Overall, increased research attention on nonabstinence treatment is vital to filling gaps in knowledge. For example, despite being widely cited as a primary rationale for nonabstinence treatment, the extent to which offering nonabstinence options increases treatment utilization (or retention) is unknown. In addition to evaluating nonabstinence treatments specifically, researchers could help move the field forward by increased attention to nonabstinence goals more broadly. For example, all studies with SUD populations could include brief questionnaires assessing short-and long-term substance use goals, and treatment researchers could report the extent to which nonabstinence goals are honored or permitted in their study interventions and contexts, regardless of treatment type.
- After transcribing the interviews, the material was analysed thematically (Braun and Clarke, 2006) by coding the interview passages according to what was brought up both manually and by using NVivo (a software package for qualitative data analysis).
- In fact, the founder of Moderation Management, Audrey Kishline, admitted that for her the program had not worked.
- Thus, there might be individuals in the sample who do not consider SUD as their main problem.
- When people aiming for abstinence make a mistake, they may feel like quitting is impossible and give up entirely.
- Alcohol moderation management programmes are often successful when tailored to an individual’s specific needs and circumstances.
More time at home may have contributed to less peer pressure to drink, less time in a “wet” culture, and lifestyle changes that might support a shift towards moderation. Dr. Sam Glazer, a NYU professor of Psychiatry, and his team at Fifth Avenue Psychiatry provide private alcohol addiction treatment in the Manhattan, New York City area and offer controlled drinking programs. In acute alcoholic myopathy, transitory functional rest is recommended, because it avoids muscle stretching and improves local muscle tenderness and pain.
2. Established treatment models compatible with nonabstinence goals
By iteratively analysing and compiling these in an increasingly condensed form, themes were created at an aggregated level, following a process of going back and forth between transcripts and the emerging themes as described by Braun and Clarke (op. cit.). In the present article, descriptions of abstinence and CD and views on and use of the AA and the 12-step programme were analysed. Alcohol has the potential to interfere with many medications, whether they’re prescription or over-the-counter. Because the liver metabolizes both alcohol and many medications (including laxatives), drinking alcohol and taking medications could impact how effective medicines may be. Pancreatic secretion also may be reduced by somatostatin (Halgreen et al, 1986; Lebenthal et al, 1994). Further studies are needed to prove whether somatostatin and its analogue octreotide have any impact on pain in patients with chronic pancreatitis (Halgreen et al, 1986; Malesci et al, 1995).
Moderation Management is a support group system developed by Audrey Kishline, a self-identified “problem drinker” in 1994. Kishline developed the program because while she struggled with drinking too much, she did not identify with abstinence-based programs. Kishline wanted access to a program that could help her to cut back on drinking and moderate because she didn’t believe she was an alcoholic. However, she saw the potential for developing full-blown alcohol dependence if she didn’t change her behavior.
Harm Reduction for Alcohol
For the first step in pain management, nonnarcotic agents, such as acetaminophen or nonsteroidal antiinflammatory drugs (NSAIDs), are recommended. Every patient requires an individualized type and dose of analgesic drug, starting with the lowest dose necessary to control pain. In patients with pain mainly caused by inflammation and by invasion of inflammatory cells, antiinflammatory drugs such as NSAIDs may be helpful.
- Research on young adults, including people in their thirties (Magaraggia and Benasso, 2019), stresses that young adults leaving care tend to have complex problems and struggle with problems such as poor health, poor school performance and crime (Courtney and Dworsky, 2006; Berlin et al., 2011; Vinnerljung and Sallnäs, 2008).
- Most participants had no change in the level of use or increased their use through the trial (68%) or transitioned from low (1-4 days a month) to high (5 or more days a month) frequency use.
- For the first step in pain management, nonnarcotic agents, such as acetaminophen or nonsteroidal antiinflammatory drugs (NSAIDs), are recommended.
- Indeed, about 95% of people with SUD say they do not need SUD treatment (SAMHSA, 2019a).
- 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.
- Perhaps the most notable gap identified by this review is the dearth of research empirically evaluating the effectiveness of nonabstinence approaches for DUD treatment.
- Besides alcohol abstinence, no specific dietary measures have been found to be effective in preventing pancreatic pain.
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. 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.
Purpose of review
Therefore, knowledge about whether and how QOL differs between
non-abstinent vs. abstinent recovery remains limited. A common objection to CD is that most people fail to return to “normal” drinking, and highlighting those able to drink in a controlled way might attract people into relapse, with severe medical and social consequences. On the other hand, previous research has reported that a major reason for not seeking treatment among alcohol-dependent people is the perceived requirement of abstinence (Keyes et al., 2010; Wallhed Finn et al., 2014, 2018). In turn, stigma and shame have been reported as a reason for not seeking treatment (Probst et al., 2015). Although research indicates that CD may be a possible option for sustained recovery, at least for certain groups and at least later in the recovery process, it seems as if the dominating approach of treatment systems is still abstinence. The 12-step approach is widely adopted by alcohol treatment facilities (Galanter, 2016) endorsing total abstinence as the treatment goal.
A better
understanding of the recovery process and tools utilized by non-abstinent vs. abstinent
individuals would inform clinical practice; for example, is it more important for those in
abstinent recovery to have abstinent individuals in their social networks? How do the
specifics of AA and other mutual aid group involvement affect long-term recovery? Finally, we hope to
further investigate the overlap between “remission” and
“recovery” from AUD, especially in the context of harm reduction. 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).
How to prevent constipation while drinking
Pain significantly reduces patients’ quality of life, and pain relief should be one of the main goals of conservative treatment in CP. Pain also may be treated interventionally or surgically, but medical treatment is generally the first-line therapy in patients with painful CP. To compare clinical indicators of improvement among those with SUDs who achieved abstinence or reduced their use, investigators pooled data from 13 randomized clinical trials with more than 2000 patients seeking treatment for cocaine or methamphetamine use disorders at centers in the United States controlled drinking vs abstinence from 2001 to 2017. “This study provides evidence that reducing the overall use of drugs is important and clinically meaningful,” study author Mehdi Farokhnia, MD, MPH, of the National Institute on Drug Abuse, North Bethesda, Maryland, wrote in a press release. “This shift may open opportunities for medication development that can help individuals achieve these improved outcomes, even if complete abstinence is not immediately achievable or wanted.” Regarding the limitations, the completion and conviction of the conclusion may be weakened by the following aspects.
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).