Australia & New Zealand

Moderation Management: Does Controlled Drinking Work?

A brief description of the controversy surrounding controlled drinking provides a context for a discussion of various approaches to controlled drinking intervention as well as relevant clinical research. At the first interview all IPs were abstinent and had a positive view on the 12-step treatment, although a few described a cherry-picking attitude. As the IP had a successful outcome, six months after treatment, their possibilities for CD might be better than for persons with SUD in general. On the other hand, as the group expressed positive views on this specific treatment, they might question the sobriety goal in a lesser extent than other groups.

Tree-based methods originated with the development of automatic interaction detection (AID) algorithms by Morgan and Sonquist (1963), Morgan and Messenger (1973) (THAID) and Kass (1980) (CHAID). Classification And Regression controlled drinking vs abstinence Tree (CART) methods were formalized by Breiman et al. (1984). Modern developments include deterministic and random forests (Zhang and Singer, 2010) and take full advantage of the computational power available today.

The Benefits of Quitting Drinking for Good

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. Harm reduction may also be well-suited for people with high-risk drug use and severe, treatment-resistant SUDs (Finney & Moos, 2006; Ivsins, Pauly, Brown, & Evans, 2019). These individuals are considered good candidates for harm reduction interventions because of the severity of substance-related negative consequences, and thus the urgency of reducing these harms. 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).

controlled drinking vs abstinence

Some clients expressed a need for other or complementary support from professionals, whereas others highlighted the importance of leaving the 12-step community to be able to work on other parts of their lives. The descriptions on how the tools from treatment were initially used to deal with SUD and were later used to deal with other problems in the lives of IPs can be put in relation to the differentiation between abstinence and sobriety suggested by Helm (2019). While abstinence refers to behaviour, sobriety goes deeper and concerns the roots of the problem (addiction) and thereby refers to mental and emotional aspects. Differentiating these concepts opens up for recovery without necessarily having strong ties with the recovery community and having a life that is not (only) focused on recovery but on life itself.

How Do You Practice Controlled Drinking?

A considerable number of clients reported changed views on the programme, some were still abstinent and some were drinking in a controlled way. Some of the abstainers still attended meetings because of a fear of what might happen if they stopped, although they questioned parts of the philosophy. 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).

The next AA? Welcome to Moderation Management, where abstinence from alcohol isn’t the answer – The Guardian

The next AA? Welcome to Moderation Management, where abstinence from alcohol isn’t the answer.

Posted: Mon, 16 Mar 2015 07:00:00 GMT [source]

In three Swedish projects, on recovery from SUD, 56 clients treated in 12-step programmes were interviewed approximately six months after treatment (Skogens and von Greiff, 2014, 2016; von Greiff and Skogens, 2014, 2017; Skogens et al., 2017). Clients were recruited via treatment units (outpatient and inpatient) in seven Swedish city areas. Inclusion criteria were drawn up to recruit interviewees able to reflect on their process of change. Therefore, the client should be at the end of or have recently completed post-treatment intervention and be judged by a professional to be in a positive change process regarding their SUD. In the initial interviews, all the clients declared themselves abstinent and stressed that substance use in any form was not an option. These answers will vary from individual to individual, and your choice of moderation vs. abstinence is a personal one.

Does Controlled Drinking Work for Alcoholics?

We first describe treatment models with an explicit harm reduction or nonabstinence focus. While there are multiple such intervention approaches for treating AUD with strong empirical support, we highlight a dearth of research testing models of harm reduction treatment for DUD. Next, we review other established SUD treatment models that are compatible with non-abstinence goals.

It’s not an easy road to lasting recovery, but with the right support and resources, it can definitely be a journey worth taking. Setting up personal guidelines and expectations—and tracking results—can make maintaining moderation easier. Drinking is often a coping strategy subconsciously used to avoid having to deal with uncomfortable or painful issues.

Stephanie S. O’Malley

Sobriety is a journey and all the individual needs for success is to keep on moving forward. This means facing all the challenges that appear along the way, and seeking out the right type of help and support. As the months and years in sobriety accumulate, dealing with life becomes a lot easier. It is important to realize, though, that the end of the path is never quite reached no matter how long people remain sober.


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