Reduction in heavy drinking as a treatment outcome in alcohol dependence.

This article, published in a prestigious journal, suggests that controlled drinking should return to the public health arena. This, even though this policy has been dismissed, about 2 decades ago, as being unworkable and dangerous to the individuals, their families and society as a whole.

Alcoholics who have tried controlled drinking will attest to the futility of such a policy and goal.

Reduction in heavy drinking for ‘problem drinkers’ is a viable goal but not for alcoholics.

The only valuable suggestion made in the article is the final one

“outcomes be individualized to patients’ goals”.

There is no clinical benefit in trying to get an alcoholic to control their drinking.

Abstract; In the field of clinical alcohol disorders treatment in North America, abstinence continues to be largely viewed as the optimal treatment goal; however, there is a growing awareness of limitations when abstinence is considered the only successful outcome.

Although this issue has been discussed in research settings, new studies on the public health significance of heavy drinking (defined as five or more standard drinks per drinking day in men, and four or more standard drinks per drinking day in women) in the past 10 years suggest that clinical providers should consider the value of alternative outcomes besides abstinence.

A focus on abstinence as the primary outcome fails to capture the impact of treatment on reduction in the pattern and in the frequency of alcohol consumption.

In addition, evaluating reduction in drinking as “positive” has value for patients as an indicator of clinical progress. Measurement of continuous variables, such as the quantity and the frequency of alcohol consumption, has provided a clearer understanding of the scope of alcohol-related morbidity and mortality at the societal level, and of the relationship between individual patient characteristics and the naturalistic course of alcohol use, abuse, and dependence.

A review of these characteristics suggests that there are clinical benefits associated with reducing heavy drinking in alcohol-dependent patients.

Given the significant public health consequences associated with heavy drinking and the benefits associated with its reduction, it is proposed that researchers, public health professionals, and clinicians consider using reduction in heavy drinking as a meaningful clinical indicator of treatment response, and that outcomes be individualized to patients’ goals and readiness to change.

Research report; David R. Gastfriend, James C. Garbutt, Helen M. Pettinati and Robert F. Forman. Reduction in heavy drinking as a treatment outcome in alcohol dependence. Journal of Substance Abuse Treatment. Volume 33, Issue 1, July 2007, Pages 71-80

Ethics For Addiction Professionals - Second Edition