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). Our sample size was small and there was a possible selection bias since we included particularly those individuals who used the app to report their return to alcohol use and who voluntarily completed the interview. These participants might be more engaged in their treatment generally and also have higher abstinence motivation. Since this type of app use behavior would already assume some kind of motivation, it was less likely in the beginning that participants express decreased motivation after the return to alcohol use. Although there were participants that did not experience an increase in motivation after the return to alcohol use, this still remains a limitation. Yet, the gender distribution is representative as it corresponds to the higher prevalence in men concerning substance use disorders in general [63] and AUD in particular [64].

What is Alcohol Moderation Management?

Do I want to give up completely, or do I want to be able to have a few drinks now and then. If the answer is a few now and then, the next question to ask is am I honestly able to do that? The majority of people I ask this question to will say no, it is never one or two, it always leads onto more. The only way to ascertain for certain whether you are capable of having just one or two drinks is to try it over a period of time, say 6 months. hypertension If during that time, you only ever drink the amount you intend to, and no problems arise as a result of the drinking, then you have found the way that works for you. Successful moderation involves understanding yourself (what factors trigger excessive drinking), planning (how much you are going to drink and how you are going to stop), and taking concrete steps to exit or avoid situations where you won’t be able to moderate.

Helpful and hindering factors of the intervention regarding abstinence motivation

This narrative review considers the need for increased research attention on nonabstinence psychosocial treatment of SUD – especially drug use disorders – as a potential way to engage and retain more people in treatment, to engage people in treatment earlier, and to improve treatment effectiveness. Despite significant empirical support for nonabstinence alcohol interventions, there is a clear gap in research examining nonabstinence psychosocial treatment for drug use disorders. Future research must test the effectiveness of nonabstinence treatments for drug use and address barriers to implementation. Most of the participants reported to having used the app daily – especially because of the abstinence tracker – and that their app use did not change after the return to alcohol use. In addition, participants stated that they had used the app particularly during free time, when they experienced craving, in risk situations or when they had strong positive or negative emotions. This leads to the conclusion that the app can be a motivational support in AUD-related crisis and may possibly even prevent a return to alcohol use in those individuals who use the app in these kind of risky situations.

Data collection and analysis

  1. They found that their controlled drinking intervention produced significantly better outcomes compared to usual treatment, and that about a quarter of the individuals in this condition maintained controlled drinking for one year post treatment (Sobell & Sobell, 1973).
  2. In prior analyses, there were no differences between the low risk drinking classes (Class 5 and 6) in drinking or psychosocial functioning in the year following treatment (Witkiewitz, Roos, et al., 2017).
  3. Goodwin, Crane, & Guze (1971) found that controlled-drinking remission was four times as frequent as abstinence after eight years for untreated alcoholic felons who had “unequivocal histories of alcoholism”.
  4. This is important given that individuals in the low risk and abstainer classes did have some occasions of heavy drinking during treatment but had significantly better outcomes than those individuals with more occasions of heavy drinking.
  5. This is especially true in light of the fact that moderate drinking might be good for health and intervention research shows us that changing behavior is possible.

In parallel with the view on abstinence as a core criterion for recovery, controlled drinking (CD) has been a recurring concept and in focus from time to time in research on alcohol problems for more than half a century (Davies, 1962; Roizen, 1987; Saladin and Santa Ana, 2004). It caused heated debates, and for a long time, it has had a rather limited impact on professional treatment systems (Coldwell and Heather, 2006). Recently, in many European countries (Klingemann and Rosenberg, 2009; Klingemann, 2016; Davis et al., 2017) and in the USA (Coldwell, 2005; Davis and Rosenberg, 2013), professionals working with clients with severe problems and clients in inpatient care tend to have abstinence as a treatment goal . However, CD is a widely accepted treatment goal in Australia, Britain and Norway (Luquines et al., 2011).

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In its original form, RP aims to reduce risk of relapse by teaching participants cognitive and behavioral skills for coping in high-risk situations (Marlatt & Gordon, 1985). More recent versions of RP have included mindfulness-based techniques (Bowen, Chawla, & Marlatt, 2010; Witkiewitz et al., 2014). The RP model has been studied among individuals with both AUD and DUD (especially Cocaine Use Disorder, e.g., Carroll, Rounsaville, & Gawin, 1991); with the largest effect sizes identified in the treatment of AUD (Irvin, Bowers, Dunn, & Wang, 1999). 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). Administrative discharge due to substance use is not a necessary practice even within abstinence-focused treatment (Futterman, Lorente, & Silverman, 2004), and is likely linked to the assumption that continued use indicates lack of readiness for treatment, and that abstinence is the sole marker of treatment success. In the United Kingdom, where there is greater acceptance of nonabstinence goals and availability of nonabstinence treatment (Rosenberg et al., 2020; Rosenberg & Melville, 2005), the rate of administrative discharge is much lower than in the U.S. (1.42% vs. 6% of treatment episodes; Newham, Russell, & Davies, 2010; SAMHSA, 2019b).

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). Importantly, there has also been increasing acceptance of non-abstinence outcomes as a metric for assessing treatment effectiveness in SUD research, even at the highest levels of scientific leadership (Volkow, 2020). Many advocates of harm reduction believe the SUD treatment field is at a turning point in acceptance of nonabstinence approaches. Indeed, a prominent harm reduction psychotherapist and researcher, Rothschild, argues that the harm reduction approach represents a “third wave of addiction treatment” which follows, and is replacing, the moral and disease models (Rothschild, 2015a). 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. Most adults with SUD do not seek treatment because they do not wish to stop using substances, though many also recognize a need for help.

In prior analyses, there were no differences between the low risk drinking classes (Class 5 and 6) in drinking or psychosocial functioning in the year following treatment (Witkiewitz, Roos, et al., 2017). However, the current study showed that Class 6 had better drinking outcomes at three years following treatment than Class 5. Individuals with expected membership in Class 5 (low risk and heavy drinking) had a low probability of abstinence days during treatment, whereas individuals in Class 6 (abstinence and low risk drinking) had a higher probability of abstinence days throughout treatment. Some days of abstinence during treatment may be important for longer term functioning among those engaging in low risk drinking during treatment.

In response to whether the reminder push notifications increased use, six participants answered affirmatively, two (P09, P06) stated not having received the reminders as their app use was already on a daily basis and one (P02) did not receive reminders due to technical issues. All how does alcohol affect blood pressure other quantitative data relevant to this study was collected in the primary study via self-report diagnostic telephone interviews and web-based assessments. For this study only descriptive outcomes for socio-demographic data and abstinence self-efficacy at baseline were included.

Nonabstinence approaches to SUD treatment have a complex and contentious history, and significant social and political barriers have impeded research and implementation of alternatives to abstinence-focused treatment. We summarize historical factors relevant to non-abstinence treatment development to illuminate reasons these approaches are understudied. The primary study SmartAssistEntz was supported by the Innovation Fund of The Federal Joint Committee (G-BA) [01NVF18025].

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 how to detox your body while pregnant their advocates grew into a national and international harm reduction movement (Des Jarlais, 2017; Friedman, Southwell, Bueno, & Paone, 2001). The results of the Sobell’s studies challenged the prevailing understanding of abstinence as the only acceptable outcome for SUD treatment and raised a number of conceptual and methodological issues (e.g., the Sobell’s liberal definition of controlled drinking; see McCrady, 1985).

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