Brad Pitt’s disclosure that he is drinking again in “a more restrained manner,” after seven years of sobriety following heavy drinking drew intense pushback. Beyond arguments about the actor’s past behavior, the reaction exposed a deeper dispute over whether recovery from alcohol problems must always mean lifelong abstinence.

Dr. Smita Das, an addiction psychiatrist at Stanford University’s Addiction Medicine Dual Diagnosis Clinic, described an evolution in health care. Medical fields increasingly recognize a spectrum of recovery that includes both sobriety and recovery without abstinence, although some clinicians, patients and abstinence organizations remain opposed.

What is commonly called alcohol addiction or alcoholism has officially been known as alcohol use disorder, or AUD, since 2013 under the DSM-5. The manual defines AUD as “frequent or heavy alcohol drinking that becomes difficult to control and leads to problems such as in relationships, work, school, family, or other areas.”

AUD can be mild, moderate or severe, depending on how many diagnostic criteria a person experienced during the previous year. This approach replaced the earlier binary diagnoses of alcohol abuse and alcohol dependence.

The DSM-5 framework supports the view that sobriety is one component of recovery rather than its entire definition, Das said. Patients may also reach remission by reducing their drinking and resolving the criteria that led to their diagnosis.

Research on recovery without abstinence has been growing. A small February study found that some participants who continued low or moderate drinking felt confident about limiting their intake and believed supportive relationships and positive life changes helped them maintain recovery.

A larger 2025 study included about 1,900 participants who reported drinking during the previous month. Their health and functioning were similar to those of abstinent participants, although people who continued drinking were slightly more likely to experience psychological distress.

In 2022, researchers with the US National Institute on Alcohol Abuse and Alcoholism proposed defining recovery as a process or outcome involving both remission from AUD and an end to heavy drinking. Remission requires having no AUD criteria other than craving.

Under that definition, up to three months without qualifying criteria is initial remission. Three months to one year is early remission, one to five years is sustained remission, and more than five years is stable remission.

For men, ending heavy drinking means consuming no more than four standard drinks in one day or 14 in one week. For women, the limits are three standard drinks in one day or seven weekly.

The definition also considers whether basic needs are being met and whether social support, spirituality, physical health and mental health have improved. NIAAA director Dr. George Koob said the earlier lack of a measurable definition made systematic research into recovery and its duration difficult.

Experts said the DSM-5 and NIAAA approaches can expand access to care by removing the expectation that patients must be perfect before being considered recovered. Mild or moderate AUD diagnoses can also make people eligible for insured care before their problems require more intensive and expensive assistance.

Abstinence works best for most people, experts said, and is associated with the greatest progress in physical health, quality of life and psychosocial functioning. Still, research also links remission from heavy drinking with meaningful long term improvements, although a 2025 study found that participants who continued drinking were more likely to relapse.

Das said limited research exists on who can safely return to normal drinking. Her clinical experience and the 2025 research suggest moderation may be more feasible for people without severe AUD, those who have managed underlying mental health issues, people sober for years, or those no longer in the circumstances where their drinking began.

Even low alcohol consumption has been linked to increased risks involving dementia, cancer, high blood pressure and stroke. Alcohol also reduces judgment, including the ability to recognize when someone has consumed more than intended.

Alcoholics Anonymous and other 12 step programs have been significantly effective for many people, said Dr. Michael Joshua Ostacher of the American Psychiatric Association’s Council on Addiction Psychiatry. Yet Das said the belief that someone is always an alcoholic is clinically outdated, even if it can provide a protective boundary for vulnerable people.

When recovered patients ask about drinking again, Das examines their motives, risks and plans for maintaining progress. If they remain determined, she reviews their former DSM-5 criteria, helps establish limits and schedules additional appointments to monitor what happens.

People struggling with alcohol can seek outpatient or inpatient rehabilitation, medications, cognitive behavioral therapy, abstinence groups or moderation programs. Anyone needing help can contact the US Substance Abuse and Mental Health Services Administration’s National Helpline at 800-662-HELP (4357).