The World Health Organization (WHO) has defined risk levels for alcohol consumption.* Reducing drinking to lower risk levels of consumption have been proposed as potential alternative treatment goals to abstinence and absence of heavy drinking days. In this study, researchers assessed the association between one- and two-level reductions and improvements in quality of life and physical health using data from COMBINE study participants who received treatment for DSM-IV alcohol dependence (N=1142).
- At baseline, most (69%) participants were in the very high risk category.
- Four months later, 36% were abstinent; 39% were in the low risk, 10% in the medium risk, 6% in the high risk, and 8% in the very high risk categories.
- 89% of participants had at least one risk level reduction, 77% had at least two.
- One- and two-level reductions in risky drinking levels were associated with:
- Significant reduction in systolic blood pressure (SBP): a one-level reduction was associated with 7.99 mmHg lower SBP (compared with no change or increase); a two-level reduction was associated with 7.38 mm/Hg (compared with one-level reduction, no change, or increase).
- Small-to-medium range changes in AST, ALT, and GGT.
- Better quality of life in all domains: physical, psychological, social, and environmental.
* Low (1–40g ethanol/day for men, 1–20g/day for women); medium (41–60g/day for men, 21–40g/day for women); high (61–100g/day for men, 41–60g/day for women); and very high (≥101g/day for men, ≥61g/day for women).
Comments: Whether the observed changes in SBP or liver enzymes can be linked to more distal outcomes (like cardiovascular events or survival) remains to be seen. Nevertheless, drinking risk level reduction as a clinical outcome, notably in a harm reduction approach, can be appropriate and is associated with better quality of life.
Nicolas Bertholet, MD, MSc
Reference: Witkiewitz K, Kranzler HR, Hallgren KA, et al. Drinking risk level reductions associated with improvements in physical health and quality of life among individuals with alcohol use disorder. Alcohol Clin Exp Res. 2018;42(12):2453–2465.