American counselors' acceptance of non-abstinence outcome goals for clients diagnosed with co-occurring substance use and other psychiatric disorders

Abstract

Previous research has examined clinicians’ acceptance of non-abstinence for clients who have a substance use disorder (SUD), but many SUD clients also present with a psychiatric disorder. To evaluate the acceptability of non-abstinence as a final outcome goal for clients with co-occurring diagnoses, we recruited a nationwide sample of 751 American substance abuse counselors to complete a web-based questionnaire. Respondents rated the acceptability of limited/moderate consumption by clients diagnosed with each of 18 co-occurring disorders: three psychiatric disorders (Major Depressive Disorder, Post-Traumatic Stress Disorder, Social Phobia) × three substances (alcohol, cannabis, opioids) × two levels of severity (DSM-5 Moderate SUD, DSM-5 Severe SUD). On average, non-abstinence was rated as unacceptable for clients with any of the 18 diagnostic pairs, although one-fourth to almost one-third rated limited/moderate use of cannabis somewhat or completely acceptable for clients diagnosed with a Moderate Cannabis Use Disorder when paired with any of the three psychiatric disorders. Furthermore, small proportions of respondents (13% to 20%) rated non-abstinence at least somewhat acceptable even when clients were diagnosed with a Severe SUD for any of the three substances and any co-occurring psychiatric disorder. Based on our findings, clients with co-occurring disorders who want to moderate their substance use will typically find their counselor does not accept that outcome goal. Because supporting non-abstinence respects client autonomy, could attract and retain clients in counseling, and is consistent with a recovery-oriented treatment model, we encourage continuing education about the benefits of non-abstinence as a treatment goal for clients with co-occurring disorders.

Acceptability of nonabstinent treatment outcome goals among addiction treatment providers in Ukraine.

“…The survey for this study was developed based on previously-published questionnaires designed to assess the acceptability of non-abstinence goals by British and American administrators and counselors working in addiction treatment agencies (Davis & Rosenberg, 2013; Rosenberg & Davis, 2014; Davis, Rosenberg, & Rosansky, 2017; Rosenberg & Melville, 2005; Rosenberg & Phillips, 2003). Each respondent was asked to rate how acceptable (Completely Acceptable = +2; Somewhat Acceptable = +1; Somewhat Unacceptable = −1; Completely Unacceptable = −2) it would be for a patient to pursue non-abstinence (defined as “moderate or controlled use of a substance”) as their intermediate or final outcome goal when they were diagnosed with one of 20 different types of substance use disorders: 10 types of substance-specific SUDs (alcohol, cannabis, opioids, sedatives, synthetic cathinones, methamphetamine, hallucinogens, tobacco, synthetic cannabis, cocaine) × 2 levels of diagnostic severity (ICD-10 Harmful Use, ICD-10 Dependence Syndrome; see column headings of Table 2).…”

Can Alcohol Use Disorder Recovery Include Some Heavy Drinking? A Replication and Extension up to 9 Years Following Treatment

“…Abstinence from alcohol remains the primary treatment target in most specialty treatment programs for alcohol use disorder (AUD; Davis and Rosenberg, 2013; Davis et al, 2017; Rosenberg and Davis, 1994) and is embedded in the program philosophies of many mutual‐help organizations (e.g., Alcoholics Anonymous). The U.S. Food and Drug Administration (FDA) recommends either abstinence or no heavy drinking days as primary clinical endpoints in alcohol medication development (FDA, 2015), and many definitions of AUD recovery focus on abstinence as a defining feature of recovery (Betty Ford Institute Consensus Panel, 2007; SAMHSA, 2011).…”

Guiding Principles for Managing Co-occurring Alcohol/Other Drug and Mental Health Conditions: a Scoping Review

“…A large survey of AOD counsellors working in comorbidity services (n = 751) found that many (71%) considered both clients' treatment history and individual context when assessing whether non-abstinence was an appropriate treatment goal for clients (Davis et al, 2017). When developing treatment goals, these AOD counsellors reported considering clients' AOD use history, treatment-related aspects (i.e.…”