It is common for people with problems related to alcohol use, known as alcohol use disorder (AUD), to experience craving (i.e., mental and/or physical desire) for alcohol. Craving can be a highly unpleasant experience and lead to increased alcohol consumption. So, what happens to craving levels when a person with AUD cuts down on or stops drinking alcohol?
In a recent publication, “Reductions in WHO risk drinking level during treatment are associated with reductions in alcohol craving for adults with alcohol use disorder,” we used data from 3 clinical trials for AUD to test this question. We found that people who reduced their drinking over the course of AUD treatment reported lower craving at the end of treatment. This result held true even when we included only those who reduced their drinking, short of total abstinence. Our finding adds to a wealth of research that non-abstinent recovery from AUD is attainable and is associated with improvements in one’s quality of life.
Additionally, in almost all cases, we found this to be true across all levels of AUD severity. In other words, even for those with severe AUD, it appears that reductions in drinking short of abstinence can improve one’s quality of life.
Why use World Health Organisation (WHO) risk drinking levels?
Very often, abstinence is used to measure success in alcohol clinical trials. However, research is clear that abstinence is not required to achieve recovery from AUD.
In our analyses, we took each participant’s average daily alcohol consumption and categorised it into abstinence or one of four WHO risk drinking levels: very high, high, moderate, or low risk. This metric gave us more information than an ‘all-or-nothing’ abstinence-based measure could have, as it allowed us to explore differences between people who had reduced their drinking by one versus two levels.
WHO risk drinking levels are also a more internationally useful way of measuring alcohol consumption than by number of standard drinks – as standard drink sizes vary from country-to-country, and WHO risk drinking levels are measured in grams, which allows for easier cross-cultural comparison between studies.
We hope that these findings will help convince others to use WHO risk drinking levels as an endpoint (i.e., measure of success) for alcohol clinical trials in the future.
How can this research help people with AUD?
Prior research has found that treatment providers are less accepting of non-abstinent drinking goals than goals of abstinence, and this is especially true for clients with severe AUD and for those from minoritized racial and ethnic backgrounds. Our work can help to correct misconceptions, reduce stigma, and increase both clients’ and treatment providers’ confidence in non-abstinent goals as a viable option.
Written by Felicia Tuchman, PhD student, University of New Mexico, and Professor Katie Witkiewitz, Director, Center on Alcohol, Substance Use, And Addiction (CASAA), University of New Mexico.
Katie Witkiewitz is a member of the Alcohol Clinical Trials Initiative (ACTIVE) Workgroup, which is recently supported by Alkermes, Dicerna, Beam Diagnostics, Otsuka, and Kinnov Pharmaceuticals. In the past 36 months, its activities were supported by Alkermes, Dicerna, Ethypharm, Lundbeck, Mitsubishi, and Otsuka.
All IAS Blogposts are published with the permission of the author. The views expressed are solely the author’s own and do not necessarily represent the views of the Institute of Alcohol Studies.