Author: Gary Jackson

Controlled Drinking vs Abstinence Addiction Recovery

On the other hand, some clients in the present study had adopted the 12-step principles, intensified their attendance and made it more or less central in their life. 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 authors also stated that future research should examine how various
recovery goals (e.g., abstinence, controlled drinking, harm reduction with continued
drinking) affect QOL (Donovan et al. 2005). Similarly, results from the 2001–02 and 2004–05 NESARC studies showed that
any remission (partial or full) from dependence, whether abstinent or not, was related to
improvements in QOL as measured by the SF-12 (Dawson et al.
2009). However, the NESARC QOL analyses examined transitions across AUD statuses
over a three-year period, and thus inherently excluded individuals with more than three
years of recovery. Therefore, knowledge about whether and how QOL differs between
non-abstinent vs. abstinent recovery remains limited. 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.

Theoretical and empirical rationale for nonabstinence treatment

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). Severity of alcoholism is the most generally accepted clinical indicator of the appropriateness of CD therapy (Rosenberg, 1993). Untreated alcohol abusers probably have less severe drinking problems than clinical populations of alcoholics, which may explain their higher levels of controlled drinking. But the less severe problem drinkers uncovered in nonclinical studies are more typical, outnumbering those who “show major symptoms of alcohol dependence” by about four to one (Skinner, 1990).

• Some clients expressed a need for other or complementary support from professionals, whereas others highlighted the importance of leaving the 12-step community to be able to work on other parts of their lives.
• Finally, the WIR survey did not ask about preferential beverage (e.g., beer, wine,
  spirits), usual quantities of ethanol and other drugs consumed per day, or specifics
  regarding AA involvement; because these factors could impact the recovery process, we will
  include these measures in future studies.
• 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).
• Here we found that a number of factors distinguish non-abstainers from abstainers
  in recovery from AUD, including younger age and lower problem severity.

However, to date there have been no published empirical trials testing the effectiveness of the approach. Individuals with fewer years of addiction and lower severity SUDs generally have the highest likelihood of achieving moderate, low-consequence substance use after treatment (Öjehagen & Berglund, 1989; Witkiewitz, 2008). Notably, these individuals are also most likely to endorse nonabstinence goals (Berglund et al., 2019; Dunn & Strain, 2013; Lozano et al., 2006; Lozano et al., 2015; Mowbray et al., 2013). In contrast, individuals with greater SUD severity, who are more likely to have abstinence goals, generally have the best outcomes when working toward abstinence (Witkiewitz, 2008). Together, this suggests a promising degree of alignment between goal selection and probability of success, and it highlights the potential utility of nonabstinence treatment as an “early intervention” approach to prevent SUD escalation. A considerable number of clients reported changed views on the programme, some were still abstinent and some were drinking in a controlled way.