Acceptance of Non-Abstinence as an Outcome Goal for Individuals Diagnosed With Substance Use Disorders: A Narrative...

Natural recovery and treatment outcome studies published over the past four decades indicate that some individuals with substance use problems moderate their consumption of alcohol and other drugs. Concurrently, a growing number of investigations have assessed service providers' attitudes regarding non-abstinence goals.

To provide a summary of that research, we identified 25 articles published between 1981 and 2019 that reported agency and/ or clinician acceptance of non-abstinence treatment goals, often as a function of severity of the client condition, finality of the outcome goal, type of substance consumed, and/or treatment setting.

Although acceptance rates varied considerably across studies, respondents more often endorsed non-abstinence as an outcome goal (a) for less severely impaired rather than for more severely impaired clients; (b) as an intermediate goal on the way to achieving abstinence rather than as the final outcome goal; and (c) when the target substance is alcohol or cannabis rather than drugs such as cocaine, heroin/opioids, hallucinogens, amphetamines, and MDMA/Ecstasy (3,4-methylenedioxymethamphetamine). Acceptance also varied by treatment setting, with more acceptance of non-abstinence goals in outpatient settings than residential settings, and by geographic location, with larger proportions of service providers in Australia and European countries endorsing non-abstinence goals than those working in the United States and Canada.

We anticipate that acceptance will increase or remain high as research continues to demonstrate improved functioning by those who achieve non-abstinence outcomes, and we recommend further evaluation of other client and clinician characteristics that might influence acceptance and rejection of non-abstinence outcome goals.