Abstinence versus Controlled Drinking as a Treatment Goal

If you have insurance coverage or other means to cover the costs, you can build your own care team. The Navigator can help you find therapists and doctors with addiction specialties to team with your primary care provider. Additionally, we offer exceptional continuing care so even after completing your programme; you’re never alone in this fight against alcohol addiction. Whether it’s through continued counselling or group meetings within the community -we’ll be there every step of the way- supporting you as much as needed so that recovery becomes less daunting and more hopeful.

Two main components of professionally led treatment

  • To reflect current clinical practice, we sought only studies that provided detoxification to participants, as well as studies that recruited participants who had undergone detoxification less than four weeks before randomisation.
  • A focus on abstinence is pervasive in SUD treatment, defining success in both research and practice, and punitive measures are often imposed on those who do not abstain.
  • Interestingly, our findings also demonstrated ambivalence in goal setting about a quarter of the time, with participants reporting a desire to avoid drinking or uncertainty about drinking plans but no specific goal for limiting their drinking.
  • Apparently, social stability predicts that alcoholics will succeed better whether they choose abstinence or reduced drinking.
  • 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.

To create clinically meaningful comparison categories, responses were dummy coded to indicate a moderation drinking goal, abstinence drinking goal, or all other goals. In Britain and other European and Commonwealth countries, controlled-drinking therapy is widely available (Rosenberg et al., 1992). The following six questions explore the value, prevalence, and clinical impact of controlled drinking vs. abstinence outcomes in alcoholism treatment; they are intended to argue the case for controlled drinking as a reasonable and realistic goal. Some strategies and guidelines to consider if you’re aiming to practice controlled drinking include setting limits, eating before drinking, choosing drinks with lower alcohol content, alternatives with non-alcoholic beverages and having abstinent days. Controlled drinking, often advocated as a moderation approach for people with alcohol use disorders, can be highly problematic and unsuitable for those who truly suffer from alcohol addiction. Alcoholism is characterised by a loss of control over one’s drinking behaviour and an inability to consistently limit consumption.

1. Review aims

We found that outcomes were reported over a wide range of time points between three and 24 months. We categorised outcomes (in a slight change from the protocol10) into short (3-6 months), medium (6-12 controlled drinking vs abstinence months), and long (12-24 months) term outcomes. If a trial reported results at multiple time points, we extracted the result at the longest time point within these periods for the main analysis.


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). Early attempts to establish pilot SSPs were met with public outcry and were blocked by politicians (Anderson, 1991). 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). Despite these obstacles, SSPs and their advocates grew into a national and international harm reduction movement (Des Jarlais, 2017; Friedman, Southwell, Bueno, & Paone, 2001).

4. Consequences of abstinence-only treatment

It’s during this period that peer support becomes invaluable; it helps to know that others are experiencing similar struggles or have overcome them already. Adi Jaffe, Ph.D., is a lecturer at UCLA and the CEO of IGNTD, an online company that produces podcasts and educational programs on mental health and addiction. Most of the information collected was self-reported by the participants, which is known to be somewhat problematic, so the researchers also contacted significant others who were used to corroborate the drinking behavior reported by the participants.

Abstinence versus Controlled Drinking as a Treatment Goal

To enable all studies to be included, in the main analysis we combined results reported at the nearest time point to 12 months from each study. Polich, Armor, and Braiker found that the most severely dependent alcoholics (11 or more dependence symptoms on admission) were the least likely to achieve nonproblem drinking at 4 years. Furthermore, younger (under 40), single alcoholics were far more likely to relapse if they were abstinent at 18 months than if they were drinking without problems, even if they were highly alcohol-dependent. Thus the Rand study found a strong link between severity and outcome, but a far from ironclad one. 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).

While a DDD value cannot be calculated for clients who are totally abstinent during the follow-up period, we assigned a value of zero in these cases to reflect their non-drinking status, following the precedent set by the Project MATCH Research Group (1997). To determine interventions that are applicable to primary care,8 three content experts (DK, ALH, and MH) examined the interventions. Interventions that involved frequent, repeated intravenous infusions, uncommon equipment in primary care, illicit drugs, experimental chemicals, and drugs unlicensed in the UK were not included in the review (see list in supplement 3). We excluded studies on pregnant women, participants https://ecosoberhouse.com/article/what-are-sober-living-homes/ with chronic liver disease, participants with HIV/AIDS, and patients with liver transplant owing to the specific clinical considerations of these populations. The position of ALCOHOLICS ANONYMOUS (AA) and the dominant view among therapists who treat alcoholism in the United States is that the goal of treatment for those who have been dependent on alcohol is total, complete, and permanent abstinence from alcohol (and, often, other intoxicating substances). By extension, for all those treated for alcohol abuse, including those with no dependence symptoms, moderation of drinking (termed controlled drinking or CD) as a goal of treatment is rejected (Peele, 1992).

  • It’s during this period that peer support becomes invaluable; it helps to know that others are experiencing similar struggles or have overcome them already.
  • For a moderation goal, however, the daily goal may change, depending on the patterns of drinking one starts with and what one aims to achieve.
  • Within-participant variability in daily drinking goal setting over the 21-day pre-treatment period is depicted graphically in Fig.

Abstinence versus Controlled Drinking as a Treatment Goal

2. Daily goal setting