Reduction in heavy drinking as a treatment outcome in alcohol dependence

Gastfriend, David R.; Garbutt, James C.; Pettinati, Helen M.; Forman, Robert F.

doi:10.1016/j.jsat.2006.09.008

Cited by 139Substance Abuse Treatment and OutcomesAlcohol Consumption and Health EffectsOpioid Use Disorder Treatment

Reduction in heavy drinking as a treatment outcome in alcohol dependence

Gastfriend, David R., Garbutt, James C., Pettinati, Helen M., Forman, Robert F.·2007·Journal of Substance Abuse Treatment

DOI 10.1016/j.jsat.2006.09.008

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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.

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A Brief Up-Date of the Use of Sodium Oxybate for the Treatment of Alcohol Use Disorder
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The Role of Brief Motivational Intervention on Self-Efficacy and Abstinence in a Cohort of Patients with Alcohol Dependence
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Efficacy of transcranial direct current stimulation (tDCS) in reducing consumption in patients with alcohol use disorders: study protocol for a randomized controlled trial
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Individual differences in the effect of menstrual cycle on basal ganglia inhibitory control
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Who Receives Nalmefene and How Does It Work in the Real World? A Single-Arm, Phase IV Study of Nalmefene in Alcohol Dependent Outpatients: Baseline and 1-Month Results
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Can Alcohol Dependent Patients Adhere to an ‘As-Needed' Medication Regimen?
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Patient-centered primary care for adults at high risk for AUDs: the Choosing Healthier Drinking Options In primary CarE (CHOICE) trial
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Decreased olfactory discrimination is associated with impulsivity in healthy volunteers
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Response Inhibition in Adolescents is Moderated by Brain Connectivity and Social Network Structure
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Open-label Study with Nalmefene as Needed Use in Alcohol-Dependent Patients with Evidence of Elevated Liver Stiffness and/or Hepatic Steatosis
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Dissociating Two Stages of Preparation in the Stop Signal Task Using fMRI
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When should clinicians switch treatments? An application of signal detection theory to two treatments for women with alcohol use disorders
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Nalmefene, Given as Needed, in the Routine Treatment of Patients with Alcohol Dependence: An Interventional, Open-Label Study in Primary Care
Castéra, P., Stewart, E., Großkopf, J., Brotons, C., Schou, M. B., Zhang, D., Steiniger‐Brach, B., Meulien, D., & on behalf of the PICASO Study Investigators (2018) · European Addiction Research · doi:10.1159/000494692 · Cited by 16 · see citing works
Nalmefene in Alcohol Use Disorder Subjects with Psychiatric Comorbidity: A Naturalistic Study
Nicola, M. D., Filippis, S. D., Martinotti, G., Risio, L. D., Pettorruso, M., Persis, S. D., Maremmani, A. G. I., Maremmani, I., Giannantonio, M. D., & Janiri, L. (2017) · Advances in Therapy · doi:10.1007/s12325-017-0546-3 · Cited by 16 · see citing works
Treatment Seeking and Subsequent 1-Year Drinking Outcomes among Treatment Clients in Sweden and the U.S.A.: A Cross-Cultural Comparison
Witbrodt, J., & Romelsjö, A. (2012) · Addictive Behaviours · doi:10.1016/j.addbeh.2012.05.007 · Cited by 17 · see citing works
A 22‐Year Follow‐Up (Range 16 to 23) of Original Subjects with Baseline Alcohol Use Disorders from the Collaborative Study on Genetics of Alcoholism
Schuckit, M. A., Smith, T. L., Danko, G. P., Kramer, J., Bucholz, K. K., McCutcheon, V. V., Chan, G., Samuel Kuperman, C., HESSELBROCK, V. M., Dick, D. M., et al. (2018) · Alcoholism Clinical and Experimental Research · doi:10.1111/acer.13810 · Cited by 14 · see citing works
The acceptability of non-abstinent treatment goals among clinical social workers in the United States
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Deep Brain Stimulation of the Internal Globus Pallidus Improves Response Initiation and Proactive Inhibition in Patients With Parkinson’s Disease
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Redefining Success: A Qualitative Investigation of Therapeutic Outcomes for Noncompleting Drug Court Clients
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Predictors of moderated drinking in a primarily alcohol dependent sample of men who have sex with men
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The predictive validity of the Drinking-Related Cognitions Scale in alcohol-dependent patients under abstinence-oriented treatment
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Psilocybin-assisted therapy for severe alcohol use disorder: protocol for a double-blind, randomized, placebo-controlled, 7-month parallel-group phase II superiority trial
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“A reduction in heavy drinking days yields clinically significant health ameliorations [94], matches the treatment objectives of numerous patients [95] and is recognized by the European Medicines Agency as an adequate measure of efficacy [96].”
Background
Electrophysiological Evidence for Distinct Proactive Control Mechanisms in a Stop-Signal Task: An Individual Differences Approach
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Mind over mood: exploring the executive function’s role in downregulation
Rodas, J. A., León-Rojas, J. E., & Rooney, B. (2024) · Frontiers in Psychology · doi:10.3389/fpsyg.2024.1322055 · Cited by 17 · see citing works
Decreased Alcohol Consumption in an Implementation Study of Computerized Brief Intervention among HIV Patients in Clinical Care
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The Cost-Effectiveness of the Integration of Nalmefene within the UK Healthcare System Treatment Pathway for Alcohol Dependence
Laramée, P., Bell, M. M., Irving, A., & Brodtkorb, T. (2016) · Alcohol and Alcoholism · doi:10.1093/alcalc/agv140 · Cited by 12 · see citing works
Drinking Status Between Ages 50 and 55 for Men From the San Diego Prospective Study Who Developed DSM-IV Alcohol Abuse or Dependence in Prior Follow-Ups
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Assessing Drug Use during Follow-Up: Direct Comparison of Candidate Outcome Definitions in Pooled Analyses of Addiction Treatment Studies
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Alcohol use and the longitudinal HIV care continuum for people with HIV who enrolled in care between 2011 and 2019
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Brief Interventions for Hazardous and Harmful Alcohol Consumption in Accident and Emergency Departments
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Exploring Attentional Bias toward Alcohol Content: Insights from Eye-Movement Activity
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Predictors of abstinence, no heavy drinking days, and a 2‐level reduction in World Health Organization drinking levels during treatment for alcohol use disorder in the COMBINE study
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Factors Predicting Change in Frequency of Heavy Drinking Days among Alcohol-Dependent Participants in the National Epidemiologic Survey on Alcohol and Related Conditions (NESARC)
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Safety and Persistence of Nalmefene Treatment for Alcohol Dependence. Results from Two Post-authorisation Safety Studies
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The association of the 5-HTTLPR polymorphism and the response to different stressors in healthy males
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Non‐abstinent recovery in alcohol use disorder is associated with greater regional cortical volumes than heavy drinking
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The New French Guidelines on Alcohol Misuse: An Initiative for Strengthening Cross‐European Interplay
Rolland, B., Mann, K. F., Paillé, F., & Aubin, H. (2015) · Addiction · doi:10.1111/add.12997 · Cited by 9 · see citing works
Alcoholism Risk Reduction in France: A Modernised Approach Related to Alcohol Misuse Disorders
Brousse, G., Bendimerad, P., de Chazeron, I., Llorca, P., Perney, P., & Demattéis, M. (2014) · International Journal of Environmental Research and Public Health · doi:10.3390/ijerph111111664 · Cited by 9 · see citing works
Acceptance and commitment therapy and motivational interviewing in the treatment of alcohol use disorder in a college woman: A case study
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Alcohol use disorders and liver fibrosis: an update
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Computer‐delivered brief alcohol intervention for patients with liver disease: a randomized controlled trial
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Patient Relapse in the Context of Drug Abuse Treatment
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Daño cerebral relacionado con el alcohol. Situación actual y llamada a la acción
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Treatment for Alcohol Use Disorder: Progress in Predicting Treatment Outcome and Validating Nonabstinent End Points
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Missed opportunities by health care providers to reduce racial/ethnic disparities in the use of alcohol treatment services
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Clinical correlates of desire for treatment for current alcohol dependence among patients with a primary psychiatric disorder
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Test-retest reliability of four cognitive tasks in a not so WEIRD samplePreprint
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Können Alkoholabhängige ihre Trinkmengen durch eine Kombination von Medikamenten und Kurzinterventionen dauerhaft reduzieren?
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Reduction of harmful consumption versus total abstinence in addiction treatment
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Patients’ Knowledge and Attitudes Towards Regular Alcohol Urine Screening: A Survey Study
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Abstinence dans l’alcoolodépendance : approche critique et actualisée des recommandations nationales de 2001
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Identifying thresholds for clinically meaningful change among clients of drug and alcohol services using the Australian Treatment Outcomes Profile
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Gut Hormones: Possible Mediators of Addictive Disorders?
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Reducing heavy drinking: A public health strategy and a treatment goal?
McLellan, A. T. (2007) · Journal of Substance Abuse Treatment · doi:10.1016/j.jsat.2006.12.004 · Cited by 28 · see citing works
Can reduced drinking be a viable goal for alcohol dependent patients?
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Drinking-reduction goals offer potential to widen the options for measuring and treating alcohol dependence
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The Clinical Benefits of Non-abstinent Outcomes in Alcohol Use Disorder Treatment: Evidence from Clinical Trials and Treatment Implications
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Reduced Drinking in Alcohol Dependence Treatment, What Is the Evidence?
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Authors: Gastfriend, D. R., Garbutt, J. C., Pettinati, H. M., & Forman, R. F.
Affiliations: Alkermes (United States) (US)
University of North Carolina at Chapel Hill (US)
University of Pennsylvania (US)
Corresponding author: Gastfriend, David R.
ORCID: Gastfriend, David R.
Venue: Journal of Substance Abuse Treatment
Publisher: Elsevier BV
Published: 2007-07
Volume: 33
Issue: 1
Pages: 71-80
ISSN: 0740-5472 (ISSN-L)
DOI: 10.1016/j.jsat.2006.09.008
OpenAlex: W2048583110
Cited by: 139
References: 75
Citations by year: 2026: 5 · 2025: 1 · 2024: 8 · 2023: 5 · 2022: 8 · 2021: 11 · 2020: 6 · 2019: 6 · 2018: 15 · 2017: 7 · 2016: 8 · 2015: 11 · 2014: 10 · 2013: 12 · 2012: 6
FWCI: 0.54
Type: journal article
Language: en
Open access: closed
Licence: www.elsevier.com/tdm/userlicense/1.0/ (tdm)
www.elsevier.com/legal/tdmrep-license (tdm)
Locations: Journal of Substance Abuse Treatment (publishedVersion)
PubMed (publishedVersion)
Funders: U.S. Food and Drug Administration
Topics: Health Sciences › Medicine › Epidemiology › Substance Abuse Treatment and Outcomes
Health Sciences › Medicine › Pathology and Forensic Medicine › Alcohol Consumption and Health Effects
Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Opioid Use Disorder Treatment
Keywords: heavy drinking, alcoholism, abstinence, treatment outcomes, drinking frequency, individualized treatment goals
MeSH terms: Alcohol Drinking, Alcoholism, Goals, Humans, Health Knowledge, Attitudes, Practice, Outcome and Process Assessment, Health Care, Temperance, United States

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Reduction in heavy drinking as a treatment outcome in alcohol dependence

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