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March 13, 2019

Why Less Is Always More in the Treatment of Alcohol Use Disorders

Author Affiliations
  • 1Centre for Academic Psychiatry, Imperial College, Hammersmith Hospital, London, United Kingdom
  • 2Addictions Unit, Hospital Clínic, Barcelona, Spain
  • 3Institut d'Investigacions Biomèdiques August Pi i Sunyer, Barcelona, Spain
  • 4Institute of Health and Society, Newcastle University, Newcastle-Upon-Tyne, United Kingdom
  • 5Faculty of Health, Medicine and Life Sciences, Maastricht University, Maastricht, the Netherlands
  • 6Institute for Mental Health Policy Research, Centre for Addiction and Mental Health, Toronto, Ontario, Canada
  • 7Institute of Clinical Psychology and Psychotherapy and Center of Clinical Epidemiology and Longitudinal Studies, Technische Universität Dresden, Dresden, Germany
JAMA Psychiatry. 2019;76(4):359-360. doi:10.1001/jamapsychiatry.2018.2807

Alcohol is a major risk factor for mortality and burden of disease1 and causally affects more than 200 International Statistical Classification of Diseases and Related Health Problems (ICD) 3-digit disease categories.2 Reducing the health harms of alcohol is therefore one of the most important medical goals in the world today. For most major causes of alcohol-attributable death, the risk associations between lifetime drinking and mortality are exponential.3 For all-cause mortality in high-income countries, depending on the distribution of causes of death in these countries, this means that the resulting risk association between the level of alcohol consumption and all-cause mortality is also exponential after 100 g of alcohol consumption per week.4 The consequence of this is that reducing the level of drinking will reduce harm, and given the exponential association between the level of alcohol use and most outcomes, it is most important to cut down the highest levels.5 Thus, a reduction from 10 drinks to 6 drinks is more important for mortality risk than the same absolute reduction from 4 drinks to 0 drinks.

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