Who achieves low risk drinking during alcohol treatment? An analysis of patients in three alcohol clinical trials

Abstract

Background and aims There is evidence that low risk drinking is possible during the course of alcohol treatment and can be maintained following treatment. Our aim was to identify characteristics associated with low risk drinking during treatment in a large sample of individuals as they received treatment for alcohol dependence. Design Integrated analysis of data from the COMBINE study, Project MATCH, and the United Kingdom Alcohol Treatment Trial using repeated measures latent class analysis to identify patterns of drinking and predictors of low risk drinking patterns during treatment. Setting USA and United Kingdom. Participants Patients (n=3589) with alcohol dependence receiving treatment in an alcohol clinical trial were primarily male (73.0%), White (82.0%), and non-married (41.7%), with an average age of 42.0 (SD=10.7). Measurements Self-reported weekly alcohol consumption during treatment was assessed using the Form-90[1] and validated with biological verification or collateral informants. Findings Seven patterns of drinking during treatment were identified: persistent heavy drinking (18.7% of the sample), increasing heavy drinking (9.6%), heavy and low risk drinking (6.7%), heavy drinking alternating with abstinence (7.9%), low risk drinking (6.8%), increasing low risk drinking (10.5%), and abstinence (39.8%). Lower alcohol dependence severity and fewer drinks per day at baseline significantly predicted low risk drinking patterns (e.g., each additional drink prior to baseline predicted a 27% increase in the odds of expected classification in heavy drinking versus low risk drinking patterns; Odds Ratio=1.27 (95% CI: 1.10, 1.47, p=0.002)). Greater negative mood and more heavy drinkers in the social network were significant predictors of expected membership in heavier drinking patterns. Conclusions Low risk drinking is achievable for some individuals as they undergo treatment for alcohol dependence. Individuals with lower dependence severity, less baseline drinking, fewer negative mood symptoms, and fewer heavy drinkers in their social networks have a higher probability of achieving low risk drinking during treatment.

A 22‐Year Follow‐Up (Range 16 to 23) of Original Subjects with Baseline Alcohol Use Disorders from the Collaborative Study on Genetics of Alcoholism

“…One potential desirable outcome for any age‐group is Abstinence, which is a goal for most AUD treatment programs, especially for people with alcohol dependence (Center for Behavioral Health Statistics and Quality, ; Probst et al., ), although this is a relatively narrow perspective on recovery. Another positive outcome involves extended periods of nonproblem drinking with quantities consumed that conform to National Institute on Alcohol Abuse and Alcoholism (NIAAA) guidelines for Low‐Risk Drinking (McCutcheon et al., ; Witkiewitz et al., ,b). On the other hand, adverse outcomes include exceeding Low‐Risk Drinking limits in the absence of multiple alcohol problems (High‐Risk Drinking), and drinking associated with multiple problems (Problem Drinking).…”

American counselors' acceptance of non-abstinence outcome goals for clients diagnosed with co-occurring substance use and other psychiatric disorders

“…Although counselors may have the client’s health and well-being in mind when they attempt to dissuade or refuse to support a client who wishes to pursue non-abstinence, such practices may put-off clients with co-occurring disorders who would benefit from therapy while attempting – either successfully or unsuccessfully – to moderate their use of substances. Whatever counselors’ understandable personal, professional and theoretical reasons for rejecting moderation goals (Davis & Rosenberg, 2013; Rosenberg & Davis, 2014), acceptance of non-abstinence respects client autonomy, could attract and retain in therapy clients who may eventually be willing to abstain if unable to moderate consumption (Ambrogne, 2002), and recognizes that recovery means improvement in functioning (Hasin et al, 2017; Witkiewitz et al, 2017), even when clients continue to experience symptoms (Sheedy & Whitter, 2009). Therefore, we encourage continuing education and training of counselors regarding the benefits of lower risk drinking and drug taking as a treatment outcome goal for clients with co-occurring disorders.…”

“…Supporting non-abstinence goals may also help set the foundation for abstinence as an alternative if moderation is not sustained. Moreover, recent research supports including lower risk drinking as a measure of effective treatment outcome because reductions in consumption are often associated with fewer negative consequences and improved mental health (Hasin et al, 2017; Witkiewitz et al, 2017). …”

Commentary on Witkiewitz et al. (2017): Abstinence or moderation—a choice for whom and why?

“…The heaviest drinking patterns were associated with the worst outcomes, while those who drank at low risk levels or who did not drink at all reported better outcomes. The study discussed here examined patient characteristics associated with favourable drinking patterns [2]. The conclusion that individuals who were lower at baseline on dependence severity, drinking, negative mood symptoms and heavy drinking in their social network had a higher probability of achieving low-risk drinking seems clear.…”

“…We may also ask what the findings mean for the most severe, often socially marginalized, drinkers. These individuals are less likely to maintain low-risk drinking [2], and one implication might be to promote only abstinence goals for them -hence limiting their choices. As socially marginalized drinkers are often excluded from clinical trials [7], evidence on how their drinking goals and practices during treatment affect outcomes is less robust.…”