Cutting down but not out: Drink reduction is a viable goal in treatment for alcohol dependence


Newswise — Drink reduction goals are achievable and sustainable for people seeking treatment for alcohol dependence, according to new study findings. Sustained abstinence has long been considered the optimal treatment outcome for those with a clinically diagnosed alcohol use disorder (AUD). However, most people who seek treatment would prefer to reduce their drinking, rather than quit completely. Interest in drinking reduction as a treatment goal is growing, although whether reductions can be maintained over time, and improve patients’ function, is uncertain.

The large COMBINE clinical trial examined combinations of medications and behavioral interventions, used over 4 months, for treating alcohol dependence. One measure of alcohol intake was the World Health Organization (WHO) drinking risk level, which defines five risk levels based on a standard drink containing .6 fluid ounces (oz) or 14 grams (g) of ethanol per day (equivalent to 1.5 oz of 80 proof liquor, 12 oz of 5% beer, or 5 oz of 12% wine): abstinence(no intake), low risk(1-40 g/up to ~3 standard drinks in persons who are biologically male, 1-20 g/~1.5 drinks in persons who are biologically female), medium risk(41-60 g/up to ~4 drinks in males, 21-40 g/up to ~3 drinks in females), high risk(61-100 g/up to ~7 drinks in males, 41-60 g/~4 drinks in females), and very highrisk (101 g/+7 drinks in males, 61 g/+4 females). Most participants were in the ‘very high risk’ category before treatment, but reduced their drinking by at least two levels during treatment.

In a new analysis of the study data, researchers examined whether reductions in drinking level were maintained 1 year after treatment ended, and were linked to improved functioning. They found that almost nine out of 10 patients with a one-level (or greater) reduction by the end of treatment maintained this one year later. So too did almost eight out of 10 patients with a two-level (or greater) reduction. A reduction in the WHO risk level was also associated with better physical health (lower blood pressure and liver enzyme levels), and fewer drinking-related consequences, through 1 year post-treatment.

These new data show that a reduction in WHO risk drinking level is a meaningful and sustainable measure, and appropriate for use in future clinical trials of new treatment approaches and in clinical care. Awareness around cutting down, rather than quitting altogether, is a viable goal that may also encourage more people who drink heavily to seek treatment.

 

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