Disadvantages to imposing the goal of abstinence on problem drinkers: an empirical study.

Abstract

SummaryThe contribution of pretreatment and within treatment drinking to outcome was investigated in a group of problem drinkers attending treatment for the first time. In a previous analysis no overall significant difference in outcome was observed between 35 clients randomly assigned to the goal of abstinence (AB), and 35 assigned to a controlled drinking condition (CD). Despite the negative result, it was noted that pretreatment consumption levels were correlated with outcome levels in the AB but not in the CD condition. Scatter plots indicated that this might be because of unexpected substantial reductions in drinking by some heavy drinkers in the CD group. Formal evaluation of this hypothesis was undertaken by splitting the clients at the median (Heavier versus Lighter) of pretreatment weekly consumption (48.5 drinks), and using a logit analysis to assess whether being a Lighter or a Heavier drinker at intake affected the odds of (a) complying with the treatment requirements regarding drinking, and (b) being a moderate drinker after treatment. The results showed that the Lighter group had better chances of becoming moderate drinkers after treatment than the Heavier group. For Lighter clients no significant difference was found between the AB and CD groups. In contrast, among the Heavier clients those assigned to the CD programme were consistently more successful in accomplishing their goals within treatment. More of them were moderate drinkers (64% versus 43%) at follow‐up, but this was not statistically significant. In other words, the AB programme failed in promoting abstinence among clients generally, and was not very helpful in promoting moderate drinking among the Heavier drinkers. An additional finding indicated that being abstinent or not during the first 3 weeks of treatment made little difference in the client's chance of being a moderate drinker during the 6 months following treatment. This chance, however, was significantly different depending on whether the client was a moderate drinker or not during the remaining 3 weeks of treatment. We interpret these results as strongly suggesting that controlled‐drinking programmes (which include the option of aiming for abstinence) should be offered to problem drinkers like our clients.