Of all of the drugs causing trouble in the United States at the moment, alcohol remains the most commonly used addictive substance. For the 17.6 million Americans who suffer from alcohol abuse or dependence issues, the usual treatment is going cold turkey. Doing so isn’t easy, even with the help of a sober sponsor, and addiction specialists have wondered whether total abstinence is really necessary.

If the results from a new World Health Organization (WHO) study are any indication, a range of new treatments may soon be available.

In a new article in The Lancet Psychiatry, the researchers outline how they used data on 22,005 drinkers to assess whether their drinking risk level could be lowered by simply reducing the amount of alcohol they drank, rather than abstaining from drinking altogether. All of the drinkers involved had been interviewed in previous studies — once in 2001-2002, and again in a follow-up in 2004-2005 — and had all been assessed for their alcohol consumption and dependence.

The researchers used the WHO’s metric for studying drinking risk level, which takes into account the volume of alcohol a person consumes, together with their drinking patterns and, occasionally, the quality of alcohol they drink. They used the characteristics listed for alcohol dependence in the DSM-IV — an older version of psychology’s go-to handbook for mental disorders — to assess dependence.

Using logistic regression, the researchers looked for a relationship between risk level and dependence in the data. They found that, between the two surveys, a reduction in risk level “predicted significantly lower odds of alcohol dependence” by the second time point, especially among drinkers who were initially considered to be “very high risk.”

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The WHO study showed that dependence decreases with drinking risk, suggesting that going cold turkey isn't totally necessary.
The WHO study showed that dependence decreases with drinking risk, suggesting that going cold turkey isn't totally necessary.

In other words, going cold turkey might not be totally necessary for people trying to manage their issues with alcohol. In a commentary about the study also published in The Lancet Psychiatry, Australian National Drug and Alcohol Research Centre addiction specialists Emily Stockings, Ph.D., and Michael Farrell, Ph.D., noted that treatment rates for alcohol addiction remain “comparatively low” and that opening up new options for treatment can only be a good thing. “Reduced drinking is a viable alternative — it might be more appealing to service users, offers the potential to expand treatment options, and could be used as a primary outcome in clinical trials,” they write.

Though abstinence-based treatment remains the standard for helping people with alcohol addiction, critics have bashed its extreme strategy for quitting — exemplified by the classic 12-step program of Alcoholics Anonymous — by claiming its methods defy the scientific literature. “Nowhere in the field of medicine is treatment less grounded by claiming its methods aren’t supported by the scientific literature,” a 2015 article on the “irrationality” of addiction treatment in the Atlantic noted. Taking new studies like this one — which don’t insist on all-out abstinence — into account when setting national standards for drinking might not only increase the rate that people seek treatment but also boost the numbers of people who adhere to them.

“Because these risk levels can be readily translated into standard drink equivalents per day of different countries, the WHO risk levels could also be used internationally to guide treatment goals and clinical recommendations on drinking reduction,” the researchers write.

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