Abstinence vs Harm Reduction Drug Treatment: Which Is Best?

For those considering controlled drinking, it’s crucial to consult with a healthcare professional or addiction specialist to determine if this approach is appropriate and to develop a personalized plan. Remember that if controlled drinking proves challenging or ineffective, abstinence-based approaches are always available and may be the safer, more effective option for many individuals struggling with alcohol use problems. Rychtarik et al. found that treatment aimed at abstinence or controlled drinking was not related to patients’ ultimate remission type. Booth, Dale, and Ansari (1984), on the other hand, found that patients did achieve their selected goal of abstinence or controlled drinking more often. Miller et al. (in press) found that more dependent drinkers were less likely to achieve CD outcomes but that desired treatment goal and whether one labeled oneself an alcoholic or not independently predicted outcome type. Harm reduction programs are important when considering treatment options for substance use disorders.

Abstinence vs. Drinking in Moderation: Which is Right for You?

Additional research should examine whether remission from AUD diagnostic symptoms, which were not examined in the current study, controlled drinking vs abstinence addiction recovery are useful in defining recovery or whether focusing on well-being and psychological functioning is sufficient to characterize recovery from AUD. 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.

Treatment and mutual-help measures

• Researchers have long posited that offering goal choice (i.e., non-abstinence and abstinence treatment options) may be key to engaging more individuals in SUD treatment, including those earlier in their addictions (Bujarski et al., 2013; Mann et al., 2017; Marlatt, Blume, & Parks, 2001; Sobell & Sobell, 1995).
• 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).
• The rules that MM provides can help people understand when they’re going overboard.
• Thus building upon the spiritual, emotional, and physical aspects for a higher achievable long-term outcome.
• 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.

Thus relying on DSM criteria to define a sample of individuals in recovery mayunintentionally exclude individuals who are engaging in non-abstinent or harm reductiontechniques and making positive changes in their lives. Multiple theories of motivation for behavior change support the importance of self-selection of goals in SUD treatment (Sobell et al., 1992). For example, Bandura, who developed Social Cognitive Theory, posited that perceived choice is key to goal adherence, and that individuals may feel less motivation when goals are imposed by others (Bandura, 1986). Miller, whose seminal work on motivation and readiness for treatment led to multiple widely used measures of SUD treatment readiness and the development of Motivational Interviewing, also argued for the importance of goal choice in treatment (Miller, 1985).

4. Consequences of abstinence-only treatment

How the risks of drinking balance out this potential benefit, if it is found to be causal, for those with Type II diabetes is not yet clear. Participants were asked about their substance use history; specifically, which drugs they used ten times or more times in their lifetime. Substances included, ‘alcohol’, ‘marijuana’, ‘cocaine’, ‘heroin’, ‘narcotics other than heroin’, ‘methadone’, ‘buprenorphine’, ‘amphetamines’, ‘methamphetamine’, ‘benzodiazepines’, ‘barbiturates’, ‘hallucinogens’, ‘synthetic marijuana/synthetic drugs’, ‘inhalants’, ‘steroids’, or ‘other’. The success of controlled drinking largely depends on an individual’s ability to consistently adhere to set limits and develop healthier coping mechanisms.

Every month, 150,000 people search for addiction or mental health treatment on Recovery.com. Recovery.com combines independent research with expert guidance on addiction and mental health treatment. Our mission is to help everyone find the best path to recovery through the most comprehensive, helpful network of treatment providers worldwide. If you’re facing your drinking, you’ve probably tried to moderate it before, with little success. The structure and support groups found in MM are likely similar to AA, but with tolerance and more trust put into the person who has a drinking problem.

2. Established treatment models compatible with nonabstinence goals

There’s also specialized alcohol therapy where you receive a personalized treatment plan catered to you and your goals. Lastly, you can join moderated alcohol support groups to get encouragement and gain accountability in a non-judgmental and secure forum. There is no “one size fits all” approach to changing your relationship with alcohol, and all pathways are unique. One person may start out with a moderation goal and later decide that a sober lifestyle more closely supports their aspirations and wellness. Another individual may pursue sobriety and later decide that they want to try to drink in moderation once they’ve clarified their boundaries. The National Institute on Alcohol Abuse and Alcoholism explains in great detail how alcohol affects your brain and the stages of the addiction cycle.

Recovery acknowledges that you have lost control and are unable to manage your use of drugs and alcohol. Admitting that you are no longer able to manage your drinking or drug use is the first step in the healing process and the beginning of your recovery journey. Many individuals believe that getting sober means simply abstaining from drugs or alcohol and that’s it. However, recovery is much more comprehensive and involves the creation of a brand new life of sobriety.

Reflect on the alcohol use disorder criteria

• Empirical support for a broader conceptualization of recovery has been reviewed in recent work16–18 and also expressed by individuals who self-identify as being in recovery19–21.
• Study (WIR) dataset, one of the largest repositoriesof individuals in recovery available.
• Abstinence may not be the easiest addiction treatment approach, but it is the most effective.
• Importantly, the only published study that asked individuals in recovery (fromcrack or heroin dependence in this particular study) how they defined the term revealedthat less than half responded in terms of substance use; the other definitions were moregeneral, such as a process of working on oneself (Laudet2007).
• The results of the assessment help healthcare providers and therapists create your treatment plan.

It has been suggested that individuals who do not want to completely abstain, but who want to moderate their use, do not seek treatment because treatment centers have a front-end requirement for abstinence to receive services (Marlatt et al., 1993). Although abstinence may be the ultimate goal for the clinician and the family and maybe on some level the patient, harm reduction programs involve a compassionate, pragmatic philosophy designed to reduce the harmful consequences of using. To evaluate this question, it’s important to recognize that alcohol use disorder (AUD) is diagnosed on a spectrum, and can be addressed in different ways depending on the individual.

Total abstinence is not the only option when changing your relationship with alcohol. For some people, drinking in moderation can be a viable pathway to a healthier life. According to the National Institute on Alcohol Abuse and Alcoholism (NIAAA), the definition of moderate alcohol use differs for men and women. When a person chooses to be abstinent, it means that they refrain from all alcohol consumption for a duration of time. However, when someone starts on a journey of sobriety, it doesn’t necessarily mean they are committing to a lifetime of abstinence.

Comparing the Health Effects: Abstinence or Moderation?

While sobriety can be achieved by anyone, it’s important to check in with your healthcare provider before making significant changes to your drinking patterns. For individuals with severe alcohol use disorder and possible physical alcohol dependence, quitting cold turkey can cause withdrawal symptoms that may be dangerous or even life-threatening. It’s vital to discuss your goals with a physician to determine how to stop drinking alcohol safely. Treatment professionals can advise if supervised detox is required, and provide next steps tailored to your needs. Unfortunately, there has been little empirical research evaluating this approach among individuals with DUD; evidence of effectiveness comes primarily from observational research. For example, at a large outpatient SUD treatment center in Amsterdam, goal-aligned treatment for drug and alcohol use involves a version of harm reduction psychotherapy that integrates MI and CBT approaches, and focuses on motivational enhancement, self-control training, and relapse prevention (Schippers & Nelissen, 2006).

This paper presents a narrative review of the literature and a call for increased research attention on the development of empirically supported nonabstinence treatments for SUD to engage and treat more people with SUD. We define nonabstinence treatments as those without an explicit goal of abstinence from psychoactive substance use, including treatment aimed at achieving moderation, reductions in use, and/or reductions in substance-related harms. We first provide an overview of the development of abstinence and nonabstinence approaches within the historical context of SUD treatment in the U.S., followed by an evaluation of literature underlying the theoretical and empirical rationale for nonabstinence treatment approaches. Lastly, we review existing models of nonabstinence psychosocial treatment for SUD among adults, with a special focus on interventions for drug use, to identify gaps in the literature and directions for future research.

Pros and Cons of Abstinence vs. Moderation

Contact a treatment provider or explore our rehab directory today to learn more about your rehab options. If you answered ‘yes’ to any of these questions, it may be time to seek help for alcohol misuse and give yourself the gift of sobriety. It can mean a male drinks 15 or more drinks within a week or five or more in a day. Use the app that helps 96.7% of members successfully drink less with no pressure to quit drinking. Harm reduction—a systematic review on effects of alcohol reduction on physical and mental symptoms. Overall, drinking reduction interventions can save hospital systems about $1000 per patient per year.