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.