Stability of Drinking Reductions and Long-term Functioning Among Patients with Alcohol Use Disorder
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Department of Psychology, University of New Mexico, MSC 03-2220, Albuquerque, NM, USA; 2Department of Psychiatry, University of Pennsylvania, Philadelphia, PA, USA; 3Department of Psychiatry and Behavioral Sciences, University of Washington, Seattle, WA, USA; 4Department of Epidemiology, Columbia University, New York, NY, USA; 5Behavioral Health Research Division, RTI International, Research Triangle Park, NC, USA; 6 Central Institute of Mental Health, Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany; 7Yale School of Medicine, New Haven, CT, USA; 8Department of Psychiatry and Behavioral Sciences, Medical University of South Carolina, Charleston, SC, USA.
BACKGROUND: The World Health Organization (WHO) categorizes alcohol consumption according to grams consumed into low-, medium-, high-, and very-high-risk drinking levels (RDLs). Although abstinence has been considered the ideal outcome of alcohol treatment, reductions in WHO RDLs have been proposed as primary outcomes for alcohol use disorder (AUD) trials. OBJECTIVE: The current study examines the stability of WHO RDL reductions and the association between RDL reductions and long-term functioning for up to 3 years following treatment. DESIGN AND PARTICIPANTS: Secondary data analysis of patients with AUD enrolled in the COMBINE Study and Project MATCH, two multi-site, randomized AUD clinical trials, who were followed for up to 3 years post-treatment (COMBINE: n = 694; MATCH: n = 806). MEASURES: Alcohol use was measured via calendarbased methods. We estimated all models in the total sample and among participants who did not achieve abstinence during treatment. KEY RESULTS: One-level RDL reductions were achieved by 84% of patients at the end of treatment, with 84.9% of those individuals maintaining that reduction at a 3-year follow-up. Two-level RDL reductions were achieved by 68% of patients at the end of treatment, with 77.7% of those individuals maintaining that reduction at a 3-year follow-up. One- and two-level RDL reductions at the end of treatment were associated with significantly better mental health, quality of life (including physical quality of life), and fewer drinking consequences 3 years after treatment (p < 0.05), as compared to no change or increased drinking. CONCLUSION: AUD patients can maintain WHO RDL reductions for up to 3 years after treatment. Patients who had WHO RDL reductions functioned significantly
better than those who did not reduce their drinking. These findings are consistent with prior reports suggesting that drinking reductions, short of abstinence, yield meaningful improvements in patient health, well-being, and functioning. KEY WORDS: World Health Organization risk drinking levels; alcohol use disorder; reduced alcohol consumption; alcohol treatment outcomes; lowrisk drinking; alcohol dependence. J Gen Intern Med DOI: 10.1007/s11606-020-06331-x © The Author(s) 2020
INTRODUCTION
Alcohol use disorder (AUD) is highly prevalent and has high social and economic costs,1 yet most individuals with AUD never seek treatme
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