Moderation vs Abstinence: Should You Cut Back, or Quit Drinking?

While harm reduction can be effective and successful in helping a person be more cognizant of their drinking behaviors and therefore decreasing them, it is not for everyone. While, of course, no one is perfect, and we expect “mistakes” or “hiccups” along the way, there are some individuals who try harm reduction and are able to recognize they cannot exercise this type of self-control. In those cases, harm reduction can be a helpful tool as a last resort, to help the individual come to the conclusion themselves that abstinence is the right avenue for them, rather than having it enforced upon them at the start of treatment. The Alcohol Dependence Scale (ADS; Skinner & Allen, 1982) was used to assess severity of alcohol dependence.

  • Additionally, individuals are most likely to achieve the outcomes that are consistent with their goals (i.e., moderation vs. abstinence), based on studies of both controlled drinking and drug use (Adamson, Heather, Morton, & Raistrick, 2010; Booth, Dale, & Ansari, 1984; Lozano et al., 2006; Schippers & Nelissen, 2006).
  • Miller et al. (in press) found that more dependent drinkers were less likely to achieve CD outcomes but that desired treatment goal and whether one labeled oneself an alcoholic or not independently predicted outcome type.
  • 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.

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 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).

3. Summary of the state of the literature

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. If you want to resolve problem drinking without medication, abstinence may be a better choice for you. When people aiming for abstinence controlled drinking vs abstinence make a mistake, they may feel like quitting is impossible and give up entirely. You can have an occasional drink without feeling defeated and sliding deeper into a relapse. As we get back to more social events, business meetings, and situations where you may have abused alcohol in the past, it may be time to consider how you can achieve moderation.

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. 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 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. While there are many obstacles to the widespread acceptance of CD as a treatment approach (Sobell & Sobell 2006), it is important to note that not all individuals entering treatment do so with the goal of achieving abstinence.

Is Controlled Drinking Possible for Alcoholics?

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. At one extreme, Vaillant (1983) found a 95 percent relapse rate among a group of alcoholics followed for 8 years after treatment at a public hospital; and over a 4-year follow-up period, the Rand Corporation found that only 7 percent of a treated alcoholic population abstained completely (Polich, Armor, & Braiker, 1981). At the other extreme, Wallace et al. (1988) reported a 57 percent continuous abstinence rate for private clinic patients who were stably married and had successfully completed detoxification and treatment—but results in this study covered only a 6-month period. Another study found that people can reason from the strategy people adopt to how they think about the conflict. In this study, participants heard about someone who had either adopted abstinence or balancing as a strategy.

  • Previous studies suggests that these strict views might prevent people from seeking treatment (Keyes et al., 2010; Wallhed Finn et al., 2014).
  • In one set of studies, they defined two types of strategies for participants—abstinence versus a “balancing” strategy.
  • Moderated drinking could give you the space to address those issues you’ve been pushing aside.
  • It is also worthwhile considering the chemical effect of alcohol addiction on the body and the way alcohol withdrawal affects it.
  • Interventions based on harm reduction principles have decreased alcohol use in various student populations.

Many advocates of harm reduction believe the SUD treatment field is at a turning point in acceptance of nonabstinence approaches. Indeed, a prominent harm reduction psychotherapist and researcher, Rothschild, argues that the harm reduction approach represents a “third wave of addiction treatment” which follows, and is replacing, the moral and disease models (Rothschild, 2015a). This paper presents a narrative review of the literature and a call for increased research attention on the development of empirically supported nonabstinence treatments for SUD to engage and treat more people with SUD.

Drinking Goals in Alcoholism Treatment

Experiences of the 12-step programmes and AA meetings were useful for a majority of the clients. Thus, it was not the sobriety goal in itself that created problems, but the strict belief presenting this goal as “the only way”. The results suggest the importance of offering interventions with various treatment goals and that clients choosing CD as part of their sustained recovery would benefit from support in this process, both from peers and from professionals. In parallel with the view on abstinence as a core criterion for recovery, controlled drinking (CD) has been a recurring concept and in focus from time to time in research on alcohol problems for more than half a century (Davies, 1962; Roizen, 1987; Saladin and Santa Ana, 2004). It caused heated debates, and for a long time, it has had a rather limited impact on professional treatment systems (Coldwell and Heather, 2006). Recently, in many European countries (Klingemann and Rosenberg, 2009; Klingemann, 2016; Davis et al., 2017) and in the USA (Coldwell, 2005; Davis and Rosenberg, 2013), professionals working with clients with severe problems and clients in inpatient care tend to have abstinence as a treatment goal .

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.

And even if you don’t plan to quit, you may find that you lose interest in alcohol after practicing moderation. Successful moderation involves understanding yourself (what factors trigger excessive drinking), planning (how much you are going to drink and how you are going to stop), and taking concrete steps to exit or avoid situations where you won’t be able to moderate. Limited social drinking is a realistic goal for some people who struggle with alcohol, and should definitely be considered by people who have not been able to successfully adhere to abstinence.

  • Our second goal was to examine differences in quality of life betweenabstainers and non-abstainers controlling for length of time in recovery.
  • Once you are able to control how much you drink, you may find that you’re better able to enjoy family gatherings, social events, and work events.
  • However, CD is a widely accepted treatment goal in Australia, Britain and Norway (Luquines et al., 2011).
  • 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).

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