Although the traditional goal of treating AUD is abstinence from alcohol, treatments that reduce drinking without requiring abstinence are more attractive to many patients and can lead to a substantial reduction in alcohol-related problems.44 In a secondary analysis45 of participants in the largest alcohol pharmacotherapy trial to date, the COMBINE Study,46 patients’ scores on a measure of alcohol-related problems increased directly with the number of binge drinking days that they reported. Findings such as these led the FDA to accept the goal of no binge drinking as an alternative to abstinence in AUD treatment trials.47 Nonetheless, in the COMBINE Study, although the no-binge-drinking group had better longer-term outcomes than the group with some binge drinking, the group that was abstinent had the best outcomes.46
