PREDICT was designed to allow direct comparisons to COMBINE but differences in some of the inclusion/exclusion criteria, the study populations, the treatment length and the outcome definitions hampered the external validation process. In particular, the two study samples differed on CDA, which turned out to be the most important predictor. In PREDICT, subjects were required to have at least 2 weeks of inpatient hospitalization prior to enrollment and thus had significantly longer CDA than subjects in COMBINE who achieved abstinence primarily as outpatients. Our decision to increase the cutoff from 2 weeks in COMBINE to 3 weeks in PREDICT was meant to assure that sufficient sample sizes were available in each group in PREDICT and may appear somewhat arbitrary.
- 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.
- In addition to shaping mainstream addiction treatment, the abstinence-only 12-Step model also had an indelible effect on the field of SUD treatment research.
- Expecting someone to potentially cut those events out of their lives to reduce the exposure to alcohol is not always realistic.
- Despite these obstacles, SSPs and their advocates grew into a national and international harm reduction movement (Des Jarlais, 2017; Friedman, Southwell, Bueno, & Paone, 2001).
- It caused heated debates, and for a long time, it has had a rather limited impact on professional treatment systems (Coldwell and Heather, 2006).
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 controlled drinking vs abstinence 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. Multiple versions of harm reduction psychotherapy for alcohol and drug use have been described in detail but not yet studied empirically. However, to date there have been no published empirical trials testing the effectiveness of the approach.
Why Moderation May Be a Better Choice Than Abstinence
Dr. Sam Glazer, a NYU professor of Psychiatry, and his team at Fifth Avenue Psychiatry provide private alcohol addiction treatment in the Manhattan, New York City area and offer controlled drinking programs. While harm reduction can be effective and successful in helping a person be more cognizant of their drinking behaviors and therefore decreasing them, it is not for everyone. While, of course, no one is perfect, and we expect “mistakes” or “hiccups” along the way, there are some individuals who try harm reduction and are able to recognize they cannot exercise this type of self-control. In those cases, harm reduction can be a helpful tool as a last resort, to help the individual come to the conclusion themselves that abstinence is the right avenue for them, rather than having it enforced upon them at the start of treatment. Therefore, for those clients who find complete abstinence to be overwhelming, we will come up with specific rules around their drinking.
Instead, the literature indicates that most people with SUD do not want or need – or are not ready for – what the current treatment system is offering. 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. However, a quarter or this group who achieved remission did so through nonproblem drinking. 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.
Moderate Drinking is About Having More Control Over Your Drinking
In alcohol research, tree-based techniques have been used only in epidemiological studies for prediction (Vik et al., 2006; Muller et al., 2008). The potential of these methods to inform clinical decisions in treatment studies and ultimately in clinical practice has not been explored. The goal of the current study was to use tree-based methods to identify groups of subjects with good drinking outcomes during treatment in COMBINE (Anton et al., 2006) and to validate these results in PREDICT (Mann et al., 2012). The ability to control drinking varies significantly from person to person and is influenced by a range of factors including genetics, environment, emotional state, and individual psychology. For people suffering from alcohol use disorders, trying to moderate drinking isn’t advised and total abstinence is always recommended.
