Differences between abstinent and non-abstinent individuals in recovery from alcohol use disorders

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. This is consistent with another important study showing there is a greater likelihood that alcohol use disorder symptoms will resurface and that there will be a complete return of alcohol use disorder for individuals in remission who are drinking versus those who are completely abstinent. Even the body of studies finding that very mild drinking could have cardio-protective effects appear to be somewhat in doubt. In a previous Bulletin, we reviewed a study that took a look closer at this issue, which concluded that abstinence is still likely to be the safest strategy when it comes to mortality risk over time.

Theoretical and empirical rationale for nonabstinence treatment

An observational study of individuals with AUD surveyed participants about their drinking practices, psychosocial functioning, and life contexts at baseline and 1, 3, 8, and 16 years later. Regardless of whether they had recently sought help or achieved abstinence, many participants showed improvement in alcohol-related functioning, life contexts, and coping26. Taken together, these studies may inform a longstanding debate in the field concerning the risks and stability of non-abstinent recovery9 and the utility of broader conceptualizations of recovery that emphasize improvements in biopsychosocial functioning16,17. Together, these analyses seek to further elucidate the predictive utility of drinking goal as well as to identify specific treatment approaches that may be better suited for patients whose goals are abstinence versus non-abstinence oriented.

Given the widespread recognition of individual differences in drinking goals for alcoholism treatment, as well as the accessible nature of this clinical variable to treatment providers, the potential clinical utility of such findings is high. In summary, these analyses of the COMBINE study provide strong evidence that drinking goal represents an important clinical predictor of treatment outcomes and thus should be an integral part of the clinical assessment of problem drinkers. Further, results from this study suggest that drinking goal may be useful in selecting a treatment approach. In particular, medically oriented treatments emphasizing abstinence appear to be an effective and cost efficient treatment modality for patients whose goals are oriented toward complete abstinence. Conversely, more intensive behavioral interventions may be particularly beneficial for patients whose goals are conditional abstinence or controlled drinking.

Is Controlled Drinking Possible for Alcoholics?

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). Advocates of managed alcohol programs also note that individuals with severe AUD and structural vulnerabilities often have low interest in and utilization of abstinence-oriented treatment, and that these treatments are less effective for this population (Ivsins et al., 2019), though there is limited research examining these What Happens When You Stop Drinking Alcohol claims. 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). Despite the intense controversy, the Sobell’s high-profile research paved the way for additional studies of nonabstinence treatment for AUD in the 1980s and later (Blume, 2012; Sobell & Sobell, 1995).

Drinking Goals in Alcoholism Treatment

Additionally, given the nature of the COMBINE study, the effects of a medically oriented intervention (i.e., MM) without a pharmacological component could not be investigated. Furthermore, it should be noted that the literature does not offer consensus on the operational definition of drinking goal (Luquiens et al., 2011). Instead, the authors categorized responses to the Commitment to Abstinence item based largely on clinical judgment and prior research using this measure.

Levels of Care in Drug and Alcohol Rehab Programs

1. Whether you’re considering moderation or complete abstinence, this article will provide information about how to begin an Alcohol Moderation Management (AMM), its effectiveness, potential drawbacks, and its applicability to people dealing with alcoholism.
2. The debate between abstinence and non-abstinence approaches, specifically controlled drinking (CD), has remained a controversial topic in the alcoholism field since the 1960s (Davies, 1962; Miller & Caddy, 1977).
3. Her counselor agreed that limiting her drinking could be a good solution and they set a goal for Sara to cut back her consumption to these special occasions only.
4. 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.

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). When the premise of AA was transformed into the 12-step treatment programme, it was performed in a professional setting. Many clients in the study described that the 12-step programme was the only treatment that they were offered.

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. Research on young adults, including people in their thirties (Magaraggia and Benasso, 2019), stresses that young adults leaving care tend to have complex problems and struggle with problems such as poor health, poor school performance and crime (Courtney and Dworsky, 2006; Berlin et al., 2011; Vinnerljung and Sallnäs, 2008). Thus, this is interesting to analyse further although the younger IPs in this article, with experience of 12-step treatment, are too few to allow for a separate analysis.

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 addition to issues with administrative discharge, abstinence-only treatment may contribute to high rates of individuals not completing SUD treatment. About 26% of all U.S. treatment episodes end by individuals leaving the treatment program prior to treatment completion (SAMHSA, 2019b). Studies which have interviewed participants and staff of SUD treatment centers have cited ambivalence about abstinence as among the top reasons for premature treatment termination (Ball, Carroll, Canning-Ball, & Rounsaville, 2006; Palmer, Murphy, Piselli, & Ball, 2009; Wagner, Acier, & Dietlin, 2018). One study found that among those who did not complete an abstinence-based (12-Step) SUD treatment program, ongoing/relapse to substance use was the most frequently-endorsed reason for leaving treatment early (Laudet, Stanick, & Sands, 2009).