Phosphatidylethanol as an outcome measure in treatment aimed at controlled drinking.

BACKGROUND: Phosphatidylethanol (PEth) is a specific marker of alcohol intake, used both as a screening method for hazardous use and as an outcome measure in the treatment of alcohol use disorder (AUD). However, what cut-off values to apply for hazardous use in a treatment setting is still unclear. We aimed to investigate the correlation between PEth and self-reported drinking and identify the optimal cut-off for hazardous use, for patients with AUD and a stated goal of controlled drinking. METHODS: We used data from a randomized controlled trial of two different psychological treatments aiming for controlled drinking, conducted within specialized addiction care in Stockholm, Sweden. A total of 181 patients left samples that could be included in the current analysis. Outcomes were measured at five different time points over 2 years of follow-up. PEth 16:0/18:1 values were correlated with subjective reports of recent drinking based on the Timeline Follow-Back Method. RESULTS: The correlation between PEth and self-reported alcohol intake increased significantly over time, with the weakest correlation found at baseline (Spearman's ρ = 0.42) and the strongest at the 104-week follow-up (ρ = 0.69). When used to indicate hazardous drinking according to Swedish guidelines (≥10 units per week), receiver operating characteristic analysis revealed PEth ≥ 0.22 µmol/l to be the optimal cut-off. CONCLUSIONS: PEth is a useful outcome measure that can be used to validate subjective reports of current drinking. In a treatment setting aimed at controlled drinking, the accuracy of patients' self-report measures seems to improve over time. In this context, a PEth value of ≥0.22 µmol/l is a sensitive and specific indicator of hazardous drinking.

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

BACKGROUND: Research 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. METHODS: This 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. RESULTS: BSCT 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. CONCLUSIONS: BSCT 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).

Behavioural self-control training versus motivational enhancement therapy for individuals with alcohol use disorder with a goal of controlled drinking: A randomized controlled trial.

BACKGROUND AND AIMS: Controlled drinking (CD) is an attractive treatment goal for a large proportion of individuals with alcohol use disorder (AUD), but the availability of treatment methods supporting a goal of CD is scarce. We tested if behavioural self-control training (BSCT) was superior to motivational enhancement therapy (MET) for individuals with AUD with a treatment goal of CD. DESIGN: Randomized controlled two-group trial. Follow-ups were conducted at 12 and 26 weeks (primary end-point) after inclusion. SETTING: Three specialized dependency care clinics in Stockholm, Sweden. PARTICIPANTS: Two hundred and fifty self-referred adults (52% men) fulfilling criteria of AUD (DSM-5) and a stated treatment goal of CD. INTERVENTION AND COMPARATOR: BSCT (n = 125), a five-session treatment based on cognitive behavioural therapy versus the active comparator, MET (n = 125), containing four sessions based on Motivational Interviewing. MEASUREMENTS: Primary outcome measure was mean weekly alcohol consumption at the 26-week follow-up, adjusted for baseline consumption. CONCLUSIONS: A randomized controlled trial found no evidence of a difference between behavioural self-control training and motivational enhancement therapy in reducing weekly alcohol consumption. Both groups substantially reduced consumption and behavioural self-control training was superior in reducing hazardous drinking.

Reductions in WHO risk drinking levels correlate with alcohol craving among individuals with alcohol use disorder.

BACKGROUND: Abstinence has historically been considered the preferred goal of alcohol use disorder (AUD) treatment. However, most individuals with AUD do not want to abstain and many are able to reduce their drinking successfully. Craving is often a target of pharmacological and behavioral interventions for AUD, and reductions in craving may signal recovery. Whether reductions in drinking during AUD treatment are associated with reductions in craving has not been well examined. METHODS: We conducted secondary analyses of data from three AUD clinical trials (N's= 1327, 346, and 200). Drinking reductions from baseline to the end of treatment were measured as changes in World Health Organization (WHO) risk drinking levels; alcohol craving was measured using validated self-report measures. Regression analyses tested whether drinking reductions were associated with end-of-treatment craving reductions; moderation analyses tested whether associations between drinking reduction and end-of-treatment craving differed across AUD severity. RESULTS: Reductions of at least 1 or at least 2 WHO risk drinking levels were associated with lower craving (all p's < 0.05). Results were substantively similar after removing abstainers at the end-of-treatment. Associations between drinking reductions and craving were generally not moderated by AUD severity. CONCLUSIONS: Individuals with WHO risk drinking level reductions reported significantly lower craving, as compared to those who did not achieve meaningful reductions in drinking. The results demonstrate the utility of WHO risk drinking levels as AUD clinical trial endpoints and provide evidence that drinking reductions mitigate craving.

A Community-Based Therapeutic Education Programme for People with Alcohol Use Disorder in France: A Qualitative Study (ETHER).

Therapeutic patient education (TPE) aims to help people with chronic disease strengthen their empowerment and psychosocial skills to better manage their condition. Although TPE has great potential for addiction medicine, studies on its benefits for reducing alcohol-related harms and increasing empowerment are sparse. We conducted a qualitative study of people with alcohol use disorder (AUD) who participated in the community-based TPE programme Choizitaconso to assess their perceptions and experiences of it. Semi-structured interviews were conducted with 16 participants who had completed the TPE programme at least six months previously. The interviews were transcribed and analysed using a sequential thematic analysis. We identified four general themes: (1) the context of participation: the TPE programme could be a strategy to facilitate engagement in AUD care; (2) representations and experiences: the programme helped to "normalize" participants' relationship with alcohol use by increasing empowerment; (3) TPE strengths: improved knowledge about alcohol use, self-image, weight loss, self-stigma reduction; (4) TPE limitations: difficulty putting learning into practice after the programme ended. The Choizitaconso programme met participants' health and psychosocial expectations, strengthening their empowerment and reducing self-stigma, thereby facilitating engagement in AUD care.

Evaluation of a novel therapeutic education programme for people with alcohol use disorder in France: a mixed-methods intervention study protocol (ETHER).

BACKGROUND: ETHER ("Education THEérapeutique pour la Réduction des dommages en alcoologie" or Therapeutic education for alcohol-related harm reduction) is a multicentre community-based mixed-methods study, which aims to evaluate the effectiveness of the innovative therapeutic patient education (TPE) programme 'Choizitaconso' in a sample of French people with alcohol use disorder (people with AUD). Choizitaconso teaches people with AUD psychosocial skills to help them (re)establish controlled drinking and reduce alcohol-related harms. Recruitment started in October 2019. We present here the protocol of the ETHER study. METHODS: ETHER's quantitative component involves a 6-month controlled intervention study which evaluates Choizitaconso's effectiveness by comparing 30 people with AUD following the programme with a control group of 60 people with AUD not enrolled in it, using a questionnaire co-constructed by the research team and members of the people with AUD community. Thirty-four alcohol-related harms are assessed and summed to provide an individual measure of the 'harm burden' from consuming alcohol (primary outcome). Secondary outcomes are anticipated and internalized stigma, alcohol consumption measures, craving for alcohol, coping strategies, health-related quality of life, self-confidence to control or abstain from drinking, treatment self-regulation, anxiety and depressive symptoms, alcohol-related neuropsychological impairments, and capabilities (a measure of wellbeing in adults). Data will be collected in face-to-face and phone-based interviews at enrolment and 6 months later. Linear regression models will be used to assess the impact of the TPE programme on changes in the primary and secondary outcomes, while adjusting for other correlates and confounders. The study's qualitative component comprises semi-structured interviews with 16 people with AUD who have already completed the TPE programme at least 6 months before the interview. Qualitative interviews will be analysed using thematic analysis. RESULTS AND CONCLUSIONS: ETHER is the first evaluation study of an innovative TPE programme specifically designed to reduce alcohol-related harms and reach controlled drinking in France. The involvement of the people with AUD community in selecting which experienced and perceived alcohol-related harms to measure ensures that ETHER will provide healthcare staff and researchers with a relevant set of harm reduction criteria for use in future research. Finally, ETHER will provide scientific justification for implementing novel alcohol-related harm reduction approaches and champion controlled drinking as a therapeutic goal. Trial registration ClinicalTrials.gov, NCT03954054. Registered 17 May 2019-Prospectively registered, https://clinicaltrials.gov/ct2/show/NCT03954054?cond=alcohol&cntry=FR&city=Marseille&draw=1&rank=1 .

Alcohol dependence severity determines the course of treatment-seeking patients.

BACKGROUND: While accumulating evidence suggests a relation between the severity of alcohol dependence and the risk of its recurrence, the impact of dependence severity on the course of the disorder has not been carefully evaluated. The present study examined the impact of several severity indices of alcohol dependence on the drinking course after inpatient treatment. METHODS: This prospective study was conducted over a 12-month period following alcohol treatment at a specialized hospital. A total of 712 consecutively admitted alcohol-dependent patients were targeted for enrollment at the time of their hospitalization, with 637 patients registered and followed. The characteristics and severity of the subjects were assessed using multiple methods at admission, with their course after discharge followed continuously using mailed questionnaires that queried them regarding their drinking behavior. RESULTS: Greater severity of dependence, assessed using the number of ICD-10 diagnostic criteria met, was associated with a lower rate of abstinence during the study period (p = 0.035). The rate of abstinence also decreased significantly as the baseline blood gamma-glutamyl transferase value and Alcohol Dependence Scale (ADS) score increased (p = 0.031 and p = 0.0002, respectively). In multivariate Cox proportional hazards analyses, the group with the most severe ADS scores had a significantly greater risk of relapse to drinking than the group with the least severe scores (HR = 2.67, p = 0.001). Dependence severity also associated with the drinking pattern; participants in both the controlled drinking group and the abstinence group had lower ADS scores at admission and a later age at first drinking (p = 0.001 and p < 0.001, respectively) than those with poorer drinking outcomes. CONCLUSIONS: The present study showed that more severe alcohol dependence predicts a poorer course after alcohol treatment, as reflected by findings on multiple measures. These results suggest that assessing the dependence severity at the outset of treatment could be useful both in predicting treatment outcome and targeting interventions to alcohol-dependent individuals who need additional support in their recovery.

Nalmefene attenuates neural alcohol cue-reactivity in the ventral striatum and subjective alcohol craving in patients with alcohol use disorder.

RATIONALE: Alcohol use disorder is a common and devastating mental illness for which satisfactory treatments are still lacking. Nalmefene, as an opioid receptor modulator, could pharmacologically support the reduction of drinking by reducing the (anticipated) rewarding effects of alcohol and expanding the range of treatment options. It has been hypothesized that nalmefene acts via an indirect modulation of the mesolimbic reward system. So far, only a few imaging findings on the neuronal response to nalmefene are available. OBJECTIVES: We tested the effect of a single dose of 18 mg nalmefene on neuronal cue-reactivity in the ventral and dorsal striatum and subjective craving. METHODS: Eighteen non-treatment-seeking participants with alcohol use disorder (67% male, M = 50.3 ± 13.9 years) with a current high-risk drinking level (M = 76.9 ± 52 g of pure alcohol per day) were investigated using a cue-reactivity task during functional magnetic resonance imaging (fMRI) in a double-blind, placebo-controlled, cross-over study/design. In addition, self-reported craving was assessed before and after exposure to alcohol cues. RESULTS: An a priori defined region of interest (ROI) analysis of fMRI data from 15 participants revealed that nalmefene reduced alcohol cue-reactivity in the ventral, but not the dorsal striatum. Additionally, the subjective craving was significantly reduced after the cue-reactivity task under nalmefene compared to placebo. CONCLUSION: In the present study, reduced craving and cue-reactivity to alcohol stimuli in the ventral striatum by nalmefene indicates a potential anti-craving effect of this drug via attenuation of neural alcohol cue-reactivity.

Controlled drinking-non-abstinent versus abstinent treatment goals in alcohol use disorder: a systematic review, meta-analysis and meta-regression.

BACKGROUND AND AIMS: The proportion of untreated patients with alcohol use disorder (AUD) exceeds that of any other mental health disorder, and treatment alternatives are needed. A widely discussed strategy is to depart from the abstinence paradigm as part of controlled drinking approaches. This first systematic review with meta-analysis aims to assess the efficacy of non-abstinent treatment strategies compared with abstinence-based strategies. METHODS: CENTRAL, PubMed, PsycINFO and Embase databases were searched until February 2019 for controlled (randomized and non-randomized) clinical trials (RCTs and non-RCTs) among adult AUD populations, including an intervention group aiming at controlled drinking and a control group aiming for abstinence. Following Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) and Cochrane Collaboration guidelines, literature search, data collection and risk of bias assessment were carried out independently by two reviewers [International Prospective Register of Systematic Reviews (PROSPERO), registration no. CRD42019128716]. The primary outcome was the proportion of participants consuming alcohol at or below the recommended threshold. Secondary outcomes were social functioning, drinking reductions, abstinence rates and dropouts. Using random-effects models, RCTs and non-RCTs were analyzed separately. Sensitivity and subgroup analyses accounted for methodological rigor, inclusion of goal-specific treatment, length of follow-up and AUD severity. RESULTS: Twenty-two studies (including five RCTs) with 4204 patients were selected. There was no statistically significant difference between both treatment paradigms in RCTs [odds ratio (OR) = 1.32, 95% confidence interval (CI) = 0.51-3.39]. Non-randomized studies of free goal choice favored abstinence-orientation (OR = 0.60, 95% CI = 0.40-0.90), unless goal-specific treatment was provided (OR = 0.79, 95% CI = 0.40-1.56), or in studies of low risk of bias (OR = 0.73, 95% CI = 0.49-1.09) or with long follow-up (OR = 1.49, 95% CI = 0.78-2.85). Effect sizes were not clearly dependent upon AUD severity. Abstinence- and controlled drinking interventions did not clearly differ in their effect on social functioning and drinking reductions. CONCLUSIONS: Available evidence does not support abstinence as the only approach in the treatment of alcohol use disorder. Controlled drinking, particularly if supported by specific psychotherapy, appears to be a viable option where an abstinence-oriented approach is not applicable.

GRATITUDE WHILE DRINKING, GRATITUDE WHILE RECOVERING: A STUDY OF ALCOHOL USE DISORDERS.

Background: For decades researchers have debated whether those diagnosed with alcohol use disorders can return to non-problematic drinking. Now, recovery researchers are measuring aspects of wellbeing in addition to aspects of pathology, producing surprising findings that have added to the debate. Recent studies show that some with alcohol use disorders who continue to drink endorse high levels of positive psychosocial functioning. Objectives: Employ trait gratitude as a marker of wellness to answer the following questions: how do individuals who continue to drink but endorse high gratitude at follow-up differ from peers at baseline? Does trait gratitude correlate differently with demographic, psychosocial, and clinical factors for abstinent members of Alcoholics Anonymous (AA) versus actively drinking non-AAs? Methods: 275 individuals with alcohol dependence were assessed for trait gratitude at 2.5-3-year follow-up in a naturalistic, longitudinal study. The sample was assessed on psychosocial and clinical indicators at baseline and follow-up. Results: Drinkers who endorsed high gratitude had higher socioeconomic status, greater levels of positive spirituality, more stable personality indicators, less addiction severity, fewer negative life events, and fewer psychiatric symptoms than their peers at baseline. For actively drinking non-AAs, trait gratitude correlated differently, and positively, with years of education, income, and purpose in life compared with sober AA members. For AA members, gratitude correlated with AA involvement and length of sobriety. Discussion: Across multiple domains, a subset of drinkers report doing relatively well despite meeting criteria for alcohol dependence. Trait gratitude correlates differently with other constructs for AAs versus non-AAs, indicating that gratitude for recovery might be contextually sensitive, operating differently within and without the structure of AA.

Advancing alcohol research and treatment: contentions and debates about treatment intensity, goals and outcomes in the 1970s and 1980s.

AIMS: This narrative exploration of alcohol treatment research focuses on key contentions and advances in alcohol treatment during the critical 1970s and 1980s. METHODS: Papers and books which signal some of the major debates and advances in alcohol treatment research were selected from the 1970s and 1980s. The selection process was based on significant debate during this period, and included those that influenced the field in general and this author in particular. RESULTS: This was a period where challenges to traditional models and concepts, and the perceived universal need for long-term treatment, were accompanied by contention but also advances in research and treatment approaches. The debates and advances resonate today. These include the recognition that: intensive and long-term treatment is not always required; for dependent drinkers, relapse is a common treatment outcome meriting specific treatment approaches to prevent and reduce this risk; controlled drinking is a treatment option, especially for younger and less dependent drinkers; and an important contributor to enduring change is access to, and realization of, improvements in the quality of life. CONCLUSIONS: Pioneering research and publications in the 1970s and 1980s, sometimes conducted and produced in contentious contexts, influenced significantly conceptualizations of alcohol-related problems, and laid the foundations for treatment hypotheses and research, improving access to a broader range of evidence-based treatment. These underpinning works influenced the development of stepped-up care from brief to intensive interventions, relapse prevention and treatment options not limited to abstinence, and they identified the need to include a stronger focus on quality of life.

Alcohol treatment goal choice predicts longitudinal drinking outcomes in adolescent substance users.

Social cognitive theory suggests that when individuals select their own goals, they work harder to achieve them as compared to clinician-imposed goals. Moreover, achieving goals during the course of treatment may increase self-efficacy, which could positively predict outcome. Research in clinical samples of adults with alcohol use disorder supports the utility of treatment goal choice in predicting longitudinal outcomes; a total abstinence (TA) goal choice has been associated with better clinical outcomes (e.g. greater percentage of days abstinent, more days to relapse to heavy drinking) compared to a controlled use (CU) goal choice. Treatment of adolescents presents unique challenges, because adolescents tend to be resistant to treatment and often enter treatment in response to external pressures (e.g. parent, school system). Data from 110 adolescents aged 14 to 18 were collected upon admission to outpatient substance use disorder treatment. A series of hierarchical linear regressions was used to test the utility of the alcohol treatment goal choice variable in predicting drinking outcomes at 6-, 12-, and 24-month follow-ups. Separate models were run to examine binge drinking days, percentage of days abstinent, and drinks per drinking day at each time point. Goal choice significantly predicted drinking outcomes at the 12-month follow-up, but not at the 6- or 24-month time points, such that TA goal choice was associated with better clinical outcomes. These findings are relevant to treatment planning, as they suggest that goal choice may have clinical utility as a predictor of alcohol use disorder clinical course in adolescents.

Pharmacologically controlled drinking in the treatment of alcohol dependence or alcohol use disorders: a systematic review with direct and network meta-analyses on nalmefene, naltrexone, acamprosate, baclofen and topiramate.

BACKGROUND AND AIMS: Pharmacologically controlled drinking in the treatment of alcohol dependence or alcohol use disorders (AUDs) is an emerging concept. Our objective was to explore the comparative effectiveness of drugs used in this indication. DESIGN: Systematic review with direct and network meta-analysis of double-blind randomized controlled trials (RCTs) assessing the efficacy of nalmefene, naltrexone, acamprosate, baclofen or topiramate in non-abstinent adults diagnosed with alcohol dependence or AUDs. Two independent reviewers selected published and unpublished studies on Medline, the Cochrane Library, Embase, ClinicalTrials.gov, contacted pharmaceutical companies, the European Medicines Agency and the Food and Drug Administration, and extracted data. SETTING: Thirty-two RCTs. PARTICIPANTS: A total of 6036 patients. MEASUREMENTS: The primary outcome was total alcohol consumption (TAC). Other consumption outcomes and health outcomes were considered as secondary outcomes. FINDINGS: No study provided direct comparisons between drugs. A risk of incomplete outcome data was identified in 26 studies (81%) and risk of selective outcome reporting in 17 (53%). Nalmefene [standardized mean difference (SMD) = -0.19, 95% confidence interval (CI) = -0.29, -0.10; I2  = 0%], baclofen (SMD = -1.00, 95% CI = -1.80, -0.19; one study) and topiramate (SMD = -0.77, 95% CI = -1.12, -0.42; I2  = 0%) showed superiority over placebo on TAC. No efficacy was observed for naltrexone or acamprosate. Similar results were observed for other consumption outcomes, except for baclofen (the favourable outcome on TAC was not reproduced). The number of withdrawals for safety reasons increased under nalmefene and naltrexone. No treatment demonstrated any harm reduction (no study was powered to explore health outcomes). Indirect comparisons suggested that topiramate was superior to nalmefene, naltrexone and acamprosate on consumption outcomes, but its safety profile is known to be poor. CONCLUSIONS: There is currently no high-grade evidence for pharmacological treatment to control drinking using nalmefene, naltrexone, acamprosate, baclofen or topiramate in patients with alcohol dependence or alcohol use disorder. Some treatments show low to medium efficacy in reducing drinking across a range of studies with a high risk of bias. None demonstrates any benefit on health outcomes.

Reduced Drinking in Alcohol Dependence Treatment, What Is the Evidence?

Abstinence from alcohol has been the prevailing treatment goal for individuals with alcohol dependence (AD) within the context of specialty alcohol treatment. Yet, alcohol use has been conceptualized as existing on a continuum. Importantly, most people who meet criteria for AD and could benefit from treatment never receive treatment. About half of these individuals do not seek treatment because they report a desire to continue drinking. To increase acceptability of treatment, reductions in alcohol consumption have been examined as alternative outcomes in treatment trials for AD. The current study reviews data which indicate that long-term reduction in alcohol consumption among patients with AD is possible. Controlled studies have tested reduced alcohol consumption and show sustained improvements in drinking reductions for many patients following behavioral treatments and pharmacotherapy. Evidence-based treatment guidelines and medicines development guidance authorities have taken note of these developments and accept "intermediate harm reduction" (European Medicines Agency) or "low-risk drinking limits" (US Federal Drug Administration) as optional trial endpoints. In conclusion, while abstinence remains the safest treatment goal for individuals with AD, evidence supports that reduced drinking approaches may be an important extension in the treatment of AD.

Who achieves low risk drinking during alcohol treatment? An analysis of patients in three alcohol clinical trials.

BACKGROUND AND AIMS: There is evidence that low-risk drinking is possible during the course of alcohol treatment and can be maintained following treatment. Our aim was to identify characteristics associated with low-risk drinking during treatment in a large sample of individuals as they received treatment for alcohol dependence. DESIGN: Integrated analysis of data from the Combined Pharmacotherapies and Behavioral Intervention (COMBINE) study, Project MATCH (Matching Alcoholism Treatments to Client Heterogeneity) and the United Kingdom Alcohol Treatment Trial (UKATT) using repeated-measures latent class analysis to identify patterns of drinking and predictors of low-risk drinking patterns during treatment. SETTING: United States and United Kingdom. PARTICIPANTS: Patients (n = 3589) with alcohol dependence receiving treatment in an alcohol clinical trial were primarily male (73.0%), white (82.0%) and non-married (41.7%), with an average age of 42.0 (standard deviation = 10.7). MEASUREMENTS: Self-reported weekly alcohol consumption during treatment was assessed using the Form-90 and validated with biological verification or collateral informants. FINDINGS: Seven patterns of drinking during treatment were identified: persistent heavy drinking (18.7% of the sample), increasing heavy drinking (9.6%), heavy and low-risk drinking (6.7%), heavy drinking alternating with abstinence (7.9%), low-risk drinking (6.8%), increasing low-risk drinking (10.5%) and abstinence (39.8%). Lower alcohol dependence severity and fewer drinks per day at baseline significantly predicted low-risk drinking patterns [e.g. each additional drink prior to baseline predicted a 27% increase in the odds of expected classification in heavy drinking versus low-risk drinking patterns; odds ratio = 1.27 (95% confidence interval (CI) = 1.10, 1.47, P = 0.002]. Greater negative mood and more heavy drinkers in the social network were significant predictors of expected membership in heavier drinking patterns. CONCLUSIONS: Low-risk drinking is achievable for some individuals as they undergo treatment for alcohol dependence. Individuals with lower dependence severity, less baseline drinking, fewer negative mood symptoms and fewer heavy drinkers in their social networks have a higher probability of achieving low-risk drinking during treatment.

Acceptability of non-abstinence goals among students enrolled in addiction studies programs across the United States.

BACKGROUND: Previous studies of acceptability of non-abstinence recruited older, experienced addiction professionals; it's possible that younger, emerging addiction professionals may be more accepting of non-abstinence, perhaps due to training in harm reduction. METHODS: One hundred seventy graduate and undergraduate students enrolled in college/university-based programs offering training in addiction studies across the United States were recruited to complete a Web-based questionnaire assessing whether acceptability of non-abstinence outcome goals varied depending on the specific substance a client consumes, severity of diagnosis, and finality of outcome goal. RESULTS: More respondents rated non-abstinence an acceptable Intermediate goal for clients diagnosed with a Moderate cannabis use disorder (57%) or Moderate alcohol use disorder (45%) than for clients diagnosed with any other listed Moderate substance use disorder (32% to 36%). Similarly, larger proportions of respondents rated non-abstinence an acceptable Final goal for clients diagnosed with a Moderate cannabis use disorder (37%) or Moderate alcohol use disorder (31%) than for clients diagnosed with any other listed Moderate substance use disorder (19% to 23%). Only 14% to 26% of respondents rated non-abstinence an acceptable Final goal for clients diagnosed with a Severe substance use disorder, but 28% to 42% rated non-abstinence acceptable for clients diagnosed with a Severe substance use disorder when non-abstinence was an Intermediate goal. CONCLUSIONS: Compared with previous research examining the acceptability of non-abstinence, these results suggest that students enrolled in addiction studies training programs may be more accepting of clients who decide to pursue non-abstinence either as an intermediate step on the way to abstinence or as a final goal.

The alcohol dependence syndrome: a legacy of continuing clinical and scientific importance.

This paper offers some reflections on Griffith Edwards' continuing legacy with particular reference to his and Milton Gross's formulation of alcohol dependence as a 'provisional' clinical syndrome. The ideas and language from this seminal paper have heavily influenced international diagnostic classification systems. However, it is observed that there has also been significant (and increasing) divergence-in particular around the original proposal that dependence and negative alcohol-related consequences are independent, if inevitably inter-related dimensions. This is most apparent in the conflation of alcohol-related problems and dependence phenomena implicit in DSM-V. It is also argued that the alcohol dependence syndrome (ADS) has substantial continuing influence and relevance to current clinical practice. The hypothesis that degree of alcohol dependence is a useful indicator of the possibility of a return to controlled drinking continues to receive support, and underpins the widespread implementation of brief interventions for 'early stage' problem drinkers. It is suggested that the kind of careful clinical observations that underpinned the original concept of alcohol dependence have continuing relevance to the formulation of improved understanding, measurement instruments, diagnostic systems and clinical responses.