In Europe, about half (44–46%) of individuals seeking treatment for AUD have non-abstinence goals (Haug & Schaub, 2016; Heather, Adamson, Raistrick, & Slegg, 2010). In the U.S., about 25% of patients seeking treatment for AUD endorsed nonabstinence goals in the early 2010s (Dunn & Strain, 2013), while more recent clinical trials have found between 82 and 91% of those seeking treatment for AUD prefer nonabstinence goals (Falk et al., 2019; Witkiewitz et al., 2019). The ability to control drinking varies significantly from person to person and is influenced by a range of factors including genetics, environment, emotional state, and individual psychology. For people suffering from alcohol use disorders, trying to moderate drinking isn’t advised and total abstinence is always recommended. Finally, in terms of financial, social, and relationship outcomes, participants identified not getting in trouble with the law as their primary concern.
MUD prevalence rates more than doubled in White, Hispanic and Asian/Native Hawaiian/Other Pacific Islander populations from 2015 to 2019, with prevalence in Black people increasing approximately six-fold during that time 1. Although White people have experienced increased overdose deaths involving methamphetamine, minoritized populations have been especially hard hit 1, 2. Further, recent evidence points to “twin” opioid and methamphetamine epidemics, particularly in rural communities, where methamphetamine surpassed opioids as the most injected substance 3. This Therapeutics Letter considers whether we should prescribe antidepressants to people with alcohol use disorder (AUD) and other substance use disorders (SUDs). Because alcohol use disorder is the most prevalent and well-studied SUD, this Letter focuses on the evidence from AUD. It also explores what is known about use of antidepressants in people with non-alcohol SUDs.
1.1. Harm reduction treatments specific to alcohol use disorder
Data collected with open ended questions were manually categorized in Microsoft Excel. This was done by developing a codebook that focused on the selected outcomes, which was also informed by the lived experience of two members of the research team, including personal experience with SUD and years of experience overseeing direct recovery support services at a recovery community center. These two coders independently reviewed the open-ended responses, and iteratively classified responses across the emerging categories to reach consensus on the resulting themes. Other members of the team audited the resulting themes for consistency and construct validity.
American Psychological Association
Finally, there is also a need for increased funding for holistic recovery support services that include programming focused on building recovery capital and supporting a broad range of recovery-oriented goals (e.g., nutrition, meditation, healthy relationships, and financial planning). Although abstinence remains the dominant paradigm for SUD recovery, findings from this study suggest that PWUM are more concerned with symptom remission than complete abstinence and may be more responsive to less demanding treatment targets. Perhaps the most notable gap identified by this review is the dearth of research empirically evaluating the effectiveness of nonabstinence approaches for DUD treatment.
This approach underestimates the compulsive nature of addiction and the neurological changes that occur with prolonged alcohol misuse. For individuals with severe alcohol dependence, abstinence remains the most effective and safe strategy to avoid the devastating consequences of alcohol-related health issues, social disruption, and the potential for relapse. While you may see the appeal in a programme that allows for some level of drink intake, it’s crucial to consider the potential drawbacks that could come with this approach.
However, it is also possible that adaptations will be needed for individuals with nonabstinence goals (e.g., additional support with goal setting and monitoring drug use; ongoing care to support maintenance goals), and currently there is a dearth of research in this area. An additional concern is that the lack of research supporting the efficacy of established interventions for achieving nonabstinence goals presents a barrier to implementation. The past 20 years has seen growing acceptance of harm reduction, evidenced in U.S. public health policy as well as SUD treatment research. Thirty-two states now have legally authorized SSPs, a number which has doubled since 2014 (Fernández-Viña et al., 2020). Regarding SUD treatment, there has been a significant increase in availability of medication for opioid use disorder, especially buprenorphine, over the past two decades (opioid agonist therapies including buprenorphine are often placed under the “umbrella” of harm reduction treatments; Alderks, 2013). Nonabstinence goals have become more widely accepted in SUD treatment in much of Europe, and evidence suggests that acceptance of controlled drinking has increased among U.S. treatment providers since the 1980s and 1990s (Rosenberg, Grant, & Davis, 2020).
1.4. Risk reduction interventions
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). The harm reduction movement, and the wider shift toward addressing public health impacts of drug use, had both specific and diffuse effects on SUD treatment research. In 1990, Marlatt was introduced to the philosophy of harm reduction during a trip to the Netherlands (Marlatt, 1998). He adopted the language and framework of harm reduction in his own research, and in 1998 published a seminal book on harm reduction strategies for a range of substances and behaviors (Marlatt, 1998).
Reasons Abstinence From Alcohol May Be the Best Choice
- It is unclear whether PWUM deem abstinence to be essential in order to accomplish this kind of stability.
- Of equal concern for routine prescribing of antidepressants to people with SUDs is the evidence suggesting lack of benefit – especially for the drugs most often prescribed.
- Goodwin, Crane, & Guze (1971) found that controlled-drinking remission was four times as frequent as abstinence after eight years for untreated alcoholic felons who had “unequivocal histories of alcoholism”.
- Therefore, our programme includes evidence-based therapies such as cognitive behavioural therapy (CBT) or dialectical behaviour therapy (DBT).
The only way to ascertain for certain whether you are capable of having just one or two drinks is to Sober House Rules: What You Should Know Before Moving In try it over a period of time, say 6 months. If during that time, you only ever drink the amount you intend to, and no problems arise as a result of the drinking, then you have found the way that works for you. If you don’t consider yourself an alcoholic or don’t feel comfortable labeling yourself one, practicing moderation helps you avoid having that discussion when you’re not in the mood.
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. It’s a healthy https://yourhealthmagazine.net/article/addiction/sober-houses-rules-that-you-should-follow/ step in a positive direction, and is often achievable with medication.
Four themes that emerged from their responses, with counts of unique and exemplary responses, are displayed in Table 5. Here, participants added nuance by expressing widely varying degrees of acceptance for different substance-related recovery outcomes. In contrast, other participants limited important substance-related recovery outcomes to abstinence from “harder drugs” such as one who shared “every one of them except the marijuana, tobacco, and suboxone.
A flight from evidence-based practice?
Furthermore, younger (under 40), single alcoholics were far more likely to relapse if they were abstinent at 18 months than if they were drinking without problems, even if they were highly alcohol-dependent (Table 3). Thus the Rand study found a strong link between severity and outcome, but a far from ironclad one. Severity of alcoholism is the most generally accepted clinical indicator of the appropriateness of CD therapy (Rosenberg, 1993).
- He adopted the language and framework of harm reduction in his own research, and in 1998 published a seminal book on harm reduction strategies for a range of substances and behaviors (Marlatt, 1998).
- Consequently, the abstinence-only approach increases the risk for adverse consequences, including overdose 28, 29.
- However, these interventions also typically lack an abstinence focus and sometimes result in reductions in drug use.
- Our findings indicate the importance of non-abstinent recovery outcomes among PWUM, suggesting high acceptability of non-abstinent recovery targets by people with lived experience.
Alcoholism: Abstinence Versus Controlled Drinking
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. To date there has been limited research on retention rates in nonabstinence 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. 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).
The Moderation Management Program
- Some people find it’s still too overwhelming to be around alcohol, and it’s too hard to change their habits.
- Further, the essential importance of non-abstinent outcomes, especially in the financial/social/relationship and mental health domains, were highlighted, providing novel targets for delivering SUD treatment/recovery.
- Individuals participating over the phone provided a waiver of documentation of informed consent.
- Similarly, 90% reported that not using substances is “very important” or “essential to recovery”.
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.
Controlled drinking, also known as moderation management or harm reduction, is an approach to addressing alcohol use problems that aims to reduce alcohol consumption to safer levels rather than achieving complete abstinence. This strategy is primarily targeted at individuals who have experienced problems related to their drinking but do not meet the criteria for severe alcohol use disorder (AUD). Controlled drinking, often advocated as a moderation approach for people with alcohol use disorders, can be highly problematic and unsuitable for those who truly suffer from alcohol addiction. Alcoholism is characterised by a loss of control over one’s drinking behaviour and an inability to consistently limit consumption.