A key aspect of abstinence is understanding and navigating through the withdrawal process – a daunting task indeed but necessary for recovery. The severity of these symptoms can vary widely depending on how much you are drinking, how frequently, and your overall physical health. As such, I think these results are very encouraging in terms of offering another possible solution for individuals who are looking to reduce their alcohol consumption and the problems that keep creeping up along with it.
2. Controlled drinking
You may feel pressured by society’s view of what is acceptable drinking behaviour or fear being ostracised due to cultural norms surrounding alcohol use. Psychologically, you might be dealing with a range of emotions from guilt over past incidents to anxiety about future relapses. Also, consider your health – excessive drinking can lead to serious conditions like liver disease or heart problems.
Risk of bias within included studies
- Although such support is currently managed by specialist care, primary care stands in a unique position to provide holistic care.
- Additionally, no studies identified in this review compared reasons for not completing treatment between abstinence-focused and nonabstinence treatment.
- Vaillant (1983) labeled abstinence as drinking less than once a month and including a binge lasting less than a week each year.
- 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.
- 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).
Results from their national survey in the UK revealed that controlled drinking was widely acceptable for alcohol misusers, regardless of whether it was their intermediate or final outcome goal. Controlled drinking was less acceptable as an outcome goal for alcohol-dependent drinkers, especially if controlled drinking was their final goal. The finding of higher rates of successful outcome among those choosing abstinence is more noteworthy because it was reported in the companion paper (Heather et al., 2010) that these clients showed more serious alcohol problems than those choosing non-abstinence on a range of variables. This higher severity included higher drinking intensity, greater likelihood of having been detoxified in the 2 weeks prior to assessment, more alcohol problems and greater mental and physical ill-health. It was shown by Adamson et al. (2009) that higher pre-treatment consumption and poorer mental health are consistent predictors of poorer outcome.
UNITED KINGDOM AND UNITED STATES HEALTHCARE PROVIDERS’ RECOMMENDATIONS OF ABSTINENCE VERSUS CONTROLLED DRINKING
On the other hand, the superiority for the abstinence goal group on DDD was significant only at 3 months’ follow-up and only when covariates were not controlled for. Thus, it appears that the greater likelihood of successful outcome in the abstinence goal group may be primarily the result of reduced frequency of drinking rather than reduced drinking intensity. Our research question and study eligibility criteria were designed to align with current practice to bridge the evidence gap in the care pathway of recently detoxified, alcohol dependent patients in a primary care setting. A main strength of our study is the sensitive search strategies and snowballing technique used to retrieve potentially eligible studies. These were required because the titles, abstracts, and indexes of many studies do not contain keywords or are poorly indexed. We also included all available interventions suitable for primary care to provide an extensive list as a reference for clinical practice.
- Models included only random intercepts and excluded any fixed-effect predictors in order to calculate intraclass correlation coefficients (ICC), which reflect the ratio of between-person variance to total variance.
- Table 3 shows that a drinking goal of abstinence continued to predict successful outcome at 3 months but that the trend at 12 months ceased to be significant.
- In 1988 legislation was passed prohibiting the use of federal funds to support syringe access, a policy which remained in effect until 2015 even as numerous studies demonstrated the effectiveness of SSPs in reducing disease transmission (Showalter, 2018; Vlahov et al., 2001).
- Social stability at intake was negatively related in Rychtarik et al. to consumption as a result either of abstinence or of limited intake.
How Successful Are Controlled Drinking Programmes?
Scores above 9 are indicative of alcohol-related problems, and scores above 13 are indicative of meeting criteria for AUD (Doyle and Donovan, 2009; Ross et al., 1990). In other studies of private treatment, Walsh et al. (1991) found that only 23 percent of alcohol-abusing workers https://ecosoberhouse.com/article/what-reasons-for-you-to-stay-sober/ 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.
The Wallace et al. patients had a high level of abstinence; patients in Nordström and Berglund had a high level of controlled drinking. Social stability at intake was negatively related in Rychtarik et al. to consumption as a result either of abstinence or of limited controlled drinking vs abstinence 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.
- In both countries, respondents’ mean ratings corresponded to the levels that were intended when the case-history scenarios were written.
- Additionally, we offer exceptional continuing care so even after completing your programme; you’re never alone in this fight against alcohol addiction.
- Screeners were trained to ensure that the recorded goal reflected the client’s wishes rather than being imposed by the clinician.
- 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).
While this change was not statistically significant, it does suggest that, combined with the larger increase in good outcomes in the non-abstinence preference group than in the abstinence preference group (see Table 1), a learning effect may be occurring in the non-abstinence group leading to somewhat better outcomes over time. Adamson and Sellman (2001) divided non-abstinent goal clients into two groups—those aiming to drink within national drinking guidelines for New Zealand and those aiming to reduce but above the national guideline level. Those aiming to reduce but remain above guidelines had worse outcomes than abstainers while the outcomes for those aiming to drink within guidelines were equivalent to those achieved by those choosing abstinence. Unfortunately, a similar distinction is not possible in the present analysis because clients were not asked about their specific aims when stating their preference of drinking goal. Conclusions Evidence is lacking for benefit from interventions that could be implemented in primary care settings for alcohol abstinence, other than for acamprosate.
Quality of evidence evaluation
Associated Data
