Aiming for moderation rather than total abstinence has been shown to be an appropriate goal for some problem drinkers, especially for those who are less severely dependent. But what is the best way to help people to moderate their drinking? Professor Nick Heather and colleagues carried out a randomised-clinical trial to compare two very different approaches. The most frequently used method of helping the less severely dependent drinker return to moderate drinking is usually referred to as Behavioural Self-Control Training. This approach includes goal setting, advice on how to refuse drinks, identifying events that trigger the urge
to drink, as well as ways of preventing relapse. This was compared to a new intervention, called Moderation Oriented Cue Exposure, that involves practising consuming a moderate amount of alcohol across a range of situations, and then resisting the temptation to continue.
- Each Moderation Oriented Cue Exposure session normally took 90 minutes, compared to 60 minutes for Behavioural Self-Control Training.
- Overall, both treatments were associated with the same good outcomes.
- Relative to levels of consumption before treatment, 63% of clients showed evidence of improvement at six month follow-up.
- Average drinks per drinking day nearly halved and average percentage days abstinent in the previous two months nearly doubled.
- These results provide no grounds for the replacement of self-control training with the new intervention in routine clinical practice, especially since the new treatment was less cost effective.
- However, the new treatment tended to produce better outcomes for those clients who were less severely dependent.
- Contrary to traditional views, a sub-sample of 14 clients showing levels of dependence above the commonly accepted cut-off point for a moderation goal showed outcomes at least as favourable as those who were less dependent for the six month follow-up period.
- The use made of health care resources was significantly reduced, Savings to the health care system were identified for both alcohol-related and non-alcohol related health care. Savings were estimated to be about £240 per client over a three-month period when compared to the three months prior to treatment.
- The effectiveness of Behavioural Self-Control Training has been demonstrated in previous trials. If commissioners and providers are developing services for less dependent alcohol misusers then Behavioural Self-Control Training is still the treatment of choice.
- The exact magnitude of savings to the health care system needs to be further investigated.
- The effectiveness of Moderation Oriented Cue Exposure among clients with lower levels of dependence should be explored further.
- In the current study the clients were mainly self-referrals responding to an advertisement (64%) or referred from general medical practitioners. Most of them were problem drinkers with relatively mild problems who may have been deterred from seeking treatment through conventional channels.
- They were all clients who preferred a moderation goal to total abstinence, and who were suitable for the moderation goal on other grounds; 75% were male.
- Treatment was delivered in up to 16 weekly sessions by two trained therapists who switched to the alternative treatment modality halfway through the trial.
Nick Heather, Jennifer Brodie, Steve McArthy, Simon Wale, Gerard Wilkinson, Elspeth Webb, Anna Luce, Christine Godfrey & Steven Parrot