Witkiewitz also arguedthat the commonly held belief that abstinence is the only solution may deter someindividuals from seeking help. Unfortunately, there has been little empirical research evaluating this approach among individuals with DUD; evidence of effectiveness comes primarily from observational research. For example, at a large outpatient SUD treatment center in Amsterdam, goal-aligned treatment for drug and alcohol use involves a version of harm reduction psychotherapy that integrates MI and CBT approaches, and focuses on motivational enhancement, self-control training, and relapse prevention (Schippers & Nelissen, 2006).
The goal of a moderation program is to support a person’s journey toward understanding their drinking behavior and create a safe environment for them to explore how to drink moderately. Harmful drinking and alcohol use disorder are among our nation’s most challenging public health problems. We would like to know what GOAL you have chosen for yourself about using alcohol at this time…Pick only one of the following goals.
Some of the abstainers reported experience of professional contacts, such as therapists or psychologists. These contacts had often complemented the support from AA but in some cases also complicated it as the IPs found that their previous SUD was related to other things that were not in line with the approach to addiction as a disease (e.g. IP19). After transcribing the interviews, the material was analysed thematically (Braun and Clarke, 2006) by coding the interview passages according to what was brought up both manually and by using NVivo (a software package for qualitative data analysis). After relistening to the interviews and scrutinizing transcripts, the material was categorized and summarized by picking relevant parts from each transcript.
But if they have a problem with alcohol, taking a harm reduction approach could be a constructive way to help them take a look at the negative consequences of their behavior and motivate them to make positive changes. Most people who seek out moderation management (MM) have already tried and been unsuccessful at stopping drinking or cutting down on their use. Of the patients studied, 90% of total abstinence patients were still sober two and a half years after treatment. In the United States, for example, there are 14 grams of ethanol in a standard drink (1 beer, 1 glass of wine, or one shot of liquor) whereas in other countries like Australia a standard drink contains 10 grams of pure ethanol. Also if the study included individuals that received an intervention (i.e., intended to help people reduce or quit drinking), the intervention had to be psychosocial, meaning patients did not receive medication.
Additionally, type I error correction was not implemented; therefore caution is warranted when interpreting marginally significant interactions. It is, however, an important clinical finding that CBI conferred no advantage over a brief, medically oriented intervention for participants whose drinking goal was complete abstinence. However, while designed to approximate the style of intervention delivered in a primary care setting, the medical management delivered in the COMBINE study was confounded with extensive and state-of-the-art assessment and follow-up. As such, further research may be required before these findings can be generalized to real-world primary care settings. The rationale and methods of the COMBINE study have been described in detail elsewhere (aCOMBINE Study Research Group, 2003a, COMBINE Study Research Group, 2003b).
Miller, whose seminal work on motivation and readiness for treatment led to multiple widely used measures of SUD treatment readiness and the development of Motivational Interviewing, also argued for the importance of goal choice in treatment (Miller, 1985). Drawing from Intrinsic Motivation Theory (Deci, 1975) and the controlled drinking literature, Miller (1985) argued that clients benefit most when offered choices, both for drinking goals and intervention approaches. A key point in Miller’s theory is that motivation for change is “action-specific”; he argues that no one is “unmotivated,” but that people are motivated to specific actions or goals (Miller, 2006). It is important to highlight that most of the studies cited above did not provide goal-matched treatment; thus, these outcomes generally reflect differences between individuals with abstinence vs. non-abstinence goals who participated in abstinence-based AUD treatment.
That’s why our approach involves taking time to know you better, identify your triggers, and help chart a path forward that aligns with your life goals. Family involvement plays an important role too since their understanding and encouragement can fuel your determination even more on challenging days. But with patience, persistence and these strategies at hand – you’re better equipped than ever before on this journey towards healthier living minus harmful drinking habits. The path towards moderation management comes with its unique set of challenges which can include social pressure or dealing with underlying emotional issues that contribute towards excessive drinking habits.
By iteratively analysing and compiling these in an increasingly condensed form, themes were created at an aggregated level, following a process of going back and forth between transcripts and the emerging themes as described by Braun and Clarke (op. cit.). In the present article, descriptions of abstinence and CD and views on and use of the AA and the 12-step programme were analysed. The role of nutrition should also not be overlooked as maintaining a balanced diet can help restore physical health damaged by excessive alcohol consumption. Multivariable stepwise regressions estimating the probability of non-abstinentrecovery and average quality of life.
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. For individuals with alcohol use disorder who make an effort to get treatment but do not end up receiving it, 25% say the reason was that they were not ready to stop drinking or using drugs. Also, for people in remission from severe alcohol use disorder, meaning they no longer have symptoms of the disorder, 65% are still drinking but not at problematic levels. In combination with the proliferation of treatments designed to help individuals reduce rather than quit drinking, these statistics are indicative of the need to understand the benefits of reduced drinking. Not surprisingly, reducing drinking can substantially improve liver functioning – authors suggest total abstinence is the most effective approach for individuals with alcohol related liver problems.
As hypothesized, the two highest functioning profiles at three years following treatment (profile 3 and 4) generally had the best psychological functioning outcomes, including greater purpose in life and lower levels of depression, at ten years following treatment. These findings support the clinical validity of the recovery profiles and reaffirm the importance of considering indicators of psychological functioning, and not simply alcohol consumption levels, when defining long-term recovery from AUD. Indeed, our findings revealed a lack of a one-to-one correspondence between drinking behavior and psychological functioning during the process of recovery over time.
As noted by Ashford and colleagues13, stakeholder institutions, including the American Society of Addiction Medicine (ASAM), have updated and modified their operational definitions of recovery over the past two decades. In 2005, ASAM’s public policy statement on recovery highlighted a state of psychological and physical health in which an individual’s abstinence from substance use was “complete and comfortable”14. Empirical support for a broader conceptualization of recovery has been reviewed in recent work16–18 and also expressed by individuals who self-identify as being in recovery19–21. When they are offered 12-step treatment, they get exposed to these strict views in a different setting than what was initially intended fetal alcohol syndrome celebrities within AA, namely a self-help group that people join voluntarily.
17 de febrero de 2022
Publicado en: Sober living