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

Abstract

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.

Technology‐Delivered Cognitive‐Behavioral Interventions for Alcohol Use: A Meta‐Analysis

“…The magnitude of effects found here is similar to that found in other meta‐analyses of Internet‐/computer‐based interventions for alcohol and tobacco (Rooke et al., ) and marijuana (Tait et al., ) use, yet much smaller than pooled effect sizes found in meta‐analyses of Internet‐/computer‐based CBT‐specific interventions for depression and anxiety disorders (Andrews et al., ; Dettore et al., ; Sijbrandij et al., ). However, emerging data suggest even small reductions in drinking quantity (e.g., reduction from 4 drinks to 3 drinks/day) have been associated with significant improvements in markers of physical health and quality of life (Witkiewitz et al., ). Only 2 trials reviewed here evaluated a stand‐alone CBT Tech compared to therapist‐delivered CBT, which produced nonsignificant between‐group effects, similar to pooled effects indicating no difference between Internet‐delivered CBT and face‐to‐face CBT for other psychiatric conditions (Carlbring et al., ).…”

World Health Organization risk drinking level reductions are associated with improved functioning and are sustained among patients with mild, moderate and severe alcohol dependence in clinical trials in the United States and United Kingdom

“…The data available in COMBINE and UKATT differed, requiring that we focus on measures that were similar across studies. For example, we previously found that the WHO risk-level reductions correspond to improvements in systolic blood pressure and percentage of carbohydrate-deficient transferrin in COMBINE [14], but these measures were not assessed in the UKATT. In both studies the drinking data were obtained by verbal report; however, both studies also included biomarkers (GGT and ALT), which corresponded to the self-reported drinking data [24,25].…”

Reduction in Drinking was Associated With Improved Clinical Outcomes in Women With HIV Infection and Unhealthy Alcohol Use: Results From a Randomized Clinical Trial of Oral Naltrexone Versus Placebo

“…Ultimately, one of the primary goals of drinking reduction is to improve overall health outcomes. Most clinical trials involving naltrexone have only examined its effect on drinking, although reanalysis of at least one study one study demonstrated that reduction in drinking among clinical trial participants is accompanied by improvements in clinical health such as blood pressure, liver enzymes, and quality of life (Witkiewitz et al., ). Two recent studies sought to determine whether naltrexone or other alcohol‐related therapy can improve HIV outcomes, one of which found that reductions in drinking were associated with improved HIV viral suppression (Edelman et al., ; Springer et al., ).…”