Reducing the amount of alcohol drinking in individuals at high- or very-high-risk drinking levels provides significant benefit, including reduction in alcohol dependence, according to a study published in Lancet Psychiatry. These results support the use of reductions in WHO drinking risk levels as an efficacy outcome in clinical trials.

Deborah S. Hasin, PhD, of Columbia University and the New York State Psychiatric Institute, New York, New York, and colleagues conducted a population-based cohort study and included data from 22,005 people who consumed alcohol who were interviewed in 2001 and 2002 (wave 1) and were re-interviewed 3 years later in 2004 and 2005 (wave 2) in the US National Epidemiologic Survey on Alcohol and Related Conditions. Alcohol consumption and dependence were assessed at both interviews. Logistic regression analysis tested the relationship between change in WHO drinking risk levels between waves 1 and 2 and alcohol dependence at wave 2.

At wave 1, 2.5% of the subjects were very-high-risk drinkers, 2.5% were high-risk, 4.8% were moderate-risk, and 90.2% were low-risk drinkers. Fifty-five percent of very-high-risk drinkers and 30% of high-risk drinkers were alcohol dependent. 

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Regardless of alcohol dependence, by wave 2, two-thirds of very-high-risk drinkers had decreased their drinking by at least 1 WHO risk level. Among very-high-risk drinkers, each decrease in WHO risk level decreased the prevalence of alcohol dependence significantly. Among those whose drinking remained at a very-high-risk level, 36.6% were alcohol dependent at wave 2, but among those whose drinking decreased by 1, 2, or 3 WHO risk levels, the prevalence of alcohol dependence was 13.5%, 8.8%, and 3.8%, respectively (P <.0001). 

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The pattern was similar in high-risk drinkers, with each reduction in WHO level by wave 2 being associated with a significantly lower prevalence of alcohol dependence. Moderate-risk drinkers also decreased their odds for alcohol dependence by decreasing drinking by one risk level. In contrast, those who were at moderate or low risk at wave 1 and increased their risk level by one or more level by wave 2 increased their risk for alcohol dependence significantly.

These results suggest that very-high-risk and high-risk drinkers could benefit substantially by reducing WHO-defined drinking risk by even one level.


Hasin DS, Wall M, Witkiewitz K, et al. Change in non-abstinent WHO drinking risk levels and alcohol dependence: a 3 year follow-up study in the US general population. Lancet Psychiatry. 2017;4(6):469-476.