Is abstinence from alcohol the only reasonable treatment goal?

Further analysis of data from the UK Alcohol Treatment Trial (UKATT) throws more light on the debate about abstinence or non-abstinence as a treatment goal for people seeking help with an alcohol problem. [1] (Initial preference for drinking goal in the treatment of alcohol problems: II. Treatment outcomes. Alcohol and Alcoholism 2010 45(2):136-142.) The analysis compared treatment outcomes for individuals who at intake were aiming at abstinence with those who were not. Outcomes were compared after three months and at a twelve-month follow-up.

A review of the analysis has just been published by Findings.[2] The Findings review discusses the analysis in some detail and provides considerable background context, including the results of several other international studies.

The headline finding of the analysis was that people aiming at abstinence were generally more successful at achieving their gaol than those with a non-abstinent aim. After three months 22% of those seeking abstinence reported being successful, compared to 13% of non-abstainers. This difference in outcomes was also seen at 12 months, with 30% and 23% reporting success respectively, but at that point the authors note that the difference was not statistically significant. It’s obviously very encouraging that reports of success increased at 12 months for both sets of individuals. That could imply that there were ongoing improvements as a longer-term result of treatment, but the review doesn’t clarify this.

The review notes that this is a post hoc analysis of data from a previous UKATT study, a study that was not designed to answer these questions. As such, the outcome of the analysis has less weight than a study specifically designed with these questions in mind.

The analysis also uses fairly narrow definitions of success. For the abstainers success is defined as complete abstinence, while for the non-abstainers success is the complete absence of any alcohol-related problem. In that sense, like is not being compared with like. An abstainer could have any number of continuing problems that were related to their drinking, but still be counted as successful, as long as they were abstinent; while the non-abstainer has to be free of any of several alcohol-related problems.

These definitions and some other aspects of the analysis tend to make it more likely for the abstainers to be able to report success. Yet even small changes in the design of the analysis would have brought different results. For example, the non-abstainers could have had a higher success rate than the abstainers, if the criterion for success was changed to be an appreciable reduction in the problem, rather than its complete elimination. If you look at the results more broadly, outcomes for both abstainers and non-abstainers seem more similar than not.

Overall the main message of the analysis and of the Findings review is that both abstinence and a reduction in alcohol use are reasonable goals for individuals entering treatment. For that reason, it’s important to work with the choice of the individual entering treatment and to build upon their motivation for change, rather than to impose a goal upon them. Of course, there are exceptions to this approach, for example, if a serious medical condition makes any alcohol use too high a risk. However, even where an attempt to reduce alcohol use is unlikely to be successful, a non-abstinent goal when entering treatment can be agreed upon as a way to engage the individual and to help them on a path towards recovery.



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