In providing this ‘early view’ of the data, we hope to facilitate timely further dialogue, discussion and interest in wider research around ‘lockdown drinking’ to inform understanding of alcohol consumption practices at a time when the pandemic and its implications remain a very real experience across the globe. To date, research examining associations among abstinent and non-abstinent substance use status and well-being, has focused primarily on treatment-seeking individuals with alcohol use disorder. Subsequently, the authors found that abstinence in this sample at three years did not predict better psychological functioning at ten years (Witkiewitz et al., 2020). 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).
Heavy drinking sessions
However, we might speculate that licensed venues could be understood, in some respects at least, to constrain consumption levels via alcohol pricing, using standard measures or glass sizes and through possible refusal of service if an individual is deemed too intoxicated. Such gendered/normative constraints may be partly or entirely absent in domestic spaces. In addition, several of those who had mainly drank alcohol abstinence vs moderation socially in pubs pre-lockdown reported that their consumption had decreased since the closure of licensed venues and that lockdown had not simply caused them to shift their consumption to domestic spaces. This included our youngest participants, Jess and Lucie, who were both in their mid-20s and suggested that they were drinking less overall as they were no longer regularly going to bars and clubs.
Abstinence vs. Drinking in Moderation: Which is Right for You?
In contrast to the holistic approach of harm reduction psychotherapy, risk reduction interventions are generally designed to target specific HIV risk behaviors (e.g., injection or sexual risk behaviors) without directly addressing mechanisms of SUD, and thus are quite limited in scope. However, these interventions also typically lack an abstinence focus and sometimes result in reductions in drug use. 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. While there is evidence that a subset of individuals who use drugs engage in low-frequency, non-dependent drug use, there is insufficient research on this population to determine the proportion for whom moderation is a feasible treatment goal. However, among individuals with severe SUD and high-risk drug or alcohol use, the urgency of reducing substance-related harms presents a compelling argument for engaging these individuals in harm reduction-oriented treatment and interventions. In addition to issues with administrative discharge, abstinence-only treatment may contribute to high rates of individuals not completing SUD treatment.
2. Relationship between goal choice and treatment outcomes
Like the Sobells, Marlatt showed that reductions in drinking and harm were achievable in nonabstinence treatments (Marlatt & Witkiewitz, 2002). 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. Most scientists who studied SUD treatment believed that abstinence was the only acceptable treatment goal until at least the 1980s (Des Jarlais, 2017). Abstinence rates became the primary outcome for determining SUD treatment effectiveness (Finney, Moyer, & Swearingen, 2003; Kiluk, Fitzmaurice, Strain, & Weiss, 2019; Miller, 1994; Volkow, 2020), a standard which persisted well into the 1990s (Finney et al., 2003). Little attention was given to whether people in abstinence-focused treatments endorsed abstinence goals themselves, or whether treatment could help reduce substance use and related problems for those who did not desire (or were not ready for) abstinence.
As shown by clusters of countries (for example, Middle Eastern countries with low alcohol intake but high GDP per capita), we tend to see strong cultural patterns that tend to alter the standard income-consumption relationship we may expect. In the chart, we see the relationship between average per capita alcohol consumption – in liters of pure alcohol per year – versus gross domestic product (GDP) per capita across countries. The charts show global consumption of spirits, which are distilled alcoholic drinks, including gin, rum, whisky, tequila, and vodka.
- An individual’s ability to avoid excessive drinking is also influenced by other factors such as past alcohol consumption, as reflected by an alcohol use disorder diagnosis.
- Here, we see particularly high levels of alcohol abstinence across North Africa and the Middle East.
- So, although abstinence is undoubtedly better for our overall health, there are some situations where abstinence may not be the best choice.
- Longstanding policymaker and practitioner concerns with managing public drinking and public order may have been unsettled by a growth in home-based drinking, although, as we argue, such changes were in motion before the global pandemic.
Mindful Drinking: A Step to Alcohol Abstinence
- We define nonabstinence treatments as those without an explicit goal of abstinence from psychoactive substance use, including treatment aimed at achieving moderation, reductions in use, and/or reductions in substance-related harms.
- The study was especially notable because most other treatment readiness measures have been validated on treatment-seeking samples (see Freyer et al., 2004).
- Our last few blogs have discussed my experience reintroducing alcohol and successfully moderating after an extended period of abstinence, and Lucy’s ongoing commitment to abstinence.
It’s estimated that globally, around 1 percent of the population has an alcohol use disorder. At the country level, as shown in the chart, this ranges from around 0.5 to 5 percent of the population. The first map shows this in terms https://ecosoberhouse.com/ of spirits as a share of total alcohol consumption. In many Asian countries, spirits account for most of total alcohol consumption. With the change country feature, it is possible to view the same data for other countries.
- Furthermore, when alcohol begins to take priority over friends and family, work responsibilities, or personal health, it may be time to consider a treatment plan.
- While multiple harm reduction-focused treatments for AUD have strong empirical support, there is very little research testing models of nonabstinence treatment for drug use.
- While there is evidence that a subset of individuals who use drugs engage in low-frequency, non-dependent drug use, there is insufficient research on this population to determine the proportion for whom moderation is a feasible treatment goal.
- As such, I think these results are very encouraging in terms of offering another possible solution for individuals who are looking to reduce their alcohol consumption and the problems that keep creeping up along with it.
In the UK and more widely, alcohol consumption in public remains largely constructed as a ‘problem’ of crime and disorder, with research exploring issues of violence, crime and sexual assault in late-night leisure spaces (see Fileborn, 2016; Lindsay, 2012). This is reinforced through a media and policy tendency to focus on ‘binge drinking’ (Frost & Gardiner, 2005) and problematise the visible drinking practices of groups such as students, young people or women (Day, Gough, & McFadden, 2004). It is arguably easier to target policy and regulation at public space, and to focus attention on young peoples’ supposed predilection toward ‘binge drinking’ and engaging in crime and disorderly behaviour in public. This focus on public drinking spaces is likely to be a ‘safer’ strategy politically than attempting to police the activities and practices of people in the private sphere. The debates around the controversial introduction of Minimum Unit Pricing to set a limit for how cheaply alcohol can be sold for home consumption are a case in point. These individuals notably made up just 14% of the sample, the smallest group of the three.
AA was established in 1935 as a nonprofessional mutual aid group for people who desire abstinence from alcohol, and its 12 Steps became integrated in SUD treatment programs in the 1940s and 1950s with the emergence of the Minnesota Model of treatment (White & Kurtz, 2008). The Minnesota Model involved inpatient SUD treatment incorporating principles of AA, with a mix of professional and peer support staff (many of whom were members of AA), and a requirement that patients attend AA or NA meetings as part of their treatment (Anderson, McGovern, & DuPont, 1999; McElrath, 1997). This model both accelerated the spread of AA and NA and helped establish the abstinence-focused 12-Step program at the core of mainstream addiction treatment. By 1989, treatment center referrals accounted for 40% of new AA memberships (Mäkelä et al., 1996). This standard persisted in SUD treatment even as strong evidence emerged that a minority of individuals who receive 12-Step treatment achieve and maintain long-term abstinence (e.g., Project MATCH Research Group, 1998). Harm reduction therapy has also been applied in group format, mirroring the approach and components of individual harm reduction psychotherapy but with added focus on building social support and receiving feedback and advice from peers (Little, 2006; Little & Franskoviak, 2010).