Controlled drinking: more than just a controversy : Current Opinion in Psychiatry


The search produced 12,937 papers after 3728 duplicates were removed, of which 12,313 were excluded after preliminary screening. After the full-text screening, data were included from 34 independent studies (Table S5) for the qualitative systematic review of the 624 papers in the remaining pool (Figure 1). If missing information could not be provided, partial publication data were not considered.

controlled drinking vs abstinence

Among the active interventions for PDA with high or moderate certainty comparisons, the four psychotherapies (MET, CT, MT, and RT) showed better effects than ART, CBT, and TSF, while MET and CT showed better effects than MT and RT, which suggests MET and CT as prior considerations in abstinence improvement. Additionally, TAU+SP controlled drinking vs abstinence was more efficacious than TAU for changing DDD in the high-quality direct comparison, although they had no other connection in the evidence network. This study supplemented a network comparison of intervention compliance to assess the patient’s ability to adhere to a specific intervention, using the risk ratio (RR) as the ES.

Strengths and Limitations of This Review

In the U.S., about 25% of patients seeking treatment for AUD endorsed nonabstinence goals in the early 2010s (Dunn & Strain, 2013), while more recent clinical trials have found between 82 and 91% of those seeking treatment for AUD prefer nonabstinence goals (Falk et al., 2019; Witkiewitz et al., 2019). 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). A “controlled drinking controversy” followed, in which the Sobells as well as those who supported them were publicly criticized due to their claims about controlled drinking, and the validity of their research called into question (Blume, 2012; Pendery, Maltzman, & West, 1982). Despite the intense controversy, the Sobell’s high-profile research paved the way for additional studies of nonabstinence treatment for AUD in the 1980s and later (Blume, 2012; Sobell & Sobell, 1995).

  • You’re not alone, and it’s important to remember that there is no one-size-fits-all solution when it comes to managing alcohol use.
  • A key aspect of abstinence is understanding and navigating through the withdrawal process – a daunting task indeed but necessary for recovery.
  • However, the results show that the view on abstinence and CD can change during the recovery process.
  • Alcoholism is characterised by a loss of control over one’s drinking behaviour and an inability to consistently limit consumption.
  • Expecting someone to potentially cut those events out of their lives to reduce the exposure to alcohol is not always realistic.
  • Only 50% of those who focused on controlled consumption succeeded in controlling their drinking.

It may be effective for people who drink too heavily; but, ineffective for those who need training to become dependent. But, for the population of drinkers that have already crossed that line, Moderation Management is an exercise in futility. In fact, the founder of Moderation Management, Audrey Kishline, admitted that for her the program had not worked. Family involvement plays an important role too since their understanding and encouragement can fuel your determination even more on challenging days. Remember that the path towards lasting recovery isn’t linear — there will be ups and downs. 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.

Study Inclusion Criteria

Moreover, it is important to consider and treat the frequent systemic organ involvement due to the toxic effects of ethanol other than in the skeletal muscle. In this regard, liver cirrhosis and dilated cardiomyopathy should also be considered and adequately compensated in the setting of alcoholic myopathy. In some cases recovery from chronic skeletal myopathy is only partial and some functional limitations may persist over time. Besides alcohol abstinence, no specific dietary measures have been found to be effective in preventing pancreatic pain. Even total abstinence from alcohol may achieve pain relief in only 50% of patients with moderate to mild CP (Gullo et al, 1988).

At the other extreme, Wallace et al. (1988) reported a 57 percent continuous abstinence rate for private clinic patients who were stably married and had successfully completed detoxification and treatment—but results in this study covered only a 6-month period. These data show that rats with a history of dependence present no overt anxiety-like effects during protracted abstinence but present an exaggerated stress response when challenged with mild restraint stress. The exaggerated stress response in the animals with a history of dependence is blocked by intracerebroventricular administration of a peptide CRF1/CRF2 receptor antagonist.

4 Stepwise regressions: Quality of life (QOL)

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). The Swedish treatment system has been dominated by total abstinence as the goal, although treatment with CD as a goal exists (e.g., Agerberg, 2014; Berglund et al., 2019).

Due to the cumulated and dose-dependent effect of ethanol intake in this disease, abstention form alcohol not only avoids the acute harmful effects, but also discontinues the progressive appearance of chronic effects in the skeletal muscle. This NMA provides evidence of psychotherapies for AUDs drinking control improvement and suggests that MET and CT may be the two preferred psychological options for primary care. There is still a need for higher-quality RCTs to strengthen the evidence network and confirm the clinical benefits of other psychotherapies. The advantages of MET and CT were indicated for abstinence in AUDs in this meta-analysis. They are two alternative psychotherapies on the primary care list of priorities to help persist in abstinence. However, at present, a comparison of rehabilitation strategies through MET for patients in different periods of AUDs remains to be explored.

Controlled drinkers

The descriptions on how the tools from treatment were initially used to deal with SUD and were later used to deal with other problems in the lives of IPs can be put in relation to the differentiation between abstinence and sobriety suggested by Helm (2019). While abstinence refers to behaviour, sobriety goes deeper and concerns the roots of the problem (addiction) and thereby refers to mental and emotional aspects. Differentiating these concepts opens up for recovery without necessarily having strong ties with the recovery community and having a life that is not (only) focused on recovery but on life itself.

controlled drinking vs abstinence

In addition, it is recommended that the use of other toxic substances such as cocaine or heroine that may potentiate the toxic effect of ethanol be avoided. This also includes the need to avoid toxic pharmacological agents such as statins, antiretrovirals (zidovudine) or colchicine. Adequate correction of chronic ionic, vitamin, calorie and protein deficiencies also contribute to a greater improvement of skeletal myopathy. Progressive active physiotherapy is recommended in these patients to avoid muscle atrophy.