And even if you don’t plan to quit, you may find that you lose interest in alcohol after practicing moderation. Non-abstainers are younger with less time in recovery and less problem severitybut worse QOL than abstainers. Clinically, individuals considering non-abstinent goalsshould be aware that abstinence may be best for optimal QOL in the long run.Furthermore, time in recovery should be accounted for when examining correlates ofrecovery.

Mental Health Newsletter

For example, in AUD treatment, individuals with both goal choices demonstrate significant improvements in drinking-related outcomes (e.g., lower percent drinking days, fewer heavy drinking days), alcohol-related problems, and psychosocial functioning (Dunn & Strain, 2013). 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). A considerable number of clients reported changed views on the programme, some were still abstinent and some were drinking in a controlled way. Some of the abstainers still attended meetings because of a fear of what might happen if they stopped, although they questioned parts of the philosophy. For these clients, the recovery process, aiming to reach sustained recovery in the broader sense covering parts of their lives other than the SUD, was in part at odds with the ongoing participation in AA. 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.

Strengths and limitations of this review

It’s not an easy road to lasting recovery, but with the right support and resources, it can definitely be a journey worth taking.

1. Nonabstinence treatment effectiveness

Our primary effectiveness outcome was continuous abstinence as reported by the trial authors. Since we were generally interested in acceptability of the interventions, we used the number of dropouts (or number lost to follow-up) for any reason as a proxy for acceptability, as a secondary outcome. We sought randomised controlled trials that investigated any treatment intervention (drug, psychological, or both) for maintaining abstinence in recently detoxified, alcohol dependent adults. We were interested only in interventions appropriate for primary care settings and only controlled drinking vs abstinence drugs that are available in the UK. Studies were eligible if the participants were older than 18 years with alcohol dependency diagnosed using standardised diagnostic criteria (eg, Diagnostic and Statistical Manual of Mental Disorders, International Classification of Diseases) or the Alcohol Use Disorders Identification Test (AUDIT; score ≥20). 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.

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). While there have been calls for abstinence-focused treatment settings to relax punitive policies around substance use during treatment (Marlatt et al., 2001; White et al., 2005), there may also be specific benefits provided by nonabstinence treatment in retaining individuals who continue to use (or return to use) during treatment. For example, offering nonabstinence treatment may provide a clearer path forward for those who are ambivalent about or unable to achieve abstinence, while such individuals would be more likely to drop out of abstinence-focused treatment. This suggests that individuals with non-abstinence goals are retained as well as, if not better than, those working toward abstinence, though additional research is needed to confirm these results and examine the effect of goal-matching on retention.

These were required because the titles, abstracts, and indexes of many studies do not contain keywords or are poorly indexed. We also included all available interventions suitable for primary care to provide an extensive list as a reference for clinical practice. Given data demonstrating a clear link between abstinence goals and treatment engagement in a primarily abstinence-based SUD treatment system, it is reasonable to hypothesize that offering nonabstinence treatment would increase overall engagement by appealing to those with nonabstinence goals. Indeed, there https://ecosoberhouse.com/ 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). Additionally, in the United Kingdom, where there is greater access to nonabstinence treatment (Rosenberg & Melville, 2005; Rosenberg & Phillips, 2003), the proportion of individuals with opioid use disorder engaged in treatment is more than twice that of the U.S. (60% vs. 28%; Burkinshaw et al., 2017).

• Alcohol had taken its toll—her job, friends, family, and health had all suffered—and she wanted it out of her life.
• Inclusion criteria were drawn up to recruit interviewees able to reflect on their process of change.
• This study on client views on abstinence versus CD after treatment advocating total abstinence can contribute with perspectives on this ongoing discussion.
• Multivariable stepwise regressions estimating the probability of non-abstinentrecovery and average quality of life.
• You can have an occasional drink without feeling defeated and sliding deeper into a relapse.
• Because he is a member of a support group that stresses the importance of anonymity at the public level, he does not use his photograph or his real name on this website.

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). A recent qualitative study found that concern about missing substances was significantly correlated with not completing treatment (Zemore, Ware, Gilbert, & Pinedo, 2021). Unfortunately, few quantitative, survey-based studies have included substance use during treatment as a potential reason for treatment noncompletion, representing a significant gap in this body of literature (for a review, see Brorson, Ajo Arnevik, Rand-Hendriksen, & Duckert, 2013). Additionally, no studies identified in this review compared reasons for not completing treatment between abstinence-focused and nonabstinence treatment.