AML Care at Home: An Evidence-Based Toolkit to Personalize the Care Setting for Recovery From Pediatric AML Chemotherapy.

An estimated 43% of the global population 15 years or older currently drink alcohol (). Nearly 11% of individuals who drink develop alcohol use disorder (AUD). Alcohol use and AUD carry a significant public health burden, with documented negative impacts on physical health (), social relationships () and the economy (; ). Alcohol is also a leading cause of morbidity and mortality, associated with more than 50 different causes of death (), and the global prevalence of alcohol use and heavy drinking (HD; for men consuming 5 or more drinks on any day and for women 4 or more drinks on any day) are both expected to increase throughout the decade (). However, few individuals affected by AUD seek formal treatment and many that do terminate treatment prematurely (). Traditional benchmarks for AUD treatment “success” have been complete cessation of alcohol use (abstinence) as the primary outcome in many AUD clinical trials. As AUD diagnostic and recovery conceptualizations evolve with the recognition that alcohol use and related harms exist on a continuum (; ), the field of AUD treatment research has begun the expansion of treatment efficacy endpoints beyond abstinence. Beginning with the study of controlled drinking () and marked by the 2015 Food and Drug Administration (FDA) endorsement of no HD days as an acceptable outcome for clinical trials (), non-abstinence endpoints have garnered considerable empirical support as viable trial endpoints. Most recently, in February 2025, the FDA added a 2-level reduction in the World Health Organization’s (WHO) drinking risk categorization so that AUD clinical trials now have two non-abstinence endpoints (). Unlike the other FDA-endorsed endpoints (abstinence and no HD days), WHO-level risk reductions account for the relative starting point of the individual and thus may provide an alternative, more personalized treatment goal for those with AUD. The evidence base for the utility of WHO level risk reductions is robust. When applied to populations with AUD, research on WHO drinking risk levels have shown that reductions are achievable and even 1-level reductions are associated with significant health benefits including decreased risk of alcohol dependence at 3-year follow up among those drinking at the very-high and high-risk levels (). For those in the very-high risk category, any reductions in WHO drinking risk were associated with significantly lower odds of anxiety or depression at 3-year follow up, indicative of clinically meaningful improvements in affect and functioning (). In pharmacotherapy trials for AUD (), WHO drinking risk level reductions have predicted reductions in alcohol-related consequences and improved mental health outcomes and these improvements have been demonstrated to be sustainable, irrespective of AUD severity. A secondary data analysis of multi-site clinical trials of AUD pharmacotherapies and behavioral interventions showed 1- and 2-level risk reductions were maintained at the one-year follow up and associated with fewer alcohol-related consequences, improved mental health, and better liver functioning, even in the context of severe AUD ().