Some people seeking treatment for alcohol use disorder hope to reduce their drinking rather than stop altogether, but few interventions are specifically tailored to support this goal. This study compared two treatments designed to help individuals reduce weekly alcohol use.
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Many people seeking treatment for severe alcohol use disorder begin with a goal of alcohol abstinence. There are also, however, many less severe cases who hope to reduce their drinking rather than stopping altogether, and evidence suggests this is possible for some individuals, usually those with these less severe drinking problems.
Historically, alcohol use disorder treatments have typically advocate for abstinence as the best treatment goal. This may serve as a disincentive to engage with treatment, which is problematic given already low treatment engagement rates for people with milder forms of alcohol use disorder. And while, on average, abstinence corresponds with overall better treatment outcomes, reducing drinking is also associated with many health benefits.
Two manualized interventions specifically geared toward helping individuals with alcohol use disorder reduce their drinking rather than stop altogether are behavioral self-control training and motivational enhancement therapy, the latter of which is sometimes also used with individuals seeking abstinence.
Behavioral self-control training is a manualized, five-session treatment. Sessions cover, 1) goal setting and motivation, 2) identifying high-risk situations, 3) moderation strategies and related skills training, 4) strategies to increase number of days of alcohol abstinence, and 5) developing a moderation maintenance plan. At the end of each session, patients are assigned homework based on the content of that session. Additionally, throughout treatment, they are asked to log their alcohol consumption.
Motivational enhancement therapy emphasizes motivational interviewing – a dialogue driven approach for helping individuals resolve ambivalence and increase motivation to change behaviors. The motivational enhancement therapy manual used in this study involves four sessions that include, 1) feedback from a baseline assessment of participants’ drinking, and 2) three sessions of motivational interviewing. Sessions utilize worksheets that cover alcohol related health consequences, behavior change planning, and planning of long-term maintenance of behavior change.
This study examined whether one of these interventions is superior to the other in a head-to-head comparison. The researchers hypothesized that behavioral self-control training’s special focus on helping individuals moderate their drinking would produce superior drinking outcomes.
This was a randomized clinical trial conducted in Stockholm, Sweden with 250 participants who received either 5 sessions of behavioral self-control training or four sessions of motivational enhancement therapy, with follow-ups at 12-, 26-, 52-, and 104 weeks post-baseline. The paper summarized here reports preliminary results from this trial up to the week 26 assessment.
The primary study outcome was average weekly alcohol consumption over the 90-day period preceding the 26-week follow-up, relative to baseline alcohol consumption. Secondary outcomes included the proportion of days with drinking, drinks per drinking day, proportion of heavy drinking days defined as number of days with 4+ or 5+ standard drinks for women and men, respectively, and alcohol use below Swedish operational definitions of hazardous use (9 or fewer weekly drinks for women and 14 or fewer weekly drinks for men). Alcohol consumption and liver health was also assessed using blood tests.
Additionally, the researchers assessed alcohol use disorder severity using the Alcohol Use Disorders Identification Test (commonly referred to as the AUDIT) and the Short Alcohol Dependence Data test. Alcohol-related harm was measured using the Short Index of Problems, while craving was measured using the Penn Alcohol Craving Scale.
Mental health was assessed using the Generalized Anxiety Disorder – 7 (abbreviated as the GAD-7), and the Montgomery Asberg Depression Rating Scale, while quality of life was measured with the EQ-5D-3L. Participants were also asked to rate how important changing their drinking was to them and how confident they were about their ability to change on a scale of 1-10. Finally, satisfaction with the treatment provide was measured with the Client Satisfaction Questionnaire.
To be included in the study, participants had DSM-5 diagnosis of alcohol use disorder, consumed alcohol in at least 30 of the last 90 days, and had a goal of controlled drinking. They were 18-70 years old and residents of Stockholm County in Sweden. Individuals were excluded if they had a substance use disorder for a drug other than alcohol, regular use of any illicit drug during the last 6 months, medical problems or recent hospitalization related to alcohol use disorder, or an ongoing cooccurring psychiatric condition (e.g., mood disorder, psychotic disorder).
Because recruitment for this clinical trial partly occurred during the COVID-19 pandemic (August 2017 to December 2020) and some participants received treatment remotely, the researchers conducted additional analyses to see if there were differences in outcomes between participants who received treatment face-to-face versus remotely via video calls.
The study’s 250 participants were on average 52 years old. The sample was 52% male and met 5.4 of 11 diagnostic criteria for alcohol use disorder, equating to moderate alcohol use disorder. Participants randomized to behavioral self-control training attended a mean number of 3.8 treatment sessions while those randomized to motivational enhancement therapy attended 3.6 sessions up to the 12-week follow-up appointment.
Both groups experienced notable reductions in drinking, but with similar improvement
From baseline to 26-week follow-up, on average, participants in the behavioral self-control training group reduced from 24 to 14 standard drinks per week, while participants in the motivational enhancement therapy group reduced from 25 to 15 standard drinks per week. Overall, 49% of participants were drinking within the Swedish guidelines for non-hazardous alcohol use (9 or fewer weekly for women and 14 or fewer weekly for men).
Groups were also similar in showing modest reductions in proportion of days with drinking, drinks per drinking day, proportion of heavy drinking days, alcohol problem severity, and alcohol craving from baseline to 26-week follow-up.
Both groups also showed modest improvements in mental health
From baseline to 26-week follow-up, groups were similar on almost all the researchers’ secondary outcome measures, with modest reductions in depressive symptoms and increased scores on perceived importance of changing alcohol use behaviors.
Anxiety, quality of life, and confidence to change remained largely unchanged across both groups.
Treatment satisfaction was modestly higher for behavioral self-control training
At 12-week follow-up, participant reported satisfaction was modestly higher for behavioral self-control training versus motivational enhancement therapy, although by 26-week follow-up, this difference was no longer evident.
Participants who received treatment via video call during COVID-19 experienced greater reductions in alcohol problem severity
At the 26-week follow-up, across the entire sample irrespective of condition, compared to participants who received treatment in-person, those receiving treatment via video call during the COVID-19 pandemic reported lower scores on the study measures of alcohol dependence, alcohol use disorder severity, and alcohol related harms.
There was, however, no difference on the main study outcome of drinks per week and those receiving treatment via video call were less satisfied with treatment at 12-week follow-up, though this difference had dissipated by 26-week follow-up.
Study findings suggest little difference on average between behavioral self-control training and motivational enhancement therapy in helping people reduce their alcohol use. This is noteworthy because the former is an intervention that directly teaches individuals skills to help them reduce and control their drinking, while the latter is a more generalist intervention designed to increase individuals’ motivation to change a target behavior.
This finding is generally consistent with previous research that has shown a benefit of both interventions for reduced drinking. It is also consistent with Project MATCH findings where comparisons between a 4-session motivational enhancement therapy and 12-week cognitive behavioral therapy showed few differences. However. without a true control group, it’s impossible to tease out how much of the observed drinking reductions in this study were a function of general study effects that are typically generated through the act of participating in a clinical trial and having frequent interactions with study staff and attendant assessments (commonly referred to as assessment reactivity) as well as improvement occurring outside study contexts in this group who wanted to reduce their alcohol use.
That said, quite large reductions in alcohol intake were observed in this study. Participants halved their weekly drinks and 50% (vs. 80% initially) were drinking within lower-risk guidelines by the end of the study. It is unclear, however, the extent to which such reductions may be sustained over time without further intervention and monitoring as such initial benefits can fade relatively quickly for some. Longer-term naturalistic monitoring would help answer this question.
It is important that alcohol use disorder treatments are available that support those with goals of reducing their alcohol use as well as those with abstinence goals. Like other studies comparing manualized treatments with strong theoretical rationale, behavioral self-control training and motivational enhancement therapy produced very similar improvements on alcohol use outcomes over time, where participants halved their weekly drinks and 50% (vs. 80% initially) were drinking within lower-risk guidelines by the end of the study
Hammarberg, S. I., Wallhed Finn, S., Rosendahl, I., Andréasson, S., Jayaram-Lindström, N., & Hammarberg, A. (2024). Behavioural self-control training versus motivational enhancement therapy for individuals with alcohol use disorder with a goal of controlled drinking: A randomized controlled trial. Addiction, 119(1), 86-101. doi:10.1111/add.16325
l
Many people seeking treatment for severe alcohol use disorder begin with a goal of alcohol abstinence. There are also, however, many less severe cases who hope to reduce their drinking rather than stopping altogether, and evidence suggests this is possible for some individuals, usually those with these less severe drinking problems.
Historically, alcohol use disorder treatments have typically advocate for abstinence as the best treatment goal. This may serve as a disincentive to engage with treatment, which is problematic given already low treatment engagement rates for people with milder forms of alcohol use disorder. And while, on average, abstinence corresponds with overall better treatment outcomes, reducing drinking is also associated with many health benefits.
Two manualized interventions specifically geared toward helping individuals with alcohol use disorder reduce their drinking rather than stop altogether are behavioral self-control training and motivational enhancement therapy, the latter of which is sometimes also used with individuals seeking abstinence.
Behavioral self-control training is a manualized, five-session treatment. Sessions cover, 1) goal setting and motivation, 2) identifying high-risk situations, 3) moderation strategies and related skills training, 4) strategies to increase number of days of alcohol abstinence, and 5) developing a moderation maintenance plan. At the end of each session, patients are assigned homework based on the content of that session. Additionally, throughout treatment, they are asked to log their alcohol consumption.
Motivational enhancement therapy emphasizes motivational interviewing – a dialogue driven approach for helping individuals resolve ambivalence and increase motivation to change behaviors. The motivational enhancement therapy manual used in this study involves four sessions that include, 1) feedback from a baseline assessment of participants’ drinking, and 2) three sessions of motivational interviewing. Sessions utilize worksheets that cover alcohol related health consequences, behavior change planning, and planning of long-term maintenance of behavior change.
This study examined whether one of these interventions is superior to the other in a head-to-head comparison. The researchers hypothesized that behavioral self-control training’s special focus on helping individuals moderate their drinking would produce superior drinking outcomes.
This was a randomized clinical trial conducted in Stockholm, Sweden with 250 participants who received either 5 sessions of behavioral self-control training or four sessions of motivational enhancement therapy, with follow-ups at 12-, 26-, 52-, and 104 weeks post-baseline. The paper summarized here reports preliminary results from this trial up to the week 26 assessment.
The primary study outcome was average weekly alcohol consumption over the 90-day period preceding the 26-week follow-up, relative to baseline alcohol consumption. Secondary outcomes included the proportion of days with drinking, drinks per drinking day, proportion of heavy drinking days defined as number of days with 4+ or 5+ standard drinks for women and men, respectively, and alcohol use below Swedish operational definitions of hazardous use (9 or fewer weekly drinks for women and 14 or fewer weekly drinks for men). Alcohol consumption and liver health was also assessed using blood tests.
Additionally, the researchers assessed alcohol use disorder severity using the Alcohol Use Disorders Identification Test (commonly referred to as the AUDIT) and the Short Alcohol Dependence Data test. Alcohol-related harm was measured using the Short Index of Problems, while craving was measured using the Penn Alcohol Craving Scale.
Mental health was assessed using the Generalized Anxiety Disorder – 7 (abbreviated as the GAD-7), and the Montgomery Asberg Depression Rating Scale, while quality of life was measured with the EQ-5D-3L. Participants were also asked to rate how important changing their drinking was to them and how confident they were about their ability to change on a scale of 1-10. Finally, satisfaction with the treatment provide was measured with the Client Satisfaction Questionnaire.
To be included in the study, participants had DSM-5 diagnosis of alcohol use disorder, consumed alcohol in at least 30 of the last 90 days, and had a goal of controlled drinking. They were 18-70 years old and residents of Stockholm County in Sweden. Individuals were excluded if they had a substance use disorder for a drug other than alcohol, regular use of any illicit drug during the last 6 months, medical problems or recent hospitalization related to alcohol use disorder, or an ongoing cooccurring psychiatric condition (e.g., mood disorder, psychotic disorder).
Because recruitment for this clinical trial partly occurred during the COVID-19 pandemic (August 2017 to December 2020) and some participants received treatment remotely, the researchers conducted additional analyses to see if there were differences in outcomes between participants who received treatment face-to-face versus remotely via video calls.
The study’s 250 participants were on average 52 years old. The sample was 52% male and met 5.4 of 11 diagnostic criteria for alcohol use disorder, equating to moderate alcohol use disorder. Participants randomized to behavioral self-control training attended a mean number of 3.8 treatment sessions while those randomized to motivational enhancement therapy attended 3.6 sessions up to the 12-week follow-up appointment.
Both groups experienced notable reductions in drinking, but with similar improvement
From baseline to 26-week follow-up, on average, participants in the behavioral self-control training group reduced from 24 to 14 standard drinks per week, while participants in the motivational enhancement therapy group reduced from 25 to 15 standard drinks per week. Overall, 49% of participants were drinking within the Swedish guidelines for non-hazardous alcohol use (9 or fewer weekly for women and 14 or fewer weekly for men).
Groups were also similar in showing modest reductions in proportion of days with drinking, drinks per drinking day, proportion of heavy drinking days, alcohol problem severity, and alcohol craving from baseline to 26-week follow-up.
Both groups also showed modest improvements in mental health
From baseline to 26-week follow-up, groups were similar on almost all the researchers’ secondary outcome measures, with modest reductions in depressive symptoms and increased scores on perceived importance of changing alcohol use behaviors.
Anxiety, quality of life, and confidence to change remained largely unchanged across both groups.
Treatment satisfaction was modestly higher for behavioral self-control training
At 12-week follow-up, participant reported satisfaction was modestly higher for behavioral self-control training versus motivational enhancement therapy, although by 26-week follow-up, this difference was no longer evident.
Participants who received treatment via video call during COVID-19 experienced greater reductions in alcohol problem severity
At the 26-week follow-up, across the entire sample irrespective of condition, compared to participants who received treatment in-person, those receiving treatment via video call during the COVID-19 pandemic reported lower scores on the study measures of alcohol dependence, alcohol use disorder severity, and alcohol related harms.
There was, however, no difference on the main study outcome of drinks per week and those receiving treatment via video call were less satisfied with treatment at 12-week follow-up, though this difference had dissipated by 26-week follow-up.
Study findings suggest little difference on average between behavioral self-control training and motivational enhancement therapy in helping people reduce their alcohol use. This is noteworthy because the former is an intervention that directly teaches individuals skills to help them reduce and control their drinking, while the latter is a more generalist intervention designed to increase individuals’ motivation to change a target behavior.
This finding is generally consistent with previous research that has shown a benefit of both interventions for reduced drinking. It is also consistent with Project MATCH findings where comparisons between a 4-session motivational enhancement therapy and 12-week cognitive behavioral therapy showed few differences. However. without a true control group, it’s impossible to tease out how much of the observed drinking reductions in this study were a function of general study effects that are typically generated through the act of participating in a clinical trial and having frequent interactions with study staff and attendant assessments (commonly referred to as assessment reactivity) as well as improvement occurring outside study contexts in this group who wanted to reduce their alcohol use.
That said, quite large reductions in alcohol intake were observed in this study. Participants halved their weekly drinks and 50% (vs. 80% initially) were drinking within lower-risk guidelines by the end of the study. It is unclear, however, the extent to which such reductions may be sustained over time without further intervention and monitoring as such initial benefits can fade relatively quickly for some. Longer-term naturalistic monitoring would help answer this question.
It is important that alcohol use disorder treatments are available that support those with goals of reducing their alcohol use as well as those with abstinence goals. Like other studies comparing manualized treatments with strong theoretical rationale, behavioral self-control training and motivational enhancement therapy produced very similar improvements on alcohol use outcomes over time, where participants halved their weekly drinks and 50% (vs. 80% initially) were drinking within lower-risk guidelines by the end of the study
Hammarberg, S. I., Wallhed Finn, S., Rosendahl, I., Andréasson, S., Jayaram-Lindström, N., & Hammarberg, A. (2024). Behavioural self-control training versus motivational enhancement therapy for individuals with alcohol use disorder with a goal of controlled drinking: A randomized controlled trial. Addiction, 119(1), 86-101. doi:10.1111/add.16325
l
Many people seeking treatment for severe alcohol use disorder begin with a goal of alcohol abstinence. There are also, however, many less severe cases who hope to reduce their drinking rather than stopping altogether, and evidence suggests this is possible for some individuals, usually those with these less severe drinking problems.
Historically, alcohol use disorder treatments have typically advocate for abstinence as the best treatment goal. This may serve as a disincentive to engage with treatment, which is problematic given already low treatment engagement rates for people with milder forms of alcohol use disorder. And while, on average, abstinence corresponds with overall better treatment outcomes, reducing drinking is also associated with many health benefits.
Two manualized interventions specifically geared toward helping individuals with alcohol use disorder reduce their drinking rather than stop altogether are behavioral self-control training and motivational enhancement therapy, the latter of which is sometimes also used with individuals seeking abstinence.
Behavioral self-control training is a manualized, five-session treatment. Sessions cover, 1) goal setting and motivation, 2) identifying high-risk situations, 3) moderation strategies and related skills training, 4) strategies to increase number of days of alcohol abstinence, and 5) developing a moderation maintenance plan. At the end of each session, patients are assigned homework based on the content of that session. Additionally, throughout treatment, they are asked to log their alcohol consumption.
Motivational enhancement therapy emphasizes motivational interviewing – a dialogue driven approach for helping individuals resolve ambivalence and increase motivation to change behaviors. The motivational enhancement therapy manual used in this study involves four sessions that include, 1) feedback from a baseline assessment of participants’ drinking, and 2) three sessions of motivational interviewing. Sessions utilize worksheets that cover alcohol related health consequences, behavior change planning, and planning of long-term maintenance of behavior change.
This study examined whether one of these interventions is superior to the other in a head-to-head comparison. The researchers hypothesized that behavioral self-control training’s special focus on helping individuals moderate their drinking would produce superior drinking outcomes.
This was a randomized clinical trial conducted in Stockholm, Sweden with 250 participants who received either 5 sessions of behavioral self-control training or four sessions of motivational enhancement therapy, with follow-ups at 12-, 26-, 52-, and 104 weeks post-baseline. The paper summarized here reports preliminary results from this trial up to the week 26 assessment.
The primary study outcome was average weekly alcohol consumption over the 90-day period preceding the 26-week follow-up, relative to baseline alcohol consumption. Secondary outcomes included the proportion of days with drinking, drinks per drinking day, proportion of heavy drinking days defined as number of days with 4+ or 5+ standard drinks for women and men, respectively, and alcohol use below Swedish operational definitions of hazardous use (9 or fewer weekly drinks for women and 14 or fewer weekly drinks for men). Alcohol consumption and liver health was also assessed using blood tests.
Additionally, the researchers assessed alcohol use disorder severity using the Alcohol Use Disorders Identification Test (commonly referred to as the AUDIT) and the Short Alcohol Dependence Data test. Alcohol-related harm was measured using the Short Index of Problems, while craving was measured using the Penn Alcohol Craving Scale.
Mental health was assessed using the Generalized Anxiety Disorder – 7 (abbreviated as the GAD-7), and the Montgomery Asberg Depression Rating Scale, while quality of life was measured with the EQ-5D-3L. Participants were also asked to rate how important changing their drinking was to them and how confident they were about their ability to change on a scale of 1-10. Finally, satisfaction with the treatment provide was measured with the Client Satisfaction Questionnaire.
To be included in the study, participants had DSM-5 diagnosis of alcohol use disorder, consumed alcohol in at least 30 of the last 90 days, and had a goal of controlled drinking. They were 18-70 years old and residents of Stockholm County in Sweden. Individuals were excluded if they had a substance use disorder for a drug other than alcohol, regular use of any illicit drug during the last 6 months, medical problems or recent hospitalization related to alcohol use disorder, or an ongoing cooccurring psychiatric condition (e.g., mood disorder, psychotic disorder).
Because recruitment for this clinical trial partly occurred during the COVID-19 pandemic (August 2017 to December 2020) and some participants received treatment remotely, the researchers conducted additional analyses to see if there were differences in outcomes between participants who received treatment face-to-face versus remotely via video calls.
The study’s 250 participants were on average 52 years old. The sample was 52% male and met 5.4 of 11 diagnostic criteria for alcohol use disorder, equating to moderate alcohol use disorder. Participants randomized to behavioral self-control training attended a mean number of 3.8 treatment sessions while those randomized to motivational enhancement therapy attended 3.6 sessions up to the 12-week follow-up appointment.
Both groups experienced notable reductions in drinking, but with similar improvement
From baseline to 26-week follow-up, on average, participants in the behavioral self-control training group reduced from 24 to 14 standard drinks per week, while participants in the motivational enhancement therapy group reduced from 25 to 15 standard drinks per week. Overall, 49% of participants were drinking within the Swedish guidelines for non-hazardous alcohol use (9 or fewer weekly for women and 14 or fewer weekly for men).
Groups were also similar in showing modest reductions in proportion of days with drinking, drinks per drinking day, proportion of heavy drinking days, alcohol problem severity, and alcohol craving from baseline to 26-week follow-up.
Both groups also showed modest improvements in mental health
From baseline to 26-week follow-up, groups were similar on almost all the researchers’ secondary outcome measures, with modest reductions in depressive symptoms and increased scores on perceived importance of changing alcohol use behaviors.
Anxiety, quality of life, and confidence to change remained largely unchanged across both groups.
Treatment satisfaction was modestly higher for behavioral self-control training
At 12-week follow-up, participant reported satisfaction was modestly higher for behavioral self-control training versus motivational enhancement therapy, although by 26-week follow-up, this difference was no longer evident.
Participants who received treatment via video call during COVID-19 experienced greater reductions in alcohol problem severity
At the 26-week follow-up, across the entire sample irrespective of condition, compared to participants who received treatment in-person, those receiving treatment via video call during the COVID-19 pandemic reported lower scores on the study measures of alcohol dependence, alcohol use disorder severity, and alcohol related harms.
There was, however, no difference on the main study outcome of drinks per week and those receiving treatment via video call were less satisfied with treatment at 12-week follow-up, though this difference had dissipated by 26-week follow-up.
Study findings suggest little difference on average between behavioral self-control training and motivational enhancement therapy in helping people reduce their alcohol use. This is noteworthy because the former is an intervention that directly teaches individuals skills to help them reduce and control their drinking, while the latter is a more generalist intervention designed to increase individuals’ motivation to change a target behavior.
This finding is generally consistent with previous research that has shown a benefit of both interventions for reduced drinking. It is also consistent with Project MATCH findings where comparisons between a 4-session motivational enhancement therapy and 12-week cognitive behavioral therapy showed few differences. However. without a true control group, it’s impossible to tease out how much of the observed drinking reductions in this study were a function of general study effects that are typically generated through the act of participating in a clinical trial and having frequent interactions with study staff and attendant assessments (commonly referred to as assessment reactivity) as well as improvement occurring outside study contexts in this group who wanted to reduce their alcohol use.
That said, quite large reductions in alcohol intake were observed in this study. Participants halved their weekly drinks and 50% (vs. 80% initially) were drinking within lower-risk guidelines by the end of the study. It is unclear, however, the extent to which such reductions may be sustained over time without further intervention and monitoring as such initial benefits can fade relatively quickly for some. Longer-term naturalistic monitoring would help answer this question.
It is important that alcohol use disorder treatments are available that support those with goals of reducing their alcohol use as well as those with abstinence goals. Like other studies comparing manualized treatments with strong theoretical rationale, behavioral self-control training and motivational enhancement therapy produced very similar improvements on alcohol use outcomes over time, where participants halved their weekly drinks and 50% (vs. 80% initially) were drinking within lower-risk guidelines by the end of the study
Hammarberg, S. I., Wallhed Finn, S., Rosendahl, I., Andréasson, S., Jayaram-Lindström, N., & Hammarberg, A. (2024). Behavioural self-control training versus motivational enhancement therapy for individuals with alcohol use disorder with a goal of controlled drinking: A randomized controlled trial. Addiction, 119(1), 86-101. doi:10.1111/add.16325
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