Of note, other SUD treatment approaches that could be adapted to target nonabstinence goals (e.g., contingency management, behavioral activation) are excluded from the current review due to lack of relevant empirical evidence. 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).
Stephanie S. O’Malley
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. Regarding day-to-day fluctuations in abstinence- versus moderation-based drinking goals, thought-provoking differences emerged. In this study, abstinence goals may be characterized as more attributable to person-level, individual differences—a person willing to set daily abstinence goals may use this as a primary strategy.
- This model both accelerated the spread of AA and NA and helped establish the abstinence-focused 12-Step program at the core of mainstream addiction treatment.
- Donovan and colleagues(2005) reviewed 36 studies involving various aspects of QOL in relation to AUDand concluded that heavy episodic drinkers had worse QOL than other drinkers, that reduceddrinking was related to improved QOL among harmful drinkers, and that abstainers hadimproved QOL in treated samples (Donovan et al.2005).
- This study suggests that CBI may help participants control their drinking as opposed to simply encouraging abstinence (Gueorguieva et al., 2010).
Data synthesis and analyses
While patients with goals of complete abstinence did succeed in drinking less frequently and taking longer to relapse to heavy drinking than participants with controlled drinking or conditional abstinence goals, they drank more per drinking day, on average. This finding is consistent with an abstinence violation effect wherein abstinence oriented participants are more likely to engage in heavy drinking following an initial lapse (Marlatt & Gordon, 1985). While CBI should theoretically reduce the impact of the abstinence violation effect by providing the opportunity to accurately process a lapse, the results presented herein did not support this effect (i.e., no goal × CBI interaction was observed).
Alcoholic Hepatitis
However, prior studies have defined“recovery” based on DSM criteria, and thus may have excluded individualsusing non-abstinent techniques that do not involve reduced drinking. Furthermore, noprior study has considered length of time in recovery when comparing QOL betweenabstinent and non-abstinent individuals. The current aims are to identify correlates ofnon-abstinent recovery and examine differences in QOL between abstainers andnon-abstainers accounting for length of time in recovery. When they are offered 12-step treatment, they get exposed to these strict views in a different setting than what was initially intended within AA, namely a self-help group that people join voluntarily.
Expanding the continuum of substance use disorder treatment: Nonabstinence approaches
- In the initial interviews, all the clients declared themselves abstinent and stressed that substance use in any form was not an option.
- 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).
- Thus, it appears that the greater likelihood of successful outcome in the abstinence goal group may be primarily the result of reduced frequency of drinking rather than reduced drinking intensity.
- To enable all studies to be included, in the main analysis we combined results reported at the nearest time point to 12 months from each study.
- Conversely, more intensive behavioral interventions may be particularly beneficial for patients whose goals are conditional abstinence or controlled drinking.
- To reflect current clinical practice, we sought only studies that provided detoxification to participants, as well as studies that recruited participants who had undergone detoxification less than four weeks before randomisation.
As a data check, all outcomes presented in the primary COMBINE manuscript were replicated prior to any model testing for this study. Additionally, drinking goal was initially analyzed as a five-level variable keeping all possible self-report responses separate. Visual inspection of these results supported our classification system (i.e., controlled drinking, conditional abstinence, and complete abstinence) in that the two possible responses for both https://ecosoberhouse.com/ controlled drinking and conditional abstinence clustered together across outcomes. Since drinking goal is a three-level variable, following the omnibus test, planned analyses were conducted to test differences between the three drinking goal groups for effects observed on all outcome variables. Setting specific goals, whether a daily abstinence goal or low-risk moderation goal, led to fewer drinks overall compared to the other goal categories.
- 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).
- The management of liver transplantation recipients for alcoholic hepatitis centers around monitoring and early detection of alcohol relapse, and pharmacologic and behavioral treatment of alcohol use disorder.
- 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).
- However, among individuals with severe SUD and high-risk drug or alcohol use, the urgency of reducing substance-related harms presents a compelling argument for engaging these individuals in harm reduction-oriented treatment and interventions.
- In the side of abstinence, this article reviews the reasons of the abstinence to the treatment of alcohol dependence.
3 Stepwise regressions: Non-abstinence
However, this approach is consistent with the goal of increasing treatment utilization by reaching those who may not otherwise present to treatment. Alternatively, researchers who conduct trials in community-based treatment centers will need to obtain buy-in to test nonabstinence approaches, which may necessitate waiving facility policies regarding drug use during treatment – controlled drinking vs abstinence a significant hurdle. It is essential to understand what individuals with SUD are rejecting when they say they do not need treatment. In this model, treatment success is defined as achieving and sustaining total abstinence from alcohol and drugs, and readiness for treatment is conflated with commitment to abstinence (e.g., Harrell, Trenz, Scherer, Martins, & Latimer, 2013).
Summary of the COMBINE Study
