Cognitive-Behavioral Therapy for Alcohol Use Disorder Results in Significant Reduction in World Health Organization Drinking Risk Levels

Background: More than 17 million U.S. adults meet diagnostic criteria for alcohol use disorder (AUD; SAMHSA, 2017). Social workers are part of the clinical workforce responsible for providing treatment to the up to 3 million people who seek treatment for AUD each year. Evidence-based treatment remains the highest standard of care.

Traditionally, treatment programs have emphasized abstinence-based outcomes (Kiluk et al., 2019). However, for some, abstinence is unattainable, inconsistent with their goals, and a barrier to treatment (Chartier et al., 2016; Marchand et al., 2019). Other measures of changes in drinking are being evaluated for their clinical utility.

One alternative outcome measure is the drinking risk levels developed by the World Health Organization (WHO; 2010). These guidelines describe four levels of drinking for women and men ranging from low risk to very high risk based on the number of grams of alcohol consumed per day. A 1- or 2-level reduction is associated with positive health and psychosocial outcomes (Falk et al., 2019; Hasin et al., 2017; Witkiewitz et al., 2017) and is a WHO-recommended treatment goal.

Evaluating CBT’s efficacy from the perspective of WHO risk level has not been done. The aim of this analysis is to determine what percentage of people reduce their drinking consistent with WHO recommendations following treatment with CBT.

Methods: Treatment-seeking men and women (N=205) with a DSM-5 diagnosis of AUD completed 12 sessions of Cognitive-Behavioral Therapy adapted from NIAAA’s Project MATCH (Allen et al., 1997). Participants completed a Timeline Follow Back (TLFB; Sobell & Sobell, 1995) to assess drinking at baseline and end-of-treatment. The number of standard drinks per drinking day were converted to grams of alcohol to determine risk level.

Descriptive statistics were used to determine the number of people who reduced their drinking by 1, 2, or 3 levels. Wilcoxon’s signed rank test was used to evaluate the significance of changes.

Results: At baseline, 53 (25.9%) people were WHO low risk drinkers; 40 (19.5%) were medium risk; 57 (27.8%) were high risk; 55 (26.8%) were very high risk. At end-of-treatment, 151 (73.7%) were low risk (including 17 abstinent); 35 (17.1%) were medium risk; 14 (6.8%) were high risk; and 5 (2.4%) were very high risk.

51 (24.9%) people reduced their drinking one level; 54 (26.3%) decreased drinking two levels; and 29 (14.1%) decreased drinking three levels. 57 (27.8%) people started treatment at low risk and ended treatment at the same level; 10 (4.9%) started treatment at medium risk or higher and ended treatment at the same level; 3 (1.5%) increased one drinking level; 1 (.05%) increased 2 levels.

According to Wilcoxon’s signed rank test, the decrease was statistically significant (Z = -10.007; p<.000).

Conclusion: CBT is an efficacious intervention for AUD (Magill et al., 2019). We found that 65.3% of people reduced their drinking by one or more risk levels (an additional 27.8% remained low risk) following CBT treatment, thus meeting WHO criteria for successful treatment. Clinicians should continue to use CBT even if stakeholders shift treatment goals towards non-abstinence outcomes.