Reduced drinking and harm reduction in the treatment of alcohol use disorders

Bischof, Gallus; Lange, Nikolaus; Rumpf, Hans‐Jürgen; Preuss, Ulrich W.

doi:10.1108/dat-10-2020-0063

Cited by 5 publications

(5 citation statements)

References 53 publications

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“…While “abstinence” is common in most addiction treatments, flexible (rather than based on rigid rules) harm reduction models have been proposed [ 84 ]. There is evidence for the efficacy of harm reduction models for other socially acceptable substances like alcohol [ 127 ].…”

Section: Ultra-processed Foods and Eating Disordersmentioning

confidence: 99%

Ultra-Processed Foods and Mental Health: Where Do Eating Disorders Fit into the Puzzle?

Wiss,

LaFata

2024

Nutrients

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Ultra-processed foods (UPFs) like pastries, packaged snacks, fast foods, and sweetened beverages have become dominant in the modern food supply and are strongly associated with numerous public health concerns. While the physical health consequences of UPF intake have been well documented (e.g., increased risks of cardiometabolic conditions), less empirical discussion has emphasized the mental health consequences of chronic UPF consumption. Notably, the unique characteristics of UPFs (e.g., artificially high levels of reinforcing ingredients) influence biological processes (e.g., dopamine signaling) in a manner that may contribute to poorer psychological functioning for some individuals. Importantly, gold-standard behavioral lifestyle interventions and treatments specifically for disordered eating do not acknowledge the direct role that UPFs may play in sensitizing reward-related neural functioning, disrupting metabolic responses, and motivating subsequent UPF cravings and intake. The lack of consideration for the influences of UPFs on mental health is particularly problematic given the growing scientific support for the addictive properties of these foods and the utility of ultra-processed food addiction (UPFA) as a novel clinical phenotype endorsed by 14–20% of individuals across international samples. The overarching aim of the present review is to summarize the science of how UPFs may affect mental health, emphasizing contributing biological mechanisms. Specifically, the authors will (1) describe how corporate-sponsored research and financial agendas have contributed to contention and debate about the role of UPFs in health; (2) define UPFs and their nutritional characteristics; (3) review observed associations between UPF intake and mental health conditions, especially with depression; (4) outline the evidence for UPFA; and (5) describe nuanced treatment considerations for comorbid UPFA and eating disorders.

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Section: Ultra-processed Foods and Eating Disordersmentioning

confidence: 99%

Ultra-Processed Foods and Mental Health: Where Do Eating Disorders Fit into the Puzzle?

Wiss,

LaFata

2024

Nutrients

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“…Most behavioral SUD treatments worldwide tend to be abstinence-focused, with legal or stigmatizing consequences for people who may not be ready, willing, or able to stop using substances. Over the past few decades, there has been an increasing interest in non-abstinence-based treatment approaches to reach this population (Bischof et al, 2021;Marlatt et al, 2011). One recent development is behavioral health treatments that focus on reducing the harms of substance use, which may involve a focus other than abstinence (e.g., Collins & Clifasefi, 2023;Denning & Little, 2012).…”

Section: Introductionmentioning

confidence: 99%

Commentary: Similarities and Differences Between Harm-Reduction and Substitute Addiction-- Implications for the Health Professions

Sussman,

Sinclair,

Clifasefi

et al. 2024

Eval Health Prof

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“Substitute addiction” refers to the process of achieving abstinence or resolution of one addictive behavior and subsequently engaging in one or more additional addictive behaviors in its place. Substitute addiction, a concept in the abstinence-based recovery field for decades, is viewed as a cause for concern because resolving one addictive behavior might not fully remove harm or ensure recovery. Conversely, “harm-reduction treatment” refers to a counseling orientation that focuses on helping service users reduce substance-related harm and improve their quality of life without necessarily requiring abstinence or use reduction. Harm-reduction treatment assesses a constellation of addictive behaviors in the larger context of a person’s life to holistically reduce harm in that constellation. In this commentary, we define and compare both constructs and point out their implications for addictions treatment.

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“…Alcohol use disorder (AUD) is one of the largest preventable contributors to the global burden of disease [ 1 , 2 ], as well as one of the most under-treated psychiatric disorders, with an estimated treatment coverage of 10–20% globally [ 3 , 4 ]. One of the major contributors to this treatment gap in AUD, is the lack of available non-abstinence-oriented treatments, coupled with the perceived expectation among people with AUD, of not being able to choose a non-abstinence treatment goal when seeking help within a health care setting [ 5 , 6 ]. Treatment goals aiming for reducing alcohol consumption rather than abstinence are commonly referred to as non-abstinence, reduced risk drinking, moderation, harm reduction, or controlled drinking (CD).…”

Section: Introductionmentioning

confidence: 99%

Predictors of treatment outcome for individuals with alcohol use disorder with a goal of controlled drinking

Ingesson-Hammarberg,

Jayaram-Lindström,

Hammarberg

2024

Addict Sci Clin Pract

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Background Research is lacking on predictors of outcome for the treatment of alcohol use disorder (AUD) with a goal of controlled drinking (CD). The aim of the study was to investigate one-year outcomes of an RCT, investigating Behavioral Self-Control Training (BSCT) and Motivational Enhancement Therapy (MET) and predictors of positive outcome for weekly alcohol consumption, CD and symptom reduction in AUD. Methods This study is based on secondary analyses from a randomized controlled trial including 250 individuals with AUD (52% men) recruited from three specialized addiction clinics in Stockholm, Sweden. Linear and logistic mixed regression models were used for outcomes at 52 weeks, and linear and logistic regression models for the predictor analyses. Results BSCT was superior to MET for the change between baseline to 52 weeks for the outcome of CD, defined as low-risk drinking below ten standard drinks per week for both genders (p = 0.048). A total of 57% of individuals in BSCT attained a level of CD, as opposed to 43% in MET. Females were significantly better in attaining low-risk drinking levels compared to men. The predictor for obtaining CD and reducing weekly alcohol consumption, was a lower baseline alcohol consumption. Predictors of symptom reduction in AUD were lower baseline level of AUD, and a lower self-rated impaired control over alcohol consumption. Conclusions BSCT was superior to MET in obtaining CD levels, and women were superior to men for the same outcome. The study corroborated baseline consumption levels as an important predictor of outcome in CD treatments. The study contributes with important knowledge on key treatment targets, and knowledge to support and advice patients in planning for treatment with a goal of controlled drinking. Trial registration: The original study was registered retrospectively at isrtcn.com (14539251).

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Reduced drinking and harm reduction in the treatment of alcohol use disorders

Cited by 5 publications

References 53 publications

Ultra-Processed Foods and Mental Health: Where Do Eating Disorders Fit into the Puzzle?

Ultra-Processed Foods and Mental Health: Where Do Eating Disorders Fit into the Puzzle?

Commentary: Similarities and Differences Between Harm-Reduction and Substitute Addiction-- Implications for the Health Professions

Predictors of treatment outcome for individuals with alcohol use disorder with a goal of controlled drinking

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