Alcohol Moderation Management: Programs and Steps to Control Drinking

However, it’s important to note that we do not really know which drugs are the most dangerous for which people, which people are more vulnerable to drug addictions, or when a person might be more vulnerable to drug addictions or overdose than others. We do know that smoking and injection are the most dangerous routes of drug administration and that overdoses are more likely to happen when fentanyl, opioids, cocaine, and amphetamines are involved. California sober is not medically recognized, lacking scientific evaluation regarding its efficacy or even safety for people with addictions. Studies of controlled drinking have been promising and suggests the treatment is successful for dependent people who have not experienced a serious addiction to alcohol, have a stable job, adequate social support, middle income and a good education. 3 In severe alcoholics, controlled drinking that may or may not include Selincro treatment was not as successful. These results showed a slow erosion in the ability to control alcohol consumption; thus, leading back into heavy drinking.

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. A number of studies have examined psychosocial risk reduction interventions for individuals with high-risk drug use, especially people who inject drugs. In contrast to the holistic approach of harm reduction psychotherapy, risk reduction interventions are generally designed to target specific HIV risk behaviors (e.g., injection or sexual risk behaviors) without directly addressing mechanisms of SUD, and thus are quite limited in scope.

• Abstinence rates became the primary outcome for determining SUD treatment effectiveness (Finney, Moyer, & Swearingen, 2003; Kiluk, Fitzmaurice, Strain, & Weiss, 2019; Miller, 1994; Volkow, 2020), a standard which persisted well into the 1990s (Finney et al., 2003).
• Recognise patterns of thought that lead to excessive drinking like stress, boredom or loneliness; addressing these underlying issues is often a key part of cutting down or cutting out alcohol.
• This approach underestimates the compulsive nature of addiction and the neurological changes that occur with prolonged alcohol misuse.
• The realization that HIV had been spreading widely among people who injected drugs in the mid-1980s led to the first syringe services programs (SSPs) in the U.S. (Des Jarlais, 2017).

1.1. Harm reduction treatments specific to alcohol use disorder

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. Vaillant (1983) labeled abstinence as drinking less than once a month and including a binge lasting less than a week each year. In sum, research suggests that achieving and sustaining moderate substance use after treatment is feasible for between one-quarter to one-half of individuals with AUD when defining moderation as nonhazardous drinking.

1. Review aims

In 1990, Marlatt was introduced to the philosophy of harm reduction during a trip to the Netherlands (Marlatt, 1998). 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). Marlatt’s work inspired the development https://weekbaby.ru/muzyka/655-club-music-and-singles-tunnel-2cd-2016.html of multiple nonabstinence treatment models, including harm reduction psychotherapy (Blume, 2012; Denning, 2000; Tatarsky, 2002). Additionally, while early studies of SUD treatment used abstinence as the single measure of treatment effectiveness, by the late 1980s and early 1990s researchers were increasingly incorporating psychosocial, health, and quality of life measures (Miller, 1994).

1. Nonabstinence treatment effectiveness

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. Despite the reported relationship between severity and CD outcomes, many diagnosed alcoholics do control their drinking. The Rand study quantified the relationship between severity of alcohol dependence and controlled-drinking outcomes, although, overall, the Rand population was a severely alcoholic one in which “virtually all subjects reported symptoms of alcohol dependence” (Polich, Armor, and Braiker, 1981).

• That’s why our approach involves taking time to know you better, identify your triggers, and help chart a path forward that aligns with your life goals.
• Lack of consensus around target outcomes also presents a challenge to evaluating the effectiveness of nonabstinence treatment.
• Several factors influence this decision, including societal perception, cultural factors, psychological impact, and health implications.
• Previous reviews have described nonabstinence pharmacological approaches (e.g., Connery, 2015; Palpacuer et al., 2018), which are outside the scope of the current review.
• Multivariable stepwise regressions (Table2) show that younger individuals were significantly more likely to benon-abstinent, and movement to the next oldest age category reduced the odds ofnon-abstinence by an average of 27%.
• Most people who seek out moderation management (MM) have already tried and been unsuccessful at stopping drinking or cutting down on their use.

Expanding the continuum of substance use disorder treatment: Nonabstinence approaches

• We prefer drinking our intoxicants like alcohol or coffee, and now Cali Sober bars are offering cannabis, kava, and kratom drinks.
• 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.
• California sober is not medically recognized, lacking scientific evaluation regarding its efficacy or even safety for people with addictions.
• Lovato’s hit song highlighted a new and alternative post-overdose and rehab treatment approach — moderated or California sobriety.
• They also may be willing to accept less cocaine use, less methamphetamine use, or less fentanyl use as they expand definitions of addiction treatment success beyond abstinence.

Finally, we hope tofurther investigate the overlap between “remission” and“recovery” from AUD, especially in the context of harm reduction. The controlled drinking approach is based on the idea that not all problem drinkers require complete abstinence to improve their health and well-being. For some individuals, learning to moderate their alcohol consumption can be an effective way to reduce alcohol-related harm while maintaining a level of social drinking. Nordström and Berglund, like Wallace et al. (1988), selected high-prognosis patients who were socially stable. The Wallace et al. patients had a high level of abstinence; patients in Nordström and Berglund had a high level of controlled drinking.

At the same time, complete abstinence sometimes isn’t achievable, and reduced use may lead to sobriety after a while for some. Lovato’s hit song highlighted a new and alternative post-overdose and rehab treatment approach — moderated or California sobriety. However, by December 2021, she completely reversed herself away from the California sober lifestyle, stating, “Sober sober is the only way to be.” This important change was not as widely covered as the suggestion that after a substance use disorder (SUD), you might still be able to use some drugs. It is also worthwhile considering the chemical effect of alcohol addiction on the body and the way alcohol withdrawal affects it. The person that decides to drink socially or now and then, is going to be consistently re-introducing that substance to the body, therefore always leaving the body craving more. Those who choose abstinence will completely avoid all alcohol, including that in food or in hygiene products such as mouthwash.

Differences between abstinent and non-abstinent individuals in recovery from

In addition to issues with administrative discharge, abstinence-only treatment may contribute to high rates of individuals not completing SUD treatment. About 26% of all U.S. treatment episodes end by individuals leaving the treatment program prior to treatment completion (SAMHSA, 2019b). Studies https://depressiontreatmentsolutions.com/7-things-look-choosing-inpatient-recovery-facility-arizona/ which have interviewed participants and staff of SUD treatment centers have cited ambivalence about abstinence as among the top reasons for premature treatment termination (Ball, Carroll, Canning-Ball, & Rounsaville, 2006; Palmer, Murphy, Piselli, & Ball, 2009; Wagner, Acier, & Dietlin, 2018).

Help for Achieving Lasting Recovery

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).