Random assignment to abstinence and controlled drinking: Evaluation of a cognitive-behavioral program for problem drinkers.

Abstract

A cognitive-behavioral program with a goal of either abstinence or controlled drinking was assessed. The 70 early-stage problem drinkers were randomly assigned to one of the two goal conditions, and within each condition to one of two therapists. On average they received six individual weekly sessions, each lasting approximately 90 min. Both groups were taught to indentify risk situations and existing competencies, to develop cognitive and behavioral coping, and to assess their progress objectively. The controlled-drinking group was also taught procedures for moderate drinking. Over the 2-year follow-up period, no significant differences were found between the groups in reported alcohol consumption. Six months after treatment drinking had been reduced from an average of about 51 drinks per week to 13, and this reduction was maintained throughout the second year. Reports of drinking were corroborated by independent measures. Although the outcomes of the groups were similar, controlled drinking was considered to be a more suitable goal; it was more acceptable to the majority of the clients, and most of those assigned to abstinence developed moderate drinking on their own. The authors wish to thank the following colleagues for their contributions to the project: C. Milton-Feasby and V. Ittig-Deland for conducting intake and follow-up assessments, B. Sisson for medical screenings, Y. Israel for recommending the biochemical corroborators of alcohol consumption, and B. Kapur for conducting the laboratory analyses. Special appreciation is extended to H. Lei for his advice on statistical analyses and to D. A. Wilkinson, K. D. Walker, H. A. Skinner, and C. Poulos for their valuable feedback and support.Requests for reprints should be sent to M.

Controlled drinking, harm reduction and their roles in the response to alcohol-related problems

“…This was shown most clearly in findings of the Rand Report 4-year follow-up (Polich, Armor & Braiker, 1980) many years ago which showed that the probability of a non-problem drinking outcome following abstinence-oriented treatment was nearly linearly related to the baseline level of "dependence symptoms" (see Figure). Since then, this basic finding has been confirmed, both from studies of abstinence-oriented and moderation-oriented treatment (Edwards et al, 1983;Miller & Baca, 1983;Sanchez-Craig et al, 1984;Rychtarik, et al, 1987;Miller et al, 1992). …”

Controlled drinking after 25 years: how important was the great debate?

“…The majority of recoveries involved abstinence (Rychtarik et al, 1987). As in the Sanchez-Craig et al (1984) study, there was no evidence that either goal advice or drinking skills training mattered.…”

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

“…Unlike trajectories of pretreatment alcohol use, treatment interventions may allow a physician to address and negotiate a drinking goal with patients. [42][43][44][45][46] But, will a negotiated goal of abstinence have the same positive outcome as a "natural" goal of abstinence, as seen in these findings? Potential interventions to help patients move toward a goal of abstinence include motivational interviewing, 42 the sobriety sampling procedure 43 of the community reinforcement approach, 44 and practitioner acceptance of a moderation goal, 45 which, when accepted, may lead to an abstinence goal, as detailed in behavioral self-control training.…”

“…Potential interventions to help patients move toward a goal of abstinence include motivational interviewing, 42 the sobriety sampling procedure 43 of the community reinforcement approach, 44 and practitioner acceptance of a moderation goal, 45 which, when accepted, may lead to an abstinence goal, as detailed in behavioral self-control training. 45,46 Although to date there is no evidence of the efficacy of brief intervention for patients with alcohol dependence or very heavy drinking in primary care as identified by screening, 9 certain aspects that may make opportunistic brief intervention successful for individuals without an alcohol use disorder in primary care may also be relevant for the management of primary care patients with an alcohol use disorder. In particular, one important aspect may be the existence of an established patient-physician relationship (in which rapport and trust exist 47 ) in which to implement effective alcohol use disorder treatment.…”