Miller et al. (in press) found that more dependent drinkers were less likely to achieve CD outcomes but that desired treatment goal and whether one labeled oneself an alcoholic or not independently predicted outcome type. The current study replicated and extended recent work (Kline-Simon et al., 2013; Witkiewitz, Roos, et al., 2017) by showing that low risk drinking is achievable by a subset of patients and that low risk drinkers and abstainers do not differ on a wide variety of outcomes at three years following treatment. This is important given that individuals in the low risk and abstainer classes did have some occasions of heavy drinking during treatment but had significantly better outcomes than those individuals with more occasions of heavy drinking.
- 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.
- We excluded studies on pregnant women, participants with chronic liver disease, participants with HIV/AIDS, and patients with liver transplant owing to the specific clinical considerations of these populations.
- Unfortunately, few quantitative, survey-based studies have included substance use during treatment as a potential reason for treatment noncompletion, representing a significant gap in this body of literature (for a review, see Brorson, Ajo Arnevik, Rand-Hendriksen, & Duckert, 2013).
- Multiple theories of motivation for behavior change support the importance of self-selection of goals in SUD treatment (Sobell et al., 1992).
- 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).
Historical context of nonabstinence approaches
- 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.
- 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.
- We reported estimated odd ratios with 95% confidence intervals comparing each intervention with placebo or with treatment as usual depending on the network structure.
- Separate network meta-analyses by intervention types (psychosocial interventions, drug, or combined drug interventions) were conducted to check the robustness of results to the possibility that treatment effects were not transitive across different approaches of studies to intervention.
- 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.
It is, however, an important clinical finding that CBI conferred no advantage over a brief, medically oriented intervention for participants whose drinking goal was complete abstinence. However, while designed to approximate the style of intervention delivered in a primary care setting, the medical management delivered in the COMBINE study was confounded with extensive and state-of-the-art assessment and follow-up. As such, further research may be required before these findings can be generalized to real-world primary care settings. The rationale and methods of the COMBINE study have been described in detail elsewhere (aCOMBINE Study Research Group, 2003a, COMBINE Study Research Group, 2003b).
Drinking Goals in Alcoholism Treatment
Several recent studies have evaluated long-term functioning outcomes among individuals classified as low risk drinkers following treatment, yet there have been two primary limitations of this prior work. Thus, these prior studies have not considered low risk drinking during the course of the treatment episode. Studying low risk drinking patterns during the course of the treatment episode is important to inform future clinical decision making regarding the likelihood of long term outcomes. Second, prior studies have relied on categorization of low risk and heavy drinking using a 5 drink cutoff for heavy drinking (or 4 drinks for women in Maisto et al., 2006, 2007). Specifically, the prior studies created groups based on never exceeding the 5 (or 4) drink cutoff on a single occasion.
What is moderation?
More recent versions of RP have included mindfulness-based techniques (Bowen, Chawla, & Marlatt, 2010; Witkiewitz et al., 2014). The RP model has been studied among individuals with both AUD and DUD (especially Cocaine Use Disorder, e.g., Carroll, Rounsaville, & Gawin, 1991); with the largest effect sizes identified in the treatment of AUD (Irvin, Bowers, Dunn, & Wang, 1999). As a newer iteration of RP, Mindfulness-Based alcohol abstinence vs moderation Relapse Prevention (MBRP) has a less extensive research base, though it has been tested in samples with a range of SUDs (e.g., Bowen et al., 2009; Bowen et al., 2014; Witkiewitz et al., 2014). But if they have a problem with alcohol, taking a harm reduction approach could be a constructive way to help them take a look at the negative consequences of their behavior and motivate them to make positive changes.
Repeated Measures Latent Class Models of Weekly Drinking During Treatment
Additionally, individuals are most likely to achieve the outcomes that are consistent with their goals (i.e., moderation vs. abstinence), based on studies of both controlled drinking and drug use (Adamson, Heather, Morton, & Raistrick, 2010; Booth, Dale, & Ansari, 1984; Lozano et al., 2006; Schippers & Nelissen, 2006). Together, these analyses seek to further elucidate the predictive utility of drinking goal as well as to identify specific treatment approaches that may be better suited for patients whose goals are abstinence versus non-abstinence oriented. Given the widespread recognition of individual differences in drinking goals for alcoholism treatment, as well as the accessible nature of this clinical variable to treatment providers, the potential clinical utility of such findings is high. Acamprosate is the only intervention with enough evidence to conclude that it is better than placebo in supporting detoxified, alcohol dependent patients to maintain abstinence for up to 12 months in primary care settings. It is uncertain whether the other current licensed drugs, naltrexone and disulfiram, improve abstinence in such patients.
- 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 severity of these symptoms can vary widely depending on how much you are drinking, how frequently, and your overall physical health.
- Differentiating these concepts opens up for recovery without necessarily having strong ties with the recovery community and having a life that is not (only) focused on recovery but on life itself.
- Inclusion criteria were drawn up to recruit interviewees able to reflect on their process of change.
- Learning more about your options and the health benefits of cutting back is already a meaningful step.
- It’s vital to discuss your goals with a physician to determine how to stop drinking alcohol safely.
This study conducted a systematic review and network meta-analysis (NMA) of psychotherapies for AUD, which will provide a reference for clinical application and evidence-based research directions of psychotherapy for AUD. Further, analyses revealed several drinking goal × CBI interactions such that the benefit of cognitive behavioral intervention over medical management was not supported for participants whose reported goal was complete abstinence. These findings were evident in two of four outcome measures and some were trend level, which, given the sample size of the present study limits the conclusions that can be drawn about matching of behavioral intervention based on drinking goal. Additionally, type I error correction was not implemented; therefore caution is warranted when interpreting marginally significant interactions.
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). 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. This study examined the effects of drinking goal on clinical outcomes in the COMBINE Study.
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, 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 https://ecosoberhouse.com/ that concern about missing substances was significantly correlated with not completing treatment (Zemore, Ware, Gilbert, & Pinedo, 2021). Unfortunately, few quantitative, survey-based studies have included substance use during treatment as a potential reason for treatment noncompletion, representing a significant gap in this body of literature (for a review, see Brorson, Ajo Arnevik, Rand-Hendriksen, & Duckert, 2013). Additionally, no studies identified in this review compared reasons for not completing treatment between abstinence-focused and nonabstinence treatment.
- In regard to help-seeking and problem severity, having attended at leastone 12-step meeting and the number of DSM-IV dependence symptoms were both significantlyrelated to non-abstinence.
- Contrary to previous methodologies that characterized all participants with any heavy drinking into one category (i.e., treatment “failures”), the findings from the current study indicate that the overall pattern of drinking is potentially more important than never exceeding an arbitrary cutoff.
- They may have adopted a sobriety challenge, such as Sober September or Dry January in order to gain the space to re-evaluate their relationship with alcohol.
- Though programs like Alcoholics Anonymous and other well-known programs meant to aid in the recovery from alcohol use disorders and alcohol misuse require or encourage full abstinence, these are not the only solutions known to help people quit or control drinking.
- However, no studies to date have assessed the moderating role of drinking goal on CBI efficacy.
Total Alcohol Abstinence vs. Moderation: Which One Wins in the End?
The ES of PDA was computed so that a positive value indicated a favorable outcome (ie, abstinence improvement), while changes in DDD and in craving were computed so that a negative value indicated a favorable outcome (ie, reduction of alcohol consumption and craving). Data based on the intention-to-treat (ITT) sample or modified sample were preferred over data based on completers for all analyses. The first, Medical Management (MM), consisted of nine brief sessions delivered by a licensed health care professional, and was intended to approximate a primary care intervention.
2. Relationship between goal choice and treatment outcomes
Eighty years of subsequent research and practice in the alcohol field has focused nearly exclusively on the drinking practices dimension (i.e., abstinence) included in the AA definition as the defining feature of recovery, to the neglect of considering improvements in well-being, functioning, and life circumstances. Abstinence may be a necessary recovery component for some individuals with AUD, yet research indicates that it is not essential for all, and positive changes in functioning and well-being often are more fundamental elements. These issues are very much intertwined in the Fan et al. (2019) study, which has many strengths that advance understanding of positive changes related to AUD recovery, but also raises questions for future research and continued development of conceptual and operational definitions of recovery. 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.
