Is Low-Risk Drinking an Appropriate Treatment Outcome for Individuals with Alcohol Use Disorders?
Although the Food and Drug Administration now recommends “no heavy drinking” (defined as abstinence or low-risk drinking) as the primary outcome for clinical trials of alcohol treatment, it is not clear if this is an appropriate outcome for patients who enter treatment with more severe alcohol use disorders. In this study, researchers examined data from 2 large randomized studies of alcohol and drug treatment delivery in an integrated health-care system. The analysis was restricted to 995 participants with alcohol abuse or dependence at baseline who provided data on past 30-day alcohol consumption and completed the Addiction Severity Index (ASI) at 6 and 12 months post-treatment.
- At 6 months, 66% of participants were abstinent, 14% drank low-risk amounts,* and 20% drank heavy amounts.** By 12 months, 7% of participants who were abstinent and 31% with low-risk drinking had progressed to heavy drinking.
- Compared with those with heavy drinking at 6 months, participants who were abstinent were more likely to be abstinent or to consume low-risk amounts at 12 months (odds ratio [OR], 16.7) and to have lower ASI psychiatric (OR, 1.8), family/social (OR, 2.2), and employment (OR, 1.9) problem severity.
- Compared with those with heavy drinking at 6 months, participants with low-risk drinking were more likely to be abstinent or to consume low-risk amounts at 12 months (OR, 3.4) and to have lower ASI psychiatric (OR, 2.2) and family/social (OR, 2.2) problem severity.
*Defined in this study as nonabstinence and no days with consumption of 5+ drinks (grams of alcohol per standard drink not provided).
**Defined in this study as 1 or more days with consumption of 5+ drinks.
Comments:This study indicates that, compared with those who drink heavily, individuals who drink low-risk amounts 6 months after treatment for alcohol use disorders have a similar decrease in alcohol-problem severity as that seen in abstinent individuals. This suggests low-risk drinking may be an appropriate harm-reduction target for alcohol treatment. However, it should also be noted that people consuming low-risk amounts had a higher rate of progression to heavy drinking than those who were abstinent, which may lead to adverse consequences later on. Kevin L. Kraemer, MD, MSc