Acceptance of non-abstinence as an outcome goal for individuals diagnosed with substance use disorders: A narrative review of published research (2020)

OBJECTIVE: 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.
METHOD: 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.
RESULTS: 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.
CONCLUSIONS: 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.