Posttreatment low-risk drinking as a predictor of future drinking and problem outcomes among individuals with alcohol use disorders.

Treatment for alcohol disorders has traditionally been abstinence-oriented, but approaches that focus on “improvement” and harm reduction are of increasing interest. This is because of clinical concerns as well as recent research examining low-risk drinking outcomes (although early research on nonabstinent outcomes dates back 30 years). Today, low-risk drinking is defined as having 4 or less drinks per day and no more than 14 drinks per week for men and 3 or less drinks per day and no more than 7 drinks per week for women (National Institute on Alcohol Abuse and Alcoholism, 2004). In alcohol clinical trials, the Food and Drug Administration (FDA) has recently moved from total abstinence to no heavy drinking as the primary treatment outcome (Falk et al., 2010; Food and Drug Administration, 2006). No heavy drinking includes both abstinence and low-risk drinking. Evaluating the merits of low-risk drinking as an outcome of primary treatment is a timely effort, as currently a wider spectrum of treatments, both medication-based and psychosocial, are being developed for alcohol disorders. In addition, because of health reform, many more individuals will have access to treatment. Therefore, continuous evaluation of treatment outcomes is a priority for the field. Most of the existing research on moderate-to-low-risk drinking has studied general population rather than clinical samples. In a longitudinal national general population sample, Dawson and colleagues (2007) examined multiple levels of drinking in relation to recurrence of alcohol use disorder symptoms over 3 years among individuals remitted from alcohol use disorders. In the follow-up period, stability was highest for abstainers; 77.2% of those abstinent at year 1 remained abstinent at year 3, while 48.3% of low-risk drinkers remained low-risk (with an additional 18.3% becoming abstinent). However, overall rates of recurrent alcohol dependence did not significantly differ between low-risk drinkers (4.0%) and abstainers (2.9%) (Dawson et al., 2007), and the likelihood of recurrent alcohol use disorder symptoms did not differ significantly for those younger than 34 years (Dawson et al., 2007). Although low-risk drinking may be acceptable for less severe patients, little is known about whether this is an acceptable outcome for individuals with problems so severe they enter specialty treatment. Recently, studies have begun to examine such outcomes in treated populations. For example, in a secondary analysis of 2 large randomized clinical trials for the treatment for alcohol dependence, the COMBINE (Anton et al., 2006) and to piramate (Johnson et al., 2007) studies, the endpoint measure of percent subjects with no heavy drinking, was generally as sensitive as many traditional continuous outcome measures in detecting differences between medication and placebo groups (Falk et al., 2010). This measure, at the end of treatment, also predicted drinking outcomes and alcohol-related consequences up to 1 year following treatment. Our study extends this research by examining a different population: individuals entering specialty treatment for alcohol use disorders in a large private, nonprofit, integrated health care system. We compare 12-month outcomes for individuals grouped by 3 levels of drinking 6 months after entering treatment: abstinence, low-risk drinking, and heavy drinking. Our measure of low-risk drinking was <5 drinks per day, as weekly quantity/frequency consumption information was not available. The 12-month outcomes include drinking levels and severity of medical, psychiatric, employment, and family problems. We examine the likelihood that compared to abstinent or heavy drinkers, low-risk drinkers after treatment (i) become abstinent or remain low-risk drinkers rather than becoming heavy drinkers and (ii) have severe problems.