For many years, complete abstinence from alcohol consumption was viewed as the most effective way to recover from alcohol use disorder (AUD) and was a primary outcome of AUD treatment. A large body of evidence, however, suggests that treatment and recovery strategies that reduce heavy alcohol consumption and alcohol-related consequences without complete abstinence can be effective for mitigating the harms associated with alcohol misuse for many individuals. Today, although abstinence is the safest course for certain subgroups, harm reduction strategies that are non-abstinence based have become an important part of the discussion around AUD treatment and the recovery process.<\/p>\n
\u201cIndeed, the\u00a0NIAAA research definition of recovery<\/a>, released in September 2020, defines recovery as a process through which a person achieves remission from AUD as well as cessation from heavy alcohol consumption, which is a non-abstinent recovery outcome,\u201d noted National Institute on Alcohol Abuse and Alcoholism (NIAAA) Director George F. Koob, Ph.D. The definition also emphasizes the importance of biopsychosocial functioning and quality of life in enhancing recovery outcomes. \u201cThis definition was developed to help standardize how we view and measure recovery for research studies and, in turn, advance recovery research and the treatment of AUD,\u201d said Dr. Koob.<\/p>\n Katie Witkiewitz, Ph.D., Distinguished Professor of Psychology and Director of the Center on Alcohol, Substance Use, and Addictions at the University of New Mexico and member of the NIAAA Advisory Council, reviewed the history of harm reduction in alcohol research at the\u00a0Council\u2019s May 2023 meeting\u00a0<\/a>. In her presentation, Dr. Witkiewitz argued that expanding the scope of treatment and research to include non-abstinent drinking reductions as a treatment target could substantially lessen the public health burden of AUD.<\/p>\n \u201cAn expanding body of research demonstrates that reductions in drinking lead to reductions in risk and has established that individuals can reduce their drinking and\/or their experience of harm associated with alcohol use without achieving abstinence,\u201d said Dr. Witkiewitz. Dr. Witkiewitz and colleagues recently reviewed this work in NIAAA\u2019s\u00a0Alcohol Research: Current Reviews<\/a>.1<\/sup><\/p>\n She added that the need to allow for other ways to define \u201csuccess\u201d for AUD treatment is driven by observations that:<\/p>\n In clinical trials for AUD, abstinence and no heavy-drinking days are currently the only endpoints approved by the U.S. Food and Drug Administration (FDA). However, many individuals who do not achieve these endpoints may still reduce their drinking to less harmful levels during treatment. Dr. Witkiewitz and other investigators have examined associations between reductions in drinking risk levels established by the World Health Organization (WHO) and improvements in physical health and quality of life.<\/p>\n WHO defines four levels of drinking risk: low, medium, high, and very high.<\/p>\n\n
Finding the Right Drinking Levels To Measure Harm Reduction<\/em><\/strong><\/h3>\n