Multivariable stepwise regressions (Table
2) show that younger individuals were significantly more likely to be
non-abstinent, and movement to the next oldest age category reduced the odds of
non-abstinence by an average of 27%. Importantly, the confidence intervals were narrow and
extremely similar across models, implying that the effect of age was robust to model
specification. In regard to help-seeking and problem severity, having attended at least
one 12-step meeting and the number of DSM-IV dependence symptoms were both significantly
related to non-abstinence. In the fully saturated models, any twelve-step attendance
decreased odds of non-abstinence by 57–76% (Model 4), while each additional DSM
symptom decreased odds of non-abstinence by 73–89% (Model 4). Non-abstainers are younger with less time in recovery and less problem severity
but worse QOL than abstainers. Clinically, individuals considering non-abstinent goals
should be aware that abstinence may be best for optimal QOL in the long run.

A recent qualitative study found that concern about missing substances was significantly correlated with not completing treatment (Zemore, Ware, Gilbert, & Pinedo, 2021). Unfortunately, few quantitative, survey-based studies have included substance use during treatment as a potential reason for treatment noncompletion, representing a significant gap in this body of literature (for a review, see Brorson, Ajo Arnevik, Rand-Hendriksen, & Duckert, 2013). Additionally, no studies identified in this review compared reasons for not completing treatment between abstinence-focused and nonabstinence treatment. Given data demonstrating a clear link between abstinence goals and treatment engagement in a primarily abstinence-based SUD treatment system, it is reasonable to hypothesize that offering nonabstinence treatment would increase overall engagement by appealing to those with nonabstinence goals. Indeed, there is anecdotal evidence that this may be the case; for example, a qualitative study of nonabstinence drug treatment in Denmark described a client saying that he would not have presented to abstinence-only treatment due to his goal of moderate use (Järvinen, 2017). Additionally, in the United Kingdom, where there is greater access to nonabstinence treatment (Rosenberg & Melville, 2005; Rosenberg & Phillips, 2003), the proportion of individuals with opioid use disorder engaged in treatment is more than twice that of the U.S. (60% vs. 28%; Burkinshaw et al., 2017).

Moderation Management: Does Controlled Drinking Work?

Rychtarik et al. found that treatment aimed at abstinence or controlled drinking was not related to patients’ ultimate remission type. Booth, Dale, and Ansari (1984), on the other hand, found that patients did achieve their selected goal of abstinence or controlled drinking more often. Miller et al. (in press) found that more dependent drinkers were less likely to achieve CD outcomes but that desired treatment goal and whether one labeled oneself an alcoholic or not independently predicted outcome type. Nordström and Berglund, like Wallace et al. (1988), selected high-prognosis patients who were socially stable. The Wallace et al. patients had a high level of abstinence; patients in Nordström and Berglund had a high level of controlled drinking.

In the case of inflammation, a significant number of inflammatory mediators in pancreatic parenchyma and pancreatic nerves are found in patients with pain (Di Sebastiano et al, 2000). Several general options are available, which may be combined with or supported by interventional methods. As for the second mechanism, options that reduce the intrapancreatic pressure may lead to a significant reduction of pancreatic pain. In the case of inflammation, a significant number of inflammatory mediators in pancreatic parenchyma and pancreatic nerves are detected in patients with pain (Ceyhan et al, 2009b; Di Sebastiano et al, 2000). Several medical, analgesic, and antiinflammatory treatment options are available, which may be combined with or supported by interventional methods. The findings from this pooled analysis of randomized clinical trials support what investigators noted was a growing recognition that reducing stimulant use can lead to better outcomes.

What is the natural history of alcoholic pancreatitis?

N rats trained to self-administer alcohol and made dependent and subsequently retested postwithdrawal, a CRF antagonist dose-dependently reduced self-administration only in the rats with a history of dependence (Valdez et al., 2002) (Fig. 5.34). Rats similarly made dependent with chronic continuous exposure to ethanol showed anxiety-like behavior on the elevated plus maze at 4 weeks postwithdrawal (Valdez et al., 2002). These results suggest that brain controlled drinking vs abstinence CRF systems remain hyperactive during protracted abstinence, and this hyperactivity is of motivational significance for excessive alcohol drinking. For people who struggle to make healthy drinking choices, but are not alcoholics, Moderation Management may be a good program to help them learn decision-making skills that can improve their lifestyle. Controlled drinking is not in the alcoholic skill set; to attempt it prolongs the pain of alcoholism.

We do not know whether the WIR sample represents the population of individuals
in recovery. However,
comparisons to other samples of individuals in recovery (e.g., National Alcohol Survey)
show no differences in demographics across samples (Subbaraman et al. in press). Furthermore, the correlates of non-abstinence we found were similar to those found in
NESARC, suggesting similarities between our sample and large, nationally representative
samples of individuals in recovery (Dawson et al.
2007). The WIR data do not include current dependence diagnoses, which would be
useful for further understanding of those in non-abstinent recovery. In addition, the WIR
quality of life measure is based on a single question; future studies could use
instruments that detail various aspects of mental and physical functioning. WIR is also
cross-sectional by design, though it did include questions about lifetime drug and alcohol
use.

3 Stepwise regressions: Non-abstinence

Prolonged abstinence from alcohol in humans involves a residual negative emotional state that can persist for weeks or months after acute withdrawal. To study protracted abstinence in animal models, one can define such a state as spanning a period when acute physical withdrawal has subsided, but behavioral changes persist. Increases in alcohol intake over the pre-dependence baseline and increases in stress responsivity persist for 2–8 weeks post-withdrawal from chronic alcohol. Rats tested 3–5 weeks post-withdrawal in the elevated plus maze, which is commonly used to evaluate anxiety-like behavior in rodents, did not show anxiogenic-like responses at baseline.

• As we get back to more social events, business meetings, and situations where you may have abused alcohol in the past, it may be time to consider how you can achieve moderation.
• However,
  comparisons to other samples of individuals in recovery (e.g., National Alcohol Survey)
  show no differences in demographics across samples (Subbaraman et al. in press).
• A brief description of the controversy surrounding controlled drinking provides a context for a discussion of various approaches to controlled drinking intervention as well as relevant clinical research.

Simply put, those who want to learn to drink in moderation are less likely to achieve their goal, while those who set a goal of quitting drinking entirely see greater success. Once you are able to control how much you drink, you may find that you’re better able to enjoy family gatherings, social events, and work events. Finding useful information and resources about addiction or alcoholism can be a minefield. To increase the chance of a successful recovery and life of sobriety it is important to receive guidance from a reliable source. At Addictionhelper, we will never tell you “you can’t ever drink again” because that is not our place.

Moderation vs. Abstinence: What’s Right for You?

While total abstinence is necessary in some cases, in other cases people are able to reduce their drinking to moderate levels without needing to abstain totally. For people who have not been able to maintain sobriety through Alcoholics Anonymous (AA) or other 12-step programs, they may wish to consider if moderation may be a more effective path for them to take. In parallel with the view on abstinence as a core criterion for recovery, controlled drinking (CD) has been a recurring concept and in focus from time to time in research on alcohol problems for more than half a century (Davies, 1962; Roizen, 1987; Saladin and Santa Ana, 2004).