In the abstinence goal group, 22% reported a successful outcome at 3 months’ follow-up and 30% did so at 12 months’ follow-up, compared with 13 and 23% in the non-abstinence goal group. This difference between goal groups was significant controlled drinking vs abstinence at the 3-month follow-up point but just failed to reach significance at the 12-month point (Table 1). It is well known to clinicians and researchers in the field of alcoholism that patients vary with respect to drinking goal.
Despite compatibility with harm reduction in established SUD treatment models such as MI and RP, there is a dearth of evidence testing these as standalone treatments for helping patients achieve nonabstinence goals; this is especially true regarding DUD (vs. AUD). In sum, the current body of literature reflects multiple well-studied nonabstinence approaches for treating AUD and exceedingly little research testing nonabstinence treatments for drug use problems, representing a notable gap in the literature. 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).
Approaches to Alcoholism Treatment
While there are many obstacles to the widespread acceptance of CD as a treatment approach (Sobell & Sobell 2006), it is important to note that not all individuals entering treatment do so with the goal of achieving abstinence. To that end, the use of abstinence as the dominant drinking goal across alcoholism treatment programs in the United States may in fact deter individuals who would otherwise seek treatment for alcohol problems should CD be proposed as an acceptable goal. Sobell et al. (1992) found that many patients entering an outpatient treatment facility for alcohol problems preferred self-selection of treatment goals, versus adoption of the goals selected by the therapist. Treatment programs that allow for and encourage patient-driven treatment goals may be more appealing, and may lead to greater treatment utilization and engagement. This is particularly important in light of the overall low treatment seeking rates for alcoholism, with only 27.8% of alcohol dependence cases seeking treatment in the past year (Cohen, Feinn, Arias, & Kranzler, 2007).
- 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.
- On balance, this study is one of the few to empirically examine the effect of drinking goal on treatment outcome, and in particular, matching treatment options to drinking goals.
- While patients with goals of complete abstinence did succeed in drinking less frequently and taking longer to relapse to heavy drinking than participants with controlled drinking or conditional abstinence goals, they drank more per drinking day, on average.
In other studies of private treatment, Walsh et al. (1991) found that only 23 percent of alcohol-abusing workers reported abstaining throughout a 2-year follow-up, although the figure was 37 percent for those assigned to a hospital program. According to Finney and Moos (1991), 37 percent of patients reported they were abstinent at all follow-up years 4 through 10 after treatment. There is less research examining the extent to which moderation/controlled use goals are feasible for individuals with DUDs. The most recent national survey assessing rates of illicit drug use and SUDs found that among individuals who report illicit drug use in the past year, approximately 15% meet criteria for one or more DUD (SAMHSA, 2019a).
The Cured Alcoholic
More recent versions of RP have included mindfulness-based techniques (Bowen, Chawla, & Marlatt, 2010; Witkiewitz et al., 2014). The RP model has been studied among individuals with both AUD and DUD (especially Cocaine Use Disorder, e.g., Carroll, Rounsaville, & Gawin, 1991); with the largest effect sizes identified in the treatment of AUD (Irvin, Bowers, Dunn, & Wang, 1999). As a newer iteration of RP, Mindfulness-Based Relapse Prevention (MBRP) has a less extensive research base, though it has been tested in samples with a range of SUDs (e.g., Bowen et al., 2009; Bowen et al., 2014; Witkiewitz et al., 2014). 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. Though programs like Alcoholics Anonymous and other well-known programs meant to aid in the recovery from alcohol use disorders and alcohol misuse require or encourage full abstinence, these are not the only solutions known to help people quit or control drinking.
