In addition, participants reported various forms of stability as important to recovery including employment stability, economic or income stability, and housing stability. For example, participants described recovery as “someone who’s living a manageable life, in control of it, back on top of it” and “sober. Sober and stable, a better life.” The desire for stability pervaded open responses in terms of financial, social, and relationship stability. In terms of cognitive functioning, there was little variability in terms of responses as participants endorsed all four domains as “important” or “very important” to recovery. Even though the open-ended questions asked about non-drug-related recovery outcomes, it is worth noting that participants clarified that their concern was ultimately drug-related.

• 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.
• Instead, abstinence was important precisely because it would prevent a return to chaotic drug use or prevent drug-related harm.
• Besides, alcohol affects your sleep quality and mental health too; it’s not uncommon for people who drink regularly to struggle with anxiety or depression.
• Finally, there is also a need for increased funding for holistic recovery support services that include programming focused on building recovery capital and supporting a broad range of recovery-oriented goals (e.g., nutrition, meditation, healthy relationships, and financial planning).
• You may feel pressured by society’s view of what is acceptable drinking behaviour or fear being ostracised due to cultural norms surrounding alcohol use.

Theoretical and empirical rationale for nonabstinence treatment

• Indeed, there is anecdotal evidence that this may be the case; for example, a qualitative study of nonabstinence drug treatment in Denmark described a client saying that he would not have presented to abstinence-only treatment due to his goal of moderate use (Järvinen, 2017).
• Similarly, Laudet (2007) found that although most participants defined recovery as total abstinence, they also suggested that recovery is marked by improvements in biomedical and psychosocial outcomes.
• 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).
• For example, all studies with SUD populations could include brief questionnaires assessing short-and long-term substance use goals, and treatment researchers could report the extent to which nonabstinence goals are honored or permitted in their study interventions and contexts, regardless of treatment type.
• In addition to evaluating nonabstinence treatments specifically, researchers could help move the field forward by increased attention to nonabstinence goals more broadly.

For example, despite being widely cited as a primary rationale for nonabstinence treatment, the extent to which offering nonabstinence options increases treatment utilization (or retention) is unknown. In addition to evaluating nonabstinence treatments specifically, researchers could help move the field forward by increased attention to nonabstinence goals more broadly. For example, all Sober Houses Rules That You Should Follow studies with SUD populations could include brief questionnaires assessing short-and long-term substance use goals, and treatment researchers could report the extent to which nonabstinence goals are honored or permitted in their study interventions and contexts, regardless of treatment type. There is also a need for updated research examining standards of practice in community SUD treatment, including acceptance of non-abstinence goals and facility policies such as administrative discharge. A number of studies have examined psychosocial risk reduction interventions for individuals with high-risk drug use, especially people who inject drugs.

Individuals with greater SUD severity tend to be most receptive to therapist input about goal selection (Sobell, Sobell, Bogardis, Leo, & Skinner, 1992). This suggests that treatment experiences and therapist input can influence participant goals over time, and there is value in engaging patients with non-abstinence goals in treatment. There has been little research on the goals of non-treatment-seeking individuals; however, research suggests that nonabstinence goals are common even among individuals presenting to SUD treatment. Among those seeking treatment for alcohol use disorder (AUD), studies with large samples have cited rates of nonabstinence goals ranging from 17% (Berglund et al., 2019) to 87% (Enggasser et al., 2015).

• This pinpoints the conflicting issues experienced by some clients during the recovery process.
• 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.
• There is also a need for updated research examining standards of practice in community SUD treatment, including acceptance of non-abstinence goals and facility policies such as administrative discharge.
• The U.S. has been slow to adopt many evidence-based harm reduction strategies including syringe service programs 30, fentanyl testing strips 31, 32, and overdose prevention sites 33.
• At CATCH Recovery, we understand that your journey towards overcoming addiction is deeply personal and unique to you.

1. Nonabstinence psychosocial treatment models

It is also worthwhile considering the chemical effect of alcohol addiction on the body and the way alcohol withdrawal affects it. The person that decides to drink https://yourhealthmagazine.net/article/addiction/sober-houses-rules-that-you-should-follow/ socially or now and then, is going to be consistently re-introducing that substance to the body, therefore always leaving the body craving more. Those who choose abstinence will completely avoid all alcohol, including that in food or in hygiene products such as mouthwash. Some people find it’s still too overwhelming to be around alcohol, and it’s too hard to change their habits.

It is important to highlight that most of the studies cited above did not provide goal-matched treatment; thus, these outcomes generally reflect differences between individuals with abstinence vs. non-abstinence goals who participated in abstinence-based AUD treatment. In the 1970s, the pioneering work of a small number of alcohol researchers began to challenge the existing abstinence-based paradigm in AUD treatment research. 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). In addition to shaping mainstream addiction treatment, the abstinence-only 12-Step model also had an indelible effect on the field of SUD treatment research. Most scientists who studied SUD treatment believed that abstinence was the only acceptable treatment goal until at least the 1980s (Des Jarlais, 2017). Abstinence rates became the primary outcome for determining SUD treatment effectiveness (Finney, Moyer, & Swearingen, 2003; Kiluk, Fitzmaurice, Strain, & Weiss, 2019; Miller, 1994; Volkow, 2020), a standard which persisted well into the 1990s (Finney et al., 2003).

Moderation techniques such as pacing yourself, choosing lower-alcohol options, or having alcohol-free days can be practical tools in this journey. As the IP had a successful outcome, six months after treatment, their possibilities for CD might be better than for persons with SUD in general. On the other hand, as the group expressed positive views on this specific treatment, they might question the sobriety goal in a lesser extent than other groups. Interviews with 40 clients were conducted shortly after them finishing treatment and five years later. All the interviewees had attended treatment programmes based on the 12-step philosophy, and they all described abstinence as crucial to their recovery process in an initial interview.

Nonetheless, Helzer et al. rejected the value of CD outcomes in alcoholism treatment. The current review highlights multiple important directions for future research related to nonabstinence SUD treatment. Overall, increased research attention on nonabstinence treatment is vital to filling gaps in knowledge.

Reasons Abstinence From Alcohol May Be the Best Choice

Which substance PWUM find acceptable to use in recovery may also be related to the legality of substance (i.e. legalization of recreational cannabis) and subsequently the perception of how “hard” a drug may be. The position of ALCOHOLICS ANONYMOUS (AA) and the dominant view among therapists who treat alcoholism in the United States is that the goal of treatment for those who have been dependent on alcohol is total, complete, and permanent abstinence from alcohol (and, often, other intoxicating substances). By extension, for all those treated for alcohol abuse, including those with no dependence symptoms, moderation of drinking (termed controlled drinking or CD) as a goal of treatment is rejected (Peele, 1992). Instead, providers claim, holding out such a goal to an alcoholic is detrimental, fostering a continuation of denial and delaying the alcoholic’s need to accept the reality that he or she can never drink in moderation. To analyze quantitative data, continuous data were summarized using means, and categorical data were summarized using frequencies and percentages.

Harm Reduction Journal

A common objection to CD is that most people fail to return to “normal” drinking, and highlighting those able to drink in a controlled way might attract people into relapse, with severe medical and social consequences. On the other hand, previous research has reported that a major reason for not seeking treatment among alcohol-dependent people is the perceived requirement of abstinence (Keyes et al., 2010; Wallhed Finn et al., 2014, 2018). In turn, stigma and shame have been reported as a reason for not seeking treatment (Probst et al., 2015). Although research indicates that CD may be a possible option for sustained recovery, at least for certain groups and at least later in the recovery process, it seems as if the dominating approach of treatment systems is still abstinence.

Alcoholism: Abstinence Versus Controlled Drinking

Like the Sobells, Marlatt showed that reductions in drinking and harm were achievable in nonabstinence treatments (Marlatt & Witkiewitz, 2002). The Swedish treatment system has been dominated by total abstinence as the goal, although treatment with CD as a goal exists (e.g., Agerberg, 2014; Berglund et al., 2019). In three Swedish projects, on recovery from SUD, 56 clients treated in 12-step programmes were interviewed approximately six months after treatment (Skogens and von Greiff, 2014, 2016; von Greiff and Skogens, 2014, 2017; Skogens et al., 2017). Clients were recruited via treatment units (outpatient and inpatient) in seven Swedish city areas. Inclusion criteria were drawn up to recruit interviewees able to reflect on their process of change.

Tracking Consumption

The Rand study quantified the relationship between severity of alcohol dependence and controlled-drinking outcomes, although, overall, the Rand population was a severely alcoholic one in which “virtually all subjects reported symptoms of alcohol dependence” (Polich, Armor, and Braiker, 1981). Edwards et al. (1983) reported that controlled drinking is more unstable than abstinence for alcoholics over time, but recent studies have found that controlled drinking increases over longer follow-up periods. Finney and Moos (1991) reported a 17 percent “social or moderate drinking” rate at 6 years and a 24 percent rate at 10 years. In studies by McCabe (1986) and Nordström and Berglund (1987), CD outcomes exceeded abstinence during follow-up of patients 15 and more years after treatment.

Should antidepressants be prescribed to people with substance use issues?

The negative effects of your drinking may have turned you off of alcohol entirely, and that’s completely okay. If your reason for choosing abstinence is simply that you want to, that’s a perfectly valid reason to quit alcohol altogether. Moderation often requires that you take anti-craving medication for an indefinite period of time. Medication makes it easier to put the brakes on after a drink or two, and sticking to moderation is challenging without it.