Among individuals remitted at 1 year after outpatient treatment, 75% of non-problem users relapsed at some point over the 10 subsequent years versus 48% of abstainers. Even when controlling for age, gender, dependence type, health status, abstinence goals at intake, length of index treatment, and 12-step involvement, non-problem users had twice the odds of relapse over the 10 subsequent years than abstainers. This is consistent with prior alcohol research which found better outcomes for abstainers than low-risk or moderate drinkers (Dawson et al., 2007; Ilgen et al., 2008; Maisto et al., 2007). However, the current findings must be understood in the context of the treatment setting – 1 year after intake to an abstinence-oriented treatment program. These results may not generalize to a harm reduction model of treatment or among less severe, untreated individuals. There is evidence that some non-abstinence-oriented alcohol treatment approaches can be effective, particularly Behavioral Self-Control Training (Saladin and Santa Ana, 2004). Moreover, it may be that those able to maintain abstinent recovery for some significant period of time (e.g., 5 years or more) may successfully “step-down” to controlled or moderate, non-problematic use (Dennis et al., 2003).
