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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. The second, Combined Behavioral Intervention (CBI), consisted of up to twenty, 50-minute sessions which integrated aspects of cognitive behavioral therapy, 12-step facilitation, motivational interviewing, and involvement of support systems. Some people aren’t ready to quit alcohol completely, and are more likely to succeed if they cut back instead. In this case, moderation serves as a harm reduction strategy that minimizes the negative consequences of drinking. They’re able to enjoy an occasional drink while still avoiding negative drinking behaviors and consequences. Our team at CATCH strongly believes in holistic healing methods as part of this process.
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). He adopted the language and framework of harm reduction in his own research, and in 1998 published a seminal book on harm reduction strategies for a range of substances and behaviors (Marlatt, 1998). Marlatt’s work inspired the development of multiple nonabstinence treatment models, including harm reduction psychotherapy (Blume, 2012; Denning, 2000; Tatarsky, 2002).
Addiction Treatment
In Europe, about half (44–46%) of individuals seeking treatment for AUD have non-abstinence goals (Haug & Schaub, 2016; Heather, Adamson, Raistrick, & Slegg, 2010). In the U.S., about 25% of patients seeking treatment for AUD endorsed nonabstinence goals in the early 2010s (Dunn & Strain, 2013), while more recent clinical trials have found between 82 and 91% of those seeking treatment for AUD prefer nonabstinence goals (Falk et al., 2019; Witkiewitz et al., 2019). The results of the Sobell’s studies challenged the prevailing understanding of abstinence as the only acceptable outcome for SUD treatment and raised a number of conceptual and methodological issues (e.g., the Sobell’s liberal definition of controlled drinking; see McCrady, 1985). A “controlled drinking controversy” followed, in which the Sobells as well as those who supported them were publicly criticized due to their claims about controlled drinking, and the validity of their research called into question (Blume, 2012; Pendery, Maltzman, & West, 1982).
- Moderation Management offers meetings that function as a support group as well as nine steps of action towards healthier choices.
- The aim is to investigate how these clients view abstinence and the role of AA[1] in their recovery process during the past five years.
- 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).
- To date, however, there has been little empirical research directly testing this hypothesis.
To that end, the use of abstinence as the dominant drinking goal across alcoholism treatment programs in the United States may in fact deter individuals who would otherwise seek treatment for alcohol problems should CD be proposed as an acceptable 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 controlled drinking vs abstinence of the goals selected by the therapist. Treatment programs that allow for and encourage patient-driven treatment goals may be more 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).
The Effects of Drinking Goal on Treatment Outcome for Alcoholism
While drinking goal represents an important clinical variable, the literature is relatively limited as to the specific influence of drinking goal on treatment outcomes for alcoholism. Likewise, the clinical implications of drinking goal on treatment matching are largely unknown. 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.
The number of drinks consumed per day alone is not a sufficient criterion to use when trying to diagnose someone with an Alcohol Use Disorder (AUD). Alcoholism is a complex issue characterised by a range of behavioural, physical, and psychological factors. It’s during this period that peer support becomes invaluable; it helps to know that others are experiencing similar struggles or have overcome them already. After the interviews, the clients were asked whether they would https://ecosoberhouse.com/ allow renewed contact after five years, and they all gave their permission. The majority of those not 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). Dr. Stanton Peele, recognized as one of the world’s leading addiction experts, developed the Life Process Program after decades of research, writing, and treatment about and for people with addictions.
What Moderation Means in Practice
Abstinence benefits extend beyond just physical improvements though; they also encompass mental health improvements. Emotional resilience begins to grow as you learn new ways to cope with stress or anxiety without reaching for a drink. Your sobriety journey is personal, and what works best for you may not work as well for someone else. For instance, abstaining from alcohol can decrease the risk of liver disease, improve cognitive function, and enhance emotional resilience. Several said that starting drinking was preceded by concerns about whether an uncontrolled craving would occur.
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. On the one hand, so much advice focuses on moderation (engaging in bad behaviors sparingly) that it was ridiculed in the Oscar Wilde quote (“Everything in moderation, including moderation”).