Future research should assess the dynamic nature of drinking goal in predicting treatment outcomes. Clinicians have long recognized that client’s attitudes and goals towards drinking change throughout the course of treatment. The dynamic nature of drinking goal may be an important clinical variable in its own right (Hodgins, Leigh, Milne, & Gerrish, https://ecosoberhouse.com/ 1997). The present study was limited to the assessment of drinking goal at the onset of treatment and future studies examining drinking goals over the course of treatment seem warranted. Likewise, further research should consider matching patients’ drinking goals to specific treatment modalities, whether behavioral or pharmacological in nature.

Expecting someone to potentially cut those events out of their lives to reduce the exposure to alcohol is not always realistic. According to research, “Many individuals experiencing problems related to their drinking (e.g., college students) are not interested in changing their drinking behavior and would most likely be characterized in the precontemplative stage of the transtheoretical model. Harm reduction provides a good method for matching these individuals at that stage and providing motivational incentives (e.g., discussing the negative consequences the person is experiencing) to motivate their desire for positive change” (Marlatt & Witkiewitz, 2002).

Abstinence vs Controlled Drinking

Harm reduction may also be well-suited for people with high-risk drug use and severe, treatment-resistant SUDs (Finney & Moos, 2006; Ivsins, Pauly, Brown, & Evans, 2019). These individuals are considered good candidates for harm reduction interventions because of the severity of substance-related negative consequences, and thus the urgency of reducing these harms. Indeed, this argument has been central to advocacy around harm reduction interventions for people who inject drugs, such as SSPs and safe injection facilities (Barry et al., 2019; Kulikowski & Linder, 2018). It has also been used to advocate for managed alcohol and housing first programs, which represent a harm reduction approach to high-risk drinking among people with severe AUD (Collins et al., 2012; Ivsins et al., 2019).

These groups tend to include individuals who use a range of substances and who endorse a range of goals, including reducing substance use and/or substance-related harms, controlled/moderate use, and abstinence (Little, 2006). Additionally, some groups target individuals with co-occurring psychiatric disorders (Little, Hodari, Lavender, & Berg, 2008). Important features common to these groups include low program barriers (e.g., drop-in groups, few rules) and inclusiveness of clients with difficult presentations (Little & Franskoviak, 2010). Individuals with greater SUD severity tend to be most receptive to therapist input about goal selection (Sobell, Sobell, Bogardis, Leo, & Skinner, 1992).

Theoretical and empirical rationale for nonabstinence treatment

While total abstinence is necessary in some cases, in other cases people are able to reduce their drinking to moderate levels without needing to abstain totally. 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. The results suggest that the 12-step philosophy, with abstinence as the only possible choice, might mean that people in the AA community who are ambivalent and/or critical regarding parts of the philosophy must “hide” their perceptions on their own process.

• Several said that starting drinking was preceded by concerns about whether an uncontrolled craving would occur.
• Further, results from this study suggest that drinking goal may be useful in selecting a treatment approach.
• Our approach is not one-size-fits-all; instead, it’s grounded in empathy, respect for your individuality, and a deep understanding of how alcohol abuse impacts different people in different ways.
• Administrative discharge due to substance use is not a necessary practice even within abstinence-focused treatment (Futterman, Lorente, & Silverman, 2004), and is likely linked to the assumption that continued use indicates lack of readiness for treatment, and that abstinence is the sole marker of treatment success.

For example, someone might want to cut back on the amount they drink, or maybe slow down their rate of drinking. 12-step programs alone do not usually address the underlying need that’s been suppressed through alcohol. Without addressing those needs, it’s like trying to cap an active volcano with a giant boulder. Sooner or later, the pressure will build up and the volcano will explode—or you will relapse. Exercise is another key factor in recovery due to its numerous benefits such as stress reduction, improvement in mood and sleep patterns in addition to promoting overall wellbeing. Regular physical activity can act as a healthy coping mechanism when dealing with cravings or anxiety related to your efforts towards alcohol moderation management.

Reasons Abstinence From Alcohol May Be the Best Choice

On the other hand, many approaches to self-control—particularly in the area of addiction—focus on abstinence. Avoiding a substance altogether is the cornerstone of 12-step programs like AA, for example. Of the patients studied, 90% of total abstinence patients were still sober two and a half years after treatment.

A key aspect of abstinence is understanding and navigating through the withdrawal process – a daunting task indeed but necessary for recovery. The severity of these symptoms can vary widely depending on how much you are drinking, how frequently, and your overall physical health. Cultural perspectives on alcohol also influence our attitudes towards its use and misuse, shaping norms around what constitutes acceptable controlled drinking vs abstinence levels of consumption. While some cultures romanticise heavy drinking others promote temperance; being aware of these cultural influences can aid in reshaping your own relationship with alcohol and eliminate harmful drinking patterns. In the results, we mention that there were a few IPs that were younger, with a background of diffuse and complex problems characterized by a multi-problem situation.

People were more likely to recommend abstinence for incompatible conflicts than for resource dilemmas. It’s hard to measure how effectively different programs are treating a condition when the two different programs are entirely different. In the case of Moderation Management, the diagnosis for members is “problem drinking,” not full-blown alcoholism. Attempting controlled drinking as a full-blown alcoholic can be extraordinarily damaging.