Background/Objectives: Alcohol consumption remains a major public health concern, with conflicting evidence on its health implications fueling ongoing debates. Recent and growing advocacies claim for total ethanol abstinence as the best public health option, but moderate drinking, particularly within the Mediterranean Alcohol Drinking Pattern (MADP), may be also associated with potential health benefits. However, evidence from randomized controlled trials (RCT) is basically absent. This pilot RCT assessed the feasibility and short-term effects of two contrasting public health messages-alcohol abstinence versus moderate consumption following the MADP.

Methods: A total of 103 participants were randomized to either abstention or adherence to the MADP, with 76 of them completing the one-year follow-up. The intervention consisted of an initial interview, a blog where new information was uploaded every 2 weeks, as well as a small weekly advice sent by WhatsApp, depending on how adherence was going.

Results: Both interventions resulted in significant reductions in alcohol consumption and binge drinking episodes. The abstention group demonstrated greater reductions in overall alcohol intake and improvements in biomarkers such as blood pressure and liver enzymes. Conversely, the MADP group showed enhanced adherence to the intended drinking pattern and a reduction in depressive symptoms. No between-group significant differences were observed in most outcomes. However, a slightly better change in the Mini-mental test for cognitive assessment was found for the abstention group (0.69 points (95% confidence interval, 0.09 to 1.30, p-value = 0.025). Recruitment and retention challenges, largely due to the COVID-19 pandemic, highlighted feasibility concerns, but also informed future trial designs.

Conclusions/Recommendations: These findings suggest that both abstention and MADP can reduce harmful drinking behaviors and offer distinct health benefits. A long-term trial is warranted to provide definitive guidance on optimal public health approaches to alcohol consumption.

Funding: Plan Nacional Sobre Drogas del Ministerio de Sanidad (2019I056).