• Lisa Berger, Michael Brondino, Michael Fisher, Robert Gwyther, and James C Garbutt.
• From the Center for Applied Behavioral Health Research, University of Wisconsin, Milwaukee (LB, MB); the Department of Family Medicine (MF, RG), the Bowles Center for Alcohol Studies (RG, JCG), and the Department of Psychiatry (JCG), University of North Carolina at Chapel Hill.
• J Am Board Fam Med. 2016 Jan 1; 29 (1): 37-49.

BackgroundIn a recent study conducted in a family medicine setting, the medication acamprosate was found not to be efficacious in the treatment of alcohol dependence, but a drinking goal of abstinence was found to have positive effects on alcohol use outcomes. The purpose of this secondary analysis was to further understand which patients with an alcohol use disorder may be most successfully treated in a primary care setting.MethodsThe study was exploratory and used a trajectory-based approach based on data from the acamprosate treatment trial of 100 participants (recruited mostly by advertisement) who were randomly assigned to receive either acamprosate or a matching placebo. Post hoc trajectories of alcohol use before treatment were identified to examine whether trajectory classes and their interactions with treatment arm (acamprosate or placebo), pretreatment drinking goal (abstinence or a reduction), and time predicted alcohol use outcomes.ResultsThree distinct trajectory classes were identified: frequent drinkers, nearly daily drinkers, and consistent daily drinkers. Consistent daily drinkers with a goal of abstinence significantly improved over time on the primary outcome measure of percent days abstinent when compared with frequent and nearly daily drinkers. In addition, all participants with a goal of abstinence, regardless of trajectory class, significantly reduced their percentage of heavy drinking days over time.ConclusionsPatients with an alcohol use disorder who have a drinking goal of abstinence, in particular consistent daily drinkers, may maximally benefit from alcohol use disorder treatment, including the use of medication, in a primary care setting.© Copyright 2016 by the American Board of Family Medicine.

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