Alcohol is one of the most damaging drugs known to man, based on its total economic and social costs. An estimated 17 million Americans have an alcohol use disorder; however, just 1.4 million adults received professional treatment in 2012, according to the National Institute on Alcohol Abuse and Alcoholism.

One of the biggest challenges for those seeking treatment for alcoholism is the prospect of never having another drink. Despite the destruction that alcohol use may cause, the physiological and psychological facets of addiction make it challenging to give up.

Dominant Treatment Model Is Sobriety-Focused

In the United States, many people seek help for alcoholism through Alcoholics Anonymous (AA) or other so-called “Twelve Step” programs. One of the central ideas in AA is that alcoholics are powerless over drinking and cannot control their compulsion to use alcohol. Thus, most treatment for alcoholism emphasizes complete sobriety from alcohol.

There is good scientific evidence that sobriety-based treatment programs help individuals manage the negative effects of alcohol use. In fact, undergoing detoxification is a central part of many professional treatment programs. During the detoxification process, the person quits using completely and must combat a range of withdrawal symptoms. These often include nausea, vomiting, tremors, depressed mood, anxiety, and even seizures. Following the detox process, many treatment programs — particularly residential treatment — require complete sobriety.

The rationale behind sobriety-focused treatment is that addiction is a serious disease that changes brain functioning. After a period of chronic drinking, the brain becomes used to receiving alcohol and comes to crave its effects. Even a single drink can trigger a cascade of events that leads a person right back to alcoholism. To maintain a healthy recovery, strict avoidance of alcohol is the best way to ensure that the cycle of alcohol abuse does not begin again.

Harm Reduction Models May Be Effective, but More Evidence Is Needed

Despite the benefits of strict sobriety in treatment programs, many recovering alcoholics struggle to manage their drinking behavior. Attending weddings, parties, or social gatherings with friends may become fraught as a person must avoid drinking to maintain sobriety.

Although many alcohol abuse researchers maintain that sobriety is necessary to maintain a long-term recovery, others disagree. A “harm reduction” approach emphasizes reducing drinking to manageable levels, rather than quitting altogether. Focused on “safer” drinking, harm reduction emphasizes practical strategies to ensure that drinking does not become harmful or destructive. Thus, a person may identify triggers for binge drinking and avoid those situations. That same person may realize that socializing with friends at a bar is an enjoyed activity, provided that she limits herself to just one drink.

Harm reduction models of alcoholism remain controversial, but some scientific evidence indicates that they may result in success. For example, a study of Australian teenagers found that those who went through a harm reduction program were 33.8% less likely to drink at risky levels after 20 months. Studies comparing harm reduction approaches to abstinence-only programs have found similar levels of relapse between the two groups.

Taken together, the evidence indicates that both abstinence-only and harm reduction programs may be helpful to curb alcoholism. For now, however, most treatment programs in the United States emphasize complete sobriety. Total abstinence from alcohol promotes biological changes that reduce risk of alcoholism. Furthermore, sobriety remains one of the best ways to ensure that a single drink does not derail months or years of hard progress during recovery.