Abstinence: The Only Way To Treat Alcoholism

Abstinence is widely considered to be the most effective goal in the treatment of alcohol use disorder. While the debate between abstinence and non-abstinence approaches has been a controversial topic in the alcoholism field, most studies show that complete abstinence yields the best outcomes for patients. Alcoholics Anonymous (AA), a worldwide fellowship of sobriety seekers, is considered the most effective path to achieving abstinence, with studies showing it to be 60% more effective than other interventions or no intervention.

Alcoholics Anonymous is the most effective path to abstinence

Alcoholics Anonymous (AA) is a worldwide fellowship of sobriety seekers that was founded in 1935. AA is the most effective path to abstinence, according to a comprehensive analysis conducted by a Stanford School of Medicine researcher, Keith Humphreys, and his collaborators. The analysis evaluated 35 studies, involving the work of 145 scientists and the outcomes of 10,080 participants.

The studies used various methods to measure AA's effectiveness on alcohol use disorder: the length of time participants abstained from alcohol, the amount they reduced their drinking, the consequences of their drinking, and healthcare costs. Most of the studies that measured abstinence found AA to be significantly better than other interventions or no intervention. In one study, it was found to be 60% more effective. None of the studies found AA to be less effective.

In the studies that measured outcomes other than complete abstinence, AA was found to be at least as effective. For example, AA was found to be as effective as professional treatments for other alcohol-related outcomes, such as drinking consequences, drinking intensity, addiction severity, and healthcare costs. In the studies that considered costs, most showed significant savings associated with AA participation. One study found that AA and 12-step facilitation counseling reduced mental health costs by $10,000 per person.

AA works because it is based on social interaction, where members give each other emotional support and practical tips to refrain from drinking. When people embark on a lifestyle of abstinence, they might begin to feel lonely because they no longer have their drinking friends. AA groups can provide the insular resilience members need when facing potential triggers, so they can continue on the path to sustained sobriety.

Abstinence is the most appropriate goal for those with psychiatric or physical comorbidities

For those with serious mental illness, the use of alcohol and drugs has been described as "self-medication" of psychotic symptoms. The additional challenge of psychiatric symptoms can complicate the process of recovery from substance abuse. Furthermore, polysubstance use is common, and many people with substance use disorders have multiple comorbidities. For example, among people with a heroin use disorder, over 66% are dependent on nicotine, nearly 25% have an alcohol use disorder, and over 20% have a cocaine use disorder. Therefore, abstinence from alcohol is a critical goal for those with psychiatric comorbidities to prevent relapse and improve recovery outcomes.

Abstinence can also lead to more accurate diagnoses and better-targeted treatments for those with psychiatric comorbidities. By observing patients after a period of abstinence, healthcare providers can distinguish between the effects of substance intoxication or withdrawal and the symptoms of comorbid mental disorders. This practice ensures that the treatment plan addresses the specific needs of the patient and can improve the chances of successful recovery.

In addition, research has shown that patients with comorbid disorders have higher rates of treatment dropout and poorer treatment adherence than those without mental illness. Abstinence can be a motivating factor for individuals with comorbidities to stay engaged in treatment and work towards recovery. The inclusion of abstinence as a goal can also facilitate effective communication and collaboration between clinical providers and organizations providing supportive services, which is crucial for addressing the complex needs of individuals with comorbidities.

While there may be concerns about the feasibility of abstinence for those with psychiatric or physical comorbidities, it is important to note that recovery is a gradual process and that relapses may occur. By providing appropriate support and incentives, such as motivational incentives for verified abstinence, individuals with comorbidities can achieve abstinence without worsening their mental health. Furthermore, abstinence can reduce the negative consequences associated with substance use, such as arrests and emergency department visits, improving overall health outcomes.

Abstinence is the best goal for alcohol treatment outcomes

Abstinence is the most effective goal for alcohol treatment outcomes. Alcohol use disorder is a severe condition, and patients with this diagnosis are usually more severely ill with common psychiatric and medical comorbidities. Most studies on the treatment outcomes of alcohol use disorder find that 70-80% of patients relapse within a year of treatment. However, clients who initially stated a preference for abstinence showed better outcomes than those who preferred a non-abstinent goal.

Complete abstinence is associated with the best outcomes, followed by conditional abstinence, and then controlled drinking. Patients who commit to absolute abstinence take longer to relapse, whereas those with abstinence goals allowing for occasional lapses do not fare as well. Abstinence is especially important for patients with significant psychiatric or physical comorbidity. If a patient asks for moderation but the clinician considers it risky, the clinician should advise that abstinence is most appropriate to prevent medico-legal problems.

Alcoholics Anonymous (AA) is the most effective path to abstinence. After evaluating 35 studies, a Stanford School of Medicine researcher and his team determined that AA was more effective than psychotherapy in achieving abstinence. AA participation also lowered healthcare costs. AA works because it is based on social interaction, providing members with emotional support and practical tips to refrain from drinking.

While abstinence is the dominant approach to alcohol treatment in the United States, non-abstinent approaches are more acceptable in other countries. The debate between abstinence and non-abstinent approaches has been controversial since the 1960s. However, there is no universally accepted definition of what constitutes successful controlled drinking or moderation.

Controlled drinking is not a universally accepted definition of successful treatment

The debate between abstinence and non-abstinence approaches to treating alcoholism has been ongoing since the 1960s. While abstinence is the dominant approach in the United States, non-abstinent approaches are more acceptable in other parts of the world. For instance, service providers in the UK tend to favour controlled drinking.

Controlled drinking, or a return to moderate drinking, is often a goal for patients who are still in denial about their inability to control their drinking. Setting a goal of moderate drinking may convince these patients to engage further with treatment. However, it is important to note that the higher the level of alcohol dependence, the lower the chance of returning to moderate or 'controlled' drinking.

There is no universally accepted definition of what constitutes successful controlled drinking. Other terms used in the literature include 'harm reduction' and 'moderation', but these terms also lack clear definitions. While the field has focused increasingly on reductions in heavy drinking days, the lack of a clear definition of controlled drinking makes it difficult to determine its success as a treatment approach.

Some studies have found that a goal of complete abstinence is associated with the best outcomes, followed by conditional abstinence, while controlled drinking is associated with the poorest outcomes. Patients who initially stated that they preferred to get abstinent showed better outcomes than those who preferred a non-abstinent goal. This is especially true for people with significant psychiatric or physical comorbidities.

In summary, while controlled drinking may be a viable goal for some patients, it is not a universally accepted definition of successful treatment for alcoholism due to the lack of a clear definition and mixed evidence regarding its effectiveness.

Abstinence is superior to non-abstinent approaches

Abstinence-based treatment for alcohol use disorder has been a subject of debate since the 1960s, with service providers in the UK favouring controlled drinking, while the US has predominantly leaned towards abstinence. However, there are several reasons why abstinence is superior to non-abstinent approaches.

Firstly, for individuals with alcohol use disorder, complete abstinence has been associated with the best treatment outcomes. Studies have shown that a goal of complete abstinence leads to a higher percentage of days abstinent, a longer time until relapse, and better global clinical outcomes. Conversely, controlled drinking is linked to poorer outcomes and a higher risk of relapse. This is particularly evident in patients with significant psychiatric or physical comorbidities, where abstinence is the recommended goal due to the higher risk of adverse health consequences associated with continued drinking.

Secondly, patients who initially express a preference for abstinence during treatment tend to have better outcomes than those who prefer a non-abstinent goal. This suggests that a commitment to abstinence indicates a stronger motivation to change drinking behaviour and engage with treatment. Setting an initial goal of moderate drinking for ambivalent patients can be a useful strategy to encourage further treatment engagement.

Additionally, Alcoholics Anonymous (AA), a fellowship of sobriety seekers, has been found to be a highly effective path to abstinence. Research has consistently shown that AA participation is associated with higher rates of abstinence compared to other interventions or no intervention, and it also leads to significant cost savings due to reduced healthcare expenses. The social support and practical advice provided by AA groups are crucial factors in helping individuals refrain from drinking and changing their behaviour.

While non-abstinent approaches may be more acceptable in some cultural contexts, the evidence suggests that abstinence is a more effective treatment goal for alcohol use disorder. The higher the level of alcohol dependence, the less likely it is that an individual will be able to return to moderate or 'controlled' drinking. Therefore, abstinence should be the primary goal of treatment to ensure the best chance of recovery and improved quality of life.

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