Conventional wisdom states that “once an alcoholic, always an alcoholic”. This is a view that many alcohol use disorder (AUD) treatment experts share. Abstinence was, and still is, the only surefire way to stop all drinking. At least, that’s how the theory goes.
Programs that employ evidence-based treatment approaches, such as those employed by SMART Recovery have gone away from this basic concept, which is something that often surprises those seeking treatment.
There is now growing evidence that abstinence is not the only way forward, at least for some people. If you’re interested in learning more, check out this resource for SMART Recovery Boston AUD specialists trust.
Problems With Abstinence
Mainstream implementations of abstinence as a long-term strategy have a historically poor record of success, which is not surprising as any relapse is often considered to be a failure. However, decades of studies seem to show that recovery isn’t and shouldn’t be that simple.
New studies seem to show that at least some people who have recovered from AUD, that is, successfully avoided drinking for over a year, develop resilience to redeveloping not just AUD, but other substance use disorders as well.
Furthermore, our better understanding of the mechanisms behind how people get hooked on substances has led to treatments like medication-assisted therapy that dramatically reduce the instances of problem drinking and drug use among people who previously had an AUD diagnosis.
While further research is likely needed, these challenge two common assumptions in AUD rehab: that so-called “alcoholism” is forever, and that recovering individuals are prone to “substituting addictions”.
This isn’t to say abstinence can’t work. It has and continues to do so for a lot of people. However, it’s starting to look like moderation may truly be a viable third path and not just a maladaptive negotiation done by people with AUD.
Is Moderation Achievable?
In traditional AUD treatment, abstinence is the only recognized positive outcome. Moderation is often seen as an unrealistic goal, and often an excuse to continue drinking.
However, there is evidence to show that moderation may be possible. A recent study of U.S. military veterans suggests that regardless if one chooses abstinence or moderation, reducing one’s drinking to non-problematic levels is highly achievable in a majority of cases. Reframing success as a harm reduction rather than using abstinence as the only yardstick for AUD recovery success seems more realistic for many.
How Can Moderation Be Achieved?
Regardless of the approach, treatment tends to involve a combination of group and individual counseling, cognitive behavioral therapy, workshops, and medication-assisted therapy. There’s also a wide variety of possible solutions within each modality.
Because the persistence of AUD is highly dependent on genetics, preexisting mental health issues, and environmental factors that vary from person to person, it’s difficult to say for certain whether any combination of approaches or modalities will help a specific person achieve moderation. Make sure to consult with a qualified mental health expert to discuss your recovery goals.
Can SMART Recovery Help Me Achieve Moderation?
Approaches like SMART Recovery claim that it is possible for at least some people to eventually go back to moderate drinking. This goes without saying that it may not be a practical goal for many others with AUD.
SMART Recovery and other similar models tend to employ highly individualized, evidence-based approaches to to treatment. In other words, your recovery path may be very different from those participating in the same group.
Unlike many other mainstream recovery approaches, SMART Recovery makes it possible to set moderation as a goal. This makes it difficult to compare with other approaches like the 12 Step model popularized by Alcoholics Anonymous, as these mainstream methods tend to lean heavily into abstinence as the only successful outcome.
Can Medication-assisted Therapy Help?
A 2015 study shows that medication-assisted therapy (MAT) can not only help AUD patients achieve abstinence compared to non-medicated approaches but may also help them achieve moderation, if that is their set goal.
However, it’s important to note that interventions for AUD need to be supervised by a qualified psychiatrist. MAT, in particular, can be extremely risky when done unsupervised.
Abstinence May Make Your Life Simpler
The main disadvantage of moderation is that it can add a lot of complexity to the recovery process. Abstinence, by contrast, is much simpler, at least conceptually. Aiming for abstinence while allowing for a few hiccups along the way may be much easier for some people to handle compared to the more in-depth actions one may need to reach a desired level of moderation.
Additionally, while moderation is now largely understood to be a valid option for some people, for many others, abstinence, so long as it’s coupled with a realistic understanding of AUD, still presents a reduced risk of redeveloping a substance use disorder.
It’s important to point out that abrupt abstinence (e.g. quitting cold turkey) is not a recommended solution in many cases, particularly if one has an advanced AUD. Withdrawals from alcohol can be extremely uncomfortable and even fatal in some cases, which makes it important to get in touch with qualified treatment professionals and to go through the whole continuum of care, regardless of the goal you want to set for yourself.
Should I Try Moderation?
It’s difficult to say for sure whether moderation is a realistic goal for any single case of AUD. Because everyone has different circumstances, it’s likely that moderation simply may not be possible for people with a genetic predisposition for AUD or those unable to realistically avoid relapse triggers. That said, it’s best to consult with qualified treatment experts to see if moderation or abstinence is more achievable for you.