A fresh approach to treating alcohol use disorder

Mar. 16—Those grappling with alcohol use disorder don't necessarily need to quit cold turkey in order to improve their health and behavior, according to new research from Washington State University in collaboration with the University of Washington.

Despite the ubiquity of time-honored cessation-based interventions like 12-step programs, a new clinical trial run by WSU researchers shows a drop in alcohol-related harm and frequency of drinking among people who received harm reduction counseling, even though they did not quit completely.

WSU psychology professor Susan Collins, lead author of the study, said rather than focusing interventions on abstention, most participants received behavioral-harm reduction counseling — a more collaborative therapeutic approach that focuses on minimizing harmful outcomes.

Collins said the Substance Abuse and Mental Health Services Administrations found in a recent poll that around 22 million people in the U.S. have substance use disorder, yet only about 10 percent receive treatment in a given year. She said for many who experience some form of substance abuse, particularly those who are homeless, cessation programs that require abstention can often seem overwhelming.

She said part of the purpose of her research isn't to replace abstinence-based programs but to provide a way forward for people who want to improve but may not be quite ready to quit drinking completely.

"As treatment providers, we want to expand that spectrum of people that we can offer help to," Collins said. "If we're only offering help to that very small percentage — that 10 percent of people who are ready to go to treatment and get sober — we're missing 90 percent of Americans who maybe want to do something to stay safer and healthier, but aren't ready, willing or able to go that entire way."

Collins said researchers studied a group of more than 300 people from homeless shelters and programs in Seattle who were split into four groups. The first received harm reduction therapy and a medication that cut down on cravings, the second received counseling and a placebo and a third group received counseling alone. A fourth group, used as a control, received the usual services, which did not include harm reduction therapy.

All three groups that received harm reduction counseling saw measurable improvement in their alcohol-related behaviors and harms when compared to the control, but those that received counseling and medication fared best.

Even though researchers did not ask participants to change their drinking in any way, Collins said participants that went through counseling and received anti-craving medication experienced a 59 percent reduction in the number of drinks they consumed on their heaviest drinking day in the past month.

"We consider that a medium to large treatment effect — we (also) saw for that group a 29 percent change in frequency of drinking over time," she said. "That's important because these folks are typically daily drinkers that we're working with, so it seems small but it's actually kind of a big effect for them."

Collins said the study also found a 43 percent reduction in alcohol-related harm — which could be anything from fighting with a spouse or partner to legal trouble caused by alcohol — and a 10 percent improvement in self-assessed physical health and quality of life.

While Collins said harm reduction strategies emphasize working with patients to "meet them where they are," to create goals and assess progress, it can be a first step toward real sobriety for some. Outside of the research trial, she said she uses a harm reduction approach in her clinical work at Harborview Medical Center in Seattle, where she is co-director of the hospital's Harm Reduction and Treatment Center, and the results have been encouraging.

"About 50 percent of my clients actually ended up stopping using substances altogether, even though we were using the harm reduction approach," she said. "But they've told me categorically they would not have been able to get sober if they had started off in an abstinence-based program."

Scott Jackson can be reached at (208) 883-4636, or by email to sjackson@dnews.com.