed for individuals with nonabstinence goals (e.g., additional support with goal setting and monitoring drug use; ongoing care to support maintenance goals), and currently there is a dearth of research in this area.

Theoretical and empirical rationale for nonabstinence treatment

For some people, the pandemic created more opportunities for reducing drinking. More time at home may have contributed to less peer pressure to drink, less time in a “wet” culture, and lifestyle changes that might support a shift towards moderation. However, in some cases, people eventually come to the realization that total abstinence is a better solution, and is actually easier than attempting to maintain control. According to Harvard University Medical School, moderate drinking is successful only for people who haven’t yet developed a serious dependence or who haven’t yet experienced serious consequences as a result of drinking. Learning moderate drinking can help people set goals and make better decisions before they cross the line to alcoholism. Given the abstinence focus of many SUD treatment centers, studies may need to recruit using community outreach, which can yield fewer participants compared to recruiting from treatment (Jaffee et al., 2009).

• Eliza’s son has struggled with substance use for years, and recently experienced a dangerous overdose.
• Some clinicians and researchers posit that the field’s current emphasis on abstinence-based recovery may fail to engage many individuals with SUD because of perceptions that a goal of abstinence is required to engage with care.
• Subsequently, the authors found that abstinence in this sample at three years did not predict better psychological functioning at ten years (Witkiewitz et al., 2020).
• 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.

Research shows that moderate drinking can work for those who abuse alcohol.

• When considered as an entire sample of 84 individuals, participants evidenced significant reductions in all three outcomes over the 7 week intervention period (total drinks, drinking days, and drinks per drinking day).
• The relationships between substance use status and indices of well-being are reported in Table 3.
• The steps include admitting you’re powerless over alcohol and your life has become unmanageable, admitting you’ve acted wrongly and, where possible, making amends with people you’ve harmed.
• Proactively cutting back on drinking can start to illuminate how drinking less can give you more, and create the mental clarity to identify your goals and values.

Moderation offers a path to sobriety without completely eliminating drinking. 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. When you stop drinking alcohol entirely, even as a moderate drinker, you allow your body and mind a chance to heal.

Why Addiction Treatment Takes Time

A study conducted at the University of Gothenburg, Sweden found that the Reagans of the world are more successful in treatment than the Saras. Survey weights were used throughout the analyses to statistically account for any under-representation in the KnowledgePanel sample, as well as differential responding to the National Recovery Study screening question. It’s already quite common to abstain in the real world; look no further than certain religions—e.g. Mormons, Muslims, and Bahais—that forbid practitioners from consuming alcohol. Similarly, there were teetotalers and prohibitionists who tried to ban alcohol altogether throughout the twentieth century. In reality, moderation can be even harder than abstinence as it can take as much, or perhaps even more, willpower to stop once you’ve already started.

When To Consider Treatment

You can have an occasional drink without feeling defeated and sliding deeper into a relapse. If you’re thinking about changing your relationship with alcohol, one of the first decisions you will make is whether you want to cut back or quit altogether. How do you walk the line between protecting your addicted loved one from potential danger while allowing the natural consequences that can lead them to want to make a change? While there are definite limits to what a family can do, there are actions that can be taken. Sticking with the CRAFT approach will help your loved one reach their goal of continuous sobriety. If, as family members, we wait around for a 100% commitment from our loved one, we will almost certainly be waiting a long time.

At Silicon Beach Behavioral Health, our mission is to ensure that every person can reach his or her full potential. When you surround yourself with others who moderate their drinking, it’s much easier to moderate your own intake. (Surely, you’ve heard that you should surround yourself with the people you want to be like?) Because many people have an unconscious desire to conform, you can essentially turn peer pressure toward alcohol in the other direction. The US Department of Health & Human Services recommends no mo than 2 drinks per day for men and only 1 drink per day for women.

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). Rather, when people with SUD are surveyed about reasons they are not in treatment, not being ready to stop using substances is consistently the top reason cited, even among individuals who perceive a need for treatment (SAMHSA, 2018, 2019a). Indeed, about 95% of people with SUD say they do not need SUD treatment (SAMHSA, 2019a). Even among those who do perceive a need for treatment, less than half (40%) make any effort to get it (SAMHSA, 2019a). Although reducing practical barriers to treatment is essential, evidence suggests that these barriers do not fully account for low rates of treatment utilization. Instead, the literature indicates that most people with SUD do not want or need – or are not ready for – what the current treatment system is offering.

Borderline Personality Disorder and Addiction

Only 50% of those who focused on controlled consumption succeeded in controlling their drinking. Alcohol had taken its toll—her job, friends, family, and health had all suffered—and she wanted it out of her life. Her counselor agreed that abstinence was a good solution and they took steps to help Reagan achieve this goal. A measure of number of psychiatric diagnoses, including alcohol use other substance use disorders, was calculated by summing the total number of affirmative responses.

• The courts failed to enforce treatment for her daughter, once out of jail.
• 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.
• Contacting a treatment providercan help you determine the next steps in your journey.