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The idea of never drinking alcohol again is something that scares a lot of alcoholics and problem drinkers away from seeking treatment. The most common rehab philosophy employed by addiction recovery facilities in the U.S. is one of abstinence, which is rooted in the Minnesota Model developed in the 1950s. However, over the last 30 years, the concepts of controlled drinking strategies and moderation management have become more and more popular options. The idea behind this approach is that it’s easier to achieve controlled drinking than abstinence. But several studies have proven this theory incorrect.

Distinguishing the Difference in Approaches

The abstinence approach to alcoholism treatment is based on the disease model of addiction. This states that alcoholism is a chronic and incurable disease. Through professional counseling and support, a person with the disease of alcoholism can recover from the condition as long as he or she abstains for life. This approach assumes that a recovered alcoholic who takes just one sip of alcohol risks the chance of relapse.[1]

bar chart showing correlation between drinking problem and higher rate of divorce

Controlled drinking strategies do not adopt the disease model of addiction and assume that a person who has an alcohol abuse problem can more easily attain the goal of reducing alcohol intake than completely eliminating it. For many diagnosed alcoholics and problem drinkers, this is a favorable approach because it allows them to continue drinking.[2] Debates about which approach is more effective date back several decades.

What Advocates Say About Controlled Drinking Strategies

Supporters of controlled drinking strategies point to the high relapse rates of addiction and the questionable success of Alcoholics Anonymous as the main justifications for this approach. With over 50 percent of alcoholics unable to reach one year of sobriety,[3] supporters of controlled drinking argue that abstinence sets up these individuals for failure and makes it less likely that they will seek treatment.

 Most people with addictions never seek treatment of any kind, and one of the largest reasons for this is the fear of completely ceasing substance abuse.[4] Controlled drinking strategies offer some leeway and allow alcohol abusers to enjoy some success in reducing alcohol intake without completely abandoning it. Supporters of the controlled drinking approach don’t believe that a person with a drinking problem risks relapse by continuing to drink moderately.

What Advocates Say About Abstinence

People who are in favor of the abstinence approach believe that controlled drinking strategies give alcoholics an excuse to continue drinking alcohol. They reason that controlled drinking asks a person with an addiction to exercise self-control in alcohol consumption when their most recent history likely suggests that they have been unable to do so.

It also makes attaining success easier, because a reduction in drinking is relative to the individual. But, just because it’s easier doesn’t mean that it’s the best approach. Should a person who drinks eight beers every day be celebrating success if he cuts down to seven per day? Or six? Or 5? Determining what is and isn’t successful is ambiguous at best using the controlled drinking approach.

Another criticism is that controlled drinking strategies take for granted the strength of a person’s addiction. The chronic nature of the condition makes it so the threat of a relapse is always present. This threat increases when an individual consumes alcohol again. The ability to recognize if a loved one is drinking too much is not always easy to recognize if they are functional alcoholics. Supporters of abstinence argue that the most effective way to overcome an alcohol addiction is to completely eliminate alcohol from one’s life.

photo of man and glass of hard liquor with his head on the bar

What the Research Says

Although there is no conclusive evidence showing one method always works better for every person, primarily because much of the information learned during research projects is based on self-reporting, which may or may not be accurate. The majority of studies, contrary to popular belief, suggest that abstinence is actually easier to maintain than controlled drinking for alcoholics.

illustrated chart showing success rates over 25 yrs for alcohol treatment options

One study followed 201 adults with alcohol addictions for 2.5 years after the onset of treatment. Researchers found that “patients whose goal was total abstinence were more successful than those who had chosen to control their drinking.” The study revealed that approximately 90 percent of patients whose goals were abstinence were still sober after 2.5 years. In contrast, 50 percent of those who chose controlled drinking strategies reported success during the same period.[5]

Research from Harvard Medical School determined that controlled drinking can only be successful in individuals who have “not developed a pervasive pattern of alcohol abuse, or who have experienced few negative consequences from drinking.” Researchers went on to say that “moderation is unlikely to be successful for patients who already meet the criteria for dependence.”[6]

A 2010 U.K. study followed patients in treatment for alcoholism and found that patients who chose abstinence instead of controlled drinking had “superior outcomes” after three-month and 12-month follow-ups.[7]

Walking the Line Between “No” and “Maybe”

Just as studies have shown that individuals with more severe alcohol addictions would most likely be more successful with abstinence-only, there are individuals who can excel with controlled drinking strategies. However, as difficult as it is to just say no, it appears that it could be even more difficult to say no at some times and yes at others.

For many individuals with drinking problems, once the first sip of alcohol goes down, all bets may be off. Controlled drinking strategies may put individuals at an unnecessary risk of a relapse. At Behavioral Wellness and Recovery, we believe in the abstinence approach, because it has been proven to lead to long-term success. We invite you to contact us to learn more about our addiction recovery strategies and philosophy.

illustrated pie charts, bar charts, graphs showing a lot of analysis

Establishing daily, weekly and monthly alcohol consumption thresholds and then adhering to them is much easier said than done. This is why the abstinence-only approach is the most popular rehab method employed by addiction care facilities in the U.S.