Moderate drinking or abstinence for alcoholics?

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ResearchBlogging.orgThere is evidence that treatment seekers favour abstinence when they come for help, but what does abstinence offer in terms of quality of life (QOL), compared to continued heavy drinking or moderate drinking? My own experience is that many dependent drinkers will first seek to try out controlled drinking. However some have already realised that after years of trying they are ready to move to abstinence. Swiss researchers sought to find out whose quality of life improves the most.

What were they interested in?

It’s known that dependent drinkers report poorer quality of life than that of healthy folk. The authors wanted to follow up a group of alcohol dependent clients over two years to see how their drinking patterns related to their quality of life (QOL).

What did they do?

Followed up 160 adults from Lausanne in Switzerland every three months over two years from initial treatment contact. Based on their drinking they divided the group up into ‘mostly abstainers’, ‘mostly moderate drinkers,’ and ‘mostly heavy drinkers.’ They used validated research tools to gauge QOL.

What did they find?

Improvements in the mental score were seen in all three clusters; however, in patients classified as mostly abstainers, the score increased to the normative level seen in the general population, whereas among mostly moderate and mostly heavy drinkers, scores remained below the norm, particularly in those who were mostly heavy drinkers.

What else?

The patients chose their own goals in treatment and could be allocated to inpatient or outpatient treatment with detox using oxazepam and a variety of psychological interventions. The researchers didn’t tie the outcome measure to whether patients accepted or declined treatment or how well they complied with it if they did accept, so there can be no causal link between treatment and QOL scores. Another challenge with the research is the low follow-up rate (37%) which really limits what you can say given that the numbers were so small. However they make the point that the ‘lost’ patients were pretty like the ones they did follow up in terms of their measured characteristics. Interestingly physical health scores didn’t improve much or vary much between groups.

Moderate drinking or abstinence?

Well, within the limitations the authors set on the generalisability of the study, it does look like alcohol dependent patients who achieve abstinence get back to ‘normal’ levels of quality of life, at least on a mental health perspective, while those who moderate their drinking make significant, but less substantial gains. We might want to ask patients what they want in terms of mental health and life quality. Based on research like this, they may choose to set the bar high.

Daeppen, J., Faouzi, M., Sanchez, N., Rahhali, N., Bineau, S., & Bertholet, N. (2014). Quality of Life Depends on the Drinking Pattern in Alcohol-Dependent Patients Alcohol and Alcoholism DOI: 10.1093/alcalc/agu027

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