> And for "rates of continuous abstinence" they found a positive effect.
It’s been a while since I reviewed the literature for substance abuse disorder, but if I remember correctly it was highly disputed whether complete abstinence was necessary (or even beneficial) for treatment. Has this changed?
The argument was that by focusing on abstinence you are setting a significant part of your patience up for failure with all the psychological harm involved in knowing that they’ve failed, which might result in severe and frequent relapses.
EDIT: To conclude. I find it hard to draw conclusions if success is measured in “days of abstinence”. That means that a patient that has recovered from cognitive behavior therapy (CBT) that uses occasionally and non-detrimentally is not considered a success! Further AA or other 12-step programs do often stress abstinence while CBT does not, this creates a counting bias in favor of 12-step programs.
I'm a recovering information addict, food addict, sex addict, and love addict.
Doing the same behaviors in a mindful way instead of out of a desire to mask/numb/avoid matters.
Also, I stopped counting my various abstinence stretches because it's not actionable information. I don't assess my recovery that way. I take a look at my needs and identify how I'm doing meeting them.
That initial honeymoon period? It’s like it fixes everything. I’m a whole different person.
Then the honeymoon period ends and I get bored and irritated and nasty. I need to find another one to fix me. Because the current relationship is clearly where the problem lies.
Repeat ad infinitum.
That’s my experience of it. Others may have a different experience.
I am very skeptical about claims that heavy alcoholics can ever moderately drink over a significant period of time again. There are a lot of studies showing successful moderate drinking over the short term, but the studies are always short-term studies using self-reporting data.
Active alcoholics are downright dishonest about how bad their alcoholic drinking is; they will claim it is moderate drinking to anyone who asks them (including scientists making a study) and lie about the amount of alcohol they actually consume.
The most famous study refuting the claims that alcoholics can moderately drink again is probably Pendery 1982, which showed that people who were reported as successfully moderately drinking in an early 1970s study were, a decade later, either not drinking at all, engaging in out of control drinking, or dead from alcohol-related complications.
The question is not whether “heavy alcoholics can moderately drink”, which you claim skepticism over, and I—for the record—claim ignorance.
The question is: “is complete abstinence necessary for some cases of substance abuse disorder?”
We have ample observational evidence that complete abstinence does relieve many people from the symptoms of substance abuse disorder. We also have some anecdotal evidence that that is not true for everyone.
I also have a problem with the term moderate drinking. I’m sure—although here I’m ignorant as well—that patients aren’t encourage to moderately drink. Rather they are—again I’m guessing—not told to have failed if they do drink.
Say a recovering alcoholic has a night out of heavy drinking, but that does not further negatively impact them, i.e. they won’t relapse into a constant drinking habit. I would hold on calling that a failure. In fact it might be actively damaging for their psychological well being to say that they failed, which might actually cause a severe relapse.
The statement “by focusing on abstinence you are setting a significant part of your patients up for failure” sounds like advocating “moderate drinking” to me.
If we’re not telling alcoholics that abstinence is the goal, we’re telling them they can “moderately drink”. “moderate drinking”, simply put, is what we call non-abstinence for alcoholics.
This is very different from saying that a one-day relapse is a complete failure, and, yes, I agree that Alcoholics Anonymous is too focused on raw sobriety time.
> The statement “by focusing on abstinence you are setting a significant part of your patients up for failure” sounds like advocating “moderate drinking” to me.
Sorry, that was not my intention. Like I stated earlier in the thread, it’s been awhile since I reviewed the literature. I’m not a psychologist, and I’m neither a recipient nor a practitiner of Cognitive Behavior Therapy for Substance Abuse Syndrome.
That said I’m sure therapists have a way of negatively reinforcing the damaging drinking behavior in such a way that a single night out is not considered a failure. I don’t know how they do it, but they are experts and I’m sure they know how to.
It’s been a while since I reviewed the literature for substance abuse disorder, but if I remember correctly it was highly disputed whether complete abstinence was necessary (or even beneficial) for treatment. Has this changed?
The argument was that by focusing on abstinence you are setting a significant part of your patience up for failure with all the psychological harm involved in knowing that they’ve failed, which might result in severe and frequent relapses.
EDIT: To conclude. I find it hard to draw conclusions if success is measured in “days of abstinence”. That means that a patient that has recovered from cognitive behavior therapy (CBT) that uses occasionally and non-detrimentally is not considered a success! Further AA or other 12-step programs do often stress abstinence while CBT does not, this creates a counting bias in favor of 12-step programs.