Zero tolerance for 0%? How should clinicians and other practitioners respond to the use of alcohol‐free and low‐alcohol products in higher risk groups

Abstract Alcohol‐free and low‐alcohol drinks (no/lo drinks) are now widely available and popular with consumers in high‐income countries; however, it is unclear whether clinicians and others working to prevent or treat severe alcohol‐related health problems should take a zero‐tolerance approach to these alcohol‐like products or encourage patients to try them. We argue that no/lo drinks may have an important role to play for people who drink at high‐risk levels and those with alcohol use disorders (AUD) or alcohol‐related liver disease (ARLD), particularly where debate and guidance related to treatment of these problems considers goals other than abstinence. The limited available evidence available suggests no/lo drinks may be useful in supporting attempts to reduce alcohol consumption or maintain abstinence among high‐risk drinkers who do not have severe AUD or ARLD; however, they may also entail significant risks of relapse in those recovering from AUD. We therefore need further experimental and longitudinal studies testing whether use of no/lo drinks can lead to, or support, reductions in alcohol consumption. We particularly need high‐quality experimental studies to test whether exposure to and sustained use of no/lo drinks affects treatment and recovery outcomes. Evidence is also needed on which subgroups of AUD and ARLD patients would benefit or be at risk from use of either alcohol‐free or low‐alcohol drinks. Finally, guidance should recognise that many patients already use these products and that a zero‐tolerance approach may alienate patients or erode trust in clinicians.