Reduction in non-abstinent WHO drinking risk levels and depression/anxiety disorders: 3-year follow-up results in the US general population

Knox, Justin; Scodes, Jennifer; Wall, Melanie M.; Witkiewitz, Katie; Kranzler, Henry R.; Falk, Daniel E.; Litten, Raye Z.; Mann, Karl; O’Malley, Stephanie S.; Anton, Raymond F.; Hasin, Deborah S.

doi:10.1016/j.drugalcdep.2019.01.009

Cited by 45 publications

(53 citation statements)

References 49 publications

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“…Consistent with a growing body of findings from other reports [3][4][5]9,[42][43][44] and clinical guidelines, 45-47 our results suggest that reduced drinking, as measured by the WHO RDL reduction metric, is associated with good clinical outcomes and can be sustained over time. Some clinicians might prefer suggesting at least a 1-level reduction for patients, whereas others might prefer suggesting at least a 2-level reduction.…”

Section: R Discussionsupporting

confidence: 90%

Stability of Drinking Reductions and Long-term Functioning Among Patients with Alcohol Use Disorder

et al. 2020

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Background The World Health Organization (WHO) categorizes alcohol consumption according to grams consumed into low-, medium-, high-, and very-high-risk drinking levels (RDLs). Although abstinence has been considered the ideal outcome of alcohol treatment, reductions in WHO RDLs have been proposed as primary outcomes for alcohol use disorder (AUD) trials. Objective The current study examines the stability of WHO RDL reductions and the association between RDL reductions and long-term functioning for up to 3 years following treatment. Design and Participants Secondary data analysis of patients with AUD enrolled in the COMBINE Study and Project MATCH, two multi-site, randomized AUD clinical trials, who were followed for up to 3 years post-treatment (COMBINE: n = 694; MATCH: n = 806). Measures Alcohol use was measured via calendar-based methods. We estimated all models in the total sample and among participants who did not achieve abstinence during treatment. Key Results One-level RDL reductions were achieved by 84% of patients at the end of treatment, with 84.9% of those individuals maintaining that reduction at a 3-year follow-up. Two-level RDL reductions were achieved by 68% of patients at the end of treatment, with 77.7% of those individuals maintaining that reduction at a 3-year follow-up. One- and two-level RDL reductions at the end of treatment were associated with significantly better mental health, quality of life (including physical quality of life), and fewer drinking consequences 3 years after treatment (p < 0.05), as compared to no change or increased drinking. Conclusion AUD patients can maintain WHO RDL reductions for up to 3 years after treatment. Patients who had WHO RDL reductions functioned significantly better than those who did not reduce their drinking. These findings are consistent with prior reports suggesting that drinking reductions, short of abstinence, yield meaningful improvements in patient health, well-being, and functioning.

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Section: R Discussionsupporting

confidence: 90%

Stability of Drinking Reductions and Long-term Functioning Among Patients with Alcohol Use Disorder

et al. 2020

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“…204,208 COMBINE study data has also been used to show that reductions in WHO drinking risk levels predict reductions in alcohol-related consequences and systolic blood pressure, and improved mental health functioning, liver enzyme levels, and quality of life. 209 In epidemiologic studies of U.S. drinkers (n=22,005) followed prospectively for three years, reductions from the very-high-risk and high-risk levels predicted decreased rates of overall and chronic alcohol dependence, improved SF-12 mental health functioning, 10 and reduced odds of liver disease, 210 psychiatric comorbidity, 211 and DUDs 212 (Table 3). While more information on the relationship between these reductions and improvements in how individuals feel or function would further strengthen the case for using WHO drinking risk level reduction as a clinical trial outcome, 213 overall, the evidence thus far supports reductions from the highest levels of the four-level WHO drinking risk categories as valid outcomes.…”

Section: Outcome Measures Of Treatment Efficacy and Aud Treatment Goamentioning

confidence: 99%

Prevention, screening, and treatment for heavy drinking and alcohol use disorder

Knox

Hasin

Larson

et al. 2019

The Lancet Psychiatry

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108

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Heavy drinking and alcohol use disorder (AUD) are major public health problems. Practitioners not specializing in alcohol treatment are often unaware of the guidelines for preventing, identifying, and treating heavy drinking and AUD. However, a consensus exists that clinically useful and valuable tools are available to address these issues. Here, we provide a critical review of existing information and recent developments in these areas. We also include information on heavy drinking and AUD among individuals with co-occurring psychiatric disorders, including drug use disorders. Areas covered include prevention; screening, brief intervention, and referral for treatment (SBIRT); evidence-based behavioral interventions; medication-assisted treatment; technology-based interventions (eHealth and mHealth); and population-level interventions. We also discuss the key issues that remain for future research.

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“…Recent work has shown that reductions in WHO drinking risk levels correspond to significant improvements in mental health and drinking consequences in a clinical sample (Witkiewitz et al, 2017a). Similarly, in a nationally representative, population-based sample in the United States, reductions in the WHO drinking risk level were associated with significantly lower risk of developing alcohol dependence (Hasin et al, 2017) and lower risk of liver disease (Knox et al, in press).…”

Section: Introductionmentioning

confidence: 99%

“…Despite recent studies, gaps remain in evaluating the utility of the WHO drinking risk level reductions. First, although population-based data show that WHO drinking risk level reductions may be associated with reduced risk of liver disease (Knox et. al.…”

Section: Introductionmentioning

confidence: 99%

Drinking Risk Level Reductions Associated with Improvements in Physical Health and Quality of Life Among Individuals with Alcohol Use Disorder

Witkiewitz

Kranzler

Hallgren

et al. 2018

Alcoholism Clin & Exp Res

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101

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Background. Abstinence and no heavy drinking days are currently the only Food and Drug Administration (FDA) approved endpoints in clinical trials for alcohol use disorder (AUD). Many individuals who fail to meet these criteria may substantially reduce their drinking during treatment and most individuals with AUD prefer drinking reduction goals. One- and two-level reductions in World Health Organization (WHO) drinking risk levels have been proposed as alternative endpoints that reflect reduced drinking and are associated with reductions in drinking consequences, improvements in mental health, and reduced risk of developing alcohol dependence. The current study examined the association between WHO drinking risk level reductions and improvements in physical health and quality of life in a sample of individuals with alcohol dependence. Methods. Secondary data analysis of individuals with alcohol dependence (n=1142) enrolled in the longitudinal, prospective COMBINE study (Anton et al. 2006), a multi-site randomized placebo-controlled clinical trial, examining the association between reductions in WHO drinking risk levels and change in blood pressure, liver enzyme levels, and self-reported quality of life following treatment for alcohol dependence. Results. One- and two-level reductions in WHO drinking risk level during treatment were associated with significant reductions in systolic blood pressure (p<0.001), improvements in liver enzyme levels (all p<0.01), and significantly better quality of life (p<0.001). Discussion. One- and two-level reductions in WHO drinking risk levels predicted significant improvements in markers of physical health and quality of life, suggesting that the WHO drinking risk level reduction could be a meaningful surrogate marker of improvements in how a person “feels and functions” (FDA, 2015) following treatment for alcohol dependence. The WHO drinking risk levels could be useful in medical practice for identifying drinking reduction targets that correspond with clinically significant improvements in health and quality of life.

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Reduction in non-abstinent WHO drinking risk levels and depression/anxiety disorders: 3-year follow-up results in the US general population

Cited by 45 publications

References 49 publications

Stability of Drinking Reductions and Long-term Functioning Among Patients with Alcohol Use Disorder

Stability of Drinking Reductions and Long-term Functioning Among Patients with Alcohol Use Disorder

Prevention, screening, and treatment for heavy drinking and alcohol use disorder

Drinking Risk Level Reductions Associated with Improvements in Physical Health and Quality of Life Among Individuals with Alcohol Use Disorder

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