1. Long-term outcome in 306 males with alcoholism
    Noda, Tetsuro, Imamichi, Hiroyuki, Kawata, Akira, Hirano, Kenji, Ando, Tatsuo, Iwata, Yasuo, and Yoneda, Hiroshi (2001).
    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
    Streeton, C. and Whelan, G. (2001).
    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.

  3. Prediction of alcohol-related harm from controlled drinking strategies and alcohol consumption trajectories
    Toumbourou, J. W., Williams, I. R., White, V. M., Snow, P. C., Munro, G. D., and Schofield, P. E. (2004).
    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.

  4. United Kingdom and United States Healthcare Providers' Recommendations of Abstinence Versus Controlled Drinking
    Cox, W. Miles, Rosenberg, Harold, Hodgins, C. Hazel A., Macartney, John I., and Maurer, Ken A. (2004).
    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.

  5. Naltrexone for the Treatment of Alcoholism: A Meta-Analysis of Randomized Controlled Trials
    Srisurapanont, Manit and Jarusuraisin, Ngamwong (2005).
    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.

  6. Controlled drinking and controlled drug use as outcome goals in British treatment services
    Rosenberg, Harold and Melville, John (2005).
    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.

  7. Behavioural self-management with problem drinkers: One-year follow-up of a controlled drinking group treatment approach
    Koerkel, Joachim (2006).
    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.

  8. Obstacles to the adoption of low risk drinking goals in the treatment of alcohol problems in the United States: A commentary
    Sobell, M.B. and Sobell, L.C. (2006).
    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.