Alcohol Use Disorder Treatment: The Association of Pretreatment Use and the Role of Drinking Goal

Abstract

Background: In a recent study conducted in a family medicine setting, the medication acamprosate was found not to be efficacious in the treatment of alcohol dependence, but a drinking goal of abstinence was found to have positive effects on alcohol use outcomes. The purpose of this secondary analysis was to further understand which patients with an alcohol use disorder may be most successfully treated in a primary care setting.Methods: The study was exploratory and used a trajectory-based approach based on data from the acamprosate treatment trial of 100 participants (recruited mostly by advertisement) who were randomly assigned to receive either acamprosate or a matching placebo. Post hoc trajectories of alcohol use before treatment were identified to examine whether trajectory classes and their interactions with treatment arm (acamprosate or placebo), pretreatment drinking goal (abstinence or a reduction), and time predicted alcohol use outcomes.Results: Three distinct trajectory classes were identified: frequent drinkers, nearly daily drinkers, and consistent daily drinkers. Consistent daily drinkers with a goal of abstinence significantly improved over time on the primary outcome measure of percent days abstinent when compared with frequent and nearly daily drinkers. In addition, all participants with a goal of abstinence, regardless of trajectory class, significantly reduced their percentage of heavy drinking days over time.

Controlled drinking—non‐abstinent versus abstinent treatment goals in alcohol use disorder: a systematic review, meta‐analysis and meta‐regression

“…The remaining trials merely assessed patients' personal goal but provided no specific or abstinence‐oriented treatment only. Four studies did not define a goal of CD as aiming for drinking within defined limits and included patients without a specific goal or those aiming for any drinking reduction into the CD‐oriented groups [19,42–44]. Seven studies included patients with alcohol dependence only; the remaining included patients with harmful use in varying degrees.…”

Treatment Goals and Alcohol Use Outcomes in Veterans With Comorbid Alcohol Dependence and Posttraumatic Stress Disorder

“…Studies indicate an association between abstinence and reduced use of alcohol treatment goals and subsequent achievement of those goals 8‐10 ; however, there is a lack of evidence clearly supporting either abstinence or reduced use as a superior treatment goal. Some studies indicate better alcohol use outcomes among those choosing an abstinence goal, 11‐17 while others have not found substantial differences in outcomes based on abstinence or reduced use goals 5,9,18,19 . Comparison across studies is made difficult by methodological differences, including procedures for defining goals, the timing of assessment, and outcomes assessed.…”

The American Psychiatric Association Practice Guideline for the Pharmacological Treatment of Patients With Alcohol Use Disorder

“…Consequently, the strength of research evidence is rated as low. However, secondary analyses of clinical trial data show that patient-stated goals of abstinence at study initiation are associated with more days abstinent and greater reductions in alcohol consumption than patient-stated goals of reduced alcohol use (Adamson et al 2010;Al-Otaiba et al 2008;Berger et al 2016;Bujarski et al 2013;Chang et al 2006;Dunn and Strain 2013;Gueorguieva et al 2014;Meyer et al 2014;Mowbray et al 2013). In addition, patient goals sometimes changed in the course of treatment.…”