Reduced-risk drinking as a treatment goal: what clinicians need to know

Ambrogne, Janet A.

doi:10.1016/s0740-5472(01)00210-0

Cited by 84 publications

(53 citation statements)

References 44 publications

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“…These results were unexpected in the treatment field, and the authors were accused of bias and unprofessional conduct (for details, see [52]). At last, all accusations were proven wrong and Sobell [53 ]noted in retrospect that the discussion would have been less emotional had they chosen the term “return to low-risk-drinking” instead of “controlled drinking”.…”

Section: Controlled Psychotherapy Trials With An Explicit Reduction Goalmentioning

confidence: 99%

Reduced Drinking in Alcohol Dependence Treatment, What Is the Evidence?

2017

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Abstinence from alcohol has been the prevailing treatment goal for individuals with alcohol dependence (AD) within the context of specialty alcohol treatment. Yet, alcohol use has been conceptualized as existing on a continuum. Importantly, most people who meet criteria for AD and could benefit from treatment never receive treatment. About half of these individuals do not seek treatment because they report a desire to continue drinking. To increase acceptability of treatment, reductions in alcohol consumption have been examined as alternative outcomes in treatment trials for AD. The current study reviews data which indicate that long-term reduction in alcohol consumption among patients with AD is possible. Controlled studies have tested reduced alcohol consumption and show sustained improvements in drinking reductions for many patients following behavioral treatments and pharmacotherapy. Evidence-based treatment guidelines and medicines development guidance authorities have taken note of these developments and accept “intermediate harm reduction” (European Medicines Agency) or “low-risk drinking limits” (US Federal Drug Administration) as optional trial endpoints. In conclusion, while abstinence remains the safest treatment goal for individuals with AD, evidence supports that reduced drinking approaches may be an important extension in the treatment of AD.

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Section: Controlled Psychotherapy Trials With An Explicit Reduction Goalmentioning

confidence: 99%

Reduced Drinking in Alcohol Dependence Treatment, What Is the Evidence?

2017

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“…whether they lead all the way to abstinence (the traditional aim of AD therapy, as indicated above), or at least to a reduction in consumption. [136][137] In the following section, we will examine whether these two approaches have any impact on mortality.…”

Section: Do Interventions Affect Survival?mentioning

confidence: 99%

Alcohol Consumption, Alcohol Dependence and Attributable Burden of Disease in Europe: Potential Gains From Effective Interventions for Alcohol Dependence

Rehm¹,

Shield²,

Rehm³

et al. 2012

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126

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Step 2 This report provides a timely and comprehensive review of the relationship between alcohol consumption and harm in Europe. While European alcohol strategies have typically focused on reducing alcohol misuse through controls on availability, marketing and price, and drunk-driving countermeasures, this report highlights the considerable potential to reduce alcohol-related harm through wider implementation of individually directed interventions for people with alcohol dependence. There is now a considerable evidence base which supports the effectiveness and cost effectiveness of brief interventions, and a range of specialist treatment for people with alcohol use disorders. However, this report highlights the current gap between evidence and practice. Less than 10%of people with alcohol dependence receive treatment in Europe; and yet alcohol dependence accounts for a substantial proportion of all harm associated with alcohol.Rehm and colleagues provide a compelling case for action in Europe-at both an individual country level and a pan-European level to make treatment for alcohol dependence more widely available. The current patchwork of services for people with alcohol dependence has resulted from a lack of strategic direction and a failure to exploit knowledge we already possess on what works in helping people to reduce or stop drinking alcohol. Many European countries have no national or professional guidelines to inform clinicians and commissioners of health care.Increasing the proportion of people with alcohol dependence who gain access to effective treatment must now be a Europe-wide priority. In doing so, one must not underestimate the potential challenges including training for health professionals and costs of implementation. However, given the proven cost-effectiveness of treatment for alcohol dependence, such investment is likely to yield significant cost savings as well as reduced human suffering.Colin Drummond, MD, FRC Psych Professor of Addiction Psychiatry, National Addiction Centre, Institute of Psychiatry, King's College London, London, UK Wakeup call for Europe's drinking problemThis study is a wake-up call that the European Union has a drinking problem. And not just a drinking problem, but an enormous drinking problem. Any practicing doctor, particularly a family doctor, as I was, or a liver doctor or psychiatrist, will know the devastation that being dependent on alcohol wreaks on the lives not just of the drinker, but also on those of family, friends and work colleagues. It is simply awful. Terrible though alcohol dependence is, as a public health doctor, I always thought it the tip of the iceberg of alcohol-related public health problems. But, according to this study, when it is fully analysed, heavy drinking and alcohol dependence is the iceberg. And at the public health level, it is also simply awful. For all drinking as a whole, one in seven of all male deaths in the European Union in the age range of 15-64 years is due to alcohol, and one in 13 of all female deaths. According to this...

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“…A recent study found that at least a quarter of people with persistent alcohol use disorders, who could benefit from specific treatment, do not seek treatment [5]. For many dependent patients, total abstinence is not considered an achievable aim of treatment, whereas reduction of alcohol consumption is often accepted as an alternative approach to reducing negative consequences [6]. Nalmefene (Selincro ® , H. Lundbeck A/S, Valby, Denmark) is an opioid system modulator licensed in Europe for the reduction of alcohol consumption in adult patients with alcohol dependence who have a high drinking risk level (DRL) without physical withdrawal symptoms and who do not require immediate detoxification [7].…”

Section: Introductionmentioning

confidence: 99%

Nalmefene, Given as Needed, in the Routine Treatment of Patients with Alcohol Dependence: An Interventional, Open-Label Study in Primary Care

et al. 2018

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Aims: This 12-week, open-label, primary care study (NCT02195817) evaluated the efficacy and safety of nalmefene, taken as needed, to reduce alcohol consumption in adults with a diagnosis of alcohol dependence and drinking at least at high drinking risk levels (DRL, > 60 g/day for men, > 40 g/day for women). Methods: Following the Screening Visit, patients recorded their daily alcohol consumption for 2 weeks. Patients were then categorised by their self-reported drinking levels; those who maintained at least a high DRL in the 2-week period were included in Cohort-A, and those who reduced their alcohol consumption below high DRL were included in Cohort-B. Cohort-A received simple psychosocial interventions and were supplied with nalmefene 18 mg to be taken on days when they perceived a risk of drinking alcohol. Patients in Cohort-B received a simple psychosocial intervention and were treated per normal practice. Results: Of the 378 enrolled patients, 330 were included in Cohort-A and 48 in Cohort-B. For patients in Cohort-A, the mean change from screening to Week-12 in the number of heavy drinking days/month was –13.1 days/month (95% CI –14.4 to –11.9, p < 0.0001). Overall, 55% of patients reduced their DRL by ≥2 risk levels and 44% of patients reduced to a low DRL. The most common adverse events were nausea (18.3%) and dizziness (17.7%). Patients in Cohort-B maintained their lower level alcohol consumption at the 12-week follow-up. Conclusions: Patients with alcohol dependence treated in primary care with nalmefene, taken as needed, in conjunction with simple psychosocial support, significantly reduced their alcohol consumption. Treatment was well tolerated.

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Reduced-risk drinking as a treatment goal: what clinicians need to know

Cited by 84 publications

References 44 publications

Reduced Drinking in Alcohol Dependence Treatment, What Is the Evidence?

Reduced Drinking in Alcohol Dependence Treatment, What Is the Evidence?

Alcohol Consumption, Alcohol Dependence and Attributable Burden of Disease in Europe: Potential Gains From Effective Interventions for Alcohol Dependence

Nalmefene, Given as Needed, in the Routine Treatment of Patients with Alcohol Dependence: An Interventional, Open-Label Study in Primary Care

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