In regard to my therapeutic approach to harm reduction as a clinical psychologist, I usually start  by understanding my client’s goals for drinking. We then start the process by monitoring their drinking as is, to understand the baseline they are starting at. This will include logging numerical data, but more importantly, triggers and impulses behind those drinks to better understand their motives. This could include the number of days they drink per week, the number of drinks they have at a time, specific types of drinks they allow themselves to drink, as well as building awareness behind the types of emotional drinking they may engage in. Most importantly, this treatment model provides accountability, where clients are working weekly and sometimes more with their providers to monitor their progress.

  • Regular physical activity can act as a healthy coping mechanism when dealing with cravings or anxiety related to your efforts towards alcohol moderation management.
  • The realization that HIV had been spreading widely among people who injected drugs in the mid-1980s led to the first syringe services programs (SSPs) in the U.S. (Des Jarlais, 2017).
  • 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.
  • Models of nonabstinence psychosocial treatment for drug use have been developed and promoted by practitioners, but little empirical research has tested their effectiveness.
  • Thus, the results may be more relevant for women with similar experiences as the investigated sample.
  • While multiple harm reduction-focused treatments for AUD have strong empirical support, there is very little research testing models of nonabstinence treatment for drug use.
  • In addition, no priorstudy has examined whether quality of life differs among those in abstinent vs.non-abstinent recovery in a sample that includes individuals who have attained longperiods of recovery.

1 Sample demographics, help-seeking and problem severity

  • However, they no longer found themselves in need of this help and did not express ambivalence regarding their decision to stop attending meetings.
  • In 1988 legislation was passed prohibiting the use of federal funds to support syringe access, a policy which remained in effect until 2015 even as numerous studies demonstrated the effectiveness of SSPs in reducing disease transmission (Showalter, 2018; Vlahov et al., 2001).
  • Our second goal was to examine differences in quality of life betweenabstainers and non-abstainers controlling for length of time in recovery.
  • There are heterogeneous views on the possibilities of CD after recovery from substance use disorder both in research and in treatment systems.
  • Moderation techniques such as pacing yourself, choosing lower-alcohol options, or having alcohol-free days can be practical tools in this journey.

These results indicate that strict views on abstinence and the nature of alcohol problems in 12-step-based treatment, and AA philosophy may create problems for the recovery process. Previous studies suggests that these strict views might prevent people from seeking treatment (Keyes et al., 2010; Wallhed Finn et al., 2014). The present study indicates that the strict views in AA also might prevent clients in AA to seek help and support elsewhere, since they percieve that this conflicts with the AA philosophy (Klingemann and Klingemann, 2017). Initially, AA was not intended to offer a professional programme model for treatment (Alcoholics Anonymous, 2011).

controlled drinking vs abstinence

NEARBY TERMS

This attachment and overall mindset of a dependent person may conflict with the current position and dominant view of Alcoholics Anonymous, rehabs and treatment professionals in that people with an alcohol dependency should remain totally and permanently abstinent from alcohol (and drugs). Controlled drinking is by and large rejected, with advocates of abstinence saying such a goal is detrimental and could enable denial as well as ignoring the need to admit there is a problem. Clinical studies and peer reviewed research have demonstrated that controlled drinking is possible, and various moderation-based treatment could be preferred over abstinence-based treatment. Nevertheless, especially in the United States, zero tolerance has remained the treatment approach most popular among the public and professionals.

Theoretical and empirical rationale for nonabstinence treatment

  • In addition, some might consider abstinence as a necessary part of therecovery process, while others might not.
  • In Europe, about half (44–46%) of individuals seeking treatment for AUD have non-abstinence goals (Haug & Schaub, 2016; Heather, Adamson, Raistrick, & Slegg, 2010).
  • It is also worthwhile considering the chemical effect of alcohol addiction on the body and the way alcohol withdrawal affects it.

A number of studies have examined psychosocial risk reduction interventions for individuals with high-risk drug use, especially people who inject drugs. In contrast to the holistic approach of harm reduction psychotherapy, risk reduction interventions are generally designed to target specific HIV risk behaviors (e.g., injection or sexual risk behaviors) without directly addressing mechanisms of SUD, and thus are quite limited in scope. However, these interventions also typically lack an abstinence focus and sometimes result in reductions in drug use. The harm reduction movement, and the wider shift toward addressing public health impacts of drug use, had both specific and diffuse effects on SUD treatment research. In 1990, Marlatt was introduced to the philosophy of harm reduction during a trip to the Netherlands (Marlatt, 1998).

2 Quality of life and recovery from AUD

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. There is less research examining the extent to which moderation/controlled use Drug rehabilitation goals are feasible for individuals with DUDs. The most recent national survey assessing rates of illicit drug use and SUDs found that among individuals who report illicit drug use in the past year, approximately 15% meet criteria for one or more DUD (SAMHSA, 2019a). About 10% of individuals who report cannabis use in the past year meet criteria for a cannabis use disorder, while this proportion increases to 18%, 19%, 58%, and 65% of those with past year use of cocaine, opioids (misuse), methamphetamine, and heroin, respectively.

The only way to ascertain for certain whether you are capable of having just one or two drinks is to try it over a period of time, say 6 months. If during that time, you only ever drink the amount you intend to, and no problems arise as a result of the drinking, then you have found the way that works for you. 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).

How Successful Are Controlled Drinking Programmes?

You might find yourself constantly preoccupied with thoughts about when you’ll have your next drink or whether you’re staying within your limits – this constant monitoring can create stress and mental exhaustion over time. Moreover, in committing to a moderate drinking plan, it’s essential to recognise that slip-ups can happen and these instances should not discourage you from continuing on your path towards moderation management, but rather serve as reminders of why moderation is necessary in the first place. While you may see the appeal in a programme that allows for some level of drink intake, it’s crucial to consider the potential drawbacks that could come with this approach.

controlled drinking vs abstinence

Further, describing recovery as a process also implies paying attention to contributing factors outside the treatment context, such as the importance of work, family and friends. In parallel with the view on abstinence as a core criterion for recovery, controlled drinking (CD) has been a recurring concept and in focus from time to time in research on alcohol problems for more than half a century (Davies, 1962; Roizen, 1987; Saladin and Santa Ana, 2004). It caused heated debates, and for a long time, it has had a rather limited impact on professional treatment systems (Coldwell and Heather, 2006). Recently, in many European countries (Klingemann and Rosenberg, 2009; Klingemann, 2016; Davis et al., 2017) and in the USA (Coldwell, 2005; Davis and Rosenberg, 2013), professionals working with clients with severe problems and clients in inpatient care tend to have abstinence as a treatment goal .