In this case, moderation serves as a harm reduction strategy that minimizes the negative consequences of drinking. “Moderation” is a term that is often used to suggest that a person with an alcohol or drug problem does not really have to give it up but can “control” it. A program called Moderation Management advocates this alternative to abstinence as a solution for a substance abuse disorder2. This team of bath salt drugs researchers undertook to compare self-identified members of Moderation Management with self-identified members of Alcoholics Anonymous (AA). They looked at demographics—who attends AA versus who attends MM—as well as the relative severity of the drinking problems in the two groups. The concept behind harm reduction is meeting the client where they are in terms of their commitment and motivation to change.
Ethics approval and consent to participate
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. Moderation can open a window for you to defuse the emotional challenges that create the craving for relief that alcohol ketamine withdrawal symptoms and recovery provides. While you are taking a break from drinking or limiting your drinking, you have an opportunity to develop better coping skills, address your drinking behaviors, and find healthier ways of dealing with the issues that drinking is covering up.
Purpose of review
Even among those who do perceive a need for treatment, less than half (40%) make any effort to get it (SAMHSA, 2019a). Although reducing practical barriers to treatment is essential, evidence suggests that these barriers do not fully account for low rates of treatment utilization. Instead, the literature indicates that most people with SUD do not want or need – or are not ready for – what the current treatment system is offering. Abstinence is not the only solution for recovering from alcohol use disorders, but it is one of the most studied and successful methods for recovering from alcohol use disorders.
Moderate Drinking is About Having More Control Over Your Drinking
- In 1990, Marlatt was introduced to the philosophy of harm reduction during a trip to the Netherlands (Marlatt, 1998).
- We do not know whether the WIR sample represents the population of individualsin recovery.
- Here we found that a number of factors distinguish non-abstainers from abstainersin recovery from AUD, including younger age and lower problem severity.
- Witkiewitz (2013) has suggestedthat abstinence may be less important than psychiatric, family, social, economic, andhealth outcomes, and that non-consumption measures like psychosocial functioning andquality of life should be goals for AUD research (Witkiewitz 2013).
- 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.
The aim is to investigate how these clients view abstinence and the role of AA[1] in their recovery process during the past five years. There are heterogeneous views on the possibilities of CD after recovery from substance use disorder both in research and in treatment systems. This study on client views on abstinence versus CD after treatment advocating total abstinence can contribute with perspectives on this ongoing discussion. Traditional alcohol use disorder (AUD) treatment programs most often prescribeabstinence as clients’ ultimate goal. “Harm reduction” strategies, on theother hand, set more flexible goals in line with patient motivation; these differ greatlyfrom person to person, and range from total abstinence to reduced consumption and reducedalcohol-related problems without changes in actual use (e.g., no longer driving drunkafter having received a DUI).
Clearly, most research agrees that most alcoholism patients drink at some point following treatment. Altogether, the app may have helped maintain abstinence motivation even after the return to alcohol use which may in turn have been a driving factor for continued stable app use after the return to alcohol use. Four individuals clearly stated that the end of the coaching sessions did not affect their use behavior.
In the present follow-up, the recovery process for clients previously treated for SUD was investigated, focusing on abstinence and CD. All the interviewees had attended treatment programmes following the 12-step philosophy and described abstinence as crucial for their recovery process in the initial interview, five years ago. In previous research, several indicators of whether CD is possible are mentioned (Klingemann and Rosenberg, 2009; Klingemann, 2016; Davis et al., 2017; Luquiens et al., 2011; Berglund et al., 2019). Clients reporting CD in the present study only met one of these criteria – an initial period of abstinence (Booth, 2006; Coldwell and Heather, 2006).
Little attention was given to whether people in abstinence-focused treatments endorsed abstinence goals themselves, or whether treatment could help reduce substance use and related problems for those who did not desire (or were not ready for) abstinence. But if they have a problem with alcohol, taking a harm reduction approach could be a constructive way to help them take a look at the negative consequences of their behavior and motivate them to make positive changes. Most people who seek out moderation management (MM) have already tried and been unsuccessful at stopping drinking or cutting down on their use.
Models of nonabstinence psychosocial treatment for drug use have been developed and promoted by practitioners, but little empirical research has tested their effectiveness. This resistance to nonabstinence treatment persists despite strong theoretical and empirical arguments in favor of harm reduction approaches. Besides its associations with the above-mentioned aspects of treatment, abstinence motivation is also understood as an important determinant before and during the process of the return to substance use [41, 42]. Yet, there is a lack of research on what happens to abstinence motivation after the return to substance use. The return to substance use might be one critical tipping point at which the motivation following the occurrence might influence how individuals continue with abstinence and their treatment.
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. Previous studies suggests that these strict views might prevent people from seeking treatment (Keyes et al., 2010; Wallhed Finn et al., 2014). The present study indicates that the strict views in AA also might prevent clients in AA to seek help and support elsewhere, since they percieve that this conflicts with the AA philosophy (Klingemann and Klingemann, 2017). Initially, AA was not intended to offer a professional programme model for treatment (Alcoholics Anonymous, 2011).
In regard to help-seeking and problem severity, having attended at leastone 12-step meeting and the number of DSM-IV dependence symptoms were both significantlyrelated to non-abstinence. In the fully saturated models, any twelve-step attendancedecreased odds of non-abstinence by 57–76% (Model 4), while each additional DSMsymptom decreased odds of non-abstinence by 73–89% (Model 4). The goal of a moderation program is to support a person’s journey toward understanding their drinking behavior and create a safe environment for them to explore how to drink moderately. Polich, Armor, and Braiker found that the most severely dependent alcoholics (11 or more dependence symptoms on admission) were the least likely to achieve nonproblem drinking at 4 years. However, a quarter or this group who achieved remission did so through nonproblem drinking.
Social stability at intake was negatively related in Rychtarik et al. to consumption as a result either of abstinence or of limited intake. Apparently, social stability predicts that alcoholics will succeed better whether they choose abstinence or reduced drinking. But other research indicates that the pool of those who achieve remission can be expanded by having broader treatment goals. To the best of our knowledge, this is the first mixed-methods alcohol withdrawal delirium study to examine motivation after the return to alcohol use, to explore whether and how a possible change of motivation is reflected in participants’ app use behavior and to identify helpful factors for maintaining motivation. By using a mixed-methods approach, we tried to gain a deeper understanding of the underlying factors of the examined motivational change and aimed to take the complexity of the participants’ experiences into account.
Comparisons between classes derived from the RMLCA on 3-year post-treatment outcomes were examined for PDD, PHDD, DDD, DrInC total score, PFI social behavior subscale, and PFI social role subscale. In the context of “harm reduction,” individuals may make positivechanges in their lives that do not include reduced alcohol use and may consider themselves“in recovery” even though their AUD status remains unchanged (Denning and Little 2012). For example, among the 2005and 2010 National Alcohol Survey respondents, 18% of current drinkers who identified as“in recovery” from alcohol problems (who do not use drugs) are DSM-IValcohol dependent, and 26% of current drinkers who also use drugs are DSM-IV alcoholdependent.
This standard persisted in SUD treatment even as strong evidence emerged that a minority of individuals who receive 12-Step treatment achieve and maintain long-term abstinence (e.g., Project MATCH Research Group, 1998). When they are offered 12-step treatment, they get exposed to these strict views in a different setting than what was initially intended within AA, namely a self-help group that people join voluntarily. Williams and Mee-Lee (2019) have discussed this shift in the 12-step programme and argue that current 12-step-based treatment settings promote practices that run contrary to the spirit of AA. For example, they point out that the original AA teaching endorses abstinence only for people with severe addiction disorders, which in the 12-step approach has been changed to abstinence for all members.
