The effects of drinking goal on treatment outcome for alcoholism.

Abstract

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.

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

“…That is, patients with a goal of abstinence may be more responsive to alcohol use disorder treatment in a primary care setting, 14 which seems to be the case in alcohol treatment settings as well. 13,[15][16][17] It should also be noted that pretreatment alcohol use seems to be associated with pretreatment drinking goal. Both frequent and nearly daily drinkers versus consistent daily drinkers were more likely to select a goal of abstinence; yet, based on our growth curve models, consistent daily drinkers with a goal of abstinence made significantly notable gains in PDA, which may be a counterintuitive finding given the frequency of drinking among participants in this trajectory class.…”

“…In other studies of alcohol-dependent or alcohol-abusing individuals, mostly in alcohol treatment settings but also in primary care-only settings, investigators found associations between a drinking goal of abstinence and improved alcohol use outcomes. [13][14][15][16][17] Finally, although not in a purely primary care setting, a trajectory-based investigation of alcohol use before treatment assignment among alcohol-dependent individuals revealed that very frequent drinkers, defined as a 75% probability of any alcohol use on a given day, benefited from acamprosate in that they were more likely to abstain from heavy drinking during the past 2 months of treatment. 18 In that same investigation, very frequent drinkers also benefited from the medication naltrexone in that they were more likely to be continuously abstinent.…”

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.…”

Factors of Long-Term Remission Formation in Patients With Al-Cohol Dependence

“…На прогноз ремиссии также оказывает влияние длительность противоалкогольной терапии (так, при лечебном курсе длительностью до 3 месяцев последу-ющие ремиссии обычно более продолжительны, чем при краткосрочной терапии около 1 месяца), а также регулярность и длительность (многие годы) поддер-живающей терапии [11,13,33,39,41]. В достижении ремиссии при алкогольной зависимости большую роль отводят установке пациента на полный отказ от спиртного [11,33], вере пациента в возможность до-стижения поставленной цели и готовность работы над этой целью [38,39].…”

“…В достижении ремиссии при алкогольной зависимости большую роль отводят установке пациента на полный отказ от спиртного [11,33], вере пациента в возможность до-стижения поставленной цели и готовность работы над этой целью [38,39]. В первый год отказа от алкоголя среди лечебных мероприятий ведущими являются поддержание установки на трезвость, лечение им-пульсивности, депрессии, социальная поддержка [36].…”