Are Drinking Goals Associated with Outcomes Among People with Alcohol Use Disorder?

This study aimed to assess treatment outcomes among patients with alcohol use disorder who reported drinking goals at the beginning of treatment, categorized as: abstinence, “low-risk” drinking,* or no decided goal. Data came from a longitudinal study in which patients were recruited 2004-2012 from 3 treatment settings: a 12-step-oriented outpatient treatment center, a 12-step-oriented inpatient center, and a community outpatient center offering psychosocial treatment. Patients (N=349) were followed up 2.5 and 5 years after entering treatment. Overall, 25% were women, the mean age was 48 years, and 93% met criteria for DSM-IV alcohol dependence.

  • Most patients reported abstinence as their drinking goal (64%); 19% reported a goal of low-risk drinking and 17% were undecided.
  • The group with abstinence as a goal and those undecided had more years with unhealthy alcohol use compared with those aiming for low-risk drinking (13 years, 12 years, and 7 years, respectively). At treatment entry, those with abstinence as a goal drank more than those undecided or aiming for low-risk drinking (880g/week, 480g/week, and 427g/week, respectively).
  • There was a significant reduction in drinking over time for all groups and at 5 years 65% of participants achieved either abstinence or low-risk drinking.
  • There were no significant differences between the 3 groups in alcohol consumption at follow-up, but there was a significant interaction effect between group and time, indicating that those with abstinence as a goal had a sharper decrease in alcohol use than the two other groups.

* Defined as average weekly consumption of <110 g alcohol for women and <170 g alcohol for men.

Comments: In this observational study, it is difficult to ascertain whether these outcomes were due to abstinence as a treatment goal, or to characteristics associated with the treatment goals (e.g., severity of alcohol use disorder), or to treatment that matched the goal (i.e., 12-step, abstinence-oriented). It is a stretch from these data to conclude that abstinence is a better treatment goal overall, but it appears that the patients with more severe disorders tended to choose abstinence as a goal and possibly had better outcomes than those who did not. Regardless of their treatment goals, all patients improved; this should encourage clinicians to offer treatment to all patients, regardless of their drinking goals.

Nicolas Bertholet, MD, MSc

Reference: Berglund KJ, Rauwolf KK, Berggren U, et al. Outcome in relation to drinking goals in alcohol-dependent individuals: a follow-up study 2.5 and 5 years after treatment entry. Alcohol Alcohol. 2019; 54(4):439–445.

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