Exploring Fit in a Mobile Health Intervention for Alcohol Use Disorder: Qualitative Study.

Pharmacotherapy of Alcohol Use Disorders in the Veterans Health Administration

Introduction:Alcohol cessation improves mortality in alcohol-associated liver disease (ALD), but few ALD patients will engage in treatment. We aimed to demonstrate the feasibility and acceptability of a mobile health intervention to increase alcohol use disorder (AUD) treatment among ALD patients.Methods:We conducted a pilot randomized controlled trial (September 2020 to June 2022) at a single tertiary care center in adults with any stage of ALD, past 6-month drinking, and no past-month AUD treatment. Sixty participants were randomized 1:1 to a mobile health application designed to increase AUD treatment engagement through preference elicitation and matching to treatment and misconception correction. Controls received enhanced usual care. The primary outcomes were feasibility (recruitment and retention rates) and acceptability. Exploratory outcomes were AUD treatment engagement and alcohol use, measured by Timeline Followback. Outcomes were measured at 3 and 6 months.Results:Baseline characteristics were balanced. The recruitment rate was 46%. Retention was 65% at 6 months. The intervention was highly acceptable to participants (91% were mostly/very satisfied; 95% felt that the intervention matched them well to AUD treatment). Secondary outcomes showed increased AUD treatment at 6 months in the intervention group (intent-to-treat: 27.3% vs. 13.3%, OR 2.3, 95% CI, 0.61–8.76). There was a trend toward a 1-level or greater reduction in World Health Organization (WHO) drinking risk levels in the intervention group (OR 2.25, 95% CI, 0.51–9.97).Conclusions:A mobile health intervention for AUD treatment engagement was highly feasible, acceptable, and produced promising early outcomes, with improved AUD treatment engagement and alcohol reduction in ALD patients.

The American Psychiatric Association Practice Guideline for the Pharmacological Treatment of Patients With Alcohol Use Disorder.

Alcohol use disorder treatment delivered outside hepatology clinic.

Health and Wellness Coaching: An Opportunity for Clinical Exercise Physiologists

New Challenges in Addiction Medicine: COVID-19 Infection in Patients With Alcohol and Substance Use Disorders-The Perfect Storm.

This is the first systematic review of the extant literature on all major psychedelic-assisted treatment for alcohol use disorder (AUD), tobacco use disorder (TUD) and other substance use disorders (SUD). We aimed to summarise the evidence for efficacy of psychedelic-assisted treatment for AUD, TUD, and SUD; to evaluate its quality; and to offer recommendations for research. This was a prospectively registered narrative systematic review of open-label, randomised controlled trials (RCT), and observational studies of d-lysergic acid diethylamide (LSD), mescaline, psilocybin, ayahuasca, ketamine, ibogaine and 3,4-methylenedioxymethamphetamine (MDMA). Eligible studies had SUD outcome measures including craving, substance use, relapse, and remission. Study quality was evaluated using the Cochrane Collaboration Risk of Bias (RoB), and Cochrane Collaboration RoB in Non-randomised Studies of Interventions tool. Certainty of evidence for RCTs was judged using the Grading of Recommendations, Assessment, Development, and Evaluations (GRADE) tool. 37 studies (2035 participants) were reviewed: LSD (14; n = 1047); mescaline (1; n = 7); psilocybin (4; n = 135); ayahuasca (3; n = 101); ketamine (10; n = 579); ibogaine (5; n = 166); and MDMA (1; n = 14). There were no serious adverse events reported in any study. A two-centre, placebo-controlled, phase 2 superiority RCT of psilocybin for AUD, and a two-centre, double-blind, four-arm, placebo-controlled phase 2 RCT of ketamine for AUD yielded the best evidence of efficacy. Progression support to a phase 3 trials was secured from an open-label phase 2 study of psilocybin for TUD and nine phase 2 RCTs of ketamine for AUD, cannabis use disorder, cocaine use disorder, and opioid use disorder (all nine with high-RoB and low-GRADE evidence certainty). Psilocybin-assisted treatment for alcohol use disorder appears to have the best evidence of efficacy among all major psychedelic-assisted treatments for alcohol, tobacco, and other substance use disorders. Future research of psychedelic-assisted treatment should report all safety events; screen for person-level characteristics indicating that psychedelic-assisted substance use disorders treatment is contraindicated; strive to mitigate blinding of participants to interventions; use factorial designs for drug and psychotherapy randomised controlled trials; and build consensus for a field-specific Core Outcome Set.

More than 3 million individuals receive treatment for alcohol use disorder (AUD) and/or substance use disorder each year, yet there exists no standardized method for measuring patient success in treatment. Quantifying a more comprehensive assessment of treatment outcomes could identify the relative efficacy of different treatment strategies for individuals with AUD/substance use disorders, and help patients to identify, in advance, appropriate treatment options. This study developed and embedded patient-reported outcome measures into the routine clinical operations of a residential treatment program. Surveys assessed demographics, drug use history, physical and mental health, and quality of life. Outcomes were assessed among participants at admission (n = 961) and in patients who completed the survey at time of discharge (n = 633). Past 30-day alcohol and/or opioid use at admission were correlated with worse self-reported physical and mental health, sleep, and quality of life, and greater negative affect and craving ( P s < 0.05). Previous history of treatment and/or withdrawal management were associated with worse self-reported physical and mental health, quality of life, and increased craving ( P s < 0.05). Physical and mental health improved across timepoints and was most pronounced when comparing persons receiving treatment for opioid use disorder versus AUD, wherein persons with opioid use disorder had worse physical health at all time points, and greater sleep disturbance and negative affect at discharge ( P s < 0.05). It is feasible to embed patient outcome monitoring into routine clinic operations, which could be used in the future to tailor treatment plans.

Diagnosis and Treatment of Alcohol-Associated Liver Disease: A Patient-Friendly Summary of the 2019 AASLD Guidelines.

Alcohol use disorder (AUD) treatment can help improve clinical outcomes among patients with alcohol-associated cirrhosis but is underutilized. Among socioeconomically disadvantaged patients with alcohol-associated cirrhosis, we examined rates of lifetime and past 12-month AUD treatment utilization and associated demographic and clinical characteristics. Racial/ethnically diverse patients with alcohol-associated cirrhosis who had at least one hepatology clinic visit in the prior 6 months were recruited from three Northern California medical centers serving veterans and safety-net populations. Participants self-reported their AUD treatment utilization, liver disease quality of life (LDQoL), history and current symptoms of anxiety and depression, and problematic drinking as measured by the Alcohol Use Disorders Identification Test (AUDIT). Clinical measures including liver disease severity were captured from medical records. Among 196 participants, the majority were male (88%) with a mean age of 62 years. Two-thirds of participants (67%) reported ever utilizing AUD treatment and 32% reported utilizing AUD treatment in the past 12 months. Compared with those who did not utilize AUD treatment, participants who utilized lifetime or past 12-month AUD treatment were younger, had lower LDQoL scores, and had higher scores on current symptoms of anxiety, depression, and problematic drinking. In multivariable analyses, the odds of ever utilizing pharmacological treatment alone or both behavioral and pharmacological treatment (vs. none) were lower with older age or higher LDQoL, and higher among those with a history of anxiety/depressive disorder. For past 12-month treatment utilization, odds were lower with older age, and higher among those with current clinically significant anxiety/depression or problematic drinking. Patients with alcohol-associated cirrhosis who were younger or had anxiety/depression and problematic drinking were more likely to utilize AUD treatment. To improve AUD treatment utilization, targeted outreach to patients less likely to receive care and the provision of integrated ALD and AUD treatment is warranted.

Reports an error in "Initiation and retention in couples outpatient treatment for parents with drug and alcohol use disorders" by Abby L. Braitman and Michelle L. Kelley (Experimental and Clinical Psychopharmacology, 2016[Jun], Vol 24[3], 174-184). In the article, there are errors in Table 2. In the corrected table, the impact of Men's perpetration of violence changes from a non-significant trend (p < .10) to a significant effect (p < .05). Also within Table 2, Women's dyadic cohesion effect changed from a significant finding to a non-significant trend (p .10). The primary conclusions of the article are unchanged. The corrected table is shown in the erratum. (The following abstract of the original article appeared in record 2016-17685-001.) The focus of the current study was to identity mental health, relationship factors, substance use related problems, and individual factors as predictors of couples-based substance abuse treatment initiation and attendance. Heterosexual couples with children that met study criteria were invited to attend 12 sessions of outpatient behavioral couples therapy. Men were more likely to initiate treatment if they had a higher income, had greater relationship satisfaction, were initiating treatment for alcohol use disorder only, were younger when they first suspected a problem, and had higher depression but lower hostility or phobic anxiety. Men attended more treatment sessions if they reported less intimate partner victimization, if they sought treatment for both alcohol and drug use disorder, if they were older when they first suspected a substance use problem, and if they were more obsessive-compulsive, more phobic anxious, less hostile, and experienced less somatization and less paranoid ideation. For women, treatment initiation was associated with less cohesion in their relationships, more somatization, and being older when they first suspected an alcohol or drug use problem. Trends were observed between women's treatment retention and being older, experiencing more somatization, and suspecting drug-related problems when they were younger; however, no predictors reached statistical significance for women. Results suggest that different factors may be associated with men and women's willingness to initiate and attend conjoint treatment for substance abuse. (PsycINFO Database Record

Widening Gaps and Disparities in the Treatment of Adolescent Alcohol and Drug Use Disorders

51 - Pharmacotherapy for Alcoholism and Some Related Psychiatric and Addictive Disorders: Scientific Basis and Clinical Findings

Alcohol is among the leading contributors to the global burden of morbidity and mortality. Alcohol Use Disorders (AUD) account for the majority of this burden. Numerous interventions have demonstrated effectiveness in the treatment of AUD, but treatment response is modest and relapse rates remain high. No one treatment approach has demonstrated unequivocal superiority, prompting calls for individualised intervention strategies. Insufficient understanding of the mechanisms involved in AUD maintenance and treatment response impair the design and implementation of such approaches. The aim of this thesis was to progress understanding of potential treatment targets within personalised treatments for AUD. Alcohol craving, alcohol outcome expectancies, and rash impulsivity comprise the focus of this thesis, as each has been implicated in AUD maintenance and treatment response. A series of studies examining clinical applications of alcohol craving, outcome expectancies, and rash impulsivity within personalised AUD interventions were conducted.Study 1 (Chapter Two) examined the clinical utility of alcohol craving, focusing on issues of measurement. Highlighting the absence of a theoretically and psychometrically robust measure of craving which is also brief enough to be routinely administered within busy clinical settings, the study aimed to develop a new measure. Using data from 747 treatment seeking AUD patients the 22-item Alcohol Craving Experience Questionnaire (ACE) was reduced to 5-items while preserving its key theoretical elements, psychometric integrity, and clinical implications. The shortened ‘Mini ACE’ (MACE) is ideal for use with AUD populations in time-limited settings, such as weekly assessment in treatment contexts. An extended review of common issues in craving measurement is provided in the following chapter (Chapter Three). The chapter is intended to assist researchers and treatment providers in the selection, effective application, interpretation of the scales comprising the Alcohol Craving Experience Questionnaire.Study 2 (Chapter Four) highlights an absence of research on targeting alcohol outcome expectancies within Cognitive Behavioural Therapy (CBT) for AUD. Alcohol expectancies of 175 patients who completed a 12-week CBT program for AUD were assessed pre-and post-treatment. Several positive expectancies were predictive of drinking behaviour during treatment, and most reduced toward community norms post-treatment. However, positive expectancy change was not related to drinking behaviour during treatment, challenging cognitive theory emphasising the importance of this process. Increase in negative expectations of alcohols effect on mood was associated with fewer drinking days, supporting emphasis on modification of negative alcohol expectations within treatment. Further implications of both positive and negative alcohol outcome expectancies regarding AUD treatment are discussed.Study 3 (Chapter Five) is a large clinical randomised controlled trial (RCT; n = 379) examining the effectiveness of personalising AUD treatment based on individual differences in a) alcohol craving, b) alcohol outcome expectancies, and c) rash impulsivity. Patients were randomly assigned to Treatment as Usual (TAU, 8 sessions of standard CBT for AUD) or Targeted Treatment (TT). TT manualised content for 4 of 8-sessions sessions to address the risk-factor most elevated for each patient based on measures standardised by AUD norms (either Craving, Expectancy or Impulsivity). No significant differences in treatment outcome were observed between overall TT and standard, CBT (TAU) conditions. Craving and impulsivity, though not positive outcome expectancies, were found to reduce more for patients within their respective target modules. Only reduction in craving was associated with reduced drinking, supporting an indirect effect for personalised interventions targeting craving. The effectiveness of targeting rash impulsivity and outcome expectancies within personalised AUD could not be confirmed. Alcohol craving stands out as useful construct for consideration within future research of personalised interventions.Study 4 (Chapter Six) examined the association between alcohol craving and rash impulsivity in the prediction of treatment response. Craving and rash impulsivity were positively associated among 470 AUD patients. Both were found to predict lapse-risk during treatment, though impulsivity was mediated by craving. Patients with higher craving pre-treatment, were found to have more persistent craving as treatment progressed, which increased risk of lapse. These findings have clinical implications for the assessment and treatment of AUD, as well as theoretical implications for cognitive models of craving and impulsivity. The mediating role of craving is further considered in the context of the RCT findings (Chapter Three, Study 4).These four studies progress understanding of key mechanisms implicated within AUD maintenance and treatment response. Support was found for the utility of alcohol craving, outcome expectancies, and rash impulsivity as prognostic markers for AUD treatment. The novel contributions of this thesis pertain to understanding their utility as treatment targets. The processes which determine treatment response are complex, requiring equally sophisticated procedures to effectively adapt treatment to individuals. The findings of this program of research can inform the progression of such approaches.

Despite the significant medical and economic consequences of coexisting alcohol use disorder (AUD) in patients with cirrhosis, little is known about AUD treatment patterns and their impact on clinical outcomes in this population. We aimed to characterize the use of and outcomes associated with AUD treatment in patients with cirrhosis. This retrospective cohort study included Veterans with cirrhosis who received Veterans Health Administration care and had an index diagnosis of AUD between 2011 and 2015. We assessed the baseline factors associated with AUD treatment (pharmacotherapy or behavioral therapy) and clinical outcomes for 180 days following the first AUD diagnosis code within the study time frame. Among 93,612 Veterans with cirrhosis, we identified 35,682 with AUD, after excluding 2,671 who had prior diagnoses of AUD and recent treatment. Over 180 days following the index diagnosis of AUD, 5,088 (14%) received AUD treatment, including 4,461 (12%) who received behavioral therapy alone, 159 (0.4%) who received pharmacotherapy alone, and 468 (1%) who received both behavioral therapy and pharmacotherapy. In adjusted analyses, behavioral and/or pharmacotherapy-based AUD treatment was associated with a significant reduction in incident hepatic decompensation (6.5% vs. 11.6%, adjusted odds ratio [AOR], 0.63; 95% confidence interval [CI], 0.52, 0.76), a nonsignificant decrease in short-term all-cause mortality (2.6% vs. 3.9%, AOR, 0.79; 95% CI, 0.57, 1.08), and a significant decrease in long-term all-cause mortality (51% vs. 58%, AOR, 0.87; 95% CI, 0.80, 0.96). Most Veterans with cirrhosis and coexisting AUD did not receive behavioral therapy or pharmacotherapy treatment for AUD over a 6-month follow-up. The reductions in hepatic decompensation and mortality suggest that future studies should focus on delivering evidence-based AUD treatments to patients with coexisting AUD and cirrhosis.