Controlled Drinking Research Articles

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

BackgroundResearch 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.MethodsThis 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.ResultsBSCT 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.ConclusionsBSCT 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).

Analysis: Controlled drinking approach comparably effective to abstinence

Philosophical arguments abound over whether controlled drinking (CD) approaches to treating alcohol use disorder (AUD) work, and which individuals they might work best for, but in many cases these discussions have not been grounded in concrete data. Researchers last November published a meta‐analysis that seeks to fill the knowledge gap, with their results suggesting that CD could be as effective as an abstinence‐based model for many patients.

Abstinence or controlled drinking – a five-year follow-up on Swedish clients reporting positive change after treatment for substance use disorders

Purpose The purpose of this paper is to investigate how clients – five years after completing treatment interventions endorsing abstinence – view abstinence and the role of Alcoholics Anonymous (AA) in their recovery process. Design/methodology/approach Interviews with 40 clients were conducted shortly after them finishing treatment and five years later. All the interviewees had attended treatment programmes based on the 12-step philosophy, and they all described abstinence as crucial to their recovery process in an initial interview. Findings At follow-up, the majority remained abstinent. For many, attending AA meetings was still important – some described attending as a routine, whereas others stressed that the meetings were crucial for remaining abstinent. For those who reported controlled drinking (CD), this was described either as a natural step in their recovery process or as associated with worries and self-doubts. Research limitations/implications The results suggest the importance of offering interventions with various treatment goals and that clients choosing CD as part of their sustained recovery would benefit from support in this process, both from peers and professionals. Originality/value There are heterogeneous views on the possibilities of CD after recovery from substance use disorder both in research and in treatment systems. This study on client views on abstinence versus CD after treatment advocating total abstinence can contribute with perspectives on this ongoing discussion.

Acceptance of Controlled Drinking Among Treatment Specialists of Alcohol Dependence in Japan

This study evaluated the acceptance of controlled drinking (CD) goals among physicians specializing in the treatment of alcohol dependence (AD) in Japan. A mailed questionnaire survey was sent to physician members of the Japanese Society of Alcohol-Related Problems (n = 232) who were specialists in the treatment of AD in Japan. The evaluated items included the acceptance of CD goals, the definition of CD, the reasons for accepting or rejecting CD and the patient factors used to make treatment-goal decisions. CD as an interim goal on the way toward abstinence was accepted by about two-thirds of the specialists, while CD as a final goal was accepted by about one-third of specialists. Specialists supported harm-free drinking and a satisfactory quality of life, rather than alcohol consumption limits, as the definition of CD. Of note, a significantly higher percentage of specialists who rejected CD, compared with those who accepted CD, supported the disease model of AD as grounds for their decision. Specialists who accepted CD relied mostly on factors such as the severity of dependence, attitude toward CD and abstinence, and the level of psychological dependence and social stability, when making treatment-goal decisions. CD was accepted as an interim goal by two-thirds and as a final goal by one-third of Japanese physician specialists. Despite differences in drinking cultures and treatment circumstances, great similarities were found between this study and those conducted in Europe and North America with regard to the reasoning of treatment providers and the use of patient characteristics to make treatment-goal decisions.

Adult neurobehavioral outcome of hyperbilirubinemia in full term neonates—a 30 year prospective follow-up study

Background. Neonatal hyperbilirubinemia (HB) may cause severe neurological damage, but serious consequences are effectively controlled by phototherapy and blood exchange transfusion. HB is still a serious health problem in economically compromised parts of the world. The long term outcome has been regarded favorable based on epidemiological data, but has not been confirmed in prospective follow-up studies extending to adulthood.Methods. We studied the long term consequences of HB in a prospective birth cohort of 128 HB cases and 82 controls. The cases are part of a neonatal at-risk cohort (n = 1196) that has been followed up to 30 years of age. HB cases were newborns ≥ 2500 g birth weight and ≥ 37 weeks of gestation who had bilirubin concentrations > 340 µmol/l or required blood exchange transfusion. Subjects with HB were divided into subgroups based on the presence (affected HB) or absence (unaffected HB) of diagnosed neurobehavioral disorders in childhood, and compared with healthy controls. Subjects were seen at discharge, 5, 9 and 16 years of life and parent’s and teacher’s assessments were recorded. At 30 years they filled a questionnaire about academic and occupational achievement, life satisfaction, somatic and psychiatric symptoms including a ADHD self-rating score. Cognitive functioning was tested using ITPA, WISC, and reading and writing tests at 9 years of life.Results. Compared to controls, the odds for a child with HB having neurobehavioral symptoms at 9 years was elevated (OR = 4.68). Forty-five per cent of the HB group were affected by cognitive abnormalities in childhood and continued to experience problems in adulthood. This was apparent in academic achievement (p < 0.0001) and the ability to complete secondary (p < 0.0001) and tertiary (p < 0.004) education. Also, the subgroup of affected HB reported persisting cognitive complaints e.g., problems with reading, writing and mathematics. Childhood symptoms of hyperactivity/impulsivity (p < 0.0001) and inattention (p < 0.02) were more common in HB groups, but in adulthood the symptoms were equal. The affected HB had lower scores in parameters reflecting life satisfaction, less controlled drinking, but not increased substance abuse.Discussion. Our results indicate that neonatal HB has negative consequences in adult age. A prospectively collected cohort with strict inclusion criteria enables to control most of the bias factors involved with retrospective data. The control and HB groups were remarkably similar at birth in terms of medical data, and the growth environment of the children, as well as the parents’ social groups, education, size of family, type of housing at birth and at 9 years of age. Our findings bear resemblance to disorders of the fronto-striatal network, and also symptoms of the ADHD spectrum were frequent in the HB group suggesting a link of HB to other neurodevelopmental disorders.

Self-determination, perceived approval, and drinking: Differences between Asian Americans and Whites

The present research assessed racial differences in the associations among controlled orientation, injunctive norms, and increased drinking by White and Asian American college students. Previous research has noted racial differences in drinking, but reasons have not been considered in the context of individual differences in self-determination or responses to social influences. The authors evaluated perceived parental and peer injunctive norms as mediators of the relationship between controlled orientation and number of drinks consumed per week. The association between controlled orientation and drinking was further expected to be moderated by race. This study consisted of 534 White and 198 Asian American participants who had at least one heavy drinking episode in the month prior to assessment. Participants completed self-report measures assessing self-determination, perceived parental/peer injunctive norms, and drinking. Results indicated that peer injunctive norms served as a mediator between controlled orientation and greater number of drinks consumed per week for Whites only. Although Asian Americans were significantly higher in controlled orientation than Whites, they drank less and perceived their peers to be less approving of drinking. In contrast, Whites who were high in controlled orientation viewed their friends as being significantly more approving of alcohol and consumed significantly more drinks per week. Results provide unique considerations for understanding cultural differences in drinking among White and Asian American young adults.

Is Controlled Drinking an Acceptable Goal in the Treatment of Alcohol Dependence? A Survey of French Alcohol Specialists

Assessing acceptance of controlled drinking (CD) among French alcohol specialists. On-line survey of 547 French alcohol specialists. We searched factors associated with acceptance of CD, and factors that affected the specialists' selection of treatment goal. Criteria for success used by specialists in clinical practice were compared with criteria expected to be used in clinical trials. CD was accepted as a treatment goal by 48.6% of alcohol specialists (n = 105, n = 216), and 61.9% practiced CD for their own patients (n = 130, n = 210). Factors in selecting outcome goals were: patient's choice, perceived self-efficacy, relapse history and severity of dependence. Age, profession and basis of specialists' opinion on CD were associated with acceptance of CD. Half of French alcohol specialists accept CD as a goal. Acceptance was associated with specialists' personal and professional characteristics. The criteria for success specialists use in their clinical practice differ from those they expect to be used in clinical trials.

Acceptance and Therapeutic Practice of Controlled Drinking as an Outcome Goal by Swiss Alcohol Treatment Programmes

Sixty-one percent (138/226) of Swiss inpatient and outpatient alcohol treatment programmes responded to a postal survey designed to assess the definition and acceptance of controlled drinking (CD) as a treatment objective, the degree to which a client’s severity of dependence and finality of CD as an outcome goal were associated with acceptance, and the perceived value of selected client characteristics when making treatment recommendations. CD was acceptable to large proportions of both outpatient services and inpatient programmes, although willingness to recommend CD was associated with client characteristics such as selecting CD as intermediate versus final outcome goal, lower severity of dependence, not being pregnant and higher social stability. Information and individual therapy to help clients pursue a CD goal are commonly available in outpatient agencies and some inpatient programmes, but group counseling, cue exposure and wet house services are not typically available from Swiss programmes.

Controlled drinking, harm reduction and their roles in the response to alcohol-related problems

This article first distinguishes three meanings of the term ‘harm reduction’ in the literature on alcohol problems: a European sense in which a change in drinking is not necessarily required; an American sense which includes the controlled drinking (CD) goal of treatment; and a government policy sense in which it is seen as an alternative to whole population alcohol policies. The article then goes on to consider the roles of the CD goal and the harm reduction philosophy in response to three groups of people with alcohol problems or increased risk of such problems: the non-treatment-seeking population of hazardous and harmful drinkers; the population of socio-economically disadvantaged street drinkers or others who are thought unlikely to make radical changes in drinking behaviour; and the regular population of treatment-seeking problem drinkers. It is concluded, inter alia, that the equation of harm reduction and the CD goal in the American sense of harm reduction is confusing and may have had a detrimental effect of the practice of CD treatment. The CD goal should imply an aim of harm-free drinking.

Psychosis and substance use problems: Using controlled drinking in interventions

Substance use is a significant problem for people with severe mental health problems such as schizophrenia. It has a high prevalence and is linked to poor clinical and social outcomes. Reasons for substance using in this population are wide-ranging and overlap with those found in non-psychotic populations. Services have traditionally not been well configured to deal with people with dual problems of psychosis and substance use leading to this group's needs not being well addressed. Current guidance from the Department of Health is attempting to address this. Treatment strategies have not, as yet, been well researched. However, some conclusions can be made about the types of treatment that are acceptable and show promise. There is an emphasis on providing treatment programmes that integrate treatment for both psychosis and substance use, incorporate motivational approaches, allow flexibility in treatment goals (such as controlled drinking rather than abstinence) and incorporate some form of individual therapy (usually cognitive-behavioural) intervention. Further research is needed to expand the evidence base around interventions for psychosis and substance use.

Behavioural self-management with problem drinkers: One-year follow-up of a controlled drinking group treatment approach

The present study tested the effectiveness of a German behavioural self-control training (BSCT) for subgroups of drinkers differentiated by sex, ICD-10 diagnosis, and severity of dependence. Hazardous, harmful, and dependent drinkers were recruited through local mass media or referred by other treatment agencies. N = 53 subjects (60% men, mean age 48.9 years, 76% employed, 64% alcohol dependent) participated in 10 weekly group treatment sessions and were assessed at intake, end of treatment, and 1-year follow-up (with 81% successfully contacted). Improvements made during BSCT remained stable over the 1-year follow-up period with 52% of subjects classified as improved (8% abstinent, 44% with a decline in alcohol consumption of at least 30%). In women, alcohol abusers and low dose drinkers (<800 g ethanol/w), alcohol intake had declined less than in men, alcohol dependent subjects, and high dose drinkers (>800 g/w). This study, as others, indicates that alcohol dependence in itself is no contraindication for controlled drinking (CD) treatment.

Solution and Resource-Oriented Addiction Treatment with the Choices of Abstinence or Controlled Drinking

The NIK-Ambulanz in Bremen is the first German solution focused model project in outpatient addiction treatment to be financed by the insurances. The Bremen therapeutic concept is based on solution focused assumptions and techniques and the Bruges Model's approach in alcohol-addiction treatment aiming to restore the clients' ability to choose and allowing controlled drinking as a possible goal. The Bremen concept fits the German insurances recent development to favour shorter therapies, outpatient treatment and to make treatment programs more attractive in order to reach more people with alcohol problems. The article includes a case example of a client who chose controlled drinking and first results of the project.

Are Attempts at Moderate Drinking by Patients with Alcohol Dependency a Form of Russian Roulette?

In 1962, Davies reported on 7 male patients who showed habits, out of a total of 93 addicts as defined by the WHO at the time (1). All 7 patients had achieved a period of complete abstinence ranging from a few months to a year before taking up normal for a period ranging from 7 to 11 years. Follow-up included outpatient attendances, contact by a social worker, and correspondence with relatives. Davies' paper received 17 critical commentaries the same journal. They included the following statements: in many years of practice, we never encountered a true alcoholic recovering the ability to drink normally, drinking resumption was a freak anomaly of human biochemistry or psychopathology, these patients may have been genuine alcoholics but not genuine drinkers, and was simply a prelude to full relapse. While Davies was not the first to report this phenomenon, he was the first to give it prominence the paper's title, hence, the widespread reaction. In 1981, Heather and Robinson marshalled the related evidence their book Controlled Drinking (2). The notion of by previously identified individuals with alcoholism essentially contradicted the dominant concept of alcoholism as an irreversible disease characterized by loss of control, that is, by the inability to stop once commenced, as described by Alcoholics Anonymous (AA, 3)-a trait later adopted by Jellinek as a characteristic of the gamma alcoholic (4). In Heather and Robinson's view, loss of control described rather than explained alcoholic drinking. Throughout, a conceptual dichotomy differentiated between individuals suffering from the disease of alcoholism and those whose might be abnormal quantity and harmful but who were not diseased. Modern versions of this dichotomy have been adopted by Edwards and others their delineation of the alcohol dependence syndrome as part of a range of alcohol-related disabilities (5). In its criteria for alcohol dependence vs alcohol abuse, the DSM-IV TR nosology reflects a similar range (6), as does the ICD-IO differentiation between dependence and harmful use (7). The Debate Today Fast-forwarding some 25 years, the professional debate the field does not, my opinion, seem to elicit as much passion as it once did, owing to several developments. The first development is recognition that the terms used required further definition. Heather and Tebbutt proposed that the definition of controlled (CD) should include some limit on the amount and frequency of consumption (that is, a maximum of 3 oz of alcohol daily) and the condition that the does not result signs of dependence (that is, withdrawal syndrome) or social, legal, and health problems (8). At present, the term drinker is increasingly replaced by the nosological dichotomies (based on DSM and ICD criteria) of abuse or harmful use and dependence. The second development is increased consensus that abstinence remains the preferred, safer outcome for individuals with alcohol dependency. However, several studies report resumption of controlled drinking, with prevalence estimates ranging from 2% to 30%, depending on definitions. Miller undertook a comparative analysis of 4 samples (n = 140) of media-recruited problem drinkers who self-referred for behavioural self-control training (9). Of the original 140 cases, 99 (71%) were accounted foras follows: at 3.5,5.0,7.0, and 8.0 years, respectively, 23 were abstinent, 14 reported controlled and asymptomatic drinking, 22 were improved but still impaired, 35 were unremitted, and 5 were deceased. Most of the long-term controlled drinkers had established their pattern within the first year of follow-up, but maintenance of this pattern could not be reliably predicted (9). Related to abstinence is the so-called dry syndrome. Dry drunk is a lay term used by AA to describe an individual with alcoholism who has stopped but who may still be suffering many of the emotional symptoms common to actively alcoholism sufferers (3). …

Alcohol & drug abuse: A research-based analysis of the Moderation Management controversy.

Perhaps the biggest controversy of the 1990s in the U.S. alcohol treatment field concerned Moderation Management (MM), the only mutual-help organization to offer its members the goal of achieving moderate drinking. MM’s supporters argued that the option of this goal would attract problem drinkers who were not dependent on alcohol and not interested in abstinence-only organizations such as Alcoholics Anonymous (AA) and professionally operated 12-step treatment programs (1). In contrast, prominent figures in the treatment and research communities denounced MM as a “dangerous temptation to alcoholics” that was “built on the illusion” that alcoholics could return to controlled drinking (2). This debate only became more intense and bitter after MM’s founder, Audrey Kishline, left MM, joined AA, and several months later caused the deaths of two people in a horrific car accident while severely intoxicated (2). This column addresses the central debates about MM by summarizing the findings of a recently completed study of the organization, described in detail elsewhere (3), and other relevant research. Fundamental argument over MM MM’s primary text, Moderate Drinking (1), and AA’s Big Book (4) actually agree on several important points. Both books make explicit distinctions between problem drinkers who are able to return to controlled drinking and alcoholics. Both texts also concur that failure at the goal of moderate drinking indicates that a drinking problem is serious and is best addressed by abstinence. These shared assumptions have been supported in prospective studies showing that, broadly speaking, when problem drinkers recover, abstinence is more common among those who are highly dependent on alcohol, are male, are older, and are socially and economically unstable, whereas moderate drinking is more common among problem drinkers who do not belong to these sociodemographic groups— for example, young women with low levels of dependence (5–7). MM’s proponents differ from advocates of abstinence-only approaches in their views on who can be trusted to judge the difference between a moderation-bound problem drinker and an alcoholic rather than in their views on whether such a distinction exists. A large proportion of the 12-step treatment community in the United States has incorporated the psychodynamic concept of denial into its theory of alcoholism; AA’s texts describe alcoholics as having a grandiose penchant for overestimating their ability to control drinking (4). Thus many 12-step advocates fear that despite MM’s intention to serve only nondependent problem drinkers, the organization’s members are in fact alcoholics who are deceiving themselves into thinking that they can drink moderately. Severity of MM members’ alcohol problems

Programas de disminución del daño en la dependencia alcohólica: el reto de la alcohología moderna

ObjectiveHarm reduction programs are widely spreat out in addictions as opiate dependence where any profesional dispute. But in the alcoholism this type of programs are not accepted. Material and methods: ResultsIn this review main concepts of the harm reduction interventions are exposured. Also, studies about this model are analysed. ConclusionsStudies reviewed are classified as belonged to primary prevention (brief interventions), secondary (controlled drinking program) and tertiary prevention (harm reduction). Considerations about how to do these interventions are made.

Controlled Drinking as a Treatment Goal in Germany

In Germany public health is impaired by high alcohol consumption and alcohol related damage. Yet very few people who participate in excessive forms of alcohol consumption obtain any alcohol specific treatment. The present German controversy surrounding Controlled Drinking (CD) as an appropriate treatment goal and a means to improve the range and effectiveness of the existing health care system is discussed. In this article the author provides an overview of the German CD trials. The German behavioral self-control programs (the “AkT” group program and the bibliotherapeutic “10 Steps Program”) that triggered the present debate on CD are discussed as well. It is concluded that with regard to public health, ethical, therapeutic, and effectiveness concerns, CD approaches should become adjunct to the traditional German abstinence oriented treatment system for alcohol and drug addicts.

Drinking goal selection and treatment outcome in out‐patients with mild‐moderate alcohol dependence

AbstractSelection of drinking goal is examined at baseline, post‐treatment and at 6 months follow‐up for a sample of mild‐moderate alcohol‐dependent out‐patients. Drinking goal is identified as abstinent or controlled drinking, with the latter group being asked to further specify per session and per week drinking limits. Group comparisons for drinking goal post‐treatment show those who were not assigned motivational enhancement therapy, had more drinking days and lower scores on the Alcohol Problems Questionnaire and Internal Motivation were more likely to choose controlled drinking. The only variable to predict independently whether or not the controlled drinking goal was within the promoted drinking guidelines was age, with younger participants more likely to choose a goal above this limit. Goal selection was significantly related to drinking outcome, with those aiming to drink within guidelines having better outcome than those aiming for higher limits. There was no significant difference in drinking outcome category when those aiming for within limits were compared to those aiming for abstinence. Clinical implications of these findings are discussed.

Low-dose ethanol consumption allows strength recovery in chronic alcoholic myopathy.

Chronic skeletal myopathy may affect one third of chronic alcohol misusers. It is generally accepted that abstinence allows partial recovery, and that continued high-dose ethanol consumption progressively deteriorates muscle function. However, the effect of low-dose ethanol consumption in alcoholic myopathy has not been studied. We studied 58 chronic alcoholic male patients with biopsy-proven chronic alcoholic myopathy over 5 years. We evaluated ethanol intake, biochemical and nutritional parameters, and assessed muscle strength. Eighteen patients who remained abstinent showed marked improvement in muscle strength. As expected, the 19 patients who persisted in high-dose ethanol consumption further diminished in their muscle strength. In the 11 patients who maintained low-dose (</=60 g ethanol/day) 'controlled' drinking, muscle strength improved (p=0.003), despite no change in nutritional and exercise status. There is a dose-dependent recovery in muscle strength according to the degree of ethanol consumption, and moderate controlled drinking of up to 60 g ethanol/day still allows improvement in muscle strength.

Quality of life in alcohol-dependent subjects--a review.

Although alcohol misuse is a major cause of morbidity and mortality and an important health care burden, the Quality of Life (QoL) of alcohol misusing subjects has been little studied to date. For example, only 5 out of 442 accepted abstracts at a recent international QoL conference concerned alcohol-dependent subjects. This paper reviews the ongoing and published work in the area focusing upon QoL characteristics of alcohol-dependent subjects, the link between QoL comorbidity and alcoholism, QoL alcohol dependency and social environment, changes in QoL status as a result of abstinence, minimal or controlled drinking, QoL as a predictor of relapse to heavy drinking and the importance of using a QoL measure when assessing treatment outcomes together with some of the present difficulties with existing measures. The main conclusions from the review were that the QoL of alcohol-dependent subjects is very poor but improved as a result of abstinence, controlled or minimal drinking. The important factors in the QoL of alcohol-dependent subjects are psychiatric comorbidity, social environment and disturbed sleep.

Self-Efficacy and Temporal Orientation as Predictors of Treatment Outcome in Severely Dependent Alcoholics

Drinking self-efficacy has been strongly advocated as an important variable in determining outcome in both abstinent and controlled drinking treatment programmes. The possibility that the predictive ability of self-efficacy could be enhanced by an understanding of time perspective was explored in this study. Thirty-one severely dependent alcoholics were enrolled in an abstinence programme. Contrary to expectations drinking self-efficacy measured at treatment onset was not a predictor of outcome, although there was some marginal significance observed for future temporal orientation as a predictor of long term abstinence.