Abstract
Abstinence from alcohol has been the prevailing treatment goal for individuals with alcohol dependence (AD) within the context of specialty alcohol treatment. Yet, alcohol use has been conceptualized as existing on a continuum. Importantly, most people who meet criteria for AD and could benefit from treatment never receive treatment. About half of these individuals do not seek treatment because they report a desire to continue drinking. To increase acceptability of treatment, reductions in alcohol consumption have been examined as alternative outcomes in treatment trials for AD. The current study reviews data which indicate that long-term reduction in alcohol consumption among patients with AD is possible. Controlled studies have tested reduced alcohol consumption and show sustained improvements in drinking reductions for many patients following behavioral treatments and pharmacotherapy. Evidence-based treatment guidelines and medicines development guidance authorities have taken note of these developments and accept “intermediate harm reduction” (European Medicines Agency) or “low-risk drinking limits” (US Federal Drug Administration) as optional trial endpoints. In conclusion, while abstinence remains the safest treatment goal for individuals with AD, evidence supports that reduced drinking approaches may be an important extension in the treatment of AD.
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References
1.
European-Medicines-Agency: Guideline on the Development of Medicinal Products for the Treatment of Alcohol Dependence. 2010. http://www.ema.europa.eu/docs/en_GB/document_library/Scientific_guideline/2010/03/WC500074898.pdf (cited 2012).
2.
World-Health-Organization (WHO): International Guide for Monitoring Alcohol Consumption and Related Harm. 2000. http://whqlibdoc.who.int/hq/2000/WHO_MSD_MSB_00.4.pdf.
3.
Maremmani I, Cibin M, Pani PP, Rossi A, Turchetti G: Harm reduction as “continuum care” in alcohol abuse disorder. Int J Environ Res Public Health 2015;12:14828-14841.
[PubMed]
4.
van Amsterdam J, van den Brink W: Reduced-risk drinking as a viable treatment goal in problematic alcohol use and alcohol dependence. J Psychopharmacol 2013;27:987-997.
[PubMed]
5.
Rehm J, Mathers C, Popova S, Thavorncharoensap M, Teerawattananon Y, Patra J: Global burden of disease and injury and economic cost attributable to alcohol use and alcohol-use disorders. Lancet 2009;373:2223-2233.
[PubMed]
6.
World-Health-Organization: Global Status Report on Alcohol and Health. World Health Organization, 2014.
7.
Rehm J, Baliunas D, Borges GL, Graham K, Irving H, Kehoe T, Parry CD, Patra J, Popova S, Poznyak V, Roerecke M, Room R, Samokhvalov AV, Taylor B: The relation between different dimensions of alcohol consumption and burden of disease: an overview. Addiction 2010;105:817-843.
[PubMed]
8.
Roerecke M, Rehm J: The cardioprotective association of average alcohol consumption and ischaemic heart disease: a systematic review and meta-analysis. Addiction 2012;107:1246-1260.
[PubMed]
9.
Baliunas DO, Taylor BJ, Irving H, Roerecke M, Patra J, Mohapatra S, Rehm J: Alcohol as a risk factor for type 2 diabetes: a systematic review and meta-analysis. Diabetes Care 2009;32:2123-2132.
[PubMed]
10.
Kerr WC, Greenfield TK, Bond J, Ye Y, Rehm J: Racial and ethnic differences in all-cause mortality risk according to alcohol consumption patterns in the national alcohol surveys. Am J Epidemiol 2011;174:769-778.
[PubMed]
11.
Rehm J, Zatonksi W, Taylor B, Anderson P: Epidemiology and alcohol policy in Europe. Addiction 2011;106(suppl 1):11-19.
[PubMed]
12.
Stockwell T, Zhao J, Panwar S, Roemer A, Naimi T, Chikritzhs T: Do “Moderate” drinkers have reduced mortality risk? A systematic review and meta-analysis of alcohol consumption and all-cause mortality. J Stud Alcohol Drugs 2016;77:185-198.
[PubMed]
13.
Knott CS, Coombs N, Stamatakis E, Biddulph JP: All cause mortality and the case for age specific alcohol consumption guidelines: pooled analyses of up to 10 population based cohorts. BMJ 2015;350:h384.
[PubMed]
14.
Zhao J, Stockwell T, Roemer A, Naimi T, Chikritzhs T: Alcohol consumption and mortality from coronary heart disease: an updated meta-analysis of cohort studies. J Stud Alcohol Drugs 2017;78:375-386.
[PubMed]
15.
Di Castelnuovo A, Costanzo S, Bagnardi V, Donati MB, Iacoviello L, de Gaetano G: Alcohol dosing and total mortality in men and women: an updated meta-analysis of 34 prospective studies. Arch Intern Med 2006;166:2437-2445.
[PubMed]
16.
Rehm J, Gmel G, Sempos CT, Trevisan M: Alcohol-related morbidity and mortality. Alcohol Res Health 2003;27:39-51.
[PubMed]
17.
Midlov P, Calling S, Memon AA, Sundquist J, Sundquist K, Johansson SE: Women's health in the Lund area (WHILA) - Alcohol consumption and all-cause mortality among women - a 17 year follow-up study. BMC Public Health 2016;16:22.
[PubMed]
18.
Shield KD, Gmel G, Makela P, Probst C, Room R, Rehm J: Life-time risk of mortality due to different levels of alcohol consumption in seven European countries: implications for low-risk drinking guidelines. Addiction 2017;112:1535-1544.
[PubMed]
19.
Charlet K, Heinz A: Harm reduction-a systematic review on effects of alcohol reduction on physical and mental symptoms. Addict Biol 2016;22:1119-1159.
[PubMed]
20.
Marlatt GA, Witkiewitz K: Update on harm-reduction policy and intervention research. Annu Rev Clin Psychol 2010;6:591-606.
[PubMed]
21.
Marlatt GA: Basic principles and strategies of harm reduction; in Marlatt GA (ed): Harm Reduction, Pragmatic Strategies for Managing High-Risk Behaviors. New York, Guilford Press, 1998, pp 69-121.
22.
Heather N, Wodak A, Nadelmann E, O'Hare P: Psychoactive Drugs and Harm Reduction: from Faith to Science. London, WHURR, 1992.
23.
Marlatt GA, Witkiewitz K: Harm reduction approaches to alcohol use: health promotion, prevention, and treatment. Addict Behav 2002;27:867-886.
[PubMed]
24.
Raistrick D, Heather N, Godfrey C: Review of the Effectiveness of Treatment for Alcohol Problems. London, National Treatment Agency for Substance Misuse, 2006.
25.
Davey CJ, Landy MS, Pecora A, Quintero D, McShane KE: A realist review of brief interventions for alcohol misuse delivered in emergency departments. Syst Rev 2015;4:45.
[PubMed]
26.
Fava GA, Visani D: Psychosocial determinants of recovery in depression. Dialogues Clin Neurosci 2008;10:461-472.
[PubMed]
27.
Kohn R, Saxena S, Levav I, Saraceno B: The treatment gap in mental health care. Bull World Health Organ 2004;82:858-866.
[PubMed]
28.
Cohen E, Feinn R, Arias A, Kranzler HR: Alcohol treatment utilization: findings from the national epidemiologic survey on alcohol and related conditions. Drug Alcohol Depend 2007;86:214-221.
[PubMed]
29.
Rumpf HJ, Meyer C, Hapke U, Bischof G, John U: Utilization of Professional Help of Individuals with Alcohol Dependence or Abuse: Findings from the TACOS-General Population Study. SUCHT, 2000, Vol. 46, pp 9-17. https://doi.org/10.1024/suc.2000.46.1.9.
30.
Substance Abuse and Mental Health Services Administration Office of Applied Studies. The NSDUH report: Alcohol Treatment: Need, utilization, and Barriers. Rockville, MD, April 9, 2009. http://www.samhsa.gov/data/2k9/AlcTX/AlcTX.htm (cited 2009).
31.
Substance Abuse and Mental Health Services Administration: Results from the 2013 National Survey on Drug Use and Health: Summary of National Findings. Rockville, Substance Abuse and Mental Health Services Administration, 2014.
32.
Tuithof M, Ten Have M, van den Brink W, Vollebergh W, de Graaf R: Treatment Seeking for alcohol use disorders: treatment gap or adequate self-selection? Eur Addict Res 2016;22:277-285.
[PubMed]
33.
Institute of Medicine: Broadening the Base of Treatment for Alcohol Problems. Washington, The National Academies Press, 1990.
34.
Mann K, Kiefer F, Smolka M, Gann H, Wellek S, Heinz A: Searching for responders to acamprosate and naltrexone in alcoholism treatment: rationale and design of the PREDICT study. Alcohol Clin Exp Res 2009;33:674-683.
[PubMed]
35.
Tatarsky A: Harm Reduction Psychotherapy: A New Treatment for Drug and Alcohol Problems: Jason Aronson, Incorporated, 2007.
36.
Larimer ME, Marlatt GA, Baer JS, Quigley LA, Blume AW, Hawkins EH: Harm reduction for alcohol problems; in Marlatt A, Larimer ME, Witkiewitz K (eds): Harm Reduction, Second Edition: Pragmatic Strategies for Managing High-Risk Behaviors. New York, Guilford Press, 2011, pp 62-105.
37.
Dawson DA, Goldstein RB, Grant BF: Rates and correlates of relapse among individuals in remission from DSM-IV alcohol dependence: a 3-year follow-up. Alcohol Clin Exp Res 2007;31:2036-2045.
[PubMed]
38.
Witkiewitz K, Dearing RL, Maisto SA: Alcohol use trajectories among non-treatment seeking heavy drinkers. J Stud Alcohol Drugs 2014;75:415-422.
[PubMed]
39.
Vaillant GE: A 60-year follow-up of alcoholic men. Addiction 2003;98:1043-1051.
[PubMed]
40.
Vaillant GE: The Natural History of Alcoholism. Harvard University Press, 1983.
41.
Mann K, Schafer DR, Langle G, Ackermann K, Croissant B: The long-term course of alcoholism, 5, 10 and 16 years after treatment. Addiction 2005;100:797-805.
[PubMed]
42.
Nordstrom G, Berglund M, Frank A: Stability of successful long-term adjustment in alcohol dependence: a follow-up study 15 years after the first long-term follow-up. Eur Addict Res 2004;10:126-132.
[PubMed]
43.
Maisto SA, Clifford PR, Stout RL, Davis CM: Moderate drinking in the first year after treatment as a predictor of three-year outcomes. J Stud Alcohol Drugs 2007;68:419-427.
[PubMed]
44.
Witkiewitz K: Lapses following alcohol treatment: modeling the falls from the wagon. J Stud Alcohol Drugs 2008;69:594-604.
[PubMed]
45.
Heather N, Adamson SJ, Raistrick D, Slegg GP; UKATT Research Team: Initial preference for drinking goal in the treatment of alcohol problems: I. Baseline differences between abstinence and non-abstinence groups. Alcohol Alcohol 2010;45:128-135.
[PubMed]
46.
Adamson SJ, Heather N, Morton V, Raistrick D; UKATT Research Team: Initial preference for drinking goal in the treatment of alcohol problems: II. Treatment outcomes. Alcohol Alcohol 2010;45:136-142.
[PubMed]
47.
Ojehagen A, Berglund M: Changes of drinking goals in a two-year out-patient alcoholic treatment program. Addict Behav 1989;14:1-9.
[PubMed]
48.
Witkiewitz K, Wilson AD, Pearson MR, Hallgren KA, Falk DE, Litten RZ, Kranzler HR, Mann KF, Hasin DS, O'Malley SS, Anton RF: Temporal stability of heavy drinking days and drinking reductions among heavy drinkers in the COMBINE study. Alcohol Clin Exp Res 2017;10:13371.
[PubMed]
49.
Dawson DA, Li TK, Chou SP, Grant BF: Transitions in and out of alcohol use disorders: their associations with conditional changes in quality of life over a 3-year follow-up interval. Alcohol Alcohol 2009;44:84-92.
[PubMed]
50.
Tuithof M, ten Have M, van den Brink W, Vollebergh W, de Graaf R: Alcohol consumption and symptoms as predictors for relapse of DSM-5 alcohol use disorder. Drug Alcohol Depend 2014;140:85-91.
[PubMed]
51.
Sobell MB, Sobell LC: Alcoholics treated by individualized behavior therapy: one year treatment outcome. Behav Res Ther 1973;11:599-618.
[PubMed]
52.
Ambrogne JA: Reduced-risk drinking as a treatment goal: what clinicians need to know. J Subst Abuse Treat 2002;22:45-53.
[PubMed]
53.
Sobell MB, Sobell LC: It is time for low-risk drinking goals to come out of the closet. Addiction 2011;106:1715-1717.
[PubMed]
54.
Sanchez-Craig M, Annis HM, Bornet AR, MacDonald KR: Random assignment to abstinence and controlled drinking: evaluation of a cognitive-behavioral program for problem drinkers. J Consult Clin Psychol 1984;52:390-403.
[PubMed]
55.
Walters GD: Behavioral self-control training for problem drinkers: a meta-analysis of randomized control studies. Behavior Therapy 2000;31:135-149.
56.
Bujarski S, O'Malley SS, Lunny K, Ray LA: The effects of drinking goal on treatment outcome for alcoholism. J Consult Clin Psychol 2013;81:13-22.
[PubMed]
57.
Jørgensen CH, Pedersen B, Tønnesen H: The efficacy of disulfiram for the treatment of alcohol use disorder. Alcohol Clin Exp Res 2011;35:1749-1758.
[PubMed]
58.
Zindel LR, Kranzler HR: Pharmacotherapy of alcohol use disorders: seventy-five years of progress. J Stud Alcohol Drugs Suppl 2014;75(suppl 17):79-88.
[PubMed]
59.
Müller CA, Geisel O, Banas R, Heinz A: Current pharmacological treatment approaches for alcohol dependence. Expert Opin Pharmacother 2014;15:471-481.
[PubMed]
60.
Franck J, Jayaram-Lindström N: Pharmacotherapy for alcohol dependence: status of current treatments. Curr Opin Neurobiol 2013;23:692-699.
[PubMed]
61.
Jonas DE, Amick HR, Feltner C, Bobashev G, Thomas K, Wines R, Kim MM, Shanahan E, Gass CE, Rowe CJ, Garbutt JC: Pharmacotherapy for adults with alcohol use disorders in outpatient settings: a systematic review and meta-analysis. JAMA 2014;311:1889-1900.
[PubMed]
62.
Bramness JG, Mann K, Wurst FM: Marketing status and perceived efficacy of drugs for supporting abstinence and reducing alcohol intake in alcohol use disorders: a survey among European federation of addiction societies in Europe. Eur Addict Res 2016;22:318-321.
[PubMed]
63.
Rösner S, Hackl-Herrwerth A, Leucht S, Lehert P, Vecchi S, Soyka M: Acamprosate for alcohol dependence. Cochrane Database Syst Rev 2010;9:CD004332.
[PubMed]
64.
Witkiewitz K, Finney JW, Harris AH, Kivlahan DR, Kranzler HR: Guidelines for the reporting of treatment trials for alcohol use disorders. Alcohol Clin Exp Res 2015;39:1571-1581.
[PubMed]
65.
Witkiewitz K, Finney JW, Harris AH, Kivlahan DR, Kranzler HR: Recommendations for the design and analysis of treatment trials for alcohol use disorders. Alcohol Clin Exp Res 2015;39:1557-1570.
[PubMed]
66.
O'Malley SS, Jaffe AJ, Chang G, Schottenfeld RS, Meyer RE, Rounsaville B: Naltrexone and coping skills therapy for alcohol dependence. A controlled study. Arch Gen Psychiatry 1992;49:881-887.
[PubMed]
67.
Volpicelli JR, Alterman AI, Hayashida M, O'Brien CP: Naltrexone in the treatment of alcohol dependence. Arch Gen Psychiatry 1992;49:876-880.
[PubMed]
68.
O'Brien C, Pettinati H, Oslin D: Naltrexone: clinical data; in Spanagel R, Mann KF (eds): Drugs for Relapse Prevention of Alcoholism. Birkhäuser, Basel, 2006.
69.
Anton RF, O'Malley SS, Ciraulo DA, Cisler RA, Couper D, Donovan DM, Gastfriend DR, Hosking JD, Johnson BA, LoCastro JS, Longabaugh R, Mason BJ, Mattson ME, Miller WR, Pettinati HM, Randall CL, Swift R, Weiss RD, Williams LD, Zweben A; COMBINE Study Research Group: Combined pharmacotherapies and behavioral interventions for alcohol dependence: the COMBINE study: a randomized controlled trial. JAMA 2006;295:2003-2017.
[PubMed]
70.
Rösner S, Hackl-Herrwerth A, Leucht S, Vecchi S, Srisurapanont M, Soyka M. Opioid antagonists for alcohol dependence. Cochrane Database Syst Rev 2010;12:CD001867.
[PubMed]
71.
Krystal JH, Cramer JA, Krol WF, Kirk GF, Rosenheck RA; Veterans Affairs Naltrexone Cooperative Study G 425 Group: Naltrexone in the treatment of alcohol dependence. N Engl J Med 2001;345:1734-1739.
[PubMed]
72.
Del Re AC, Maisel N, Blodgett J, Finney J: The declining efficacy of naltrexone pharmacotherapy for alcohol use disorders over time: a multivariate meta-analysis. Alcohol Clin Exp Res 2013;37:1064-1068.
[PubMed]
73.
Kranzler HR, Wesson DR, Billot L: Naltrexone depot for treatment of alcohol dependence: a multicenter, randomized, placebo-controlled clinical trial. Alcohol Clin Exp Res 2004;28:1051-1059.
[PubMed]
74.
Garbutt JC, Kranzler HR, O'Malley SS, Gastfriend DR, Pettinati HM, Silverman BL, Loewy JW, Ehrich EW; Vivitrex Study Group: Efficacy and tolerability of long-acting injectable naltrexone for alcohol dependence: a randomized controlled trial. JAMA 2005;293:1617-1625.
[PubMed]
75.
Mann K, Ackermann K, Diehl A, Ebert D, Mundle G, Nakovics H, Reker T, Richter G, Schmidt LG, Driessen M, Rettig K, Opitz K, Croissant B: Galantamine: a cholinergic patch in the treatment of alcoholism: a randomized, placebo-controlled trial. Psychopharmacology (Berl) 2006;184:115-121.
[PubMed]
76.
Diehl A, Nakovics H, Croissant B, Smolka MN, Batra A, Mann K: Galantamine reduces smoking in alcohol-dependent patients: a randomized, placebo-controlled trial. Int J Clin Pharmacol Ther 2006;44:614-22.
[PubMed]
77.
Aubin HJ, Luquiens A, Berlin I: Pharmacotherapy for smoking cessation: pharmacological principles and clinical practice. Br J Clin Pharmacol 2014;77:324-336.
[PubMed]
78.
Aubin HJ, Luquiens A: Feeding two birds with one scone: the case of varenicline. Alcohol Clin Exp Res 2015;39:2299-2301.
[PubMed]
79.
Erwin BL, Slaton RM: Varenicline in the treatment of alcohol use disorders. Ann Pharmacother 2014;48:1445-1455.
[PubMed]
80.
Litten RZ, Ryan ML, Fertig JB, Falk DE, Johnson B, Dunn KE, Green AI, Pettinati HM, Ciraulo DA, Sarid-Segal O, Kampman K, Brunette MF, Strain EC, Tiouririne NA, Ransom J, Scott C, Stout R; NCIG (National Institute on Alcohol Abuse and Alcoholism Clinical Investigations Group) Study Group: A double-blind, placebo-controlled trial assessing the efficacy of varenicline tartrate for alcohol dependence. J Addict Med 2013;7:277-286.
[PubMed]
81.
de Bejczy A, Lof E, Walther L, Guterstam J, Hammarberg A, Asanovska G, Franck J, Isaksson A, Söderpalm B: Varenicline for treatment of alcohol dependence: a randomized, placebo-controlled trial. Alcohol Clin Exp Res 2015;39:2189-2199.
[PubMed]
82.
Sinclair JD: Evidence about the use of naltrexone and for different ways of using it in the treatment of alcoholism. Alcohol Alcohol 2001;36:2-10.
[PubMed]
83.
Sinclair JD, Scheinin H, Lammintausta R, Inventors: Method for Treating Alcoholism with Nalmefene. USA Patent 5,086,058. February 4, 1992.
84.
Altshuler HL, Phillips PE, Feinhandler DA: Alteration of ethanol self-administration by naltrexone. Life Sci 1980;26:679-688.
[PubMed]
85.
Kranzler HR, Tennen H, Penta C, Bohn MJ: Targeted naltrexone treatment of early problem drinkers. Addict Behav 1997;22:431-436.
[PubMed]
86.
Heinälä P, Alho H, Kiianmaa K, Lonnqvist J, Kuoppasalmi K, Sinclair JD: Targeted use of naltrexone without prior detoxification in the treatment of alcohol dependence: a factorial double-blind, placebo-controlled trial. J Clin Psychopharmacol 2001;21:287-292.
[PubMed]
87.
Mann K, Torup L, Sorensen P, Gual A, Swift R, Walker B, van den Brink W: Nalmefene for the management of alcohol dependence: review on its pharmacology, mechanism of action and meta-analysis on its clinical efficacy. Eur Neuropsyhcopharmacol 2016;26:1941-1949.
[PubMed]
88.
Karhuvaara S, Simojoki K, Virta A, Rosberg M, Löyttyniemi E, Nurminen T, Kallio A, Mäkelä R: Targeted nalmefene with simple medical management in the treatment of heavy drinkers: a randomized double-blind placebo-controlled multicenter study. Alcoholism Clin Exp Res 2007;31:1179-1187.
[PubMed]
89.
Mann K, Bladstrom A, Torup L, Gual A, van den Brink W: Extending the treatment options in alcohol dependence: a randomized controlled study of as-needed nalmefene. Biol Psychiatry 2013;73:706-713.
[PubMed]
90.
Gual A, He Y, Torup L, van den Brink W, Mann K: A randomised, double-blind, placebo-controlled, efficacy study of nalmefene, as-needed use, in patients with alcohol dependence. Eur Neuropsychopharmacol 2013;23:1432-1442.
[PubMed]
91.
van den Brink W, Sorensen P, Torup L, Mann K, Gual A: Long-term efficacy, tolerability and safety of nalmefene as-needed in patients with alcohol dependence: a 1-year, randomised controlled study. J Psychopharmacol 2014;28:733-744.
[PubMed]
92.
Jonas DE, Amick HR, Feltner C, Bobashev G, Thomas K, Wines R, Kim MM, Shanahan E, Gass CE, Rowe CJ, Garbutt JC: Pharmacotherapy for adults with alcohol use disorders in outpatient settings: a systematic review and meta-analysis. JAMA 2014;311:1889-1900.
[PubMed]
93.
Palpacuer C, Laviolle B, Boussageon R, Reymann JM, Bellissant E, Naudet F: Risks and benefits of nalmefene in the treatment of adult alcohol dependence: a systematic literature review and m-analysis of published and unpublished double-blind randomized controlled trials. PLoS Med 2015;12:e1001924.
[PubMed]
94.
Fitzgerald N, Angus K, Elders A, de Andrade M, Raistrick D, Heather N, McCambrdige J: Weak evidence on nalmefene creates dilemmas for clinicians and poses questions for regulators and researchers. Addiction 2016;111:1477-1487.
[PubMed]
95.
Aubin HJ, Reimer J, Nutt DJ, Bladstrom A, Torup L, Francois C, Chick J: Clinical relevance of as-needed treatment with nalmefene in alcohol-dependent patients. Eur Addict Res 2015;21:160-618.
[PubMed]
96.
Laramée P, Millier A, Rahhali N, Cristeau O, Aballéa S, François C, Chalem Y, Toumi M, Rehm J: A Trial-based predictive microsimulation assessing the public health benefits of nalmefene and psychosocial support for the reduction of alcohol consumption in alcohol dependence. Appl Health Econ Health Policy 2016;14:493-505.
[PubMed]
97.
Johnson BA: Update on neuropharmacological treatments for alcoholism: scientific basis and clinical findings. Biochem Pharmacol 2008;75:34-56.
[PubMed]
98.
Blodgett JC, Del Re AC, Maisel NC, Finney JW: A meta-analysis of topiramate's effects for individuals with alcohol use disorders. Alcohol Clin Exp Res 2014;38:1481-1488.
[PubMed]
99.
Johnson BA, Ait-Daoud N, Bowden CL, Di Clemente CC, Roache JD, Lawson K, Javors MA, Ma JZ: Oral topiramate for treatment of alcohol dependence: a randomised controlled trial. Lancet 2003;361:1677-1685.
[PubMed]
100.
Johnson BA, Rosenthal N, Capece JA, Wiegand F, Mao L, Beyers K, McKay A, Ait-Daoud N, Anton RF, Ciraulo DA, Kranzler HR, Mann K, O'Malley SS, Swift RM; Topiramate for Alcoholism Advisory Board; Topiramate for Alcoholism Study Group: Topiramate for treating alcohol dependence: a randomized controlled trial. JAMA 2007;298:1641-1651.
[PubMed]
101.
Kranzler HR, Covault J, Feinn R, Armeli S, Tennen H, Arias AJ, Gelernter J, Pond T, Oncken C, Kampman KM: Topiramate treatment for heavy drinkers: moderation by a GRIK1 polymorphism. Am J Psychiatry 2014;171:445-452.
[PubMed]
102.
Feinn R, Curtis B, Kranzler HR: Balancing risk and benefit in heavy drinkers treated with topiramate: implications for personalized care. J Clin Psychiatry 2016;77:e278-e282.
[PubMed]
103.
Pettinati HM, O'Brien CP, Rabinowitz AR, Wortman SP, Oslin DW, Kampman KM, Dackis CA: The status of naltrexone in the treatment of alcohol dependence: specific effects on heavy drinking. J Clin Psychopharmacol 2006;26:610-625.
[PubMed]
104.
Rosner S, Leucht S, Lehert P, Soyka M: Acamprosate supports abstinence, naltrexone prevents excessive drinking: evidence from a meta-analysis with unreported outcomes. J Psychopharmacol 2008;22:11-23.
[PubMed]
105.
Aubin HJ, Daeppen JB: Emerging pharmacotherapies for alcohol dependence: a systematic review focusing on reduction in consumption. Drug Alcohol Depend 2013;133:15-29.
[PubMed]
106.
Davis AK, Rosenberg H: Acceptance of non-abstinence goals by addiction professionals in the United States. Psychol Addict Behav 2013;27:1102-1109.
[PubMed]
107.
Haber P, Lintzeris N, Proude E, Lopatko O: Guidelines for the Treatment of Alcohol Problems. University of Sydney, June 2009.
108.
NICE: Alcohol-use disorders: diagnosis, assessment and management of harmful drinking and alcohol dependence, 2011.
109.
Rolland B, Paille F, Gillet C, Rigaud A, Moirand R, Dano C, Dematteis M, Mann K, Aubin HJ: Pharmacotherapy for alcohol dependence: the 2015 recommendations of the French alcohol society, issued in partnership with the European federation of addiction societies. CNS Neurosci Ther 2016;22:25-37.
[PubMed]
110.
Société-Française-d'Alcoologie: Good Practice Recommendation - Alcohol Misuse: Screening, Diagnosis and Treatment. http://www.sfalcoologie.asso.fr/download/SFA-GPR-AlcoholMisuse.pdf?PHPSESSID=df10f34a9d9ef5f445823e99114a1145] (cited 2015).
111.
Rolland B, Mann K, Paille F, Aubin HJ: The new French guidelines on alcohol misuse: an initiative for strengthening cross-European interplay. Addiction 2015;110:1362-1363.
[PubMed]
112.
Mann K, Batra A, Fauth-Buhler M, Hoch E: German guidelines on screening, diagnosis and treatment of alcohol use disorders. Eur Addict Res 2017;23:45-60.
[PubMed]
113.
Mann K, Hoch E, Batra A, Bonnet U, Gunthner A, Reymann G, Soyka M, Wodarz N, Schäfer M: [Guideline-oriented treatment of alcohol-related disorders]. Nervenarzt 2016;87:13-25.
[PubMed]
114.
National Institute on Alcohol Abuse and Alcoholism: Helping Patients Who Drink Too Much. A Clinician's Guide. Washington, National Institutes of Health, US Department of Health and Human Services, 2005.
115.
Kalinowski A, Humphreys K: Governmental standard drink definitions and low-risk alcohol consumption guidelines in 37 countries. Addiction 2016;13:13341.
116.
Hasin DS, Wall M, Witkiewitz K, Kranzler H, Falk D, Litten R, Mann K, O'Malley S, Scodes J, Robinson RL, Anton R on behalf of the Alcohol Clinical Trials Initiative (ACTIVE) Workgroup: Change in non-abstinent WHO risk drinking levels and alcohol dependence: a 3-Year follow-up study in the US General Population. Lancet Psychiatry 2017;4:469-476.
[PubMed]
117.
Witkiewitz K, Hallgren KA, Kranzler HR, Mann KF, Hasin DS, Falk DE, Litten RZ, O'Malley SS, Anton RF: Clinical validation of reduced alcohol consumption after treatment for alcohol dependence using the world health organization risk drinking levels. Alcohol Clin Exp Res 2017;41:179-186.
[PubMed]
118.
Kline-Simon AH, Litten RZ, Weisner CM, Falk DE: Post-treatment low-risk drinking as a predictor of future drinking and problem outcomes among individuals with alcohol use disorders: a 9-year follow-up. Alcohol Clin Exp Res 2017;10:13334.
[PubMed]
119.
Miquel L, Gual A, Vela E, Lligoña A, Bustins M, Colom J, Rehm J: Alcohol consumption and inpatient health service utilization in a cohort of patients with alcohol dependence after 20 years of follow-up. Alcohol Alcohol 2017;52:227-233.
[PubMed]
120.
Rehm J, Roerecke M: Reduction of drinking in problem drinkers and all-cause mortality. Alcohol Alcohol 2013;48:509-513.
[PubMed]
121.
Pettinati HM, Gastfriend DR, Dong Q, Kranzler HR, O'Malley SS: Effect of extended-release naltrexone (XR-NTX) on quality of life in alcohol-dependent patients. Alcohol Clin Exp Res 2009;33:350-356.
[PubMed]
122.
Luquiens A, Reynaud M, Falissard B, Aubin HJ: Quality of life among alcohol-dependent patients: how satisfactory are the available instruments? A systematic review. Drug Alcohol Depend 2012;125:192-202.
[PubMed]
123.
François C, Rahhali N, Chalem Y, Sørensen P, Luquiens A, Aubin HJ: The effects of as-needed nalmefene on patient-reported outcomes and quality of life in relation to a reduction in alcohol consumption in alcohol-dependent patients. PLoS One 2015;10:e0129289.
[PubMed]
124.
Luquiens A, Whalley D, Crawford SR, Laramée P, Doward L, Price M, Hawken N, Dorey J, Owens L, Llorca PM, Falissard B, Aubin HJ: Development of the Alcohol Quality of Life Scale (AQoLS): a new patient-reported outcome measure to assess health-related quality of life in alcohol use disorder. Qual Life Res 2015;24:1471-1481.
[PubMed]
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