Abstinence versus Controlled Drinking as a Treatment Goal

There is controversy regarding controlled drinking versus abstinence as a treatment goal for alcohol use disorders. Nevertheless, when stated by the patient, it may be a useful predictor of treatment outcome. Researchers compared treatment outcomes at 3 and 12 months among patients meeting DSM-IV criteria for alcohol abuse or dependence who, at baseline, preferred either abstinence or a treatment goal that did not include abstinence. A successful outcome was defined as abstinence or drinking without alcohol-related problems.*

• Patients whose initial goal was abstinence were more likely to have a successful outcome at 3 months (22% versus 13%). This difference was not statistically significant at 12 months (30% versus 23%, p=0.06).
• Among patients with a successful outcome (i.e., abstinence or drinking without problems at 12 months), the majority of patients who had stated a preference for abstinence as a treatment goal achieved it by abstaining (71%). A substantial number of those who preferred a goal that did not include abstinence also, in fact, achieved success by abstaining (44%).
• There were no differences in dependence severity between groups at 3 and 12 months.

Comments:

In this study, patients with a treatment goal of abstinence were more likely to have a successful outcome at 3 months than patients whose goal did not involve abstinence. We should not conclude, however, that abstinence is the preferred goal for everyone, since success rates were similar (and low) regardless of preference at 12 months. Interestingly, since many successful outcomes occurred that differed from the patient’s initial treatment goal, such goals should be seen as dynamic and likely to evolve over the course of treatment without necessarily threatening a favorable outcome.

Nicolas Bertholet, MD, MSc

Reference:

Adamson SJ, Heather N, Morton V, et al. Initial preference for drinking goal in the treatment of alcohol problems: II. Treatment outcomes. Alcohol Alcohol. 2010;45(2):136–42.