OBJECTIVES. The study was conducted to refine guidelines on moderate drinking for problem drinkers, persons whose alcohol use is hazardous or harmful. Information on levels of alcohol intake unlikely to cause problems is useful for health professionals, educators, and policymakers. METHODS. Based on their reports of alcohol-related problems, participants in three studies assessing interventions to reduce heavy drinking (114 men, 91 women) were categorized as "problem-free" or "problem" drinkers at follow-up. Drinking measures were examined to identify patterns separating these outcome categories. RESULTS. Analyses using 95% confidence intervals for means on drinking measures showed that guidelines should be sex-specific. Based on analyses of positive and negative predictive value, sensitivity, and specificity, it is recommended that men consume no more than 4 standard drinks in any day and 16 drinks in any week, and that women consume no more than 3 drinks in any day and 12 drinks in any week. CONCLUSIONS. These guidelines are consistent with those from several official bodies and should be useful for advising problem drinkers when moderation is a valid treatment goal. Their applicability to the general population is unevaluated.

A cognitive-behavioral program with a goal of either abstinence or controlled drinking was assessed. The 70 early-stage problem drinkers were randomly assigned to one of the two goal conditions, and within each condition to one of two therapists. On average they received six individual weekly sessions, each lasting approximately 90 min. Both groups were taught to indentify risk situations and existing competencies, to develop cognitive and behavioral coping, and to assess their progress objectively. The controlled-drinking group was also taught procedures for moderate drinking. Over the 2-year follow-up period, no significant differences were found between the groups in reported alcohol consumption. Six months after treatment drinking had been reduced from an average of about 51 drinks per week to 13, and this reduction was maintained throughout the second year. Reports of drinking were corroborated by independent measures. Although the outcomes of the groups were similar, controlled drinking was considered to be a more suitable goal; it was more acceptable to the majority of the clients, and most of those assigned to abstinence developed moderate drinking on their own. The authors wish to thank the following colleagues for their contributions to the project: C. Milton-Feasby and V. Ittig-Deland for conducting intake and follow-up assessments, B. Sisson for medical screenings, Y. Israel for recommending the biochemical corroborators of alcohol consumption, and B. Kapur for conducting the laboratory analyses. Special appreciation is extended to H. Lei for his advice on statistical analyses and to D. A. Wilkinson, K. D. Walker, H. A. Skinner, and C. Poulos for their valuable feedback and support.Requests for reprints should be sent to M.

Present methods to screen for alcohol abuse are generally obtrusive and result in referral to services that deal mainly with alcoholics. These factors deter physicians from identifying alcohol abuse patients at an early stage. In the present study, 81% of all primary care physicians of a single city evaluated (i) the efficiency and the acceptability of a nonobtrusive screening method for the identification of problem drinkers and (ii) the effectiveness of brief cognitive behavioral counseling given by a nurse in a lifestyle context. Patients (n = 15,686) attending the private practices of 42 primary-care physicians were asked four alcohol-neutral trauma questions in the reception area. Physicians asked about alcohol use and alcohol-related problems only to patients with previous trauma. Problem drinkers by defined criteria were offered an appointment with a nurse who, by random assignment, gave either 3-hr of cognitive behavioral counseling over 1 year or simply advised patients to reduce their alcohol intake. The screening method identified 62-85% of expected number of problem drinkers in this population. Following the application of exclusion criteria, 105 problem drinkers were entered in the intervention part of the study. After 1 year, patients who received counseling showed significant reductions in reported alcohol consumption (-70%; p < 0.001), psychosocial problems (-85%; p < 0.001) and serum gamma glutamyl transferase (-32% to -58%; p < 0.02). Physician visits were reduced (-34%; p < 0.02) following counseling. Patients receiving only advice showed neither reductions in psychosocial problems nor in serum gamma glutamyl transferase or physician visits, but reported a 46% reduction (p < 0.01) in alcohol consumption. Data indicate that asking patients about recent trauma is efficient and is well accepted as the first screening instrument in the identification of the problem drinker. Cost of screening per patient is under one dollar. Counseling of 3 hr given by a nurse is markedly superior (p < 0.05) to simple advice in reducing alcohol consumption, objective indicators of alcohol-related morbidity, and the frequency of physician visits.

We conducted a double-blind, placebo-controlled trail in which 40 patients who had undergone long-term therapy with benzodiazepines were switched to placebo or to diazepam in a dose approximately equivalent to their usual dose of the benzodiazepine; the dose of diazepam was then tapered during an eight-week period. Patients were assessed clinically and psychologically and had weekly sessions of behavioral therapy. The subjects who received placebo had more symptoms, assessed their symptoms as more severe, and stopped taking the study drug at a higher rate than those receiving the tapering doses of diazepam. The subjects in the placebo group also had symptoms shortly after being switched to placebo, whereas those in the diazepam group had symptoms much later. Some withdrawal symptoms were distinct from those of anxiety (e.g., tinnitus, involuntary movement, and perceptual changes). Withdrawal symptoms occurred earlier in patients who had received short-acting benzodiazepines than in those who had received long-acting benzodiazepines. Symptoms gradually disappeared over a four-week period in both the placebo and the diazepam groups. Serial determination of plasma benzodiazepine concentrations was a useful way to assess compliance, treatment outcome, and relapse during withdrawal. We conclude that a clinically important, mild, but distinct withdrawal syndrome occurs after discontinuation of long-term therapeutic use of benzodiazepines.

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