Alcohol Moderation Management: Programs and Steps to Control Drinking

A recent meta-analysis of CBT for substance use disorders found support for a modest benefit of CBT over treatment as usual (Magill & Ray, 2009). Furthermore, one report using a trajectory analysis of the COMBINE study data found the Combined Behavioral Intervention (CBI), which is principally grounded in CBT, to reduce the risk of being in an “increasing to nearly daily drinking” trajectory. This study suggests that CBI may help participants control their drinking as opposed to simply encouraging abstinence (Gueorguieva et al., 2010). However, no studies to date have assessed the moderating role of drinking goal on CBI efficacy. Individuals with fewer years of addiction and lower severity SUDs generally have the highest likelihood of achieving moderate, low-consequence substance use after treatment (Öjehagen & Berglund, 1989; Witkiewitz, 2008). Notably, these individuals are also most likely to endorse nonabstinence goals (Berglund et al., 2019; Dunn & Strain, 2013; Lozano et al., 2006; Lozano et al., 2015; Mowbray et al., 2013).

What Are the 4 Types of Drinkers?

Moderation techniques such as pacing yourself, choosing lower-alcohol options, or having alcohol-free days can be practical tools in this journey. 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. This narrative controlled drinking vs abstinence 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.

• Thus, it may be important for clinicians to assess for patterns of drinking and to encourage at least some abstinent days, even among those clients with low risk drinking goals.
• Together, these findings suggest that naltrexone may be better suited to a controlled drinking approach and thus may be more effective among patients with controlled drinking goals.
• In addition, Helzer et al. identified a sizable group (12%) of former alcoholics who drank a threshold of 7 drinks 4 times in a single month over the previous 3 years but who reported no adverse consequences or symptoms of alcohol dependence and for whom no such problems were uncovered from collateral records.

Drinking Goals in Alcoholism Treatment

In this model, treatment success is defined as achieving and sustaining total abstinence from alcohol and drugs, and readiness for treatment is conflated with commitment to abstinence (e.g., Harrell, Trenz, Scherer, Martins, & Latimer, 2013). Additionally, the system is punitive to those who do not achieve abstinence, as exemplified by the widespread practice of involuntary treatment discharge for those who return to use (White, Scott, Dennis, & Boyle, 2005). 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). Results from this study support the need for a broader conceptualization of the clinical course of AUD (Maisto, Witkiewitz, Moskal, & Wilson, 2016) that does not rely solely on binary cutoffs to determine treatment success (e.g., abstinence). Research is needed to explore time-varying predictors of low risk drinking and alternative definitions of reduction outcomes (e.g., World Health Organization risk levels; Witkiewitz, Hallgren, et al., 2017) that may promote beneficial longer term functioning.

Days to Relapse to Heavy Drinking

Williams and Mee-Lee (op. cit.) also claim that AA originally taught that it was not the responsibility of group members or counsellors to give medical advice to others while there is a widespread opposition to using medically assisted treatment in the 12-step approach. Further, that the original focus on support has been replaced by a focus on denial and resistance as personality flaws. This pinpoints the conflicting issues experienced by some clients during the recovery process. If the 12-step philosophy https://ecosoberhouse.com/ and AA were one option among others, the clients could make an informed choice and seek options based on their own situation and needs. This would probably reduce the risk of negative effects while still offering the positive support experienced by the majority of the clients in the study. 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.

• This may be due to the fact that the vast majority of participants (78%) consumed alcohol during the trial, such that the drinking mediated effects of naltrexone were not restricted to patients with controlled drinking goals.
• Exclusion criteria were any serious mental illnesses or unstable medical conditions, current abuse or dependence on any drug other than nicotine or marijuana, and taking or requiring any medication that interfered with the study medications, including any current opioid use.
• Despite the reported relationship between severity and CD outcomes, many diagnosed alcoholics do control their drinking.
• 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.

Abstinence Vs. Moderation Management: Success and Outcomes

The evaluation consists of 11 yes or no questions that are intended to be used as an informational tool to assess the severity and probability of a substance use disorder. The test is free, confidential, and no personal information is needed to receive the result.

Moderated Drinking: A Creative Strategy to Treat Alcoholism?

It is unclear whether the same patterns of drinking would be found among clients with low risk drinking goals. Correspondence between an individual’s drinking goal and the approach of the treatment program can affect long term outcome, so this is an important limitation (Berglund, Svensson, Berggren, Balldin, & Fahlke, 2016). Further, the aftercare sample, which was more severe at baseline was not followed for the three year follow-up assessment. It is also important to note that Project MATCH included individuals who met DSM-III-R criteria for alcohol abuse (4.6%) or dependence (95.4%), and it is unclear whether the small proportion of individuals with alcohol abuse would meet DSM-5 criteria for AUD. Finally, the measure of psychosocial functioning was not specific to alcohol use and only captured social behavior and roles.

• When your goal is only one drink instead of no drinks at all, the temptation to stray can become less powerful and you can more often enjoy positive reinforcement from your successes.
• You might find yourself constantly preoccupied with thoughts about when you’ll have your next drink or whether you’re staying within your limits – this constant monitoring can create stress and mental exhaustion over time.
• Moderation techniques such as pacing yourself, choosing lower-alcohol options, or having alcohol-free days can be practical tools in this journey.
• In addition, some might consider abstinence as a necessary part of therecovery process, while others might not.

For example, a recent study found that patients stating a preference for abstinence had better treatment outcome than those stating a preference for non-abstinence (Adamson, Heather, Morton, & Raistrick, 2010). These effects, however, were seen for percent days abstinent but not for drinking intensity, suggesting that a comparable number of drinks per drinking episode may be achieved regardless of drinking goal. These results suggest that carefully considering drinking goals at treatment entry represents an important aspect of the initial assessment. As noted by Adamson and colleagues (2010), treatment goals may change over the course of treatment and must be continuously evaluated in order to promote the best possible outcomes. 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.

Global Clinical Outcome

Those who commit to a Moderation Management (MM) program must undergo a 30-day period of abstinence during which they learn strategies for identifying and controlling triggers, adopting other healthy behaviors and activities to replace drinking, and managing future moderate drinking behaviors. MM asks participants to take a realistic look at their drinking patterns and reasons for drinking. The controversial past of controlled drinking is slowly giving way to a hopeful future in which individuals are less likely to be forced into an abstinence-only treatment scenario. The enhanced accessibility of effective controlled-drinking interventions should significantly expand the treatment options of individuals within the full spectrum of alcohol-related problems. 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, also known as “moderate drinking” or “drinking in moderation,” is an approach that involves setting limits around alcohol consumption to ensure that drinking remains safe and doesn’t interfere with one’s health, daily life, or responsibilities.

• Guided-self change is a relatively new and brief cognitive-behavioral intervention that has demonstrated efficacy with problem drinkers.
• Alternatively, researchers who conduct trials in community-based treatment centers will need to obtain buy-in to test nonabstinence approaches, which may necessitate waiving facility policies regarding drug use during treatment – a significant hurdle.
• However, the extent of their problems according to ICD-10 (International Statistical Classification of Diseases and Related Health Problems, 10th edition) or DSM 5 (Diagnostic and Statistical Manual of mental disorders, 5th edition) was not measured.
• In contrast, individuals with greater SUD severity, who are more likely to have abstinence goals, generally have the best outcomes when working toward abstinence (Witkiewitz, 2008).

In general, the efficacy of both techniques does not appear to vary as a function of drinking severity but may vary as a function of drinking-related self-efficacy. Guided-self change is a relatively new and brief cognitive-behavioral intervention that has demonstrated efficacy with problem drinkers. Interventions based on harm reduction principles have decreased alcohol use in various student populations. Finally, Moderation Management is the only self-help program that supports non-abstinence goals, a feature that makes it popular with problem drinkers who are avoidant of traditional treatment services.