Abstinence Vs Moderation: WhatS Best For Alcohol Recovery?

Some strategies and guidelines to consider if you’re aiming to practice controlled drinking include setting limits, eating before drinking, choosing drinks with lower alcohol content, alternatives with non-alcoholic beverages and having abstinent days. Our approach is not one-size-fits-all; instead, it’s grounded in empathy, respect for your individuality, and a deep understanding of how alcohol misuse impacts different people in different ways. That’s why our approach involves taking time to know you better, identify your triggers, and help chart a path forward that aligns with your life goals. 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. Regular physical activity can act as a healthy coping mechanism when dealing with cravings or anxiety related to your efforts towards alcohol moderation management.

Future research must test the effectiveness of nonabstinence treatments for drug use and address barriers to implementation. The current review highlights a notable gap in research empirically evaluating the effectiveness of nonabstinence approaches for DUD treatment. While multiple harm reduction-focused treatments for AUD have strong empirical support, there is very little research testing models of nonabstinence treatment for drug use.

. Associations between substance use status and current indices of well-being

The success of treatment depends on factors like the person’s motivation, support system, and the severity of their condition. Abstinence is often considered the primary goal for alcohol treatment, especially for individuals with severe alcohol use disorder (AUD). For some individuals, harm reduction strategies, such as moderating drinking or improving overall health and functioning, may be more realistic and beneficial.

One Glass a Day? The Impact of Low Volume Drinking on Mortality Risk

Its structured nature, clear goals, and emphasis on behavioral change make it a powerful tool for achieving and maintaining sobriety. However, its effectiveness is contingent on individual readiness and commitment, as well as the availability of comprehensive support systems. For those who embrace abstinence as a goal, the potential for long-term recovery and improved quality of life is substantial. As the field of addiction treatment continues to evolve, abstinence-based programs remain a vital and evidence-based option for addressing alcohol use disorder. Multiple versions of harm reduction psychotherapy for alcohol and drug use have been described in detail but not yet studied empirically.

5. Feasibility of nonabstinence goals

The debate between controlled drinking and abstinence approaches continues in the addiction treatment field. While abstinence is generally considered the safest option, especially for those with severe AUD, controlled drinking may be a viable alternative for some individuals. Full abstinence leads to reduced physical and mental health risks, improved physical and psychological health, and greater well-being. Specifically among older persons, better outcomes are experienced with abstinence rather than controlled drinking. Remember that every person’s journey is unique; there are no one-size-fits-all solutions for managing alcohol intake. People suffering from alcohol addiction will thrive in absolute abstinence and find solace in sobriety groups like Alcoholics Anonymous, while others will less severe drinking habits will be able to manage their relationship with alcohol through controlled moderation techniques without feeling deprived or isolated socially.

Further, people appear to gravitate toward abstinence/lower risk substance use with greater time since problem resolution. By comparison, whether someone attended treatment, and the severity of their alcohol problem were not significantly related to quality of life. Controlled drinking is not appropriate for individuals with severe AUD or those with certain medical conditions exacerbated by alcohol use. Abstinence is characterized by a commitment to an alcohol-free, sober lifestyle, which is supported by detox, psychotherapy, medications, and peer support groups like Alcoholics Anonymous (AA) or SMART Recovery. Going cold turkey on your own can lead to discomforting and even dangerous withdrawal symptoms, so always consider medical care controlled drinking vs abstinence addiction recovery if you choose abstinence. When you begin to drink more and more often and become wary of what it is doing to your mind and body, there will come a point where you want to change your relationship with alcohol.

We focus our review on two well-studied approaches that were initially conceptualized – and have been frequently discussed in the empirical literature – as client-centered alternatives to abstinence-based treatment. Of note, other SUD treatment approaches that could be adapted to target nonabstinence goals (e.g., contingency management, behavioral activation) are excluded from the current review due to lack of relevant empirical evidence. Despite the growth of the harm reduction movement globally, research and implementation of nonabstinence treatment in the U.S. has lagged. Most U.S. treatment providers still utilize abstinence-focused approaches such as 12 Step Facilitation and AA/NA groups as a mandatory aspect of treatment (SAMHSA, 2017), and while providers demonstrate growing acceptance of controlled drinking, acceptance of nonabstinence outcomes for drug use remains very low (Rosenberg et al., 2020). Furthermore, abstinence remains a gold standard treatment outcome in pharmacotherapy research for drug use disorders, even after numerous calls for alternative metrics of success (Volkow, 2020).

Controlled drinking as well as abstinence is an appropriate goal for the majority of problem drinkers who are not alcohol-dependent. In addition, while controlled drinking becomes less likely the more severe the degree of alcoholism, other factors—such as age, values, and beliefs about oneself, one’s drinking, and the possibility of controlled drinking—also play a role, sometimes the dominant role, in determining successful outcome type. Finally, reduced drinking is often the focus of a harm-reduction approach, where the likely alternative is not abstinence but continued alcoholism. 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). Regular attendance at support group meetings, ongoing therapy sessions, and maintaining open communication with loved ones can all contribute to sustained sobriety.

Emotional resilience begins to grow as you learn new ways to cope with stress or anxiety without reaching for a drink. A key aspect of abstinence is understanding and navigating through the withdrawal process – a daunting task indeed but necessary for recovery. The severity of these symptoms can vary widely depending on how much you are drinking, how frequently, and your overall physical health. For each substance with lifetime use, participants indicated the age at which they first used the substance, age at which they initiated regular use (i.e.., weekly) if applicable, and age of last use for substances they no longer used at the time of survey completion.

However, this approach can be exclusionary, as it may not account for the complexities of individual circumstances, such as cultural attitudes toward alcohol or personal readiness for complete sobriety. For some, the all-or-nothing mindset can lead to feelings of failure and discouragement if abstinence is not achieved, potentially deterring them from seeking further treatment. Additionally, abstinence-only programs may not address underlying issues such as trauma, mental health disorders, or social determinants of health that contribute to alcohol misuse. However, the effectiveness of abstinence-based treatment is not universal, and its success often depends on individual factors such as motivation, social support, and the severity of the addiction. Some critics argue that a one-size-fits-all abstinence approach may not address the diverse needs of individuals with AUD, particularly those with milder forms of the disorder or those who are not ready to commit to lifelong sobriety.

Psychological distress

• 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.
• The success of controlled drinking largely depends on an individual’s ability to consistently adhere to set limits and develop healthier coping mechanisms.
• For most alcoholics, total abstinence is considered the safest and most effective approach to recovery, as even moderate drinking can lead to relapse.
• Total abstinence is emphasized because alcoholism is a chronic disease, and any alcohol consumption can trigger cravings and lead to a return to problematic drinking.
• Over time, a sober lifestyle is better – abstinence indeed shows stronger positive outcomes compared to moderation.

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). Marlatt, in particular, became well known for developing nonabstinence treatments, such as BASICS for college drinking (Marlatt et al., 1998) and Relapse Prevention (Marlatt & Gordon, 1985). Like the Sobells, Marlatt showed that reductions in drinking and harm were achievable in nonabstinence treatments (Marlatt & Witkiewitz, 2002). For instance, family members and friends can help create a sober living environment by removing alcohol from the home and engaging in activities that do not revolve around drinking.

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 claims. AA was established in 1935 as a nonprofessional mutual aid group for people who desire abstinence from alcohol, and its 12 Steps became integrated in SUD treatment programs in the 1940s and 1950s with the emergence of the Minnesota Model of treatment (White & Kurtz, 2008). The Minnesota Model involved inpatient SUD treatment incorporating principles of AA, with a mix of professional and peer support staff (many of whom were members of AA), and a requirement that patients attend AA or NA meetings as part of their treatment (Anderson, McGovern, & DuPont, 1999; McElrath, 1997). This model both accelerated the spread of AA and NA and helped establish the abstinence-focused 12-Step program at the core of mainstream addiction treatment. In a national study of SUD treatment centers that same year, 95% of treatment center administrators reported their programs were based on AA’s 12-Step model; demonstrating the wide adoption of AA’s abstinence-focused approach, 90% of administrators indicated that abstinence was the only acceptable goal for recovery from SUD (Miller, 1994).

From a broader public health perspective, increasing access to effective SUD interventions and recovery support services is likely to enhance their overall impact (Glasgow et al., 2003). Thus, it is believed that greater adoption of flexible, patient-centered treatment and recovery approaches that support non-abstinence goals and harm reduction are likely to attract and engage more individuals in substance use related health behavior change, in turn benefitting public health. The concept of abstinence as a goal in alcohol treatment has been a subject of debate, and its psychological impacts are multifaceted.

• Alternatively, researchers who conduct trials in community-based treatment centers will need to obtain buy-in to test nonabstinence approaches, which may necessitate waiving facility policies regarding drug use during treatment – a significant hurdle.
• While research examining non-abstinent recovery is ongoing, one area in recovery research receiving less focus is quality of life, often considered a key piece of the recovery process.
• For those who embrace abstinence as a goal, the potential for long-term recovery and improved quality of life is substantial.
• In a nutshell, if your drinking has not yet led to any major concerns of abuse or dependence, or other health complications, then moderation with strict limits can be good for you.
• 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.

Support groups, such as Alcoholics Anonymous (AA), offer a safe and non-judgmental environment where members can share their experiences, strengths, and hopes with peers who truly understand the challenges they face. This sense of belonging and camaraderie can be a powerful motivator for change and can help individuals feel less alone in their struggles. Moreover, these groups often provide a structured framework for recovery, offering guidance and a clear path towards sobriety, which can be particularly beneficial for those who thrive in a supportive community setting.

1 Non-abstinent recovery from alcohol use disorders

This cultural difference highlights how societal norms influence the treatment and understanding of alcoholism, suggesting that total abstinence may not be the only choice in every context. For alcoholics in such environments, moderation might be a more culturally aligned and feasible goal, provided it is carefully monitored and supported. For those with mild to moderate AUD, controlled drinking or harm reduction strategies may be viable options. Abstinence remains the safest and most recommended path for those with severe AUD or a history of failed attempts at moderation.