Kline-Simon Andrea H, Litten Raye Z, Weisner Constance M, Falk Daniel E
Division of Research, Kaiser Permanente Northern California, Oakland, California.
National Institute on Alcohol Abuse and Alcoholism (NIAAA), Bethesda, Maryland.
Alcohol Clin Exp Res. 2017 Mar;41(3):653-658. doi: 10.1111/acer.13334. Epub 2017 Feb 7.
Treatment for alcohol use disorders (AUDs) has traditionally been abstinence oriented, but new research and regulatory guidelines suggest that low-risk drinking may also be an acceptable treatment outcome. However, little is known about long-term outcomes for patients who become low-risk drinkers posttreatment. This study explores a posttreatment low-risk drinking outcome as a predictor of future drinking and psychosocial outcomes over 9 years.
Study participants were adults with AUDs at treatment entry who received follow-up interviews 6 months posttreatment intake (N = 1,061) in 2 large randomized studies conducted at Kaiser Permanente Northern California, a large private, nonprofit, integrated health system. Six-month drinking status was defined as abstinent, low-risk (nonabstinent, no 5+ drinking days), or heavy drinking (1 or more days of 5+ drinks). Using logistic regression models, we explored the relationship between past 30-day drinking status at 6 months and odds of being abstinent or a low-risk drinker (compared to heavy drinking), and positive Addiction Severity Index psychosocial outcomes over 9 years (9-year follow-up rate of 73%).
Abstainers and low-risk drinkers at 6 months had higher odds of recent abstinence/low-risk drinking over 9 years than heavy drinkers; abstainers had better drinking outcomes than low-risk drinkers. Additionally, among those with interview data, 95% of abstainers and 94% of low-risk drinkers at 6 months were abstinent/low-risk drinkers at 9 years; surprisingly, 89% of heavy drinkers at 6 months were also abstinent/low-risk drinkers although still significantly fewer than the other groups. Abstainers and low-risk drinkers at 6 months had better psychiatric outcomes, and abstainers had better family/social outcomes than heavy drinkers; medical outcomes did not differ. Low-risk drinkers and abstainers showed no reliable differences across psychosocial measures.
The findings suggest that a low-risk drinking outcome may be reasonable over the long-term for some alcohol-dependent individuals receiving addiction treatment.
酒精使用障碍（AUDs）的治疗传统上以戒酒为导向，但新的研究和监管指南表明，低风险饮酒也可能是可接受的治疗结果。然而，对于治疗后成为低风险饮酒者的患者的长期结果知之甚少。本研究探讨治疗后低风险饮酒结果作为未来9年饮酒及心理社会结果预测指标的情况。
研究参与者为入组治疗时患有酒精使用障碍的成年人，在北加利福尼亚凯撒医疗集团（一个大型私立非营利性综合医疗系统）进行的两项大型随机研究中，他们在治疗摄入后6个月接受了随访访谈（N = 1,061）。6个月时的饮酒状态定义为戒酒、低风险（非戒酒，无5天及以上饮酒日）或重度饮酒（1天及以上有5杯及以上饮酒量）。使用逻辑回归模型，我们探讨了6个月时过去30天饮酒状态与戒酒或成为低风险饮酒者（与重度饮酒相比）的几率之间的关系，以及9年期间成瘾严重程度指数心理社会结果为阳性的情况（9年随访率为73%）。
6个月时的戒酒者和低风险饮酒者在9年期间近期戒酒/低风险饮酒的几率高于重度饮酒者；戒酒者的饮酒结果优于低风险饮酒者。此外，在有访谈数据的人群中，6个月时95%的戒酒者和94%的低风险饮酒者在9年时为戒酒者/低风险饮酒者；令人惊讶的是，6个月时89%的重度饮酒者也是戒酒者/低风险饮酒者，尽管仍明显少于其他组。6个月时的戒酒者和低风险饮酒者有更好的精神科结果，戒酒者的家庭/社会结果优于重度饮酒者；医疗结果无差异。低风险饮酒者和戒酒者在心理社会指标上没有可靠的差异。
研究结果表明，对于一些接受成瘾治疗的酒精依赖个体，低风险饮酒结果从长期来看可能是合理的。
