Abstinence and controlled drinking in the treatment of problem drinkers.

Miller, William R.; Caddy, Glenn R.

doi:10.15288/jsa.1977.38.986

Cited by 88 publications

(28 citation statements)

References 42 publications

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“…This small subgroup of patients appeared to have established prolonged periods of controlled drinking 21 with nearly all of these pa-33 pretransplantation variables were noted between abstinent (n Å 7) and nonabstinent groups (n Å 8) in this poly-tients (ie, 5/6) not experiencing liver graft dysfunction (Fig. 2).…”

Section: Discussionmentioning

confidence: 87%

“…Such recovery from severe problem drinking to controlled drug dependent group: presence of an active, pretransplantation life insurance policy (abstinent group: insurance-yes Å drinking has been previously noted in transplantation 5 and nontransplantation alcoholic patients. 21,29 5, insurance-no Å 2; nonabstinent group: insurance-yes Å 1, insurance-no Å 7: x 2 , P Å .02). The six other previously deDespite these excellent overall results, the most compelling argument against performing liver transplantation for pascribed variables noted in the original cohort (n Å 63) were not significantly different in this subgroup.…”

Section: Discussionmentioning

confidence: 99%

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Prediction of abstinence from ethanol in alcoholic recipients following liver transplantation

Foster¹,

Fabrega²,

Karademir³

et al. 1997

Hepatology

150

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End-stage liver disease secondary to alcoholic cirrhosis conThe prediction of abstinence from ethanol may be tinues to be a significant cause of death. 1 Most alcoholics with crucial to the optimal selection of liver transplantation end-stage liver disease do not have significant extrahepatic candidates with alcoholism. Of 84 consecutive end-stage complications of ethanol abuse. 2 Therefore, these patients are alcoholic patients who underwent transplantation not usually excluded because of other terminal medical condi-(1986-1994) at our institution, we analyzed 63 long-surtions, and many times will die shortly without transplantaviving recipients for pretransplantation variables to tion intervention. 2 Furthermore, excellent survival following predict posttransplantation abstinence (follow-up: 49.3 liver transplantation is noted with alcoholic recipients. [3][4][5][6][7][8][9][10][11] Be-{ 21 mo). Thirty-three pretransplantation variables cause these patients usually have liver disease solely because were reviewed from our transplantation data base and of the intake of a toxin (ie, ethanol), abstinence from this supplemented and confirmed with interviews with retoxin usually predicts minimal problems with liver disease cipients. The psycho-social inclusion criteria included following liver transplantation. The appropriate allocation of the following: patient recognition of alcoholism, a domiliver transplantation to specific alcoholic patients is made cile, an occupation, and at least one close personal relamore difficult by the large number of patients with end-stage tionship. The incidence of abstinence from ethanol was alcoholic cirrhosis and the intense demand for donor organs (50/63) 79%. A logistic regression of the 33 variables in for other end-stage liver diseases in which disease recurrence conjunction with our above inclusion criteria accurately may be less likely or more predictable. 12-14 Herein lies the predicted abstinence (90% accuracy, x 2 model, P õ problem that besets transplantation physicians: the appro-.00001) based on the absence of previous history of any priate selection of alcoholics with end-stage liver disease for illicit drug use (Drug Use: yes Å 1/no Å 0), the presence transplantation based on the prediction of long-term abstiof an active, personal life insurance policy (Life Ins: yes nence from alcohol. number of alcoholic sisters (ETOH-SIS), andThe aims of this study are to describe the following: 1) the the length of pretransplantation abstinence (PREresults of liver transplantation for patients with alcoholic TRANS-ABS, mos): Prob. of abstinence Å 1/1 / e 0F , F Å end-stage liver disease (survival, the incidence of abstinence, 00.33 / 0.89 (DRUG USE) 01.02 (LIFE INS) 01.68 (ETOHand pattern of recidivism); and 2) an analysis of pretrans-SIS) /0.24 (PRE-TRANS-ABS). In contrast, receiver-opplantation variables that may predict abstinence from alcohol erating characteristic curve analysis found that 7 and 9 following transplantation. months of pretransplantation abstinence were the be...

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Section: Discussionmentioning

confidence: 87%

Section: Discussionmentioning

confidence: 99%

Prediction of abstinence from ethanol in alcoholic recipients following liver transplantation

Foster¹,

Fabrega²,

Karademir³

et al. 1997

Hepatology

150

View full text Add to dashboard Cite

show abstract

“…4,13,23,24 Whether this selected group of patients who underwent transplantation for ALD are able to return to controlled drinking is uncertain. Only 17 of the 39 patients with ALD (43.6%) correctly recalled the advice to completely abstain from alcohol after transplantation.…”

Section: Discussionmentioning

confidence: 99%

Orthotopic liver transplantation for alcoholic liver disease: A retrospective analysis of survival, recidivism, and risk factors predisposing to recidivism

Mackie¹

2001

Liver Transplantation

159

102

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The aim of this study performed at the Liver Unit at the Queen Elizabeth Hospital, Birmingham, UK, is to assess posttransplantation alcohol consumption and identify risk factors associated with recidivism. This retrospective case-control study used a self-report questionnaire to assess pretransplantation and posttransplantation drinking, and a retrospective cohort study used patient notes to analyze risk factors for recidivism. Of 64 patients who underwent transplantation for alcoholic liver disease (ALD) between May 1996 and November 1999, a total of 49 surviving patients (40 men, 9 women) were available for study. The comparison group consisted of 49 patients matched for age, sex, and date of transplantation who underwent transplantation for non-alcohol-induced chronic liver disease. Two-year patient survival rates were 82% in both study groups. The questionnaire response rate was 69.3% and 75.5% in patients with and without ALD, respectively. Data on recidivism (defined as any alcohol consumption after transplantation) were available in 46 of the 49 patients with ALD. Of these, 45.6% were drinking; 21.7% reported only occasionally drinking; 17.3%, moderate drinking; and 6.5%, heavy drinking. Information on alcohol consumption was available from 41 of the 49 controls. Of these, 52.5% consumed alcohol; 22.0% reported drinking only on special occasions; 24.4%, moderate drinking; and 4.9%, a return to heavy drinking. However, these differences were not statistically significant, and log-rank analysis found no significant difference in time to resumption of drinking. In the ALD cohort, no significant risk factors were identified to predict recidivism. No pretransplantation risk factors (including period of abstinence before transplantation) correlated with recidivism. Survival after transplantation for ALD is similar to that in other forms of chronic liver disease. Recidivism rates for patients with ALD are high, but patients with ALD do not drink more than their control counterparts posttransplantation. In most instances, alcohol consumption posttransplantation is minimal to moderate (<20 units/wk) and seems to be controlled. (Liver Transpl 2001;7:418-427.)

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“…The debate between abstinence and non-abstinence approaches, specifically controlled drinking (CD), has remained a controversial topic in the alcoholism field since the 1960s (Davies, 1962; Miller & Caddy, 1977). As far as treatment outcomes are considered, there is no universally accepted definition of what constitutes successful CD.…”

Section: Introductionmentioning

confidence: 99%

The effects of drinking goal on treatment outcome for alcoholism.

Bujarski¹,

O’Malley²,

Lunny³

et al. 2013

Journal of Consulting and Clinical Psychology

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Objective It is well known to clinicians and researchers in the field of alcoholism that patients vary with respect to drinking goal. The objective of this study is to elucidate the contribution of drinking goal to treatment outcome in the context of specific behavioral and pharmacological interventions. Method Participants were 1226 alcohol dependent individuals enrolled in a large, multi-site trial of Combined Behavioral Intervention (CBI), acamprosate, and naltrexone. Drinking goal was coded as follows: (a) controlled drinking, (b) conditional abstinence, and (c) complete abstinence. Results Analysis revealed a main effect of drinking goal on percent days abstinent (p < .0001), days to relapse to heavy drinking (p < 0.0001), and global clinical outcome (p < .001). These results were such that a goal of complete abstinence was associated with the best outcomes, followed by conditional abstinence; controlled drinking was associated with the poorest outcomes. Conversely, a main effect of drinking goal was observed on drinks per drinking day (p < .01), such that controlled drinking was associated with fewer drinks per drinking day whereas complete abstinence was associated with the highest drinks per drinking day. CBI performed better than medical management alone for participants whose drinking goal was not complete abstinence. Conclusion These results suggest that drinking goal represents a highly predictive clinical variable and should be an integral part of the clinical assessment of patients with alcohol dependence. Assessment of patients' drinking goals may also help match patients to interventions best suited to address their goals and clinical needs.

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Abstinence and controlled drinking in the treatment of problem drinkers.

Cited by 88 publications

References 42 publications

Prediction of abstinence from ethanol in alcoholic recipients following liver transplantation

Prediction of abstinence from ethanol in alcoholic recipients following liver transplantation

Orthotopic liver transplantation for alcoholic liver disease: A retrospective analysis of survival, recidivism, and risk factors predisposing to recidivism

The effects of drinking goal on treatment outcome for alcoholism.

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