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.

只有少数物质使用障碍 (SUD) 患者接受治疗。对禁欲的关注在 SUD 治疗中普遍存在，定义了研究和实践的成功，并且惩罚措施通常强加于那些不禁欲的人。大多数患有 SUD 的成年人不寻求治疗，因为他们不想停止使用物质，尽管许多人也认识到需要帮助。这篇叙述性综述认为需要增加对 SUD 的非戒断心理社会治疗的研究关注——尤其是吸毒障碍——作为一种潜在的方式来吸引和留住更多的人参与治疗，让人们更早地参与治疗，并提高治疗效果。我们描述了在美国 SUD 治疗的历史背景下非禁欲方法的发展，审查非禁欲 SUD 治疗的理论和实证原理，并审查成人 SUD 非禁欲社会心理治疗的现有模型，以确定文献中的差距和未来研究的方向。尽管对非戒酒干预措施有重要的实证支持，但在检查非戒酒心理社会治疗对吸毒障碍的研究中存在明显差距。未来的研究必须测试非戒毒治疗对药物使用的有效性，并解决实施障碍。在检查药物使用障碍的非戒断心理社会治疗的研究中存在明显差距。未来的研究必须测试非戒毒治疗对药物使用的有效性，并解决实施障碍。在检查药物使用障碍的非戒断心理社会治疗的研究中存在明显差距。未来的研究必须测试非戒毒治疗对药物使用的有效性，并解决实施障碍。