Reduced Drinking in Alcohol Dependence Treatment, What Is the Evidence?

Abstract

Abstinence from alcohol has been the prevailing treatment goal for individuals with alcohol dependence (AD) within the context of specialty alcohol treatment. Yet, alcohol use has been conceptualized as existing on a continuum. Importantly, most people who meet criteria for AD and could benefit from treatment never receive treatment. About half of these individuals do not seek treatment because they report a desire to continue drinking. To increase acceptability of treatment, reductions in alcohol consumption have been examined as alternative outcomes in treatment trials for AD. The current study reviews data which indicate that long-term reduction in alcohol consumption among patients with AD is possible. Controlled studies have tested reduced alcohol consumption and show sustained improvements in drinking reductions for many patients following behavioral treatments and pharmacotherapy. Evidence-based treatment guidelines and medicines development guidance authorities have taken note of these developments and accept “intermediate harm reduction” (European Medicines Agency) or “low-risk drinking limits” (US Federal Drug Administration) as optional trial endpoints. In conclusion, while abstinence remains the safest treatment goal for individuals with AD, evidence supports that reduced drinking approaches may be an important extension in the treatment of AD.

Efficacy and safety of sodium oxybate in alcohol‐dependent patients with a very high drinking risk level

“…Similarly, ‘low‐risk drinking limits’ are accepted by the US Federal Drug Administration as an optional trial endpoint. While abstinence remains the safest treatment goal (in the sense of lowest risk for subsequent mortality (Roerecke, Gual & Rehm )), increasing evidence now supports EMA and FDA guidelines demonstrating that reduced drinking approaches is an important goal in the treatment of alcohol dependence (Mann, Aubin & Witkiewitz ). In fact, any reduction in DRLs during treatment is associated with significantly fewer alcohol‐related consequences and improved mental health at the end of treatment and in a follow‐up for at least 1 year (Witkiewitz et al .…”

Medication Development: Reducing Casualties in the Valley of Death and Providing Support for Survivors

“…The poor implementation of AUD treatment programs has been well documented in many countries (Chartier et al., ; Cohen et al., ; Knudsen et al., ; Kohn et al., ; Litten et al., ; Mann et al., ; O'Donnell et al., ; Rehm et al., ; SAMHSA, ). Barriers have been identified in health professionals and AUD subjects.…”

Personalised treatment for Alcohol Use Disorder: Identification and intervention of target mechanisms

“…craving and quality of life, see Tiffany, Friedman, Greenfield, Hasin, & Jackson, 2011), though change in drinking behaviour is the primary focus. There is, however, debate about what constitutes meaningful change in drinking behaviour, which complicated further by differences in intervention goals (Mann, Aubin, & Witkiewitz, 2017).…”

“…Interventions" (COMBINE) study (Raymond F. Anton et al, 2006), finding patients who selected abstinence as a goal were more likely to be abstinent at follow up (Bujarski, O'Malley, Lunny, & Ray, 2013). Abstinence remains the recommended goal for patients seeking treatment for severe AUD (Connor et al, 2016;European Medicines Agency, 2010;Mann, Aubin, et al, 2017). However, intermediary reduced drinking strategies have recognised value and may be an important component of the progression of AUD treatment (Mann, Aubin, et al, 2017).…”

“…Abstinence remains the recommended goal for patients seeking treatment for severe AUD (Connor et al, 2016;European Medicines Agency, 2010;Mann, Aubin, et al, 2017). However, intermediary reduced drinking strategies have recognised value and may be an important component of the progression of AUD treatment (Mann, Aubin, et al, 2017).…”