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Controlled Drinking Candidacy — MRCPsych Paper B MCQ

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ModerateSubstance MisuseControlled Drinking CandidacyMRCPsych Paper B

A specialist alcohol service is agreeing treatment goals with the following adults, all of whom would prefer to continue drinking at a reduced level. Which person is the best candidate for a goal of controlled (moderate) drinking rather than abstinence?

Educational content. Not a substitute for clinical judgement or local policy.

Reveal the answer and explanation

Correct answer: B — A person with mild alcohol dependence, adequate social support and no significant comorbidity

Explanation lettering: D = shown as A · E = shown as D · A = shown as E

B is correct. NICE recommends considering a moderate-drinking goal for harmful drinking or mild alcohol dependence when there is adequate social support and no significant psychiatric or physical comorbidity. The goal should be agreed with the patient, taking their preference and individual risks into account. Severe dependence and previous withdrawal seizures (A) make abstinence and appropriately supported withdrawal preferable. Significant depression with suicide risk (C) and alcohol-related liver disease (E) are important comorbidities favouring abstinence. Moderate dependence combined with very limited support (D) also makes controlled drinking a less suitable goal. A harm-reduction programme may still be offered when a high-risk patient declines abstinence, but this is not equivalent to identifying controlled drinking as the preferred treatment goal.

Reference: National Institute for Health and Care Excellence. Alcohol-use disorders: diagnosis, assessment and management of harmful drinking and alcohol dependence, CG115, recommendations 1.2.2.1–1.2.2.3. Published 2011; current with maintenance updates through 2026. https://www.nice.org.uk/guidance/cg115/chapter/Recommendations