Expanding the continuum of substance use disorder treatment: Nonabstinence approaches

• Published in: Clinical psychology review 2022-02, Vol.91, p.102110-102110, Article 102110
• Main Authors: Paquette, Catherine E., Daughters, Stacey B., Witkiewitz, Katie
• Format: Article
• Language: English
• Subjects: Addiction; Adult; Attention; Harm reduction; Humans; Psychosocial treatment; Substance use disorder; Substance-Related Disorders - therapy; Treatment Outcome; United States
• ISSN: 0272-7358; 1873-7811
• DOI: 10.1016/j.cpr.2021.102110

Only a small minority of people with substance use disorders (SUDs) receive treatment. A focus on abstinence is pervasive in SUD treatment, defining success in both research and practice, and punitive measures are often imposed on those who do not abstain. Most adults with SUD do not seek treatment because they do not wish to stop using substances, though many also recognize a need for help. This narrative review considers the need for increased research attention on nonabstinence psychosocial treatment of SUD – especially drug use disorders – as a potential way to engage and retain more people in treatment, to engage people in treatment earlier, and to improve treatment effectiveness. We describe the development of nonabstinence approaches within the historical context of SUD treatment in the United States, review theoretical and empirical rationales for nonabstinence SUD treatment, and review existing models of nonabstinence psychosocial treatment for SUD among adults to identify gaps in the literature and directions for future research. Despite significant empirical support for nonabstinence alcohol interventions, there is a clear gap in research examining nonabstinence psychosocial treatment for drug use disorders. Future research must test the effectiveness of nonabstinence treatments for drug use and address barriers to implementation. •Abstinence-only treatment excludes most adults with substance use disorder.•Nonabstinence treatment may improve engagement, retention, and effectiveness.•There is a gap in research examining nonabstinence psychosocial drug treatment.•Future work is needed to test effectiveness of nonabstinence treatments for drug use.•Addressing barriers to implementing nonabstinence treatment is also vital.