1987 (1)

  1. Peele, S (1987).
    Why do controlled-drinking outcomes vary by investigator, by country and by era? - Cultural conceptions of release and remission in alcoholism.
    Drug and Alcohol Dependence, 20(3), 173--201.
    Keywords: Alcoholism, cbt, controlled {drinking, Culture, expectations} and beliefs, harm {reduction, Humans, moderation, natural} {remission, and Recurrence}
    [link]
    Variations in the reported rates of controlled drinking by former alcoholics are notable, at times startling. Reports of such outcomes (which in some cases involved a large percentage of subjects) were common for a brief period ending in the mid- to late 1970s. By the early 1980s, a consensus had emerged in the United States that severely alcoholic subjects and patients could not resume moderate drinking. Yet--at a point in the mid-1980s when the rejection of the possibility of a return to controlled drinking appeared to be unanimous--a new burst of studies reported resumption of controlled drinking was quite plausible and did not depend on the initial severity of alcoholics' drinking problems. Variations in controlled-drinking outcomes--and in views about the possibility of such outcomes--involve changes in the scientific climate and differences in individual and cultural outlooks. These cultural factors have clinical implications as well as contributing to the power of scientific models of recovery from alcoholism.

1993 (1)

  1. Harm reduction: application to alcohol abuse problems.
    NIDA Research Monograph, 137, 147--66.
    Keywords: {abstinence, Acquired} Immunodeficiency Syndrome, harm {reduction, and Substance-Related} Disorders
    [link]
    The terms harm reduction, harm minimization, and risk reduction often are used interchangeably in the addictive behaviors literature (Heather et al. 1993; OHare et al. 1992). Although they refer to the same general approach or model, Europeans (particularly the Dutch) call it harm reduction, the British refer to harm minimization, and Americans are more likely to prefer the term risk reduction. In this chapter, harm reduction is defined as the application of methods designed to reduce the harm (and risk of harm) associated with ongoing or active addictive behaviors. Harm reduction methods are based on the assumption that habits can be placed along a continuum ranging from temperate to intemperate use along with associated risks for harm (Marlatt and Tapert 1993). Figure 1 represents this continuum; the left side represents excess, the middle part is moderation, and at the farthest point to the right is abstinence. The risk of harm increases to the left and decreases to the right along this continuum. The goal of harm reduction programs is to move the individual with excessive behavior problems from left to right-to begin to take steps in the right direction to reduce the harmful consequences of the habit. It is important to note that this continuum model accepts abstinence as the ultimate risk-reduction goal. With the exception of eating habits, abstinence greatly reduces or entirely eliminates the risk of harm from most excessive behaviors.

1995 (2)

  1. Controlled drinking after 25 years: how important was the great debate?.
    Addiction (Abingdon, England), 90(9), 1149--53; discussion 1157-77.
    Keywords: Alcohol {Drinking, Alcoholism, Humans, Patient} {Compliance, Recurrence, Temperance, and Treatment} Outcome
    [link]
    There's nothing quite like a controlled drinking debate to arouse the passions of even the mildest-mannered addiction professional. In a recent issue, the scientific journal Addiction asked scientists Linda and Mark Sobell to look back on 25 years of controlled drinking research and to answer the question, "How important was the great debate?" Editors then asked eight experts from the addictions field to critique the article. The Sobells were given the last word. Following are excerpts from the discussion.
  2. Interpreting the Evidence on Brief Interventions for Excessive Drinkers.
    Alcohol Alcohol., 30(3), 287--296.
    Keywords: alcohol-related {harm, Alcoholism, brief} intervention, and motivation
    [link]
    Two recent reviews of the evidence on brief interventions in the alcohol field reach highly favourable conclusions regarding their effectiveness and cost-effectiveness. However, both can be criticized on three grounds: (1) they pay insufficient regard to important differences within the family of brief interventions; (2) they do not sufficiently emphasize the crucial distinction between brief interventions among treatment seekers and non-treatment seekers; and (3) they arrive at over-optimistic and uncritical conclusions. While not wishing to dampen enthusiasm for the potential of brief interventions in reducing alcohol-related harm, the present article argues that, if the evidence is not to be misinterpreted by policy makers and purchasers of services, differences between brief interventions must be borne in mind and analyses of effectiveness in the treatment-seeking population must be clearly separated from those in the area of opportunistic interventions in the non-treatment-seeking population. The evidence for the effectiveness of opportunistic brief interventions is much stronger than for brief interventions in specialist settings for those seeking help, where their most prudent application should be restricted to patients with problems of relatively low severity.

1996 (1)

  1. Carey, Kate (1996).
    Substance use reduction in the context of outpatient psychiatric treatment: A collaborative, motivational, harm reduction approach.
    Community Mental Health Journal, 32(3), 291--306.
    Keywords: abstinence, harm reduction, motivation, outpatient, psychiatric treatment, stages of change, and substance abuse
    [link] [doi]
    A conceptual model for reducing substance use within the context of outpatient psychiatric treatment is described. The proposed model incorporates four themes from the psychological treatment literature: treatment intensity, stages of change, motivational interventions, and harm reduction. The five steps of the model include (1) establishing a working alliance, (2) evaluating the cost-benefit ratio of continued substance use, (3) individualizing goals for change, (4) building an environment and lifestyle supportive of abstinence, and (5) anticipating and coping with crises. This model attempts to integrate clinical realities of mental health treatment with empirically-grounded strategies applicable to substance abuse problems.

1998 (1)

  1. MacCoun, R J (1998).
    Toward a psychology of harm reduction.
    The American Psychologist, 53(11), 1199--208.
    Keywords: harm reduction, prevalence reduction, quantity {reduction, Risk-Taking, Social} Behavior {Disorders, and Substance} Use Disorders
    [link]
    This article discusses 3 different strategies for dealing with the harmful consequences of drug use and other risky behaviors: We can discourage people from engaging in the behavior (prevalence reduction), we can encourage people to reduce the frequency or extent of the behavior (quantity reduction), or we can try to reduce the harmful consequences of the behavior when it occurs (harm reduction). These strategies are not mutually exclusive; this article offers a framework for integrating them. The framework is useful for examining frequent claims that harm reduction "sends the wrong message." Opposition to harm reduction is based in part on a recognition of potential trade-offs among the strategies, but it is also fueled by several more symbolic psychological factors. Strategies for successfully integrating prevalence reduction, quantity reduction, and harm reduction are explored.

1999 (1)

  1. Toward a psychology of harm reduction.
    RAND

2001 (2)

  1. Long-term outcome in 306 males with alcoholism.
    Psychiatry and Clinical Neurosciences, 55(6), 579--586.
    [link] [doi]
    The subjects of this study were 306 male alcoholics who lived in Osaka, Japan, and who were initially diagnosed with alcoholism at a psychiatric institution between 1972 and 1983. Follow-up studies were done on three occasions: 1 March 1985 (Time 1), 1 November 1988 (Time 2) and 1 March 1992 (Time 3). We followed up 232 (75.8%) of the 306 male alcoholics. By the end of the study period 110 (35.9%) of the subjects were deceased. Regarding cross-sectional sobriety status, from Time 1 to Time 3 the complete abstinence rate changed from 16.0 to 18.6%, excessive drinking rate was from 13.1 to 9.8%, and controlled drinking rate was from 6.9 to 9.8%. The longitudinal sobriety status of 122 living patients during the 5 years before the close of this study were: rate of stable abstinence, 28.7%; unstable abstinence, 21.3%; controlled drinking, 12.3%; and relapse 37.7%. Such variables as being without public assistance at the time of the initial diagnosis of alcoholism and attending a self-help group soon after the initial treatment were associated with stable abstinence. Age (20201339 years) and receiving outpatient treatment at the time of the initial treatment also emerged as predictors of survival. However, those variables, except attending a self-help group soon after the initial treatment, might merely indicate severity of alcoholism. For improving treatment results, it may be most important to provide a treatment environment within the residential area so that alcoholics may receive treatment at an early stage of alcoholism and attend a self-help group.
  2. Naltrexone, A Relapse Prevention Maintenance Treatment of Alcohol Dependence: a Meta-Analysis Of Randomized Controlled Trials.
    Alcohol Alcohol., 36(6), 544--552.
    [link] [doi]
    -- The objective of this study was to review the evidence for the efficacy and toxicity of naltrexone, a treatment of alcohol dependence. A systematic review and meta-analysis of randomized controlled trials of naltrexone used in the treatment of alcohol dependence was conducted. We searched MEDLINE, EMBASE, PsychLIT and the Cochrane Controlled Trials Registry for articles published between 1976 to January 2001. The manufacturer of naltrexone was asked to submit additional complete trial reports not in the literature. We analysed data from seven studies that compared naltrexone to placebo. The meta-analysis of benefit indicates that naltrexone is superior to placebo. Subjects treated with naltrexone experience significantly fewer episodes of relapse, and significantly more remain abstinent when compared to placebo-treated subjects risk difference of relapse rates = -14% [95% confidence interval (CI): -23%, -5%]; and risk difference of abstinence rates = 10% (95% CI: 4%, 16%) after 12 weeks of treatment. The naltrexone-treated subjects also consume significantly less alcohol over the study period than do placebo-treated subjects. There is no significant difference between naltrexone and placebo in terms of the number of subjects with at least one adverse event or the number of subjects who discontinued the trial due to an adverse event.

2002 (4)

  1. Naltrexone improves outcome of a controlled drinking program.
    Journal of Substance Abuse Treatment, 23(4), 361--366.
    Keywords: alcohol use disorders, alcoholism, controlled drinking, naltrexone, open randomized study, and outcome
    [link] [doi]
    Naltrexone is widely used in therapeutic programs with abstinence as a goal. However, it has been used in only a few studies aimed at reducing alcohol consumption. The purpose of this study was to evaluate the efficacy of naltrexone as an adjunct in controlled drinking programs. This was an open randomized study of 12 weeks duration that compared two therapeutic strategies: use of naltrexone in a controlled drinking program (NTX+CD) and the controlled drinking program alone (CD), without NTX. Each group comprised 30 male patients with mild alcohol dependence. During treatment, there were no differences between groups in drinking behavior, though the NTX+CD group showed significantly less craving. In the 12-month follow-up period, the NTX+CD group showed significantly fewer drinking days and heavy drinking days and less craving than the CD group. The results of this study suggest a role for naltrexone in controlled drinking programs. Author Keywords: Naltrexone; Controlled drinking; Alcoholism; Outcome; Follow-up
  2. The Effect of Controlled Drinking in Alcoholic Cardiomyopathy.
    Ann Intern Med, 136(3), 192--200.
    Keywords: abstinence, alcohol consumption, alcohol use {disorders, alcoholism, cardiomyopathy, Harm} reduction, and heart disease
    [link] [doi]
    Background: Cardiomyopathy is a potentially fatal complication of alcohol abuse. In alcoholic persons who develop cardiac dysfunction, abstinence is thought to be essential to halt further deterioration of cardiac contractility. Some evidence indicates that reducing alcohol intake may also be beneficial. Objective: To evaluate the effect of moderate "controlled" drinking on cardiac function in patients with alcoholic cardiomyopathy. Design: 4-year prospective cohort study. Setting: A university hospital in Barcelona, Spain. Patients: 55 alcoholic men with cardiomyopathy who had been drinking a minimum of 100 g of ethanol per day for at least 10 years. Measurements: Evaluation of ethanol intake and nutrition, clinical assessment of cardiac status, and sequential echocardiography and radionuclide cardiac angiography. Results: After the first year of evaluation, all patients with cardiomyopathy who abstained from alcoholic beverages demonstrated significant improvement in left ventricular function (average increase in left ventricular ejection fraction, 0.131 [95% CI, 0.069 to 0.193]). Patients who drank 20 to 60 g of ethanol per day showed a comparable mean improvement of 0.125 (CI, 0.082 to 0.168). In contrast, left ventricular ejection fraction deteriorated further in most patients who continued to abuse alcohol (80 g/d). After 4 years, left ventricular ejection fraction had continued to improve in both abstinent patients and those who controlled their drinking. Ten patients who had continued to consume more than 80 g of ethanol per day died during the study. Conclusion: In patients with alcoholic cardiomyopathy, both abstinence and controlled drinking of up to 60 g of ethanol per day (four standard drinks) were comparably effective in promoting improvement in cardiac function.
  3. Brief interventions for alcohol problems: a meta-analytic review of controlled investigations in treatment-seeking and non-treatment-seeking populations.
    Addiction, 97(3), 279--292.
    Keywords: alcohol problems, alcohol use disorders, brief intervention, meta-analysis, motivation, outcome, problem severity, treatment, and treatment-seeking
    [link] [doi]
    Brief interventions for alcohol use disorders have been the focus of considerable research. In this meta-analytic review, we considered studies comparing brief interventions with either control or extended treatment conditions. We calculated the effect sizes for multiple drinking-related outcomes at multiple follow-up points, and took into account the critical distinction between treatment-seeking and non-treatment-seeking samples. Most investigations fell into one of two types: those comparing brief interventions with control conditions in non-treatment-seeking samples (n = 34) and those comparing brief interventions with extended treatment in treatment-seeking samples (n = 20). For studies of the first type, small to medium aggregate effect sizes in favor of brief interventions emerged across different follow-up points. At follow-up after months, the effect for brief interventions compared to control conditions was significantly larger when individuals with more severe alcohol problems were excluded. For studies of the second type, the effect sizes were largely not significantly different from zero. This review summarizes additional positive evidence for brief interventions compared to control conditions typically delivered by health-care professionals to non-treatment-seeking samples. The results concur with previous reviews that found little difference between brief and extended treatment conditions. Because the evidence regarding brief interventions comes from different types of investigation with different samples, generalizations should be restricted to the populations, treatment characteristics and contexts represented in those studies.
  4. Harm reduction approaches to alcohol use : : Health promotion, prevention, and treatment.
    Addictive Behaviors, 27(6), 867--886.
    Keywords: 12-step, abstinence, abstinence uber alles, alcohol problems, alcohol use disorders, harm reduction, moderation, and zero tolerance
    [link] [doi]
    Harm reduction approaches to alcohol problems have endured a controversial history in both the research literature and the popular media. Although several studies have demonstrated that controlled drinking is possible and that moderation-based treatments may be preferred over abstinence-only approaches, the public and institutional views of alcohol treatment still support zero-tolerance. After describing the problems with zero-tolerance and the benefits of moderate drinking, the research literature describing prevention and intervention approaches consistent with a harm reduction philosophy are presented. Literature is reviewed on universal prevention programs for young adolescents, selective and indicated prevention for college students, moderation-based self-help approaches, prevention and interventions in primary care settings, pharmacological treatments, and psychosocial approaches with moderation goals. Overall, empirical studies have demonstrated that harm reduction approaches to alcohol problems are at least as effective as abstinence-oriented approaches at reducing alcohol consumption and alcohol-related consequences. Based on these findings, we discuss the importance of individualizing alcohol prevention and intervention to accommodate the preferences and needs of the targeted person or population. In recognizing the multifaceted nature of behavior change, harm reduction efforts seek to meet the individual where he or she is at and assist that person in the direction of positive behavior change, whether that change involves abstinence, moderate drinking, or the reduction of alcohol-related harm. The limitations of harm reduction and recommendations for future research are discussed. Author Keywords: Alcohol abuse; Alcohol drinking patterns; Alcohol rehabilitation; Drug abuse prevention; Public health; Risk-taking Corresponding author. Tel.: +1-206-685-1200; fax: +1-206-685-1310; email: marlatt@u.washington.edu

2004 (4)

  1. Oral Topiramate Reduces the Consequences of Drinking and Improves the Quality of Life of Alcohol-Dependent Individuals: A Randomized Controlled Trial.
    Arch Gen Psychiatry, 61(9), 905--912.
    [link] [doi]
    Background Topiramate, a fructopyranose derivative, was superior to placebo at improving the drinking outcomes of alcohol-dependent individuals. Objectives To determine whether topiramate, compared with placebo, improves psychosocial functioning in alcohol-dependent individuals and to discover how this improvement is related to heavy drinking behavior. Design Double-blind, randomized, controlled, 12-week clinical trial comparing topiramate vs placebo for treating alcohol dependence (1998-2001). Participants One hundred fifty alcohol-dependent individuals, diagnosed using the DSM-IV. Interventions Seventy-five participants received topiramate (escalating dose of 25 mg/d to 300 mg/d), and 75 had placebo and weekly standardized medication compliance management. Main Outcome Measures Three elements of psychosocial functioning were measured: clinical ratings of overall well-being and alcohol-dependence severity, quality of life, and harmful drinking consequences. Overall well-being and dependence severity and quality of life were analyzed as binary responses with a generalized estimating equation approach; harmful drinking consequences were analyzed as a continuous response using a mixed-effects, repeated-measures model. Results Averaged over the course of double-blind treatment, topiramate, compared with placebo, improved the odds of overall well-being (odds ratio [OR] = 2.17; 95% confidence interval [CI], 1.16-2.60; P = .01); reported abstinence and not seeking alcohol (OR = 2.63; 95% CI, 1.52-4.53; P = .001); overall life satisfaction (OR = 2.28; 95% CI, 1.21-4.29; P = .01); and reduced harmful drinking consequences (OR = -0.07; 95% CI, -0.12 to -0.02, P = .01). There was a significant shift from higher to lower drinking quartiles on percentage of heavy drinking days, which was associated with improvements on all measures of psychosocial functioning. Conclusions As an adjunct to medication compliance enhancement treatment, topiramate (up to 300 mg/d) was superior to placebo at not only improving drinking outcomes but increasing overall well-being and quality of life and lessening dependence severity and its harmful consequences.
  2. Controlled drinking: more than just a controversy.
    Current Opinion in Psychiatr, 17(3).
    Keywords: abstinence, alcohol use {disorders, Behavioural} Self-Control Training, bsct, controlled drinking, great debate, gsc, guided self-change, harm reduction, moce, and moderation-oriented cue exposure
    [link]
    Purpose of review: We intend to provide clinicians and clinical scientists with an overview of developments in the controlled-drinking literature, primarily since 2000. A brief description of the controversy surrounding controlled drinking provides a context for a discussion of various approaches to controlled drinking intervention as well as relevant clinical research. Recent findings: Consistent with previous research, behavioral self-control training continues to be the most empirically validated controlled-drinking intervention. Recent research has focused on increasing both the accessibility/availability and efficacy of behavioral self-control training. Moderation-oriented cue exposure is a recent development in behaviorally oriented controlled drinking that yields treatment outcomes comparable to behavioral self-control training. The relative efficacy of moderation-oriented cue exposure versus behavioral self-control training may vary depending on the format of treatment delivery (group versus individual) and level of drinking severity. In general, the efficacy of both techniques does not appear to vary as a function of drinking severity but may vary as a function of drinking-related self-efficacy. Guided-self change is a relatively new and brief cognitive-behavioral intervention that has demonstrated efficacy with problem drinkers. Interventions based on harm reduction principles have decreased alcohol use in various student populations. Finally, Moderation Management is the only self-help program that supports non-abstinence goals, a feature that makes it popular with problem drinkers who are avoidant of traditional treatment services. Summary: The controversial past of controlled drinking is slowly giving way to a hopeful future in which individuals are less likely to be forced into an abstinence-only treatment scenario. The enhanced accessibility of effective controlled-drinking interventions should significantly expand the treatment options of individuals within the full spectrum of alcohol-related problems.
  3. United Kingdom and United States Healthcare Providers' Recommendations of Abstinence Versus Controlled Drinking.
    Alcohol Alcohol., 39(2), 130--134.
    Keywords: abstinence, alcohol use disorders, controlled drinking, harm reduction, moderation, problem {drinking, and US} vs UK
    [link] [doi]
    Aim: To assess whether selected characteristics of problem drinkers influence treatment goal recommendations -- abstinence or controlled drinking -- by healthcare providers in the UK and the US. Methods: Sixteen case-histories, composed with varying information regarding the clients' level of problem severity, degree of social support and sex, were read by 41 UK and 31 US healthcare providers, who then gave a recommendation of controlled drinking versus abstinence for each case on a seven-point Likert scale. Results: Overall, abstinence was recommended more strongly for higher-severity problem drinkers, those with higher social support (an unpredicted finding), and for female clients. Controlled drinking was more often recommended in the UK than in the US. However, the degree to which drinkers' problem severity, social support and sex each affected respondents' ratings depended on the level of one or more of the other variables and the country of the respondents. Conclusion: The degree to which healthcare providers recommend abstinence or controlled drinking as an outcome goal for problem drinkers varies according to both client characteristics and the country in which they work.
  4. Prediction of alcohol-related harm from controlled drinking strategies and alcohol consumption trajectories.
    Addiction, 99(4), 498--508.
    [link] [doi]
    Aims: To establish predictors of age 21 alcohol-related harm from prior drinking patterns, current levels of alcohol consumption and use of controlled drinking strategies. Participants: One thousand, five hundred and ninety-six students recruited from an initial sample of 3300 during their final year of high school in 1993. Design: Longitudinal follow-up across five waves of data collection. Setting: Post high school in Victoria, Australia. Measurements: Self-administered surveys examining a range of health behaviours, including alcohol consumption patterns and related behaviour. Findings: Drinking behaviours at age 21 were found to be strongly predicted by drinking trajectories established through the transition from high school. Multivariate regression analysis revealed that alcohol-related harms at age 21 were reduced where current levels of alcohol use fell within limits recommended in Australian national guidelines. After controlling for this effect it was found that the range of strategies employed by participants to control alcohol use maintained a small protective influence. Post-high-school drinking trajectories continued to demonstrate a significant effect after controlling for current behaviours. Findings revealed that over one quarter of males and females drank alcohol, but on a less-than-weekly basis. This pattern of alcohol use demonstrated considerable stability through the post-school transition and was associated with a low level of subsequent harm at age 21. Conclusions: Future research should investigate whether encouraging more Australian adolescents to drink alcohol on a less-than-weekly basis may be a practical intervention target for reducing alcohol-related harms.

2005 (2)

  1. Naltrexone for the Treatment of Alcoholism: A Meta-Analysis of Randomized Controlled Trials.
    The International Journal of Neuropsychopharmacology, 8(02), 267--280.
    Keywords: Alcohol, meta-analysis, naltrexone, and opioid antagonists
    [link] [doi]
    Many trials of naltrexone have been carried out in alcohol-dependent patients. This paper is aimed to systematically review its benefits, adverse effects, and discontinuation of treatment. We assessed and extracted the data of double-blind, randomized controlled trials (RCTs) comparing naltrexone with placebo or other treatment in people with alcoholism. Two primary outcomes were subjects who relapsed (including heavy drinking) and those who returned to drinking. Secondary outcomes were time to first drink, drinking days, number of standard drinks for a defined period, and craving. All outcomes were reported for the short, medium, and long term. Five common adverse effects and dropout rates in short-term treatment were also examined. A total of 2861 subjects in 24 RCTs presented in 32 papers were included. For short-term treatment, naltrexone significantly decreased relapses [relative risk (RR) 0.64, 95% confidence interval (CI) 0.51??????0.82], but not return to drinking (RR 0.91, 95% CI 0.81??????1.02). Short-term treatment of naltrexone significantly increased nausea, dizziness, and fatigue in comparison to placebo [RRs (95% CIs) 2.14 (1.61??????2.83), 2.09 (1.28??????3.39), and 1.35 (1.04??????1.75)]. Naltrexone administration did not significantly diminish short-term discontinuation of treatment (RR 0.85, 95% CI 0.70??????1.01). Naltrexone should be accepted as a short-term treatment for alcoholism. As yet, we do not know the appropriate duration of treatment continuation in an alcohol-dependent patient who responds to short-term naltrexone administration. To ensure that the real-world treatment is as effective as the research findings, a form of psychosocial therapy should be concomitantly given to all alcohol-dependent patients receiving naltrexone administration.
  2. Controlled drinking and controlled drug use as outcome goals in British treatment services.
    Addiction Research and Theory, 13, 85--92.
    Keywords: abuse vs dependence, alcohol use {disorders, Controlled} {Drinking, Controlled} Drug {Use, Harm} Reduction, outcome, treatment {goal, and US} vs UK
    [link] [doi]
    We mailed a questionnaire to the directors of a nationwide sample of substance abuse service agencies in England, Wales, and Scotland (response rate 70%; 436 of 623 potential respondents) to assess the acceptance and availability of both controlled drinking and controlled drug use, and to examine whether acceptance was associated with clients' severity (abuse versus dependence) and ultimate goal choice (non-abstinence as intermediate versus final outcome goal). Chi-square analyses revealed a statistically significant association of acceptance ratings with client severity/goal choice conditions. Specifically, larger majorities of agency administrators rated controlled drinking and controlled drug use as somewhat or completely acceptable for clients described as abusing versus dependent on their key substance, and non-abstinence was rated as acceptable less often for dependent drinkers and dependent drug users who select non-abstinence as their final outcome goal. Consistent with several decades of research on treatment outcome, natural recovery, and harm reduction, there is widespread and ongoing support for controlled or moderate consumption as an outcome goal by clients presenting to British treatment services with alcohol and drug problems, but such support is moderated by the clients' severity and ultimate goal choice.

2006 (3)

  1. Effect of oral acamprosate on abstinence in patients with alcohol dependence in a double-blind, placebo-controlled trial: The role of patient motivation.
    Journal of Psychiatric Research, 40(5), 383--393.
    Keywords: {Acamprosate, Alcohol} {dependence, Alcoholism, Manual-guided} {therapy, Pharmacotherapy, and Relapse} prevention
    [link] [doi]
    This is the first US study to evaluate the clinical efficacy of acamprosate (Campral), a newly FDA-approved medication for maintaining abstinence in patients with alcohol dependence following alcohol withdrawal. We compared effects of the standard 2 g dose (n = 258) and an exploratory 3 g dose of acamprosate (n = 83) versus placebo (n = 260), and evaluated drug safety in a double-blind, placebo-controlled 6-month trial conducted in 21 outpatient clinics across the US. Participants were 601 volunteers with current alcohol dependence recruited primarily by advertisement. All patients concomitantly received eight sessions of brief manual-guided counseling (www.alcoholfree.info). The main outcome measure was the percentage of alcohol-free days over the 6-month study. Self-report was validated by breath alcohol concentration, ????-glutamyltransferase (GGT) and collateral informant interviews. The percentage of abstinent days did not differ significantly across groups in a priori analysis (54.3% for placebo, 56.1% for 2 g, 60.7% for 3 g). Post-hoc analysis controlling for baseline variables and treatment exposure found acamprosate was associated with a significantly higher percentage of abstinent days than placebo (52.3% for placebo, 58.2% for 2 g, 62.7% for 3 g; P = 0.01), with an even greater effect in the subgroup of 241 patients having a baseline goal of abstinence (58.1% for placebo, 70.0% for 2 g, 72.5% for 3 g; P = 0.02). There were no deaths or serious drug-related adverse events. The US study findings suggest that acamprosate is safe and well tolerated in a broadly inclusive sample of alcoholics and appears effective in populations of patients motivated to have a treatment goal of abstinence. Keywords: Acamprosate; Alcohol dependence; Alcoholism; Manual-guided therapy; Pharmacotherapy; Relapse prevention
  2. Behavioural self-management with problem drinkers: One-year follow-up of a controlled drinking group treatment approach.
    Addiction Research and Theory, 14, 35--49.
    Keywords: {1, Behavioural} Self-Control {Training, Controlled} {Drinking, and Implementation}
    [link] [doi]
    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 ( 800g/w). This study, as others, indicates that alcohol dependence in itself is no contraindication for controlled drinking (CD) treatment.
  3. Obstacles to the adoption of low risk drinking goals in the treatment of alcohol problems in the United States: A commentary.
    Addiction Research and Theory, 14, 19--24.
    Keywords: {1, Alcohol, Controlled} {Drinking, Moderation, and Treatment} Goal
    [link] [doi]
    Although moderation and harm reduction approaches to the treatment of alcohol problems are accepted in many parts of the world, they continue to be rare in the US. A major reason for this state of affairs has to do with the way alcohol treatment services in the US developed, and in particular the creation of a group of paraprofessional counselors many of whom attributed their recovery to the 12-step philosophy. While it is unlikely that these counselors will offer moderation services, the provision of services to problem drinkers in primary care medical settings presents a promising alternative.

2007 (2)

  1. Topiramate for Treating Alcohol Dependence: A Randomized Controlled Trial.
    JAMA, 298(14), 1641--1651.
    Keywords: alcohol dependence, alcohol use disorders, pharmacotherapy, randomized controlled trials, rct, and topiramate
    [link] [doi]
    Context Hypothetically, topiramate can improve drinking outcomes among alcohol-dependent individuals by reducing alcohol's reinforcing effects through facilitation of gamma-aminobutyric acid function and inhibition of glutaminergic pathways in the corticomesolimbic system. Objective To determine if topiramate is a safe and efficacious treatment for alcohol dependence. Design, Setting, and Participants Double-blind, randomized, placebo-controlled, 14-week trial of 371 men and women aged 18 to 65 years diagnosed with alcohol dependence, conducted between January 27, 2004, and August 4, 2006, at 17 US sites. Interventions Up to 300 mg/d of topiramate (n = 183) or placebo (n = 188), along with a weekly compliance enhancement intervention. Main Outcome Measures Primary efficacy variable was self-reported percentage of heavy drinking days. Secondary outcomes included other self-reported drinking measures (percentage of days abstinent and drinks per drinking day) along with the laboratory measure of alcohol consumption (plasma gamma-glutamyltransferase). Results Treating all dropouts as relapse to baseline, topiramate was more efficacious than placebo at reducing the percentage of heavy drinking days from baseline to week 14 (mean difference, 8.44%; 95% confidence interval, 3.07%-13.80\%; P = .002). Prespecified mixed-model analysis also showed that topiramate compared with placebo decreased the percentage of heavy drinking days (mean difference, 16.19%; 95% confidence interval, 10.79%-21.60\%; P .001) and all other drinking outcomes (P .001 for all comparisons). Adverse events that were more common with topiramate vs placebo, respectively, included paresthesia (50.8% vs 10.6%), taste perversion (23.0% vs 4.8%), anorexia (19.7% vs 6.9%), and difficulty with concentration (14.8% vs 3.2%). Conclusion Topiramate is a promising treatment for alcohol dependence. Trial Registration clinicaltrials.gov Identifier: NCT00210925
  2. Medications to Treat Alcohol Dependence: Adding to the Continuum of Care.
    JAMA, 298(14), 1691--1692.
    [link] [doi]
    The most prevalent form of treatment for alcohol dependence in the United States is group counseling and referral to community support groups, a treatment that was developed more than 30 years ago.1 At that time, the only medication available to prevent relapse was disulfiram, which has limited efficacy and patient acceptability. Since that time, acamprosate and naltrexone have been approved for the treatment of alcohol dependence, the latter in both oral and long-acting injectible forms. However, few physicians prescribe these drugs, and most treatment programs do not use them.2 In this issue of JAMA, Johnson and colleagues3 report on a large multisite trial of topiramate, a drug with complex actions including activity at gamma-aminobutyric acid and glutamate receptors. Replicating the results of a smaller randomized controlled trial,4 topiramate produced significant and meaningful improvement in a wide variety of drinking outcomes. ...

2008 (1)

  1. Topiramate as Treatment for Alcohol Dependence.
    Keywords: abstinence uber alles and topiramate
    [link]