AIMS To examine whether World Health Organization (WHO) risk level reductions in drinking were achievable, associated with improved functioning, and maintained over time among patients at varying initial alcohol dependence severity levels. DESIGN AND SETTING Secondary data analysis of multisite randomized clinical trials: the US COMBINE Study and the UK Alcohol Treatment Trial (UKATT). PARTICIPANTS Individuals with alcohol dependence enrolled in COMBINE (n=1383; 68.8% male) and seeking treatment for alcohol problems in UKATT (n=742; 74.1% male). INTERVENTIONS Naltrexone, acamprosate, or placebo, and combined behavioral intervention or medication management in COMBINE. Social behavior network therapy or motivational enhancement therapy in UKATT. MEASUREMENTS WHO risk level reductions were assessed via calendar method. Alcohol dependence was measured by the Alcohol Dependence Scale, the Leeds Dependence Questionnaire, and the Diagnostic and Statistical Manual of Mental Disorders. Measures of functioning included alcohol-related consequences (Drinker Inventory of Consequences and Alcohol Problems Questionnaire), mental health (Short Form Health Survey), and liver enzyme tests. FINDINGS One- and 2-level reductions in WHO risk levels in the last month of treatment were maintained at the 1-year follow-up [aOR(95% CI) 1-level reduction in COMBINE: 3.51 (2.73, 4.29) and UKATT: 2.65 (2.32, 2.98)] and associated with fewer alcohol-related consequences [e.g., B(95% CI) 1-level reduction COMBINE: -26.22 (-30.62, -21.82)], better mental health [e.g., B(95% CI) 1-level reduction UKATT: 9.53 (7.36, 11.73)], and improvements in γ-glutamyltransferase [e.g., B(95% CI) 1-level reduction UKATT: -89.77 (-122.50, -57.04)] at the end of treatment, even among patients with severe alcohol dependence. Results were similar when abstainers were excluded CONCLUSIONS: Reductions in World Health Organization risk levels for alcohol consumption appear to be achievable, associated with better functioning, and maintained over time in both the United States and the United Kingdom.

中文翻译：

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世界卫生组织 在美国和英国的临床试验中，降低饮酒风险与改善功能相关，并且在轻度、中度和重度酒精依赖患者中持续存在

目的 旨在检查世界卫生组织 (WHO) 饮酒风险水平的降低是否可以实现，与改善的功能相关，并在不同初始酒精依赖严重程度的患者中随着时间的推移而保持。设计和设置 多中心随机临床试验的二级数据分析：美国联合研究和英国酒精治疗试验 (UKATT)。参与者 酒精依赖者参加了 COMBINE（n=1383；68.8% 的男性）并在 UKATT 寻求酒精问题的治疗（n=742；74.1% 的男性）。干预 纳曲酮、阿坎酸或安慰剂，以及联合行为干预或药物管理。UKATT 中的社会行为网络疗法或动机增强疗法。测量 通过日历方法评估世卫组织风险水平的降低。酒精依赖是通过酒精依赖量表、利兹依赖问卷和精神疾病诊断和统计手册来衡量的。功能测量包括与酒精相关的后果（饮酒者后果清单和酒精问题问卷）、心理健康（简短健康调查）和肝酶测试。结果 在 1 年的随访中，WHO 风险水平在治疗的最后一个月保持 1 级和 2 级降低 [aOR(95% CI) COMBINE 1 级降低：3.51 (2.73, 4.29) 和 UKATT : 2.65 (2.32, 2.98)] 并且与较少的酒精相关后果相关 [例如，B(95% CI) 1 级降低组合：-26.22 (-30.62, -21.82)]，更好的心理健康 [例如，B( 95% CI) 1 级降低 UKATT：9.53 (7.36, 11.73)]，以及 γ-谷氨酰转移酶的改善 [例如，B(95% CI) 1 级降低 UKATT：-89.77 (-122.50, -57.04)] 在治疗结束时，即使在严重酒精依赖的患者中也是如此。当戒酒者被排除时，结果是相似的 结论：降低世界卫生组织饮酒风险水平似乎是可以实现的，与更好的功能相关，并随着时间的推移在美国和英国保持。